Trends in Standardized Developmental Screening: Results from National Surveys of Pediatricians, 2002-2016

Paul H. Lipkin⁴, Briella Baer⁴, Michelle M. Macias⁵, Susan L. Hyman³, Susan E. Levy², Daniel Coury⁶, Audrey Wolfe⁷, Blake Sisk¹.

¹Research, American Academy of Pediatrics, Elk Grove Village, IL; ²Developmental Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; ³Pediatrics, University of Rochester, Rochester, NY; ⁴Medical Informatics, Kennedy Krieger Institute, Baltimore, MD; ⁵Pediatrics, Medical University of South Carolina, Charleston, SC; ⁶Nationwide Children's Hospital, Columbus, OH; ⁷Massachusetts General Hospital, Boston, MA.

Presented at the 2017 Pediatric Academic Societies Annual Meeting.

Background: Current guidelines of the American Academy of Pediatrics (AAP) recommend screening for developmental problems in children using formal standardized screening tools at ages 9, 18, and 30 months. Adoption of these guidelines into practice has been gradual, with prior research showing many children still not being screened. 

Objective: To examine trends from 2002-2016 and predictors in 2016 of formal developmental screening practices for children less than 36 months of age in the U.S.

Methods: The AAP Periodic Survey surveyed pediatricians on developmental screening practices in 2002 (n=538; response rate=55%), 2009 (n=509; 57%), and 2016 (n=469; 47%). The surveys were national random samples of U.S. members who provide primary care to children less than 36 months of age. The surveys asked about current screening practices, including the use and administration of standardized developmental screening tools. Chi- square tests assessed descriptive differences in screening practices over time and a multivariable logistic regression model was estimated to determine predictors of using a formal screening tool in 2016. Trainees were excluded.

Results: Pediatricians' reported use of one or more developmental screening tools increased from 23% in 2002, to 46% in 2009, and to 63% in 2016 (Figure). The reported use of the Ages and Stages Questionnaire and Parents' Evaluation of Developmental Status tools increased each survey year. Screenings shifted from being performed primarily by the pediatrician in 2002 (86%) to other staff (60%) in 2016 (p<.001). However, 87% of pediatricians reported that they alone review and interpret the screenings in 2016. Model results (using data from 2016 only) indicate that respondents in medical school/hospital practice settings are more likely than those in small practices to report use of a formal screening tool (AOR 2.97, 95% CI 1.27-6.96), while other respondent characteristics in the model were not statistically significant.

Conclusions: Pediatricians' reported use of a formal developmental screening tool has tripled since 2002 to 63% in 2016. Pediatricians increasingly rely on staff to administer the formal screening, but typically interpret the results themselves. Those in hospital or medical school settings show the highest rates of developmental screening, indicating that quality improvement efforts to further increase screening may best be targeted at group and small practice settings.