Developmental Screening in the Primary Care Setting Dr Kang Ying Qi - - PowerPoint PPT Presentation

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Developmental Screening in the Primary Care Setting Dr Kang Ying Qi - - PowerPoint PPT Presentation

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Developmental Screening in the Primary Care Setting Dr Kang Ying Qi Associate Consultant Child Development Unit National University Hospital 28 May 2016 Content 1. Overview of terminology and concepts 2. Importance of Primary Care setting

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Developmental Screening in the Primary Care Setting

Dr Kang Ying Qi Associate Consultant Child Development Unit National University Hospital 28 May 2016

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Content

  • 1. Overview of terminology and concepts
  • 2. Importance of Primary Care setting
  • 3. Importance of developmental screening
  • 4. Singapore Health Booklet
  • 5. MCHAT
  • 6. Vanderbilt assessment scale
  • 7. Pediatric Symptom Checklist
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Ov Overvie iew of

  • f Con
  • ncepts

s an and Te Terminology

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Culture Community Children’s services Support for parenting Housing Family Family relationships Parenting styles and values Financial situation Parent’s level of education / occupation Parent’s physical and mental health Siblings

Factors influencing a child’s development

Child Genetic inheritance Temperament Gender Physical Health

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Developmental Domains

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Tervo R. Red Flags and Rules of Thumb: Sorting Out Developmental Delay. Gillette Children’s Specialty Healthcare: A Pediatric Perspective 2009; 18: 1.

Developmental Quotient (DQ) = Developmental Age x 100 Chronological Age

  • DQ = 100 → average
  • DQ < 70 → significant delay

> 2 domain

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WH WHY Pr

Primary Care Setting?

?

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Ongoing relationship

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Age related developmental manifestation

1 – 2 % 8 %

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Family factors and trust

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1 in 6 children with developmental delay or disorder

Lian WB, Ho SKY, Yeo CL et al. General Practitioners’ Knowledge on Childhood Developmental and Behavioural Disorders. Singapore Med J 2003; 44: 397.

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WH WHY De

Deve velopmental screening?

?

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Detection Methods

Developmental Surveillance Developmental Evaluation

http://www.medmerits.com/index.php/article/developmental_delay_in_children_evaluation_and_management/P2

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Half detected before 5 years old

Hamilton S. Screening for developmental delay: Reliable, easy-to-use tools. J Fam Pract 2006; 55: 415.

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Developmental disorders exist as a spectrum

Language

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Developmental Surveillance Developmental Evaluation

Developmental Screening

http://www.medmerits.com/index.php/article/developmental_delay_in_children_evaluation_and_management/P2

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Early Intervention Matters.

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Developmental Surveillance Developmental Screening

Glascoe FP . Screening for Developmental and Behavioral Problems. Ment Retard Dev Disabil Res Rev 2005; 11: 173. Hamilton S. Screening for developmental delay: Reliable, easy-to-use tools. J Fam Pract 2006; 55: 415.

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Tools for screening for developmental delays

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Denver Developmental Screening Test (DDST)

developed in 1989

Lim HC, Chan T, Yoong T. Standardisationand Adaptation of the Denver Developmental Screening Test (DDST) and Denver II for Use in Singapore Children. Singapore Med J 1994; 35: 156. Lim HC, Ho LY, Goh LY et al. The Field Testing of Denver Developmental Screening Test, Singapore: A Singapore Version of the Denver II Developmental Screening Test. Ann Acad Med

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  • Objective: The aim of this study was to investigate parents' perceptions of developmental checklists and the

child development monitoring schedule in the Singapore health booklet.

  • Method: Parents of children aged 2 years 6 months to 3 years 11 months with or without developmental

concerns (n = 450) completed a structured interview, and their child's health booklets were reviewed.

  • Results: Most parents reported reading and using the developmental checklists. However, only about half of

them attempted the checklists with minimal help from professionals. Approximately 7 in 10 parents of children with developmental concerns found the checklists useful for identifying concerns about their child. Despite positive feedback from parents about the checklists, only about 1 in 4 parents brought their child for a 2 to 3 years developmental monitoring visit at the time of the survey, and the completion rates of the checklists were less than desirable.

  • Conclusions: Further revisions to the checklists can include simplifying the words and sentences and

providing relevant pictures to aid understanding. If the checklists are to be used for screening, standardization of how the checklists are to be completed and how children at risk of developmental delays can be identified on the checklists need to be provided. Parents' awareness of the importance of evaluating their child's development at 9 months, 18 months, and particularly at 2.5 years, needs to be raised. Developmental screening for children at these critical ages can be made mandatory. An electronic version of the health booklet is likely to facilitate implementation of developmental screening in the health care system.

Journal of Developmental and Behavioural Pediatrics: JDBP 2016 May 5

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11 time points for development surveillance and screening

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Other similar screening tools are yet to be comparable

Personal Communication. KKH DCD Physicians and Psychologists. April 2014. Kiing J, Low PS, Chan YH et al. Interpreting Parents’ Concerns about Their Children’s Development With The Parents Evaluation of Developmental Status: Culture Matters. J Dev Behav Pediatr 2012; 33: 179.

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https://www.m-chat.org

Nathan Mother

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Scoring instructions for MCHAT

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https://www.m-chat.org

Nathan Mother 16 points

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MCHAT

  • 16 – 30 months
  • AAP guidelines: 18 and 24 months
  • High false positive rate -> other developmental disorder
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Vanderbilt Scoring

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Hyperactive Inattentive ODD CD CD Mood Function

9/9 9/9 0/8 > 6/9 = sig > 6/9 = sig > 4/8 = sig > 3/14 = sig 0/14 0/7 > 3/7 = sig And any score

  • f 4 or 5
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Vanderbilt Assessment Scale

  • 6 – 12 years old
  • Together with the teacher assessment scale, used by paediatricians

and psychiatrists, to aid in the diagnosis of ADHD

  • Parent assessment scale can be used by GPs as screening tool in clinic
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Tool for screening for mental / emotional health in children

http://www.massgeneral.org/psychiatry/services/psc_forms.aspx

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Mental Health is more than the absence of mental illness

  • A state of well-being in which

every individual realizes his or her

  • wn potential, can cope with the

normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

http://www.who.int/features/factfiles/mental_health/en/

Mental wellness Mental health problem Mental illness

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Case

  • 11 year old boy comes for the 4th time in 3 months to your clinic for a

series of non specific complains like abdominal pain and headache. Each time asking to be excused from school.

  • The child comes alone to your consult each time, when questioned if

there are any stressors and asked about his mood, he gives you nonchalant responses.

  • What do you do?
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1 2

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1 2

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Pediatric Symptom Checklist

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Pediatric Symptom Checklist

  • 3 to 18 years old
  • Psychosocial screen : cognitive, emotional, and behavioral problems
  • School age children: Scores of 28 or greater
  • Younger kids: Scores of 24 or greater
  • -> referral for further mental health assessment
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Pediatric Symptom Checklist - 17

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Difficulties faced

Time

Cost Literacy

Knowledge about tools

Logistics Parents receptivity

Follow up

Responsibility for the results

Competing healthcare priorities

Lack of training

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Caution

  • Positive screening does not equal diagnosis
  • Negative screening does not mean there is no issues
  • Lack of standardized measures for Singaporean children
  • Care giver reports are subject to biases
  • Confidentiality
  • Crisis management
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Resources

  • HEALTH PROMOTION BOARD
  • Healthy Start For Your Baby http://www.hpb.gov.sg/HOPPortal/health-article/12206 Healthy Start For Your Growing Child http://www.hpb.gov.sg/HOPPortal/health-

article/12294

  • EARLY CHILDHOOD DEVELOPMENT AGENCY
  • Growing with Your Child booklet http://www.ecda.gov.sg/growatbeanstalk/Pages/articledetail.aspx? type=4&category=Growing+With+Your+Child+Booklet
  • Care & Development: A Resource for Parents of Children with Developmental Needs http://www.ecda.gov.sg/growatbeanstalk/Pages/ArticleDetail.aspx? type=4&articleid=145

http://www.childcarelink.gov.sg/ccls/uploads/MSF-Child Development-Booklet.pdf

  • CENTERS FOR DISEASE CONTROL AND PREVENTION USA

Learn the Signs.Act Early http://www.cdc.gov/ncbddd/actearly/milestones/index.html

  • MINISTRY OF HEALTH
  • AMS-MOH Clinical Practice Guideline on Autism Spectrum Disorders in Preschool Children 2010 http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/

doctors/guidelines/cpg_medical/2010/cpgmed_autism_spectrum_dis orders_preschool_children.html

  • Summary
  • http://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg_m edical/current/2010/ASD%20CPG(Card).pdf
  • Patient Version http://www.moh.gov.sg/content/dam/moh_web/HPP/Doctors/cpg _medical/current/2010/Autism%20Spectrum%20D.pdf
  • http://www.mentalhealthamerica.net/every-child-needs
  • RECOGNISING CHILDREN WITH DEVELOPMENTAL DELAYS: A STRATEGY FOR SURVEILLANCE. THE SINGAPORE FAMILY PHYSICIAN VOL40(2)APRIL-JUNE2014:18
  • http://www.medmerits.com/index.php/article/developmental_delay_in_children_evaluation_and_management/P2