Recommendations on screening for developmental delay.

CMAJ 2016. DOI:10.1503 /cmaj.151437 Developmental delay in children may be transitory or sustained and is characterized by a significant delay (i.e., performance 1.5 standard deviations or more below age-expected norms) in one or more of the following domains: gross and fine motor skills, speech and language, social and personal skills, activities of daily living and cognition.1,2 Children with sustained developmental delay are at higher risk of learning difficulties, behavioural problems and functional impairments later in life.2,3 Many factors are associated with increased risk of developmental delay, including poor maternal health during pregnancy, birth complications, infections, genetic characteristics, exposure to toxins, trauma, maltreatment and possibly low socioeconomic status.1,3–7 There is considerable interest in the possibility that early identification and intervention may improve health outcomes among children with developmental delay.1,8,9 Population-based screening of all preschool children has been proposed to facilitate early identification and treatment. For example, the province of Ontario recommends developmental screening of all children at 18 months,10 and the American Academy of Pediatrics recommends developmental screening at 9, 18 and 30 months and autism screening at 24 and 30 months.11,12 The Canadian Task Force on Preventive Health Care assessed the evidence on the effectiveness of populationbased screening for developmental delay in primary care settings. To inform the resulting recommendations, the task force also assessed evidence on the accuracy of screening tools to identify undetected developmental delay and the effectiveness of behavioural interventions.