Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood: 2002-2009
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.
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ABSTRACT: Background: The Council on Medical Student Education in Pediatrics (COMSEP) pediatric clerkship curriculum is widely followed. To date, there are no known studies on clerkship instruction related to developmental-behavioral pediatric (DBP) curricular elements. Purposes: The goals of this study are to examine pediatric clerkships' current DBP teaching methods and to identify barriers and solutions to recommended curriculum implementation. Methods: Electronic survey was conducted with COMSEP-member pediatric clerkship directors. Descriptive statistics and qualitative data analysis was conducted. Results: Response rate was 66%. General Pediatricians (87.1%) were mostly responsible for clerkship DBP teaching. Around 18% of directors reported not assessing DBP competencies. Most clerkship directors report time constraints (61.8%) as a barrier to implementing the curriculum, along with faculty availability and resources. Suggested solutions included DBP faculty collaboration and resources. Conclusions: General pediatricians should collaborate with DBP faculty for instructional content creation, and community-based observational opportunities and web-based shared resources could help clerkship directors achieve the COMSEP DBP curriculum competencies.Teaching and Learning in Medicine 10/2014; 26(4):366-372. DOI:10.1080/10401334.2014.945392 · 1.12 Impact Factor
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ABSTRACT: Parents (n = 11,845) completed the Modified Checklist for Autism in Toddlers (or its latest revision) at pediatric visits. Using sociodemographic predictors of maternal education and race, binary logistic regressions were utilized to examine differences in autism screening, diagnostic evaluation participation rates and outcomes, and reasons for non-participation. Families of lower maternal education and racial minorities exhibited inflated initial screen positive rates and lower participation at Follow-Up, although not at the evaluation. Economic challenges, such as invalid phone numbers, were identified as barriers to reaching these families. Families of higher education and White race were more likely to decline participation in evaluation. Results suggest the need for increased public education about childhood development to enhance awareness, reduce stigma, and streamline screening.Journal of Autism and Developmental Disorders 12/2014; DOI:10.1007/s10803-014-2339-8 · 3.34 Impact Factor
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ABSTRACT: Developmental disorders, including autism spectrum disorders (ASDs), are increasing in prevalence. Early identification is necessary for early intervention, which is critical for reducing challenges and lifetime costs, especially for ASDs. Because not all children have equal access to developmental and autism screening through primary care settings, nontraditional methods are needed to reach underserved populations.PurposeIn this proof-of-concept study, the 2-1-1 Los Angeles County Developmental Screening Project (2-1-1 LA Project) provided developmental and autism screening by telephone in a population of low-income and racially and ethnically diverse children.Methods Aggregate data were reviewed for 2845 children who were screened for developmental delays using the Parents' Evaluation of Developmental Status (PEDS) instrument and/or autism using the Modified Checklist for Autism in Toddlers (M-CHAT) instrument between September 1, 2009, and October 31, 2011.ResultsData analysis was conducted December 2011 through February 2012. A majority of children (56%) screened with the PEDS had a moderate to high risk of developmental delays, including 28.2% classified as high-risk, which indicates need for further evaluation. Among 1605 children screened with the M-CHAT, 21.2% had an elevated risk of ASDs. Follow-up care coordination was provided for 2625 children to facilitate completion of referrals for diagnostic evaluation, early childhood education, and other developmental or behavioral needs.Conclusions The project's approach enhanced access to screenings and referral uptake in a population of children that may have difficulty accessing primary care. Findings suggest the potential of nontraditional developmental screening models.American Journal of Preventive Medicine 12/2012; 43(6):S457-S463. DOI:10.1016/j.amepre.2012.08.011 · 4.28 Impact Factor