Improving Developmental and Behavioral Screening for Spanish-speaking Children
Statement of Problem
It’s estimated that 10-20 percent of young children experience delays in development, manifest behavioral challenges or are at risk for autism. However, only 2.5 percent of children in the United States under the age of five are actively participating in Early Intervention services that could address these disorders, underscoring the need to improve early identification, referral and follow-up on services for affected children. Valid and reliable screening and diagnosis are essential to identifying children’s risk of developmental and behavioral delays and connecting children and caregivers with necessary intergenerational family services. These services can include supports for caregivers in pediatric settings and provide opportunities for education and referral to services, such as Early Intervention, but screening rates using standardized instruments are low.
Furthermore, culturally and linguistically appropriate screeners are particularly important when socioeconomic, cultural and language differences between parents and providers are present, which may heighten the potential for misunderstandings. As such, identifying early delays in children of Spanish-speaking immigrant families is especially difficult. This is unfortunate given that dual language learners in general, and Hispanic children in particular, are at high risk for developmental delays. Furthermore, familial factors such as maternal depression have shown to relate to delays in development and language and increases in behavioral challenges. Screening tools that effectively identify and diagnose children with developmental delays and behavioral concerns will facilitate connections to Early Intervention and other services, ultimately improving children’s overall well-being.
To inform developmental and behavioral screening for Spanish-speaking children, Dr. Marsha Gerdes and colleagues conducted the KiDDS Study to compare the effectiveness of two sets of developmental-behavioral screening instruments. The first set was the newly available Spanish-language versions of the Survey of Well Being of Young Children (SWYC), a publically available comprehensive screener created by Tufts University that screens for risk of developmental delay, behavior problems and autism. SWYC surveys are written at a low reading level for ease of comprehension and can be administered in 15 minutes or less, making it highly attractive to the general population and clinicians alike. The second set included established Spanish-translated screening instruments such as the Ages and Stages Questionnaire (ASQ) and Modified Checklist for Autism in Toddlers (MCHAT).
The KiDDS study included a series of interviews and assessments that were carried out over a period of three and a half years. We recruited nearly 1,000 Spanish-speaking children ages nine months to five years, from low-income, mostly immigrant households who used clinics, daycares and community centers throughout Philadelphia, Norristown, Pennsylvania, and Camden, New Jersey. The first interview was a parental interview that collected demographic information and screeners for Autism, behavioral and developmental delays. Eligible participants were then randomized to come for a second visit based on the results of the screeners at the first. The second visit included a standardized clinical psychological assessment conducted in the child’s primary language. At the end of the second visit, parents would receive feedback from the assessors. If the child was found to have any possible delays, we referred them to Early Intervention and/or provided them with information about other resources related to their needs.
Currently, Dr. Gerdes and colleagues have completed data collection and are analyzing and interpreting that data. Over the next months, we will be focused on dissemination of the KiDDS study findings.
Children's Hospital of Philadelphia, PolicyLab. Improving Developmental and Behavioral Screening for Spanish-speaking Children [Online]. Available at: http://www.policylab.chop.edu [Accessed: plug in date accessed here].