User:Christinechon/sandbox

Reference: Timing and Method of screening for pediatric developmental delay

Diagnosis
Currently, there is no consensus on a general diagnostic pathway and specific tests to approach the diagnosis of developmental delay in children. Keeping the child development stages or milestones in mind, closely monitoring these social-emotional, cognitive, behavioral and motor-sensory milestones can provide important clues about a child's overall development. The Centers for Disease Prevention and Control (CDC) program "Learn the Signs. Act Early" provides materials for parents to reference and keep track of child development at specified milestones starting from two months old up to five years of age. If there are any missed milestones that may be a concern for the parent, these materials can help initiate a conversation with the primary care physician and assign the child with more specific testing to assess the child's developmental progress. Identifying and addressing early signs, symptoms, and risk factors of developmental delay in children with an effective management strategy have shown an overall positive improvement in cognitive and academic performance and outcomes. Significant delays in one or more of the defined child developmental milestones is typically diagnosed by the primary care physician as a delayed milestone or as Global developmental delay.

Assessment

Assessment of developmental progress involves a combination of surveillance, screening tools, and other points to take into consideration:


 * Developmental Surveillance: Monitoring that is performed once any risk factors and/or symptoms for developmental delay have been identified in a child, surveillance will be used at subsequent well-child visits with the primary care physician. Attentive supervision through surveillance footage alongside an age-appropriate milestone checklist to document observations will help gain a better understanding of the child's overall developmental progress and confirm a potential diagnosis following discussion of the findings with parents.
 * Screening Tools: Utilized when a child is identified to have a potential risk for developmental delay with no identified symptoms at a regularly scheduled well-child visit. Assigned by the primary care physician, these validated tests may include an Ages and Stages Questionnaire, Child Development Review - Parent Questionnaire, and Parents' Evaluation of Developmental Status. Each of these tests differ in terms of whether the screener is completed by the child or the parent, sensitivity, specificity, the age range assigned, and the time to complete and generate a score.
 * Genetics: With proper informed consent, obtaining a family history is an important factor to include in the diagnostic process for a child presenting with symptoms and/or missed milestones. An identified genetic risk factor or cause can be used to determine a more specific approach to address any documented delayed milestones.
 * Physical Examination: Completed at all scheduled well-child visits, examining the growth parameters, such as head circumference and body mass index (BMI), are within range can help ensure proper child growth development.
 * Neuroimaging: Performed when a child's medical history or physical examination suggests that the presenting symptoms stem from the brain, which may further imply an underlying neurological diagnosis causing any observed delayed milestones to occur. Since performing brain imaging is not standard practice for diagnosing developmental delay in children, the imaging results alone are insufficient to affirm that any delayed milestones are due to any potential brain abnormalities observed through brain imaging procedures. If any brain abnormalities are observed with neuroimaging, further investigation may be pursued to determine the potential underlying cause for any missed milestones in child development. There currently are no specified guidelines or recommendations indicating that computed tomography (CT) or magnetic resonance imaging (MRI) is required to evaluate a child with any missed milestones in child development.

Current Guidelines

There are three U.S. organizations that provide varying recommendations in terms of when and how to screen children for developmental delays in children below the age of five, including the U.S. Preventative Services Task Force (USPSTF), Canadian Task Force on Preventative Health Care, and the American Academy of Pediatrics (AAP). The USPSTF provides limited information on developmental delay as a whole since it only screens for communication delays and autism, specifically speech and language. Due to lack of evidence supporting asymptomatic children benefitting from repeated early screening and surveillance at well-child visits before the age of five, the USPSTF does not recommend screening for communication delays for children showing no symptoms of developmental delay. Additionally, if there are no concerns by the parent or pediatrician in terms of any developmental delays, then the Canadian Task Force on Preventative Health Care also does not recommend screening asymptomatic children before the age of five with surveillance and screening tools. On the other hand, the AAP does have specific recommendations for developmental and autism screening regardless of the child showing any delayed milestones or not.

Genetic testing is the first line approach if a child (less than 5 years old) has no identified external factor(s) contributing to delayed milestone. It is more efficient and cost effective to perform comprehensive evaluations with the available diagnostic screening tools prior to investigations in cases without an identified external factor or genetic cause for the child's delayed milestone.

Diagnosis (of Delayed Milestone)
Identifying and addressing early signs, symptoms, and risk factors of developmental delay in children with an effective management strategy have shown an overall improvement in cognitive and academic performance.

=Current Recommendations=

There are three U.S. organizations that provide varying recommendations in terms of when and how to screen children for developmental delays in children below the age of five, including the U.S. Preventative Services Task Force (USPSTF), Canadian Task Force on Preventative Health Care, and the American Academy of Pediatrics (AAP). The USPSTF provides limited information on developmental delay as a whole since it only screens for communication delays and autism, specifically speech and language. Due to lack of evidence supporting asymptomatic children benefitting from repeated early screening and surveillance at well-child visits before the age of five, the USPSTF does not recommend screening for communication delays for asymptomatic children. Additionally, if there are no concerns by the parent or pediatrician in terms of any developmental delays, then the Canadian Task Force on Preventative Health Care also does not recommend screening asymptomatic children before the age of five with surveillance and screening tools. On the other hand, the AAP does have specific recommendations for developmental and autism screening regardless of the child showing any delayed milestones or not.

Genetic testing is the first line approach if a child (less than 5 years old) has no identified external factor(s) contributing to delayed milestone. It is more efficient and cost effective to perform comprehensive evaluations with the available diagnostic screening tools prior to investigations in cases without an identified external factor or genetic cause for the child's delayed milestone.

=Tools for Screening Delayed Milestones=

A combination of using the currently available broad and sensitive screening tools, as well as multiple repeated assessments over time, at well-child visits will provide an overall better understanding of a child's development and potential diagnosis. Assigned by the primary care physician, these validated tests may include an Ages and Stages Questionnaire, Child Development Review - Parent Questionnaire, and Parents' Evaluation of Developmental Status. Each of these tests differ in terms of sensitivity, specificity, the age range assigned, and the time to complete and generate a score.