reply to discussion
Early detection of developmental delays and the forthcoming interventions are an integral part of the well-child visit and family nurse practitioner role. Early childhood is an important time for language, cognition, social, and motor development. Failure to meet developmental milestones can have lasting and long-term effects on the pediatric patient and their family (Lamsal et al., 2018).
Using a standardized development screening tool, 2 to 6 times more children with suspected learning delays are identified (Gellasch, 2019). In the same study, it was found that most primary care providers do not use a standardized testing questionnaire but rather informal interviews.
Easily available and accurate tools such as Ages and Stages Questionnaire (ASQ), Parents Evaluation of Developmental Status (PEDS), and Survey of Well-Being of Young Children (SWYC) show both adequate specificity and modest sensitivity (Sheldrick et al., 2020) should be highly utilized.
In my experience this term, I have gotten excellent mentoring on using the ASQ screening tool and the MCAT (Modified Checklist for Autism in Toddlers). My preceptor works in a dual primary care clinic and a pediatric clinic. They pay the annual fee for the ASQ and MCAT questionnaires to be available and updated. This allows them to screen each child in a standardized manner. Both they and their nursing staff are familiar with scoring and can easily recognize outliers when they review the parents’ answers. My preceptor has shared how it has screened for a few positive cases along with their professional assessment.
In previous family practice experiences, I have seen the providers use more of the informal interview process and no standardized questionnaires. Likely the barrier for this rural clinic was the number of patients being seen and the cost of the program. In a quick google search, it appeared the annual cost for ASQ access was approximately $1600 per year for unlimited access. This is a capital expense for small rural clinics. Another barrier would be the time if not familiar with educating staff and parents on how to fill out the screening tool and then the provider being familiar with the tool. One solution in the google search as a free screening tool available at easterseals.com.
I see the absolute benefit of using these tools in helping screen children. In my experience, it isn’t the provider that chooses not to use the tool but rather the availability of resources in a family practice clinic serving all ages versus a pediatric specialty clinic. The provider may be able to request the tools but it must be part of the clinic’s overall budget which is usually addressed by a clinic administrator. I can see that finding the best practice may look different for one of my experiences versus the other. As a beginning and new provider, finding ways to navigate the real world will be both challenging and exciting and should keep us all being lifelong learners!
Gellasch P (2019) The developmental screening behaviors, skills, facilitators, and constraints of family nurse practitioners in primary care: a qualitative descriptive study. Journal of Pediatric Health Care 33(4): 466–477.
Lamsal, R., Dutton, D. J., & Zwicker, J. D. (2018). Using the ages and stages questionnaire in the general population as a measure for identifying children not at risk of a neurodevelopmental disorder. BMC pediatrics, 18(1), 122. https://doi.org/10.1186/s12887-018-1105-z
Sheldrick RC, Marakovitz S, Garfinkel D, Carter AS, Perrin EC. Comparative Accuracy of Developmental Screening Questionnaires. JAMA Pediatr. 2020;174(4):366–374. doi:10.1001/jamapediatrics.2019.6000
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