Developmental and Social-Emotional Screening Module
Section 2: Background Information
What is screening? Why is screening performed?
The American Academy of Pediatrics (AAP) defines developmental screening as the administration of a brief standardized tool which aids in the identification of children who are at risk of a developmental delay. (AAP, 2006) Developmental disorders include conditions beginning in childhood which “[manifest] as physical, psychological, cognitive, or speech impairments.” (Boyle, et al, 1994)
The AAP recommends that “developmental screening tests should be administered regularly at the 9-, 18-, and /30-month visits” and states that the medical home is the ideal setting for developmental screening to take place. (AAP, 2006) The AAP states that since “the 30-month visit is not yet a part of the preventive care system…developmental screening can be performed at 24 months of age.” (AAP, 2006) According to a recent estimate, 17% of children in the United States have had a developmental delay at some point in their lives, while 12% to 16% of children are currently living with a developmental or behavioral delay. (Boyle, et al, 1994)
Consequences of not identifying developmental delays early:
- Children with developmental problems often “[have] lower self-esteem, more depression and anxiety, more problems with learning, missed more school, and were less involved in sports and other community activities.” (Blanchard, et al, 2006)
- Clinical impressions alone often lead to missed delays, and currently 60% to 80% of children with developmental delays are not identified in a timely manner. (Hix-Small, et al, 2007)
Social-emotional screening is designed to identify children who may have or are at risk of social-emotional and behavioral delays. “An estimated 10% to 15% of 1- and 2-year-old children experience significant social-emotional problems” while “fewer than 8% of 1- and 2-year-olds with social-emotional/behavioral problems received any developmental or mental health services.” (Briggs-Gowan, et al, 2004) General societal stigma associated with child mental health is an added barrier to focusing adequate attention on young children’s mental health. (Carter, et al, 2004)
Currently, the social-emotional domain embedded within developmental screening instruments does not demonstrate adequate reliability and validity to determine if a child needs further assessment. Therefore, separate instruments are designed to identify children who are at risk of social-emotional delays. Social-emotional screening is recommended in addition to developmental screening.
It is imperative that developmental and social-emotional screening be performed on all children. The implementation of developmental screening in practice settings has been shown to increase referral rates to early intervention services. (Hix-Small, et al, 2007) Studies also indicate that early intervention programs during the preschool years are more successful than later interventions. (Knudsen, et al, 2006)
What is the difference between screening and surveillance?
While developmental screening refers to the use of standardized tools and should require only 30 minutes or less for administration, developmental surveillance refers to a longitudinal and cumulative process. (Meisels, Atkins-Burnett, 2005, and AAP, 2006) Developmental surveillance is a flexible, longitudinal, continuous, cumulative process. (Drotar, et al, 2008)
Developmental surveillance is performed at well-baby and well-child checks with the primary care provider and includes the following components regarding the health and developmental history of the child:
- Documenting and maintaining the child’s developmental history.
- Making accurate and informed observations of the child’s development.
- Identifying the presence of risk and protective factors for developmental delay.
- Documenting the process of ongoing developmental surveillance and screening activities. (Drotar, et al, 2008)
Referral Information - Interagency Early Intervention Committees
In Minnesota, the Interagency Early Intervention Committees (IEICs) are the designated body for coordinating early intervention services for children with disabilities, such as developmental delays, under the Individuals with Disabilities Education Act (IDEA). The IEICs have responsibilities to assure the development of Individual Family Service Plans (IFSPs); to coordinate, provide, and pay for appropriate services; and to facilitate payment from public and private sources. Minnesota has 95 operating IEICs in 87 counties.
Additional information can be found on the IDEA website.
1. At which ages does the American Academy of Pediatrics recommend developmental screening?
2. The same instruments used for the purposes of developmental screening are also used to identify children at risk of social-emotional delays.
3. What percentages of children with developmental delays are identified in a timely manner?
American Academy of Pediatrics, Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, and Medical Home Initiatives for Children With Special Needs Project Advisory Committee. (2006). Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics. Vol. 118(1):405-20.
Blanchard LT, Gurka MJ, Blackman JA. (2006). Emotional, Developmental, and Behavioral Health of American Children and Their Families: A Report From the 2003 National Survey of Children's Health. Pediatrics. Vol. 117:e1202-e1212.
Boyle CA, Decoufle P, Yeargin-Allsopp M. (1994). Prevalence and Health Impact of Developmental Disabilities in US Children. Pediatrics. Vol. 93(3):399-403.
Briggs-Gowan MJ, Carter AS, Irwin JR, Wachtel K, Cicchetti DV. (2004). The Brief Infant-Toddler Social and Emotional Assessment: Screening for Social-Emotional Problems and Delays in Competence. Journal of Pediatrics Psychology. Vol. 29(2):143-55.
Carter AS, Briggs-Gowan MJ, Davis NO. (2004). Assessment of young children's social-emotional development and psychopathology: recent advances and recommendations for practice. Journal of Child Psychology and Psychiatry. Vol. 45(1):109-34.
Drotar D, Stancin T, Dworkin P. Pediatric Developmental Screening: Understanding and Selecting Screening Instruments, Part I: Defining Your Practice's Screening Needs. The Commonwealth Fund. Published February 26, 2008. (Accessed May 22, 2008)
Hix-Small H, Marks K, Squires J, Nickel R. (2007). Impact of Implementing Developmental Screening at 12 and 24 Months in a Pediatric Practice. Pediatrics. Vol. 120:381-9.
Knudsen EI, Heckman JJ, Cameron JL, Shonkoff JP. (2006). Economic, neurobiological, and behavioral perspectives on building America's future workforce. PNAS. Vol. 103(27):10155-62.