A new study finds that U.S. pediatricians have plenty of room for improvement when it comes to using a screening questionnaire to flag developmental delays in premature children.
The study was a collaboration between physicians at PeaceHealth Medical Group, led by pediatrician Dr. Kevin Marks, lead author, and co-author Professor Hollie Hix-Small, of Ryerson University’s School of Child and Youth Care, formerly of the Early Intervention Program at the University of Oregon. The study was published in the June issue of Pediatrics.
In the study, a group of 1,427 caregivers and children in the U.S. attending their 12- or 24-month well-child visits (regular screening for developmental delays by pediatricians) completed the Ages & Stages Questionnaire® (ASQ), a child development screening tool.
The study examined the number of lower-risk, pre-term (most who were born between 34 and 37 weeks gestational age) children versus the number of term children who were referred to an early-intervention agency. Higher-risk premature infants already involved with an early-intervention agency or previously identified with a delay were excluded.
The data shows the selected pre-term children were approximately two times more likely to be eligible for early intervention programs than term children, but that many of these children are being missed due to insufficient standardized screening at well-child visits. In addition, the study shows that an unacceptably high percentage of children who are identified as potentially delayed (and likely to benefit from early intervention), are not accessing services due to lack of follow-up between parents and early intervention programs.
“Pediatricians identify children with delays through a process of developmental surveillance and screening, which primarily occurs at well-child visits between zero to five years of life. This study indicates that pediatricians should provide more diligent surveillance and actively lower their thresholds for administering a quality (valid, reliable and feasible) screening tool like the Ages & Stages Questionnaire in preterm children,” says Dr. Kevin Marks.
Adds Hix-Small: “We need more research in Canada to find out how many physicians are using a high quality screen tool, such as the ASQ Questionnaire, and how children can benefit from this. Developmental screening is a very real, tangible and cost effective way to improve the quality of health care and child outcomes and should be considered a key element in well-child care.”
Without a screening tool, says Hix-Small, physicians fail to detect up to 60 to 80 per cent of children with developmental delays in a timely manner.
“This study highlights the increased importance of using standardized screening with pre-term children who are at an increased risk for developmental difficulties and have been shown to greatly benefit from early intervention services. Physicians are in an incredible position to identify delays and open up opportunities for parents to access early supports and services for their children.”
Hix-Small will hold a training session on the benefits of developmental screening for preterm children and their caregivers, such as the ASQ Questionnaire, with clinicians and practitioners at the Hospital for Sick Children’s Infant Mental Health Program in October.
- Kevin Marks, Hollie Hix-Small, Kathy Clark, and Judy Newman. Lowering Developmental Screening Thresholds and Raising Quality Improvement in Pre-term Children. Pediatrics, Vol. 123 No. 6 June 2009, pp. 1516-1523 DOI: 10.1542/10.1542/peds.2008-2051
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