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Bar graph: Developmental screening by CSHCN status Bar graph: Developmental screening among CSHCN by presence of developmental problems

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Developmental Screening

The American Academy of Pediatrics recommends assessment of child development and behavior at every well-child visit, and formal developmental, social and behavioral screening with a standardized instrument at the 9, 18, and 24-30 month visits.1 Early identification of developmental disorders is important so that at-risk children can receive needed services as promptly as possible.

To assess developmental screening, the 2007 NSCH asks parents of children age 10 months to 5 years if they “filled out a questionnaire about specific concerns or observations” about their child's development communication or social behaviors. In addition, parents are asked a series of questions about the content of the questionnaire to confirm that that questionnaire was a developmental screening instrument.

Overall, fewer than one in five children (19.5 percent) aged 0-5 received developmental screening. States ranged in their rates of developmental screening from 10.7 percent in the worst-performing state to 47.0 percent in the best-performing state. CSHCN were more likely to be screened than non-CSHCN, even after adjusting for other socio-demographic differences between CSHCN and non-CSHCN. However, overall rates were low, with less than 1 in 4 CSHCN receiving developmental screening.

Screening is particularly important among children with emotional, behavioral, or developmental (EBD) conditions, such as attention deficit hyperactivity disorder, autism, speech problems, anxiety, or depression. The data suggest that these children are being screened more frequently than other CSHCN; however, the overall rate of screening was still low, with less than 1 in 3 CSHCN with an EBD condition receiving screening.

Previous studies show that publicly insured children are more likely to receive standardized developmental and behavioral screening than privately insured children.1 Among CSHCN, there is a trend toward increased screening of publicly insured CSHCN compared to privately insured CSHCN, though due to small sample sizes, this is not statistically significant (28.5 percent versus 21.3 percent). Similarly, there are no significant differences in rates of developmental and behavioral screening of CSHCN according to race, sex, or household income.

1 Council on Children With Disabilities, Section on Developmental Behavioral Pediatrics, Bright Futures Steering Committee, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. Identifying infants and young children with developmental disorders in the medical home: An algorithm for developmental surveillance and screening. Pediatrics. 2006;118(1):405-420.