Developmental Screening: Preschool Screening Tests
1. Why do preschoolers undergo developmental screening?
Brain maturation is most rapid when children are young. Developmental research has shown that interventions are most effective during times of rapid neuronal growth. Assessing and treating developmental delay (DD) at the infant and toddler level will achieve optimal results. Presently 15% of elementary children are developmentally delayed (1), 15% are obese (2), and 14.3% have psychiatric disorders (3). The sooner these conditions are assessed through developmental screening, the more effective will be the subsequent treatment.
2. Are all children screened?
Most definitely not! Studies have shown that only 50% of developmental delays are detected prior to school entry (1). One of the problems with developmental screening is that there is no standardized assessment process, leaving each community, state or province to determine their own methods. Sweden is quite advanced, requiring monthly physician visits from 0-18 months. Process for detecting DD is usually by primary physician initial assessment who is acting on reports from either parent or preschool staff. Referral is usually then initiated to a child development center for further assessment by physical, occupational or speech and language therapists.
3. At what age are they screened?
As stated previously, there is no standardized method for developmental screening. As a pediatric occupational therapist, I’ve observed the following developmental screening periods:
Early Infant Screening
Infants are brought to the family physician for developmental screening at around 12-18 month of age, when they have failed to meet the three primary developmental milestones of sit (6 mo.), stand (9 mo.) and walk (12 mo.).
Toddlers are often referred to the physician by the preschool when the toddler is 2.5-3 years of age and shows significant gross and fine motor delays, is not communicating or socializing with peers, exhibits unusual behavior, or is aggressive.
School Age Screening
Children are usually referred to the school based physical (PT), occupational (OT), or speech and language (SLP) therapists anywhere from grade 1-3. These referrals are generally made by the school’s special education team, and are based on the child’s performance skills in gym (PT), printing, reading, socializing, and paying attention (OT), or expression or comprehension of speech (SLP).
4. Can you describe the tests?
Physicians and Pediatricians – tests assess for quality of reflexes, strength and muscle tone, meeting milestones for sit, stand, walk, talk.
Physical therapy – tests assess and treat delays or impairment in the following: gross motor skills, mobility, posture, strength, muscle tone, reflex inhibition, bilateral coordination.
Occupational therapy – tests assess and treat delays or impairment in the following: fine motor skills, sensory processing and integration, visual-motor integration, visual perception, oral motor skills, activities of daily living, play skills, social skills, foundation skills for eventual school entry.
Speech and Language therapy – tests assess and treat delays or impairment in the following: expressive and comprehensive communication.
5. What types of tests do they take and what do they measure?
While there are numerous tests, I’ve only listed the ones I am familiar with and that are used in our area. You may want to contact a few more professionals to gain a more comprehensive list.
Physicians – Parents Evaluation of Developmental Status (parent concerns regarding child development), Ages and Stages Questionnaire (communication, gross and fine motor, problem solving, personal-social), Brigance Screens (speech-language, motor skills, readiness, general knowledge), Bayley Infant Neurodevelopomental Screen (screen for high risk infants).
Physical therapists - Bruininks Test of Motor Proficiency (Gross Motor Composite) measures , Peabody Developmental Motor Scales-2, Brigance Screen, Bayley Scales of Infant Development-II (neurodevelopment).
Occupational therapists – Sensory Integration and Praxis Test (proprioceptive, tactile and vestibular integration), Bruininks Test of Motor Proficiency – Fine Motor Composite (response speed, visual motor, bilateral integration), Miller Assessment for Preschoolers (foundation, coordination, verbal, nonverbal and complex task skill), Peabody Developmental Motor Scales-2, Test of Visual Motor Skills-2, Sensory Profile (sensory processing, modulation, and behavioral and emotional responses), Clinical Observations of Motor and Postural Skills-2 (motor coordination), Berry Developmental Test for Visual Motor Integration, Developmental Test of Visual Perception-2.
Speech and Language Pathologists – Test for Auditory Comprehension of Language – Revised (understanding of word classes e.g. nouns, verbs, adjectives, grammatical morphology and sentence structures), Beery Picture Vocabulary Test (expressive vocabulary by requiring the naming of pictures), Preschool Language Assessment Instrument (use of varying length of abstract language), Structured Photographic Expressive Language Test (expressive grammar).
6. What special services might a child need or what type of intervention is necessary if a child is at risk for developmental delays?
Physicians - referral onto pediatrician is generally first line approach. Pediatrician may then refer onto other specialists depending on area of impairment e.g. genetics, orthopedics, neurology, gastroenterology, physiatry, ophthalmology etc.
Physical therapists – treatment sessions might be one to one or group based, performed in hospital, child development center, preschool or school, private clinic, or community gym settings, and might consist of education and a variety of exercises to improve muscle strength, reduce or increase muscle tone, improve bilateral coordination, improve overall endurance etc.
Occupational therapists – treatment sessions might be one to one or group based, performed in hospital, child development center, preschool, or private clinic, and might consist of education regarding environmental modifications, prescription of equipment, instruction in use of sensory or motor tools or techniques etc.
Speech and Language therapists – treatment sessions might be one to one or group based, performed in hospital, child development center, preschool, or private clinic, and might consist of parent and child instruction and training of a variety of expressive and receptive language acquisition techniques.
7. Any resources you might suggest for more information?
American Academy of Pediatrics, CanChild Centre for Childhood Disability Research, Sensory Processing Disorder Foundation, local health unit, child care centers, family physician, school special education directors.
8. Any additional comments?
Technology overuse by infants, toddlers and children is causally linked to developmental delays, mental illness and behavior disorders. Parents and child care workers in the preschool setting should identify children with high usage patterns, and refer to appropriate information sources for technology reduction and management. Please refer to attached Creating Sustainable Futures Program for additional information and research.
Foundation skills for learning are not being achieved in pre-school settings, and children are entering the school system with low postural tone, poor motor coordination, and unable to maintain arousal states necessary to pay attention and learn (4). Eight hours per day combined technology use by the elementary population is rapidly destroying family structure and eroding the health and education systems as we know them, and it’s time to act (5). School-based Balanced Technology Management programs would ensure children and their families get the information and tools they need to achieve a balance between technology use, and what they need to grow and succeed.
1. Hamilton S. Screening for developmental delay: Reliable, easy-to-use tools. Journal of Family Practice. 2006; 55 (5): 416-422.
2. Birmingham CL, Muller JL, Palepu A, Spinelli JJ, Anis AH. The cost of obesity in Canada. Canadian Medical Association Journal. 1999; 160:483-488.
3. Waddell C. Improving the Mental Health of Young Children. Children’s Health Policy Centre, Simon Fraser University, Vancouver BC, Canada. 2007. Available at: http://www.firstcallbc.org/pdfs/Communities/4-alliance.pdf.
4. Jennings JT. Conveying the message about optimal infant positions. Physical and Occupational Therapy in Pediatrics. 2005; 25 (3); 3-18.
5. Rideout VJ, Vandewater EA, Wartella EA. Zero to six: electronic media in the lives of infants, toddlers and preschoolers. Menlo Park (CA): Kaiser Family Foundation; Fall 2003.
Let me know if you should require any additional information. These questions could be quite exhaustive, and I’ve just touched the surface so to speak.
Have a GREAT day!
Cris Rowan, BScOT, BScBi, SIPT, Approved Provider AOTA
CEO Zone’in Programs Inc.
6840 Seaview Rd.
Sechelt, BC V0N3A4
604-885-0986 office, 604-885-0389 fax, 604-740-2264 cell