Structured
Developmental Assessment
Presenter Name
Bright Futures Training Intervention
With Office Staff
Workshop I
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Overview of Assessment
 Screening—Looks at the whole population to identify
those at risk—flags those who need further assessment
 Assessment—Determines existence of delay or
disability—generates decision regarding intervention
 Surveillance—Periodic evaluation of development in
relation to the child as a whole
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“The American Academy of Pediatrics Committee
on Children with Disabilities recommends the use
of standardized screening tests at well visits.”
About 16% of children have disabilities,
including speech and language delays,
mental retardation, learning disabilities,
and emotional/behavioral problems.
_____________________
(Only 50% are detected prior to
school entrance.)
____________________
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“Under-detection … Eliminates the Possibility
of Early Intervention...”
• No point in waiting to do structured
assessments until the problem is
observable.
• Do not ignore assessment results;
there is no value to “wait and see.”
• Informal checklists have no validated
criteria for referral.
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Limited use of structured developmental
assessments at well visits because…
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Takes too long.
Difficult to administer.
Children may not cooperate.
Reimbursement is limited.
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So….
What Should We Do?
 Use new, brief, accurate tools.
 Use parents.
 Use family-centered principles.
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Family-centered Principles
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Continuous
Comprehensive
Coordinated
Compassionate
Culturally Responsive
Family Centered
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The Screening Tools
Types of screening include
 Parent Questionnaire
 History/Interview
 Direct Elicitation
 Observation
Desired Sensitivity and Specificity
 Seventy percent to 80%
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What Is Possible,
What Works
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Structured Developmental Assessments
Help Focus Visit on Parents’ Concerns
 Can facilitate parent-provider communication
 Can aid in prioritizing issues for visit
 Can help ensure that parents’ concerns are
addressed during visit
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Talking With Families
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Point Out Child’s Strengths
Discuss Developmental Issues
Discuss Transition Stages
Discuss Sharing Information
Discuss Community Partners/Resources
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The Ages and Stages
Questionnaire
Each questionnaire reviews 5 areas.
 Communication
 Gross motor
 Fine motor
 Problem solving
 Personal/social
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The Ages and Stages
Questionnaire
 Original work—1981; revised 1991, 1994
 Original sample—2008
 Validation—Gesell, Bayley, Stanford-Binet, McCarthy,
Batelle; Overall = 83%
 Sensitivity—72%
 Specificity—86%
______________________________
Ages Tested: 4 to 60 months
Elicits parent input/concerns
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Parents’ Evaluation of
Developmental Status
Validation—771 children.
Standardized—971 children across the United States.
Sensitivity—74% to 80%
Specificity—70% to 80%
Format—Each questionnaire reviews 10 items.
“No,” “yes,” and “a little” are responses.
Decision pathways A through E, based on score, to refer or do a
second stage screen with Ages and Stages Questionnaire, Bayley
Infant Neurodevelopmental Screener, Batelle, or CDI.
_____________________________________________
Ages Tested: 0 to 8 years
Elicits parent input/concerns
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Implementing Structured
Developmental Assessments
in Your Practice
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Planning for Use of
Structured Assessments
 Assess your current method of developmental
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assessment.
Elicit support from practice leaders.
Select an assessment tool.
Assign responsibility for coordinating use of
structured assessments.
Determine when parent will receive assessment.
Test tool on small scale.
Plan for needed resources/referrals.
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Implementing Use of Structured
Developmental Assessments
 Train staff.
 Determine what to do with completed
assessments.
 Monitor your new system for using structured
assessment.
 Use feedback from structured assessments to
periodically determine needs/concerns of
“average” patient.
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Primary Care Practice Screening
and Referral Practice Flow
Parent checks in/Regsiters- updated demographics, insurance is
Nurse puts parent
in exam room
and gives them
the ASQ
questionnaire to
complete
Nurse reviews
immunization record
prepares shots,
education sheets on
shots
Child examed by MD.
MD scores ASQ
and discusses
results with
parents
collected
Nurse pulls chart,
encounter form,
anticipatory
development
guideline sheet,
ASQ;
Nurse takes child's
vitals
Encounter Form sent to
Nurses Station
Nurse administers shots-Nurse
obtains consent
and puts copy on chart. Children who failed should be
referred/presented to consortium; Obtain feedback
on child referred.
Parent Checks Out - Staff assists with Checkout
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Resources
Ages and Stages Questionnaire
Paul H. Brookes Publishers, PO Box 10624,
Baltimore, MD 21285 (1-800-638-3775)
Parents’ Evaluation of Developmental
Status
Ellsworth & Vandermeer Press, Ltd, PO Box
68164, Nashville, TN 37206 (615-226-4460)
For more information on developmental screening (ie, who
should be screened, pitfalls of screening, etc), investigate the
Developmental Behavioral Pediatrics Online Web site at
www.dbpeds.org.
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