This morning, Dr. Halfon discussed the use of developmental screening in young children. He commented on the PEDS screening tool and stated that "...even Denver does not use the Denver anymore." I was wondering what your opinion is on the various ways to screen development in the outpatient setting. Thanks.

The Denver certainly has serious shortcomings. It is not as refined and reliable as tests like the Bayley, for example, which are standardized and specific and need trained administerers with a lot of time. It is particularly poor on language development in the toddler years between 12 and 36 months, when most of our developmental questions come up.

It has some advantages, including being on one page, and the easy visual demonstration of the relationship among achievement levels in different areas of development.

I do think it is valuable for the pediatricians to actually try some play activities directly with the child and am reluctant to give up and use only questionnaires directed to the parents. These are promoted to save time while still finding and referring kids in need of services. The PEDS (Parents Evaluation of Developmental Status), for example, is an excellent tool in which parents fill out, or in our case, as the literacy requirements are high, we would interview parents to decide what, if any evaluations should be considered. This means a standardized interview added to your exam, followed by direct ascertainment if needed.

The Ages and Stages Questionnaire is theoretically being mailed to everyone in our clinic population and we are supposed to be notified of children about whom some concern has been raised. I haven't seen results yet, but last I heard we should be expecting that. There is a "pre-screening" Denver questionaire that asks the parents all the items on the Denver before they're seen to make our administration easier, but I think we'll wait a long time before that happens.

To me, the most tempting substitute for the Denver is the ELMS language development test, which looks like a denver but only covers up to 36 months. Probably if we use that, we should still use the Denver or some other instrument after that.

Finally, the question is between an efficient way to gather information to allow referral to whatever services may still be available after Bloomberg and Pataki finish dismantling everything we have, and a screening that reminds the examiner to engage the parent and the child on a level of detail that helps him to understand something about the quality of the child's ability. For all its faults, I think the Denver is adequate for this. Questionnaires are limited in their usefullness because of the poor literacy, and lack of sophistication about child development among our patients' parents, and our own need for training and personal satisfaction of being involved in and understanding the specifics of the deficits for which we are making referrals.

I am very open to any suggestions. You could look at a little more detail by looking at a web site called www.uvm.edu/~cdci/pedilinks/ei/tools/earlylang.htm

Yours, Harriet McGurk