Making developmental-behavior screening work in your practice

This article is the second in a 3-part series devoted to early detection of children with developmental and behavioral problems. In the first article, which appeared in the November 2009 issue, Drs. Michelle Macias and Paul Lipkin reviewed the American Academy of Pediatrics (AAP) 2006 policy statement on early detection (available at http://www.contemporarypediatrics.com/devpt1. In this article, we discuss the many considerations that need to be addressed before deploying quality screening tools in primary care.

Although many clinicians believe they are effectively identifying children with developmental and behavioral problems, there is evidence that this is not the case. A recent study focused on infants and toddlers, an age group for whom there are frequent health maintenance visits, found that only 10% of children with delays had been identified and enrolled in early intervention.¹ In the 0 to 4 year age range, enrollment in special services has a prevalence of only about 25%.² Thus, the majority of children with problems are not identified until school entrance and therefore do not benefit from the well-established advantages of early intervention, including reducing school failure, high school drop-out rates, teen pregnancy, and delinquency.³

Why aren't we detecting more young children with developmental and behavioral problems? Too many of us use informal questions to parents or milestones checklists (and that includes items selected from standardized measures). These approaches lack decision-making criteria and are insensitive in early identification. Few of us receive feedback from parents or nonmedical providers about the many children we fail to detect, and therefore we are far too complacent about our informal methods. We are often the only professionals in contact with young children and their families, and so are in the forefront of early recognition. Only when quality measures are used do enrollment rates in early intervention rise to reach prevalence (8% to 12% in the 0 to 3 year age range, 16% to 18% overall) ( http://www.cdc.gov, see also ABCD project results at http://www.commonwealthfund.org).

If you are still not convinced, consider testing yourself. Use these questions and exercises to assess the quality of your own efforts to detect children with difficulties: