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ABSTRACT. Early identification of children with de- Screening is a “brief assessment procedure de-
velopmental delays is important in the primary care set- signed to identify children who should receive more
ting. The pediatrician is the best-informed professional intensive diagnosis or assessment.”3 Developmental
with whom many families have contact during the first 5 screening is aimed at identifying children who may
years of a child’s life. Parents look to the pediatrician to need more comprehensive evaluation. It communi-
be the expert not only on childhood illnesses but also on
development. Early intervention services for children
cates the pediatrician’s interest in the child’s devel-
from birth to 3 years of age and early childhood educa- opment, not just his or her physical health.4 Devel-
tion services for children 3 to 5 years of age are widely opmental evaluation may lead to a definitive
available for children with developmental delays or dis- diagnosis, development of an interdisciplinary com-
abilities in the United States. Developmental screening prehensive plan of remediation, realization that there
instruments have improved over the years, and instru- is no significant problem, or a decision that addi-
ments that are accurate and easy to use in an office tional observation is warranted.
setting are now available to the pediatrician. This state- The Individuals With Disabilities Education Act
ment provides recommendations for screening infants (IDEA) Amendments of 19975 mandate early identi-
and young children and intervening with families to fication of, and intervention for, developmental dis-
identify developmental delays and disabilities.
abilities through the development of community-
based systems. Because the passage of IDEA, the
ABBREVIATIONS. IDEA, Individuals With Disabilities Education emphasis of screening has shifted to identifying dis-
Act; CHAT, Checklist for Autism in Toddlers. abilities at a younger age, with the current focus
being on infants and children from birth through 2
BACKGROUND years of age. At this age, the pediatrician is involved
D
evelopmental and behavioral problems are very closely with children and families and is in a
commonly seen by pediatricians and other position to have significant impact on their function-
primary care practitioners. According to a ing. The IDEA requires physicians to refer children
recent estimate, 12% to 16% of American children with suspected developmental delays in a timely
have developmental or behavioral disorders.1 Iden- manner to the appropriate early intervention system.
tifying and addressing these concerns is of great The pediatrician has specific roles within the sys-
importance so that appropriate intervention can be tem that are described in a recent policy statement by
instituted. The primary care practitioner’s office is the Committee on Children With Disabilities.6 Chil-
the only place where most children younger than 5 dren and families are best served when pediatricians’
years are seen and is ideal for developmental and screening efforts are coordinated with tracking and
behavioral screening. intervention services available in the community.
Developmental surveillance is an important tech- Developmental surveillance and screening during
nique used by pediatricians. Dworkin defined devel- preventive health care visits also provide the ideal
opmental surveillance as “a flexible, continuous pro- opportunity for the pediatrician to offer anticipatory
cess whereby knowledgeable professionals perform guidance to the family about supporting their child’s
skilled observations of children during the provision development.
of health care. The components of developmental
surveillance include eliciting and attending to paren- STATEMENT OF THE PROBLEM
tal concerns, obtaining a relevant developmental his- The emphasis on earlier identification creates the
tory, making accurate and informative observations opportunity to provide the benefits of early interven-
of children, and sharing opinions and concerns with tion but also poses greater challenges in screening.
other relevant professionals.”2 Pediatricians often Parents expect their pediatricians to give them guid-
use age-appropriate developmental checklists to ance on developmental issues but will turn to other
record milestones during preventive care visits as community systems if the pediatrician does not fill
part of developmental surveillance. this role. Lack of appropriate physician guidance
may result in delays in diagnosis and appropriate
intervention. Detecting developmental delays early
The recommendations in this statement do not indicate an exclusive course is challenging. Delays or deviations in development
of treatment or serve as a standard of medical care. Variations, taking into
account individual circumstances, may be appropriate.
may come to the attention of professionals and par-
PEDIATRICS (ISSN 0031 4005). Copyright © 2001 by the American Acad- ents because a child is known to have risk factors by
emy of Pediatrics. history, has physical findings or medical conditions
Updated Information & including high resolution figures, can be found at:
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References This article cites 29 articles, 13 of which you can access for free at:
http://pediatrics.aappublications.org/content/108/1/192.full#ref-list-1
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following collection(s):
Developmental/Behavioral Pediatrics
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nt:behavioral_issues_sub
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Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2001 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/108/1/192
Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it
has been published continuously since . Pediatrics is owned, published, and trademarked by the
American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,
60007. Copyright © 2001 by the American Academy of Pediatrics. All rights reserved. Print ISSN:
.