Developmental Screening
Surveillance vs. Screening
Developmental surveillance, also known also as developmental monitoring, is a flexible, longitudinal, continuous, and cumulative process that should be included at each pediatric preventive care visit throughout the first 5 years of life. [American: 2014] If concerns arise as a result of developmental surveillance, a developmental screening tool should be administered or, when there is sufficient concern, further evaluation should be undertaken for specific developmental disabilities.
Screening involves:
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Surveillance involves:
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When to Screen
Screening Tools
- Validated for a primary care population for screening use at the 9-, 18- and 30- (or 24-) month visits
- Broadband instruments that screen multiple domains of development, including some combination of gross and fine motor, language/communication, cognitive, academic, self-help, problem-solving, social-emotional, and behavioral skills
- Vetted for favorable psychometric properties, defined as sensitivity and specificity of at least 70%, and reliable, consistent results when used in different settings
- Parent-completed questionnaire (screens requiring a trained observer to complete the questionnaire are not included here)
- Administered in 15 minutes or less
- Compatible with electronic medical records
- Available in multiple languages

Ages & Stages Questionnaires, 3rd edition (ASQ-3)
- Format: 21 questionnaires that are age specific, 30 items per questionnaire
- Age range: 1 - 66 months
- Scoring: cut off points for each domain that indicate recommendation for further monitoring or referral
- Parent reading level: 4th - 6th grade
- Languages: English, Spanish, French. An online system can be purchased for use in English, Spanish, Somali, and Hmong.
- Can be supplemented with concurrent use of ASQ:SE-2 (Ages and Stages Questionnaire: Social-Emotional)
Parents Evaluation of Developmental Status (PEDS)
- Format: single parental response form, 10 items per questionnaire
- Age range: birth to 7 years 11 months
- Scoring: algorithm that indicates need for referral, further screening, or continued surveillance
- Parent reading level: 4th - 5th grade
- Languages: English, Spanish, Vietnamese. Licensed translations also available in Albanian, Amharic, Arabic, Armenian, Bengali, Bulgarian, Burmese, Cambodian, Chinese (Traditional and Simplified characters), Danish, Dutch, Dzongkha, Farsi, Filipino Tagalog, French, Galician, German, Greek, Gujarati, Haitian-Creole, Hebrew, Hindi, Hmong, Icelandic, Indonesian, Karen, Korean, Laotian, Malay, Nepali, Polish, Portuguese and Cape Verdean, Punjabi, Russian, Serbian (Cyrillic and Latin), Somali, Swahili, Tagalog, Taiwanese, Thai, Turkish, Urdu, Visayan, and Yoruba
- May also be useful as a surveillance tool
- Can be supplemented with concurrent use of Parents’ Evaluation of Developmental Status: Developmental Milestones (PEDS:DM)
Parents Evaluation of Developmental Status: Developmental Milestones (PEDS:DM)
- Format: different age-specific questionnaires, 6 to 8 items per questionnaire
- Age range: birth to 7 years 11 months
- Scoring: pass/no pass for each of the tested domains
- Parent reading level: 4th - 5th grade
- Languages: English and some forms available in Spanish
- Can be supplemented with concurrent use of Parents’ Evaluation of Developmental Status (PEDS)
Survey of Well-Being of Young Children (SWYC)
- Format: set of age-specific tools usually completed in less than 10 minutes, which include:
- Baby Pediatric Symptom Checklist (BPSC): 18-item screen for social-emotional development from birth to 18 months. The SWYC/MA version adds postpartum depression screening to the early infancy visits.
- Preschool Pediatric Symptom Checklist (PPSC): 25-item screen for social-emotional development from 18-60 months
- Parent’s Observations of Social Interactions (POSI): autism screen for 16-30 month olds; questions are integrated into the 18-, 24-, and 30-month screens
- Family Risk Factors: questions assembled from other previously validated instruments to screen caregivers for substance abuse, parental depression, inadequate food supply, and domestic violence
- The Developmental Milestones Checklists: Various 10-item, age-specific screens for language, fine and gross motor skills, and cognitive development. The overall sensitivity for the milestones portion was 76% and specificity was 77%.
- Age range: age specific from 1 month to 5 years 6 months
- Scoring: different scoring algorithms for each component. Scoring can be done in Excel or manually, or via the electronic medical record in an integrated eSWYC system. Developmental Milestones are pass/no pass (or “needs review”).
- Parent reading level: 6th grade
- Languages: English, Spanish, Burmese, Nepali, and Portuguese with additional languages undergoing validation.
- Some clinical practices use the entire set of tools at every well child check-up, whereas other practices use only 1 component of the set of screens, such as using only the Developmental Milestones.
Pearls and Alerts
- Be aware that each screening tool carries its own sets of strengths and limitations.
- When choosing a screening tool for your practice, consider cost, implementation, language and literacy barriers, and privacy issues for family members filling out information.
- Some questions may not be as relevant in certain cultures or for children living in foster families or in group care settings.
- Recognize that these tools may not be validated for children from bilingual or multilingual homes, or in children who have complex medical conditions or disabilities.
- Remember to correct for prematurity in children under 24 months.
- Be prepared to answer questions about typical vs. atypical development and to provide appropriate support and referrals.
- Use of developmental milestone trackers at each check-up can be useful for monitoring and to engage families, but it does not take the place of formal, validated screening instruments.
- Diagnosis of a specific developmental disability is NOT necessary for an early intervention program (EIP) referral to be made or for services to begin.
Response to a Positive Screen
Primary Care
Specialty Care
- Early intervention programs (Early Intervention for Children with Disabilities/Delays (see NM providers [35])): Families may self-refer to early intervention, but the clinician may send a referral form to provide specific information and to better coordinate care. The program may provide services such as developmental therapies, service coordination, family training, counseling, and home visits. The program will NOT perform a medical evaluation or other evaluations to establish a diagnosis of a specific developmental disability
Subspecialist Collaborations
- Audiologist (Audiology (see NM providers [19])): Evaluates for hearing loss as a potential cause or contributor to developmental delay.
- Geneticist and genetic counselor (Medical Genetics (see NM providers [2]) and Genetic Testing and Counseling (see NM providers [5]): Performs evaluation when an underlying medical condition or genetic syndrome is suggested by family history, examination, or clinical course.
- Licensed social worker (Social Workers (see NM providers [0])): Identifies family needs and refers family to formal and informal support agencies and organizations (some social workers provide direct counseling and therapy).
- Occupational therapist Occupational Therapy (see NM providers [17]): Evaluates for self-help and self-care deficits and sensory processing deficits. Develops a plan for treatment to optimize function and participation in daily tasks and activities (some also work on feeding problems).
- Pediatric neurologist (Pediatric Neurology (see NM providers [5])): Evaluates for underlying neurological and neuromuscular disorders, develops treatment plan.
- Physical medicine and rehabilitation physician (Pediatric Physical Medicine & Rehabilitation (see NM providers [3])): Evaluates physical function and movement, develops medical and rehabilitation treatment plan for children with brain or spinal cord injuries, neuromuscular disorders, and other musculoskeletal conditions.
- Physical therapist (Physical Therapy (see NM providers [12])): Evaluates physical function and movement. Develops a plan for treatment including physical activities and adaptive equipment to optimize function.
- Primary care clinician or developmental pediatrician (Developmental - Behavioral Pediatrics (see NM providers [2])): Performs medical evaluation; identifies and treats associated conditions.
- Psychiatrist (Psychiatry/Medication Management (see NM providers [2])): Evaluation and treatment of associated psychiatric conditions and maladaptive behaviors.
- Psychologist (Mental Health Evaluation/Assessment (see NM providers [4])): Cognitive or developmental testing or other diagnostic tools. Identification of associated psychiatric conditions and development of or referral for behavioral treatment plan.
- Speech-language pathologist (Speech - Language Pathologists (see NM providers [22])): Evaluates for expressive, receptive, and pragmatic language deficits; develops a plan for treatment (some also work on feeding problems).
Resources
Information & Support
For Professionals
Birth to 5: Watch Me Thrive (HHS & DOE) ( 1007 KB)
An early care and education provider’s guide for developmental and behavioral screening. Contains developmental screening
measures for young children and information about the reliability and validity of commonly-used developmental screening tools;
U.S. Department of Health and Human Services and U.S. Department of Education, 2014.
Developmental Surveillance Resources for Healthcare Providers
Free research-based, parent-friendly resources to assist healthcare providers with developmental surveillance from age 2 months
to 5 years; Centers for Disease Control and Prevention.
Early Intervention Contacts (CDC)
Contact information by state; Centers for Disease Control and Prevention.
Developmental Red Flags (Kids Get Care) ( 186 KB)
A printable developmental surveillance checklist that gives tips for finding possible developmental delays; not a validated
screening instrument.
For Parents and Patients
Learn the Signs Act Early (CDC)
Offers many tools, videos, lists, learning materials, and a developmental Milestone Tracker app (ages 2 months to 5 years);
Centers for Disease Control and Prevention.
Positive Parenting Tips: Babies, Toddlers & Preschoolers (CDC) ( 137 KB)
How to nurture, protect, and guide your child through different life stages; Centers for Disease Control & Prevention.
Early Intervention: What It Is and How It Works (understood.org)
General explanation about the purpose of early intervention and what types of services are available through early intervention
programs around the country.
Tools and Materials for Tracking Milestones (CDC)
Milestone tracker apps, parent kits, videos, photos, books and tip sheets for tracking developmental milestones; Centers for
Disease Control and Prevention.
Early Intervention Contact Information by State (CDC)
Phone numbers and links to websites of early intervention programs in each state, commonwealth, and territory; Centers for
Disease Control and Prevention.
Physical Developmental Delays (healthychildren.org)
Checklists that are organized by age and activity, which have some illustrations and videos of how to monitor your child for
motor delays; from the American Academy of Pediatrics.
Zero to Three
A national nonprofit organization that aims to promote the health and development of infants and toddlers, with information
and resources for parents and professionals. Information about parenting, development, learning, behavior, and well-being
of infants and toddlers. Includes video real-life examples, articles, and FAQs.
Parents' Guide to Understanding Pediatric Specialists (healthychildren.org)
Learn more about pediatric medical subspecialists and their role in care of your child; from the American Academy of Pediatrics.
Developmental Milestones (pathways.org)
Developmental milestones for 0-3 years.
Practice Guidelines
American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance
and screening.
Pediatrics (original publication 2006; reaffirmed 2014).
2014;118(1):405-20.
PubMed abstract / Full Text
Includes the 5 components of developmental surveillance, screening, follow-up on a positive screen, CPT coding, and an algorithm
for assessing development at each pediatric preventive care visit throughout the first 5 years of life.
Tools
ASQ:SE-2 (Ages and Stages Questionnaire: Social-Emotional)
A parent-completed series of 19 age-specific questionnaires screening communication, gross motor, fine motor, problem-solving,
and personal adaptive skills. Results are in a pass/fail format for domains; available for purchase.
Ages and Stages Questionnaire: Developmental (ASQ-3)
Parent-completed, age-specific questionnaires that screen for developmental delays in children between 1 month and 5½ years
old; available for purchase.
Parents Evaluation of Developmental Status (PEDS and PEDS:DM)
Parent-completed age-specific questionnaires used for children 0 months to 7 years old. Includes an algorithm that indicates
need for referral, further screening, or continued surveillance (PEDS:DM). Parent reading level: 4th to 5th grade. Available
for purchase in many languages.
The Survey of Well-Being of Young Children (SWYC)
Free, 10-minute screening tools encompassing behavioral, developmental, social-emotional, autism, and family well-being for
well-child visits ages 2 months to 5 ½ years-by Tufts Medical Center.
Services for Patients & Families in New Mexico (NM)
Service Categories | # of providers* in: | NM | NW | Other states (4) (show) | | NV | OH | RI | UT |
---|---|---|---|---|---|---|---|---|---|
Audiology | 19 | 3 | 8 | 4 | 25 | 28 | |||
Developmental - Behavioral Pediatrics | 2 | 1 | 2 | 2 | 12 | 9 | |||
Early Intervention for Children with Disabilities/Delays | 35 | 3 | 32 | 3 | 14 | 55 | |||
Genetic Testing and Counseling | 5 | 5 | 12 | 6 | 7 | 12 | |||
Head Start/Early Head Start | 7 | 1 | 58 | 2 | 19 | 32 | |||
Medical Genetics | 2 | 1 | 5 | 1 | 4 | 8 | |||
Mental Health Evaluation/Assessment | 4 | 10 | 24 | 144 | |||||
Occupational Therapy | 17 | 1 | 27 | 2 | 19 | 38 | |||
Pediatric Neurology | 5 | 5 | 17 | 7 | |||||
Pediatric Physical Medicine & Rehabilitation | 3 | 3 | 3 | 3 | 6 | 14 | |||
Physical Therapy | 12 | 11 | 1 | 5 | 47 | ||||
Psychiatry/Medication Management | 2 | 49 | 79 | 56 | |||||
Social Workers | 8 | 12 | |||||||
Speech - Language Pathologists | 22 | 4 | 13 | 4 | 31 | 69 |
For services not listed above, browse our Services categories or search our database.
* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.
Authors & Reviewers
Author: | Jennifer Goldman, MD, MRP, FAAP |
2017: update: Jennifer Goldman, MD, MRP, FAAPSA |
2011: first version: Sarah Winter, MDA; Paul Carbone, MDR |
Page Bibliography
Adams RC, Tapia C.
Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes.
Pediatrics.
2013;132(4):e1073-88.
PubMed abstract / Full Text
Published in 2013 and reaffirmed in August 2017, this clinical report provides information for primary care providers about
early intervention services and optimal partnership and referrals.
American Academy of Pediatrics.
Identifying infants and young children with developmental disorders in the medical home: an algorithm for developmental surveillance
and screening.
Pediatrics (original publication 2006; reaffirmed 2014).
2014;118(1):405-20.
PubMed abstract / Full Text
Includes the 5 components of developmental surveillance, screening, follow-up on a positive screen, CPT coding, and an algorithm
for assessing development at each pediatric preventive care visit throughout the first 5 years of life.
Bagner DM, Frazier SL, Berkovits M.
Getting ready for preschool: linking early intervention and family mental health for infants and toddlers with developmental
delay.
Adm Policy Ment Health.
2014;41(6):707-11.
PubMed abstract / Full Text
Boulet SL, Boyle CA, Schieve LA.
Health care use and health and functional impact of developmental disabilities among US children, 1997-2005.
Arch Pediatr Adolesc Med.
2009;163(1):19-26.
PubMed abstract