TORONTO - Simple tests can accurately pick up developmental delays in children before they start school, but too few doctors are using the screening tools, researchers say.
"Only 30 per cent of children with developmental delays are identified prior to school age -- whether that's social, physical or learning -- and most experts would agree that we should be identifying those delays earlier through regular screening," says principal investigator Dr. Marjolaine Limbos, a psychologist at BC Children's Hospital in Vancouver.
In a study of more than 300 children, Limbos and co-author Dr. David Joyce found that the Ages and Stages Questionnaire (ASQ) and the Parents' Evaluation of Developmental Status (PEDS) tests are reasonably accurate in identifying delays.
ASQ and PEDS can be filled out by parents at home or in the doctor's office, then scored in minutes by the physician. But surveys suggest that less than half of Canadian family doctors offer the questionnaires to parents, said Joyce, an assistant professor of family medicine at the University of British Columbia.
"Right now, the majority of family physicians do the eyeball test," said Joyce, explaining that doctors often rely on visual cues and clinical judgment to assess whether a young child appears to be meeting so-called developmental milestones.
"You'd think you'd be able to just see this and pick it up, and it's actually not that easy to do when you're doing it unaided," he said.
The ASQ and PEDS tests can flag any delays in a child's progress compared to other kids their age -- including speech and language comprehension; cognitive or intellectual development; and motor skills such as the ability to pick up an object or walking and throwing a ball.
Developmental delays are common, affecting an estimated 10 to 15 per cent of Canadian children, and range from mild problems to disabling deficits, including conditions covered by autism spectrum disorder.
But Joyce stressed that detecting lags in cognitive and physical progress as early in life as possible is critical if remedial treatments are to be effective.
"Children's brains are very plastic, meaning they can change and reconnect their wiring a lot easier when they're under the age of six or seven, and they become a little bit more hard-wired after that time period," he said. "So the opportunities for change if you identify the developmental delay before school age are higher.
"And so you can sometimes see these problems reverse or no longer be an issue when they get to school."
Dr. Ruth Wilson, a professor of family medicine at Queen's University, said the study is beneficial for practitioners because it validates the ASQ and PEDS tests as screening tools with "pretty good sensitivity and specificity."
Wilson, a former president of the College of Family Physicians of Canada, said that in Ontario, at least, family doctors generally use two other screening tools -- the Rourke Baby Record and the Nipissing checklist -- to assess whether a child is meeting developmental targets.
The Ontario government also has instituted an enhanced 18-month well-baby checkup that includes more in-depth developmental testing.
"There's a big resurgence in interest in screening for developmental delays in kids," Wilson said Wednesday from Kingston, Ont. "The idea is if we pick up delays early and intervene, we can make a difference in these children's lives. And, of course, all of us would want to do that."
However, she worries that even minor lags in development can lead to children being labelled and create anxiety in the parents, which in itself can be harmful to youngsters.
And some problems -- such as a permanent intellectual disability -- can't be corrected, Wilson said. "So we should not be overly optimistic that we can cure everything by detecting it a few months earlier than we might otherwise have done."
In their 2007-2008 study of 334 children aged one to five, Limbos and Joyce found both the ASQ and PEDS tests were reasonably accurate in picking up developmental abnormalities when judged by the gold standard -- a full battery of psychological testing and assessment.
The study, published in the September issue of the Journal of Developmental and Behavioral Pediatrics, found 34 of the children had delays in cognitive, speech-language and-or motor skills.
The PEDS test, which takes five minutes to complete and asks parents about any concerns they have about their child's development, was somewhat less accurate than the ASQ. That test takes about 15 minutes to complete and looks at a child's ability to perform certain activities, such as throwing a ball.
The American Academy of Pediatrics issued a policy statement in 2006 recommending that primary-care doctors administer developmental screening using a validated test with children at nine, 18 and 30 months of age.
"Our research shows that overall, the ASQ and, to a lesser extent, the PEDS are accurate and can be administered effectively and at low cost," noted Limbos.
"That's a definite advantage," said Joyce, "because one of the big barriers why physicians don't use these tests in their offices is that they don't feel they have the time or ability to do it."
But because the questionnaires are simple for parents and take little time for a doctor to score, "they could be incorporated into your busy practice and could potentially help a lot of children," he said.
Parents should not be shy about asking their doctors about taking one of the tests during a well-baby checkup, he advised.
"I think it's important for parents to know that developmental screening is an important priority. It can be helpful to bring up the issue with their physicians and that sometimes does encourage the physicians to get engaged."
