Evidence-based Early Detection of Developmental-behavioral Problems in Primary Care
What to Expect and How to Do It
Frances Page Glascoe, PhD, J Pediatr Health Care. 2015;29(1):46-53.
PEDS Online offers developmental-behavioral/mental health and autism screens with automated scoring, report writing, and a mineable database. Problematic screening results were found in more than 1 out of 5 children, and rates of screening test failures increased with children’s ages. Children screened outside the well-child visit schedule were more likely to have screening test failures. Personnel at 22 of the 79 clinics were either interviewed or observed in person to identify implementation strategies. Clinics, even those serving families with limited education or lack of facility with English, found a variety of ways to make use of online screening services.
The American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners (NAPNAP) have created a number of policy and position statements regarding early detection of developmental-behavioral difficulties, autism spectrum disorders, mental health problems, and motor impairments (American Academy of Pediatrics, 2006, American Academy of Pediatrics, 2009, American Academy of Pediatrics Task Force on Mental Health, 2010, High, 2008, Myers and Johnson, 2007, National Association of Pediatric Nurse Practitioners, 2009, National Association, 2011, National, 2013a, National, 2013b, Noritz and Murphy, 2013). The rationale, thoroughly grounded in evidence, is that early detection leads to early intervention, and through early intervention, children’s outcomes and families’ well-being are vastly improved (Anderson et al., 2003, Campbell et al., 2002, Farran, 2005, Muennig et al., 2009, Reynolds et al., 2011, Reynolds et al., 2011, Schweinhart et al., 2005).
In the United States, one in six children have developmental-behavioral problems, including deficits or disorders in language, motor, or pre-academic/academic skills; deficits in intelligence; mental health/behavioral/social-emotional problems; or autism spectrum disorders (Baio, 2008, Boyle et al., 2011). One in four to one in five children have either mild delays or psychosocial risk factors predictive of future difficulties (e.g., housing instability, parental depression, limited parental education, poverty, and parenting behaviors that fail to promote children’s language and academic skills). Psychosocial risk factors are strong predictors of present and future developmental and mental health problems (Simon, Pastor, Avila, & Blumberg, 2013). The majority of these children who are not treated in early childhood experience school failure, drop out before completing high school, are less likely to be employed as adults, are more likely to become teen parents, incur high health care costs, and engage in criminal behavior (Simon et al., 2013, Stevens, 2006). If the problems are identified and treated early through services such as Head Start, parent training, or the Individuals with Disabilities Education Act, outcomes are vastly improved. Research on cost savings to society show that for every $1 spent on early intervention, taxpayers save up to $17 (Anderson et al., 2003, Campbell et al., 2002, Farran, 2005, Muennig et al., 2009, Reynolds et al., 2011, Reynolds et al., 2011, Schweinhart et al., 2005).
Accurate early detection depends on validated, standardized screening measures.