Developmental screening usually takes place during routine pediatric visits. In addition to the usual physical assessment in which a child’s growth and vital signs are monitored, your pediatrician will probably ask questions related to your child’s physical, social and emotional, language, and cognitive development. Depending on the child’s age, the pediatrician may ask whether the child is crawling, standing alone, walking, running, using language to express himself, drawing pictures, or doing well in school.
In addition to these questions, you may be asked to complete an Ages and Stages Questionnaire (ASQ), which is a standard set of questions parents answer to determine, for instance, if a child is climbing stairs, stacking blocks, or finishing a sequence of numbers. The questions contained in ASQs are tailored to each age and designed to determine if a child is meeting developmental milestones appropriate to the age.
While the ASQ is a widely used and highly regarded tool, it relies on parental input and is not used to diagnose delays, but rather to determine whether a child may need further screening. Parents complete the questionnaire before a routine visit, and the child’s healthcare practitioner reviews the results during the office visit.
The results of the ASQ, your answers to your pediatrician’s questions, and your own concerns about your child’s development may lead to a developmental evaluation, which is a much more in-depth assessment of your child’s strengths and weaknesses for his or her chronological age.
Evaluations are usually conducted by a team of health care professionals that can include a developmental pediatrician, nurse practitioner, psychologist, speech-language pathologist, parent educator, and physical therapist. These evaluations usually include the administration of the Childhood Autism Rating Scale (CARS) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth edition) criteria checklist for autism. Providers may also administer other autism-specific tests.
During these visits, the child’s medical history is taken and a physical examination done, and, depending on the child’s age, assessments are done either with or without the parent present. For babies and younger children, the assessments are designed to feel like play. Older children may take a battery of tests. All of the assessment materials are used diagnostically to evaluate a child’s development.
Screening, then, is the precursor to evaluation and the results of the screening determine whether further, more in-depth evaluation is appropriate in order to obtain a diagnosis and a treatment plan for the child.