ABSTRACT
Presented at the Pediatric Academic Societies annual meeting, May 2004
Pediatricians’
Reported Practices Regarding Developmental Screening: Are guidelines used?
Do they help?
N Sand 1, M Silverstein 2, FP Glascoe 3, T Tonniges 4, B Gupta 5 and K O’Connor 4. (Sponsored by Colin M Sox)1, The Children’s Hospital, Boston, MA; 2, University of Washington, Seattle, WA; 3, Vanderbilt University, Nashville, TN; 4, American Academy of Pediatrics, Elk Grove, IL and 5, New York University, New York, NY.
Background: Clinical judgment and other nonstandardized screening techniques detect <30% of children with developmental disabilities. In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children be screened for developmental delay at health supervision visits, and recommended the use of valid, reliable screening tools.
Objective: (1) Describe the use of developmental screening techniques among board-certified pediatricians practicing health supervision; (2) determine the association between standardized screening and the identification of children with developmental difficulties.
Design/Methods: National random sample, mailed Periodic Survey of 1626 AAP members, 2002. Pediatricians who practiced health supervision and spent >10% of their time in general pediatrics were included in the analysis. We used multivariable logistic regression to determine the association between standardized screening and self-reported identification of children with developmental disability. Because of the estimated prevalence of children with development problems in the general pediatric population, we chose a 10% cut-off to constitute a ‘high’ identification rate.
Results: Response rate=55%; 646 subjects analyzed. 71% of the study cohort indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delay. 23% reported using a standardized screening instrument. The most commonly used instrument was the Denver II (14%). Those who used standardized methods were more likely to see a high proportion of Medicaid recipients (60% vs. 48%; p<0.05) than those using nonstandardized methods. They also were more likely to report a high identification rate of children with developmental problems (26% vs. 15%; p<0.05). In a multivariable logistic regression, those using standardized measures were more likely to report identifying a high proportion of patients with developmental problems (adjusted odds ratio 1.71; 95% CI 0.96, 3.07).
Conclusions: Despite the AAP’s policy and national efforts to improve developmental screening in the clinical setting, few pediatricians use standardized techniques to screen for developmental problems. Standardized screening is associated with modestly enhanced self-reported identification of children with developmental disabilities.