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Early Detection of Developmental and Behavioral Problems

	OBJECTIVES

 
After completing this article, readers should be able to:

1. List the percentage of children who drop out of school and have undetected disabilities or known environmental risk factors.
   
2. Describe the ways in which early intervention is effective.
   
3. Delineate methods of detecting disabilities and development delays.
   
4. Describe the percentage of children in whom assessment tools can detect disabilities correctly.
   
5. Determine how often children should undergo developmental testing.
   
6. Describe the role of parents in detecting and addressing developmental and behavioral problems.
   

	Epidemiology and Issues for Clinicians

 
Approximately 15% to 18% of children in the United States have developmental or behavioral disabilities. An additional 7% to 10% experience substantive school failure and drop out before completing high school. Overall, one in four children has serious psychosocial problems. To ensure that these children are detected early and their difficulties addressed, the American Academy of Pediatrics’ Committee on Children with Disabilities recommends that pediatricians use validated screening tools at each health supervision visit.

Many pediatricians find it difficult to comply with this recommendation because of minimal reimbursement, young patients’ limited compliance with requests to stack blocks or answer questions, time constraints, and concerns about the accuracy and length of well-known screening tools. Finally, children who are at environmental risk for developmental delays and subsequent school failure due to poverty, limited parental education, and similar risk factors do not always receive health supervision visits. Accordingly, they are unavailable at times when pediatricians typically are most vigilant in their search for developmental problems.

     UNDERDETECTION
Most physicians depend on clinical judgment rather than screening tools. Unfortunately, research shows that clinical judgment detects fewer than 30% of children who have mental retardation, learning disabilities, language impairments, and other developmental disabilities. Clinical judgment also identifies fewer than 50% of children who have serious emotional and behavioral disturbances. Use of improved classification systems, such as the Primary . . . [Full Text of this Article]

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