Developmental and Autism Screening Tools: What are they ?

Donald R. Burgess, MD, FAAPSMMC Developmental Pediatrics

First Steps ConferenceImproving Developmental and

Autism ScreeningFriday, May 11, 2012

Why Developmental Screening ?

• AAP Policy Statement: July 2006Identifying Infants and Young Children with Developmental Disorders in the Medical Home : An Algorithm for Developmental Surveillance and Screening

• Need for Early Identification of Children with Developmental Disabilities including Autism

Surveillance and Screening Guidelines• Perform developmental surveillance at every

well-child visit• Perform developmental screening using a

standardized screening tool at 9, 18, and 30* months or when concern is expressed

• If screening results are concerning, refer to developmental and medical evaluations and early intervention services

• Follow up on referrals made and continually track child’s developmental status

• *If the 30 month visit is not implemented, the 24 month visit may be used

Surveillance versus Screening

What’s the Difference?

Developmental Surveillance

“A flexible, longitudinal, continuous, and cumulative process whereby knowledgeable health care professionals identify children who may have developmental problems” (AAP Policy Statement 2006)

• Longitudinal• Continuous• Cumulative

Developmental Screening

”The administration of a brief standardized tool aiding the identification of children at risk of a developmental disorder” (AAP Policy Statement 2006)

• Brief• Standardized• Identification of risk• NOT DIAGNOSTIC

Developmental Evaluation “Aimed at identifying the specific developmental disorder or disorders affecting the child ” (AAP Policy Statement 2006)

• Synonym: Developmental Assessment• Completed in children who do not pass

developmental screening• Coupled with medical evaluation• Diagnostic

Developmental Screening Instruments-Considerations

• Ease of administration• Time to complete

• Time to score and interpret• How accurate are they?

• Literacy level

Developmental Screening Instruments

• Ages and Stages Questionnaire• Battelle Developmental Inventory (BDI) Screening Test• Bayley Infant Neurodevelopmental Screener (BINS)• Brigance Screens-II• Infant Development Inventory• Child Development Review• Child Development Inventory (CDI)• Denver-II Developmental Screening Test• Parents' Evaluation of Developmental Status (PEDS)• Modified Checklist for Autism in Toddlers (MCHAT)

Developmental Screening Instruments

Ages and Stages Questionnaire (ASQ-3)

• 30 Item Questionnaire divided into 5 sections or domains:

Communication Gross MotorFine Motor Problem SolvingSocial-Emotional

• Ages 1-66 months

Developmental Screening Instruments

Ages and Stages Questionnaire (ASQ-3)

Sensitivity/Specificity 80/83% for DDAdministration: 10-15 minutesScoring: 5 minutesCutoff Score: Pass/Fail/Borderline

10 5 0

Developmental Screening Instruments

Parent’s Evaluation of Developmental Status (PEDS)

• 10-item Parent Questionnaire assessing their concerns

• Administration Time

Parent Report: 2 minutes

Scoring: 5 minutes

Developmental Screening Instruments

Parent’s Evaluation of Developmental Status (PEDS)

• 2 or more concerns are the cutoff-Sorts into Low, Mod, High

Risk for Developmental Disability

• Sensitivity/specificity 76/75% for DD

• 3 months-8 years

Developmental Screening Principles

• When the results are normal:– Inform the parents and continue with other aspects of the

preventive visit– Provide an opportunity to focus on developmental

promotion

• When administered due to concerns:– Schedule early return visit for additional surveillance, even

if the screening tool results do not indicate a risk of delay

• When results are concerning:– Schedule developmental evaluations– Schedule medical evaluations

Developmental Screening Instruments

Modified Checklist for Autism in Toddlers (MCHAT)• Part 1-23 yes-no questions 95% sensitive/50% specific

• Part 2- in depth questions >90% specificity

• Measures

• Social reciprocity

• Language

• Some motor

• 16m to 3y

• Detects ASD, Language Impairment, MR

Developmental Screening Instruments

Modified Checklist for Autism in Toddlers (MCHAT)Part I (Parent Completed)

• Failed score- 2 or more critical items or any 3 total items

• Public Domain/AAP “Autism Toolkit”

• 5 - 10 minutes to complete

Part II (Follow Up Interview)• Schedule a separate visit, follow the indicated algorithm

Scoring Tool

The table below are the failed responses for the MCHAT. Critical Items are in bold.

Scoring Tool

www.mchatscreen.com

M-CHAT_Scoring.xls

Comparison-PEDS vs ASQ

ASQ-3Cost- $249.95

No Ongoing Costs

Subjective/Objective

Studied-18,000

Reading Level: 4th-6th Grade

PEDSCost-$305.00

After 100 checklist-$15.00/50

Subjective

Studied-771

Reading Level: 5th Grade

Comparison-PEDS vs ASQ

J Dev Behav Pediatr. 2011 Sep;32(7):499-511.Comparison of the ASQ and PEDS in screening for developmental delay in children presenting for primary care.Limbos MM, Joyce DP

SourceDepartment of Psychology, British Columbia Children's Hospital, Vancouver, BC, Canada. mlimbos@cw.bc.ca

You want me to do what?

Developmental Screening SMMC Pediatrics-Positives

• Great talking point for discussing development• More children have come back for follow-up

before their next WCC• More children have been referred for

developmental evaluations• Additional screening has been done on

children at risk or with issues on developmental surveillance

Developmental Screening Resources

• www.medicalhomeinfo.org/screening

• www.developmentalscreening.org

• abcdresources.org

• www.dbpeds.org