1. Developmental and Autism Screening Tools: What are they ? Donald R. Burgess, MD, FAAP SMMC Developmental Pediatrics First Steps Conference Improving Developmental and Autism Screening Friday, May 11, 2012

2. Why Developmental Screening ? AAP Policy Statement: July 2006 Identifying Infants and Young Children with Developmental Disorders in the Medical Home : An Algorithm for Developmental Surveillance and Screening Need for Early Identification of Children with Developmental Disabilities including Autism

3. Surveillance and Screening Guidelines Perform developmental surveillance at every well-child visit Perform developmental screening using a standardized screening tool at 9, 18, and 30* months or when concern is expressed If screening results are concerning, refer to developmental and medical evaluations and early intervention services Follow up on referrals made and continually track child’s developmental status *If the 30 month visit is not implemented, the 24 month visit may be used

4. Surveillance versus Screening What’s the Difference?

5. Developmental Surveillance “A flexible, longitudinal, continuous, and cumulative process whereby knowledgeable health care professionals identify children who may have developmental problems” (AAP Policy Statement 2006) Longitudinal Continuous Cumulative

6. Developmental Screening ”The administration of a brief standardized tool aiding the identification of children at risk of a developmental disorder” (AAP Policy Statement 2006) Brief Standardized Identification of risk NOT DIAGNOSTIC

7. Developmental Evaluation “Aimed at identifying the specific developmental disorder or disorders affecting the child ” (AAP Policy Statement 2006) Synonym: Developmental Assessment Completed in children who do not pass developmental screening Coupled with medical evaluation Diagnostic

9. Developmental Screening Instruments-Considerations Ease of administration Time to complete Time to score and interpret How accurate are they? Literacy level

10. Developmental Screening Instruments Ages and Stages Questionnaire Battelle Developmental Inventory (BDI) Screening Test Bayley Infant Neurodevelopmental Screener (BINS) Brigance Screens-II Infant Development Inventory Child Development Review Child Development Inventory (CDI) Denver-II Developmental Screening Test Parents' Evaluation of Developmental Status (PEDS) Modified Checklist for Autism in Toddlers (MCHAT)

11. Developmental Screening Instruments Ages and Stages Questionnaire (ASQ-3) 30 Item Questionnaire divided into 5 sections or domains: CommunicationGross Motor Fine MotorProblem Solving Social-Emotional Ages 1-66 months

12. Developmental Screening Instruments Ages and Stages Questionnaire (ASQ-3) Sensitivity/Specificity 80/83% for DD Administration: 10-15 minutes Scoring: 5 minutes Cutoff Score: Pass/Fail/Borderline

15. 10 5 0

22. Developmental Screening Instruments Parent’s Evaluation of Developmental Status (PEDS) 10-item Parent Questionnaire assessing their concerns Administration Time Parent Report: 2 minutes Scoring: 5 minutes

23. Developmental Screening Instruments Parent’s Evaluation of Developmental Status (PEDS) 2 or more concerns are the cutoff-Sorts into Low, Mod, High Risk for Developmental Disability Sensitivity/specificity 76/75% for DD 3 months-8 years

27. Developmental Screening Principles When the results are normal: – Inform the parents and continue with other aspects of the preventive visit – Provide an opportunity to focus on developmental promotion When administered due to concerns: – Schedule early return visit for additional surveillance, even if the screening tool results do not indicate a risk of delay When results are concerning: – Schedule developmental evaluations – Schedule medical evaluations

28. Developmental Screening Instruments Modified Checklist for Autism in Toddlers (MCHAT) Part 1-23 yes-no questions 95% sensitive/50% specific Part 2- in depth questions >90% specificity Measures Social reciprocity Language Some motor 16m to 3y Detects ASD, Language Impairment, MR

29. Developmental Screening Instruments Modified Checklist for Autism in Toddlers (MCHAT) Part I (Parent Completed) Failed score- 2 or more critical items or any 3 total items Public Domain/AAP “Autism Toolkit” 5 - 10 minutes to complete Part II (Follow Up Interview) Schedule a separate visit, follow the indicated algorithm

32. Scoring Tool The table below are the failed responses for the MCHAT. Critical Items are in bold.

33. Scoring Tool www.mchatscreen.com M-CHAT_Scoring.xls

34. Comparison-PEDS vs ASQ ASQ-3 Cost- $249.95 No Ongoing Costs Subjective/Objective Studied-18,000 Reading Level: 4 th -6 th Grade PEDS Cost-$305.00 After 100 checklist-$15.00/50 Subjective Studied-771 Reading Level: 5 th Grade

35. Comparison-PEDS vs ASQ J Dev Behav Pediatr.J Dev Behav Pediatr. 2011 Sep;32(7):499-511. Comparison of the ASQ and PEDS in screening for developmental delay in children presenting for primary care. Limbos MMLimbos MM, Joyce DPJoyce DP Source Department of Psychology, British Columbia Children's Hospital, Vancouver, BC, Canada. mlimbos@cw.bc.ca

37. You want me to do what?

39. Developmental Screening SMMC Pediatrics-Positives Great talking point for discussing development More children have come back for follow-up before their next WCC More children have been referred for developmental evaluations Additional screening has been done on children at risk or with issues on developmental surveillance

44. Developmental Screening Resources www.medicalhomeinfo.org/screening www.developmentalscreening.org abcdresources.org www.dbpeds.org