Developmental delay: Need of screening tools for primary care providers.

Sir,

India is committed to reducing childhood mortality and morbidity. This requires advocacy and action (among all stakeholders), focused on locally relevant issues.[1] Developmental delay, “the condition in which a child is not developing and/or achieving skills according to the expected time frame,” is of concern. The barrier to screening for developmental delay is the lack of time in the current practice (82%). Beside the duration of the tests, other reasons for limited use include unfamiliarity, difficulty with their administration, obtaining cooperation of children in a short time, lack of validation in a local setting or language/culture, problems with parental ability to perform self-administered tests and the cost of purchasing some tests.[2]

Methods designed specifically for developmental monitoring of young children by health care providers in low- and middle-income (LAMI) countries are lacking.[3] Timely and periodic assessment of young childrens’ development makes it possible to identify and treat developmental disabilities at the earliest possible point of manifestation and to prevent loss of developmental potential.[4]

Two tools that are of importance among primary care providers include Ages and Stages questionnaire (ASQ)[56] and Guide for Monitoring Child Development (GMCD).[3]

The ASQ is a parent-completed, child development screening test. The ASQ can be used for two purposes:

As a first-level screening tool to identify infants and children that may require further assessment

As a monitoring tool to gauge the development of children who are at risk for developmental disabilities or delays.[5]

The overall sensitivity of ASQ for detecting developmental delay was 83.3% and specificity was 75.4%.[7] A cross-sectional study showed the prevalence of global developmental delay assessed by ASQ to be 19.8%.[8]

The GMCD is a practical, open-ended interview that catalyzes communication between clinicians and caregivers. The GMCD is an innovative method for monitoring child development that is designed specifically for use by health care providers in LAMI countries. Studies in Turkey provide preliminary evidence for its reliability and validity.[3] The prevalence of developmental delay assessed by GMCD was found to be 48.5% of children, which shows that a large percentage of children were in need of further follow-up after GMCD assessment.[9]

Considering the prevalence of developmental delays, the primary care provider must be vigilant in identifying those children who require further evaluation and referral. Early identification leads to early treatment and, ultimately, improved long-term outcomes.