PM2006: An Examination of Previous Primary Care Developmental Screening of Patients Presenting for Developmental and Behavioral Pediatrics Evaluation

Background: The AAP recommends screening children with formal developmental tools at 9,18 & 30 months, and autism-specific tools at 18 & 24 months. It is important for children with developmental delays to be evaluated early; it is unknown if fidelity to recommended primary care pediatrician (PCP) screening practices in children with developmental concerns (CDC) results in earlier presentation to appropriate specialists.

The objectives were:
To examine screening practices by PCP in a cohort of CDC who present for DBP evaluation (DBE).
To assess the age and MCHAT-R scores at time of DBE request in patients screened by PCP compared with those not screened.

Methods: This is a cross-sectional cohort study of CDC age < 48months from English speaking families requesting DBE (n=219). An original survey was distributed at intake request, including demographic questions (Table 1), symptom history (Table 1), prior diagnostics and MCHAT-R. 𝝌2 analysis, Spearman’s correlation coefficient, and Wilcoxon signed-rank tests were used to examine relationships between factors with a Bonferroni-like adjustment; p-value of 0.01 for significance.

Results: Of 219, 54% of cohort (n=120) were referred to DBP by PCP. Of the cohort, 65% (n=142) of CDC were not screened by PCP. Of respondents who reported a failed screen as a reason for DBE (n=21), 85.7% (n=19) were referred by PCP.

Median age of presentation =32.4 months (IQR:24.4, 40.0). There was no significant difference in age at DBE intake based on a PCP screen (p=0.04), if PCP referred (p=0.37), or [for those ≥16 months] if they had previously completed MCHAT-R (p=0.16)(Table 2).

Median intake MCHAT-R score was 5 (IQR:1.00,9.00). Intake MCHAT-R scores were not significantly different if PCP administered screen (p=0.36). However, the intake MCHAT-R score had moderate negative correlation with age at DBE request, indicating higher scores for those presenting at younger age (Spearman rs= -0.40, p < -.01).

Conclusion: The majority of CDC requesting DBE were not reported by their caregiver to have had a developmental screen by their PCP; this may represent under-screening or failure to discuss results. Only about half of CDC requesting DBE were referred by a PCP. Referrals for CDC with more severe intake MCHAT-R symptoms presented earlier, yet PCP screening, referral, and prior MCHAT-R did not contribute to younger age at DBE. This is suggestive of possible delays in PCP screening until problems are already serious enough for layperson referral. Research exploring reasons for lack of PCP screening and prompt DBP referrals by PCPs is critical to expedite diagnosis and treatment.