Pediatricians’ reported practices regarding developmental screening: do guidelines work? Do they help?
Abstract
Background. In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties. Objectives. To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties. Methods. We mailed a survey to a random sample of AAP members. We used multivariate logistic/linearregression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities. Results. Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a >10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates. Conclusions. Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities.
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Comparison of Griffiths-II and Bayley-II tests for the developmental assessment of high-risk infants
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Diagnóstico precoce de anormalidades no desenvolvimento em prematuros: instrumentos de avaliação
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Carroll, K. N., Arbogast, P. G., Dudley, J. A., & Cooper, W. O. (2008) · PEDIATRICS · doi:10.1542/peds.2007-3252 · Cited by 52 · see citing works
Baduel, S., Guillon, Q., Afzali, M. H., Foudon, N., Kruck, J., & Rogé, B. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-016-2950-y · Cited by 49 · see citing works
Glascoe, F. P., Macias, M. M., Wegner, L. M., & Robertshaw, N. S. (2007) · Clinical Pediatrics · doi:10.1177/0009922807303928 · Cited by 49 · see citing works
Self-citationAssessing outcomes in paediatric trauma populations
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Worldwide national intervention of developmental screening programs in infant and early childhood
Kim, S. (2021) · Korean Journal of Pediatrics · doi:10.3345/cep.2021.00248 · Cited by 48 · see citing works
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Comparative study of the cognitive sequelae of school-aged victims of Shaken Baby Syndrome
Stipanicic, A., Nolin, P., Fortin, G., & Gobeil, M.-F. (2008) · Child Abuse & Neglect · doi:10.1016/j.chiabu.2007.07.008 · Cited by 44 · see citing works
Ocular Manifestations of Child Abuse
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“However, 83 % of pediatricians report time limitations as a barrier to conducting standardized behavioral, emotional, and developmental screenings for young children (Sand et al. 2005).”
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“Despite AAP recommendations, screening rates for ASDs in pediatric practices remain low (DosReis et al., 2006; Radecki et al., 2011; Sand et al., 2005).”
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“Moreover, prior research suggests that health and mental health providers in community settings typically rely on their clinical skill rather than standardized tools to conduct developmental and mental health screening, even when formal guidelines and standardized methods are available (Romer & McIntosh, 2005; Sand et…”
BackgroundMethodLanguage development and affecting factors in 3- to 6-year-old children
Muluk, N. B., Bayoğlu, B., & Anlar, B. (2013) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-013-2567-0 · Cited by 40 · see citing works
“Because trained specialists are needed for detailed language assessment in young children, screening tools and even questionnaires are frequently used in routine practice [12].”
BackgroundMissed, Misused, or Mismanaged
Macy, M. G., Marks, K., & Towle, A. L. (2014) · Topics in Early Childhood Special Education · doi:10.1177/0271121414525997 · Cited by 40 · see citing works
Developmental screening: is there enough time?
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Infants and Toddlers Left Behind
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Low adherence to national guidelines for thyroid screening in Down syndrome
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Neuroprotective effects of MK-801 against traumatic brain injury in immature rats
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Autism and Pervasive Developmental Disorders
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Neurodevelopmental Screening in Toddlers and Early Preschoolers With Sickle Cell Disease
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Early Childhood Screening Practices and Barriers: A National Survey of Primary Care Pediatricians
Coker, T. R., Gottschlich, E. A., Burr, W. H., & Lipkin, P. H. (2024) · PEDIATRICS · doi:10.1542/peds.2023-065552 · Cited by 37 · see citing works
Barker, L. A., Andrade, J., Morton, N., Romanowski, C. A. J., & Bowles, D. (2010) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2010.05.001 · Cited by 35 · see citing works
Language Development Survey Provides a Useful Screening Tool for Language Delay in Preterm Infants
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Engaging Pediatricians in Developmental Screening: The Effectiveness of Academic Detailing
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“…average age of identification of autism in children has been shown to vary from 3.1 years (Mandell et al. 2005) to 5.7 years, (Shattuck et al. 2009) and for other developmental delays, reports show (Sand et al. 2005) that only 20–30% of children with delays are identified before entering school.”
BackgroundInfluentialScreening Practices of Family Physicians and Pediatricians in 2 Southern States
Gillis, J. L. (2009) · Infants & Young Children · doi:10.1097/iyc.0b013e3181bc4e21 · Cited by 35 · see citing works
“Earlier reports (Sand et al., 2005; Sices, Feudtner, McLaughlin, Drotar, & Williams, 2003) identified similar reasons for failure to screen (ie, most pediatricians do not consistently use developmental screening tools, given the time constraints).”
BackgroundMethodResultInfluentialDevelopmental disabilities across the world: A scientometric review from 1936 to 2020
Carollo, A., Bonassi, A., Lim, M., Gabrieli, G., Setoh, P., Dimitriou, D., Aryadoust, V., & Esposito, G. (2021) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2021.104031 · Cited by 35 · see citing works
The “Cough Trick:” A Brief Strategy to Manage Pediatric Pain From Immunization Injections
Wallace, D. P., Allen, K. D., Lacroix, A. E., & Pitner, S. L. (2010) · PEDIATRICS · doi:10.1542/peds.2009-0539 · Cited by 34 · see citing works
Thomas, S. A., Cotton, W. H., Pan, X. J., & Ratliff-Schaub, K. L. (2011) · Clinical Pediatrics · doi:10.1177/0009922811420711 · Cited by 34 · see citing works
- Authors
- Sand, N., Silverstein, M., Glascoe, F. P., Gupta, V. B., Tonniges, T. P., & O'Connor, K. G.
- Affiliations
- Akron Children's Hospital (US)
- Boston University (US)
- Dr. Glascoe is an independent consultant in Nashville, TN
- New York Medical College (US)
- Department of Community Pediatrics
- Division of Health Policy Research, American Academy of Pediatrics, Elk Grove Village, Illinois
- ORCID
- Silverstein, Michael
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2005-07-01
- Volume
- 116
- Issue
- 1
- Pages
- 174-179
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2121239228
- Cited by
- 344
- References
- 31
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 7 · 2023: 12 · 2022: 10 · 2021: 9 · 2020: 10 · 2019: 42 · 2018: 12 · 2017: 15 · 2016: 19 · 2015: 21 · 2014: 20 · 2013: 12 · 2012: 25
- FWCI
- 41.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Developmental and Educational Neuropsychology
- Keywords
- developmental screening, developmental delay, American Academy of Pediatrics policy, Denver II, clinical evaluation, developmental disabilities, guideline adherence, primary care, infants and young children
- MeSH terms
- Developmental Disabilities, Child, Preschool, Data Collection, Humans, Infant, Pediatrics, Practice Patterns, Physicians', Practice Guidelines as Topic, Guideline Adherence
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