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Periodic Survey #53 Identification of Children <36 Months at Risk for Developmental Problems and Referral to Early Identification Programs

Periodic Survey of Fellows
American Academy of Pediatrics
Division of Health Policy Research
Executive Summary



This survey was initiated by the American Academy of Pediatrics' Project Advisory Committee-Medical Home Initiatives for Children with Special Needs (National Center) to explore pediatricians' experiences with identifying children <36 months at risk for developmental problems and their perceptions of, involvement with, and referrals to Early Intervention (EI) programs. This project was part of a collaborative effort between the Academy, the federal Maternal and Child Health Bureau (MCHB), the Department of Education Office of Special Education Programs (OSEP), and the OSEP-funded ChildFind. Funding for this survey was provided by the OSEP.


Periodic Survey #53 was an eight-page self-administered questionnaire sent to 1,617 active United States members of the AAP from May through September 2002. After an original and five follow-up mailings a total of 894 completed questionnaires were received for a response rate of 55.2%. Analyses are based on 649 pediatricians (73% of all respondents) who provide health supervision to children birth through 35 months of age and who assess for developmental risk. Developmental delay or problem was defined as including motor, language, cognitive, behavioral or emotional delay or problems. 

Identification of Children at Risk for Devleopmental Delay/Problem

  • Nearly all pediatricians (96%) who provide health supervision to children birth through 35 months of age assess for developmental risk.
  • Pediatricians estimate an average of 9% of their patients have been identified with a possible developmental problem through assessments/screens performed in their office.
Screening Methods:

Most pediatricians (75%) use more than one method to identify children birth through 35 months of age at risk for developmental delay or problems.

  • 7 out of 10 pediatricians always identify potential problems via clinical assessment without the use of a screening instrument or checklist and 15% sometimes do so.
  • One-third (34%) say their clinical assessment is always guided by the Denver; 40% say sometimes.
  • Most pediatricians use a checklist filled out by them or staff (34% always, 20% sometimes) but not checklists filled out by parents (62% never do so).
  • Overall, 50% of pediatricians say they always or sometimes conduct formal developmental screenings of infants in their practice. Specifically, 14% always and 26% sometimes use the Denver II screening instrument; 3% and 10%, respectively, use the Bayley neurodevelopmental screen; 7% and 6% use Ages & Stages; 2% and 6% use PEDS.
Primary Conditions for which Formal Screenings are Conducted:

  • Conditions with the highest likelihood of eliciting a formal screen include: parents concerned about a developmental delay (69% of pediatricians say they are very likely to conduct a formal screen), premature birth VLBW (65% very likely), known genetic syndrome (63% very likely), hearing or vision impairment (58%), premature birth LBW (55%), and traumatic birth/asphyxia (53%).

Primary Barriers to Screening:

  • The barrier to screening for developmental delay or problems most frequently named by pediatricians is the lack of time in their current practice (82%). Nearly half of pediatricians say lack of medical office staff to perform screenings is a barrier (48%), and 44% say inadequate reimbursement is a barrier. Other barriers were named by fewer than 20% of respondents.

II. Referrals for Early Intervention (EI)

  • Pediatricians estimate directly referring approximately 39% of their current patients identified with a possible developmental problem to their state's Early Intervention program.
Primary Conditions Referred:

  • 9 out of 10 pediatricians say they are very likely to refer children <36 months with global developmental delays to their state's EI program. About 8 out of 10 would refer children with loss of milestones and delayed speech. Three-fourths would refer to EI for sensory impairment and abnormal muscle-tone or delayed motor development.
Primary Barriers to Referrals:

  • Nearly half of pediatricians (46%) say a lack of understanding of the EI program's processes and procedures are barriers to referring children <36 months to the EI program and 45% agree lack of information about the EI program and its services are barriers. However, nearly 4 out of 10 pediatricians do not think that either of these are barriers.
  • Thirty-six percent of pediatricians think lack of feedback from the EI program about the child's progress/outcomes is a barrier. Fewer than 30% of pediatricians think the following are barriers: uncertainty about EI eligibility criteria, lack of time to deal with the EI program, failure to incorporate pediatricians' input into EI assessment and inconsistent quality of EI services.
  • A lack of available services and evidence of effectiveness were named as barriers in the decision to refer children to the EI program by only 20% and 10% of pediatricians, respectively.

III. Follow-Up to Early Intervention Referrals

Awareness of Information and Services Provided by State EI Programs:

  • 7 out of 10 pediatricians say their state's EI program provides them with assessment/evaluation results.

  • About half of pediatricians say their EI program notifies them upon receipt of referral (47%), informs them of reasons for enrollment decisions (53%), presents them with an Individualized Family Service Plan (IFSP) and progress reports on achievement of its goals (51%), and notifies them when the child is discharged from the EI program (46%).

IV. Educational Needs

  • Most pediatricians would like to know more about Early Intervention: 81% say they would like to receive additional information regarding their state's EI program, primarily via written materials (84%), CME from developmental specialists (65%), and in-service from state Early Intervention providers (56%).



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