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Developmental delays and autism: Screening and surveillance

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SCREENING TOOLS

The two types of screening are problem-specific screening and broadband developmental-behavioral screening.

  • Problem-specific screens are available for autism, speech delay, cognitive delay, or motor delay; they do not assess multiple different areas of development.
  • Broadband developmental-behavioral screening tests are general and assess multiple areas of development, including autism.

Standardized tools with known reliability, sensitivity, specificity, and validity should be used. If the parents express no specific concerns, broadband developmental-behavioral and autism screening should be conducted at the AAP-recommended intervals. If a concern is noted on screening using a problem-specific tool, broadband screening is recommended because an abnormality in one domain may be a red flag for other developmental abnormalities.

Factors to consider in the choice of a test are the age range for which the test is intended, cost, length of time it takes to complete and to score, whether the test is paper-based or electronic, and the language availability (many tests are available in several languages).

Screening tests may be administered by the primary care physician or trained office staff before the scheduled office visit and then interpreted by the physician. Alternatively, screening tests meant to be completed by parents, teachers, or daycare providers can be mailed to the home before a scheduled visit to be completed and then interpreted by the physician at the next office visit.

There are many resources for screening tools and algorithms, both broadband and autism-specific. Some commonly used tests are compared in Table 1.6,7

BILLING CODES

The CPT code 96110 (developmental testing; limited, with interpretation and report) is used for screenings completed by a parent (or other caregiver) and interpreted by the health care provider. The code can be used for each screening tool, if multiple tools are used per visit. Testing administered, scored, and interpreted by the provider can be billed under CPT code 96111 (developmental testing; extended, with interpretation and report). The CPT code 96111 can be used only once per encounter, regardless of the number of tests administered.

DISCOVERING AN ABNORMALITY: REFERRALS, RESOURCES

Appropriate referral is indicated if a developmental concern has been uncovered during screening. If a concern is raised, either by parent report or identified by screening/surveillance, the child should be referred to the appropriate specialist for diagnostic testing (eg, developmental and behavioral pediatrics, neurology).

If the child is younger than 3 years, the Help Me Grow program (www.Helpmegrow.org) can provide additional screening and connect families to developmental services. It uses a network of community providers for support and maintenance during the referral process. Children 3 years and older are eligible for evaluation through the public school system.

Referral to physical therapy, occupational therapy, and speech and language evaluation may be appropriate. An audiology referral for a hearing evaluation is recommended whenever a concern is raised.

Neurology or physiology can be useful for evaluating abnormal gait and other motor disabilities typically seen with muscular dystrophy, cerebral palsy, and spina bifida. A genetics consult may identify causes of developmental delays and autism spectrum disorders. Neurology or genetics also may offer testing to assess for neurologic and metabolic causes of developmental delays. Developmental pediatricians can also evaluate for developmental disorders including autism.

Recognize that verbal children also can have autism spectrum disorders. In these children, the quality of communication is abnormal. When a concern about developmental delay is expressed or uncovered during screening, refer immediately for a diagnostic evaluation to avoid a delay in diagnosis and access to services. Early identification permits early intervention, which offers the best chance to improve outcomes.

SUMMARY

Screening for developmental delays and autism spectrum disorders in addition to ongoing developmental surveillance is recommended for all children at regular intervals, and is indicated whenever a parent expresses concern. Multiple screening tests are available. If a developmental concern is identified during screening, appropriate referral is indicated for further assessment.

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