You've probably heard of "developmental screening," but what does it actually entail? How often should your child be screened? What does screening look for?
This article will seek to briefly explain the importance of screening and introduce the three primary types of screening tools used by healthcare providers and childcare professionals today.
In this article:
What is “screening”?
Screening is used by medical professionals to detect potential health conditions in people who do not yet show any symptoms. It allows them to quickly and easily assess risk and identify who requires more comprehensive follow-up, such as additional testing.
The type of widespread screening done in early childhood is known as developmental screening. Developmental screening refers to a formal assessment of the milestones that a child has achieved at a very specific point in time, which provides important insights into how the child is developing, where they might need additional help, and what might come next.
The American Academy of Pediatrics (AAP) recommends every child be screened 5 times before the age of 3 for developmental health, including Autism.
Unfortunately, most primary care providers are not following through–nationally, developmental screening rates are an abysmal 17%.
Why is developmental screening so important for young children?
Brain growth
The first 5 years after your child’s birth are particularly crucial to their health, well-being, and the overall trajectory of their life. In fact, 90% of your child's brain develops by age 5. This is the time when the foundations for future learning, health, and behavior are established.
During these 5 years, your child will achieve hundreds of developmental milestones–tasks or skills that most children can do by a certain age. Generally, children achieve milestones in a set pattern: for example, they crawl, then stand, then walk.
Developmental milestones are a way of tracking a child's development and making sure that they are progressing normally. If a child has not reached a specific milestone by a certain age–for example, if they have not said a single word by 12 months–it suggests that there could be a concern in that area and follow-up is warranted.
Pathfinder Health divides child and baby milestones into four major developmental domains:
(1) movement,
(2) social and emotional,
(3) language, and
(4) cognitive
Other sources sometimes divide these developmental domains differently, so don’t be confused if you’ve seen a slightly different version elsewhere.
Each one of these areas is equally important in helping your child reach full developmental maturity.
Early intervention
While developmental delays may sound scary, it's important to remember that early intervention and proper support provide many benefits for infants and toddlers with developmental delays or disabilities and can even change your child's developmental path.
Early intervention services can help your young child learn the skills they need to be successful in school and life, reducing the need for more costly special education and related services later on.
The key is to identify developmental issues as early as possible.
Parent engagement in child development
Screening is not just about detecting developmental delays–it’s also about tracking developmental milestones and celebrating your child’s accomplishments!
It’s exciting to know that your child is achieving milestones and fun to understand why those milestones are so significant to their future development.
If you would like more information about the significance of particular milestones as your child achieves them, visit the Pathfinder Help app and begin tracking your child's progress!
How does screening work?
Administration of developmental screenings
For the most part, parents can complete screening questionnaires (at home, in a doctor's waiting room, or as part of an in-person or phone interview).
The questionnaires can also be completed by a caregiver or teacher. Healthcare professionals then score the questionnaires.
Types of screening tools
There are only three screening tools validated by the American Academy of Pediatrics—the ASQ-3, SWYC, and PEDS.
All are relatively quick to complete (under 15 minutes) and easy to score.
As we describe below, there are pluses and minuses to each and different providers may use or recommend different screening tools. If you have any questions or concerns about the type of screening instrument used or the results of any screening, speak with your child's healthcare provider.
ASQ-3
The Ages and Stages Questionnaire Version 3 (“ASQ-3”) is a series of 21 individual age-specific questionnaires that cover five areas of child development: communication, gross motor, fine motor, problem-solving, and personal-social.
Physicians generally administer the ASQ-3 at every well-child visit from 1 to 66 months (although Medicaid restrictions may limit how frequently it can be given).
To conduct the screening, the healthcare provider asks the parent whether their child does or does not do a certain task or skill and assigns points depending on their response (5 points for “sometimes,” 10 points for “always,” and 0 for “never”).
The healthcare provider then uses the total points to determine if the child's development appears to be on schedule, in the monitoring zone, or below the cutoff (meaning that follow-up is suggested).
ASQ-3 is recommended by the American Academy of Pediatrics.
SWYC
The Survey of Well-being of Young Children ("SWYC") is a comprehensive screener for children under 5 years of age that features separate forms for every age on the pediatric well-child visit schedule.
The SWYC age forms include separate sections relating to three primary areas of child development: developmental milestones, behavioral and emotional development, and family risk factors such as postpartum depression quiz. Certain ages also include an autism screening section.
The forms for certain ages also feature a special screening for autism. On each form, parents respond "Not at all/Not Yet" (0 points), "Somewhat" (1 point), or "Very Much" (2 points). Each section has its own point threshold that indicates whether a child is “at risk” and should be further evaluated.
SWYC is recommended by the American Academy of Pediatrics. It is available online ONLY in the Pathfinder Health app.
PEDS
The third approved screening tool is the Parents' Evaluation of Developmental Status (“PEDS”). The PEDS is designed for children ages 0 to 8 years and covers expressive and receptive language, gross and fine motor skills, behavior, self-help, and school and social skills.
The questionnaire uses the same 10 questions across the entire age range and was specifically designed to be more open-ended in order to elicit parents’ concerns about their child’s development, behavior, and mental health.
Questions ask about concerns in certain areas and the parent circles "No," "Yes," or "A Little" and adds comments where necessary.
The scoring form for PEDS identifies the concerns that predict developmental problems and provides evidence-based guidance on next steps.
PEDS is recommended by the American Academy of Pediatrics.
Comparing ASQ-3, SWYC, and PEDS screening tools
| ASQ-3 | SWYC | PEDS |
Child age | 1-66 months | 2-60 months | Birth to 8 years |
Structure | 21 age-specific questionnaires | 12 age-specific forms on the well-child visit schedule; each form includes separate sections related to developmental milestones, behavioral/emotional development, and family risk factors. Certain ages also include an autism screening section. | One questionnaire is administered to all ages containing 10 open-ended questions designed to elicit and address parents’ concerns. |
Developmental domains | ASQ-3: Communication, gross motor, fine motor, problem solving, and personal/social ASQ-SE-2: self-regulation, compliance, adaptive functioning, autonomy, affect, social communication, and interaction with people | Cognitive, language, motor, behavior, social-emotional interaction | Expressive language, receptive language, fine motor, gross motor, social/emotional, self-help, academics (older children) |
Sample question | Does your child stack a small block or toy on top of another one? (18-month questionnaire) | Does your child name at least 5 familiar objects – like ball or milk? (18 month developmental milestone form) | Do you have any concerns about how your child talks and makes speech sounds? |
Parent input | The parent answers Yes, Sometimes, or Not Yet. | The parent indicates Not Yet, Somewhat, or Very Much. | In response to questions about concerns, the parent circles No, Yes, or A Little and adds comments. |
Results | The results clearly indicate whether to (1) evaluate the child further, (2) closely monitor the child, or (3) provide information to parents about the child’s strengths and recommend activities for healthy development | The results indicate whether the child should be referred for counseling and/or intervention and provide some options for immediate counseling and intervention. | PEDS “provides decision-making paths to aid in interpreting parents’ responses to questions.” |
Time required | 10-15 min to complete; 2-3 min to score | 15 min or less | Approx. 2 min to administer and score if healthcare provider interviews parent based on form |
Accuracy of Developmental Screening Tools
A 2020 study tested the diagnostic accuracy of all 3 questionnaires using a pool of 1495 families.
This study determined that all three had trade-offs in highlighting developmental delays and weeding out false positives, but no single instrument was clearly superior to the others.
These results suggest that developmental screeners can provide valuable information to healthcare professionals, but by itself should not be relied on to provide definitive recommendations.
Instead, screening questionnaires should be considered only one element in a larger system of care.
1. What is the ASQ-3 developmental screening?
The Ages & Stages Questionnaires, Version 3 (ASQ-3) is a tool designed to assess the development of children between 1 and 66 months in 5 different areas, highlight concerns, and recommend any necessary monitoring or further evaluation.
2. What does the ASQ-3 measure?
The ASQ-3 measures a child’s developmental progress in 5 different areas: communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. It then categorizes them as on schedule, in the monitoring zone, or requiring further evaluation.
3. How many ASQ-3 questionnaires are there?
The ASQ-3 has a series of 21 individual age-specific questionnaires designed for children aged 2, 4, 6, 8, 9, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60 months.
4. What is a good ASQ score?
A child gets a separate score in each of the 5 different areas. The ASQ-3 interprets the score for each area and finds development in that area to be on schedule, close to the cutoff score (monitor the child), or below the cutoff score (may need further evaluation).
5. How is ASQ age calculated?
The online ASQ Age Calculator determines the child’s correct age for the questionnaire based on the current date, the child’s birth date, and the number of weeks premature (how long before 39 weeks they were born).
6. What age does ASQ go up to?
The final ASQ questionnaire is the 60 month questionnaire. This is designed to accurately assess child development from 57 months and 0 days to 66 months and 0 days.
7. Is the ASQ-3 free?
The ASQ is not free through the official website or at doctor’s offices. However, parents can take the ASQ for free through organizations such as Easterseals and state and local Children & Family services
8. How often should the ASQ-3 be completed for a child?
The AAP recommends that every child be screened at 9, 18, and 30 months of age. The ASQ has forms for most ages and can be done more frequently if concerns exist. If a screening flags a possible delay, the child should be rescreened after 2-3 months.
9. What is the SWYC?
The Survey of Well-being of Young Children (SWYC) is a screening test for children under age 5 that covers developmental milestones, behavioral and emotional development, and family risk factors. At certain ages it also screens for autism.
10. Is SWYC validated?
The American Academy of Pediatrics recommends performing developmental screenings using validated tests. It includes the SWYC on its list of approved general developmental screening tests.
11. How is the SWYC scored?
Parents mark whether their child does certain developmental tasks "Not at all/Not Yet" (0 points), "Somewhat" (1 point), or "Very Much" (2 points). Each section has its own point threshold that indicates whether a child is “at risk” and should be further evaluated.
12. What age is SWYC for?
The SWYC has 12 age-specific forms for the following ages: 2, 4, 6, 9, 12, 15, 18, 24, 30, 36, 48, and 60 months. The 60 month questionnaire can be used to accurately assess child development through 65 months, 31 days.
Final Verdict
The main strength of the ASQ-3 is that it highlights results that fall in a “monitoring zone,” which helps to keep track of children who may be at risk of developmental delay but do not yet require intervention.
The downside to the ASQ-3 is that it does NOT formally screen for social and emotional development. A separate questionnaire–the ASQ:SE-2--covers social and emotional milestones, but many providers do not use this screener.
With the recent increase in autism diagnoses and focus on mental health (in particular in the wake of the Covid-19 pandemic), social and emotional screening is more important than ever.
In this sense, the SWYC has a distinct advantage over the ASQ-3 because it is more comprehensive. The SWYC is also more holistic in its approach to child development than both the ASQ-3 and the PEDS and asks about such factors as reading to a child, postpartum depression, and alcohol abuse in the home, since a child’s environment has a significant impact on healthy development.
Ultimately, the most important thing is to ensure that a healthcare professional is monitoring your child’s development to make sure that they stay on track.
This will allow for diagnosis and intervention as early as possible if they have a delay and help them lead their best life!
And if you'd like guidance and a simple way to track your child's milestones and conduct screenings that you can discuss with your doctor, visit Pathfinder Health!
Sources:
1. Brain Plasticity and Behaviour in the Developing Brain. Bryan Kolb, PhD and Robbin Gibb, PhD. J Can Acad Child Adolesc Psychiatry. 2011 Nov; 20(4): 265–276.
2. Comparative Accuracy of Developmental Screening Questionnaires. R. Christopher Sheldrick, PhD, Susan Marakovitz, PhD, Daryl Garfinkel, Alice S. Carter, PhD, and Ellen C. Perrin, MD. JAMA Pediatr. 2020 Apr; 174(4): 366–374.
3. Prevalence and Variation of Developmental Screening and Surveillance in Early Childhood. Ashley H. Hirai, PhD, Michael D. Kogan, PhD, Veni Kandasamy, MSPH, Colleen Reuland, MS, and Christina Bethell, PhD. JAMA Pediatr. 2018 Sep; 172(9): 857–866.
