Implementing developmental surveillance and screening for identifying issues early

November 1, 2009

To encourage accurate and early identification of children with delays, disabilities, and emerging problems, in 2006 the American Academy of Pediatrics (AAP) updated its policy statement on developmental surveillance (DS) and screening to include a decision-making paradigm.

To encourage accurate and early identification of children with delays, disabilities, and emerging problems, in 2006 the American Academy of Pediatrics (AAP) updated its policy statement on developmental surveillance (DS) and screening to include a decision-making paradigm.1 In this article, we cover definitions and tenets of the AAP's algorithm. Two subsequent articles in this series will cover how to make developmental-behavior screening work in your practice and how to help parents understand developmental-behavioral screening.

The new recommendations

AAP policy involves 2 strategies to promote early detection of developmental problems. These are:

What is DS?

If surveillance indicates a low risk of a developmental disorder, healthcare providers should recommend the usual age-appropriate developmental stimulation activities to parents such as reading aloud, talking with children about their interests, talking at mealtimes, and so on. Remember that observable problems may be the "tip of the iceberg" and perhaps only one component of a more extensive disorder. Most developmental behavioral problems in young children are extremely subtle and thus virtually asymptomatic. Careful scrutiny is required, especially when clinicians do not suspect a problem.

Why DS?

Many developmental problems are a result of psychosocial risk factors such as limited parental education and income, lack of social support, dearth of parenting skills that promote language and learning, parental depression, and stressor pile-ups such as housing instability and food insufficiency. In the first year of life, children at psychosocial risk appear to have typical development. By the second year, there is a marked decline in the rate of acquiring skills critical for eventual school success (ie, language, cognition, and preacademics). DS seeks to detect and intervene with families and children at risk so that developmental and behavioral problems can be prevented.

What is formal screening?

Developmental behavioral screening depends on accurate, validated standardized tests. Without general, high-quality screening tools of proven accuracy, providers have difficulty discerning which children are delayed.1,2 These tests can be administered directly to the child or completed by the parent. The use of screening tools is clearly defined by the AAP and does not include items used for longer measures; rather, each test must be administered at once in its entirety.