Developmental delay screening tools not beneficial, new guidelines reveal

Early childhood is an important time for brain development. As a paediatrician at SickKids, I witness the amazing and often rapid changes in a child’s early development, including the development of gross motor skills (i.e. sitting or walking), fine motor skills (i.e. using hands for clapping or playing), speech and language skills, social and emotional skills, and thinking skills. We think about all of these skills together generally as ‘child development’.

Although development typically follows a similar pattern for most children, there is also some variation in the age and order that children acquire these important skills. For example, a child who shows atypical development in gross motor function at one year may quickly ‘catch up’ and ultimately demonstrate a healthy development pattern. Conversely, sometimes an atypical pattern of development can indicate an underlying health problem. This is why there has been a movement in the past few decades towards the importance of monitoring child development during the early years of life. It is thought that identifying problems early on may allow for early interventions.

A few years ago, the province of Ontario implemented a developmental screening program, which involved a physician-administered standardized questionnaire that parents fill out at the 18-month well child visit. Seeing the need for a national-level guideline for paediatricians and family doctors on this topic, the Canadian Task Force on Preventive Health Care (CTFPHC) is releasing a recommendation that primary care doctors not use a screening questionnaire at the 18-month visit (or any other visits) based on a systematic review of the available evidence. Instead of using a screening tool, we advise that doctors discuss with parents, at every visit, how their child is developing and listen carefully to any concerns raised by parents.

The evidence revealed that available screening questionnaires were not particularly accurate and had the potential to result in ‘false positive’ tests, meaning that children are identified with developmental concerns when in fact their development is on track. This can cause unnecessary stress and worry for parents and can also lead to unnecessary referrals to specialists. The CTFPHC also found that there was no evidence to suggest that using parent-completed screening questionnaires leads to improved development or academic performance.

Overall, the CTFPHC concluded that there is a serious lack of high-quality research studies on monitoring or screening for child development and how to best identify any delays. We believe that more research on this topic should be a high priority. More research is also urgently needed to determine the best treatments for children with known developmental delays.

For more details, please visit the Canadian Task Force on Preventive Health Care webite.