We appreciate and thank Dr. Marks for the positive comments regarding the developmental surveillance and screening clinical report and algorithm.1 The recommended visits for administration of standardized developmental screening tools are meant to reflect a minimum standard for screening in early childhood and does not preclude a pediatrician’s performing such screening at other visits. The timing of screening was originally determined on the basis of expert consensus opinion from individuals representing groups from across primary and specialty care, Bright Futures, and the medical home. The recommendations were based on what was felt could feasibly be integrated into busy pediatric practices and still detect the maximum number of children with delays in development.2 Pediatricians are encouraged to individualize the number of screens administered at the frequency that works best for their practice and may include administering a developmental screen at 24 months in conjunction with an autism screen. On the basis of a review of the literature and consultation with the authors of the autism spectrum disorder clinical report,3 we maintained the recommendations for general developmental screening at 9, 18, and 30 months and autism screening at 18 and 24 months. We have continued our recommendation for general developmental screening at 30 months given the short interval past the 18-month visit that a 24-month visit would represent as well as the concern of missing children with milder developmental problems before the period of early intervention eligibility ends.
We agree that developmental screening at 4 to 5 years of age may be beneficial in detecting early learning and school readiness concerns, and we would not dissuade pediatricians from adding a screen at this age on the basis of best practice. Indeed, we recommend in the report that any child falling in an at-risk status or found to be at risk on surveillance should be screened. We share the concern that some children with developmental disorders may be missed in the earlier screenings or have later emergence of developmental problems. However, researchers have not uniformly evaluated the balance of benefits and harms (including cost and potential added burden) of screening asymptomatic children at this age, including whether screening leads to improved outcomes. As a result, on the basis of this concern and extensive discussion with reviewers of the clinical report, we are not recommending screening at this age. Instead, we strongly urge pediatricians to continue developmental surveillance at this and later ages, with screening when concerned, to identify previously unrecognized problems.
Developmental screening has been widely adopted into routine pediatric care, as evidenced by recent data revealing a tripling of screening rates, as reported by pediatricians.4 We look forward to this practice continuing so that young children with developmental problems receive early intervention for delays that are identified. We hope that further research will help to identify the optimal frequency and ages for screening and such early identification and treatment.
CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.