Developmental-behavioral disorders are among the most common chronic medical problems encountered in primary care pediatric practice. In addition, the numbers of children with identified developmental-behavioral disorders have increased over time, and thus, so has the need for greater educational, therapeutic, and developmental-behavioral health supports. Primary pediatric medical providers are ideally positioned to identify developmental-behavioral problems at the earliest possible age, given their frequent and longitudinal contact with children and their families beginning at birth. While families rely on their primary care providers for their knowledge of diseases of childhood, they also consider primary pediatric medical providers as expert in all aspects of children’s health, including development and behavior, and they typically first approach their primary pediatric medical providers about their concerns about their children’s development or behavior before approaching any other professionals. This family reliance on their medical providers, combined with the prevalence of developmental-behavioral disorders, highlights the importance of routine developmental and behavioral surveillance, screening, and evaluation within the primary care medical home.
DEVELOPMENTAL AND BEHAVIORAL SURVEILLANCE
The American Academy of Pediatrics (AAP) has published a policy statement on developmental surveillance, screening, and evaluation, and a clinical report on behavioral screening. Developmental and behavioral surveillance is a longitudinal process of developmental and behavioral monitoring over time within the primary care medical home. Developmental and behavioral surveillance should occur at every well child visit, and it helps to provide parent education, assists in supporting healthy development and behavior, and is useful in identifying children who may be at an increased risk of developmental and behavioral differences. Developmental surveillance relies on the clinical judgment and accumulated experience of pediatric medical providers, and it consists of five key components: (1) specifically asking about parental developmental-behavioral concerns, (2) identifying neurobiologic (eg, prematurity) and psychosocial (eg, maternal depression) risk and protective factors, (3) obtaining a developmental and behavioral history, (4) observing the child’s development and behavior during the clinic visit, and (5) maintaining an accurate documentation of findings. If concerns are raised through developmental-behavioral surveillance, the child should be referred to his or her local early intervention (birth through 3 years of age) or early childhood special education (3 to 5 years of age) program.
DEVELOPMENTAL AND BEHAVIORAL SCREENING
With the goal of identifying developmental and behavioral disorders as early as possible, so that interventions can begin at the youngest possible age when the central nervous system has increased capacity for plasticity, pediatric medical providers should implement developmental and behavioral screening during early childhood. Developmental and behavioral screening involves the administration of standardized and validated measures to parents/caregivers, as research has shown that parents reliably report on their children’s development and behavior. Important screening test properties include sensitivity, specificity, predictive validity, reliability, and standardization sample. These screening tools are most commonly parent questionnaires, and developmental and behavioral screening tests are designed to identify children at significant risk for a ...