Developmental Delay: When and How to Screen

 

Am Fam Physician. 2017 Jul 1;96(1):36-43.

Author disclosure: No relevant financial affiliations.

An estimated 15% of children in the United States have at least one developmental delay, yet less than one-fifth of those children receive early intervention services before three years of age. Many barriers exist to implementing initial screening and referral, but screening tools can be easily incorporated into the workflow of the primary care practice with preparation. The use of a validated screening tool at regular, repeated intervals, in addition to physician surveillance at well-child visits, may improve early detection. Early intervention is effective in high-risk children and associated with improvements in cognitive and academic performance. Parent-completed tools are preferable to directly administered tools in the primary care setting because of time constraints. The most extensively evaluated parent-completed tools are the Ages and Stages Questionnaire and the Parents' Evaluation of Developmental Status. Family physicians should be familiar with currently available screening tools and the limitations and strengths of these tools. Additional evaluations and referrals are recommended if screening suggests developmental delays are present.

The prevalence of any developmental delay is estimated at 15% in U.S. children three to 17 years of age.1 Only 3% of all children received public early intervention services by three years of age in 2014.2 The percentage of school-aged children receiving public intervention services reaches a peak of 12.5% between the ages of nine and 12 years.2 Risk factors for developmental delay include male sex, lower socioeconomic status, perinatal risk factors, and lower level of maternal education.1,3,4  Table 1 indicates the prevalence of delays in specific domains such as cognition and language.4,5 Identification of developmental delays and their etiology allows for the implementation of interventions and treatment plans specific to the disorder.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Early intervention services should be used when a developmental delay is identified because they improve cognitive development and academic performance, and decrease engagement in risky behaviors.

B

810

The AAP recommends surveillance at all well-child visits, and screening for developmental delay at nine, 18, and 30 (or 24) months of age using a standardized developmental screening tool. However, the USPSTF and AAFP found insufficient evidence to assess the balance of benefits and harms of screening for autism or speech and language delays in asymptomatic young children. The USPSTF has not addressed broad developmental screening.

C

35, 13

Validated screening tools should be used instead of surveillance alone to assess for developmental delay.

C

13, 15, 27

A parent-completed tool (e.g., Parents' Evaluation of Developmental Status; Ages and Stages Questionnaire, 3rd ed.) should be used initially instead of a directly administered tool when screening for developmental delay.

C

15, 18, 27


AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; USPSTF = U.S. Preventive Services Task Force.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Early intervention services should be used when a developmental delay is identified because they improve cognitive development and academic performance, and decrease engagement in risky behaviors.

B

810

The AAP recommends surveillance at all well-child visits, and screening for developmental delay at nine, 18, and 30 (or 24) months of age using a standardized developmental screening tool. However, the USPSTF and AAFP found insufficient evidence to assess the balance of benefits and harms of screening for autism or speech and language delays in asymptomatic young children. The USPSTF has not addressed broad developmental screening.

C

35, 13

Validated screening tools should be used instead of surveillance alone to assess for developmental delay.

C

13, 15, 27

A parent-completed tool (e.g., Parents' Evaluation of Developmental Status; Ages and Stages Questionnaire, 3rd ed.) should be used initially instead of a directly administered tool when screening for developmental delay.

C

15, 18, 27


AAFP = American Academy of Family Physicians; AAP = American Academy of Pediatrics; USPSTF = U.S. Preventive Services Task Force.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system,

The Authors

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KIRSTEN VITRIKAS, MD, FAAFP, is the program director of the David Grant USAF Medical Center Family Medicine Residency at Travis Air Force Base, Calif. She is also an assistant professor at the Uniformed Services University of the Health Sciences, Bethesda, Md....

DILLON SAVARD, MD, FAAFP, is a faculty member at the Ehrling Bergquist Family Medicine Residency at Offutt Air Force Base, Neb. He is also an assistant professor at the Uniformed Services University of the Health Sciences.

MERIMA BUCAJ, DO, is a faculty member at the David Grant USAF Medical Center Family Medicine Residency at Travis Air Force Base. She is also an assistant professor at the Uniformed Services University of the Health Sciences.

Address correspondence to Kirsten Vitrikas, MD, David Grant USAF Medical Center Family Medicine Residency, 101 Bodin Cir., Travis Air Force Base, CA 94535 (e-mail: Kirsten.vitrikas@us.af.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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