Background
Current guidelines of the American Academy of Pediatrics (AAP) recommend screening for
developmental problems in children using formal standardized screening tools at ages 9, 18, and 30 months. Adoption
of these guidelines into practice has been gradual, with prior research showing many children still not being screened.
Objective
To examine trends from 2002-2016 and predictors in 2016 of formal developmental screening practices for
children less than 36 months of age in the U.S.
Design/Methods
The AAP Periodic Survey surveyed pediatricians on developmental screening practices in 2002
(n=538; response rate=55%), 2009 (n=509; 57%), and 2016 (n=469; 47%). The surveys were national random
samples of U.S. members who provide primary care to children less than 36 months of age. The surveys asked about
current screening practices, including the use and administration of standardized developmental screening tools. Chisquare
tests assessed descriptive differences in screening practices over time and a multivariable logistic regression
model was estimated to determine predictors of using a formal screening tool in 2016. Trainees were excluded.
Results
Pediatricians’ reported use of one or more developmental screening tools increased from 23% in 2002, to
46% in 2009, and to 63% in 2016 (Figure). The reported use of the Ages and Stages Questionnaire and Parents'
Evaluation of Developmental Status tools increased each survey year. Screenings shifted from being performed
primarily by the pediatrician in 2002 (86%) to other staff (60%) in 2016 (p<.001). However, 87% of pediatricians
reported that they alone review and interpret the screenings in 2016. Model results (using data from 2016 only)
indicate that respondents in medical school/hospital practice settings are more likely than those in small practices to
report use of a formal screening tool (AOR 2.97, 95% CI 1.27-6.96), while other respondent characteristics in the
model were not statistically significant.
Conclusion(s)
Pediatricians’ reported use of a formal developmental screening tool has tripled since 2002 to 63% in
2016. Pediatricians increasingly rely on staff to administer the formal screening, but typically interpret the results
themselves. Those in hospital or medical school settings show the highest rates of developmental screening,
indicating that quality improvement efforts to further increase screening may best be targeted at group and small
practice settings.
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