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Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis for potential developmental delays. Developmental screening allows daycare providers and parents the ability to receive a snapshot of a child’s development.
Part 2 of our interview with Cris Rowan, pediatric occupational therapist , sensory specialist, CEO of Zone’in Programs Inc. discusses what developmental screening in  daycare centers and preschools measure as well as special services for developmental delay.

OwnADaycare: What types of tests do young children take and what do they measure?
Cris Rowan: 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).

OwnADaycare: What special services might a child need or what type of intervention is necessary if a child is at risk for developmental delays?
Chris Rowan:
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.

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Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis for potential developmental delays. Developmental screening allows daycare providers and parents the ability to receive a snapshot of a child’s development.

Our interview with Cris Rowan, pediatric occupational therapist, sensory specialist, CEO of Zone’in Programs Inc. discusses the importance of developmental screening in daycare centers and preschools:

OwnADaycare: Why do preschoolers undergo developmental screening?
Cris Rowan: 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.

OwnADaycare: Are all children screened?
Cris Rowan: 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.

OwnADaycare At what age are preschoolers screened?
Chris Rowan: 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.).

Toddler Screening
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).

OwnADaycare: Can you describe the screening tests?
Cris Rowan:

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.

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Attention Deficit and Hyperactivity Disorder (ADHD) is a group of disorders that include inattentiveness, over-activity, and/or impulsivity. Daycare providers must recognize the signs of symptoms of ADHD as well as how to manage children diagnosed with the disorder.

Our interview with special educator and author of A Parent’s Guide to Developmental Delays, Laurie LeComer, details the important aspects of ADHD in a daycare or preschool setting.

OwnADaycare: What is ADHD?

Laurie LeComer: The letters ADHD stand for a common disorder called Attention Deficit Hyperactivity Disorder. It is believed that approximately 9 percent of children have one form of ADHD. It most commonly occurs in boys. Some children are considered to have ADD, Attention Deficit Disorder, which is marked by inattentiveness, confusion, distractibility, and an avoidance of tasks that require focus and effort. Others have Hyperactivity Disorder, which causes excessive physical activity along with impulsivity. Children that are hyperactive have difficulties with waiting, tend to interrupt, and often act before thinking. Some children have the “combined type” of difficulties, meaning they struggle with both compromised attention and hyperactive behaviors.

OwnADaycare: How is ADHD diagnosed?

Laurie LeComer: ADHD in children may be diagnosed by a pediatrician, or by an evaluation team in your local public school system. Children may also be diagnosed at a child development clinic at a university or hospital center. Doctors and child professionals may try to observe a child’s behavior in a couple different environments.  They will also have parents, teachers, or daycare providers fill out detailed checklists on the child’s symptoms, strengths, and weaknesses. Though brain scans have shown slight differences in the brains of children with ADHD, the disorder is diagnosed through observable behaviors that have occurred over time in multiple environments. No scans or blood tests are currently used to diagnose a child with ADHD.

OwnADaycare: Many times, diagnosis of ADHD comes sometime after the age of 6. Can you please explain why? In other words, why is early diagnosis difficult and when is the earliest that a child can be diagnosed with ADHD?

Laurie LeComer: It is very difficult to diagnose ADHD before the age of seven-years-old. Typically, children from ages 2 to 6 develop self-regulation skills and “in seat/focus” behaviors at different rates. There are even some differences exhibited between male and female children. It is important to make sure that the behaviors in question are not environmentally caused or situation-based. Different styles of family life, structured/unstructured home or daycare settings, even personal traumas can affect children’s behavior. While many young children “develop out of” ADHD-like behaviors as they naturally grow and develop new skills, children with true ADHD continue to struggle. The symptoms of ADHD cause children to begin to fall behind both socially, and academically.

OwnADaycare: What are the symptoms of ADHD in preschool children?

Laurie LeComer: It is very difficult to diagnose ADHD in preschool children. Though some children may exhibit inattention, learning and social difficulties, these symptoms may be indicative of other delays or disabilities, or not be anything other than a difficult -yet typical- stage of the child’s development. Congruently, some children who have ADHD may not show clear symptoms before the age of 4 or 5.

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Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis for potential developmental delays. Developmental screening allows daycare providers and parents the ability to receive a snapshot of a child’s development.

Our interview with Dr. Pio Andreotti, NYS Licensed Psychologist, discusses the importance of developmental screening in the daycare centers and preschools:

OwnADaycare: Why do preschoolers undergo developmental screening? Are all children screened? At what age are they screened?

Dr. Andreotti: A preschooler will undergo a screening when there is some concern regarding their development.  Typically, parents notice that their child is not walking by a certain age or that their language is not developing appropriately.  Also, many times, schools and daycares will recommend to a parent that their child be screened due to concerns about language, behavior, or socialization.  Not all children are evaluated.  A child is referred for a developmental screening only when there is a concern regarding a delay in development.  Preschool evaluations typically occur when a child is between 3 and 5 years of age.

OwnADaycare: Can you describe the tests? What types of tests do they take and what do they measure?

Dr. Andreotti: There are many different methods of evaluation.  Most commonly, a child will receive a measure of cognitive functioning (i.e., an IQ test).  This attempts to provide a general description of how a child will perform on certain types of verbal and non-verbal tasks.  An IQ test may look at vocabulary skills, block building skills, conceptual thinking and problem solving. Children are also given tests of language development (word usage and understanding), learning and academics (letters, colors, numbers, etc), memory, organization and planning, fine motor skills, sensory-integration (how they tolerate sensory information), and gross-motor skills. All of these tests compare a child to other children in their age range.  The parents are then provided with scores describing their child’s performance.  So, for example, if your child’s score was at the 50^th percentile, that means they are functioning above 50% of the children in their age range.  Parents are also asked to complete forms.  These forms attempt to determine a child’s level of adaptive functioning (i.e., self-care, communication, socialization skills).  There are also forms that assess specific behaviors such as attention and hyperactivity, social language and behavior, as well as organization and self-regulation skills.  Sometimes, the current daycare or child-care provider is also asked to complete these forms.  All of this information is compiled and an educational plan is generated (if necessary).

OwnADaycare: What special services might a child need or what type of intervention is necessary if a child is at risk for developmental delays?

Dr. Andreotti: Under the Individuals with Disabilities Education Act (IDEA), children who are identified as having a delay in a developmental domain typically qualify for special education services.  These services vary and are determined by the child’s Individualized Educational Program (IEP).  Services can range from no services, to “Related Services Only” (i.e., no special class placement but the child receives speech/ occupational/ physical/ play therapy), to placement in a special class.  A child will be provided a  therapist to address any specific need that they may have (i.e., Speech-Language Pathologist for language difficulties, Occupational therapist for fine-motor and/or sensory-integration issues, etc.).

OwnADaycare: Are there any resources you might suggest for more information?

Dr. Andreotti: These evaluations can be done through your local school district or by private providers. Most school districts provide these evaluations at not cost to the parent.  Private evaluations are conducted by independently licensed professionals and are usually on a fee-for-service basis.  Depending on the age of the child and the type of coverage, medical insurance will sometimes cover the cost of a private evaluation.  Parents should consult with their local school district, local disabilities organization or with national centers such as the Learning Disabilities Association of American (http://www.ldanatl.org/) for information about providers in their area.

OwnADaycare: Do you have any additional comments?

Dr. Andreotti: If you feel that your child has a delay, it is important that you seek assistance.  Research suggests that the earlier an intervention can be implemented, the greater the benefit. Parents should contact their local school district to receive information regarding evaluation centers in the area.

Bio:

Dr. Pio Andreotti is a NYS Licensed Psychologist experienced in working with diverse populations of all ages. He is a Neuropsychologist in private practice and the Clinical Supervisor for the Stanley S. Lamm Institute Preschool at Long Island College Hospital. In addition to his clinical experience, Dr. Andreotti has given national trainings and symposiums. He is frequently interviewed by the media, and has appeared nation-wide in media outlets such as the ABC network, CW network, and Forbes.com.

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Does your daycare center participate in developmental screening? Screening is the process by which a brief, well-validated, standardized tool is administered among young children to aid in the identification of children who may be at risk of a delay or disorder. Most screening tools take only 10-20 minutes to administer per child.

A child in your daycare center will undergo screening if there is some concern about their development. Typically, parents notice developmental problems. For example, they may notice their child is not walking by a certain age or that there are language development issues. Preschools and daycare centers may also recommend to a parent that their child be screened due to concerns about behavior, language or socialization.

Not all children are evaluated. A child is referred for a developmental screening only when there is a concern regarding a delay in development. Preschool evaluations typically occur when a child is between 3 and 5 years of age.

There are many different methods of evaluation. Usually, a child will is measured for cognitive functioning such as an IQ test to measure how a child will perform on certain types of verbal and non-verbal tasks. An IQ test evaluates such things as vocabulary skills, conceptual thinking, block building skills, and problem solving. Language development tests are also given. This evaluates word usage and understanding, along with learning and academics (letters, colors, numbers, etc), sensory-integration, memory, organization and planning, and fine and gross-motor skills.

The tests will compare the child to other children in their particular age range. Next, the parents are given scores which describe their child’s performance. So, for example, if your child’s score was at the 40^th percentile, that means they are functioning above 40% of the children in their age range.

Parents may also be asked to complete forms. The parent or guardian of each child will fill in and submit a child enrollment form which contain basic demographic information and also asks if the parent or guardian has any concerns about the child’s health, learning and other issues. The parent is also asked if the child has been diagnosed (and if so with what), and if there is an Individualized Education Plan (IEP).

Special Services for Developmental Delay

There are many special services and intervention for children based on their diagnoses. Positive screening results call for referral to the local school district, a medical provider, or other intervention center. Then the child is provided with resources, recommendations or further referrals.

Some examples of special services/intervention could include:

Speech and Language development support: A speech therapist may be called to work on the child’s language development or pronunciation.

Sensory Needs Support: An occupational therapist may work with an autistic child to help him or her process various sensations in a way that does not agitate him/her.

Medical Support: If a child is has severe asthma, he or she might be referred to a primary care physician to receive appropriate services and medication.

Home daycare providers or family daycare providers can suggest developmental screening if they notice apparent developmental delay in the children they care for.

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