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Study shows importance of developmental screening tool for identifying delays in pre-term children

Prof. Hollie Hix-Small, Ryerson University, and Dr. Kevin Marks, PeaceHealth Medical Group

Professor Hollie Hix-Small (left), School of Child and Youth Care, Ryerson University, and Dr. Kevin Marks, PeaceHealth Medical Group, have released a study that shows the importance of using screening tools to flag developmental delays in pre-term children.

(Eugene, Ore.)- A new study finds that U.S. pediatricians have plenty of room for improvement when it comes to using a screening questionnaire to flag developmental delays in premature children.

The study was a collaboration between physicians at PeaceHealth Medical Group, led by pediatrician Dr. Kevin Marks, lead author, and co-author Professor Hollie Hix-Small, of Ryerson University's School of Child and Youth Care, formerly of the Early Intervention Program at the University of Oregon. The study, Lowering Developmental Screening Thresholds and Raising Quality Improvement in Pre-term Children, was published in the June issue of Pediatrics and can be viewed online at

In the study, a group of 1,427 caregivers and children in the U.S. attending their 12- or 24-month well-child visits (regular screening for developmental delays by pediatricians) completed the Ages & Stages Questionnaire(r) (ASQ), a child development screening tool.

The study examined the number of lower-risk, pre-term (most who were born between 34 and 37 weeks gestational age) children versus the number of term children who were referred to an early-intervention agency. Higher-risk premature infants already involved with an early-intervention agency or previously identified with a delay were excluded.

The data shows the selected pre-term children were approximately two times more likely to be eligible for early intervention programs than term children, but that many of these children are being missed due to insufficient standardized screening at well-child visits. In addition, the study shows that an unacceptably high percentage of children who are identified as potentially delayed (and likely to benefit from early intervention), are not accessing services due to lack of follow-up between parents and early intervention programs.

"Pediatricians identify children with delays through a process of developmental surveillance and screening, which primarily occurs at well-child visits between zero to five years of life. This study indicates that pediatricians should provide more diligent surveillance and actively lower their thresholds for administering a quality (valid, reliable and feasible) screening tool like the Ages & Stages Questionnaire in preterm children," says Dr. Kevin Marks.

Adds Hix-Small: "We need more research in Canada to find out how many physicians are using a high quality screen tool, such as the ASQ Questionnaire, and how children can benefit from this. Developmental screening is a very real, tangible and cost effective way to improve the quality of health care and child outcomes and should be considered a key element in well-child care."

Without a screening tool, says Hix-Small, physicians fail to detect up to 60 to 80 per cent of children with developmental delays in a timely manner.

"This study highlights the increased importance of using standardized screening with pre-term children who are at an increased risk for developmental difficulties and have been shown to greatly benefit from early intervention services. Physicians are in an incredible position to identify delays and open up opportunities for parents to access early supports and services for their children."

Hix-Small will hold a training session on the benefits of developmental screening for pre-term children and their caregivers, such as the ASQ Questionnaire, with clinicians and practitioners at the Hospital for Sick Children's Infant Mental Health Program in October.


Dr. Kevin Marks is available for phone interviews on Monday, June 15, and Tuesday, June 16.

Professor Hix-Small is available for on-camera and phone interviews on Monday, June 15, and Tuesday, June 16. Please contact Andrea Ash, Peacehealth Media Relations, for interviews with Dr. Marks, and Suelan Toye, Public Affairs, Ryerson University, for interviews with Professor Hix-Small.

PeaceHealth Medical Group (PHMG) is a multi-specialty group practice with more than 130 physicians and 600 staff members at clinic locations in western Oregon. PHMG is part of PeaceHealth Oregon Region, a non-profit, locally governed, spiritually-based health care system based in Eugene, Oregon.
Ryerson University is Canada's leader in innovative career-focused education, offering close to 90 PhD, master's, and undergraduate programs in the Faculty of Arts; the Faculty of Communication & Design; the Faculty of Community Services; the Faculty of Engineering, Architecture and Science; and the Ted Rogers School of Management.  Ryerson University has graduate and undergraduate enrolment of 26,500 students. With more than 68,000 registrations annually, The G. Raymond Chang School of Continuing Education is Canada's leading provider of university-based adult education.


Andrea Ash, PeaceHealth Media Relations, Oregon, U.S.
Office: (541) 686-7110, cell: (541) 501-3296
Contact for media interviews with Dr. Kevin Marks, lead author of study and pediatrician at PeaceHealth Medical Group
Suelan Toye, Public Affairs
Ryerson University, Toronto, Canada
Office: 416-979-5000 x7161
Contact for media interviews with Hollie Hix-Small, co-author of study and professor, School of Child and Youth Care, Ryerson University



Created by the Center on Human Development at the University of Oregon in 1980, ASQ is a set of written questions parents answer about their child's activities. Available in English, Spanish, Korean, and other languages, the questions probe for specific answers about the child's skills in communicating, moving large and small muscles, problem-solving and socialization skills.  One of the goals of ASQ is to identify children who may need further assessment because of a possible developmental delay.   Doctors can then refer the child (and caregiver) to a local early intervention or special education agency.  At-risk children who are not found eligible for services, can also be linked to other early childhood community resources (i.e. Head Start).

Developmental and behavioral problems are estimated to affect 12 to 16 percent of children in the United States. Since 2001, the ASQ project has been used across the U.S., helping parents of infants and toddlers monitor their child's overall development. The ASQ is a screening instrument now used extensively by PeaceHealth Medical Group (PHMG) pediatricians to determine if a child's development is on schedule.

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