Developmental Surveillance and Screening in Primary Care: A New AAP Policy Statement

Martin T. Stein, MD

Journal Watch. 2007;5(11) 

Summary

The AAP recently published a new policy statement on the early identification of infants and young children with developmental disorders in primary care practice. The 2001 recommendations were updated because an AAP survey revealed that only 23% of pediatricians routinely use standardized, developmental screening tests during well-child visits. The new policy statement provides a practice algorithm for developmental surveillance and screening.

Developmental surveillance is recommended for all well-child visits. Surveillance is defined as a flexible, longitudinal, and continuous process that includes eliciting and attending to parents' concerns, maintaining a developmental history, making accurate and informed observations, identifying the presence of risk and protective factors, and documenting the process and findings.

Standardized screening is recommended at least three times during the first 3 years of life to ensure early recognition and referral of young children with developmental delay. A standardized developmental screening test should be administered at the 9-, 18-, and 30-month (or 24-month) visits. School-readiness screening before entry into preschool or kindergarten is also recommended. In addition to the practice algorithm, the policy statement includes a table of Current Procedural Terminology (CPT) codes for developmental screening and a description of specific tests that meet psychometric criteria for developmental screening in primary care for generalized development, language and cognitive development, motor development, and autism. However, the statement does not recommend specific tests.

Comment

This policy statement represents a major step forward in ensuring comprehensive monitoring of development in young children. Many studies indicate that standardized developmental tests improve detection and referral rates among pediatricians. The big questions are how often and when to screen. Although there is no established evidence base for the specific ages when screening is recommended, the schedule seems logical because it represents ages when domains of developmental achievement can be accurately assessed: gross and fine motor skills and early social skills at 9 months; early language and social skills at 18 months (when signs of autistic spectrum disorder might be detected); and expressive and receptive language at 30 months (including the 15% to 20% of "late-talking" toddlers who might not start talking until 30 months). Some screening tests take less than 5 minutes, and some can be completed by parents before or while waiting for an office visit. One cautionary note: Standardized screening tests should not substitute for open-ended questions and careful listening to parents and children at each clinical encounter.

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