Outcomes from an enhanced developmental screening programme in Singapore

Abstract

Introduction: Historically, low referral rates of 3-4 % have been reported from Singapore primary health care. Early identification of and intervention for developmental delays and autism enable achievement of optimal outcomes. An enhanced developmental screening (EDS) programme was introduced in primary care to improve identification of developmental delays and autism for children aged 18 and 30 months. This study evaluated prevalence of positive screening for developmental delays/autism at 18 months, identified associated socio-demographic risk factors and studied the correlation between primary care screening tools with outcomes following tertiary care assessments.

Methods: In primary care, EDS was conducted using Parents' Evaluation of Developmental Status (PEDS), Parents' Evaluation of Developmental Status: Developmental Milestones (PEDS:DM), Ages & Stages Questionnaires-Third Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised - Follow-Up (M-CHATR/F) along with collection of socio-demographic data. Tertiary care assessment included Developmental Profile-3 (DP-3) screening and, a developmental paediatrician consultation.

Results: Of 4212 children screened at 18 months, 14 % screened positive for developmental delays and 2 % for autism at primary care. Lower maternal education, ethnic minority status and lower socioeconomic status were associated with a positive screen. Moderate- strong correlation was seen between the ASQ-3 gross motor domain and DP-3 physical domain, moderate correlation between the communication domains of the 2 tools and the ASQ-3 personal-social domain with DP-3 adaptive domain.

Conclusion: EDS enabled improved identification of children for developmental delays/autism. Identification of socio-demographic risk factors will enable children from such families to be identified early and referred for intervention.

Keywords: Autism; Developmental delay; Developmental screening.