Developmental screening can be done by a number of professionals in health care, community, and school settings. However, primary healthcare providers are in a unique position to promote children's developmental health.
Primary care providers have regular contact with children before they reach school age and are able to provide family-centered, comprehensive, coordinated care, including a more complete medical assessment when a screening indicates a child is at risk for a developmental problem.
Keep Reading: MythBusters for Healthcare Providers: Developmental ScreeningResearch has found that autism spectrum disorder (ASD) can sometimes be detected at 18 months or younger. By age 2 years, a diagnosis by an experienced professional can be considered very reliable. 1 However, many children do not receive a final diagnosis until they are much older. This delay means that children with ASD might not get the help they need. The earlier ASD is diagnosed, the sooner treatment services can begin.
Early identification of developmental disorders is critical to the well-being of children and their families. It is an integral function of the primary care medical home and an appropriate responsibility of all pediatric healthcare professionals.
The American Academy of Pediatrics (AAP) recommends that developmental surveillance be incorporated at every health supervision visit. Any concerns raised during surveillance should be addressed promptly with standardized developmental screening tests. In addition, AAP recommends that all children be screened for developmental delays and disabilities during regular well-child doctor visits at
Additional screening might be needed if a child is at high risk for developmental problems because of preterm birth or low birth weight.
In addition, all children should be screened specifically for ASD during regular well-child doctor visits at:
Additional screening might be needed if a child is at high risk for ASD (e.g., having a sibling with ASD) or if symptoms are present.
It is important for doctors to screen all children for developmental delays, but especially to monitor those who are at a higher risk for developmental problems due to preterm birth, low birth weight, or having a sibling or parent with ASD.
The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. If a child is diagnosed with a developmental disorder through the evaluation and diagnostic process, they should be identified as a child 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 genetic counseling for his or her parents.
See Also: Identification, Evaluation, and Management of Children With ASDIn February 2016, the U.S. Preventive Services Task Force (USPSTF) released a recommendation regarding universal screening for ASD among young children.
► This final recommendation statement applies to children ages 3 years and younger who have no obvious signs or symptoms of ASD or developmental delay and whose parents, caregivers, or doctors have no concerns about the child's development.
► The USPSTF reviewed research studies on the potential benefits and harms of ASD screening in young children who do not have obvious signs or symptoms of ASD. They looked at whether screening all children for ASD helps with their development or quality of life.
The final recommendation statement here summarizes what the USPSTF learned following its review:
There is not enough evidence available on the potential benefits and harms of ASD screening in all young children to recommend for or against this screening.
This recommendation statement is not a recommendation against screening; it is a call for more research.
Integrating routine developmental screening into the practice setting can seem daunting. Following are suggestions for integrating screening services into primary care efficiently and at low cost, while ensuring thorough coordination of care.
Research indicates that parents are reliable sources of information about their children's development. Evidence-based screening tools that incorporate parent reports (e.g., Ages and Stages Questionnaire, the Parents' Evaluation of Developmental Status, and Child Development Inventories) can facilitate structured communication between parents and providers to discover parent concerns, increase parent and provider observations of the child's development, and increase parent awareness. Such tools can also be time- and cost-efficient in clinical practice settings. 234 A 1998 analysis found that, depending on the instrument, the time for administering a screening tool ranged from about 2 to 15 minutes, and the cost of materials and administration (using an average salary of $50/hour) ranged from $1.19 to $4.60 per visit. 5
Screening children and providing parents with anticipatory guidance―that is, educating families about what to expect in their child's development, how they can promote development, and the benefits of monitoring development―can also improve the relationship between the provider and parent. 6 By establishing relationship-based practices, providers promote positive parent-child relationships, while building the strongest possible relationship between the parent and provider. Such practices are fundamental to quality services.
Screening tools are designed to help identify children who might have developmental delays. Screening tools can be specific to a disorder (e.g., autism) or an area (e.g., cognitive development, language, or gross motor skills), or they may be general, encompassing multiple areas of concern. Some screening tools are used primarily in pediatric practices, while others are used by school systems or in other community settings.
Screening tools do not provide conclusive evidence of developmental delays and do not result in diagnoses. A positive screening result should be followed by a thorough assessment. Screening tools do not provide in-depth information about an area of development.
When selecting a developmental screening tool, take the following into consideration:
There are many different developmental screening tools. CDC does not approve or endorse any specific tools for screening purposes. This list is not exhaustive, and other tests may be available.
A more comprehensive list of developmental screening tools is available from the American Academy of Pediatrics (AAP), including descriptions of the tools and their sensitivity and specificity. The list includes general screening tools as well as those for ASD.
