Why Screen?
• Infants, toddlers, and preschoolers are
not required to participate in publicly
supported educational programs
• Early intervention can eliminate or
reduce the need for extensive later
remediation program
• Therefore, finding children in need of
early intervention services is key role of
programs serving young children &
families
HD FS 340:
Screening Infants & Toddlers
HD FS 340
November 7, 2002
Susan Hegland, Ph. D.
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Screening
Child Find
• A systematic process of identifying young
children eligible for enrollment in intervention
programs
• Mandated by IDEA
• Brief assessment procedure
• To identify children who should receive more
intensive diagnosis or assessment
• Designed to help children at risk to receive
ameliorative intervention services ASAP!!
• Characteristics:
– Includes procedures to be used by primary referral
sources (e.g., hospitals, physicians, child care
programs, social services agencies)
– Referral for infants and toddlers must be made no
more than two working days after identification
– Quick & economical
– Cost effective (reduces need for complete evaluations
• Three groups of children:
– Children with diagnosed disabilities
– Children with “hidden” disabilities
– Children at risk for developmental problems
• Biological at-risk factors
• Environmental at-risk factors
– Reduce total long-term cost of special education
– Not needed for children clearly eligible for services!
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Guidelines for screening & assessment
Guidelines
1.
Screening & assessment should be viewed as services (part of
intervention), not only as means of identification & measurement.
Processes, procedures, and instruments intended for screening
should only be used for intended purpose.
3. Multiple sources of information should be included.
4. Developmental screening should take place on a recurrent or
periodic basis.
5. Developmental screening should be viewed as only one path to
more in-depth assessment.
6. Screening and assessment procedures should be reliable and
valid
7. Family members should be an integral part of the screening and
assessment process.
8. During screening/assessment of developmental strengths and
problems, the more relevant and familiar the tasks and setting are
to child and family, the more likely it is that results will be valid.
9. All tests, procedures, and processes intended for screening must
be culturally sensitive.
10. Extensive and comprehensive training is needed by those who
screen and assess very young children.
2.
• Multiple sources of information
• Provision of family-centered services
• Evaluation of screening program
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Meisels & Provence, 1989
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Family Centered
Multiple sources
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Family centered practice is beneficial and desirable:
• Both legally and practically!
• Parents must be empowered to feel and be responsible
as “child’s first teacher”
• When family members are present and feel supported,
more likely to stay involved in planning, implementation,
and evaluation
• Parents need to be
Developmental measures
Sensory (vision, hearing)
Health
Adding environmental & caregiving factors
increased accuracy
– Screening tool(s)
– Parent questionnaire
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Informed about screening process
Purpose and potential outcomes
Qualifications of persons involved
Given option of participating
Given results of screening immediately
• In jargon-free terminology
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Evaluation of screening
program
Selecting Screening Instruments
• Did some children “pass” the screening
but later required special education
services?
• Were some children referred for evaluation
who were found not to need special
services?
• Were families involved satisfied with
experience?
• Is evaluation completed in a timely
manner?
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Criteria
Brief
Norm-referenced
Inexpensive
Standardized in administration
Objectively scored
Broadly focused across all areas of development
(motor, language, cognitive, social, emotional)
• Sensitive to sample of children developmentally
at risk
• Specific to the portion of children who are not at
risk
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Potential Outcomes from Screening
Reliable and Valid
• Reliability
Referred for
diagnostic
assessment
– Consistency
– Stable
• Validity (accuracy)
Not referred
for diagnostic
assessment
– Concurrent validity
Eligible for
Special
Services
• Scores correlated with more thorough, diagnostic tests
– Predictive validity
• Scores correlated with children’s performance on
outcome measures later in time
False Negative
• Norm-referenced
– Standardization sample includes this child’s racial,
linguistic, economic, geographic background.
– Free from bias due to sex, geography, economic
background, culture, ethnicity, race
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Not Eligible for
Special
Services
False Positive
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Sensitivity and Specificity
High Sensitivity, High Specificity
• Sensitivity
– Ability of test to identify a high proportion of the children wi th
developmental delays (disabilities)
Referred for diagnostic
assessment
Not referred for
diagnostic assessment
Eligible for Special
Services
High
Low
Not Eligible for Special
Services
Low
High
• Specificity
– Ability of the test to NOT identify children who do NOT have a
disability or developmental delays
• Goal
– high sensitivity and high specificity!
• High in sensitivity, low in specificity:
– Identify children who need services
– waste diagnostic funds assessing too many kids
– Unnecessarily worry parents
• Low in sensitivity, high in specificity:
– Delay services for children who need them
– Increase costs and decreasing impact of remediation services
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High Sensitivity, Low Specificity
Referred for
diagnostic
assessment
Not referred
for diagnostic
assessment
Eligible for
Special
Services
High
Low
Not Eligible for
Special
Services
High
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Low Sensitivity, High Specificity
Referred for
diagnostic
assessment
Not referred
for diagnostic
assessment
Eligible for
Special
Services
Low
High
Not Eligible for
Special
Services
Low
High
Low
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ASQ (Ages & Stages Questionnaires: A
Parent-Completed, Child Monitoring System)
• Standardization Sample
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ASQ Description
Areas:
– 2008 children (53% males; 65% Caucasian)
– Families
– Communication
– Gross motor
– Fine motor
– Problem solving
– Personal-Social
• income from < $5000 (13%) to more than $40,000 (2.3%)
• Education from <7th grade (1.6%) to post-grad (6.8%)
– Age range from 4 to 36 months
– Children were full term (>37 weeks)
• Reliability:
– Internal consistency from .54 to .83
– Test-retest: 94% agreement across 2 weeks
Age levels:
• Validity (concurrent, with Bayley , Stanford-Binet)
– 4, 5, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30,
33, 36, 42, 48, 54, 60 months
– Sensitivity: 72%
– Specificity: 86%
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Explaining screening/monitoring process
Possible method of use
1.
• On-site (by parent and/or professional)
– Child care center
– Parent education/support program
2.
– Homeless shelter
– Health clinic
3.
4.
• Home visit (by parent and home visitor)
• Mail out
– Danger: discriminates against parents with limited
reading skills
5.
Written parent consent required for each!!
6.
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Explain that child must be
n rested,
n fed, and
n ready to play
Explain questionnaires designed to determine what child
can and cannot do. Be sure they understand that the child
will probably NOT be able to do all the activities targeted.
Emphasize importance of trying each activity with the child
Many questions have 3 possible answers:
n Yes (child is doing activity now)
n Sometimes (child just beginning to do activity)
n Not yet (child has not yet started to do activity)
Clarify how to answer questions about activities child did
earlier but no longer does, or does infrequently (e.g.,
crawling = yes)
Emphasize name of contact person, name & address &
phone number of program
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Refer/follow up criteria
• Refer child
– whose score in one or more areas is below
established cutoff point (2 standard deviations
below mean)
• Follow up with child
– whose score in a particular area is close to
cutoff score
• Follow up with child
– whose scores are above cutoff points for each
area, but whose parent has indicated a
concern in the Overall section.
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