 Oct. 18, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
The baby girl on your lap is bright-eyed and delightful, and her parents obviously want to hear you say she is in perfect health. The baby coos and laughs on time, including when you clap. You perform a few more simple tests and wonder about the best way to tell them you suspect congenital deafness.
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The benefits of early identification include reducing the parent's and the child's frustration, having great impact on the child's self-esteem, and possibly preventing secondary disability. |
This was just one of the scenarios outlined by Jeffrey Quinlan, M.D., associate director of the family practice residency at Naval Hospital Jacksonville in Florida, in his clinical seminar on "Childhood Growth and Development Screening" Wednesday afternoon.
Children with developmental delays usually present first to primary care offices in a routine well-baby visit. The burden of identifying delays therefore falls most often to the family physician, according to Quinlan.
To be equipped for this, the FP must understand the four "streams of development:" motor, language, problem-solving and psychosocial.
That's not all. Per Quinlan, the physician also needs to be aware of the biases and pitfalls that challenge diagnosis.
Parental expectations are primary biases and will affect how parents describe their child. From birth to 18 months, growth is the parents' primary concern, and from 6 to 24 months, it's motor development. They don't focus on cognitive development until 18 months and beyond.
"So what?" you may say. That's the parents' point of view, and you're the doctor. But you don't live with the child 24/7, said Quinlan, and they do, and the clues are subtle. This is why motor delays are often missed until 8 to 10 months of age, and the mean age of diagnosis of cerebral palsy is 14 months, Quinlan said.
Language delays are often simply disregarded until 24 months or later, and the mean age of diagnosis of mental retardation is 39 months.
It may be worse if the child is athletic, because there's a widespread misconception that gross motor skills correlate with intelligence, when they actually don't, Quinlan said. Nor does appearance. And language development begins at birth, not at 3.
Early identification allows early intervention
Beyond the obvious, the benefits of early identification include reducing the parent's and child's frustration, having great impact on the child's self-esteem, and possibly preventing secondary disability, Quinlan said. Through early identification, society is saved money, and the family physician's impact on life is immeasurable.
Children who receive early intervention are more likely to complete high school, avoid teen pregnancy and crime, keep jobs, and live independently, he said. All of this is within the FP's hands.
No shortage of screening tests
Physicians have a broad array of developmental tests to choose from. Quinlan recommended looking for four features: reliability, validity, applicability and appropriateness.
Combined stream developmental screening tools use a single instrument to look at all or most of the four streams.
They include the Revised Denver Developmental Questionnaire, Ages and Stages Questionnaire, Bayley Infant Neurodevelopmental Screen, Brigance Screens, Child Development Inventories, Parents' Evaluations of Developmental Status, and the Bright Futures Project.
The baby on the doctor's lap was expressive but not receptive. When she smiled at clapped hands, she was smiling at motion and not sound. The parents might be chagrined at first, but they will be far better off for this early diagnosis.
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Copyright © 2002 by
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