Windows to Success: Developmental Screening In the Early Years

1. Windows to Success: Developmental Screening In the Early Years Jane Squires, Ph.D. Chile Grows With You November, 2008 Santiago, Chile Jsquires@uoregon.edu

2. Objectives • What is risk in early development? • What is the importance of early identification? • Why screen young children?

3. Risk factors • Factors that hamper typical development in young children • Environmental • Poverty • Teen parents • Abuse/neglect • Biological • Low birth weight • Identified/established delays • Down syndrome

4. Cumulative Effects of RiskSameroff et al, 1987

5. Poverty • How does poverty affect developmental outcomes? • Is not a direct cause of poor outcomes • Parents in poverty are not “poor parents” • Produces a constellation of stresses and risks

6. Poverty • Lack of food • Iron deficiency • Anemia • Problems with problem-solving, concentration, lower IQ • Housing Problems • Homelessness • Infant mortality, asthma, delayed immunizations • Frequent moving • Not completing high school

7. Poverty • Family stress • Perceived financial hardship • Parent stress and depression • Family conflict, less effective parenting behavior • Child behavior problems, aggressiveness, learning problems

8. Poverty • Fewer resources for learning • Inferior child care • Less exposure to print, learning materials • More child stress--anxious, aggressive, less active • Financial barriers for school, college • Less educational attainment

9. Meaningful Differencesin the Everyday Experiences of Young American ChildrenHart & Risley, 1995, Brookes Publishing

10. Meaningful Differencesin the Everyday Experiences of Young American ChildrenHart & Risley, 1995, Brookes Publishing

11. How can we improve child outcomes?

12. Early Child Development • Series of interactions between child and environment • Series of qualitative reorganizations among and within biological systems stimulated by environmental interactions

13. Transactional Model of Development • Reciprocal, ongoing exchanges between the child and environment serve as the foundation of development. • Child is active participant in development. • Outcomes depend upon quality of caregiving environment as well as the child’s characteristics.

14. Plasticity of Young Brain • Brain imaging research shows affects of stimulating environment on young children • Children of depressed mothers show 40% less brain activity (Shore, 1997) • With rich interactions from the environment, brain develops in optimal way • Differential genetic susceptibility to effects of caregiving environment • Genes + caregiving environment = adult outcomes

15. Early Identification • On going monitoring of young children’s development • Identifying children with delays in development • Providing enrichment activities and/or special education

16. Early Intervention Early intervention provides continuum of supports to children and families Intervening early is necessary to compensate Continued intervention and support are often necessary to sustain gains Early intervention makes a substantial difference in the lives of young children and families

17. Evidence for Early Intervention Intelligence is enhanced in some children. Substantial gains are made in all developmental areas Secondary handicapping conditions are inhibited or prevented. Family support is provided.

18. Evidence for Early Intervention Dependency is reduced Need for special education services at school age is reduced. Substantial cost savings in health care and education costs.

19. 11.6 % 2.3% 5.9% Incidence of children identified as having a disability by age

20. Prevention Triangle Tertiary Level Special education, OT/PT Secondary Prevention Targeted interventions with risk population Primary Prevention Building Positive Relationships for Families Screening, education, health

21. Early childhood programs save money • 3 to 1 benefit-cost ratio • Better health and academic outcomes • $3-9 for every dollar invested • 16% annual return • http://epinet.org • http://brookings.edu • http://minneapolisfed.org/

23. Risk Factors and Development:Review • Environmental, medical, and combination risk factors affect development • Quality of caregiving environment can mitigate effects of risk • Poverty presents most devastating risk factors for young children • Prevention is cost-efficient and effective

24. WHAT IS SCREENING?

25. Screening • A brief assessment procedure designed to identify children who should receive more intensive diagnosis or evaluation from local education, health, mental health agencies

26. Screening Notnearcutoff NearCutoff Beyond Cutoff Professional Assessment Continue to monitor (re-screen) & use curriculum-based assessment to develop learning plans Not Eligible Eligible

27. WHY SCREEN YOUNG CHILDREN?

28. Why use screening tests? • Clinical judgment is not accurate • Increases identification rates of children with delays • If used system-wide, increase communication, collaboration among agencies

29. Why screen? • Increased rates of poverty for families with young children • Poverty associated with increased medical, developmental, and social-emotional problems • Medical interventions increasing numbers of children with delays • Children born below 1500 grams have greatly increased chance for developmental delays • Increased use of illegal substances by stressed families

30. Why screen? • Early childhood time for brain plasticity and growth • Neurons to Neighborhoods, • http://www4.nationalacademies.org/ • Early intervention is effective • For low-birth weight children • McCormick et al. 2006 • Ecological focus on family and child • Bronfenbrenner, 1977; Sameroff & Fiese, 2000 • Home and center based programs effective • Olds, 1997; Ramey & Ramey, 2000

31. Identification by pediatricians • In U.S. 60-80% with delays not identified early • American Academy of Pediatrics 2006: Pediatricians recommended screening at • 9, 18-24, 30 months • Referral rates in 1 practice increased 224% in one year with formal screening test (Hix-Small, Marks, Squires & Nickel, 2007)

32. What are effective screening measures?

33. Qualities of assessment tools to consider • Validity • Reliability • Adequate normative population • Cultural sensitivity • Comprehensiveness • Attractiveness to children

34. Types of screening instruments • Professionally-administered • Parent-completed • Information on screening tools • http://www.dbpeds.org/ • http://www.fpnotebook.com • http://www.cimh.org • Individual publishers

35. Professionally-administered • Battelle Developmental Inventory Screen, 2nd • (http://www.assess.nelson.com) • Bayley Scales of Infant Development Screen, 3rd • (http://harcourtassessment.com) • Brigance Screens • (http://www.curriculumassociates.com) • Denver II • (http://www.denverii.com/DenverII.html) • Early Screening Inventory • (www.pearsonearlylearning.com)

36. Parent-Completed • Pediatric Evaluation of Developmental Status PEDS--Glascoe • www.pedstest.com • MacArthur Communicative Development Inventory--Fenson et al. • Minnesota Child Development Inventories • http://www.childdevrev.com/cdi.html • Ages & Stages Questionnaires • http://www.brookespublishing.com • http://agesandstages.com

37. Assessment “the science of examining the strange behaviors of children in a strange situation with strange adults for the briefest possible periods of time” (Bronfenbrenner, 1979)

38. Advantages of Parent-Completed Screening Measures

39. Engaging families in the assessment of their child • Parents are reservoirs of rich information about their children • Parental involvement reduces cost • Screening structures observations, reports and communications about child development

40. Engaging families in the assessment of their child • Screening may become a teaching tool for parents and teaching staff • Information/communication can be useful for primary health care providers and communication based rehabilitation center • Effective and efficient method of early identification

41. Research on parent report of child developmental level • As accurate as formal measures for identifying cognitive delay (Glascoe, 1989, 1990; Pulsifer, 1994) • As accurate as formal measures for identifying language delay (Tomblin, 1987) • As accurate as formal measures for identifying symptoms of ADHD and school related problems (Mulhern, 1994) • More accurate than Denver for predicting school-age learning problems (Diamond, 1987)

42. Accuracy of low and middle income parents • Agreement between parent-completed ASQ and • professionally administered standardized assessment: • Low income parents .85 • (below federal poverty level) • Middle income parents .89 • No statistical significance between groups (Squires, Potter, & Bricker, (1998) Early Childhood Research Quarterly,13, 2, 345-354.)

43. Advantages of parent-completed screening tests • Parents/caregivers can provide rich information about child across settings • Parent involvement reduces cost • 3-5 times less • Screening structures observations, reports, communications about child development

44. Cost Effective • Parent-completed assessments range between $3-10 per assessment (U.S. interview/mail models) • Professionally-administered cost 3-5 times more (Chan & Taylor, 1998; Dobrez Lo Sasso, Holl et al., 2001; Glascoe, Foster, & Wolraich, 1997)

45. Factors that may affect the accuracy of parental report Characteristics of parents • Impaired mental functioning • Mental health issues • Cultural and language differences • Involvement with child protective agencies • Low literacy

46. PARENTS’ EVALUATION OF DEVELOPMENTAL STATUS PEDS A Method for Detecting and Addressing Developmental and Behavioral Problems • For children 0 through 8 years • In English, Spanish and Vietnamese • Takes 2 minutes to score • Elicits parents’ concerns/family-focused/culturally competent • Sorts children into high, moderate or low risk • 4th – 5th grade reading level • Score/Interpretation form printed front and back • and used longitudinally • Screens for developmental and behavioral/mental • health problems

47. Circle: Yes No A little Comment: PEDS Response Form 1. Please list any concerns about your child’s learning, development, and behavior. 2. Do you have any concerns about how your child talks and makes speech sounds? 7. Do you have any concerns about how your child gets along with others? Circle: Yes No A little Comment:

48. What are the ASQ and ASQ:SE? • Series of parent- completed developmental questionnaires • Screen children for possible developmental delays, difficulties • Monitor the development of young children from 1 month to 5 years • Enlist parents and caregivers in assessment process

49. ASQ Communication • 12 month ASQ • Does your baby follow one simple command, such as Come here, Give itto me, Put it back, without your using gestures? Yes Sometimes Not Yet • Does your baby say one word in addition to Mama and Dada? Yes Sometimes Not Yet

50. 24-month ASQ Does your child turn the pages of a book by himself? (He may turn more than one page at a time.) Yes Sometimes Not Yet Does your child flip switches off and one? Yes Sometimes Not Yet ASQ Fine motor