Meeting Special Needs: A Call for Universal Screenings

Anthony and Raj started kindergarten the same year. Identical in age, preferences for cheese sticks over carrots, and a penchant for constantly taking off their shoes, they also shared similar academic and behavioral tendencies. Both boys struggled to interact with their peers and retain information from one day to the next. There was one significant difference between them, however. Anthony had been diagnosed at age two with a form of autism spectrum disorder (ASD), and had been receiving additional support services for three years, while his classmate, Raj, had not.

Anthony’s family had concerns about his rate of development, and had requested a developmental screening through his doctor. The screening revealed delays compared to peers his age, and he was formally evaluated and ultimately received the diagnosis of ASD. This enabled Anthony to start working with specialists from almost the youngest possible age, and he entered kindergarten with a history of paperwork that would enable him to immediately receive school-based interventions upon his arrival. Without this background, Raj (who in 2nd grade would also be diagnosed with a form of ASD), could not receive any additional support in school until he began the screening process mid-way through kindergarten. The differences in Anthony and Raj’s stories are not uncommon, but they highlight the critical role that early childhood screenings can play in enabling children with disabilities to get the supports they need as early as possible.

A number of screening tools exist to determine a child’s progress in areas such as language, social, or motor development, relative to norms for children at their exact age. Screeners can take many forms, but guidance from the U.S. Department of Health and Human Services (HHS) from 2014 notes that early childhood developmental screenings must be both reliable and valid. Reliability refers to the stability of scores on the tool regardless of when or where it is administered, or who is administering it. Validity means the scores reported by the screener accurately assess what they are meant to assess. Both elements should be present, according to HHS, in order to have a clear sense of how children are developing.

The importance of reliable and valid screenings cannot be understated. (Something my colleagues point out in From Crawling to Walking.) According to the Pennsylvania Department of Public Welfare, as many as one in four children ages 0-5 are at risk for developmental, behavioral, or social delays. The Centers for Disease Control and Prevention (CDC) further notes that one in every 68 children in the U.S. has been identified as having an autism spectrum disorder (ASD). ASD can be diagnosed as early as age two, but most children are not identified until after age four. Early screenings could change that, as high-quality early intervention can dramatically alter a child’s developmental trajectory.

Despite the potential benefits, developmental screenings in early years (birth to 5) are not widely used in most places. Their use is determined on a state-by-state basis, otherwise screenings take place at the behest of a pediatrician, typically after a family has requested it. As of 2008, Minnesota is the only state that practices free, statewide early childhood screenings, and has since 1977. State law in Minnesota mandates all children are screened before entering kindergarten in public schools.

Although Minnesota has a greater chance than other states of catching children who need early intervention services, questions about the practice remain. Is it worth the taxpayer’s dime, not to mention the time commitment it takes annually to screen over 60,000 children for an hour or more each? The Minnesota Department of Education reports screenings cost approximately $70 per child, and argues this is cost effective because early intervention can be highly successful in addressing issues before they compound.

For children from low-income and minority populations, this argument is particularly poignant, as these groups are more likely than others to be affected by developmental delays. Additionally, and unfortunately, they are also least likely to have access to services that could address these delays. Federal law requires all states provide early intervention services to children identified as having a developmental delay. The sticking point for many groups is the simple act of identification. The American Academy of Pediatrics (AAP) recommends children receive developmental screenings at 9, 18, and either 24 or 30 months of age. AAP estimates 13 percent of young children between 9-24 months old have developmental delays, but that only one in ten receives intervention services by 24 months.

In light of this, in 2014 the U.S. Department of Education’s Office of Special Education and Rehabilitative Services launched an initiative to encourage the wider use of early developmental and behavioral screenings.  The Birth to Five: Watch Me Thrive! program provided information to families and health providers on available, research-based screening tools as well as guidelines for invested parties. The federal government does not require early screenings, however, so not all schools and early education programs expend resources toward their universal use. From Crawling to Walking calls for states to require licensed child care providers and state-funded pre-K programs to conduct developmental screenings. In the past, however, many states have cited additional barriers to mandating screenings prior to kindergarten, including time constraints, staff limitations, financial restrictions, and lack of information during selection process of screening instruments available.

We’ve all heard the proverb, “It takes a village to raise a child,” articulating the need for a supportive community made up of family, friends, and oftentimes specialists, in order to ensure the proper development of a child. In cases where young children are struggling, or developing at a rate slower than similarly-aged peers, the question of which specialists are most needed becomes highly relevant. Early childhood screenings are a useful strategy for beginning to answer that question, and have the potential to make an enormous difference in the trajectory of support received by children who need it most."