Screening and Treatment for Developmental Delay in Early Childhood (Ages 1-4): Systematic Review
Warren, R., Kenny, M., et al. (2015).
Calgary, AB (Canada): Canadian Task Force on Preventive Health Care, 1-117.
This three-part systematic review investigates the effectiveness and harms of 1) screening, 2) treatment and 3) the psychometric properties of screening methods in young children (ages 1-4 years) with suspected developmental delay.
Canadian Task Force on Preventive Health Care
Note: The authors' definition of developmental delay includes autism spectrum disorders, autistic disorder, and pervasive developmental disorder (as defined by Diagnostic and Statistical Manual of Mental Disorders- Fourth Edition).
Inception to September 16, 2015
Systematic reviews; randomized controlled trials; studies examining psychometric properties (any designs)
29 to 31 total (inconsistently reported)
The following screening tools were reported to have low sensitivity (range: 31.8% to 62.5%) in screening developmental delay and pervasive developmental disorder:
<ul>
<li><em>Checklist for Autism in Toddlers</em> (CHAT);</li>
<li><em>Social Communication Questionnaire</em> (SCQ);</li>
<li><em>Bayley Infant Neurodevelopmental Screener</em> (BINS); and</li>
<li><em>Parents’ Evaluation of Developmental Status</em> (PEDS).</li>
</ul>
The following screening tools were indicated to have poor performance and low sensitivity (range: 35.1% to 69.2%) in screening for autism spectrum disorders:
<ul>
<li><em>Checklist for Autism in Toddlers</em> (CHAT);</li>
<li><em>Communication and Symbolic Behaviour Scales</em> (CSBS);</li>
<li><em>Social Communication Questionnaire</em> (SCQ); and</li>
<li><em>Parents’ Evaluation of Developmental Status</em> (PEDS).</li>
</ul>
"This low sensitivity implies a high level of false negatives and a large proportion of ASD cases would not be identified at population level" (p. 32).
The authors were unable to make a conclusive statements on the effectiveness of autism spectrum disorder interventions due to variability of sample sizes and effect sizes. Studies indicated no harms associated with treatment for developmental delay
For screening autism spectrum disorders. The <em>Modified Checklist for Autism in Toddlers</em> (MCHAT) demonstrated modest sensitivity with 78% (range: 64% to 88%). However, the MCHAT demonstrated low specificity with 69% (range: 47% to 85%), which implies a higher rate of false positives and assessment of the population without the actual disorder.
"The evidence on screening for developmental delay [DD] in children aged 1 to 4 years of age without suspected DD to improve cognitive, educational and adaptive functioning outcomes is inconclusive" (p. 34). Results suggest no harms associated with screening for DD.
In 2/3 studies, treatment for DD demonstrated significant language impairment benefits for young children as compared to controls (SMD=0.81; 95% CI=0.02 to 1.6). One study investigating adaptive functioning or socialization found no difference in effect (SMD=0.60; 95% CI=-3.05 to 4.25). No studies reported on the harms of DD treatments.
