Developmental delays occur in 15% children under
five years of age [1]. Early recognition of developmental delay
facilitates the implementation of prevention and intervention programs
and results in improvement in cognitive, behavioral, academic and
adaptive functioning [2]. Hence, it is important that early
identification of delayed development be done using standardized
developmental tests, especially during the follow up of premature and
"high risk" infants.
The American Academy of Pediatrics (AAP) has
recommended a regular developmental assessment using standardized tools
at the ages of 9, 18, 30 months. But their surveys have shown that a
minority of pediatricians perform routine screening using standardized
tools. This may be due to several factors like inadequate time and
remuneration, conflicting reports on accuracy of available screening
tests. It has been estimated that only about half of the children with
developmental problems are detected before they join school [3]. Parents
are usually the first to pick up signs of possible developmental delay,
and any concern that the parents have about their child’s development
should always be taken seriously. On the other hand, the absence of
parental concern does not necessarily mean that all is well. Parents’
reports of current attainment of developmental tasks have been shown to
be accurate and reliable [4].
Developmental surveillance is defined as a flexible,
longitudinal, continuous process through which potential risk factors
for developmental and behavioral disorders can be identified [5-7]. In a
busy practice, obtaining parents’ reports of development is a good
‘first line screen’, and an efficient and effective way of selecting out
children who require a more detailed assessment and/or referral.
There are a variety of screening tests to choose
from, many of which are completed by parents and require only a short
period of time to administer and score. These questionnaire-based
screening forms are convenient, as there are no directly administered
test items and scoring requires only minimal training. For example, the
Parents’ Evaluation of Developmental Status (PEDS) is a parent interview
form that provides an algorithm to guide the need for referral, more
screening, or continued surveillance [8]. The Ages and Stages
Questionnaire (ASQ), is a parent completed questionnaire that may be
used as a general developmental screening tool, evaluating five
developmental domains: communication, gross motor, fine motor,
problem-solving, and personal adaptive skills, for children from the
ages of 4 to 60 months [9].
In this issue, Juneja, et al. [10] have
evaluated a Hindi translation of the Ages and Stages Questionnaire on
Indian infants. They confirmed their results by assessing the same
children by the Development Assessment Scales for Indian Infants
(DASII), which is considered the gold standard. They found a fairly high
sensitivity (83.3%) and good specificity (75.4%) at 18-24 months of age.
This test can be translated in other Indian languages and more studies
can be done to validate it even further. It can help in identifying
developmental delays in both the high risk and low risk children, who
can then be referred for more definitive diagnosis.
Considering the prevalence of developmental delays,
the primary care provider must be vigilant in identifying those children
who require further evaluation and referral. Early identification leads
to early treatment and ultimately improved long-term outcomes.
Competing interests: None stated
Funding: Nil
References
1. National Health and Medical Research Council.
Child health screening and surveillance: a critical review of the
evidence. Canberra: NHMRC, 2002.
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Developmental Behavioral Pediatrics; Bright Futures Steering Committee;
Medical Home Initiatives for Children with Special Needs Project
Advisory Committee. Identifying infants and young children with
developmental disorders in the medical home: an algorithm for
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