Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood | Child Development | JAMA Pediatrics | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 35.153.100.128. Please contact the publisher to request reinstatement.
1.
Boyle  CA, Boulet  S, Schieve  LA,  et al.  Trends in the prevalence of developmental disabilities in US children, 1997-2008.  Pediatrics. 2011;127(6):1034-1042.PubMedGoogle ScholarCrossref
2.
Rosenberg  SA, Zhang  D, Robinson  CC.  Prevalence of developmental delays and participation in early intervention services for young children.  Pediatrics. 2008;121(6):e1503-e1509.PubMedGoogle ScholarCrossref
3.
Institute of Medicine.  From Neurons to Neighborhoods: The Science of Early Childhood Development. Washington, DC: The National Academies Press; 2000.
4.
Reichow  B, Barton  EE, Boyd  BA, Hume  K.  Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD).  Cochrane Database Syst Rev. 2012;10(10):CD009260.PubMedGoogle Scholar
5.
Law  J, Garrett  Z, Nye  C.  Speech and language therapy interventions for children with primary speech and language delay or disorder.  Cochrane Database Syst Rev. 2003;(3):CD004110.PubMedGoogle Scholar
6.
Committee on Children With Disabilities.  Developmental surveillance and screening of infants and young children.  Pediatrics. 2001;108(1):192-196.PubMedGoogle ScholarCrossref
7.
Council on Children With Disabilities; Section on Developmental Behavioral Pediatrics; Bright Futures Steering Committee; Medical Home Initiatives for Children With Special Needs Project Advisory Committee.  Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance and screening.  Pediatrics. 2006;118(1):405-420.PubMedGoogle ScholarCrossref
8.
Hagan  JF, Shaw  JS, Duncan  PM, eds.  Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017.
9.
Carroll  AE, Bauer  NS, Dugan  TM, Anand  V, Saha  C, Downs  SM.  Use of a computerized decision aid for developmental surveillance and screening: a randomized clinical trial.  JAMA Pediatr. 2014;168(9):815-821.PubMedGoogle ScholarCrossref
10.
Guevara  JP, Gerdes  M, Localio  R,  et al.  Effectiveness of developmental screening in an urban setting.  Pediatrics. 2013;131(1):30-37.PubMedGoogle ScholarCrossref
11.
King  TM, Tandon  SD, Macias  MM,  et al.  Implementing developmental screening and referrals: lessons learned from a national project.  Pediatrics. 2010;125(2):350-360.PubMedGoogle ScholarCrossref
12.
National Improvement Partnership Network. IP project topics. http://www.med.uvm.edu/nipn/topic. Accessed September 26, 2015.
13.
Shaw  JS, Norlin  C, Gillespie  RJ, Weissman  M, McGrath  J.  The national Improvement Partnership Network: state-based partnerships that improve primary care quality.  Acad Pediatr. 2013;13(6)(suppl):S84-S94.PubMedGoogle ScholarCrossref
14.
Connelly  CA.  A History of The Commonwealth Fund’s Child Development and Preventive Care Program. New York, New York: Commonwealth Fund; 2013.
15.
Office of Disease Prevention and Health Promotion, US Department of Health and Human Services. Healthy People 2020 maternal, infant, and child health objectives. https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health/objectives. Accessed September 26, 2017.
16.
Centers for Medicaid & Medicare Services. CHIP quality of care and performance measurement. https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/chip-performance-measurement/index.html. Accessed January 15, 2018.
17.
Health Resources and Services Administration, Maternal and Child Health Bureau. Explore the Title V federal-state partnership. https://mchb.tvisdata.hrsa.gov/. Accessed May 18, 2018.
18.
Bethell  C, Reuland  C, Schor  E, Abrahms  M, Halfon  N.  Rates of parent-centered developmental screening: disparities and links to services access.  Pediatrics. 2011;128(1):146-155.PubMedGoogle ScholarCrossref
19.
Rice  CE, Naarden Braun  KV, Kogan  MD,  et al; Centers for Disease Control and Prevention (CDC).  Screening for developmental delays among young children—National Survey of Children’s Health, United States, 2007.  MMWR Suppl. 2014;63(2):27-35.PubMedGoogle Scholar
20.
Barger  B, Roach  A, Moreno  G.  Caretaker awareness of health care provided developmental screening: increases from 2007 to 2012.  Matern Child Health J. 2017;21(12):2169-2177.PubMedGoogle ScholarCrossref
21.
Data Resource Center for Child and Adolescent Health. 2011/12 National Survey of Children's Health. Indicator 4.16: developmental screening during health care visit, age 10 months-5 years. http://www.childhealthdata.org/browse/survey/results?q=2498&r=1. Accessed September 25, 2017.
22.
US Census Bureau. 2016 National Survey of Children's Health methodology report. https://census.gov/content/dam/Census/programs-surveys/nsch/tech-documentation/methodology/2016-NSCH-Methodology-Report.pdf. Published February 26, 2018. Accessed April 4, 2018.
23.
Ghandour  RM, Jones  JR, Lebrun-Harris  LA,  et al.  The design and implementation of the 2016 National Survey of Children’s Health  [published online May 9, 2018].  Matern Child Health J. doi:10.1007/s10995-018-2526-xGoogle Scholar
24.
Mangione-Smith  R, Schiff  J, Dougherty  D.  Identifying children’s health care quality measures for Medicaid and CHIP: an evidence-informed, publicly transparent expert process.  Acad Pediatr. 2011;11(3)(suppl):S11-S21.PubMedGoogle ScholarCrossref
25.
Radecki  L, Sand-Loud  N, O’Connor  KG, Sharp  S, Olson  LM.  Trends in the use of standardized tools for developmental screening in early childhood: 2002-2009.  Pediatrics. 2011;128(1):14-19.PubMedGoogle ScholarCrossref
26.
Andersen  RM.  National health surveys and the behavioral model of health services use.  Med Care. 2008;46(7):647-653.PubMedGoogle ScholarCrossref
27.
Aday  LA, Andersen  R.  A framework for the study of access to medical care.  Health Serv Res. 1974;9(3):208-220.PubMedGoogle Scholar
28.
Andersen  RM.  Revisiting the behavioral model and access to medical care: does it matter?  J Health Soc Behav. 1995;36(1):1-10.PubMedGoogle ScholarCrossref
29.
Guerrero  AD, Rodriguez  MA, Flores  G.  Disparities in provider elicitation of parents’ developmental concerns for US children.  Pediatrics. 2011;128(5):901-909.PubMedGoogle ScholarCrossref
30.
Child and Adolescent Health Measurement Initiative. Measuring medical home for children and youth: methods and findings from the National Survey of Children with Special Health Care Needs and the National Survey of Children’s Health. http://childhealthdata.org/docs/medical-home/mhmanual_withappendices-updated-12-7-10-pdf.pdf. Accessed September 29, 2017.
31.
Bethell  CD, Read  D, Stein  RE, Blumberg  SJ, Wells  N, Newacheck  PW.  Identifying children with special health care needs: development and evaluation of a short screening instrument.  Ambul Pediatr. 2002;2(1):38-48.PubMedGoogle ScholarCrossref
32.
Bethell  CD, Blumberg  SJ, Stein  RE, Strickland  B, Robertson  J, Newacheck  PW.  Taking stock of the CSHCN screener: a review of common questions and current reflections.  Acad Pediatr. 2015;15(2):165-176.PubMedGoogle ScholarCrossref
33.
Bieler  GS, Brown  GG, Williams  RL, Brogan  DJ.  Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data.  Am J Epidemiol. 2010;171(5):618-623.PubMedGoogle ScholarCrossref
34.
National Center for Education Statistics. t Test for partly overlapping groups. NAEP technical documentation. https://nces.ed.gov/nationsreportcard/tdw/analysis/2004_2005/infer_compare2_overlap.aspx. Accessed November 14, 2017.
35.
Bethell  CD, Kogan  MD, Strickland  BB, Schor  EL, Robertson  J, Newacheck  PW.  A national and state profile of leading health problems and health care quality for US children: key insurance disparities and across-state variations.  Acad Pediatr. 2011;11(3)(suppl):S22-S33.PubMedGoogle ScholarCrossref
36.
Sand  N, Silverstein  M, Glascoe  FP, Gupta  VB, Tonniges  TP, O’Connor  KG.  Pediatricians’ reported practices regarding developmental screening: do guidelines work? do they help?  Pediatrics. 2005;116(1):174-179.PubMedGoogle ScholarCrossref
37.
Sices  L, Feudtner  C, McLaughlin  J, Drotar  D, Williams  M.  How do primary care physicians identify young children with developmental delays? a national survey.  J Dev Behav Pediatr. 2003;24(6):409-417.PubMedGoogle ScholarCrossref
38.
Medical Home Initiatives for Children With Special Needs Project Advisory Committee, American Academy of Pediatrics.  The medical home.  Pediatrics. 2002;110(1, pt 1):184-186.PubMedGoogle ScholarCrossref
39.
Hadland  SE, Long  WE.  A systematic review of the medical home for children without special health care needs.  Matern Child Health J. 2014;18(4):891-898.PubMedGoogle ScholarCrossref
40.
Kaye  N, May  J.  Findings From the ABCD Screening Academy: State Policy Improvements That Support Effective Identification of Children At-Risk for Developmental Delay. Portland, ME: National Academy for State Health Policy; 2009.
41.
Child Trends Databank. Well-child visits. https://www.childtrends.org/?indicators=well-child-visits. Accessed November 20, 2017.
42.
Selden  TM.  Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000-2002.  Pediatrics. 2006;118(6):e1766-e1778.PubMedGoogle ScholarCrossref
43.
National Commission for Quality Assurance. Child and adolescent well-care visits. http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2017-table-of-contents/child-well-care-visits. Accessed May 15, 2018.
44.
Hambidge  SJ, Phibbs  SL, Chandramouli  V, Fairclough  D, Steiner  JF.  A stepped intervention increases well-child care and immunization rates in a disadvantaged population.  Pediatrics. 2009;124(2):455-464.PubMedGoogle ScholarCrossref
45.
Meghea  CI, Raffo  JE, Zhu  Q, Roman  L.  Medicaid home visitation and maternal and infant healthcare utilization.  Am J Prev Med. 2013;45(4):441-447.PubMedGoogle ScholarCrossref
46.
Van Cleave  J, Kuhlthau  KA, Bloom  S,  et al.  Interventions to improve screening and follow-up in primary care: a systematic review of the evidence.  Acad Pediatr. 2012;12(4):269-282.PubMedGoogle ScholarCrossref
47.
Oregon Health Authority. Oregon's health system transformation coordinated care organizations performance reports. http://www.oregon.gov/oha/HPA/ANALYTICS-MTX/Pages/HST-Reports.aspx. Accessed November 20, 2017.
48.
Centers for Medicaid & Medicare Services. 2016 Child health care quality measures. https://data.medicaid.gov/Quality/2016-Child-Health-Care-Quality-Measures/wnw8-atzy. Accessed November 20, 2017.
Original Investigation
September 2018

Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood

Author Affiliations
  • 1Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland
  • 2Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
  • 3Department of Pediatrics, Oregon Health and Sciences University, Portland
  • 4Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
JAMA Pediatr. 2018;172(9):857-866. doi:10.1001/jamapediatrics.2018.1524
Key Points

Question  What are the latest national estimates of standardized developmental screening and surveillance, as well as individual and state variation, that may identify opportunities for improvement?

Findings  In this cross-sectional analysis of the 2016 National Survey of Children’s Health, an estimated 30.4% of children 9 through 35 months of age received a parent-completed developmental screening and 37.1% received developmental surveillance from a health care professional in the past year. State-level differences far exceeded those by child and family characteristics, spanning 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon).

Meaning  Overall rates of developmental screening and surveillance remain low; however, substantial state-level variation underscores the importance and potential of quality improvement efforts.

Abstract

Importance  Since 2001, the American Academy of Pediatrics has recommended universal developmental screening and surveillance to promote early diagnosis and intervention and to improve the outcomes of children with developmental delays and disabilities.

Objective  To examine the current prevalence and variation of developmental screening and surveillance of children by various sociodemographic, enabling, and health characteristics.

Design, Setting, and Participants  This cross-sectional analysis of the Health Resources and Services Administration’s 2016 National Survey of Children’s Health—a nationally representative survey of US children completed between June 2016 and February 2017—examined 5668 randomly selected children 9 through 35 months of age whose parent or caregiver responded to the address-based survey by mail or via a website. All analyses were weighted to account for the probability of selection and nonresponse and to reflect population counts of all noninstitutionalized US children residing in housing units.

Main Outcomes and Measures  Developmental screening was measured through a validated set of 3 items indicating receipt in the past year of parent-completed screening from a health care professional with age-appropriate content regarding language development and social behavior. Surveillance was determined by an item capturing verbal elicitation of developmental concerns by a health care professional.

Results  Of the estimated 9.0 million children aged 9 through 35 months, an estimated 30.4% (95% CI, 28.0%-33.0%) were reported by their parent or guardian to have received a parent-completed developmental screening and 37.1% (95% CI, 34.4%-39.8%) were reported to have received developmental surveillance from a health care professional in the past year. Characteristics associated with screening and/or surveillance that remained significant after adjustment included primary household language, family structure, household education, income, medical home, past-year preventive visit, child health status, and special health care needs. Having health care that meets medical home criteria was significantly associated with both developmental screening (adjusted rate ratio, 1.34; 95% CI, 1.13-1.57) and surveillance (adjusted rate ratio, 1.24; 95% CI, 1.08-1.42), representing an 8 to 9 absolute percentage point increase. State-level differences spanned 40 percentage points for screening (17.2% in Mississippi and 58.8% in Oregon) and surveillance (19.1% in Mississippi and 60.8% in Oregon), with approximately 90% of variation not explained by child and family characteristics.

Conclusions and Relevance  Despite more than a decade of initiatives, rates of developmental screening and surveillance remain low. However, state-level variation indicates continued potential for improvement. Systems-level quality improvement efforts, building on the medical home, will be necessary to achieve recommended screening and surveillance goals.

×