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In the United States, about 1 in 8 children (13%) have a developmental or behavioral disability. [Boulet: 2009] Opportunities for early intervention are lost or significantly delayed if children with developmental disabilities are not identified early on. A minority of children with developmental delays receive early intervention services before the age of 3 years, and children belonging to racial and ethnic minority groups are less likely to receive needed services than their white peers. [Rosenberg: 2013] [Magnusson: 2016] Developmental screening programs increase the detection of developmental delays. [Bagner: 2014] [Adams: 2013] In addition, Title V of the Social Security Act and the Individuals with Disabilities Education Improvement Act (IDEIA) mandate that clinicians provide these services.

• Each screening tool carries its own set of strengths and limitations.
• When choosing a screening tool for your practice, consider cost, implementation, language, literacy barriers, and privacy issues for family members filling out information.
• Some questions may not be as relevant in certain cultures or for children living in foster families or group care settings.
• Recognize that these tools may not be validated for children from bilingual or multilingual homes or children with complex medical conditions or disabilities. Consider evaluation by a multi-disciplinary team and/or neurodevelopmental pediatrician for these children.
• Correct for prematurity in children under 24 months.
• Be prepared to answer questions about typical vs. atypical development and to provide appropriate support and referrals.
• Using developmental milestone trackers at each check-up can be useful for monitoring and engaging families, but it does not replace formal, validated screening instruments.
• Diagnosis of a specific developmental disability is NOT necessary for an early intervention program (EIP) referral to be made or for services to begin.

Zubler JM, Wiggins LD, Macias MM, Whitaker TM, Shaw JS, Squires JK, Pajek JA, Wolf RB, Slaughter KS, Broughton AS, Gerndt KL, Mlodoch BJ, Lipkin PH.
Evidence-Informed Milestones for Developmental Surveillance Tools.
Pediatrics. 2022;149(3). PubMed abstract

American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.
Pediatrics (original publication 2006; reaffirmed 2014). 2014;118(1):405-20. PubMed abstract / Full Text

In 2022,, the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) revised developmental surveillance checklists in the Learn the Signs Act Early (CDC) program. Previously, the checklists used 50th percentile milestones. The revised checklists include milestones that 75% or more of children are expected to achieve by each age and added 15- and 30-month checklists. The purpose of using milestones that most children, rather than average children, would be expected to achieve was to help clinicians more easily identify children at risk for developmental delays and, therefore, who would need additional validated developmental screening. It also helps prevent unnecessary concern for children who achieve a milestone slightly later than the average age. [Zubler: 2022]

Developmental Surveillance
Developmental surveillance, also known as developmental monitoring, is a flexible, longitudinal, continuous, and cumulative process that should be included at each pediatric preventive care visit throughout the first 5 years of life. [American: 2014] If concerns from developmental surveillance, a screening tool should be administered, or when there is sufficient concern, further evaluation should be undertaken for specific developmental disabilities.

Developmental Screening
Developmental screening is the administration of a brief standardized tool to help identify children at risk of a developmental disability. It is administered in the medical home or by trained providers and teachers in some daycares or early learning centers. Concerning results from the screen should trigger further evaluation for specific developmental disabilities.

Screening provides greater sensitivity (correctly identifying children at risk for a developmental delay) and specificity (correctly avoiding positive screen results in children who do not have a developmental delay) than surveillance.

Using developmental checklists can help with monitoring but does not replace using validated developmental screening instruments.

Screening and Surveillance Process Overview

Developmental screening of ALL children is recommended at the 9-, 18-, and 24- or 30-month well-child visits. [American: 2014] Repeated developmental screening provides a more accurate assessment of development than a single evaluation and allows for monitoring of developmental progression (or regression). Additional screening may benefit children with a history of prematurity, low birth weight, or other unique circumstances. [American: 2014]

The developmental screens listed below are:

• Validated for a primary care population for screening at the 9-, 18- and 30- (or 24-) month visits
• Broadband instruments that screen multiple domains of development, including some combination of gross and fine motor, language/communication, cognitive, academic, self-help, problem-solving, social-emotional, and behavioral skills
• Vetted for favorable psychometric properties, defined as sensitivity and specificity of at least 70%, and reliable, consistent results when used in different settings
• Parent-completed questionnaire (screens requiring a trained observer to complete the questionnaire are not included here)
• Administered in 15 minutes or less
• Compatible with electronic medical records
• Available in multiple languages

For a detailed overview of developmental screening instruments and how to choose one for your practice, see Birth to 5: Watch Me Thrive (HHS & DOE) ( 1007 KB).

Ages & Stages Questionnaires, 3rd edition (ASQ-3)

Parents' Evaluation of Developmental Status (PEDS)

• Format: Single parental response form, 10 items per questionnaire. A revised version, PEDS-R, is due to be published soon and will add 2 questions that prompt for global/cognitive and health concerns.
• Age range: Birth to 7 years 11 months
• Scoring: Use the scoring algorithm to identify high-risk children who need a referral as opposed to further screening or continued surveillance.
• Parent reading level: 4th - 5th grade
• Languages: English, Spanish. Licensed translations are also available in Albanian, Amharic, Arabic, Armenian, Bengali, Bulgarian, Burmese, Cambodian, Chinese (Traditional and Simplified characters), Congolese Swahili, Danish, Dutch, Dzongkha, Farsi, Filipino Tagalog, French, Galician, German, Greek, Gujarati, Haitian-Creole, Hebrew, Hindi, Hmong, Icelandic, Indonesian, Isixhosa, Karen, Korean, Laotian, Malay, Nepali, Pashto, Polish, Portuguese, and Cape Verdean, Punjabi, Quechua, Russian, Serbian (Cyrillic and Latin), Samoan, Somali, Sotho, Swahili, Swedish, Tagalog, Taiwanese, Tamil, Thai, Turkish, Urdu, Vietnamese, Visayan, Yoruba, and Zulu.
• May also be useful as a surveillance tool
• Can be supplemented with concurrent use of Parents’ Evaluation of Developmental Status: Developmental Milestones (PEDS:DM)

Parents' Evaluation of Developmental Status: Developmental Milestones (PEDS:DM)

• Format: Different age-specific questionnaires, 6 to 8 items per questionnaire
• Age range: Birth to 7 years 11 months
• Scoring: Pass/no pass for each of the tested domains
• Parent reading level: 4th - 5th grade
• Languages: English and Spanish. Licensed translations are also available in Arabic, Chinese, French Canadian, Japanese, Korean, Punjabi, Swahili, Taiwanese, Tamil, and Thai.
• Can be supplemented with concurrent use of Parents’ Evaluation of Developmental Status (PEDS)

Survey of Well-Being of Young Children (SWYC)

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