NRNP 6810 Week 4 Developmental Screening Analysis Example

Developmental Screening Analysis: An 18-Month-Old With Flagged Communication and Personal-Social Domains and a Positive M-CHAT-R/F, Referred Now Rather Than Rechecked Later

Student Name

College of Nursing, Walden University

NRNP 6810: Primary Care Approaches for Children

Instructor Name

Month Day, Year

Developmental Screening Analysis: An 18-Month-Old With Flagged Communication and Personal-Social Domains and a Positive M-CHAT-R/F, Referred Now Rather Than Rechecked Later

Two Instruments, Introduced

Composite patient: an 18-month-old boy at his well visit with his mother. The Ages and Stages Questionnaire, Third Edition, is a parent-completed screen that scores five domains of development against age-based cutoffs (Squires & Bricker, 2009); his mother completed the 18-month form in the waiting room. The M-CHAT-R/F, a two-stage autism screen for toddlers, is a 20-item parent questionnaire for autism risk, followed by a structured interview on the failed items when the first score is 3 or higher (Robins et al., 2014); the interview was carried out at this visit. Both are screens. Neither diagnoses anything.

Results in the Tools' Own Terms

ASQ-3, 18 months: communication below the cutoff; personal-social below the cutoff; gross motor, fine motor, and problem-solving above the cutoff. The flagged communication items include naming objects and pointing to pictures on request; the flagged personal-social items include imitating household tasks and pointing to show.

M-CHAT-R: total 5. Scores from 3 through 7 sit in the middle band, where the structured interview is the next step. Items failed: pointing to ask, pointing to show interest, following a point, bringing objects to show, responding to name, and looking at the parent's face in new situations. M-CHAT-R/F follow-up interview: 3 items remained failed after the structured questions, pointing to show, following a point, and bringing objects to show, for a follow-up score of 3.

With 2 or more items still failed after the interview, the screen is positive. In the validation study of 16,071 toddlers, children who scored 3 or more at first and 2 or more after follow-up had a 47.5% chance of an autism diagnosis and a 94.6% chance of some developmental delay or concern (Robins et al., 2014).

The Mother's Concern

Before either result was discussed, she was asked if she had concerns. Her words: "He doesn't really point to show me things. If he wants something, he pulls my hand to it. And he only says a few words, like 'ba' and 'mama', but not all the time." She added that her older daughter was talking in short phrases at this age. Parental concern about development is itself part of surveillance, and the AAP recommends that it be sought and recorded at every visit (Lipkin et al., 2020).

Screening Is Not Diagnosis

Explained to his mother in these words: "These questionnaires look for children who might need a closer look. They can't tell us what's going on, and they don't mean he has autism. What they tell us is that he should be seen by people who specialize in how young children develop, and that we shouldn't wait to do that." The note records that the results were described as a positive screen, and that no diagnosis was given.

What the Clinician Now Owes

1. Document both results, by domain and by item, with the follow-up interview score.

2. Refer for a formal hearing evaluation, since hearing loss can present as delayed speech and reduced response to name (Hyman et al., 2020).

3. Refer to the state's early intervention program today, without waiting for a diagnosis. The AAP clinical report on autism advises referral to early intervention when there is concern, rather than waiting for a diagnostic evaluation to be completed (Hyman et al., 2020).

4. Refer for a diagnostic evaluation for autism spectrum disorder with a developmental-behavioral pediatrician or specialty team; note the expected wait and add the family to any cancellation list.

5. Arrange follow-up in the practice in 4 weeks, to confirm the referrals were received, the hearing test is scheduled, and early intervention has made contact.

6. Rescreen with the M-CHAT-R/F at 24 months, as the AAP recommends for all children at 18 and 24 months, whatever the results of the evaluation (Lipkin et al., 2020).

What the Family Heard

Teach-back, in the mother's words: "He needs a hearing test, and someone from early intervention will call me, and he'll see a specialist, but it could take a while. It doesn't mean he has autism, but it means we're not waiting." Her next question was whether speaking both Spanish and English at home had slowed him down. She was told that growing up with two languages is not what these screens are picking up, that pointing to show and following a point do not depend on which language he hears, and that she should keep speaking to him in whichever language feels most natural to her. The evaluation will look at his development in both languages as a whole. She was given a written list of the referrals with phone numbers and the practice's number to call if no one contacts her within 2 weeks.

Because his father was not at the visit, she asked for something she could show him. She was given a one-page summary of the results in plain language, the list of next steps, and a line explaining that a positive screen is a reason to look closer, not a label. The note records that the summary was given and to whom.

References

Hyman, S. L., Levy, S. E., Myers, S. M., & Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), Article e20193447. https://doi.org/10.1542/peds.2019-3447

Lipkin, P. H., Macias, M. M., & Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), Article e20193449. https://doi.org/10.1542/peds.2019-3449

Robins, D. L., Casagrande, K., Barton, M., Chen, C.-M. A., Dumont-Mathieu, T., & Fein, D. (2014). Validation of the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F). Pediatrics, 133(1), 37-45. https://doi.org/10.1542/peds.2013-1813

Squires, J., & Bricker, D. (2009). Ages & Stages Questionnaires, Third Edition (ASQ-3): A parent-completed child-monitoring system. Paul H. Brookes Publishing.