American Academy of Pediatrics: Universal Screening Urged for Developmental Delays

The American Academy of Pediatrics (AAP) equips pediatricians with new clinical recommendations to screen young children for developmental delays, autism and behavioral problems in a newly published clinical report that updates 2006 recommendations.

“Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening,” encourages pediatricians to work closely with families and incorporate input from preschool educators and childcare providers into their patient evaluations. The report is published in the January 2020 Pediatrics (Dec. 16 online).

“Through comprehensive screenings, we hope to identify problem areas and missed milestones before a child turns 3,” said Paul H. Lipkin, MD, FAAP, lead author of the clinical report. “With continued surveillance, early learning and attention problems often become more apparent by age 4 or 5. The earlier we can address these problems, the better.”

The AAP describes children who are at higher risk of developmental or behavioral delays, based on their medical history or adverse experiences, such as poverty, effects of racism, abuse or neglect. The AAP Council on Children With Disabilities and the AAP Section on Developmental and Behavioral Pediatrics worked together to author the report, which calls for a unified system of screening. The report provides a new clinical algorithm to guide clinicians, as well as a table of developmental and behavioral screening tools that may be used in pediatric practice.

The AAP provides recommendations for the medical home, for policy and advocacy, and for research and development. They include:

• Physicians should perform developmental surveillance at every well child visit from early childhood through adolescence.
• Physicians should refer a child to early intervention or preschool special education as well as for complete developmental and medical evaluations when the child is determined to be at risk for a developmental disorder based on screening or surveillance.
• Standardized developmental screenings should be conducted at the 9-, 18-, and 30-month well-child visits. In addition, physicians should administer a screening for autism spectrum disorder during the 18- and 24-month health supervision visits.
• Medical providers should identify and address barriers to screening in the medical home -- such as payment, professional education and office workflow -- to achieve universal screening of all children during early childhood.
• Ongoing investigation into screening and referral rates should continue, with the goal of achieving universal screening of all children.
• More research should be conducted to increase the evidence base for effectiveness of developmental surveillance and screening tools.

“Research tells us that, as children grow older, problems with development or behavior may worsen in severity if they go undetected,” said Michelle M. Macias, MD, FAAP, coauthor of the AAP report.

“We encourage families to tell their doctor what they have noticed about their children’s milestones and behavior, as well as any concerns that other care providers have shared with them about their child. There are helpful therapies and sometimes medical treatments that can ease those symptoms considerably.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.