<p>Sir,</p> <p>India is committed to reducing childhood mortality and morbidity. This requires advocacy and action (among all stakeholders), focused on locally relevant issues. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>Developmental delay, "the condition in which a child is not developing and/or achieving skills according to the expected time frame," is of concern. The barrier to screening for developmental delay is the lack of time in the current practice (82%). Beside the duration of the tests, other reasons for limited use include unfamiliarity, difficulty with their administration, obtaining cooperation of children in a short time, lack of validation in a local setting or language/culture, problems with parental ability to perform self-administered tests and the cost of purchasing some tests. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Methods designed specifically for developmental monitoring of young children by health care providers in low- and middle-income (LAMI) countries are lacking. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>Timely and periodic assessment of young childrens′ development makes it possible to identify and treat developmental disabilities at the earliest possible point of manifestation and to prevent loss of developmental potential. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup></p> <p>Two tools that are of importance among primary care providers include Ages and Stages questionnaire (ASQ) <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>and Guide for Monitoring Child Development (GMCD). <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>The ASQ is a parent-completed, child development screening test. The ASQ can be used for two purposes:</p> <p> <list list-type="order"> <list-item> <p>As a first-level screening tool to identify infants and children that may require further assessment</p> </list-item> <list-item> <p>As a monitoring tool to gauge the development of children who are at risk for developmental disabilities or delays. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup></p> </list-item> </list> </p> <p>The overall sensitivity of ASQ for detecting developmental delay was 83.3% and specificity was 75.4%. <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>A cross-sectional study showed the prevalence of global developmental delay assessed by ASQ to be 19.8%. <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup></p> <p>The GMCD is a practical, open-ended interview that catalyzes communication between clinicians and caregivers. The GMCD is an innovative method for monitoring child development that is designed specifically for use by health care providers in LAMI countries. Studies in Turkey provide preliminary evidence for its reliability and validity. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>The prevalence of developmental delay assessed by GMCD was found to be 48.5% of children, which shows that a large percentage of children were in need of further follow-up after GMCD assessment. <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup></p> <p>Considering the prevalence of developmental delays, the primary care provider must be vigilant in identifying those children who require further evaluation and referral. 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JRMS

J Res Med Sci

Journal of Research in Medical Sciences

1735-1995 1735-7136

Medknow Publications Pvt Ltd

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JRMS-18-1013

24520237

Letter to Editor

Developmental delay: Need of screening tools for primary care providers

Ali

Syed S

Mustafa

Syed A

Balaji

Pishey A

Poornima

Siddaraju

Department of Physiology, Dr. B R Ambedkar Medical College, KG Halli, Bangalore, Karnataka, India Department of Pediatrics, GKNM Hospital, Coimbatore, Tamil Nadu, India Department of Physiology, Dr. B R Ambedkar Medical College, KG Halli, Bangalore, Karnataka, India Department of Physiology, Dr. B R Ambedkar Medical College, KG Halli, Bangalore, Karnataka, India

Address for correspondence:Syed Ali, Department of Physiology, Dr. B R Ambedkar Medical College, KG Halli, Bangalore, Karnataka, India drsadatali@gmail.com

November 2013

18 11 1013 1013

2013

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

<p>Sir,</p> <p>India is committed to reducing childhood mortality and morbidity. This requires advocacy and action (among all stakeholders), focused on locally relevant issues. <sup> <xref ref-type="bibr" rid="ref1">1</xref> </sup>Developmental delay, "the condition in which a child is not developing and/or achieving skills according to the expected time frame," is of concern. The barrier to screening for developmental delay is the lack of time in the current practice (82%). Beside the duration of the tests, other reasons for limited use include unfamiliarity, difficulty with their administration, obtaining cooperation of children in a short time, lack of validation in a local setting or language/culture, problems with parental ability to perform self-administered tests and the cost of purchasing some tests. <sup> <xref ref-type="bibr" rid="ref2">2</xref> </sup></p> <p>Methods designed specifically for developmental monitoring of young children by health care providers in low- and middle-income (LAMI) countries are lacking. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>Timely and periodic assessment of young childrens′ development makes it possible to identify and treat developmental disabilities at the earliest possible point of manifestation and to prevent loss of developmental potential. <sup> <xref ref-type="bibr" rid="ref4">4</xref> </sup></p> <p>Two tools that are of importance among primary care providers include Ages and Stages questionnaire (ASQ) <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup>, <sup> <xref ref-type="bibr" rid="ref6">6</xref> </sup>and Guide for Monitoring Child Development (GMCD). <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup></p> <p>The ASQ is a parent-completed, child development screening test. The ASQ can be used for two purposes:</p> <p> <list list-type="order"> <list-item> <p>As a first-level screening tool to identify infants and children that may require further assessment</p> </list-item> <list-item> <p>As a monitoring tool to gauge the development of children who are at risk for developmental disabilities or delays. <sup> <xref ref-type="bibr" rid="ref5">5</xref> </sup></p> </list-item> </list> </p> <p>The overall sensitivity of ASQ for detecting developmental delay was 83.3% and specificity was 75.4%. <sup> <xref ref-type="bibr" rid="ref7">7</xref> </sup>A cross-sectional study showed the prevalence of global developmental delay assessed by ASQ to be 19.8%. <sup> <xref ref-type="bibr" rid="ref8">8</xref> </sup></p> <p>The GMCD is a practical, open-ended interview that catalyzes communication between clinicians and caregivers. The GMCD is an innovative method for monitoring child development that is designed specifically for use by health care providers in LAMI countries. Studies in Turkey provide preliminary evidence for its reliability and validity. <sup> <xref ref-type="bibr" rid="ref3">3</xref> </sup>The prevalence of developmental delay assessed by GMCD was found to be 48.5% of children, which shows that a large percentage of children were in need of further follow-up after GMCD assessment. <sup> <xref ref-type="bibr" rid="ref9">9</xref> </sup></p> <p>Considering the prevalence of developmental delays, the primary care provider must be vigilant in identifying those children who require further evaluation and referral. Early identification leads to early treatment and, ultimately, improved long-term outcomes.</p> </sec> </body> <back> <ref-list> <ref id="ref1"> <label>1</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Mathew</surname> <given-names>JL</given-names> </name> <name> <surname>Shah</surname> <given-names>D</given-names> </name> <name> <surname>Gera</surname> <given-names>T</given-names> </name> <name> <surname>Gogia</surname> <given-names>S</given-names> </name> <name> <surname>Mohan</surname> <given-names>P</given-names> </name> <name> <surname>Panda</surname> <given-names>R</given-names> </name> <etal /> </person-group> <article-title>UNICEF-PHFI Series on Newborn and child health, India: Methodology for systematic reviews on child health priorities for advocacy and action</article-title> <source>Indian Pediatr</source> <year>2011</year> <volume>48</volume> <fpage>183</fpage> <lpage>9</lpage> </nlm-citation> </ref> <ref id="ref2"> 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http://childrendisabilityblogspotin/2006/10/1st-national-early-childhoodhtml(Last accessed on 24 Dec 2012)</comment> </nlm-citation> </ref> <ref id="ref3"> <label>3</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Ertem</surname> <given-names>IO</given-names> </name> <name> <surname>Dogan</surname> <given-names>DG</given-names> </name> <name> <surname>Gok</surname> <given-names>CG</given-names> </name> <name> <surname>Kizilates</surname> <given-names>SU</given-names> </name> <name> <surname>Caliskan</surname> <given-names>A</given-names> </name> <name> <surname>Atay</surname> <given-names>G</given-names> </name> <etal /> </person-group> <article-title>A guide for monitoring child development in low and middle-income countries</article-title> <source>Pediatrics</source> <year>2008</year> <volume>121</volume> <fpage>e581</fpage> <lpage>9</lpage> </nlm-citation> </ref> <ref id="ref4"> <label>4</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Halfon</surname> <given-names>N</given-names> </name> <name> <surname>Regalado</surname> <given-names>M</given-names> </name> <name> <surname>Sareen</surname> <given-names>H</given-names> </name> <name> <surname>Inkelas</surname> <given-names>M</given-names> </name> <name> <surname>Peck Reuland</surname> <given-names>CH</given-names> </name> <name> <surname>Glascoe</surname> <given-names>FP</given-names> </name> <etal /> </person-group> <article-title>Assessing development in the pediatric office</article-title> <source>Pediatrics ;;-</source> <year>3</year> <volume></volume> <fpage></fpage> <comment>Assessing development in the pediatric office Pediatrics 2004;113;1926-33</comment> </nlm-citation> </ref> <ref id="ref5"> <label>5</label> <nlm-citation citation-type="internet"> <person-group person-group-type="author"> <name> <surname>Ages & Stages Questionnaires (ASQ): A</surname> 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person-group-type="author"> <name> <surname>Juneja</surname> <given-names>M</given-names> </name> <name> <surname>Mohanty</surname> <given-names>M</given-names> </name> <name> <surname>jain</surname> <given-names>R</given-names> </name> <name> <surname>Ramji</surname> <given-names>S</given-names> </name> </person-group> <article-title>Ages and Stages Questionnaire as a screening tool for developmental delay in Indian children</article-title> <source>Indian Pediatr</source> <year>2012</year> <volume>49</volume> <fpage>457</fpage> <lpage>61</lpage> </nlm-citation> </ref> <ref id="ref8"> <label>8</label> <nlm-citation citation-type="journal"> <person-group person-group-type="author"> <name> <surname>Ali</surname> <given-names>SS</given-names> </name> <name> <surname>Balaji</surname> <given-names>PA</given-names> </name> <name> <surname>Dhaded</surname> <given-names>SM</given-names> </name> <name> <surname>Goudar</surname> <given-names>SS</given-names> </name> </person-group> 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