Don't screen all kids for developmental delays, experts advise

Don't test children for developmental delays if they're not showing any signs of problems, a government-backed panel of Canadian experts advises.

The recommendation from the Canadian Task Force on Preventive Health Care largely mirrors U.S. recommendations regarding screenings for speech and language delays and autism spectrum disorders.

The advice applies to children ages one to four who have no signs or symptoms of developmental delays, said Dr. Brett Thombs, who is a member of the Task Force.

"If parents think their child is behind on some of their important milestones, this doesn't apply to those kids," said Thombs, who is affiliated with McGill University in Montreal.

Developmental delays can include, for example, problems with motor skills, speech, language, thinking, social skills and activities of daily life.

The Task Force writes in CMAJ that when these delays persist, children are at higher risk of learning difficulties, behavioral problems and functional impairments later in life.

For the new recommendation, the Task Force commissioned a review of existing evidence to see if the benefits of screening for developmental delays in all children ages one to four, regardless of whether they showed signs of problems, would outweigh the potential harms.

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The screening tools are usually questionnaires that add up to a certain number of points, said Thombs.

"Those points would determine if the physicians should act or be more concerned," he said.

Overall two relevant randomized controlled studies were found, but the Task Force found that the screening tools did not ultimately improve health outcomes among children.

Instead, the screening tools had very high rates of false positives, said Thombs.

Those false positives would lead to many children with normal development being referred for more testing, he added. Those referrals may take health resources away from children who would actually benefit from the services.

"We don't recommend parents get their kids tested unless they have any specific concerns," said Thombs.

In February, the U.S. Preventive Services Task Force said it did not find enough evidence to recommend universal autism spectrum disorder screening for toddlers between 18 and 30 months of age. Likewise, in 2015, the U.S. Task Force said there's not enough evidence to recommend universal screening for speech and language delay and disorders in children under age five.

"We're not suggesting parents and physicians don't keep ongoing surveillance," said Thombs. "If they have any concerns at all, they should have their physicians check it out."