Screening for developmental delay.

According to the literature, 12 to 16 percent of children in the United States have at least one developmental delay, yet as many as one-half of affected children will not be identified by the time they enter kindergarten. If developmental delays are detected too late, opportunities for early intervention may be lost. Empirical literature on clinical recommendations for developmental delay screening in primary care is inconsistent and often insufficient to direct the family physician. In addition, multiple barriers exist, which often prevent physicians from performing initial screening and completing additional evaluation and referrals. Implementing office-based systems for screening and referrals may overcome these barriers and improve outcomes. Recent studies support the use of a validated screening tool at regular, repeated intervals, in addition to physician surveillance, at all well-child visits. The literature also supports screening for developmental delay with parent-completed tools rather than directly administered tools. The most extensively evaluated parent-completed tools are the Parents' Evaluation of Developmental Status and the Ages and Stages Questionnaire. Family physicians should be familiar with currently available screening tools, as well as their limitations and strengths. Additional evaluations and referrals are recommended if developmental delay is identified or suspected.