Developmental Screening and Follow-up by Nurses.
OBJECTIVE
The Ages and Stages Questionnaire (ASQ) and Modified Checklist for Autism in Toddlers (M-CHAT) are commonly used screening tools for developmental delay and autism, respectively. This study aimed to evaluate the effectiveness of implementing 18-month developmental and autism screening by mail, with a standardized follow-up process for abnormal screen results.


METHODS
Within a prospective cohort study design, parents of 892 children received by mail the 18-month ASQ and M-CHAT questionnaires between December 2008 and September 2009. A registered nurse scored the questionnaires and, if needed, administered follow-up screening or set up a referral to Early Intervention or subspecialty pediatrics. Medical record reviews determined clinical outcomes of children who required intervention after initial screening through September 2010. Additionally, demographic factors were evaluated for association with responding to the questionnaires.


RESULTS
The ASQ and M-CHAT questionnaires were returned by 529 (59.3%) of the parents. Parents of White children (390/575 [67.8%]) and those with private insurance (457/660 [69.2%]) were significantly more likely to return screening questionnaires than parents of non-White (64/171 [37.4%]; P < .001) and government-insured children (58/169 [34.3%]; P < .001), respectively. Of the 529 children with returned surveys, 109 (20.6%) did not pass at least 1 of the initial screens and 12 (2.3%) were referred after not passing the follow-up screening process.


CONCLUSIONS
Developmental and autism screening by mail is not a sufficient method to comprehensively screen a general pediatric population. A nurse-completed, standardized follow-up process after an initial failed developmental screen may increase the yield of appropriate Early Intervention or subspecialty referrals.
Brian A. Lynch is an Assistant Professor of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. The author can be reached via e-mail at lynch.brian@mayo.edu Amy L. Weaver is a Statistician, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Stephanie R. Starr is an Assistant Professor of Pediatrics, Mayo Clinic, Rochester, MN. Karen L. Ytterberg is an Assistant Professor of Pediatrics, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Paulette V. Rostad is a Developmental Screening Coordinator, Division of Community Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. David J. Hall is a Mayo Clinic Pediatric Resident, Mayo Clinic, Rochester, MN. Sharon J. Tucker is the Director, Nursing Research, Evidence-Based Practice and Quality, Department of Nursing Services and Patient Care, University of Iowa Hospitals and Clinics, Iowa City, IA.
Brian A
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Lynch
Amy L
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Weaver
Stephanie R
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Starr
Karen L
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Ytterberg
Paulette V
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Rostad
David J
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Hall
Sharon J
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Tucker
D001321:Autistic Disorder / Q000175:diagnosis* / Q000451:nursing; D057189:Checklist; D002657:Child Development; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000451:nursing; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000451:nursing / Q000706:statistics & numerical data; D011446:Prospective Studies; D011795:Surveys and Questionnaires