Don’t screen healthy Canadian kids for developmental delay

No benefit found for commonly used screening tools in kids without signs of problems.

When doctors assess and monitor a child’s development at regular visits, it’s an opportunity for parents to raise any concerns.

From left, Isabella Chang, 6, Nicole Chang, 9, and Rachel Tome, 5, give their teddy bears a checkup at Joe DiMaggio Children's Hospital's teddy bear clinic during Nova Southeastern University's A Day for Children event in Davie. Sun Sentinel photo by Gina Fontana.

From left, Isabella Chang, 6, Nicole Chang, 9, and Rachel Tome, 5, give their teddy bears a checkup at Joe DiMaggio Children’s Hospital’s teddy bear clinic during Nova Southeastern University’s A Day for Children event in Davie. Sun Sentinel photo by Gina Fontana.

CBC News March 29, 2016

Healthy children aged one to four with no signs of delays in their development shouldn’t be screened with questionnaires and instead doctors should continue to assess the kids in the tried and true way, new Canadian guidelines recommend.

Children with developmental delays perform lower than expected for their age in areas including gross and fine motor skills such as hopping on one foot or using scissors, or language such as speaking in sentences. Children with such delays often have learning difficulties or behavioural problems later in life.

The Canadian Task Force on Preventive Health Care recognized research has changed since it last issued guidelines on developmental delays in 1994. In Monday’s issue of the Canadian Medical Association Journal, the experts in primary care reviewed the evidence on screening healthy children.

The trouble begins, it explained in the journal, with the screening checklists that parents fill out (Is your toddler speaking in sentences? Can he pick up small objects?). These tools identify as developmentally delayed many children who, upon examination by a developmental expert or pediatrician, turn out not to be. As many as 55 percent of those labeled as delayed are not, a 2015 analysis found. – Does screening for developmental delays help children? in Stat.

Researchers have created several screening tools or questionnaires for doctors to give parents to assess how a child is progressing physically, cognitively and socially, using a scoring system to check for appropriate patterns on concerns.

The hope was that screening tools would allow a child’s difficulties to be identified as early as possible to intervene and improve his or her development.

Despite the research progress, the task force found no evidence from randomized controlled trials, the gold standard test, that screening children without recognized signs of possible developmental delays improves health outcomes.

Conversations encouraged

Parents “would want us to use screening tools if they were both beneficial and not harmful, but we haven’t been able to identify benefits and we have postulated there’s potential harms,” said Dr. Patricia Parkin, a member of the task force and a pediatrician at the Hospital for Sick Children in Toronto.

The potential harms include the fallout from inaccurate, false positive results on screening tools that lead to worry and anxiety for families when a child is labelled as having a developmental delay when it isn’t really there.

Instead, the group recommends clinicians such as family doctors stick with what they’ve always done: use their knowledge to observe and examine a child and ask parents if they have any concerns.

“Many children in Canada have many visits to their family doctor in that crucial early childhood period,” Parkin said in an interview. “It’s at these visits that in addition to receiving immunizations, the doctor should be assessing and monitoring the children’s development and this a wonderful opportunity for parents to have that conversation with their doctor.”

Dr. Patricia Parkin is a pediatrician at the Hospital for Sick Children, and professor in the Department of Pediatrics at the University of Toronto. She co-authored the guideline, published in the CMAJ.

The guidelines do not apply to children with signs or symptoms, or when parents have concerns that could point to developmental delays, or when children are being closely monitored because of risk factors such as premature birth or low birth weight.

The authors also found there is some evidence that structured treatments for those aged two to five with speech and language difficulties may help.

Parkin said the guidelines focus on general development. For children with developmental delays due to autism spectrum disorder, intensive behavioural interventions appeared to improve their cognitive function.

The task force is funded by the Public Health Agency of Canada and the Canadian Institutes of Health Research.

Source CBC News


Recommendations on screening for developmental delay, Canadian Task Force on Preventive Health Care. Marcello Tonelli, Patricia Parkin, Alejandra Jaramillo Garcia, Wendy Martin, Sarah Connor Gorber and Brett Thombs. CMAJ March 29, 2016. doi: 10.1503/cmaj.151437

  Further reading

Screening for Speech and Language Delay in Children 5 Years Old and Younger: A Systematic Review, Wallace IF, Berkman ND, Watson LR, Coyne-Beasley T, Wood CT, Cullen K, Lohr KN. Pediatrics. 2015 Aug;136(2):e448-62. doi: 10.1542/peds.2014-3889. Epub 2015 Jul 7.

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Screening for developmental delay among children aged 1-4 years: a systematic review, Rachel Warren MA, Meghan Kenny MA, Teresa Bennett MD PhD, Donna Fitzpatrick-Lewis MSW, Muhammad Usman Ali MD, Diana Sherifali PhD, Parminder Raina PhD. CMAJ Open, cmajo January 25, 2016 vol. 4 no. 1 E20-E27. doi: 10.9778/cmajo.20140121.

Also see
Children are diagnosed with autism at younger ages since push for universal screening EurakAlert! AAAS
Does screening for developmental delays help children? Stat

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