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CTFPHC says there is a lack of high-quality evidence demonstrating the benefits of standardized screening tools in healthy children
OTTAWA, ON, March 29, 2016 – Today the Canadian Task Force on Preventive Health Care (CTFPHC) released an updated guideline that recommends against screening for developmental delay using standardized tools in healthy children not suspected of having a developmental delay. This guideline recommendation applies to those children who are not at high risk1 for developmental delay and whose parents, caregivers, or clinicians have no concerns about development. Guidelines are published in the Canadian Medical Association Journal (CMAJ).
Screening with questionnaires is sometimes recommended to detect conditions in individuals that do not have any signs or symptoms of a disease. Screening tests are particularly useful if they can accurately and consistently detect a condition at an early stage and therefore allow for more effective treatment. However, screening tests can cause more harm than benefit if they have high rates of false positive results or do not lead to better outcomes for patients.
Because of the lack of evidence of benefits of screening using standardized tools in primary care and evidence of the inaccuracy of commonly used screening tools, the new guideline strongly recommends against screening using standardized tools for children aged 1 to 4 years without recognized signs of developmental delay and whose parents, caregivers, and clinicians have no concerns about development. The 2016 guideline replaces the 1994 recommendations.
This recommendation does not apply to children who present with signs, symptoms, or parental concern that could indicate developmental delay or whose development is being closely monitored because of identified factors, such as premature birth or low birth weight.
“We know there is considerable debate within the medical community about developmental delay and the use of screening tools but there is no evidence that screening in primary care using a standardized tool improves health outcomes for children without recognized signs of developmental delay,” said Dr. Brett Thombs, member of the CTFPHC and guideline working group. “There has been strong interest in determining whether screening can provide early identification and intervention that might improve health outcomes among children with developmental delay; however, use of standardized screening tools can also result in false positives2 which can create undue stress, anxiety, and labeling for those children and their families.”
“All parents and caregivers want to ensure the very best for their children,” added Dr. Patricia Parkin, member of the CTFPHC and guideline working group. “We recommend that clinicians continue to monitor and assess children’s development at every visit, ask parents about their child’s development, and be alert to any risk factors. Parents and caregivers should speak to their child’s physician if they have any concerns about their child’s development.”
About Development Delay
There are many factors associated with increased risk of developmental delay, including poor maternal health during pregnancy, birth complications, infections, genetic characteristics, exposure to toxins, trauma, maltreatment, and possibly low socioeconomic status.
Developmental delay is characterized by performance that is significantly lower than age-expected norms in any of the following domains: gross and fine motor skills, speech and language, social and personal skills, activities of daily living, and cognition. Children with developmental delay in their early years often have learning difficulties, behavioural problems, and functional impairments later in life.
Treatment
There is some evidence that structured language-based interventions for children aged 2 to 5 years with speech/language impairments may lead to improvement in receptive and expressive language. Among children with known developmental delays due to autism spectrum disorders (ASD), intensive behavioral interventions (20-40 hours/week) appear to improve cognitive function but parent-mediated interventions do not improve cognitive outcomes. These interventions, however, were tested among children whose developmental delays were identified without screening. Applicability to screen-detected developmental delay, which would typically be less severe, is uncertain.
For the complete report and details on the CTFPHC’s findings, recommendations, and accompanying knowledge translation tools, please visit www.canadiantaskforce.ca
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care (CTFPHC) is an independent body of primary care and prevention experts. The mandate of CTFPHC is to develop and disseminate clinical practice guidelines for primary and preventive care based on systematic analysis of scientific evidence.
1There are many factors associated with increased risk of developmental delay, including poor maternal health during pregnancy, birth complications, infections, genetic characteristics, exposure to toxins, trauma, maltreatment, and possibly low socioeconomic status.
2In medical screening, a false positive screen occurs when a test result improperly indicates the presence of a disease or condition.