Transcript PRESENTATION NAME - Maine Quality Counts

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
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
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
Surveillance versus Screening
What’s the Difference?
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
Developmental Screening
”The administration of a brief
standardized tool aiding the
identification of children at risk of a
developmental disorder” (AAP Policy
Statement 2006)
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Brief
Standardized
Identification of risk
NOT DIAGNOSTIC
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
Developmental Screening
Instruments-Considerations
• Ease of administration
• Time to complete
• Time to score and interpret
• How accurate are they?
• Literacy level
Developmental Screening
Instruments
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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)
Developmental Screening
Instruments
Ages and Stages Questionnaire (ASQ-3)
• 30 Item Questionnaire divided into 5
domains:
Communication
Fine Motor
Social-Emotional
• Ages 1-66 months
sections or
Gross Motor
Problem Solving
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
10
5
0
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
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
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
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
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
Scoring Tool
The table below are the failed responses for the MCHAT. Critical Items are
in bold.
Scoring Tool
www.mchatscreen.com
M-CHAT_Scoring.xls
Comparison-PEDS vs ASQ
ASQ-3
Cost- $249.95
PEDS
Cost-$305.00
No Ongoing Costs
After 100 checklist-$15.00/50
Subjective/Objective
Subjective
Studied-18,000
Studied-771
Reading Level: 4th-6th Grade
Reading Level: 5th Grade
Comparison-PEDS vs ASQ
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 MM, Joyce DP
Source
Department of Psychology, British Columbia Children's Hospital, Vancouver, BC,
Canada. [email protected]
You want me to do what?
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
Developmental Screening
Resources
• www.medicalhomeinfo.org/screening
• www.developmentalscreening.org
• abcdresources.org
• www.dbpeds.org