Is Developmental Screening Enough in High-Risk Populations?

In this issue of Pediatrics, Sananes et al1 leverage the Pediatric Heart Network Single Ventricle Reconstruction Trial to describe developmental and behavioral concerns in a cohort children with hypoplastic left heart syndrome related single right ventricle conditions. The recognized importance conducting screening as recommended by American Academy Pediatrics (AAP)2,3 population at high risk for neurodevelopmental concerns.The researchers evaluate how well diagnostic evaluation 14 months age, Bayley Scales Infant Development-II,4 3, 4, 5 years Ages & Stages Questionnaire (ASQ),5 predicted outcome “developmental functioning” measured Adaptive Score on Behavior Assessment System Children-2 (BASC-2)6 6 age.There were some correlations between early evaluations later outcomes age years, such “failure” (scoring 2 SDs below mean) Psychomotor Developmental Index Development-II having relatively good sensitivity (0.79) identify lower adaptive skills age. general, however, study found that scores had low positive predictive value BASC-2 Scores years. Some domains ASQ, including personal-social, problem-solving, communication scales, correlated 6-year-old Scores, “fail” ratings problem-solving personal-social 4 PPVs ranging from 75 93. Additionally, rates parent-reported behavior problems significantly higher than younger ages.It is helpful understand specific tasks assessment tools measure. broad-based rating scale measures different constructs ASQ differs other functioning.A signature profile described congenital disease (CHD) involves “low severity, prevalence” pattern deficits.7 Thus, may have mild deficits across numerous development subsequently culminate impairments day-to-day functioning. More subtle challenges attention regulation executive functioning are common CHD not present functional impact until school-age. These concepts underscore depth, multidisciplinary critical time points AAP-approved Association scientific statement treatment7 guidelines incorporating formal follow-up programs into cardiac care.8 Targeted should be conducted addition ongoing AAP-recommended surveillance all children.2,3In study, it was reassuring more three-quarters who passed ages scored within average range Authors raise important issues about screening, surveillance, high-risk pediatric populations, those conditions factors associated neurologic injury delay or disability). include following:The work has implications surgical specialties. Implementing populations known can serve touchpoint discuss chronic diseases offer hope support. When been diagnosed delays delays, proactive support approach important. A blended logical. Unlike many medical conditions, named diagnosis required child access benefit interventions physical, occupational, speech-language therapy Part C Early Intervention programming.