Who are we missing? Early Developmental & Behavioural Screening Shirley V. Leew, PhD Pediatric Rehabilitation Clinical Research Scientist Decision Support Research Team Calgary Health Region Why is this research important? • Present methods of early screening miss between 70 - 80% of the 16% of children who have developmental &/or behavioural disabilities. – We need reliable and usable ways to identify all young children who are at risk • Mild to moderate • Possibly to ameliorate future disability. Who are most at risk? • Children of mothers with history of poor mental health (including depression) • Children living in poverty • Children of mothers with poor social supports • Children of young mothers • Children of single mothers • Children of mothers with less than high school education Who are not being referred early? • Children who don’t regularly see a developmental pediatrician or a family doctor • Children in good general health • Children with no ear infections before 2 years of age • Girls • First born or only child • Children born at term Enhancing screening for developmental &/or behavioural problems • Maternal mental health characteristics: – Infant – mother social interactions • influence development – short and long term consequences for an infant’s cognitive, social and emotional development ‘Early identification of developmental risk associated with maternal mental well-being revealed in early screening’ Cuddles Research Questions • 1) What is the rate of identification of developmental concerns in infants when using a standardized, online, screening measure in a community health clinic at 6 month, 12 month, and 18 month well-child visits? • 2) What is the relationship between maternal selfreported depression and developmental screening outcomes at 6 month, 12 month and 18 month wellchild visits? • 3) What is the relationship between maternal selfreported anxiety and developmental screening outcomes at 6, 12, and 18 month well-child visits? Methods • Recruitment screening at 6 month well child visits • 2 CHC in Calgary • 200 participants per clinic • Re-screening at 12 and 18 month well child visits • Measures – The Parental Evaluation of Developmental Status (PEDS) – – – – • Computer/online administered Edinburgh Postpartum Depression Scale STAI-Y (State-Trait Anxiety Inventory, form Y) Brigance Parent-Child Interaction Scale Demographic questionnaire Planned Analyses • Descriptions of prevalence and proportions of risk – means and ratios • Relationships between maternal mental health and developmental/behavioural risk: – Stepwise regression analyses • dependent variable: – numerical value assigned to PEDS paths • independent variables: – EPDS, STAI-Y • Relationship between infant-mother social interactions and maternal mental health – Regression analyses • DV: maternal mental health • IV: Brigance • Relationship between mother-child interactions and developmental risk – Regression analyses • DV: PEDS Path • IV: Brigance Cuddles Progress • Acadia CHC – Piloting is completed – Screening has started • NW CHC – Recruitment posters are in the community • Recruitment screening will begin Feb1,2008 Anticipated Impact • Rate of identification of developmental &/or behavioural risk/disabilities of children < 2yrs in Calgary will increase: – including children with symptomatic (high) and asymptomatic (low – moderate) risk • Primary health care providers will develop trust in early screening processes – Screening as education – Partnerships with community providers • Mothers with history of poor mental health will get parenting guidance that will impact development/behaviour for their children.