Developmental Screening & Surveillance in Children
Susan Berry, MD, MPH, FAAP (LSUHSC / Louisiana Bureau of Family Health)
Every Louisiana pediatric medical home shares a goal: identify children withdevelopmental or behavioral concerns early, when intervention does the most good. About one in six children has a developmental disability, but many are misseduntil they reach school age. Two practices work together to close that gap. Developmental surveillance — eliciting parent concerns, tracking milestones, andwatching parent-child interaction — happens at every well-child visit. Standardized screening with validated tools happens at set ages (9, 18, and 30months for general development; 18 and 24 months for autism) and any time aconcern arises. This page outlines the current AAP-recommended schedule, how tochoose and use screening tools such as the ASQ-3 and M-CHAT-R/F, and the Louisianapathways — EarlySteps, Child Search, and the medical home — that turn a positivescreen into services for the child and family.
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Why early identification matters
The developing brain forms new neural connections at an extraordinary rate in the first years of life, and that architecture is shaped by a child's experiences and environment. Landmark early-childhood studies — among them the Abecedarian Project, followed for decades — found that children who received high-quality early intervention were more likely to finish school, hold jobs, and live independently, with measurable gains in adult health.
Adverse childhood experiences (ACEs) push in the opposite direction. The original ACE study linked a higher ACE count to greater lifelong risk of depression, chronic disease, and shortened lifespan. Chronic, unbuffered "toxic" stress in early childhood can disrupt developing stress-regulation systems — which is why screening looks not only at the child's milestones but at the family and environmental context around them.
Surveillance vs. screening
These are two distinct, complementary activities. Increased risk identified through surveillance should trigger screening — not a wait-and-see approach.
Developmental surveillance
A flexible, longitudinal process done at every health supervision visit:
- Elicit and address parent concerns
- Maintain a developmental history
- Observe the child and parent–child interaction
- Identify risk and protective factors
- Document findings and share developmental promotion
Developmental screening
Use of a standardized, validated tool to flag children who need further evaluation. A screen:
- Does not diagnose or give a developmental level
- Identifies who needs assessment, and in what domains
- Points toward the right referral
AAP recommended screening schedule
The AAP's 2020 clinical report, Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening (Lipkin & Macias), sets the current standard, carried in the annually updated Bright Futures periodicity schedule:
| Domain | Standardized screen at |
|---|---|
| General development | 9, 18, and 30 months |
| Autism spectrum disorder | 18 and 24 months |
| Maternal / caregiver depression | 1, 2, 4, and 6 months |
| Any domain | Whenever surveillance, a parent, or the clinician raises a concern |
Surveillance happens at all other visits. A concern surfaced at any visit should be followed by a standardized screen or a direct referral. The 2020 report also aligns with the CDC/AAP developmental milestone checklists, which were revised in 2022 (Zubler et al.) to add 15- and 30-month checklists, use milestones ~75% of children reach by a given age, and discourage the wait-and-see pattern.
Choosing a screening tool
A well-chosen developmental screening instrument should:
- Have sensitivity and specificity in roughly the 70–80% range or better
- Be validated in a population resembling yours (socioeconomics, culture, language, literacy)
- Be published in a peer-reviewed journal
- Be quick, easy, and low-cost to administer and score
- For general development, cover gross motor, fine motor, language, cognition, and personal-social domains
Commonly used validated tools
A layered set of instruments covers general development, autism, social-emotional health, family context, and caregiver depression:
| Domain | Tool | Age range | Notes |
|---|---|---|---|
| General development | ASQ-3 (Ages & Stages Questionnaire) | 1–66 mo | Parent-completed; 10–15 min; use at 9/18/30 mo |
| Autism | M-CHAT-R/F | 16–30 mo | Current standard; two-stage with follow-up interview; use at 18 & 24 mo |
| Social-emotional | ASQ:SE-2 · PPSC · ECSA | ~1–72 mo | PPSC free via SWYC; ECSA single form |
| Family context / safety | SEEK (Safe Environment for Every Kid) | Family | Screens for maltreatment risk and family stressors |
| Caregiver depression | PHQ-2 · EPDS | Caregiver | Brief; PHQ-2 embedded in SEEK; EPDS in SWYC |
| Multi-domain "one form" | SWYC (Survey of Well-being of Young Children) | 2–60 mo | Free; bundles development, autism (POSI), behavior, family context, and depression |
From positive screen to services
A positive screen begins a process, not a diagnosis. Under the Individuals with Disabilities Education Act (IDEA), a healthcare provider must refer an identified child to early intervention or the school system promptly. In Louisiana:
- EarlySteps — Louisiana's IDEA Part C early intervention system for children birth to 3
- Child Search — the public school system's evaluation pathway for children 3 and older
- Developmental-behavioral pediatricians, psychologists, and OT/PT/speech therapists for comprehensive assessment
Within the medical home, an identified delay should move into chronic-condition management: enter the child in the practice's registry of children with special health care needs, complete a family needs assessment, develop a written care plan, work up associated medical problems, and link the family to community and public-health supports.
Billing note
Standardized developmental screening is reported with CPT 96110 (per instrument), brief emotional/behavioral assessment with 96127, and caregiver-focused screens such as maternal depression with 96161. Code descriptors and payer rules change; verify current CPT guidance and Louisiana Medicaid policy before billing. (Louisiana Medicaid reimburses the 30-month screen.)
Adapted by the Louisiana Chapter of the American Academy of Pediatrics from a presentation, Developmental Screening and Surveillance: New Recommendations for Children in Louisiana, by Susan Berry, MD, MPH, FAAP (LSUHSC / Louisiana Bureau of Family Health). Content on this page has been updated to reflect current national guidance, including the AAP 2020 clinical report (Lipkin & Macias, Pediatrics 2020;145(1):e20193449), the 2022 CDC/AAP developmental milestone revision (Zubler et al.), and the AAP 2025 report on screening for mental, emotional, and behavioral problems.
For further reading: AAP, The Lifelong Effects of Early Childhood Adversity and Toxic Stress; Center on the Developing Child, Harvard University (developingchild.harvard.edu). This page is educational and does not indicate an exclusive course of treatment or serve as a standard of medical care; variations accounting for individual circumstances may be appropriate. Clinicians should confirm ages, tool selection, and coding against current AAP/Bright Futures and Louisiana Medicaid guidance before applying them in practice.