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Digital Technology and Screening for Developmental Concerns in the Early Years


Screening and assessment for developmental delay rely largely on questionnaires, checklists, and guided interviews. Emerging technologies are beginning to offer ways of extending and improving identification efforts. Here, we briefly discuss some of the potential uses, as well as dangers, of virtual reality, gait analysis, dysmorphological analysis, and social media.
Digital Technology and Screening for Developmental Concerns
in the Early Years
Scott Veldhuizen
&John Cairney
Published online: 3 March 2017
#Springer International Publishing Switzerland 2017
Abstract Screening and assessment for developmental delay
rely largely on questionnaires, checklists, and guided inter-
views. Emerging technologies are beginning to offer ways of
extending and improving identification efforts. Here, we brief-
ly discuss some of the potential uses, as well as dangers, of
virtual reality, gait analysis, dysmorphological analysis, and
social media.
Keywords Digital technology .Screening .Developmental
disorders .Commentary
In previous articles, we have argued that screening and sur-
veillance could benefit from the use of multiple sources of
information: multiple perspectives, multiple measures, multi-
ple situations, and multiple time points [1,2]. To this list, we
might usefully add multiple technologies.
At present, most developmental screens and assessments
are text-based: clinicians often use validated lists of tasks or
questions that attempt to measure functioning in various de-
velopmental domains (e.g., the Bayley Scales of Infant and
Child Development [3]), while brief screens ask parents about
developmental milestones (e.g., the Ages and Stages
Questionnaires) or about concerns they may have about their
childs development (e.g., the ParentsEvaluation of
Developmental Status [4]).
These assessments are useful but imperfect. Different in-
struments use different sets of developmental domains; func-
tioning can be difficult to assess accurately in very young
children; and all suffer from errors due to observer mistakes,
imperfect recall, misinterpretation, and other factors. Screens
using parental concern are also dependent on parentsjudg-
ment and may be affected by parental anxiety or education.
A more fundamental issue with these types of assess-
ments is that they can only access certain kinds of infor-
mation: they use a second party to evaluate a childs
level of functioning. We have suggested in the past that
augmenting these types of assessments with other
sources of information might improve the accuracy of
screening and diagnosis. Here, we briefly review some
of the many recent technological developments that
might supply information not captured by more tradition-
al tools. These are of two types. Some offer important
improvements on more or less traditional testing modal-
ities, while others attempt to directly identify signs relat-
ed to movement or physical appearance that are linked to
developmental conditions.
Virtual reality (VR) is one technology that might im-
prove existing testing approaches. One difficulty with
traditional assessments concerns ecological validitydi-
rect assessment, even by an assessor who is highly
trained and experienced in working with children, is
not a natural condition for the child, and the circum-
stances of every assessment will vary. In addition to be-
ing potentially more fun and engaging for a child than an
ordinary clinical assessment, VR technologies can pro-
vide consistency across evaluations. More importantly,
they can make it possible to modify testing environments
*John Cairney
Department of Family Medicine, McMaster University, Toronto, ON,
Faculty of Kinesiology and Physical Education, University of
Toronto, 55 Harbord Street, WSB Rm 2044, Toronto, ON, Canada
Curr Dev Disord Rep (2017) 4:57
DOI 10.1007/s40474-017-0107-0
to provide challenges analogous to those in the real
world. In a commentary in this issue, for example, Dr.
Rodríguez and colleagues review the use of this technol-
ogy in evaluations of attention deficits [5]. As they point
out, VR allows assessors to examine responses to dis-
traction, which can be introduced into real-world assess-
ments only with great difficulty, but is easily and consis-
tently incorporated into VR environments.
Technology has also dramatically changed the types of
information that exist about individuals. Thanks to the
ubiquity of smart phones and tablets, many children now
have their livesand, incidentally, their developmental
journeysthoroughly documented. Early movement,
speech, play, and interaction with others are all commonly
recorded, and all these records are made in natural settings.
Such archivaldata have occasionally been used in epi-
demiological research; one study from the mid-1990s, for
example, used videos of early crawling and walking to
identify poor motor skills among people later diagnosed
with schizophrenia [6]. Poor motor coordination is associ-
ated with developmental conditions such as ADHD [7]and
ASD [8,9]. Existing video evidence could therefore be
useful in efforts to identify these conditions. Crucially, re-
cent technological developments in gait analysis offer tools
that reduce the need for expert administration. This type of
evidence is never likely to be diagnostic on its own except
for the most severe conditions but may offer information
that can contribute to assessment and diagnostic efforts.
A related area of research concerns computer-aided
dysmorphological analysis. Several genetic conditions,
such as Down and Angelman syndromes, produce charac-
teristic facial features. Researchers have long been inter-
ested in the role of technology might play in diagnosis
[10] and have begun to develop software capable of rec-
ognizing these types of physical signs [11,12]. Weaker
associations also exist between physical features and
some non-genetic developmental conditions, including
some that are relatively prevalent. These include, most
notably, fetal alcohol spectrum conditions, but visible an-
atomical features are also potential endophenotypes in
schizophrenia [13], which is itself often thought of as
neurodevelopmental in origin [14]. Software and hard-
ware have in recent years become powerful enough to
provide information from photographs or video that may
be diagnostically useful. Associations between physical
features and developmental conditions are not always
strong; as with gait analysis, however, these approaches
need not attempt to be diagnostic on their ownif they
offer information that meaningfully shifts the probability
that a condition is present, they offer at least the potential
to improve the accuracy of screening and diagnosis.
As always with new technology, there are threats as
well as promises. Privacy becomes ever more important
when technology can unearth information that people
never intended to make public. Accessing information
from social media for developmental assessments, for
example, requires thorough explanation and clear con-
sent. As we have noted, many of these approaches are
also unlikely to clearly identify conditions when applied
in isolation; they must be used only in the context of a
responsible and coherent assessment protocol. Otherwise,
their benefits could be outweighed by the harms that
come from false diagnosis.
Despite the risks, new technologies are likely to be-
come increasingly important in the assessment of child
development. The methods we use today, which rely
mostly on text and on assessor judgment, are in no dan-
ger of obsolescence, but they use only some of the in-
formation that is available. Development and evaluation
of measures and tools that incorporate new technologies
into assessment protocols is an exciting area of inquiry
in the field of measurement.
Compliance with Ethical Standards
Conflict of Interest Scott Veldhuizen and John Cairney declare that
they have no conflict of interest.
Human and Animal Rights and Informed Consent This article does
not contain any studies with human or animal subjects performed by any
of the authors.
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