Bradley S. Hood, MD, FAAP
Developmental-Behavioral Pediatrics, Mary Bridge Children’s
Trustee, Washington Chapter of the American Academy of Pediatrics
One of the maxims that I lived by as a pediatric resident was that if someone asked the question whether a child needed a lumbar puncture, the answer was almost always “yes.” As a developmental-behavioral pediatrician, I would say the same is true when a provider is considering referral for evaluation through Early Intervention or Child Find. The upside of a timely referral is that the child begins receiving essential developmental or special education services sooner. In the worst case, the child simply will not qualify for services, which can be a reassurance to the family that there are currently no significant developmental or learning problems.
States are required by federal law, specifically the Individuals with Disabilities Education Act (IDEA), to provide necessary services for children with disabilities from birth until age 21. Service delivery can vary by state and by county, but in most instances Early Intervention provides services from birth until age 3, while children ages 3 and older receive services through their local school districts. Child Find refers to the legal requirement for states to identify children with disabilities and/or who are in need of services. Though medical professionals often direct patients to Early Intervention or Child Find, others can request an evaluation or to access services. Families are highly encouraged to seek an assessment if they have concerns about their child’s development. The agencies are required by law to consider all parent requests, though they do not have to conduct formal assessments in cases where it is deemed unnecessary. Similarly, no medical diagnosis is required to qualify for services when children have identifiable developmental delays.
It is important to remember that the early delivery of services is more important to a child’s outcome than an early diagnosis of a developmental disorder or disability. All too often in developmental pediatrics, we see patients referred at age 3 or 4 for an autism spectrum disorder evaluation when there had been clear language delays at age 2 or earlier. Developmental language disorder and intellectual disability, along with autism disorders, can present similarly, and early implementation of developmental services can benefit all of these children.
Another thing to consider is that in essentially all regions of Washington and in most other states, the wait time for consultation with a developmental specialist is often six months or more. When referring to a developmental pediatrician for a diagnostic assessment, providers should simultaneously direct families to either Early Intervention or Child Find so that the child can begin receiving services as quickly as possible. Moreover, the Early Intervention or Child Find assessment, as well as the child’s response to therapy and/or a classroom environment is often a critical component of the diagnostic assessment itself. For example, developmental preschool teachers can provide valuable information about a child’s peer interactions when considering whether that child is on the autism spectrum.
Similarly, when considering diagnoses of global developmental delay or intellectual disability, cognitive and adaptive testing performed by Early Intervention specialists or school psychologists is often an essential component of the evaluation. Many developmental pediatricians do not perform cognitive or adaptive testing themselves in a clinical setting. As a result, the diagnostic process may be prolonged because children wait months for the initial visit with a developmental specialist. Patients then are directed to the school psychologist or Early Intervention specialist for formal assessment, and subsequently wait again for a follow-up visit to review the results. Decisions regarding medical evaluations such as genetic testing are sometimes dependent on these findings, so it is always helpful to have formal developmental or educational evaluation results at the initial visit.
Editor’s note: This article is endorsed by the WCAAP Early Learning Committee.