Developmental Evaluation

Aka: Developmental Evaluation, Developmental Exam, Developmental Screening, Developmental Delay, Developmental Disability, Developmental Disorder

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II. Epidemiology

  1. Prevalence Developmental Delay in U.S.: 15% of those ages 3-17 years old
    1. Speech Delay or Language Delay: Up to 19% Prevalence
    2. Learning Disorder: 8% Prevalence
    3. Cognitive Disorder: Up to 1.5% Prevalence

III. Precautions

  1. Early intervention for Developmental Delay is associated with the best outcomes
    1. However, only 3% of all children received early intervention by age 3 years old (2014, U.S.)
    2. Public interventions for Developmental Delay peaks at ages 9-12 years old (12.5% of children)
  2. Parental concern alone may be insufficient screening
    1. Parental concern alone misses half of children identified with standardized screening tools
  3. However, screening recommendations varies
    1. Only AAP recommends routine screening in asymptomatic children (at 9, 18, 24-30 and 48 months)
    2. USPTF and AAFP recommend screening in symptomatic children (e.g. parental concern)

IV. Indications

  1. Periodic screening in all children at ages 9, 18, 24 and 30 months
  2. High risk for Disability
    1. Low income family
    2. Parents with limited education
    3. Parents with mental health concerns
    4. Single parent family
    5. Numerous siblings
    6. Parental unemployment
    7. Lack of parental concerns
  3. Other risks
    1. Perinatal risk factors
    2. Lower level or maternal education
    3. Male gender

V. Approach: Survey Parental Concerns

  1. Use standardized questionnaire (preferred for primary care)
    1. Example: Ages and Stages Questionnaire (ASQ) for age 4-60 months
    2. See Tools below for preferred options (ASQ, CDR/IDI or PEDS)
  2. Use Clinician Trigger Question (Glascoe)
    1. Ask Parent "Please tell me any concerns you have:"
      1. Learning
      2. Developing
      3. Behaving

VI. Approach: Developmental Screening Tests for parental concerns

  1. Behavior (35%)
  2. Speech and Language (30%)
  3. Gross motor (less common)
  4. Fine motor
    1. Often reflects true developmental problems
  5. Global concerns
    1. Needs screening!

VII. Tools

  1. Developmental Screening Tests ("Does a problem exist?")
    1. Preferred Options (per AAP, one of the following tests is performed at 9, 18, 24-30 and 48 months)
      1. Ages and Stages Questionnaire (ASQ): 4-60 months (10 parent completed questions)
      2. Infant Development Inventory (IDI): 0-18 months
      3. Child Development Review (CDR): 18-60 months
      4. Parent's Evaluations of Developmental Status (PEDS): 0-8 years (10 parent completed questions)
    2. Other options
      1. Battelle Developmental Inventory
      2. Bayley Infant Neurodevelopmental Screen
      3. Brigance Screen
      4. CAT/CLAMS
      5. Denver Developmental Screening Test II (not recommended due to low efficacy)
      6. Minnesota Child Developmental Inventory (replaced by CDR and IDI)
  2. Autism Screening (per AAP performed at 18 and 24 months)
    1. Modified Checklist for Autism in Toddlers (M-CHAT-R/F)
      1. http://mchatscreen.com/wp-content/uploads/2015/09/M-CHAT-R_F.pdf
    2. Other tools
      1. Pervasive Developmental Disorders Screening (PDDST)
      2. Autism Screening Questionnaire
      3. Australian Scale for Asperger Syndrome
  3. Developmental Assessment Tools (abnormal screening)
    1. Young children under age 3 years: Cognitive Test
      1. Bayley II Developmental Assessment
      2. McCarthy Scales of Children's Ability
    2. Children 3 years and older: Intelligence Testing
      1. Stanford-Binet Intelligence Scale
      2. Wechsler Intelligence Scale
  4. Behavioral Screening
    1. Eyberg Child Behavior Inventory
    2. Family Psychosocial Screening
    3. Pediatric Symptom Checklist
  5. Broad-based testing
    1. Survey of Wellbeing of Young Children (SWYC)
  6. Other Tests
    1. Language and communication
      1. Sequenced Inventory Communication Development
        1. Abbreviation: SICD
        2. Used in 4-48 months
    2. Adaptive and social Functioning
      1. Vineland Adaptive Behavior Scales
        1. Used in birth to 18 years

VIII. Resources

  1. Healthcare Provider Intervention Guidelines (CDC)
    1. https://www.cdc.gov/ncbddd/actearly/hcp/index.html
  2. U.S. Early Intervention Programs by State (CDC)
    1. https://www.cdc.gov/ncbddd/actearly/parents/state-text.html
  3. Developmental Disabilities (CDC)
    1. https://www.cdc.gov/ncbddd/developmentaldisabilities/
  4. Bright Futures Developmental Screening
    1. https://brightfutures.aap.org/materials-and-tools/tool-and-resource-kit/Pages/Developmental-Behavioral-Psychosocial-Screening-and-Assessment-Forms.aspx

IX. References

  1. Mackrides (2011) Am Fam Physician 84(5): 544-9 [PubMed]
  2. Hamilton (2006) J Fam Pract 55(5): 415-22 [PubMed]
  3. Glascoe (2005) Ment Retard Dev Disabil Res Rev 11(3): 173-9 [PubMed]
  4. Rydz (2005) J Child Neurol 20(1): 4-21 [PubMed]
  5. Vitrikas (2017) Am Fam Physician 96(1): 36-43 [PubMed]

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