Asking the right questions can spot childhood developmental delays early: study issues, issues

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Asking the right questions can spot childhood developmental delays early: study



VANCOUVER — Doctors should routinely ask parents to complete quick and simple questionnaires about their preschool children to ensure developmental delays are caught and treated early, says a new study.


The questionnaires, put to the test in a study by a pair of B.C. researchers, were found to be largely accurate in identifying problems like learning disabilities, speech difficulties, fine or gross motor issues and autism.


They should therefore be used more frequently, the study by researchers at BC Children's Hospital and the University of B.C. says.


Treating children early has been shown to improve success in school and potentially avoid even higher costs of treatment later in life. Early treatment can mitigate health problems and reduce use of the welfare system and even crime, previous research suggests.


"Until recently, there weren't really good screening tests available to us. Now there are, and so they should be used, because the brain is very plastic when children are young," said study co-researcher Dr. David Joyce.


"If you identify problems early, there's a good chance you can re-wire things. After age six, it's not hopeless, but it's a lot harder."


The existing, standardized questionnaires used in the study were effective at pre-screening children aged one to five for developmental abnormalities.


Yet a minority of doctors use the screening tests across Canada, according to Marjolaine Limbos, a psychologist at BC Children's Hospital and lead author of the study published in the Journal of Developmental and Behavioural Pediatrics.


Limbos, who also has a private practice for children up to age 18, said that about 15 per cent of children have developmental delays that may affect their speech, motor skills, cognition, social skills and emotional states. But only about 30 per cent of children with such delays are diagnosed before they enter school.

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Joyce said finding and treating such problems earlier is an advantage because the sooner children are referred for treatment, the more likely their problems can be addressed or even reversed.


Early diagnosis can also lead to improvements in social, communication and self-help skills, even among children who have serious physical handicaps or cognition problems.


"After about age six, the brain becomes more hardwired and opportunities for change get more difficult," said Joyce, a family doctor who teaches medical students as a clinical assistant professor and works in various physician roles. Apart from being a research collaborator with Limbos, he is also her spouse.


The pair moved to B.C. from Ontario three years ago. Their study began in Ontario, so all 334 subjects were residents of communities in northern Ontario, where Limbos was an associate professor of psychology at Laurentian University, the institution that funded the $50,000 study.


Patients and their parents attending 80 different doctor offices took part in the study.


The parents completed two different questionnaires — an Ages and Stages Questionnaire (ASQ) and a Parent Evaluation of Developmental Status (PEDS) form.


Children who were shown to have at least one abnormality were then given psychological testing which served as the comparison testing, to determine whether the questionnaires were effective at identifying problems. Most of the time, the tests were accurate in alerting doctors to potential abnormalities, Limbos said.


She is hoping the study convinces B.C. doctors to use the screening tests. One of the reasons Ontario doctors use the questionnaires more frequently than those in other provinces is that so many studies have been done there to validate them.

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Joyce said doctors in Ontario also have a billing fee code they can submit to government when they use the tests on toddler patients at their 18-month visit. "It's a good time to do the tests during this enhanced developmental assessment, when the patients are coming in for their immunization," he said.


Joyce said eliciting the observations of parents through the screening tests is a superior method for diagnosing developmental problems, compared to doctors' observations or clinical impressions alone.


He said without such tests, it's possible parents might not bring up certain things or doctors might brush off the concerns of parents who feel their babies might not be meeting certain milestones like sitting up by eight months, for example, or walking at a year.


Preschool programs and interventions have been shown to reduce the risk of school failure as families learn how to develop strategies and get linked up with the right resources, the authors said.


In their study, 10 per cent of children were identified as having developmental delays. Another five per cent, who were initially recruited into the study, were excluded because they had already been diagnosed with a problem.


The authors conclude that their findings support the guidelines of the American Academy of Pediatrics, that both the ASQ and the PEDS tests are worthwhile for developmental screening in doctors' offices. The ASQ test is a little more accurate but the choice of which to use should be left up to doctors, they said.


Early questionnaire screening at doctors' offices can catch developmental problems in very young children in time to help them, says a new Canadian study.