Who are we missing?Early Developmental & Behavioural Screening

Shirley V. Leew, PhDPediatric Rehabilitation Clinical

Research ScientistDecision Support Research Team

Calgary Health Region

Why is this research important?

• Present methods of early screening miss between 70 - 80% of the 16% of children who have developmental &/or behavioural disabilities.– We need reliable and usable ways to

identify all young children who are at risk • Mild to moderate• Possibly to ameliorate future disability.

Who are most at risk?

• Children of mothers with history of poor mental health (including depression)

• Children living in poverty• Children of mothers with poor social supports• Children of young mothers• Children of single mothers• Children of mothers with less than high school

educationWho are not being referred early?

• Children who don’t regularly see a developmental pediatrician or a family doctor

• Children in good general health• Children with no ear infections before 2 years of age• Girls• First born or only child• Children born at term

Enhancing screening for developmental &/or

behavioural problems

• Maternal mental health characteristics:– Infant – mother social interactions

• influence development– short and long term consequences for an infant’s

cognitive, social and emotional development

‘Early identification of developmental risk associated with maternal mental well-

being revealed in early screening’

Cuddles Research Questions• 1) What is the rate of identification of

developmental concerns in infants when using a standardized, online, screening measure in a community health clinic at 6 month, 12 month, and 18 month well-child visits?

• 2) What is the relationship between maternal self-reported depression and developmental screening outcomes at 6 month, 12 month and 18 month well-child visits?

• 3) What is the relationship between maternal self-reported anxiety and developmental screening outcomes at 6, 12, and 18 month well-child visits?

Methods• Recruitment screening at 6 month well

child visits• 2 CHC in Calgary• 200 participants per clinic

• Re-screening at 12 and 18 month well child visits

• Measures– The Parental Evaluation of Developmental

Status (PEDS)• Computer/online administered

– Edinburgh Postpartum Depression Scale– STAI-Y (State-Trait Anxiety Inventory, form Y)– Brigance Parent-Child Interaction Scale– Demographic questionnaire

Planned Analyses• Descriptions of prevalence and proportions of risk

– means and ratios

• Relationships between maternal mental health and developmental/behavioural risk: – Stepwise regression analyses

• dependent variable: – numerical value assigned to PEDS paths

• independent variables: – EPDS, STAI-Y

• Relationship between infant-mother social interactions and maternal mental health– Regression analyses

• DV: maternal mental health• IV: Brigance

• Relationship between mother-child interactions and developmental risk – Regression analyses

• DV: PEDS Path• IV: Brigance

Cuddles Progress

• Acadia CHC– Piloting is completed– Screening has started

• NW CHC– Recruitment posters are in the

community• Recruitment screening will begin

Feb1,2008

Anticipated Impact • Rate of identification of developmental

&/or behavioural risk/disabilities of children < 2yrs in Calgary will increase:– including children with symptomatic (high) and

asymptomatic (low – moderate) risk

• Primary health care providers will develop trust in early screening processes– Screening as education– Partnerships with community providers

• Mothers with history of poor mental health will get parenting guidance that will impact development/behaviour for their children.