- Routine screening for all children is an important gateway to ensure their healthy development.
In This Report:
- Early identification and treatment of developmental delays can help children access the services and supports they need to reach their full potential. All children should receive developmental screens at pediatrician-recommended intervals to ensure their healthy development.
- States may voluntarily report a developmental screening measure in Medicaid and/or the Children’s Health Insurance Program (CHIP). Of the 26 states reporting in 2016, developmental screening rates for children under age 3 in Medicaid and/or CHIP ranged from 1.6 percent in Alaska to 77.5 percent in Massachusetts, with a median of 36 percent. Reporting on the full Core Set of Child Health Care Quality Measures, including the developmental screening measure, will be mandatory for all states beginning in 2024.
- Across all health coverage types, a separate 50-state parent survey found that 27.1 percent of all children under age 5 received a developmental screen in 2016. State rates ranged from 11 percent in Mississippi to 48.9 percent in Oregon.
- Wide variation in reported developmental screening rates among states suggests much room for improvement to assess whether children are being universally screened according to pediatrician-recommended standards. Data availability and voluntary reporting in Medicaid/CHIP make accessing data for all 50 states more difficult. Even more work remains to adequately capture and assess what happens to children following a developmental screen to ensure they get the care they need.
As our nation reaches historic levels of health coverage for children, there is increased interest in further ensuring access to the care needed for children to reach their full potential. Years of research have confirmed the critical importance of the earliest years of a child’s development.1 The first months and years of a child’s life are marked by rapid growth and early brain development that pave the way for school readiness and overall physical and social emotional health impacting them well into adulthood. Early identification and treatment of developmental delays can help children access the services and supports they need to reach their full potential. Routine screening for all children is an important gateway to ensure those identified with certain delays or needs receive early intervention or other appropriate services that can help them meet developmental milestones and enter school ready to learn.
As many as one in four children under age 6 may be at moderate or high risk for developmental, behavioral, or social delays2. Larger shares of young children of color are at risk for delays compared with their white peers3. Young children living in poverty (100 percent of the federal poverty line, or FPL) are more than twice as likely to be at high risk of developmental delay than those in families with incomes more than double the poverty line (above 200 percent FPL).4
Routine, universal developmental screenings as recommended by pediatric and child development experts work to identify children with or at risk of such delays. A screen is the first step in a process to uncover an issue that warrants a closer, more detailed evaluation. That evaluation may, in turn, determine whether a child and their family should be referred to early intervention services or other supports. Yet more consequential than a screen itself is what happens once a child is identified as needing referrals and additional services. Children with developmental delays wait, on average, nine months after a parent’s stated concern to receive follow-up assessments and supports.5 This wait could have serious implications: The sooner children get to early intervention and treatment, the sooner their delays can be successfully addressed. Ensuring children receive developmental screenings, specifically, marks one step toward identifying and addressing their needs. For example, a child with speech challenges that go unchecked could enter preschool or kindergarten behind. A screening could detect hearing challenges, a speech disorder, or other delays. Early identification and treatment can mitigate negative impacts on a child’s development and improve their ability to thrive in school.
What are developmental screenings?
Use of the term “developmental screening” can denote different things to different people in different sectors. A child’s growth and development should be regularly measured to identify any delays or problems that require further monitoring or intervention. Developmental screening differs from the broader monitoring or “surveillance” that should occur during every regular checkup, where a healthcare, community, or school-based professional observes the child and asks parents about their physical and cognitive progress.6 As defined and recommended by the American Academy of Pediatrics (AAP), developmental screening entails using a validated, standardized tool during well-child visits at regular intervals to determine if a child is meeting developmental milestones at various ages and stages.
Developmental screening tools focus on issues such as motor, communications, problem-solving and social development.7 These tools usually consist of an evidence-based parent questionnaire or series of questions answered by parents or caregivers, as the most frequent observer of their child’s developmental progress.8 Research has shown that using a validated screening tool, beyond surveillance alone, to ask parents about their child’s development can more accurately identify a child’s risk of a developmental delay or disability.9 This means that rather than asking typical questions, the professional uses a validated tool that has been research tested in health care practices and other community settings and has shown consistent results, compared to surveillance. Screening results that signal concerns prompt further follow-up, which could include a range of actions, from gathering additional child and family history, asking follow-up questions, close monitoring, referrals to specialists for diagnosis and treatment, or others.
AAP’s Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents10, provides medical providers with an evidence-based template for preventive care screenings and well-child visits. Bright Futures recommends as a best practice that a developmental screening occur at pediatric well-child visits when a child is 9 months, 18 months and 30 months old.11
Pediatricians also use well-child visits as opportunities to screen and address the broader social, economic, educational, environmental, and related needs of the children and families they serve. The Bright Futures Guidelines recommend a full host of child health screenings that are important for child development, including check-ups for vision, hearing, social/emotional health, and autism. The 2017 update of the guidelines also recommends that pediatricians screen for social determinants of health, such as poverty and food insecurity, as well as for parent or caregiver depression or mental health, which can also greatly affect a child’s development.12 This broader range of physical, developmental and social-emotional screens offers the most thorough look at a child’s overall development. This brief, however, refers to the narrower AAP definition of developmental screenings, which excludes autism screenings. This specific definition is also reflected in the available state-level survey data detailed below and in the appendices.
- See for example, Institute of Medicine. From Neurons to Neighborhoods: The Science of Early Childhood Development. (The National Academies Press. 2000), available at https://doi.org/10.17226/9824 or Center on the Developing Child at Harvard University (2016). From Best Practices to Breakthrough Impacts: A Science-Based Approach to Building a More Promising Future for Young Children and Families. Retrieved from www.developingchild.harvard.edu.
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, “The Health and Well-Being of Children: A Portrait of States and the Nation 2011-2012,” (U.S. Department of Health and Human Services, 2014), available at: http://mchb.hrsa.gov/nsch/2011-12/health/child/childs-health-status/risk-developmental-delay.html.
- Ibid (2).
- Child Trends: Data Bank, “Screening and Risk for Developmental Delay: Indicators of Child and Youth Well-Being,” (Child Trends, July 2013), available athttps://www.childtrends.org/indicators/screening-and-risk-for-developmental-delay/.
- G. Kenney and J. Pelletier, “Improving the Lives of Young Children: The Role of Developmental Screenings in Medicaid and CHIP,” (Urban Institute, December 2010), available at https://www.urban.org/sites/default/files/publication/29436/412275-Improving-the-Lives-of-Young-Children-.PDF
- “Developmental Monitoring and Screening,” Centers for Disease Control and Prevention, available at http://www.cdc.gov/ncbddd/childdevelopment/screening.html
- Examples of commonly used standardized tools include the Ages and Stages Questionnaires (ASQ), the Parents’ Evaluation of Developmental Status (PEDStest), and the Survey of Well-being of Young Children (SWYC). A full list is available at US Department of Health and Human Services, “Birth to 5: Watch Me Thrive! A Compendium of Screening Measures for Young Children,” (US Department of Health and Human Services, March 2014), available at https://www.acf.hhs.gov/sites/default/files/ecd/screening_compendium_march2014.pdf
- US Department of Health and Human Services, “Birth to 5: Watch Me Thrive! A Compendium of Screening Measures for Young Children,” (US Department of Health and Human Services, March 2014), available at https://www.acf.hhs.gov/sites/default/files/ecd/screening_compendium_march2014.pdf
- C. Bethell., et al., “Rates of Parent-centered Developmental Screening: Disparities and Links to Services Access,” Pediatrics (2011): 146-155. Also see Guevara, J., et al., “Effectiveness of Developmental Screening in an Urban Setting, Pediatrics, (2013): 30-37, available at http://pediatrics.aappublications.org/content/131/1/30.
- Bright Futures Guidelines (Hagan JF, Shaw JS, Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. 4th ed. American Academy of Pediatrics; 2017). Periodicity schedule available at https://www.aap.org/en-us/documents/periodicity_schedule.pdf Periodicity schedule available at https://www.aap.org/en-us/documents/periodicity_schedule.pdf
- American Academy of Pediatrics. “Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening,” Pediatrics, (2006): 405–420.
- See for example: American Academy of Pediatrics, “Poverty and Child Health in the United States,” (American Academy of Pediatrics, 2016), available at http://pediatrics.aappublications.org/content/pediatrics/early/2016/03/07/peds.2016-0339.full.pdf.