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With as many as one in eight children having mental retardation and/or a developmental disability (Glascoe 1997), it is vital that delays and disabilities are identified as early as possible so these children receive the benefits of early detection and intervention. Scientific research consistently shows that the first three years of life are critical for the development of brain structure and functioning. Because developmental screening is a process that selects those children who will receive the benefits of more intensive evaluation, or of treatment, all infants and children should be screened for developmental disabilities, otherwise some may be denied access to needed care. (AAP, 1994) Unfortunately, many are not identified until after these critical years. Screening to create a complete developmental profile is a brief assessment procedure designed to identify children who should receive more intensive diagnosis or assessment. The emphasis in screening has shifted to a younger age, with the current focus being on infants and children birth through 2 years of age. This is an age at which the clinician is very closely involved with children and families and is in a position to have significant impact on the course of the child’s development.
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The limited ability of infant tests, whether intended for screening or definitive diagnosis of intellectual functioning, to predict future function has led to controversy concerning their use. However, when physicians use only clinical impressions, estimates of children’s developmental status are often inaccurate. The advantage of screening instruments is that they state their norms explicitly, serve as a reminder to the clinician to observe development, and are an efficient way to record the observations.
Essential components of the screening process are as follows:
Screening will likely lead to one of the following conclusions:
There are several brief screening tests available for primary care physicians to conduct in their offices. Examples include:
Additional tests through more informal questioning or formal questionnaires examples include:
Detecting Delays or Disabilities
Delays or deficits in development may be suspected based on one or more of the following:
Risk Factors for Developmental Disabilities
Visual and problem solving
Recommendations for Primary Care Physicians
Informing parents that their child may have a developmental delay or disability may be difficult. This information should be discussed in a comfortable setting and presented in an understandable way. Parents will likely experience feelings of grief, confusion, shock, anger, stress, anxiety, disbelief, guilt, and loss. Educating them about the disability and what can be done to maximize their child’s potential, and referring them to appropriate intervention services, can be extremely helpful.
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Peer-reviewed Journal Articles/Academies
American Academy of Pediatrics, Committee on Children With Disabilities. (1993). Pediatric Services for Infants and Children With Special Health Care Needs. Pediatrics, 92(1), 163-165.
American Academy of Pediatrics, Committee on Children With Disabilities. (1994). Screening Infants and Young Children for Developmental Disabilities. Pediatrics, 93(5): 863-865.
American Academy of Pediatrics, Committee on Children with Disabilities. (2001). Developmental Surveillance and Screening of Infants and Young Children. Pediatrics 108, 192-195.
American Academy of Pediatrics, Committee on Children with Disabilities. (1999). The Pediatrician’s Role in the Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP). Pediatrics 104(1), 124-127.
American Academy of Pediatrics, Committee on Children with Disabilities, (2001). Role of the Pediatrician in Family-Centered Early Intervention Services. Pediatrics, 107(5), 1155-1157.
Bailey, D.B, Jr., et al. (1998). Family Outcomes in Early Intervention: a Framework for Program Evaluation and Efficacy Research. Exceptional Children 64(3), 313-328.
Bernstein, H.K., Steitner-Eaton, B., Ellis, M.,(1995). Individuals with Disabilities Education Act: Early Intervention by Family Physicians. American Family Physician, 52(1), 71-75.
Cameron, R.J., (1997). Early Intervention for Young Children with Developmental Delay: the Portage Approach. Child Care, Health and Development 23(1), 11-27.
Epps, S and R Kroeker. (1995). Physician Early Intervention Referral as a Function of Child Age and Level of Developmental Delay. Mental Retardation, 33(2), 104-110.
Glascoe, F.P., Foster, E.M., Wolraich, M.L., (1997). An Economic Analysis of Developmental Detection Methods. Pediatrics, 99(6), 830-837.
Thompson, L., et al. (1997). Pathways to Family Empowerment: Effects of Family-centered Delivery of Early Intervention Services. Exceptional Children 64(1), 99-113.
Special Interest Groups/Other Publications
California’s Early Start Program: The Role of the Health Care Provider. Sacramento: (1999). Department of Developmental Services, Prevention and Children Services Branch.
Capute, A.J., Accardo, P.J. (1991). Developmental Disabilities in Infancy and Childhood. Baltimore: Paul H. Brookes Publishing.
American Academy of Pediatrics (2001). Committee on Children with Disabilities
Developmental Surveillance and Screening of Infants and Young Children. Pediatrics, (108), 192 – 195.
Johnson, C.P., Kastner T.A. (2005).The Committee/Section on Children With Disabilities
Helping Families Raise Children with Special Health Care Needs at Home
Pediatrics,115, 507 – 511.
Sand, N, Silverstein, M., Glascoe, F.P.,Gupta, V.B., Tonniges, T.P., O’Connor, K.G.
Pediatricians’ (2005). Reported Practices Regarding Developmental Screening: Do Guidelines Work? Do They Help?
Pediatrics,116, 174 – 179.
Shipman, S.A, Helfand,M., Moyer, V.A., and Yawn, B.P.(2006). Screening for Developmental Dysplasia of the Hip: A Systematic Literature Review for the US Preventive Services Task Force. Pediatrics, 117, 557 – 576.
Shonkoff, J.P., Dworkin, P.H., Leviton, A., Levine, M.D.(1979). Primary Care Approaches to Developmental Disabilities
Pediatrics, 64, 506 – 514.
Child, Parent, Primary Health Care Provider: ‘Important Relationship’ Promotes Long-Term Development of Children.(1999). Early Start Connections 2 (1): 1. Department of Developmental Services, Early Start Resources
Hochstein, M.. Halfon, N. (1998). Brain Development: Nearly Half of California Parents Unaware of Important First Three Years. Sacramento, CA: California , Growing Up Well series.
Johnson, L, et al. (1994). Meeting Early Intervention Challenges: Issues from Birth to Three (2nd ed.). Baltimore: Paul H. Brookes Publishing.
RESOURCES FOR FAMILIES
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California Children’s Services
California Department of Developmental Services
California Family Resource Centers
California Regional Centers
California’s Early Start Program
Child Health and Disability Prevention Program
Early Start Resources
Exceptional Parent Magazine
National Childhood Technical Assistance System
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Theodore A. Kastner, M.D., M.S.
Felice Weber Parisi, M.D., M.P.H.
Patricia Samuelson, M.D.
Larry Yin, M.D., M.S.P.H., F.A.A.P.
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This document does not provide advice regarding medical diagnosis or treatment for any individual case, and any opinions or statements contained in this document are not intended to serve as a standard of medical care. Physicians are encouraged to view the considerations presented in this document in light of evolving scientific information. This document is not intended for use by the layperson. Reproduction of this document may be done with proper credit given to California Department of Developmental Services.