PEDIATRICS Vol. 120 No. 2 August 2007, pp. 381-389 (doi:10.1542/peds.2006-3583)
ARTICLE |
Impact of Implementing Developmental Screening at 12 and 24 Months in a Pediatric Practice
a Early Intervention Program, Special Education Department, College of Education, University of Oregon, Eugene, Oregon
b Pediatrics Department, PeaceHealth Medical Group, Eugene, Oregon
c Developmental Pediatrics Department, Child Development and Rehabilitation Center, Eugene, Oregon
d Developmental Pediatrics Department, Oregon Health Sciences University, Portland, Oregon
 |
ABSTRACT |
|---|
 TOP ABSTRACT METHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
OBJECTIVES. The purpose of this study was to investigate the effectiveness and costs of incorporating a parent-completed developmental screening tool, the Ages and Stages Questionnaire, into the 12- and 24-month well-child visits under "real-world" conditions, using a combined in-office and mail-back data collection protocol.
METHODS. A convenience sample of 1428 caregivers and children presenting for their 12- or 24-month well-child visit between April 2005 and March 2006 participated. Children with identified delays or disorders were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2) acted as secondary participants. Pediatricians were blinded to Ages and Stages Questionnaire results when completing the Pediatric Developmental Impression. Patients with delayed Ages and Stages Questionnaire or Pediatric Developmental Impression results were referred for additional evaluation.
RESULTS. Referral rates increased by 224%. Pediatrician referral on the basis of the Pediatric Developmental Impression was predicted significantly by suspected communication delay and gross motor delay. The Ages and Stages Questionnaire and Pediatric Developmental Impression results differed significantly, with overall agreement of 81.8%. Of Ages and Stages Questionnaire–delayed cases, 67.5% were not detected by pediatricians. Of the 78 patients referred on the basis of combined Ages and Stages Questionnaire and Pediatric Developmental Impression results, 53 would not have been referred on the basis of Pediatric Developmental Impression results alone; 37 patients qualified for special services, and 44 were scheduled for additional developmental monitoring. The rate of Ages and Stages Questionnaire return by caregivers/parents was 54%.
CONCLUSIONS. Referral rates increased dramatically, with the greatest increase at 12 months. Although patients with pediatrician referrals were likely to qualify for services (96%), physician referrals accounted for only 42% of total referrals, which highlights the need for pediatric developmental screening. The 54% Ages and Stages Questionnaire return rate, although acceptable under study conditions, calls for alternative implementation strategies.
Key Words: Ages and Stages Questionnaire • developmental delay • developmental screening • developmental surveillance • early intervention • parent-completed screening
Abbreviations: ASQ—Ages and Stages Questionnaire • EI—early intervention • PDI—Pediatric Developmental Impression • IDEA—Individuals with Disabilities Education Act
One challenge in a busy office practice is how best to incorporate formal developmental screening, as recommended by the American Academy of Pediatrics.1,2 Early intervention (EI) has been shown to improve children's developmental outcomes.3–6 Recent data on premature infants with low birth weights (excluding infants with birth weights of <2000 g) provide the best evidence to date of the sustained positive effects of EI on long-term reading, mathematics, and behavioral outcomes.3
Developmental and behavioral problems are estimated to be present in 12% to 16% of US children.7–10 However, rates of children with delays receiving EI services are reported to be 
5% for 3- to 5-year-old children and 1.8% for children from birth through 2 years of age.10 Although rates increase with age, significant numbers of young children with disabilities are not identified until well into their school years.
Research suggests that pediatrician appraisal of a child's developmental status is often inaccurate without the use of a standardized developmental screening tool. It has been reported that pediatricians fail to identify and to refer 60% to 80% of children with developmental delays in a timely manner.11,12 These figures are not surprising, because well-child checks typically are scheduled for 15 to 30 minutes, an insufficient time for assessment of all domains of development in addition to administration of vaccines and discussion of other anticipatory guidance topics.
How can children with delays be identified systematically in the context of a busy pediatric practice? A variety of technically sound, parent-report, developmental screening tools for the early identification of delays are now available.2,13 One validated tool, the Ages and Stages Questionnaire (ASQ),14,15 shows promise for pediatric practice.7 Extensive research on the ASQ supports its validity and reliability across the 4-month to 5-year age span.8
We hypothesized that parent completion of the ASQ in the pediatric office or at home in conjunction with the 12- or 24-month well-child visit would increase referral and EI service eligibility rates. We also sought to learn more about which cases pediatricians were likely to refer when blinded to ASQ results. A "real-world," convenience-sample, study design was used, by keeping regular office constraints in place to evaluate implementation issues, including ASQ return rates, costs, training requirements, and medical personnel time allocation. The study was designed and performed before the July 2006 American Academy of Pediatrics recommendations on developmental surveillance and screening.1
|
METHODS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
Participants
Participants were 1428 parents or legal guardians of children arriving for their 12- or 24-month well-child visit between April 1, 2005, and March 1, 2006. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2) employed by a large, Pacific Northwest, medical group (PeaceHealth Medical Group) serving the children and their families acted as secondary participants. Children identified previously as having developmental delays/disorders were excluded. An accredited institutional review board approved the study procedures. Consent, including Health Insurance Portability and Accountability Act authorization, was obtained, and participants did not receive compensation. Study forms were available in English and Spanish, the primary participant languages. Measures included the ASQ,8,14–16 a family information form (demographic data), a pediatrician-completed, developmental impression sheet (Pediatric Developmental Impression [PDI]) developed for this study, and follow-up screening and assessment results from the county EI part C service provider.
ASQ
The ASQ is a parent-completed, child-development, screening test with 19 questionnaire intervals, ranging from 4 to 60 months, that are identical in format and organized into five 6-item domains (communication, gross motor, fine motor, problem-solving, and personal-social), for a total of 30 items. ASQ questions are written at the fourth- to sixth-grade reading level and can be administered as an interview for parents with low literacy levels. Parents indicate "yes," "sometimes," or "not yet" in response to each item. The ASQ requires 15 minutes to complete and 2 to 3 minutes to score. It has moderate to high sensitivity (0.70–0.90) and specificity (0.76–0.91) and excellent reliability (test-retest reliability: 0.95; inter-rater reliability: 0.95), with the 12- and 24-month intervals having the highest sensitivity and specificity in the first 24 months of life.8 The tool seems to work well with families lacking a high school education, Hispanic families, and families of children with psychosocial risk factors.17 Participating pediatricians reviewed several developmental screening tools and selected the ASQ before study implementation.
A multidisciplinary panel of specialists in neurology, child neurology, communication disorders, pediatrics, psychology, and psychiatry endorsed the ASQ as a recommended screening tool to assist in the early identification of autism and developmental disorders,18,19 and it has been recommended for pediatric practice13 and early childhood programs, including Head Start. The ASQ has been used for developmental monitoring in several large-scale, pediatric, research studies, including the Magpie Trials,20 and follow-up monitoring of premature infants21 and pediatric heart patients.22
Family Information Form
The family information form consisted of demographic questions that required parents to provide information about their age, level of education, ethnicity, and home language, in addition to their child's home language and ethnicity. Respondents could indicate that help was needed to complete the ASQ. A final question asked about Internet access. Insurance status was used as an income proxy.
PDI
At the end of the well-child visit, physicians documented their overall ratings of the child's developmental status, indicating typical, questionable, or delayed. If "questionable" or "delayed" was indicated, then pediatricians specified developmental areas of concern from the following options: communication, gross motor, fine motor, problem-solving, and personal-social (the 5 areas assessed with the ASQ). Physicians also indicated whether they would make a referral to the Individuals with Disabilities Education Act (IDEA) part C agency for additional eligibility evaluation. Practitioners were blinded to ASQ results when they completed the PDI. The PDI was created for this study.
EI Assessment Outcomes
Results of additional screening/evaluation (eligible for services, not eligible, ongoing monitoring, and referral source) were obtained for children referred to the local IDEA part C EI agency.
Data Collection Procedures and Analyses
Thirty minutes of initial training on ASQ administration and data collection procedures were provided to pediatric support staff members. Receptionists provided parents with study materials at check-in and instructed them to review and to complete the forms. The packet included an introductory letter, consent form, demographic questions, and ASQ, with a postage-paid return envelope. In the examination room, the nurse answered questions and collected completed forms. The nurse and pediatrician both relayed a simple message to caregivers, "The ASQ is a fun and very important part of this well-child visit. Please fill it out. If you don't have time, take it home and mail it in." The pediatrician filled out the PDI after the well-child visit, blinded to the ASQ results. A flowchart depicting the implemented ASQ screening process is shown in Fig 1.
|
Referral Criteria and Referral Rate Comparison
Pediatricians referred cases according to their usual care procedures. ASQ referral rules followed eligibility criteria set forth in the state where the study took place, that is, 2 SDs below the mean in 1 developmental area or 1.5 SDs below the mean in 2 areas. Recorded physician referrals from April 2003 to March 2004 were used for comparison. (Data for 2004–2005 could not be used because a pilot test of the ASQ system was conducted during that period.) Physicians remained constant (no changes) during the comparison and study years.
Physician Referral Probability and ASQ Return
The 
2 test, the t test, and backward-elimination logistic models were used to determine the probability of physician referral and differences in no-return cases. For the no-return analysis, 13 demographic variables were tested and evaluated with an adjusted Bonferroni P value.
PDI-ASQ Agreement
Only cases with PDI and ASQ results were analyzed (n = 699). PDI categories of questionable and delayed were collapsed, to capture all cases of physician concern even if a referral was not made; ASQ questionable and delayed categories were also collapsed. A 2 test was used to examine the relative distribution frequency of the PDI and ASQ developmental categories.
Screening, Evaluation Criteria, and Eligibility Outcomes
After receiving the referral, part C EI service providers conducted customary intake screening over the telephone with the parent. Additional information, including parent medical concerns, psychosocial issues, risk factors, and clarification or readministration of ASQ items, was collected. Children were placed in 1 of 3 categories, that is, (1) eligible for evaluation, (2) ongoing monitoring, or (3) not eligible for services. Subjects who were determined to be not eligible under the state's part C eligibility guidelines were screened out, with no planned future contact.23 Subjects who had low test scores but were unlikely to meet eligibility criteria were placed on an "ongoing monitoring" list, with repeat ASQ testing over the telephone by the part C agency 2 to 6 months later. ASQ and part C agency agreement was examined with cross-tabulation using a 2-SD ASQ cutoff value for delayed classification, as advised in the ASQ technical report. The 2 test could not be used because of small cell size.
|
RESULTS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
Patient Characteristics
The 12-month sample consisted of approximately equal male (49.9%) and female (50.1%) proportions; the 24-month sample included slightly more male subjects (53.0%) than female subjects (47.0%). For the combined sample, white children constituted the largest ethnic group (72.2%). Hispanic/Latino children made up the second largest ethnic group, with 7.7% Spanish-first and 5.9% English-first language groups. Patient characteristics are summarized in Table 1.
|
Parent/Guardian Characteristics
Parents/guardians presenting at the appointment were predominantly female (88.9%), with mothers most often acting as the study respondent (86.9%), followed by fathers (10.8%), foster parents (1.2%), and grandparents (1.1%). The mean respondent age was 29.69 years, with 88.7% self-reported as high school or higher education graduates. Parents were 77.1% white, 10.3% Hispanic/Latino, Spanish-first, and 4.5% Hispanic/Latino, English-first. Insurance status, collected as a proxy for income, was recorded as self-pay, Oregon Health Plan, or commercial insurance. During the study, the Oregon Health Plan provided Medicaid coverage to Oregon families with incomes at or below 133% (families with children <6 years of age) and 185% (families with children <19 years of age) of the federal poverty level, with income cutoff values being dependent on the number of family members. Thirty-nine percent of patients received coverage under the Oregon Health Plan. Internet use was assessed by asking parents the following question: "Do you log on and use the Internet by yourself, without help, either at work or at home?" Although the current study did not use an Internet-based system, the participating medical group (PeaceHealth) was interested in assessing the practicality of moving toward an electronic system. Results showed that 81.7% accessed and used the Internet. Parent/guardian characteristics are presented in Table 2.
|
Nonresponse bias was assessed by testing participant characteristic differences listed in Table 3. Notable significant differences existed for just 2 of the 13 tested demographic factors, that is, younger parents and lower-income participants (Medicaid). A Bonferroni-adjusted P value was used to control for multiple tests and associated spurious findings attributable to chance.
|
Practitioner Characteristics
Of the 18 pediatricians, 44.4% were female and 99.6% had been practicing for
5 years (mean years in practice: 18.67; SD: 11.53). Almost one half were in full-time practice (44.5%), with 5.6% employed less than half time.
Office Feasibility
Office feasibility pertained primarily to implementing a low-cost screening system that did not disrupt office flow. Total itemized costs ranged from $1.61 to $2.43 per patient. Cost variability included in-office or mail-back ASQ completion and practitioner follow-up time. The needed time per patient was <30 seconds for the receptionist to explain the process, <30 seconds for the practitioner and nurse to give instructions, and 3 to 4 minutes for resource office staff members to enter ASQ results into the electronic medical charts, complete referrals, and score the ASQ. Approximately 3% of participants requested assistance with completing the ASQ (72% Hispanic/Latino and 67% Medicaid). Although the system required training of both receptionists and nursing staff members for specific tasks, this training was minimal (30 minutes).
Referral Rates
Referral rates increased by 224% from the control year to the screening year (from 33 to 107 patients), with physicians referring 45 of 107 patients on the basis of their clinical impression alone. Of those patients, 78% were 24 months of age and 73% were male. Patient volume for children in the 0- to 2-year age group was tracked, to determine whether changes in total patient volume were correlated with observed changes in referral rates. A 14.65% decrease in patient volume between the comparison year and the screening year was found, whereas no pediatrician or clinical nurse practitioner changes occurred between the comparison and screening periods. The greatest referral increase was for 12-month-old patients (Fig 2). Physician focus on normative development might have increased as a result of study participation; otherwise, there were no historical cohort reasons for referral increase. Total pediatrician referrals without the ASQ during the screening year were slightly higher at 12 months (from 5 to 7 referrals) and lower at 24 months (from 28 to 23 referrals), compared with the control/comparison year.
|
The probability of pediatrician referral was significantly elevated for children with physician-suspected communication delay (odds ratio: 136.50; 95% confidence interval: 45.83–406.52) and gross motor delay (odds ratio: 58.80; 95% confidence interval: 9.48–364.69). An adjusted Bonferroni P value was used to control for chance findings (10 variables were entered into the model). Did physicians "miss" or use a "wait and see" approach with likely delayed children who went on to receive EI services? Thirty-eight percent of 12-month cases and 23% of 24-month cases were missed (considered typical by doctors and eligible for services or monitoring by the part C agency). Thirteen percent of 12-month-old patients and 16% of 24-month-old patients were not referred when doctors indicated questionable or delayed development on the PDI. In summary, compared with wait and see delays, there were 3 times as many missed delays at 12 months and 1.43 times as many missed delays at 24 months, which resulted in more missed delays than wait and see delays at both times but a greater percentage of missed delays at the 12-month visit.
EI Assessment Algorithm
For the 107 combined pediatrician and ASQ referrals, 81 unique cases were identified, with 38 referred cases (36%) meeting strict state IDEA eligibility requirements for part C special education services; 44 (41%) were scheduled for future screening because of suspect development that may lead to future eligibility. Twenty-five referred cases (23%) did not qualify for additional follow-up assessment (Fig 3).
|
By using the part C agency evaluation results as "true" developmental status, 25 cases were screened out, 44 patients were placed on an on-going monitoring list, and 38 patients were placed in services. Of those who were found to be not eligible, 67% had a delay in only 1 developmental area. All except 1 of the 12-month-old patients qualified in >1 domain, as well as communication. Ninety-six percent of 24-month-old patients qualified in >1 domain, as well as communication. Eligible female subjects made up 43% of 12-month-old subjects and 32% of 24-month-old subjects.
PDI and ASQ Agreement
Of the 699 patients with ASQ and PDI data, pediatricians indicated that 89.4% (n = 625) were developing typically, 6.7% (n = 47) had questionable development, and 3.9% (n = 27) had delayed development. The ASQ indicated that 78.4% (n = 548) were developing typically, 6.0% (n = 42) had questionable development, and 15.6% (n = 109) had delayed development. Seven cases were considered typical by the ASQ and delayed by the physician, with suspected communication delays indicated in all 7 cases, but a referral for additional EI evaluation made for only 1 child.
Because of small cell sizes (n < 5) in the 2 analysis, PDI and ASQ cases with questionable and delayed ratings were combined; results are presented in Table 4. A significant difference between ASQ and pediatrician developmental impressions was found, with overall agreement at 81.8%. Of ASQ delayed cases, 67.5% (n = 102) were not detected by pediatricians (considered typical). Conversely, 25 cases (33.8%) were of concern to physicians but the ASQ results did not indicate delayed development.
|
|
DISCUSSION |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
This study's focus was to investigate the impact of implementing a paper-based, parent-completed, developmental screening system in a busy office practice at the 12- and 24-month well-child visits. This in-office or at-home ASQ screening system took little time (<30 seconds) away from the nurse and pediatrician during the limited minutes of the well-child check. The system was low cost, at $1.61 to $2.43 per patient. Only 3.4% of parents requested help to complete the ASQ, with overrepresentation of Spanish-speaking, low-income participants. Referral rates in this practice increased 224% between the comparison and screening years, despite the 14.65% decline in patient volume. The increase in referrals at both 12 and 24 months, with a more-notable increase for the 12-month-old group, suggests that physicians may have greater difficulty identifying younger, potentially delayed children and children with questionable developmental status or may prefer to use a wait and see approach.
Thirty-eight (36%) of the 107 referred patients qualified for special education services, 44 (41%) required closer observation, and 25 (23%) did not qualify. With pediatrician referral for suspected delay, almost all patients (96%) received some services after part C agency evaluation. Use of the ASQ more than doubled, from the comparison year to the study year, the number of children who were identified with delays and later became eligible for EI services (from 42 to 89 patients). Although 23% of the children (n = 25) did not qualify for services immediately, the state's stringent eligibility requirements might be the reason. We know that long-term follow-up monitoring may result in eligibility of these children for services at a later time because of increased demands in the school environment, as well as broader IDEA eligibility guidelines beginning at 3 years.24 In addition, children and families that did not immediately qualify for part C services received needed resources that might improve child outcomes, such as referral for in-depth audiologic examinations and referral to day care settings with low child/adult ratios.
A disadvantage of this paper-based system was the 54% return rate. Nonresponse might be explained in part through the theory of social exchange25 in relation to participant-perceived study elements such as trust, costs, and benefits associated with participation. It is likely that some caregivers had no developmental concerns or simply were not interested in filling out the ASQ. It is also possible that other caregivers did not return the ASQ because of limited literacy. Although the moderate return rates could have led to selection bias, demographic analyses showed no statistically significant differences for the majority of demographic items (11 of 13 items) between those who did and did not return the ASQ. Notable statistically significant differences were present, however, for Medicaid (Oregon Health Plan) (P < .000) and younger parents (P < .003). Although the 54% ASQ return rate was slightly below the 60% mean response rate for surveys published in medical journals,26 we considered it acceptable under "real-world" conditions. ASQ screening could increase caregiver concern about a potential delay. For this study, parental anxiety before and after screening was not a measured variable.
|
CONCLUSIONS |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
This study concurred with a previous study that reliance on clinical impressions or developmental milestone review alone leads to significantly fewer children receiving developmental services.11 Interestingly, when pediatrician appraisal using the PDI indicated abnormal findings, the child almost always qualified for EI services; pediatricians should trust their impressions but should realize their observational limitations, because 37 of the total of 82 EI-eligible or monitored children would have been missed on the basis of doctor impression alone (no ASQ). A larger PDI-ASQ discrepancy, a more-notable increase in referrals, and more missed delays were observed at 12 months, which suggests a more-dramatic impact with ASQ screening at this visit. Implementing this screening system fostered a more-collaborative partnership between this local pediatric practice and the part C agency. The system was found to be feasible and low cost and did not impede office flow. However, quality improvement opportunities exist to overcome real-world obstacles by increasing return rates and designing a process that corrects for prematurity easily.
What is the future direction of developmental screening in the office setting? Because the waiting room did not seem to be an ideal environment for parents to complete the ASQ thoughtfully with their children, we devised a system of "do it in the office or mail it from home." As an alternative, an Internet-based ASQ version will soon be developed in multiple languages. An electronic system should reduce photocopying expenses, paper, and office staff time devoted to processing and scoring questionnaires. With an electronic system, it should be easier to correct for prematurity and to administer the ASQ for the correct age interval when performing surveillance and screening, as recommended by the American Academy of Pediatrics.1
Caregivers eventually should be able to complete the ASQ in their home before the office visit or at a kiosk in a quiet corner of the waiting room. Results would be scored automatically by the computer and handed to the doctor by office staff members at the beginning of the well-child check, for discussion. Internet-based systems could have additional advantages, such as the use of embedded video clips to illustrate targeted skills and voice synthesis capabilities to read questionnaires in the available language translations for those with limited reading ability. Periodic use of standardized screening tests, coupled with powerful Internet-based and video capabilities, should improve early identification of developmental delays in young children.
|
ACKNOWLEDGMENTS |
|---|
We thank Sandy Campbell, Kathy Clark, and Kimberly Murphy for careful data tracking and management; Judy Newman and Elizabeth Twombly for assistance with training and collaboration; Dr Igor Gladstone for valuable input and foresight; and all of the young children and their participating parents who made this study possible.
|
FOOTNOTES |
|---|
Accepted Mar 16, 2007.
Address correspondence to Hollie Hix-Small, PhD, Early Intervention Program, 5253 University of Oregon, 901 E 18th St, Suite 100, Eugene, OR 97403–5253. E-mail: hhixsmal{at}uoregon.edu
Financial Disclosure: Drs Squires and Nickel are ASQ authors and receive publication royalties.
Drs Hix-Small and Marks are coauthors.
|
REFERENCES |
|---|
|
TOPABSTRACTMETHODSRESULTSDISCUSSIONCONCLUSIONSREFERENCES |
|---|
1. American Academy of Pediatrics, Council on Children with Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening. Pediatrics. 2006;118 :405 –420
2. American Academy of Pediatrics, Committee on Children with Disabilities. Developmental surveillance and screening of infants and young children.
Pediatrics. 2001;108
:192
–196
3. McCormick MC, Brooks-Gunn J, Buka SL, et al. Infant health and development program at 18 years of age.
Pediatrics. 2006;117
:771
–786
4. Shonkoff JP. From neurons to neighborhoods: old and new challenges for developmental and behavioral pediatrics. J Dev Behav Pediatr. 2003;24 :70 –76[Web of Science][Medline]
5. Guralnick MJ. Effectiveness of early intervention for vulnerable children: a developmental perspective. Am J Ment Retard. 1998;102 :319 –345[CrossRef][Web of Science][Medline]
6. Ramey CT, Landesman Ramey S. Effective early intervention. Ment Retard. 1992;30 :337 –345[Web of Science][Medline]
7. Hamilton S. Screening for developmental delay: reliable, easy-to-use tools: win-win solutions for children at risk and busy practitioners. J Fam Pract. 2006;55 :415 –422[Web of Science][Medline]
8. Squires J, Bricker D, Potter L. Ages and Stages Questionnaires User's Guide. 2nd ed. Baltimore, MD: Paul Brookes Publishing; 1999
9. Boyle CA, Decoufle P, Yeargin-Allsopp M. Prevalence and health impact of developmental disabilities in US children.
Pediatrics. 1994;93
:399
–403
10. Bailey DB, Hebbeler K, Scarborough A, Spiker D, Mallik S. First experiences with early intervention: a national perspective.
Pediatrics. 2004;113
:887
–896
11. Halfon N, Regalado M, Sareen H, et al. Assessing development in the pediatric office.
Pediatrics. 2004;113
:1965
–1972
12. Sand N, Silverstein M, Glascoe FP, Tonniges T, Gupta B, O'Connor K. Pediatricians' reported practices regarding developmental screening: are guidelines used? Do they help? Presented at: annual meetng of the Pediatric Academic Societies; May 1–4, 2004; San Francisco, CA
13. Glascoe FP. Standards for screening test construction. Available at: www.dbpeds.org/articles/detail.cfm?TextID=%2029. Accessed June 1, 2007
14. Bricker D, Squires J. Ages and Stages Questionnaires: A Parent-Completed, Child-Monitoring System (ASQ). Baltimore, MD: Brookes Publishing; 1995
15. Bricker D, Squires J. Ages and Stages Questionnaires: A Parent-Completed Child-Monitoring System. 2nd ed. Baltimore, MD: Brookes Publishing; 1999
16. Squires J, Potter L, Bricker D. ASQ User's Guide. Baltimore, MD: Brookes Publishing; 1995
17. Squires J, Potter L, Bricker D, Lamorey S. Parent-completed developmental questionnaires: effectiveness with low and middle income parents. Early Child Res Q. 1998;13 :345 –354[CrossRef][Web of Science]
18. Filipek P, Accardo P, Baranek G, et al. The screening and diagnosis of autistic spectrum disorders. J Autism Dev Dis. 1999;29 :439 –484[CrossRef]
19. Filipek PA, Accardo P, Ashwal S, et al. Practice parameter: screening and diagnosis of autism: a report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society.
Neurology. 2000;55
:468
–479
20. Tucker M. MgSO4 does not raise disability risk in children: follow-up study of Magpie Trial participants also shows no increased risk of death. OB/GYN News. December 15, 2004. Available at: http://findarticles.com/p/articles/mi_m0CYD/is_24_39/ai_n8697291. Accessed June 1, 2007
21. Skellern C, Rogers Y, O'Calliaghan M. A parent-completed developmental questionnaires: follow up of ex-premature infants. J Paediatr Child Health. 2001;37 :125 –129[CrossRef][Web of Science][Medline]
22. Williams DL, Gelijns AC, Moskowitz AJ, et al. Hypoplastic left heart syndrome: valuing the survival.
J Thorac Cardiovasc Surg. 2000;119
:720
–731
23. Shackelford J. State and Jurisdictional Eligibility Definitions for Infants and Toddlers With Disabilities Under IDEA. Chapel Hill, NC: University of North Carolina, FPG Child Development Institute, National Early Childhood Technical Assistance Center; 2006
24. Glascoe FP. Are overreferrals on developmental screening tests really a problem? Pediatr Adolesc Med. 2001;155 :54 –65
25. Emerson R. Power-dependence relations. Am Soc Rev. 1962;27 :31 –41[CrossRef]
26. Asch DA, Jedrziewski MK, Christakis NA. Response rates to mail surveys published in medical journals. J Clin Epidemiol. 1997;50 :1129 –1136[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  S. H. Jee, M. Szilagyi, C. Ovenshire, A. Norton, A.-M. Conn, A. Blumkin, and P. G. Szilagyi Improved Detection of Developmental Delays Among Young Children in Foster Care Pediatrics, February 1, 2010; 125(2): 282 - 289. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. King, S. D. Tandon, M. M. Macias, J. A. Healy, P. M. Duncan, N. L. Swigonski, S. M. Skipper, and P. H. Lipkin Implementing Developmental Screening and Referrals: Lessons Learned From a National Project Pediatrics, February 1, 2010; 125(2): 350 - 360. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sices, T. Stancin, H. L. Kirchner, and H. Bauchner PEDS and ASQ Developmental Screening Tests May Not Identify the Same Children Pediatrics, October 1, 2009; 124(4): e640 - e647. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. E. Jensen, K. S. Chan, J. P. Weiner, J. B. Fowles, and S. M. Neale Implementing Electronic Health Record-Based Quality Measures for Developmental Screening Pediatrics, October 1, 2009; 124(4): e648 - e654. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Marks, H. Hix-Small, K. Clark, and J. Newman Lowering Developmental Screening Thresholds and Raising Quality Improvement for Preterm Children Pediatrics, June 1, 2009; 123(6): 1516 - 1523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schonwald, N. Huntington, E. Chan, W. Risko, and C. Bridgemohan Routine Developmental Screening Implemented in Urban Primary Care Settings: More Evidence of Feasibility and Effectiveness Pediatrics, February 1, 2009; 123(2): 660 - 668. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Sices, D. Drotar, A. Keilman, H. L. Kirchner, D. Roberts, and T. Stancin Communication About Child Development During Well-Child Visits: Impact of Parents' Evaluation of Developmental Status Screener With or Without an Informational Video Pediatrics, November 1, 2008; 122(5): e1091 - e1099. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Drotar, T. Stancin, P. H. Dworkin, L. Sices, and S. Wood Selecting Developmental Surveillance and Screening Tools Pediatr. Rev., October 1, 2008; 29(10): e52 - e58. [Full Text] [PDF]
|
|
|
|
 |
|
 K. B. Brothers, F. P. Glascoe, and N. S. Robertshaw PEDS: Developmental Milestones--An Accurate Brief Tool for Surveillance and Screening Clinical Pediatrics, April 1, 2008; 47(3): 271 - 279. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Kemp Developmental screening tool picks up delays AAP News, November 1, 2007; 28(11): 2 - 2. [Full Text] [PDF]
|
|
|
|
|
|
K. Marks Should General Pediatricians Not Select the Ages & Stages Questionnaire in Light of the Rydz et al Study? Pediatrics, August 1, 2007; 120(2): 457 - 458. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
