Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood: 2002-2009

Department of Research, American Academy of Pediatrics, 141 Northwest Point Blvd, Elk Grove Village, IL 60007, USA. .
PEDIATRICS (Impact Factor: 5.47). 06/2011; 128(1):14-9. DOI: 10.1542/peds.2010-2180
Source: PubMed

ABSTRACT Early identification of developmental delays is essential for optimal early intervention. An American Academy of Pediatrics (AAP) 2002 Periodic Survey of Fellows found <25% of respondents consistently used appropriate screening tools. Over the past 5 years, new research and education programs promoted screening implementation. In 2006, the AAP issued a revised policy statement with a detailed algorithm. Since the 2002 Periodic Survey, no national surveys have examined the effectiveness of policy, programmatic, and educational enhancements.
The goal of this study was to compare pediatricians' use of standardized screening tools from 2002 to 2009.
A national, random sample of nonretired US AAP members were mailed Periodic Surveys (2002: N=1617, response rate: 55%; 2009: N=1620, response rate: 57%). χ(2) analyses were used to examine responses across survey years; a multivariate logistic regression model was developed to compare differences in using ≥1 formal screening tools across survey years while controlling for various individual and practice characteristics.
Pediatricians' use of standardized screening tools increased significantly between 2002 and 2009. The percentage of those who self-reported always/almost always using ≥1 screening tools increased over time (23.0%-47.7%), as did use of specific instruments (eg, Ages & Stages Questionnaire, Parents' Evaluation of Developmental Status). No differences were noted on the basis of physician or practice characteristics.
The percentage of pediatricians who reported using ≥1 formal screening tools more than doubled between 2002 and 2009. Despite greater attention to consistent use of appropriate tools, the percentage remains less than half of respondents providing care to patients younger than 36 months. Given the critical importance of developmental screening in early identification, evaluation, and intervention, additional research is needed to identify barriers to greater use of standardized tools in practice.

5 Reads
  • Source
    • "However, the U.S. Preventive Services Task Force (2013) deemed that evidence is insufficient to recommend for or against screening and counseling for youth SU. Pediatrician use of standardized screening tools for developmental delays has recently increased (Radecki et al., 2011) whereas using standardized tools for risk of behavior problems has lagged (Jee et al., 2011; Kelleher and Stevens, 2009). Reasons for their reluctance include practice burden (time, staffing cost), unfamiliarity with treatment resources for referral, high false-positive rates of screens, and fear of alienating patients or parents with queries about sensitive behaviors (Van Hook et al., 2007). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Youth substance use (SU) is prevalent and costly, affecting mental and physical health. American Academy of Pediatrics and Affordable Care Act call for SU screening and prevention. The Youth Risk Index(©) (YRI) was tested as a screening tool for having initiated and propensity to initiate SU before high school (which forecasts SU disorder). YRI was hypothesized to have good to excellent psychometrics, feasibility and stakeholder acceptability for use during well-child check-ups. A high-risk longitudinal design with two cross-sectional replication samples, ages 9-13 was used. Analyses included receiver operating characteristics and regression analyses. A one-year longitudinal sample (N=640) was used for YRI derivation. Replication samples were a cross-sectional sample (N=345) and well-child check-up patients (N=105) for testing feasibility, validity and acceptability as a screening tool. YRI has excellent test-retest reliability and good sensitivity and specificity for concurrent and one-year-later SU (odds ratios=7.44, CI=4.3-13.0) and conduct problems (odds ratios=7.33, CI=3.9-13.7). Results were replicated in both cross-sectional samples. Well-child patients, parents and pediatric staff rated YRI screening as important, acceptable, and a needed service. Identifying at-risk youth prior to age 13 could reap years of opportunity to intervene before onset of SU disorder. Most results pertained to YRI's association with concurrent or recent past risky behaviors; further replication ought to specify its predictive validity, especially adolescent-onset risky behaviors. YRI well identifies youth at risk for SU and conduct problems prior to high school, is feasible and valid for screening during well-child check-ups, and is acceptable to stakeholders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Drug and Alcohol Dependence 03/2015; 150. DOI:10.1016/j.drugalcdep.2015.02.013 · 3.42 Impact Factor
  • Source
    • "Previous studies have suggested that few clinicians have implemented developmental screening into their practices despite the dissemination of recommendations supporting their use [16-20]. It is currently estimated that nearly half of pediatricians do not routinely use developmental screening tools for children under the age of 36 months [21]. This limited implementation of screening is not surprising given studies that have shown that physicians prefer to rely on developmental surveillance rather than developmental screening. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Research is needed to identify challenges to developmental screening and strategies for screening in an urban pediatric setting. Parents of young children and clinicians at four urban pediatric practices participated in focus groups prior to implementation of screening. Participants were queried regarding attitudes, social norms, and barriers to developmental screening. Using information from the focus groups, workflow strategies were developed for implementing screening. Referral rates and satisfaction with screening were gathered at the conclusion. Six focus groups of parents and clinicians were conducted. Major themes identified included 1) parents desired greater input on child development and increased time with physicians, 2) physicians did not fully trust parental input, 3) physicians preferred clinical acumen over screening tools, and 4) physicians lacked time and training to conduct screening. For the intervention, developmental screening was implemented at the 9-, 18-, 24-, and 30-month well visits using the Ages & Stages Questionnaire-II and the Modified Checklist for Toddlers. 1397 (98% of eligible) children under 36 months old were enrolled, and 1184 (84%) were screened at least once. 1002 parents (85%) completed a survey at the conclusion of the screening trial. Most parents reported no difficulty completing the screens (99%), felt the screens covered important areas of child development (98%), and felt they learned about their child's strengths and limitations (88%). Developmental screening in urban low-income practices is feasible and acceptable, but requires strategies to capture parental input, provide training, facilitate referrals, and develop workflow procedures and electronic decision support.
    BMC Pediatrics 01/2014; 14(1):16. DOI:10.1186/1471-2431-14-16 · 1.93 Impact Factor
  • Source
    • "The parent-completed Ages and Stages Questionnaire is used in this context [7]. The ASQ is the most commonly used parent-completed developmental screener worldwide [8] [9]. The ASQ is inexpensive to use, easy to understand, and fast to complete (approximately ten to fifteen minutes) [6] [7]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The Ages and Stages Questionnaire (ASQ) is currently the most used parent-completed developmental screener consisting of different age-specific questionnaires. Psychometric evaluation of the ASQ 60-month version (ASQ-60) is limited. Furthermore, it is unclear which of the available scoring methods of the ASQ is most useful in the identification of children with potential developmental problems. To evaluate the internal consistency and construct validity of the ASQ-60 with a large sample size, and to assess the effects of three scoring-methods on this validity. Parents of 394 term-born and 1063 preterm-born children from the prospective cohort-study Lollipop completed the ASQ-60 and a general questionnaire on school-problems. Internal consistency and construct validity of the ASQ-60 were determined using the ASQ total score. Construct validity was also determined using two other types of scoring-methods based on low domain-scores ('ASQ domain score') and parental concerns ('ASQ total score with parental concerns'). Cronbach's alpha for total score was 0.86, confirming internal consistency. Male gender, prematurity, low paternal education, low family income and small-for-gestational-age were associated with low 'ASQ total scores,' confirming construct validity. Regarding construct validity with special education as criterion, sensitivity was best using the 'ASQ domain score' or the 'ASQ total score' with parental concerns (both 0.96). However, the specificity was best (0.93) using the ASQ total score. The ASQ-60 has a good internal consistency and validity to screen for developmental problems in the general population. The 'ASQ total score' has the best performance, the 'ASQ domain score' is recommended in case of preferred high sensitivity.
    Early human development 09/2013; 89(12). DOI:10.1016/j.earlhumdev.2013.08.016 · 1.79 Impact Factor
Show more