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Trends in the Use of Standardized Tools for Developmental Screening in Early Childhood, 2002-2009

Linda Radecki, Karen G. O'Connor, Sanford Sharp, Nina Sand-Loud, Michael Silverstein,
Lynn M. Olson. American Academy of Pediatrics, Elk Grove Village, IL; Akron Children's Hospital, Akron, OH; Boston Medical Center, Boston, MA.

Presented at the May 2010 Pediatric Academic Societies Annual Meeting.
Background: A 2002 study of AAP Fellows found that <25% consistently utilized appropriate screening tools. Over the past 5 years, new Bright Futures guidelines and revised AAP policy have placed greater emphasis on developmental screening of infants and young children. Given this increased attention, has the use of standardized screening tools increased?
Objective: Compare pediatricians' use of standardized developmental screening tools from 2002-2009.
Design/Methods: National, random sample, mailed AAP Periodic Surveys (PS) #53, 2002 (N=1,617; response=55%) and #74, 2009 (N=1,620; response=57%). Surveys asked identical questions on use of developmental screening tools. Analysis was limited to those spending≥10% time in General Pediatrics (n=646 and n=628, respectively); Chi-square analysis compared responses across years.
Results: Self-reported use of standardized screening tools increased significantly from 2002-2009. The percentage of pediatricians who always/almost always use ≥1 screening tool increased over time, as did use of specific instruments (eg, Ages and Stages, PEDS, and MCHAT). Differences by physician characteristics revealed a greater percentage of physicians in group practices (compared to solo/two physician and hospital based practice) consistently using ≥1 formal screening tool in 2009 than 2002. No other differences were noted by physician/practice demographics.
Table 1 
2002 (PS#53)​ 2009 (PS#74)​ Significance​
​Always/almost always use ≥ 1 formal screening tool ​23.0% ​47.7% ​.000
​Commontly used tools

​Ages and Stages
​7.3% ​22.4% .000
​PEDS ​2.4% ​15.9% ​.000
​MCHAT ​- ​10.8% ​.000
​<formal o w assessment>                                     71.0% ​60.5% ​.000

Conclusions: The percentage of pediatricians who report using ≥1 formal screening tool more than doubled from 2002-2009, demonstrating significant increase following AAP policy changes. However, despite greater attention to consistent use of developmental screening through policy enhancements and new health supervision guidelines, the percentage remains less than half of all respondents providing care to patients <36 months of age. Because developmental screening is central to early identification, evaluation, and intervention, further research is needed to identify barriers to greater use of standardized tools in pediatric practice.
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