Common pitfalls in the evaluation of developmental screening tests.

Wilson has written that screening puts a responsibility on the physician to provide some benefit to the person being screened. He made the distinction between the physician who is confronted by a patient with a problem that the physician may attempt to cure with unproved means, on one hand, and persons who mount community screening programs with unproved procedures on the other. He considers the former to be ethical and the latter unethical. Similarly, we consider the failure to avoid pitfalls--such as improper screening test administration, failure to use reliable outcome criteria, making inappropriate (although well-intentioned) predictions, and making inappropriate generalizations or drawing inappropriate conclusions--to be unethical. The pitfalls jeopardize the achievement of the desired outcome by screening programs. They also lead to inappropriate conclusions and possibly, therefore, to the use of inappropriate tests. If the scientific community does not take steps to avoid such pitfalls in developmental screening, it invites those who make health care decisions to eliminate such screening or to mandate procedures which may not be scientifically sound. Neither of these alternatives is acceptable. The only alternative, first, is to ensure that one avoids common pitfalls when screening in one's own practice and, second, to be on guard against developmental screening studies and reports that fail to avoid these errors.