By Mei Elansary and Michael Silverstein, Pediatrics, March 2020
In this issue of Pediatrics, Lipkin et al describe trends in pediatrician-reported developmental screening and referral practices between 2002 and 2016. The authors compare data across serial American Academy of Pediatrics (AAP) Periodic Surveys conducted in 2002, 2009, and 2016. They demonstrate that pediatricians’ self-reported use of formal developmental screening tools increased from 21% in 2002 to 63% in 2016 and that referral of patients identified as at risk for developmental delay to early intervention (EI) services increased concomitantly from 41% to 59%. Their data, however, also suggest that in 2016, more pediatricians considered lack of available treatment options to be a barrier to screening than did so in 2002 (21% vs 9%).
Although developmental screening, surveillance, and referral to services has long been an important aspect of pediatric primary care, the AAP issued its first policy statement calling for universal developmental screening in 2001. The unique sampling frames queried with each Periodic Survey included in the current study preclude a true longitudinal analysis of individual-level practice changes; however, the current study represents an important barometer of screening and referral practices over the nearly 20 years since the AAP’s initial policy statement. Notably, these years have been characterized by an epidemic of autism spectrum disorder diagnoses and increasing recognition of the effect of late preterm birth and adverse childhood experiences (both highly prevalent exposures) on children’s developmental trajectories. This period has also seen conflicting recommendations between the AAP and the US Preventive Services Task Force over screening for speech and language delay and autism spectrum disorder.
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