The CDI takes 35 to 50 minutes to complete, requires a seventh- to eight-grade reading level, and may thus be impractical for screening large groups of low-risk children. Additionally, the CDI’s generalizability to diverse populations is not established, as the normative data was gathered from a population that was 95% Caucasian. The length and depth of the CDI has called some to question whether it is an instrument for developmental assessment rather than developmental screening.
The Child Development Inventories (plural) are shortened versions of the CDI (singular), tailored for ages 0 to 18 months and 18 months to 5 years.47 The Infant Development Inventory (IDI) requires a parent to describe their child’s development, using a chart of milestones, in social, gross motor, fine motor, and language skills areas.
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Administrative costs associated with PEDS and ASQ are lower than other screens
The Child Development Review (CDR) is designed to screen for developmental problems in children ages 18 months to 5 years. The IDI and CDR are brief and easy to administer and score. Both rely on the formalized gathering of a parent’s concerns and the parent’s assessment of the child’s progress in achieving milestones in several streams of development. Unfortunately, evidence in the technical manual or medical literature is insufficient to establish the validity of this instrument, and thus it is difficult to recommend the child development inventories when other parent-report instruments exist with well established validity.
Economics of developmental screening
It is useful to look at the economics of developmental screens from 2 perspectives—that of the physician and that of society. A 1998 review of the literature by the RAND group48 concluded that 2 studies—the Elmira Prenatal/Early Infancy Project (EPEIP) and the Perry Preschool Project—followed children for sufficient time to allow for the assessment of the economic implications of intervention in children at risk for developmental delays.
Societal perspective
Both studies found that interventions led to considerable savings, with the biggest savings from decreased criminality in adulthood. The RAND group48 estimated a government savings of $18,611 per child who underwent early intervention in the Elmira Prenatal/Early Infancy Project, and a savings of $13,289 per child for individuals receiving intervention in the Perry Preschool Project (figures in 1996 dollars.)
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Two long-term studies found that developmental screening led to significant saving for society—as much as $18,000 for each child who had intervention
It is difficult to know whether these same savings would be seen in developmental intervention applied on a larger scale. Additionally, it is difficult to know how generalizable research from intervention with high-risk children is to intervention stemming from screening in a doctor’s office.
The physician perspective
Developmental screening is associated with additional costs. Dobrez et al49 estimated the physician’s expense in administering a number of developmental screens, accounting for the administration costs and costs associated with time required to discuss abnormal results. This analysis found screens based on parental report such as the ASQ, CDI, and PEDS considerably less expensive, with a per-visit expense of approximately $12 for negative screen results and approximately $16 for positive results. Tests requiring the direct elicitation of skills from children such as the Denver–II and BINS had an estimated cost of $55.12 and $22.22 for normal screens, respectively, and $59.57 and $26.67 for abnormal screens.49 Medicaid reimbursement varies by state; information can be obtained though the Center for Medicaid/Medicare website. Private payers may or may not reimburse physicians for developmental screening.
CORRESPONDENCE Sutton Hamilton, MD, Underwood-Memorial Family Medicine Residency, 35 Oak Street, Woodbury, NJ 08033. E-mail: HamiltonS@umhospital.org
