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

1. National Health and Medical Research Council. Child health screening and surveillance: a critical review of the evidence. Canberra: NHMRC, 2002.

2. Council on Children with Disabilities; Section on 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 developmental surveillance and screening. Pediatrics. 2006;118:405-20.

3. Glascoe FP, Dworkin PH. The role of parents in the detection of developmental and behavioural problems. Pediatrics. 1993;95:829-36.

4. Glascoe FP. Parents’ concerns about children’s development: pre-screening technique or screening test? Pediatrics. 1997;99:522-8.

5. Kemper K, Kellerher K. Family psychosocial screening: instruments and techniques. Ambul Child Health. 1996;4:325-39.

6. Dworkin PH. Detection of behavioral, developmental and psychosocial problems in pediatricprimary care practice. Curr Opin Pediatr. 1993;5:531-6.

7. Dworkin PH. British and American recommendations for developmental monitoring: the role of surveillance. Pediatrics. 1989;84:1000-10.

8. Glascoe FP. Parents’ evaluations of developmental status: A method for detecting and addressing developmental and behavioral problems in children. Nashville: Ellsworth & Vandermeer Press LLC; 1997.

9. Squires J, Potter L, Bricker D. The ASQ User’s Guide. 2nd ed. Baltimore: Paul H Brookes Publishing Company; 1999.