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Fast Facts
A brief refresher with useful tables, figures, and research summaries
Screening, Referrals, Evaluation, and Services
Screening
The American Academy of Pediatrics (AAP) recommends developmental surveillance at all medical visits, and routine and regular developmental screening in the primary care setting at ages 9, 18, and 30 months. Screening is performed to identify children who require close developmental monitoring with repeat screening (borderline performance on screen) or referral for more in-depth developmental assessment, early intervention, or both. In addition, screening of all children for autism spectrum disorder (ASD) should occur between ages 18 and 24 months. A standardized tool is used to identify children who might be missed by a general developmental history alone.
Standardized screening tools include:
Modified Checklist for Autism in Toddlers (M-CHAT), with follow-up questionnaire if screen is positive
Referrals and Evaluation
When there are concerns about a child’s development, the child should be referred for further evaluation and treatment as follows:
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Children ages 0−3 years: referral to local early intervention teams (see Services below)
A referral to a developmental pediatrician, occupational, speech, and/or physical therapist may also be warranted if a specific diagnosis, such as autism, or need, such as motor delay, is suspected.
Children ages 3 years to school-age (around age 5): referral to the local Child Find agency for evaluation to determine if they qualify for developmental preschool offered by the local public school system
School-age children: Public schools are mandated to evaluate children and provide services as needed.
When developmental delay is suspected, other evaluations may be indicated based on the presentation of the child. Potential tests include:
hearing screen/audiology evaluation (e.g., concern for speech and language delay)
lead screen
genetic workup (e.g., chromosomal microarray analysis, fragile X DNA analysis, specific gene panels)
electroencephalogram (EEG; e.g., concern for seizures)
brain MRI (e.g., concern for microcephaly, motor asymmetries)
other medical tests based on history, physical exam, or both (e.g., thyroid function tests, nutritional labs)
The pediatrician also may refer children for diagnostic developmental evaluations, which may be interdisciplinary, and include combined assessment by a developmental pediatrician, psychologist, speech-language pathologist, occupational therapist, and/or physical therapist. Referrals also may be made to the individual disciplines noted above, and to other medical specialties, such as neurology or genetics, based on local resources and the child’s presentation.
Services
Individuals with Disabilities Education Act (IDEA)
IDEA is a law that governs how states and public agencies provide free appropriate public education to eligible children with disabilities throughout the nation and ensures special education and related services to those individuals from birth to age 21 years. IDEA was a groundbreaking law signed in 1975, originally as the Education for All Handicapped Children Act, that guaranteed children with disabilities access to free public education. The law has been amended to improve access to services for all individuals with disabilities.
Individuals with Disabilities Education Act (IDEA) |
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The purpose of IDEA is:
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Early intervention (EI): Services for infants and children at risk for a disability, or with identified developmental delay, from birth through age 2 years (up to the third birthday) are provided through EI under IDEA Part C. EI services are provided in the home or other natural environments free of charge for qualifying children. EI is administered by each state and therefore services and qualification criteria may vary across the country. In general, after a referral is made to EI, a formal assessment is scheduled to determine if the child qualifies for services. Some children may qualify automatically based on certain circumstances (e.g., diagnosis of Down syndrome). Once a child qualifies, the determined services will be provided at home with caregiver involvement. The child can continue to receive EI services until their third birthday, provided they continue to qualify.
Special education: When a child turns age 3 years, EI services end and children enrolled in EI undergo an assessment through the school system to determine continuation of services. If a child did not receive EI services before age 3, the child will be evaluated to determine eligibility for special education services. These services fall under IDEA Part B. To qualify, children must meet the criteria for a disability under IDEA and for special education. After qualification for special education, it is the role of the public school system to provide free and appropriate public education (FAPE) in the least restrictive environment (LRE). LRE means the school district should aim to enroll a child within a general education setting as much as appropriate for the child and provide the required support to the child in that environment to assure success. Children receiving special education services should have individualized education programs (IEPs) that are tailored to their needs. Parents or guardians are involved in the IEP process and ultimately sign off on the plan if they agree or they have the right to disagree with recommendations and subsequently work with the school to determine a mutually agreeable plan.
Special education services continue to be provided through age 21 years and include transition planning for adulthood. When adolescents start high school, they become involved in their IEP meetings, in order to participate in transition-planning goals. Goals may range from daily-living skill development to job training to working toward a postsecondary school education. Transition planning generally begins at age 14, and initial implementation of an individual transition plan (ITP) occurs around age 16.
In 2018−2019, the Department of Education reported:
>400,000 infants and children are served through EI
>60% of children with disabilities were integrated into general education classrooms for most of their day
Reviews
The best overviews of the literature on this topic
Lipkin PH et al. Pediatrics 2015.
![[Image]](content_item_thumbnails/peds.2015-3409.jpg)
Moeschler JB et al. Pediatrics 2014.
![[Image]](content_item_thumbnails/41287.jpg)
Guidelines
The current guidelines from the major specialty associations in the field
Zubler JM et al. Pediatrics 2022.
![[Image]](content_item_thumbnails/peds.2021-052138.jpg)
Hyman SL et al. Pediatrics 2020.
![[Image]](content_item_thumbnails/peds.2019-3447.jpg)
American Academy of Pediatrics 2017.
![[Image]](content_item_thumbnails/41289.jpg)
Noritz G and Murphy N. Pediatrics 2013.
A guide for the primary care provider for the evaluation of a child with motor delays, including next steps once a child is identified as having a delay
![[Image]](content_item_thumbnails/41285.jpg)
Additional Resources
Videos, cases, and other links for more interactive learning
American Academy of Pediatrics 2023.
Provides technical assistance to states and communities to facilitate implementation, offers additional tools and resources to encourage use in different settings and by different disciplines, and promotes the use of Bright Futures Preventive Services Measures in clinical practice and in quality-improvement efforts
![[Image]](content_item_thumbnails/41300.jpg)
Weitzman CC et al. Pediatrics. 2022.
![[Image]](content_item_thumbnails/peds.2021-054771.jpg)
First Words Project 2021.
Resources to help families identify early signs of delays
![[Image]](content_item_thumbnails/41295.jpg)
Center for Disease Control and Prevention 2022.
![[Image]](content_item_thumbnails/41294.jpg)