Recommendations on screening for developmental delay

Canadian Task Force on Preventive Health Care
CMAJ 2016. DOI:10.1503/cmaj.151437
PubMed PMID: 27026672

This guideline focuses on population-based screening of children aged one to four years with no apparent signs of developmental delay, whose parents and clinicians have no concerns about development.
Screening refers to use of a standardized tool to search for developmental delay in children without recognized signs of such delay and whose parents or clinicians have not raised concerns. Screening differs from developmental surveillance, which refers to ongoing monitoring by clinicians of a child’s development, identification of risk factors and elicitation of parental concerns.

Key points:
  • There is no evidence from randomized controlled trials (RCTs) that screening children for developmental delay improves health outcomes.
  • There is no evidence that commonly used screening tools would consistently identify otherwise unrecognized cases, but there is evidence that the low specicity of these tools would lead to a high proportion of false positives.
  • High-quality evidence from RCTs on the effectiveness of treatment for known developmental delay is lacking; a few small trials have suggested that speech and language therapy may improve language impairment and that treatment of autism may improve cognitive function.
  • The task force recommends against use of population-based screening with standardized questionnaires in children aged 1 to 4 years with no apparent signs of developmental delay and whose parents and clinicians have no specific concerns.
  • Clinicians should remain vigilant to deficits in children’s performance in terms of gross and fine motor skills, cognition, speech and language, and personal and social abilities. They should consider further evaluation for children whose development does not meet age-expected milestones.