Developmental Surveillance and Screening

Developmental Surveillance and Screening Patient Care Overview

Given the prevalence of developmental delays and disabilities, all pediatric primary care clinicians should be prepared to screen, identify, and care for children and youth with developmental delays and disabilities and their families.

Activities to promote developmental surveillance and screening are implemented across numerous Academy initiatives, including Bright Futures, the Council on Children with Disabilities, Council on Early Childhood, Section on Developmental and Behavioral Pediatrics, and the Screening Technical Assistance and Resource (STAR) Center.

Below you will find information about developmental surveillance and screening tools and resources for pediatricians. Resources for parents, families, and caregivers are available on the AAP parenting website, HealthyChildren.org.

AAP Policies and Clinical Reports

Quick Facts

• 1 in 6 children aged 3-17 years have developmental disabilities- conditions that affect how children play, learn, speak, act, or move.
• Many children with a developmental disability are not identified until after starting school.
• Nationally, only 17% of children younger than 5 years of age with developmental delays received services for those delays.
• Studies of children who are younger than 3 show that large numbers of presumably eligible children are not enrolled in early intervention. Despite high rates of developmental delays among children who receive Early Head Start, <5% of these children were also enrolled in early intervention.
• The percentage of children aged 3–17 years diagnosed with a developmental disorder increased–from 16.2% in 2009–2011 to 17.8% in 2015–2017.
  • Specifically, diagnoses increased for attention-deficit/hyperactivity disorder (ADHD) (8.5% to 9.5%), autism spectrum disorder (ASD) (1.1% to 2.5%), and intellectual disabilities (ID) (0.9% to 1.2%).

This information is sourced from the following  CDC document and page .

What is the Difference Between Developmental Surveillance and Developmental Screening?

It is important to understand how developmental surveillance is different from developmental screening.

Developmental Surveillance is an important way for clinicians to identify children at risk for developmental delay and should occur during every health supervision visit. During these visits, clinicians should address developmental progress, concerns, and promotion. AAP recommends conducting developmental surveillance at every health supervision visit, with special attention at the 4- to 5-year visit as the child prepares to enter elementary school. Developmental surveillance resources can be integrated into office procedures.

Six components of developmental surveillance

1. Eliciting parent’s concerns
2. Obtaining a developmental history
3. Observing the child
4. Identifying risks, strengths, and protective factors
5. Maintaining a record
6. Sharing opinions and findings

Developmental screening supplements and strengthens ongoing developmental surveillance to identify subtle risks for developmental delays that parents and pediatricians may not recognize during routine interactions. General developmental screening tests should be conducted at the 9-, 18-, and 30-month health supervision visit. Autism spectrum disorder screening tests should be conducted at the 18- and 24- month health supervision visits. Screening tests should also be administered when a clinician, parents, or early childhood professionals have concerns during surveillance or at any other time concerns arise. Screening involves the use of validated, standardized screening tests used universally at specific ages, as well as when developmental surveillance reveals a concern.

It’s very important to remember that surveillance is NOT screening and should not be thought to take the place of a validated screening tool. Think of surveillance as working together with those specific screening tools!