II. Health Supervision

Screening Services and Assessments: Developmental and Behavioral Screening

Monitoring the developmental and behavioral status of the infant, child, or teen is a critical part of each pediatric preventive health visit. These visits provide opportunities to observe and evaluate the child’s development and behavior over time.

Developmental and behavioral screening is an ongoing process in which the focus of evaluation changes as the child grows. In infancy and early childhood, the focus is primarily on physical and cognitive development. As the child matures, the importance of assessing behavioral health increases. Behavioral health includes areas often identified as classic mental health issues as well as substance abuse.

NEW! Download a PDF developed by Nathaniel Beers, MD, MPA explaining Developmental Screening Tools in the Office Setting.

Identifying and monitoring developmental status is more accurate when providers use validated screening tools.
The following tools are brief, easy to use, and can be completed by parents before or during the HealthCheck visit:

Periodicity and Guidelines for Developmental and Behavioral Screening

Health Check requires a developmental/ behavioral assessment at each preventive health visit from birth to 21 years.

Developmental Health Assessment

Assess developmental status through age-appropriate questions and careful observations during the visit and the physical examination.
(For suggested developmental questions, see Health History, Specific Visits.)

From Birth through 5 Years

• Obtain, update, and document a developmental history at each preventive health visit
• Ask about and observe the child’s developmental skills and achievements, including:

Fine and gross motor Behavioral or social Self-help/self-care Speech or language Problem-solving Cognition or school readiness

• Note and document any concerns that might indicate behavioral or mental health problems

Beginning at age 6 years

• Continue to evaluate the child’s physical and developmental status
• Assess the child’s psychosocial adjustment, including school performance and peer and family relationships

From age 10 years and older

• Evaluate physical development, including Sexuality Maturity Ratings or Tanner staging
• Assess developmental status and psychosocial adjustment:
  • Peer and family relationships
  • School/job performance
  • Use of drugs, alcohol, or tobacco
  • Sexual development and activity

Referrals For Developmental Services

Testing

If the child is experiencing difficulties that interfere with normal development and is not progressing as expected, further assessment is required.

The following tests are strongly recommended:

For children up to age 3 years (also may be used up to age 5)

• Denver Developmental Screening Test (DDST II) - described above under provider-administered tools.
• Revised Developmental Screening Inventory - assesses fine motor, gross motor, social emotional-adaptive and language skills.
• Gesell Development Examination More information

For children ages 3 through 5 years

• Meisels Early Screening Inventory - a brief developmental screening instrument, individually administered to children from 3 to 6 years of age. (available in Spanish)

It is also important to note any previously conducted developmental screening tests, including those administered by the Early Intervention Program (EIP), Head Start, early education or childcare staff, DC Public Schools, or other community-based providers.

For more information on developmental screening tools, consult the District of Columbia Developmental Disabilities Council at (202) 671-4490.

Referrals for Further Developmental Testing and Treatment

Make referrals for in-depth diagnostic testing and possible treatment in areas of concern if a child has a:

• Negative result on a developmental screening assessment
• Known risk for developmental delay (e.g., HIV infection)

For Children from Birth to 3 Years

DC Early Intervention Program

Children from birth to 3 years of age who are identified as having a developmental delay or disability should be referred to the District of Columbia’s Early Intervention Program.

For Children from 3 Years and Older

DC Child Find Program

Children from 3 years of age and older who have developmental delays should be referred to the Child Find Program in the DC Public Schools.

Cultural Competency in Testing

Few developmental tests are known to be culturally bias-free. When administering tests to members of culturally diverse groups, it is essential to be sensitive and well informed. Be sure to: Become knowledgeable about the culture and language of the child being tested Respect the family's cultural values Consult the norming procedures that accompany the testing manual Ensure all tests, evaluation materials, and procedures are given in the native language of the child’s family or through other modes of communication (when feasible)

Since behavioral assessments (combined with developmental evaluations) are an integral part of pediatric preventive health care, the PCP is usually the first to see children or teens with behavioral or mental health problems. Assessing behavioral health is crucial in identifying, documenting, and addressing potential problems.

For all children and teens

After performing a complete health history and physical examination:

• Conduct a psychosocial assessment including:
  • Family history
  • Childhood experience
  • Developmental history
  • School history, when applicable
  • Frequency of moving
• Evaluate for risk in the following areas:
  • Increased emergency room use
  • Increased hospitalizations
  • School attendance, truancy, or absences
  • Attention deficit hyperactivity disorder (ADHD)
  • Substance abuse by the child, teen or family member
  • Violent behavior, including fire setting or cruelty to animals or other children
  • Problems with the law, including theft or selling drugs
  • Homicidal or suicidal ideation
• Review all information individually or as part of an interdisciplinary team
• Identify children and teens at risk
• Make referrals to appropriate behavioral or mental health providers

Referrals For Behavioral or Mental Health Services

If an initial assessment reveals potential problems, provide appropriate referrals for children and teens needing the following behavioral or mental health services.

Emergency Referral to a Psychiatrist

Non-emergency Referral to a Psychiatrist

Referral to a Psychologist

Referral to a Psychiatric Social Worker

Acute Psychiatric Hospitalization

Residential Treatment