Developmental delay screens for healthy Canadian kids not recommended

Healthy children aged one to four with no signs of delays in their development shouldn't be screened with questionnaires and instead doctors should continue to assess the kids in the tried and true way, new Canadian guidelines recommend.

Children with developmental delays perform lower than expected for their age in areas including gross and fine motor skills such as hopping on one foot or using scissors, or language such as speaking in sentences. Children with such delays often have learning difficulties or behavioural problems later in life.

The Canadian Task Force on Preventive Health Care recognized research has changed since it last issued guidelines on developmental delays in 1994. In Monday's issue of the Canadian Medical Association Journal, the experts in primary care reviewed the evidence on screening healthy children.

Researchers have created several screening tools or questionnaires for doctors to give parents to assess how a child is progressing physically, cognitively and socially, using a scoring system to check for appropriate patterns on concerns.

The hope was that screening tools would allow a child's difficulties to be identified as early as possible to intervene and improve his or her development.

Despite the research progress, the task force found no evidence from randomized controlled trials, the gold standard test, that screening children without recognized signs of possible developmental delays improves health outcomes.

Conversations encouraged

Parents "would want us to use screening tools if they were both beneficial and not harmful, but we haven't been able to identify benefits and we have postulated there's potential harms," said Dr. Patricia Parkin, a member of the task force and a pediatrician at the Hospital for Sick Children in Toronto.

The potential harms include the fallout from inaccurate, false positive results on screening tools that lead to worry and anxiety for families when a child is labelled as having a developmental delay when it isn't really there.

Instead, the group recommends clinicians such as family doctors stick with what they've always done: use their knowledge to observe and examine a child and ask parents if they have any concerns.

"Many children in Canada have many visits to their family doctor in that crucial early childhood period," Parkin said in an interview. "It's at these visits that in addition to receiving immunizations, the doctor should be assessing and monitoring the children's development and this a wonderful opportunity for parents to have that conversation with their doctor."

The guidelines do not apply to children with signs or symptoms, or when parents have concerns that could point to developmental delays, or when children are being closely monitored because of risk factors such as premature birth or low birth weight.

The authors also found there is some evidence that structured treatments for those aged two to five with speech and language difficulties may help.

Parkin said the guidelines focus on general development. For children with developmental delays due to autism spectrum disorder, intensive behavioural interventions appeared to improve their cognitive function.

The task force is funded by the Public Health Agency of Canada and the Canadian Institutes of Health Research.