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

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Related Studies

Ontology: Developmental Disabilities (C0008073)

Definition (MEDLINEPLUS)

Developmental disabilities are severe, long-term problems. They may be physical, such as blindness. They may affect mental ability, such as learning disorders. Or the problem can be both physical and mental, such as Down syndrome. The problems are usually life-long, and can affect everyday living.

There are many causes of developmental disabilities, including

Often there is no cure, but treatment can help the symptoms. Treatments include physical, speech, and occupational therapy. Special education classes and psychological counseling can also help.

NIH: National Institute of Child Health and Human Development

Definition (NCI) A disorder diagnosed in childhood that is marked by either physical or mental impairment or both, which in turn affects the child from achieving age related developmental milestones.
Definition (MSH) Disorders in which there is a delay in development based on that expected for a given age level or stage of development. These impairments or disabilities originate before age 18, may be expected to continue indefinitely, and constitute a substantial impairment. Biological and nonbiological factors are involved in these disorders. (From American Psychiatric Glossary, 6th ed)
Definition (PSY) As encompassed in federal legislation for educational assistance to handicapped children, includes disabilities originating before age 18 that constitute substantial barriers to normal functioning. Use a more specific term if possible.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D002658
ICD10 F89
SnomedCT 192149001, 5294002
LNC LP75919-8
English Child Development Disorder, Child Development Disorders, Development Disorder, Child, Development Disorders, Child, Developmental Disability, Disabilities, Developmental, Disability, Developmental, CHILD DEVELOPMENT DIS, DEVELOPMENT DIS CHILD, developmental disability, Developmental Disabilities [Disease/Finding], Developmental disabilities, child developmental disabilities, child development disorder, developmental disorders, Developmental disorder NOS, Developmental Disorder, Developmental disorder NOS (disorder), child development disorders, developmental delay disorders, developmental disabilities, disorder developmental, disorder developmental (diagnosis), Developmental disorder, Developmental disorder (disorder), developmental disorder, child; developmental disorder, developmental disorder; child, Developmental disorder, NOS, Developmental Disabilities
Swedish Utvecklingsstörningar
Czech dítě - vývojové poruchy, opoždění vývoje
Finnish Kehitysvammaisuus
Italian Disturbi dello sviluppo del bambino, Ritardi nello sviluppo
Japanese 小児発育偏差, 児童発達障害-特殊, 児童発育障害, 発育遅滞障害, 児童発育偏差, 特殊な児童発達障害, 児童発育偏移, 発達障害, 小児発育障害
Polish Zaburzenia rozwoju dziecka, Niesprawności rozwojowe
Norwegian Utviklingsforstyrrelser
Spanish trastorno del desarrollo, SAI, trastorno del desarrollo, SAI (trastorno), trastorno del desarrollo (trastorno), trastorno del desarrollo, Discapacidades del Desarrollo, Trastornos del Desarrollo Infantil
Dutch kind; ontwikkelingsstoornis, ontwikkelingsstoornis; kind, Ontwikkelingsstoornis, Ontwikkelingsstoornissen, Ontwikkelingsstoornissen bij het kind, Ontwikkelingsstoornissen van het kind, Specifieke ontwikkelingsstoornissen van het kind, Stoornissen door een vertraagde ontwikkeling
French Troubles du développement de l'enfant, Troubles du développement, Handicaps du développement
German Entwicklungsbedingte Fähigkeitsstörungen, Entwicklungsverzögerungen, Behinderungen durch, Fähigkeitsstörungen, entwicklungsbedingte, Kindliche Entwicklungsstörungen
Portuguese Deficiências do Desenvolvimento, Transtornos do Desenvolvimento Infantil

Ontology: Developmental delay (disorder) (C0424605)

Definition (PSY) Delays in any or all areas including cognitive, social, language, sensory, and emotional development.
Concepts Mental or Behavioral Dysfunction (T048)
ICD9 315.9
SnomedCT 268787000, 268790006, 288196003, 154957005, 154953009, 248290002
English Unspecified delay in development, Delayed development, DEVELOPMENTAL DELAY, Developmental delay NOS, Development delay NOS, delays developmental, developmental retardation, child developmental delay, delayed development, developmental delay, development delay, Development delay NOS (disorder), Development delay - NOS, Developmental delay, development; retardation, disturbance; learning, retardation; developmental, Delayed Development, Developmental delay (disorder), Delay;developmental
Italian Ritardo di sviluppo, Ritardo non specificato dello sviluppo, Ritardo di sviluppo NAS
Dutch ontwikkelingsvertraging NAO, niet-gespecificeerde vertraging in de ontwikkeling, ontwikkeling; retardatie, retardatie; ontwikkeling, ontwikkelingsvertraging
French Retards du développement non précisés, Retard de développement SAI, RETARD DU DEVELOPPEMENT, Retard du développement
German Entwicklungsverzoegerung NNB, unspezifische Verzoegerung in der Entwicklung, ENTWICKLUNGSVERZOEGERUNG, Entwicklungsverzoegerung
Portuguese Atraso NE do desenvolvimento, Atraso de desevovimento NE, ATRASO DO DESENVOLVIMENTO, Atraso de desenvolvimento
Spanish Retraso en el desarrollo NEOM, Retraso no especificado del desarrollo, retardo del desarrollo, SAI (trastorno), retardo del desarrollo, SAI, retraso congénito (trastorno), retraso congénito, Retraso en el desarrollo
Japanese 詳細不明の発達遅延, 発育遅延, 発育遅延NOS, ハツイクチエン, ハツイクチエンNOS, ショウサイフメイノハッタツチエン
Czech Vývojové opoždění, Vývojové zpoždění NOS, Nespecifikované zpoždění ve vývoji
Hungarian Fejlődési visszamaradás, Fejlődési visszamaradás k.m.n., Nem meghatározott visszamaradás a fejlődésben

Ontology: Developmental handicap screening (C0588354)

Concepts Diagnostic Procedure (T060)
SnomedCT 171206002, 275976000
English Developmental handicap screen, Developmental h'cap screen, Develop h'cap screen, Developmental handicap screening, Developmental handicap screening (procedure)
Spanish rastreo para la detección de retraso madurativo, pesquisa para la detección de retraso madurativo, pesquisa de retraso madurativo, detección selectiva de retraso madurativo (procedimiento), cribado para la detección de retraso madurativo, screening de retraso madurativo, cribado para la detección de retraso madurativo (procedimiento), tamizaje para la detección de retraso madurativo, screening para la detección de retraso madurativo, cribado de retraso madurativo, tamizaje de retraso madurativo, cribaje para la detección de retraso madurativo, detección selectiva de retraso madurativo