Pediatric Toolkit

Tips and tools to help you implement

ASQ developmental and social-emotional screening in your pediatric practice

“Why should I use in my pediatric practice?”

Screening is recommended by the AAP.

Given the critical role pediatricians can play in the early identification of children at risk, the American Academy of Pediatrics recommends in its policy statement on screening that pediatricians and primary care providers:

• conduct developmental surveillance of all infants and young children during preventive care visits and screen using evidence-based tools at 9, 18, and 24 or 30 months, or whenever a concern is expressed
• present the results of the screening to the family using a culturally sensitive, family-centered approach
• maintain links with community-based resources, such as early intervention, school, and other programs, and coordinate care with them
• increase parents awareness of developmental delays and disabilities and resources for intervention

ASQ makes it simple to incorporate screening.

Screening doesn't have to be overly time consuming. Simple strategies can be incorporated into office visits to help identify children at risk much like routinely checking a child's height and weight. Pediatricians are the professionals most likely to see a child on a regular basis. You have the opportunity to play a crucial role in identifying children with developmental delays at a young age. You can even integrate ASQ results with your electronic health record (EHR) using ASQfi Online.

Using ASQ helps you catch more delays.

Some pediatricians use clinical judgment alone to identify potential developmental problems. But studies have shown that while clinical judgment is undoubtedly valuable, when used alone, it detects fewer than 30% of children who have developmental disabilities.

When pediatricians complement their clinical judgment with the use of a standardized screening tool, they identify 70% to 80% of children with developmental disabilities. The percentage rises when screening is conducted at periodic intervals (rather than at a single point in time or only as problems are suspected).

Concerned about overidentifying children with delays? Though screening does result in occasional referrals of children later found not to qualify for services, most overreferrals are shown to be for children with below-average development who would benefit from extra attention.

ASQ is parent-completed.

Studies show that parents observations of their children are excellent predictors of developmental delays. Since ASQ is a parent-completed tool, it makes the most of families' in-depth knowledge and helps them become active partners in the screening process.

Of the screening tools available, parent-report tools such as Ages & Stages Questionnaires are the most time- and cost-efficient time and cost being the two biggest barriers pediatricians face when implementing screening.

ASQ is family friendly, with fun learning activities.

The ASQ system includes fun, simple, and inexpensive learning activities that you can share with parents. The activities cover the same developmental and social-emotional areas screened with ASQ-3 and ASQ:SE-2 and help children progress in areas of concern.

ASQ is culturally sensitive and appropriate.

Not only are ASQ-3 and ASQ:SE-2 the most reliable, valid developmental and social-emotional screeners available, they’ve also been thoroughly reviewed for cultural sensitivity. Illustrations, wording, and examples in the questionnaires have been refined according to user feedback, so parents of diverse backgrounds can give the most accurate responses.

ASQ makes it easy to share children's strengths with families, which helps you improve your rapport with parents. With ASQ, parents also have an easy way to learn about developmental milestones and actively encourage their child's progress.

Tips for setting up a developmental screening program in your pediatric practice

Most residents come out of medical school now with the expectation that developmental screening will be a routine part of any pediatric practice they join. They are surprised to discover that what was a given in their residency clinics does not necessarily translate into practice.

In fact, fewer than half of established practices have a structured developmental screening program in place.

Dr. Kevin Marks, pediatrician, provides key pointers on how to implement a successful developmental screening program:

1. Screening Champion: An office leader or anyone in the practice who recognizes the importance of early detection and advocates for the adoption of developmental screening.
2. Patient Scheduler: Instructs the caregiver to come in 15 minutes early for a well-child visit to complete the ASQ-3.
3. Receptionist: Provides the correct age-interval ASQ-3 as soon as the caregiver enters the waiting room.
4. Nurse: Checks that the caregiver received the correct ASQ-3, assists with completion, and scores the ASQ-3 before the clinician enters the exam room.
5. Clinician: Reviews and interprets ASQ-3 results and addresses parental concerns. Also provides activity sheets to encourage development and makes referrals as appropriate.
6. Resource Staff: After discussing next steps with the caregiver, generates referrals and acts upon clinician recommendations.

AAP Screening Recommendations

• General developmental screen routinely at 9, 18, and 24 or 30 months, at 4 years to measure kindergarten readiness, plus as needed if at risk for a developmental delay.
• Social-emotional screen routinely at 5 years, plus as needed if at risk for social-emotional problems.
• Autism-specific screen routinely at 18 and 24 months, plus as needed if at risk for ASD.

12 Key Components of a Periodic Screening Program

1. Eliciting and addressing parent/caregiver concerns
2. Gathering and maintaining a developmental-behavioral history
3. Identifying biological and environmental developmental-behavioral risk and protective factors
4. Making accurate observations about child and parent-child interactions
5. Promoting healthy development and behavior
6. Making a referral decision using surveillance
7. Referring to IDEA agencies and other community programs
8. Documenting the process and outcomes
9. Providing referral care coordination and/or follow-up
10. Following up with supplemental screening and/or medical tests
11. Reviewing referral feedback reports and recommendations
12. Monitoring progress and the need for additional services after initiating chronic-condition management for children with special needs

Adapted from Developmental Screening in Your Community: An Integrated Approach for Connecting Children with Services by Diane Bricker, Ph.D., Marisa Macy, Ph.D., Jane Squires, Ph.D., & Kevin Marks, M.D.