Using developmental and behavioral screening tests

Missed opportunities in surveillance and screening systems to detect developmental delay: A developing country perspective

The future of human societies depends on children being able to achieve their optimal physical and psychological development. Developmental delay is failure to acquire age-appropriate functionality. It may involve one or more streams of development. Responsive parenting has potential to promote better development. Primary health physicians are in the best arrangement to provide this assistance as they can monitor child's development longitudinally and understand the child's developmental trajectory better. Current strategy employed by majority of primary-care providers to monitor the trajectory is termed 'developmental surveillance'. It is "a flexible, continuous process whereby knowledgeable professionals perform skilled observations of children during the provision of health care". Age-appropriate developmental checklists are also used to record milestones as part of surveillance. Both, the American Academy of Pediatrics and the British Joint Working Party on Child Health Services, recommend developmental surveillance by physicians as a method of identification of developmental delays. Developmental screening, however, improves the accuracy of identifying children with delay, compared with surveillance. Primary health physicians should consider using developmental screening tools that are standardized, reliable, valid and practical in the office setting, be familiar with screening techniques which should be incorporated into ongoing care, and keep abreast of current literature. Pakistan, as a developing country, needs specific strategies to ensure that we seize all the chances to detect this delay at an earlier age and introduce intervention, in order to lessen the burden of the disability on child, family and society.

Developmental screening

An estimated 5 to 10% of the pediatric population has a developmental disability. The current strategy to identify these children is through developmental surveillance, a continuous procedure in which the health professional observes the infant, takes a developmental history, and elicits any concerns that the caregiver might have. However, identification of delayed children is ineffective when based solely on routine surveillance. A necessary adjunct is developmental screening: the process of systematically identifying children with suspected delay who need further assessment. Screening tests greatly improve the rate of identification. With the advent of intervention programs and the support of organizations such as the American Academy of Pediatrics, the topic of developmental screening is a timely and essential one. This review aims to describe the properties of screening tests, to evaluate the available tools for developmental screening while providing a representative sample of the currently available developmental tests, and, finally, to evaluate the efficacy of intervention programs, a needed prerequisite to justify screening.