Developmental Screening in the First Three Years of Life
Approximately 17% or one in six children aged three to 17 in the United States have one or more developmental disabilities, yet less than one-fifth of those children receive early intervention services before three years of age. Pediatricians and pediatric health care providers play a critical role in recognizing children who might be at risk for developmental delays. Developmental surveillance and monitoring should be a component of every preventive care visit. The American Academy of Pediatrics (AAP) and Centers for Disease Control (CDC) recommend that all children be screened for developmental, behavioral, and social delays using a standardized screening tool during regular well-child visits at nine, 18 and 30 months. Early identification of developmental delays and early intervention are proven to enhance abilities, promote better school performance and increase opportunities for later success in life.
Mandatory reporting for Quality Measure DEV-CH for all states beginning 2024. Quality Measure DEV-CH: Developmental Screening in the First Three Years of Life will require providers to perform and document developmental screenings for children. Developmental Screenings must be performed utilizing a validated standardized tool. This measure includes three age-specific indicators assessing whether children are screened before or on their first, second or third birthdays. There will be a total of four rates calculated and reported (one rate for each age group and a combined rate).
It is advised that all children should receive developmental screens at recommended intervals using an evidence-based screening tool at nine, 18 and 30 months, or whenever a concern is expressed. Documentation in the medical record must include the following: a note indicating the date on which the test was performed, the standardized tool used and evidence of a screening result or screening score.
A list of validated screening tools can be found in the Screening Tool Finder in the American Academy of Pediatrics Screening Technical Assistance and Resource (STAR) Center. This table is not exhaustive, and other screening tools may be available. The AAP does not approve or endorse any specific tool for screening purposes.
View our Aug. 19, 2022 webinar: Developmental Screening in the First Three Years of Life
Strategies for Success
Remain Informed of Federal Measures and Guidelines.
- DEV-CH: Developmental Screening in the First Three Years of Life
- Mandatory reporting for all states beginning 2024
- Document a note within the medical record indicating which standardized tool was used, the date of screening and evidence that the tool was completed and scored
- Positive screening result for a developmental problem, developmental and medical evaluations to identify the specific developmental disorders and related medical problems are warranted
- Children diagnosed with specific developmental disorders should be identified as children with special health care needs; chronic-condition management for these children should be initiated
- Standardized Tool – Are tools that have been normed and validated and must meet the following criteria:
- Developmental domains: The following domains must be included in the standardized developmental screening tool: motor, language, cognitive and social-emotional.
- Established Reliability: Reliability scores of approximately 0.70 or above
- Established Findings Regarding the Validity: Validity scores for the tool must be approximately 0.70 or above. Measures of validity must be conducted on a significant number of children and using an appropriate standardized developmental or social-emotional assessment instrument(s).
- Established Sensitivity/Specificity: Sensitivity and specificity scores of approximately 0.70 or above
Remain Informed of State Medicaid Guidelines.
- Developmental surveillance to be performed at each EPSDT well-child visit and developmental screening to be performed at nine, 18 and 30 months as indicated in the Arkansas Medicaid Manual.
- Utilize a standardized developmental screening tool during EPSDT well-child visits to determine if a child is meeting developmental milestones at various ages and stages as indicated in the Arkansas Medicaid Manual.
Education
- Educate parents and/or caregivers on developmental milestones and the importance of reporting unmet milestones to the child’s Primary Care Provider.
- Encourage providers to have parent (s) and/or caregiver(s) to complete a standardized developmental screening questionnaire prior to the well-child visit.
- Refer patients to appropriate therapy (i.e., speech, occupational, physical, etc.).
Resources
- Development milestones (CDC Milestone tracker) resources/education materials for parent(s) and/or caregiver(s)
- Arkansas Medicaid Well-Child booklet
- Recommendations for Preventive Pediatric Health Care - Periodicity Schedule
Tools
Many tools are available to assess children’s development in the early years. A list of validated screening tools can be found in the Screening Tool Finder in the American Academy of Pediatrics Screening Technical Assistance and Resource (STAR) Center. The STAR table is not exhaustive, and other screening tools may be available. The American Academy of Pediatrics does not approve nor endorse any specific tool for screening purposes.
Some of the most commonly used screening tools include:
General Development
- Ages & Stages Questionnaires, Third Edition (ASQ-3)
- Parents’ Evaluation of Developmental Status (PEDS)
- Survey of Well-being of Young Children (SWYC)
The American Academy of Pediatrics does not approve or endorse any specific tool for screening purposes. This list includes examples of validated tools and is not exhaustive. Other screening tests may be available.
EPSDT Booklet
References
- American Academy of Pediatrics, (April 2023). "Recommendations for Preventive Pediatric Health Care Periodicity Schedule." Retrieved March 2024 from https://downloads.aap.org/AAP/PDF/periodicity_schedule.pdf
- Arkansas Department of Human Services (2024). “Child Health Services/Early And Periodic Screening, Diagnosis, And Treatment (EPSDT).” Retrieved March 2024 from https://humanservices.arkansas.gov/divisions-shared-services/medical-services/helpful-information-for-providers/manuals/epsdt-prov/
- Centers for Disease Control and Prevention (September 2023). “Developmental Monitoring and Screening for Health Professionals.” Retrieved March 2024 from https://www.cdc.gov/ncbddd/childdevelopment/screening-hcp.html
- Centers for Medicare & Medicaid Services. Children's Health Care Quality Measures (2024). Retrieved March 2024 from https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/childrens-health-care-quality-measures/index.html
- Centers for Medicare & Medicaid Services (2024). "Child Core Set Reporting Resources. Retrieved March 2024 from https://www.medicaid.gov/medicaid/quality-of-care/performance-measurement/adult-and-child-health-care-quality-measures/child-core-set-reporting-resources/index.html
Web Resources
Articles
- American Academy of Pediatrics “Evidence-Informed Milestones for Developmental Surveillance Tools” Retrieved March 2023 from https://publications.aap.org/pediatrics/article/149/3/e2021052138/184748/Evidence-Informed-Milestones-for-Developmental?searchresult=1
- American Academy of Pediatrics (2020). “Promoting Optimal Development: Identifying Infants and Young Children with Developmental Disorders Through Developmental Surveillance and Screening.” 145 (1): e20193449. Retrieved March 2023 from https://doi.org/10.1542/peds.2019-3449
- American Family Physician (2022). “CDC's Revised Developmental Milestone Checklists.” Am Fam Physician. 2022;106(4):370-371. Retrieved March 2024 from https://www.aafp.org/pubs/afp/issues/2022/1000/editorial-cdc-developmental-milestone-checklist.html
- Centers for Disease Control and Prevention (2021). “CDC’s Work on Developmental Disabilities.” Retrieved March 2023 from https://www.cdc.gov/ncbddd/developmentaldisabilities/about.html
- Centers for Disease Control and Prevention (Last Reviewed September 2023). “Developmental Monitoring and Screening for Health Professionals.” Retrieved March 2024 from https://www.cdc.gov/ncbddd/childdevelopment/screening-hcp.html
- Child and Adolescent Health Measurement Initiative. 2020-2021 National Survey of Children’s Health (NSCH) data query. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). Retrieved March 2024 from childhealthdata.org.
- The Annie. E. Casey Foundation, Kids Count Data Center (2022). “Children who have one or more emotional, behavioral, or developmental conditions in Arkansas.” Retrieved March 2024 from https://datacenter.kidscount.org/data/tables/10668-children-who-have-one-or-more-emotional-behavioral-or-developmental-conditions?loc=5&loct=2#detailed/2/5/false/1696
Educational Tools for Parents
- Centers for Disease Control and Prevention. (Last Reviewed June 2023). “Learn the Signs. Act Early.” Retrieved March 2024 from https://www.cdc.gov/ncbddd/actearly/index.html
- CDC’s Milestone Tracker app in English and Spanish Download the Milestone Tracker app from the App Store external iconMilestone TrackerDownload the Milestone Tracker app from the App Store external icon Download the Milestone Tracker app from Google Play external iconMilestone TrackerDownload the Milestone Tracker app from Google Play external icon
Reviewed and revised March 2024