Developmental Screening Fall 2012

7/31/2019 Developmental Screening Fall 2012

1/36

Developmental Screening

Slides adapted from the American Academy of Pediatrics and Ages and Stages


2/36

Objectives

Discuss the importance of developmentalscreening

Differentiate between surveillance and screening

Identify components of a good screeninginstrument

Define and discuss benefits of developmentalscreening

Describe features of the Ages and StagesQuestionnaire (ASQ)

Implement and score the ASQ


3/36

How common are developmental

disabilities?

17% of children have developmental

disabilities

Less than 50% are detected prior to school

entrance

EARLY DETECTION = EARLY INTERVENTION


4/36

Why is early detection of developmental

problems so critical?

Children involved in Early Intervention programs

are more likely:

To live independently

Graduate from high school

Save society $30,000-$100,000 per child


5/36

5

Preterm Births

United States, 1983-2003

Preterm is less than 37 completed weeks gestation.

Source: National Center for Health Statistics, 2003 final natality data. Prepared by March of Dimes Perinatal Data Center, 2006.

Percent

HealthyPeople

Objective28 Percent Increase


6/36

Preterm is less than 37 completed weeks gestation. Very preterm is less than 32 completed weeks

gestation. Moderately preterm is 32-36 completed weeks of gestation.

Source: National Center for Health Statistics, final natality data. Retrieved March 29, 2012, from

www.marchofdimes.com/peristats.

Preterm births

US, 1999-2009


7/36

All race categories exclude Hispanics. Preterm is less than 37 completed weeks gestation. Very

preterm is less than 32 completed weeks gestation. Moderately preterm is 32-36 completed weeks of

gestation.

Source: National Center for Health Statistics, final natality data. Retrieved March 29, 2012, fromwww.marchofdimes.com/peristats.

Preterm births by maternal race/ethnicity

US, 2009


8/36

An infant death occurs within the first year of life.

Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved March 29,

2012, from www.marchofdimes.com/peristats.

Infant mortality rates by maternal age

US, 2007


9/36

The key to early detection

of disabilities is quality

surveillance and screening


10/36

WHAT IS SURVEILLANCE VS. SCREENING?

Surveillance: Ongoing and systematic collection,

analysis, and interpretation of health data for

the purpose of planning, implementing, and

evaluating public health interventions.

Surveillance is a continuous process


11/36

What is surveillance involving

children?A flexible, continuous process, in which

knowledgeable professionals perform skilled

observations of children (in consultation w/families,specialists, child care providers, etc).

SM Dworkin, A Shannon, and P Dworkin. ChildServ Curriculum. Center for Childrens Health and Development, St Francis Hospital and Medical

Center; 1999; Hartford, CT.


12/36

Surveillance techniques:

LISTEN

Think

Talk


13/36

Components of Effective Surveillance

Elicit and/or attend to parents' concerns

Obtain a relevant history Skillful observation of the child

Share opinions with other professionals


14/36

What are some good open-ended

questions to ask parents about theirchilds development?


15/36

What is screening?

Screening identifies individuals withunrecognized health risk factors orasymptomatic disease conditions in

populations. Screening tools are used to enhance the

surveillance process.


16/36

CLEARLY

TYPICAL

CLEARLY

ATYPICAL?


17/36

Importance of Being Objective

TOUCH OR TAKE TEMP?

Clinical judgment detects fewer than 30% of children

with developmental disabilities


18/36

Benefits of Screening

Sorts children into 3 categories:

Needs additional evaluation - Did not pass

screening Needs closemonitoring- Passed screening

but has risk factors (e.g. premature infant)

Needs ongoing monitoring in the contextof well-child assessment - Passed screening

and has no known risk factors


19/36

Standards for Screening Tools

Standardized on a national sample

Proof ofreliability

ability of a measure to produce consistent results Evidence ofvalidity

ability of a measure to discriminate between a child

at a determined level of risk for delay (i.e. high,moderate) from the rest of the population (low risk)


20/36

Standards for Screening Tools

Accuracy in ability to categorize is measured

by:

Sensitivity: accuracy in identifying delayed

development. True positive proportion.

Specificity: accuracy in identifying individuals who

are not delayed or typically developing children.

For developmental screenings,Sensitivity and Specificity of 70-80% are

acceptable


21/36

Developmental Screening Instruments:

General 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)

Parents' Evaluation of Developmental Status (PEDS)


22/36


23/36

Prescreening Activities

Obtain consent from parent or caregiver and encourageparent to be involved. Check your agency for specific consent form, if required.

Explain purpose of screening to parents and review

questionnaire content. Make sure parents know that ascreening is not the same as a diagnosis.

Provide appropriate questionnaire (if child is premature,correct for prematurity).


24/36

ASQ Screens 5 Domains

Communication

Gross Motor

Fine MotorProblem solving

Personal-social

Overall sensitivity = 72%, specificity = 86%


25/36

Ages and Stages Questionnaire

(ASQ) 4 months to 6 years

19 color-coded questionnaire for use at 2, 4,6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33,36, 42, 48, 54, and 60 months

30 35 items per form describing skillsCompleted by nurse and parent during home visit,

preferred method. Can also be completed by parent alone.

Takes about 10-15 minutes, and 3 to score

Reading level of tool is 4-6th grade


26/36

Which ASQ to give?

Use a questionnaire that is within a 2 monthwindow of the childs age (or corrected age ifpremature)

If child is exactly in between, then give thelower interval and then follow up with thenext interval.

Questions are hierarchical, easy to difficult Questions are answered: Yes, Sometimes, Not

yet


27/36

ASQ Sample Items

1.When your child wantssomething, does she tell

you bypointing to it?

Yes Sometimes Not Yet

4. Does your child say

eight or more words in

addition to Mama and

Dada?

Yes Sometimes Not Yet


28/36

Scoring the ASQ

Step 1: Total the points in each area. yes= 10,

sometimes= 5, not yet= 0.

Step 2: Transfer the area totals to the informationsummary page. Fill in the matching circle in thespace provided.

Step 3: Read the answers to overall sectionquestions

carefully and respond appropriately.

Step 4: Any score falling near or into the shadedarea


29/36


30/36

Bell curve used to determine cutoff

point

Percentage of Population68%

13.5% 13.5%

2.5% 2.5%

ASQ cutoff

-2 SD +2 SD-1 SD +1 SD


31/36

Follow-up Criteria:

Well above cut-off points.

Provide follow up activities for developmentalpromotion

Continue to monitor (surveillance). Rescreen in 4-6 months. Close to cutoffs:

Provide follow up activities to practice specificskills.

Make community referrals as appropriate.

Re screen later, interval based on age


32/36

Referral Criteria for ASQ

Below cutoff in one or more areas:

Refer for developmental evaluation

Parent concern:

Respond to all concerns

Refer if necessary

Your own concern


33/36

Communication tips when there are

concerns:

Avoid terms such as test, passor fail.

Review the screening tool and explain area scores.

Emphasize child and family strengths.

Provide specific examples of concerns.

Use language that encourages follow-up

Avoid negative and meaningless words Be sensitive to cultural meanings of words

People-first language!


34/36

Early Intervention

Zero to three years - Early Start Program.

Services are provided through Regional Centers

(21 in state).

Emphasis is in the natural home setting

3 21 years Special Education

Individual Education Plan

Free and Appropriate Education (FAPE) in theLeast Restrictive Environment (LRE)


35/36

Special Education

3 to 21 years old

Anyone can request eval, but parent must

consent

Eval must be conducted in childs primary

language and in English

DC requires eval started within 90 days of request

(does not include summer or vacation) Repeat eval every 3 years


36/36

IMPORTANT RESOURCE

Learn the Signs. Act Early

http://www.cdc.gov/ncbddd/actearl

y/index.html

Developmental Screening Fall 2012

Documents

Transcript of Developmental Screening Fall 2012