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)
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• 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.