OBJECTIVES: To determine: 1) if preterm children were referred, identified and received early intervention (EI)/ early childhood special education (ECSE) services at rates equivalent to term children after implementation of a universal, periodic Ages and Stages Questionnaire (ASQ) surveillance and screening system; 2) if pediatricians sufficiently lowered their screening thresholds with preterm children; and 3) if quality improvement opportunities exist.
PATIENT AND METHODS: Secondary analysis was performed on 64 lower-risk, mostly late-preterm and 1363 term children who originally presented to their 12- or 24-month well- visits. Higher-risk preemies already involved with an EI agency/ identified with a delay were excluded. Board-certified pediatricians (N = 18), and nurse practitioners (N = 2), blind to the ASQ results, were secondary participants. Differences between preterm and term developmental agency referrals were examined comparing Pediatric Developmental Impression to the ASQ under natural clinic conditions using a combined in-office or mail-back data collection protocol. Medical record and county EI/ECSE follow-up outcomes were conducted at 36 to 60 months.
RESULTS: At 12 and 24 months, preterm (versus term) referral rates were 9.5% (versus 5.6%) with Pediatric Developmental Impression and 26.2% (versus 8.1%) with the ASQ. By 36 to 60 months, 37.5% of preterm (20.8% term) children were referred to EI/ECSE; of which, 50.0% of preterm (42.4% term) children were eligible for services, 54.2% of preterm children were identified with a developmental-behavioral disorder and 29.2% of preterm (20.8% term) children did not follow-up. For ASQ-only preterm referrals, 55.6% were subsequently diagnosed with a developmental delay and/or disorder. Preterm children were ∼2 times more likely to be eligible than term children.
CONCLUSIONS: Combined referral, quality improvement and outcome data suggests that clinicians should lower their threshold for administering a psychometrically sound developmental screen when providing surveillance for ex-preemies. Quality improvement opportunities exist with diligent developmental surveillance and a more collaborative, standardized, reliable and interpersonal referral process.
Errors occurred in the abstract of this article by Marks et al (doi:10.1542/peds.2008-2051). The corresponding author edited the abstract so that the results section more clearly indicated that early intervention referral rates were originally evaluated at 12 and 24 months of age. Two to three years later, referral rates and developmental-behavioral outcomes were re-evaluated when the participants were 36 to 60 months of age. The abstract should have read:
- Copyright © 2011 by the American Academy of Pediatrics