The appropriate use of any standardized screening instrument requires skill and experience in testing as well as familiarity with the specific screening tool used. Despite national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. Limited availability and access to pediatric neurologists, development pediatricians and therapists in low-resource countries significantly delays identification of neuromotor impairments [2,3]. It is uncertain whether standardized screening as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities [4].

To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Colombia, 925 children attending primary health care facilities were studied [5]; rates between 12% and 29% were found. The range of mental disorders diagnosed was similar to that encountered in industrialized countries. The research procedure involved a two-stage screening in which a 10-item reporting questionnaire constituted the first stage. The study showed that mental disorders were common among children attending primary health care facilities in the four developing countries and that accompanying adults (usually the mothers) readily recognized and reported common psychologic and behavioral symptoms when these were solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only 10-22% of the patients with mental disorders. The results have been used to design appropriate short training courses in childhood mental disorders for primary health workers in these countries [5].

Unfortunately, traditional primary-care management of pediatric mental disorders is characterized by non-specific counseling, low-dose prescribing, and referrals to specialty settings that are often not completed. Even when a specific neuromotor diagnosis has not been established, children with motor delays benefit from educationally and medically based therapies, possible only when they are picked up early in the community [6].

The American Academy of Pediatrics recommends the use of valid and reliable developmental surveillance and screening instruments through formal protocols for all infants and children in the primary care setting because this practice has been shown to improve accuracy and increase the likelihood that developmental delays will be identified and referrals for services made in a timely fashion [7].

Need for a diagnostic tool for use by primary care physicians in the developing countries has been felt of late. It will considerably increase access to specific care and rehabilitation of children with neuromotor impairments. There is no validated, reliable and comprehensive tool for diagnosing and categorizing neuromotor impairments for children older than 2 years in resource-constrained environments. A national program for screening, diagnosis and treatment of neurodevelopmental disorders (NDD) within primary care settings has been included in the recently launched Rashtriya Bal Swasthya Karyakram (RBSK) in India [8].

In this issue of Indian Pediatrics, the INCLEN study group has reported development and validation of a diagnostic tool for neuromotor impairment which employs standardized and uniform diagnostic criteria for use in 2-9 year-old children [9]. The tool has three sections consisting of triage questions, observations and the operator conducted neurological examination. Meant to be used by graduate physicians after a structured short training in primary care setting, it has been developed by 55 experts, and the findings put up after applying on 454 children selected through systematic random sampling from Pediatric neurology speciality clinics of 3 tertiary centers in India. The candidate test had good sensitivity and specificity. The performance of this tool needs to be systematically evaluated in primary care settings of different geographic regions and general practice environment for its diagnostic capability. The tool is a simple, valuable aid, based on algorithmic approach for early diagnosis of neuromotor impairments in primary care settings, and for early institution of physiotherapy and referral to a specialist for detailed evaluation.

Funding: None; Competing interests: None stated.

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5. Giel R, de Arango MV, Climent CE, Harding TW, Ibrahim HH, Ladrido-Ignacio L, et al. Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative study on strategies for extending mental health care. Pediatrics. 1981;68:677-83.

6. Garey H. Noritz, Nancy A. Motor Delays: Early identification and evaluation. Pediatrics. 2013;131: e2016.

7. American Academy of Pediatrics Council on Children with Disabilities. Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics. 2006;118:405-20.

8. Ministry of Health and Family Welfare, Government of India. Operational Guidelines, Rashtriya Bal Swathya Karyakram (RBSK). Child Health Screening and Early Intervention Services Under NRHM. Available from: http://www.unicef.org/india/7._Rastriya_Bal_ Swaasthya_karyakaram.pdf. Accessed June 24, 2014.