The importance of early identification and intervention for children with developmental disorders has been widely adopted through the incorporation of developmental surveillance and screening into routine pediatric care. A new AAP clinical report provides pediatric clinicians with updated recommendations to expand this practice to promote the optimal development of every child.
The report, Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening, is available at https://doi.org/10.1542/peds.2019-3449 and will be published in the January issue of Pediatrics.
Following are changes in the clinical report from the Council on Children with Disabilities and the Section on Developmental and Behavioral Pediatrics.
Universal screening model
The new guidance aims for a unified vision of developmental screening, merging screening for general development, autism, motor delay and developmental disorders in high-risk medical conditions into a single algorithm for pediatric practice. This model is aligned with others, such as newborn metabolic, hearing, vision, and behavior and emotional screenings, for comprehensive early identification aimed at lifelong optimal development for every child with problems in these areas.
Pediatric clinicians are guided to continue developmental screening in their practices with a standardized screening tool at the 9-, 18- and 30-month well-child visits. The report provides a new clinical algorithm to guide the practitioner, as well as updated tables of acceptable tools for developmental, autism and behavioral screening in pediatric practice. Updated coding and billing guidance also is provided.
This longstanding pediatric practice of monitoring children’s development continuously at every well-child visit remains critical, with additional emphasis now at the 4- to 5-year well-child visit when early learning and/or attention problems may be recognized.
Many early childhood education and child care programs also are performing developmental screening. The practice of screening outside of the medical home necessitates communication between staff in the pediatric medical home and in early childhood programs regarding the child’s development and screening results. Families should be asked not only about the child’s milestones but also about screening or feedback of the child’s development from child care or preschool program professionals.
In addition, the increasing evidence of the impact of social determinants of health and adverse childhood experiences on a child’s development and behavior requires continuous monitoring of these factors at well-child visits.
The pediatric clinician continues to have the unique responsibility for initiating medical testing of children with identified developmental concerns. In accordance with other AAP guidance, a detailed physical and neurologic examination should be performed on the child with delayed development. When normal or low muscle tone is found, serum creatine kinase and thyroid function testing is recommended; when high tone is noted, neuroimaging may be indicated.
Genetic testing and referral to specialty pediatric care also should be considered in children suspected of having autism spectrum disorder, global developmental delay or intellectual disability.
Despite improved rates of developmental and autism screening over the last decade, referral rates of children with developmental concerns to medical and developmental professionals and for initiation of developmental intervention remain low. The new guidance reiterates the importance of such referrals to ensure the earliest treatment possible and initiation of critical educational, community and family supports.
This new clinical report re-emphasizes the importance of early identification and treatment, while maintaining the schedule for standardized screening of each child at well-child visits. It incorporates surveillance and screening for developmental delay, autism spectrum disorder, motor delay and high-risk conditions into a unified system of screening, while supporting increased collaboration with early childhood programs.
Practice time and costs associated with this guidance will not change and will ensure earlier diagnosis, intervention and treatment for children with developmental disorders to achieve optimal lifelong development.
Drs. Lipkin and Macias are lead authors of the clinical report. Dr. Lipkin is former chair of the Council on Children with Disabilities Executive Committee. Dr. Macias is former chair of the Section on Developmental and Behavioral Pediatrics Executive Committee.