It is the administration of a brief standardized tool to aid in the identification of children at risk of a developmental disability. [Soreca: 2008] Concerning results from the screen should trigger further evaluation for specific developmental disabilities. Developmental screening of ALL children is recommended at the 9, 18, and 30 month well-child visits (or at 24 months if a 30 month visit is not conducted). [Hagan: 2008]
What is Developmental Surveillance?
It is a flexible, longitudinal, continuous, and cumulative process whereby health care professionals identify children who may have developmental problems. Developmental surveillance is recommended to occur at every pediatric visit. If concerns arise as a result of developmental surveillance, a developmental screening tool should be administered or, if there is sufficient concern, further evaluation undertaken for specific developmental disabilities.
Developmental surveillance entails:
- Listening to parents' concerns
- Obtaining and maintaining a developmental history
- Observing the child during visits
- Identifying risk and protective factors
- Documenting relevant information and findings
Why is it Recommended to Repeat Developmental Screening at Multiple Ages?
Repeated developmental screening provides a more accurate assessment of development than a one-time evaluation, and developmental screening at multiple ages allows for monitoring of developmental progress (or regression) over time.
What is the Rationale for Developmental Screening?
Developmental disabilities are common, yet many children with developmental disabilities are not identified in primary care settings and opportunities for early intervention thus lost or significantly delayed. [Palfrey: 1987] Developmental screening programs result in increased detection of developmental delays. [Earls: 2009] Participation in an Early Intervention Program improves child and family outcomes. [Berlin: 1998] [Guralnick: 1998] [Reynolds: 2001]
The use of checklists of developmental skills are ineffective because they lack the consistent scoring to trigger referrals found in validated developmental screening tools. Though developmental surveillance could occur at every visit, a variety of issues may lead to its omission or incomplete performance at times. A recent study found that only 57% of parents reported their child’s development was assessed during a pediatric visit. [Zuckerman: 2004] Developmental screening tools can save time in thoroughly evaluating all domains of development (social/emotional, language, cognitive, gross/fine motor). And parents who report receiving developmental screening tools are more satisfied with their pediatric care. [Zuckerman: 2004]
Finally, federal law mandates that health care professionals provide services that identify children with developmental disabilities (Title V of the Social Security Act and the Individuals with Disabilities Education Improvement Act- IDEIA).
315, Specific delays in development
317, Mild mental retardation
318, Other specified mental retardation
783.4, Lack of expected normal physiologic development in childhood
The above are general codes, each of which includes a number of more specific codes (with 4th and 5th digits) that should be specified. The last, 783.4, is generally used more for anatomic/physiologic delays or failure to thrive.
96110, Developmental testing, limited
This code reflects the associated physician work and screening program expenses. Compensation varies by geography and insurer. Many insurers “bundle” compensation into their standard compensation for health supervision visits. However, in some states and, particularly, in some Medicaid programs, compensation is provided when the codes described below are submitted. Working with insurers, perhaps through your Chapter of the American Academy of Pediatrics or American Academy of Family Physicians, may be effective in their providing appropriate compensation. For insurers that compensate for screening, the health supervision code is used with the modifier 25 appended and 96110 listed for each screening tool administered.
- validated for a primary care population
- broadband instruments that screen in multiple domains of development
- favorable psychometric properties, defined as sensitivity and specificity between 70% and 80%
- parent completed questionnaire
- administration time of 15 minutes or less
- designed for use at the 9, 18 and 30 (or 24) month visits
- compatible with electronic medical records
- available in multiple languages
- 21 age-specific questionnaires, 30 items per questionnaire
- Age range: 2 – 60 months published validation studies [Gollenberg: 2010]
- Scoring: cut off points for each domain that indicate recommendation for referral
- Parent reading level: 4th to 6th grade
Source: Can be purchased from Paul H. Brookes Publishing Co. Ages and Stages Questionnaire: Developmental (ASQ-3) (Brookes)
- Single parental response form used for all ages, 10 items per questionnaire
- May also be useful as a surveillance tool
- Age range: same questionnaire used from 0 – 8 years
- Published validation studies
- Scoring: algorithm that indicates need for referral, further screening or continued surveillance
- Parent reading level: 5th grade
Source: By Frances P. Glascoe, PhD; can be purchased at Parent's Evaluation of Developmental Status (PEDS) site
- Early Intervention (see Early Intervention Programs service provider listed under Services below)
- Families may self-refer to Early Intervention, but the clinician may send a referral form to provide specific information and to better coordinate care
- The Early Intervention Program (EIP) may provide services such as developmental therapies, service coordination, family training, counseling, and home visits
- The EIP will NOT perform a medical evaluation or other evaluations to establish a diagnosis of a specific developmental disability
- A diagnosis of a specific developmental disability is NOT necessary for an EIP referral to be made or for services to begin
- Comprehensive Evaluation
- The goal of a comprehensive evaluation is to identify a specific developmental disability to aid in developing an appropriate treatment plan and to offer a prognosis for the child.
- The developmental and medical components of the comprehensive evaluation should ideally be interdisciplinary. The table below describes the roles of the various disciplines in such an evaluation.
|Audiologist||Evaluates for hearing loss as a potential cause or contributor to developmental delay
(Audiology service provider listed under Services below)
|Primary care clinician or
|Performs medical evaluation;
identifies and treats associated conditions
(Developmental Evaluation service provider listed under Services below)
|Geneticist and genetic counselor||Performs evaluation when an underlying medical condition or genetic syndrome is suggested by family history, examination,
or clinical course
(we currently have no Pediatric Genetics service providers listed, please search our Services database for related services)
|Psychiatrist||Evaluates and treats associated psychiatric conditions and maladaptive behaviors
(Children's Neurodevelopment Center, (401-444-5685) and/or Bradley Outpatient Clinic for Autism and Developmental Disabilities CADD, (401-432-1119); See also Services below)
|Psychologist||Administers cognitive or developmental testing or other diagnostic tools;
Identifies associated psychiatric conditions and develops behavioral treatment plan
(Psychologist, Child-18 service provider listed under Services below)
|Occupational therapist||Evaluates for fine and gross motor deficits;
Evaluates for sensory processing deficits;
develops plan for treatment
(see all Occupational Therapy, Pediatric services providers (6) in our database)
|Licensed Social Worker||Identifies family needs;
refers family to formal and informal support agencies and organizations
(see all Clinical Social Worker (LCSW, MSW) services providers (1) in our database)
|Speech-language pathologist||Evaluates for expressive, receptive, and pragmatic language deficits;
develops plan for treatment
(University of Rhode Island Hearing and Speech Center, (401-874-5969); See also Services below)
Rhode Island Child Outreach Screening Program ( 3.2 MB)
Rhode Island Child Outreach is a universal developmental screening system designed to screen all children, aged three to five years old. Screening serves as a first step in the identification of children who might have developmental delays or disabilities and who could benefit from intervention. Child Outreach also serves as a resource to families, providing information about general development, the development of their child, opportunities for involvement in their child’s development and information regarding referrals to agencies and community programs.
Developmental Red Flags ( 186 KB)
From Kids Get Care, King County, Washington, this checklist gives tips for finding possible developmental delays.
Learn the Signs. Act early. Physicians Primer ( 1.2 MB)
Resources to assist physicians with developmental surveillance from age 2 months to 5 years.
Developmental Screening and Assessment Instruments ( 997 KB)
This 20-pg document, published in 2008, compares developmental and social-emotional screening instruments with descriptions; age ranges; time to administer, scoring procedures, psychometric properties; requirements for administrators; who can administer the instrument; and more. From the National Early Childhood Technical Assistance Center, with funding from the U.S. Office of Special Education Programs.
Genetics in Primary Care Institute (AAP)
The goal of this site is to increase collaboration in the care of children with known or suspected genetic disorders. It includes health supervision guidelines and other useful resources; represents a collaboration among the Health Resources & Services Administration, the Maternal and Child Health Bureau, and the American Academy of Pediatrics.
Developmental Screening (CDC)
Provides an overview of screening, the pros and cons of screening tools, links to federal resources; Centers for Disease Control and Prevention.
Early Developmental Guide for Parents
From the Utah Department of Health, a list of milestones for ages 1-2 months, 3-4 months, 6 months, 9 months, 12 months, 18 months, 2-3 years. Includes development, nutrition, communication/hearing/vision, and guidance for parents
Parenting Children Aged Zero to Three
A webpage from the Zero to Three national, nonprofit organization dedicated to supporting families and communities in the care of young children. This site has links to FAQs; parenting tips; and reproducible handouts for parents. Topics include behavior, play, language, and more.
Parent's Guide to Understanding Subspecialists
An American Academy of Pediatrics webpage that links to information about pediatric subspecialists and transport teams. Includes guidelines for referral to pediatric surgical specialists.
Learn the Signs. Act Early. Tools
Checklists, booklets, and other tools to learn about and track developmental milestones for infants and young children.
American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
Pediatrics. 2006;118(1):405-20. PubMed abstract / Full Text
Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.
Learn the Signs. Act Early (CDC)
A CDC program to address the importance of early identification of developmental delay and disability. Early intervention (before school age) can have a significant impact on a child’s ability to learn new skills, as well as reduce the need for costly interventions over time; Centers for Disease Control and Prevention.
Ages and Stages Questionnaire: Developmental (ASQ-3) (Brookes)
Parent-completed questionnaire of about 30 age-related questions that screens for developmental delays between one month and 5½ years. Available for purchase from Brookes Publishing Company.
Developmental Milestones (pathways.org)
Developmental milestones for 0-3 years. Material supported by the American Academy of Pediatrics and developed by Pathways.org to maximize child development.
Developmental Screening Tools (dbpeds.org)
From Developmental Behavioral Pediatrics Online, this page provides brief descriptions of several commonly used developmental screening tools and includes source, scoring information, age range for use, time needed to complete, accuracy, cost, and links.
Parent's Evaluation of Developmental Status (PEDS) site
PEDS and PEDS:DM provide 5-minute screenings, longitudinal surveillance, and triage for developmental as well as behavioral/social-emotional/mental health problems. Can be completed by parent self-report, interview, or administered directly to children; available for a fee.
See all Audiology services providers (13) in our database.
See all Clinical Social Worker (LCSW, MSW) services providers (1) in our database.
See all Developmental Evaluation services providers (28) in our database.
See all Early Intervention Programs services providers (13) in our database.
See all Occupational Therapy, Pediatric services providers (6) in our database.
We currently have no Pediatric Genetics service providers listed; search our Services database for related services.
See all Psychiatrist, Child-18 services providers (116) in our database.
See all Psychologist, Child-18 services providers (7) in our database.
See all Speech/Language Therapy services providers (7) in our database.
For other services related to this condition, browse our Services categories or search our database.
Drotar D, Stancin T, Dworkin PH, Sices L, Wood S.
Selecting developmental surveillance and screening tools.
Pediatr Rev. 2008;29(10):e52-8. PubMed abstract
Sices L .
Developmental Screening in Primary Care: The Effectiveness of Current Practice and Recommendations for Improvement.
(2007) http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007.... A comprehensive report from The Commonwealth Fund. Accessed on 2-10-11.
Developmental conditions are common in early childhood, and are predictive of later behavioral difficulties. Early treatment improves outcomes. This report makes recommendations to strengthen developmental surveillance and screening, and improve outcomes for young children and families.
|Author:||Paul Carbone, MD - 2/2011|
|Reviewing Author:||Sarah Winter, MD - 2/2011|
|Content Last Updated:||2/2011|
Berlin LJ, Brooks-Gunn J, McCarton C, McCormick MC.
The effectiveness of early intervention: examining risk factors and pathways to enhanced development.
Prev Med. 1998;27(2):238-45. PubMed abstract
The effectiveness of early intervention, especially vis-à-vis (a) child and family risk factors and (b) the pathways to enhanced child and family development, is examined. Findings were drawn from the Infant Health and Development Program (IHDP) for low-birth-weight premature infants. The data presented reveal the considerable effectiveness of the IHDP intervention in enhancing several aspects of early and later child and family development.
Earls MF, Andrews JE, Hay SS.
A longitudinal study of developmental and behavioral screening and referral in North Carolina's Assuring Better Child Health and Development participating practices.
Clin Pediatr (Phila). 2009;48(8):824-33. PubMed abstract
The main objectives of this descriptive study were to determine the number of children who were screened and whether this rate improved with time, observe patterns and trajectories for children identified at risk in 1 or more of the 5 developmental domains, and examine referral rates and physician referral patterns.
Gollenberg AL, Lynch CD, Jackson LW, McGuinness BM, Msall ME.
Concurrent validity of the parent-completed Ages and Stages Questionnaires, 2nd Ed. with the Bayley Scales of Infant Development II in a low-risk sample.
Child Care Health Dev. 2010;36(4):485-90. PubMed abstract
Study results suggest the ASQs provide a simple, valid, and cost-effective method for clinicians and researchers to reduce the number of standardized assessments required to identify developmentally delayed infants at age 24 months.
Effectiveness of early intervention for vulnerable children: a developmental perspective.
Am J Ment Retard. 1998;102(4):319-45. PubMed abstract
An analysis of the current state of our knowledge of the effectiveness of early intervention for children at risk and for those with established disabilities was provided.
Hagan JF, Shaw JS, Duncan PM, eds. .
Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents.
3rd ed. Elk Grove Village, IL: American Academy of Pediatrics; 2008. 978-1-58110-223-9 http://brightfutures.aap.org/
Authoritative compilation of guidelines and evidence for health supervision, including developmental surveillance and screening, physical exam, laboratory and other testing, and anticipatory guidance. The Affordable Care Act of 2010 cites Bright Futures as the standard for well child and adolescent care.
Palfrey JS, Singer JD, Walker DK, Butler JA.
Early identification of children's special needs: a study in five metropolitan communities.
J Pediatr. 1987;111(5):651-9. PubMed abstract
In the absence of clear assumption of responsibility for early identification, much terrain remains uncharted by medical practitioners and the schools. A better systematic sharing of responsibility for the early identification of developmentally disabling conditions is needed.
Reynolds AJ, Temple JA, Robertson DL, Mann EA.
Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools.
JAMA. 2001;285(18):2339-46. PubMed abstract / Full Text
Soreca I, Fagiolini A, Frank E, Houck PR, Thompson WK, Kupfer DJ.
Relationship of general medical burden, duration of illness and age in patients with bipolar I disorder.
J Psychiatr Res. 2008;42(11):956-61. PubMed abstract
Zuckerman B, Stevens GD, Inkelas M, Halfon N.
Prevalence and correlates of high-quality basic pediatric preventive care.
Pediatrics. 2004;114(6):1522-9. PubMed abstract
Because of its association with other services, processes, and outcomes of care, the BPS scale may serve as a useful construct for monitoring quality and stimulating efforts to improve national pediatric preventive care.