Authors’ Response: Re: My Concerns About the American Academy of Pediatrics Clinical Report on “Motor Delays: Early Identification and Evaluation”

We thank Drs Marks, Glascoe, and Squires for their thoughtful commentaries on our recently published clinical report, “Motor Delays: Early Identification and Evaluation.” We appreciate this opportunity to respond to their concerns.

First, we respect the expertise of Drs Glascoe and Squires as authors of the ASQ and PEDS and appreciate their openly disclosed conflicts of interest. However, their concerns and those of Dr Marks about the validity of currently available developmental screening tools to detect motor delays miss the major point of our report. Moreover, because less than half of US children are formally screened for developmental delays, screening alone is not the solution. Our overarching message to clinicians is that a combined clinical approach of developmental screening, coupled with systematic and skilled neuromotor examinations, is currently our best strategy to identify motor delays in children. Medical home providers can then use the combined results of screenings and examinations to proceed with high-yield diagnostic testing, prompt referrals to specialists and early intervention programs, care coordination, and chronic condition management as indicated. We agree with Dr Marks’s emphasis on the importance of care coordination in this process.

We stand by our recommendation that every child with normal or low muscle tone and suspected motor delays have creatine phosphokinase and thyroid stimulating hormone blood tests performed. The costs of these tests are minimal when compared with magnetic resonance imaging and genomic testing, which are of much higher cost and even lower yield.

Lastly, we agree on the need for the American Academy of Pediatrics to develop a single, practical algorithm that pediatricians can use for developmental screening and surveillance for infants and young children. In fact, the Council on Children with Disabilities is currently collaborating with the Section on Developmental and Behavioral Pediatrics to do this very thing, as the 2006 policy on Developmental Screening and Surveillance is being revised.