Overview 

It is universally acknowledged, that early detection of developmental disorder is the cornerstone for early interventions to achieve substantial child health improvement. This is because caregivers may not be able to detect every developmental delay, it is essential to screen children as many of the disorders can go unnoticed until late childhood. 

 In this topic we are going to answer the fundamental questions regarding child developmental screening, how it is conducted, and its different aspects.

What is a developmental screen?

Child development refers to the physical, emotional, and social changes that occur as a child progresses from a reliant infant to an independent adult.¹ 

Screening child development is a formal process by which the healthcare provider uses standardised tools to closely monitor how a child is developing in comparison to other children.² ​

Screening vs surveillance

Developmental surveillance or monitoring includes a wide-scope assessment of a child's developmental progress. It should be performed by the doctor or the nurse on every visit to pick up children at risk, and it involves taking detailed history, performing clinical examinations, and performing growth measurements with the help of information provided by the parents, caregivers, and school.

On the other hand, developmental screening uses a more in-depth approach to identify subtle signs and risks that may not be detected by conventional surveillance, because it utilises standardised tools created specifically to screen all areas of development. It is performed at certain ages like at 9, 18, 24, or 30 months of age or when there is a concern raised by the developmental surveillance.² ​

Developmental domains 

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Child development is divided into five main domains or milestones to better understand its aspects. A child may have a delay in one or multiple domains where it is referred to as “Global developmental delay” in the latter.

Physical domain 

Physical domain covers all matters related to the physical body and involves the assessment of a child motor skills, performed by the muscles, which means the skills related to body movement, coordination, and balance.

Motor skills are divided into: 

• Gross motor: The skills done by large muscle groups of the body like assessing the child's ability to support the head, to walk or sit, and to run and balance
• Fine motor: Skills carried out by small muscle groups of the body like grasping objects, writing, and stacking blocks

Mental domain 

The cognitive or mental domain concerns the ability of the child to perform mental processes executed by the brain, to understand information inputs from the child's surrounding environment. It involves thinking and reasoning which manifest in learning and information processing abilities. It also involves problem-solving and memory.³ 

Language domain

Language domain encompasses all aspects of verbal communication and covers: 

• Language structure like word forms and phonics (sounds)
• Language content like vocabularies and semantics 
• Language use²

Social domain

Social domain addresses all areas related to the child's interaction with other individuals, including the parents, siblings, friends, and teachers.

Emotional domain

Emotional development is strongly tied to social development. The screening assesses the child's emotions, how they regulate them, and their self-perception.³

Examples of child developmental milestones which evolve with age until the age of 2 years are: ​

Children need to meet the required milestones specific to their age group in order to be classified as developmentally appropriate to age.⁴ 

Disorders to be screened for

Some conditions are frequently discovered during the screening process spanning various developmental, physical, and emotional domains that may affect the child's overall health and growth. Examples include:

• Cerebral palsy (CP): In which there is movement, muscle tone, and posture which is usually discovered during infancy when a child shows motor developmental delay. It is considered the most significant cause of motor delay 
• Autism (ASD): In which there is impairment in social interactions and behaviour and is either diagnosed during infancy or later 
• Speech and language delay: characterised by impaired speech or use of language for communication and has a wide range of causes 
• Attention-deficit/Hyperactivity disorder (ADHD): The child shows reduced attention span, hyperactive behaviour, and impulsivity
• Vision and hearing problems: issues with hearing and eyesight impairments 
• Emotional disorders: like depression and anxiety
• Intellectual disabilities²​

Screening tools 

Comprehensive evaluation of child development requires the use of standardised and reliable tools which takes a few minutes to accurately identify even the minor unnoticed disorders.

Examples of such tools are:

Ages and stages questionnaire (ASQ)

Is a questionnaire that is filled by the parents to assess the general development of their child, It is composed of around 30 questions and it is most suitable for ages younger than or equal to five years of age.

Denver developmental screening test

A professional tool that covers all the domains of development, it is used for children younger than six years of age. 

Modified checklist for autism in toddlers. Revised with follow-up (M-CHAT-R/F) 

It is a parent-based screening tool to identify children at risk of autism spectrum disorder.¹ 

What is the next step?

When a child is identified to have the risk of any developmental disorder either noticed by the doctor or the nurse during usual visits, or after being detected to have a high risk by a screening tool then consultations with professionals specialised in child development should be made to perform more detailed and comprehensive assessments to either confirm or rule out any abnormality.¹ ​

Benefits of early developmental screening 

Early developmental screening offers many benefits including: 

Early recognition of disorders 

Every detected developmental delay will be followed by investigations to identify the cause of this delay which is essential as the treatment options or interventions are different from one condition to another. For instance, hearing impairment in children can result from simple temporary causes like ear infections or can result from more limiting genetic hearing disorder each of which requires a different treatment approach.

Early intervention 

Timely interventions address developmental disorders before they become more severe and allow the child to catch up to normal development. Interventions can be: 

• Physiotherapy 
• Occupational therapy 
• Surgery 
• Speech therapy

Better outcomes 

Children who receive early intervention can be able to achieve higher outcomes and are more likely to reach their full potential which enhances their social skills, school performance, and improves their overall quality of life.⁴

Improve health literacy

Screening tools help the parents and caregivers to become more acquainted with the aspects related to their child's development, like the developmental domains and milestones making them aware of any health-related issues and when to act upon them.⁵ 

What are the challenges? 

Developmental screening faces several challenges that impact its implementation such as:

Health-provider related

Physicians sometimes trust and overestimate their clinical skills over the screening tool despite the tools being proven to be more reliable and accurate in spotting developmental issues.

Administrative related 

There is a limitation when it comes to educating and training the providers about the significance and implementation of the screening.

Cultural related 

In multinational societies problems such as language differences can form a significant barrier to the application of the screening process and the screening tools should be in all the available languages and the providers must be prepared for such situations. 

Accessibility related

Not all children can access good health services and screening. Therefore, it is essential to ensure the availability of the screening tools for underserved groups.^5,6

How to address the challenges? 

Some measures can be employed to overcome the challenges encountered during developmental screening such as: 

• Providers training 
• Using electronic screenings which save time and have better access 
• Promoting health equality⁵​

Summary

Child developmental screening involves the use of standardised tools to perform a comprehensive assessment of the child's physical, cognitive, emotional, and social development in order to detect potential disorders which allows for early intervention that enhances the overall well-being of the child.