Early identification of children with delays in their development is important because there are programs that can help boost their progress in key areas and make them more successful as they start school. Well-child checks are an important time to monitor development in speech, motor skills like walking and hand-eye coordination, and social skills like smiling, playing with others, and using their imagination.
Recently, formal questionnaires have been developed for parents to fill out that help families and their doctor track a child’s progress in these key areas. Parents are experts on their own children, and these questionnaires are a good way to tap into that expertise.
While checking for appropriate development is an important part of every well-child visit, the American Academy of Pediatrics recommends a standardized form, such as the Ages and Stages Questionnaire (ASQ), be used to screen every child at 9, 12, and either 24 or 30 months. There are many reasons these tests are beneficial. Primarily, it is patient-centered as parents get the chance to observe the child and complete the questionnaire. Additionally, the ASQ is standardized, meaning it can normalize a child’s development by comparing it with thousands of other children their same age (not just a sibling or other kids in the neighborhood). Studies also show that the test is more sensitive, i.e. it can identify subtle differences.
The goal of the ASQ is to identify children early who will benefit from extra help. Since this test is very sensitive, some children who score below normal may actually be developing fine, causing unnecessary worry for parents. Doctors and communities should balance the benefit of finding children who will benefit from early identification of delays with the risk of abnormally labeling children who have normal development. One common reason for an abnormal test result would be filling out the form early. When you are talking about a 9 month old, filling out the form even a month early may have a big impact, as babies can develop new skills daily!
For children whose ASQ score suggest a developmental delay, the clinician and family should make a decision together about how to proceed. They should search for other factors that may influence test scores such as: gestational age, health or illnesses, hearing and vision, sibling development, and family and past medical history. One conservative option is to monitor and retest the child at the next visit. Another option is a referral to Birth to Three, a program with staff specially trained to identify and work with children who have delays. If you have concerns about your child’s development and would like more information about resources in your county, you can contact Wisconsin First Step at 1-800-642-7837.
Using Ages and Stages, health care providers and families can work together to reliably identify delays in speech, motor, or social development and use local resources, such as Birth to Three, to get children appropriate help. For more information, contact your primary care doctor.