Curious about the new CDC/AAP SURVEILLANCE milestones?
Some background first!
Its important to know the difference between surveillance, screening, and diagnosis
And that these changes affect ONLY surveillance, and began BEFORE the pandemic
Alright, Let's go...🧵1/16
Some background first!
Its important to know the difference between surveillance, screening, and diagnosis
And that these changes affect ONLY surveillance, and began BEFORE the pandemic
Alright, Let's go...🧵1/16
Surveillance v. Screening v. Diagnosis
Surveillance: Identifying at-risk children by discussing parents’ worries and clinical observations and milestones
Any child identified as "at-risk" for developmental delay (DD) through surveillance, goes on to get a validated screen.
Surveillance: Identifying at-risk children by discussing parents’ worries and clinical observations and milestones
Any child identified as "at-risk" for developmental delay (DD) through surveillance, goes on to get a validated screen.
Screening v. Diagnosis
Screening: Validated assessments at specific ages, or when surveillance concerns arise, to quantify a risk for DD and refer for therapies or diagnostic evaluation. Ex. MCHAT/ASQ
Diagnostic: Evaluations by developmental experts. Ex ADOS/Bailey/Mullen...
Screening: Validated assessments at specific ages, or when surveillance concerns arise, to quantify a risk for DD and refer for therapies or diagnostic evaluation. Ex. MCHAT/ASQ
Diagnostic: Evaluations by developmental experts. Ex ADOS/Bailey/Mullen...
The overarching goal of the project was to clarify milestones in an evidenced-based way that captured the most "at risk" children
But why was this necessary?
Old checklists were based on broadly accepted clinical opinion, but generally uncited, unvalidated and inconsistent.
But why was this necessary?
Old checklists were based on broadly accepted clinical opinion, but generally uncited, unvalidated and inconsistent.
Old checklists left too much room for interpretation
Milestones were defined by what 50% of children should be able to do, arguably too low, as many clinicians adopted a "wait and see" approach.
Retrospectively, less than 1/4 of children with delays received EI before 3y
Milestones were defined by what 50% of children should be able to do, arguably too low, as many clinicians adopted a "wait and see" approach.
Retrospectively, less than 1/4 of children with delays received EI before 3y
Old checklists were repetitive, with certain milestones spanning multiple ages
They were subjective, using language like "May" or "begins to"
They didn't include important Social-Emotional milestones
They weren't based on empirical evidence
Checklists didn't exist for all WCC
They were subjective, using language like "May" or "begins to"
They didn't include important Social-Emotional milestones
They weren't based on empirical evidence
Checklists didn't exist for all WCC
So, 3 years ago, experts in DBpeds, Neurodevelopment, GenPeds, Child Psychology, and Special Education conducted a thorough lit review,
Comparing empirical data against already established CDC milestones
Milestones with conflicting data were hotly debated
Comparing empirical data against already established CDC milestones
Milestones with conflicting data were hotly debated
Y'all, these milestones hadn't been updated in like TWENTY years. The experts reviewed 2 decades worth of research from the people evaluating, treating, and working with these children every day.
It was time to address the huge amounts of knowledge we've acquired.
It was time to address the huge amounts of knowledge we've acquired.
So the experts evaluated every single CDC milestone, against the data, and placed it in 1 of 4 categories, based on where it would make the most sense for PARENTS, who know their kids best.
1. Social Emotional
2. Language
3. Cognitive
4. Motor
1. Social Emotional
2. Language
3. Cognitive
4. Motor
Then, they placed the milestones based on normative data indicating achievement by 75% of children in that age range, instead of 50%
The most basic take, is that if the child is not meeting the new milestone,
refer
Refer
REFER
No more "wait and see" grey zone
The most basic take, is that if the child is not meeting the new milestone,
refer
Refer
REFER
No more "wait and see" grey zone
The best example they give is instead of "Beginning to transfer objects between hands", the child must "Move things from one hand to another" by 9 months.
No grey zone, no subjective language. There is no excuse for not referring the child not reaching the milestones.
No grey zone, no subjective language. There is no excuse for not referring the child not reaching the milestones.
New guidelines also removed the "warning signs" turning them into official milestones, at the appropriate must-not-miss age
They also created guidelines for the 15mo/30mo well child checks, which didn't exist before
They dramatically increased the social-emotional milestones ♥️
They also created guidelines for the 15mo/30mo well child checks, which didn't exist before
They dramatically increased the social-emotional milestones ♥️
Goals were clarity, simplicity, capturing the most children with true delays
The new guidelines are NOT intended to replace or change current developmental screening, provide a risk categorization, or diagnose DD.
Only provide clear context for conversations with parents
The new guidelines are NOT intended to replace or change current developmental screening, provide a risk categorization, or diagnose DD.
Only provide clear context for conversations with parents
The new guidelines do nothing to affect qualification for services, and are not meant to replace clinical judgement.
They don't prevent ANY caregiver, clinician, or parent from referring or self-referring for services at any time.
They don't prevent ANY caregiver, clinician, or parent from referring or self-referring for services at any time.
I look forward to seeing these guidelines implemented. I'm proud of the work my mentors have done. I have no doubts that more children will benefit from their work
Questions? Just ask...
But I InstaBlock assholes and charlatans
#MedTwitter #PedsTwitter #IamDBP
Questions? Just ask...
But I InstaBlock assholes and charlatans
#MedTwitter #PedsTwitter #IamDBP
This may have been my most boring thread ever, but the article's worth reading in full
publications.aap.org/pediatrics/art…
@DrKorb @dfreedman7 @rubin_allergy @acweyand @TripleThreat_MD @drfixus @otnotes @PatriciaTranMD @AnnieAndrewsMD @DrNikki4Kids @snarkypeds @DrHeardGarris @PaulLipkinMD
publications.aap.org/pediatrics/art…
@DrKorb @dfreedman7 @rubin_allergy @acweyand @TripleThreat_MD @drfixus @otnotes @PatriciaTranMD @AnnieAndrewsMD @DrNikki4Kids @snarkypeds @DrHeardGarris @PaulLipkinMD
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