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Q&A with Dr. Justin Morgan: What are developmental screening tools?

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Dr. Justin Morgan
Bundoo Pediatrician

Justin Morgan, MD, FAAP, is a board-certified pediatrician who practices general pediatrics in Louisville, Kentucky. He cares for children of all ages.

Well baby visits are an important part of your baby’s health — and not just so the doctor can see how your baby is growing. In fact, throughout the first few years of your baby’s life, your baby will likely undergo a number of screening tests that are designed to identify developmental and other delays. This makes it possible to start treatment early (if necessary) and, in many cases, increases the chances of successful treatment. Dr. Morgan talks about which screening tools you might see.

Bundoo: Infant screening really begins at birth. In the first few years of life, what are the major screening tools you use to assess an infant’s development?

Dr. Justin Morgan: There are many validated, general developmental screening tools for varying age groups including the Ages & Stages Questionnaires (ASQ), Battelle Developmental Inventory Screening Tool (BDI-ST), Bayley Infant Neurodevelopmental Screening (BINS), Brigance Screens-II, Child Development Inventory (CDI), Child Development Review-Parent Questionnaire (CDR-PQ), Denver-II Developmental Screening Test, Infant Development Inventory, and Parents’ Evaluation of Developmental Status (PEDS). There are many other screening tools specifically focused on language and cognition, motor skills, or autism screening. There is not a universally-adopted screening test, and many pediatricians may use a variety of tools depending on the age of the child, cost of the test, or familiarity in administering the test.

When are these screening tools used?

A pediatrician should assess a child’s development at every well-child preventative care visit. Any concerns from these visits (or a parental concern for developmental delay) should prompt a standardized developmental screening test. However, the American Academy of Pediatrics (AAP) does recommend formal evaluation at the 9-, 18-, and 24- or 30-month well visits. In addition to a general developmental screening tool, an autism-specific screening tool should be used at the 18- and 24-month visits.

What happens if there is a developmental concern based on a screening tool?

Your child’s pediatrician will compare the results of the tool with his or her own clinical observations. A child with concerning screening tool results should be referred for early intervention evaluation as soon as possible. Most states have an early intervention team composed of interdisciplinary professionals who specialize in developmental delays and who can help diagnose and formulate a treatment plan in conjunction with your pediatrician. One important point to remember is that a child should be referred for further evaluation at any time (the earlier, the better) if a parent or professional has concerns, even if a screening tool does not show significant developmental risk. An early intervention evaluation may pick up on a developmental concern missed by a screening tool.

Who typically administers the most common screening tools? Should parents complete a screening tool on their own?

Many screening tools can be completed by parents and scored by an office staff member, such as a nurse or medical assistant. The pediatrician will likely interpret the screening results. It is important to remember that a “positive” screening result only means that there is a difference in the child’s development when compared to norms from the same age. No diagnosis or treatment plan can be inferred from a screening test alone. It is for this reason that home screening tool results should be discussed promptly with your pediatrician.

Many parents are worried about autism in their babies and toddlers. What tool is used to screen for autism, and when is it administered?

The most common autism screening tool used is a scientifically validated questionnaire called the Modified Checklist for Autism in Toddlers-Revised with Follow-up (MCHAT-R/F). It is best implemented between 16 and 30 months of age and is a two-stage screening questionnaire that can be done at home or in a pediatric office setting to assess the risk for autism spectrum disorder. The AAP recommends all children receive formal autism screening at 18 and 24 months of age regardless of whether there are any developmental concerns.

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