ECE 354 Assessment & Intervention During Early Childhood / week 3 discussion 1 and discussion 2

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5Screening

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Pretest

1. Screening tools can be used to make important decisions about a child, such as diagnosing a disability or determining a need for special services. T/F

2. A good screening tool has multiple items for each behavior to ensure that the tool reliably identifies those children who need further evaluation. T/F

3. It is not important to screen children for developmental or health problems until they are in preschool. T/F

4. Children with autism are now easily identified using specialized screening tools. T/F 5. Screening tools require extensive training to implement and score and should be completed by

psychologists and medical professionals. T/F

Answers can be found at the end of the chapter.

Introduction

Learning Objectives

By the end of this chapter, you should be able to:

ሁ Explain the purposes of screening as part of a comprehensive assessment process. ሁ Describe purposeful observation and screening practices. ሁ Understand the link between screening and referral. ሁ Analyze and describe quality indicators of screening instruments. ሁ Explain the role of screening across developmental areas, including health, cognition,

motor abilities, language, and social and emotional development. ሁ Describe the importance of screening for autism spectrum disorder and childhood

trauma. ሁ Identify and discuss early screening tools completed by parents.

Payton is a 4-year-old enrolled in a half-day preschool program. Shortly after his admission to the program, his three teachers agree that Payton is struggling to adjust. In comparing notes collected through informal observation, his teachers notice that Payton has difficulty sitting for more than 5 minutes at a time, wants to be touching and physically near the teachers at all times, refuses to follow simple requests such as using his fork and spoon at mealtime, and reacts in frustration by throwing items. The teachers also note that Payton has the most difficulty dur- ing transitions and highly structured group activities.

On the other hand, Payton seems to get along with some of his peers, can express himself ver- bally, and is a good problem solver in project-based activities. Based on these careful observa- tions, the teachers decide to use a more formal assessment plan that includes a tiered screening approach. First, they interview Payton’s parents using a health screening (to rule out possible health reasons for behavior) and social–emotional questionnaire focused on Payton’s parents’ observations regarding his behaviors.

Following the interview with Payton’s parents, the teaching team completes its own general screening of development across all areas, including motor, cognition, language and social–emo- tional. Finally, if the general screening is positive for delays, the teachers will consider screening for evidence of childhood trauma and possibly autism.

Introduction As the vignette above exemplifies, screening is an important part of assessment. Payton’s needs were first identified through purposeful but informal observation, followed by a parent interview and brief formal screening assessments using direct testing. This chapter explores informal and formal screening methods, either of which may signal that a child is at risk and requires further evaluation, or may reveal a child needs no further evaluation based on scores that show typical developmental progress.

Section 5.1Screening in Early Childhood

5.1 Screening in Early Childhood Screening is the administration of a brief assessment to identify possible problems that may later be further evaluated using more extensive and more accurate assessment. Approxi- mately half of children with developmental delays were not screened or identified prior to entering kindergarten, even though most of these delays were present to a degree that would be sensitive to screening tools by the age of 2 (Quigley, 2014). The earlier that health and developmental problems areas are identified, the earlier children may receive the necessary services. This is critical, since prolonged delays in addressing development or health prob- lems increase the risk of problems worsening (Walker et al., 2011).

Medical practitioners are at the front lines in terms of screening infants and toddlers for devel- opmental delays. Yet too few referrals are made by medical professionals; perhaps because they underestimate the extent to which observed problems might lead to serious develop- mental delays (Smith, Akai, Klerman, & Keltner, 2010). At the same time, mothers—particu- larly first-time mothers who may not know what to expect of children at different ages—also fail to recognize delays. Although it is recommended that all young children receive health and development screens at 9, 18, 24, and 30 months of age, fewer than 50% of parents nationally could recall a health care provider performing any such screen. Consequently, many children who would benefit from early intervention are not being screened and do not receive neces- sary services (Bethell, Reuland, Schor, Abrams, & Halfon, 2011).

Children are initially screened once they reach formal schooling, through preschool or kin- dergarten. This school-based screening is typically administered by a teacher or health care, child care, or community agency that has regular contact with families. Such screening has the potential to identify those children who were not screened prior to starting school. More- over, ongoing health, social, and academic screening conducted throughout the first years of school are intended as early identifiers of risk.

Purposes of Screening in Early Childhood Screening devices are brief, easy-to-administer assessments that evaluate a vast array of cog- nitive, social, emotional, behavioral, motor, language, and other behaviors and skills. By way of distinguishing the role of screening from other formal testing described in Chapter 4, a positive screen (that is, if a child’s score deviates significantly from the norm) triggers more comprehensive assessment. The use of multiple comprehensive assessments to confirm the presence of developmental or academic lags is called evaluation. It is only through evalua- tion—not screening—that educators can confidently determine whether meaningful devia- tions exist.

In general, screening is primarily used to identify children who should be referred to a health care provider or an EC assessment team for further evaluation. Members of an assessment team may include educators, health and related service professionals, administrators, and most importantly, parents. This group of individuals meets to make decisions regarding spe- cial services that may be provided to a child who is at risk or with a disability. Such decisions can include evaluation for eligibility of services, planning, and resource allocation.

In addition to being used for referrals, screening tools have three subpurposes. They are the first step in the process of identifying individuals who may be at risk or eligible for special services, and also provide developmental and health monitoring as a way to identify and thus

Section 5.1Screening in Early Childhood

intervene early in a child’s experience (Pool & Hourcade, 2011). Screening tools are also used to regularly monitor children for progress across a range of behavioral, developmental, and academic indices. Because screening tools are by their nature an abbreviated assessment, they should never be used alone to make important educational decisions.

Levels of Screening There are three levels of screening assessment. Each involves different processes, but their purposes remain the same. The first level of screening is purposeful observation, where trained caregivers and professionals continuously observe the developmental progress of infants, preschoolers, and young children. Vigilant adults follow developmental domains and recognize normal or atypical patterns. For example, in the opening vignette, Payton’s teachers noticed the ways in which Payton’s behavior was or was not developmentally appropriate and caused Payton to struggle to adjust to preschool.

At the second level of screening, agencies—including health and educational entities— often provide universal screening. Universal screening is when all children, regardless of whether they exhibit specific signs of atypical development, are assessed using a formal test- ing procedure. For example, all newborns in the United States receive a hearing screening at birth to detect hearing loss. On the other hand, universal developmental screening is not federally mandated, though it is required in many states when children are enrolled in public programs such as Early Head Start, Head Start, and kindergarten. Universal screening may assess a single area of development, such as vision or mental health, or multiple areas of development.

The goal of universal screening is to “catch” children whose scores suggest a significant devia- tion from norms and identify them as requiring further attention. As an example, suppose Mr. Newton individually screens all his 4-year-olds using the Ages and Stages Questionnaire (ASQ), a widely used developmental screening tool. Mr. Newton is surprised to find that Dawn scores well behind the norm in social and emotional development. He decides to follow this

up by observing and collecting anecdotal data on Dawn while she plays. These records are analyzed according to expected behavior described in the state learning standards for 4-year-olds. This analysis corroborated the universal screening results, so Mr. Newton con- cludes that a more specific screening of Dawn’s social and emotional behavior is needed.

Finally, targeted screening is when a child’s development is suspected to be atypical and professionals conduct an assessment of a single developmental skill (such as language) or area of health (such as vision). Some targeted screens, such as hearing screenings, must be administered by specialized personnel who have expertise in the discipline. For example, only trained audiologists conduct hearing screenings. Many screens do not require disciplinary expertise, however, and can be conducted by teachers or other EC professionals. This form of screening is usually done after parents or providers observe a behavior that concerns them. In the chapter’s opening example, after assessing Payton in all areas of development, it is likely that a concern arose only in social and emotional development. Therefore, targeted screening of this single domain may have led his teachers to the McArthur Health and Behav- ior Questionnaire (Boyce et al., 2002), a screening tool for mental health concerns.

Reflection If universal screening practices were greatly improved, what impact would that have on ECE?

http://agesandstages.com/

http://macarthurhbq.files.wordpress.com/2014/05/hbq-manual-1-0-05-29-2014.pdf

Section 5.1Screening in Early Childhood

When a screening tool is used to assess multiple areas of development, it is referred to as global screening. For example, the Bayley Screening Test, which assesses language, cogni- tion, social, emotional, and motor development, would be considered a global screening tool. Such tools may be used regularly by health care providers and educators, whether universally administered or not.

Quality of Screening Instruments Remembering that screening is primarily used to identify children who need to be referred for further evaluation, and because of their brevity and technical qualities, screening tools should never be used to make important decisions. Indeed, screening tools are not meant to indicate a problem and do not establish absolute conclusions about a child’s development. As an analogy, consider a car’s engine light indicator, which illuminates when there is a possible problem. This light indicates that there may be a problem, though it is not a certainty; the engine light also does not indicate if the potential problem is serious or minor. However, it is prudent to pay attention to the indicator and investigate whether there is a problem, where the problem lies, and if the problem is significant. Usually, the longer one delays in investi- gating the cause of the illuminated engine light, the more damage is likely to occur, the more difficult it will be to fix, and the more costly it will be to remedy—if a remedy is possible at all by that point. Similarly, a score below the cutoff on a screening assessment does not mean that a child actually has a special need, but that caregivers and professionals should give the child more attention.

ECE professionals should be aware that some screening tools are better than others. A poorly developed tool might find problems where there are none, or fail to find problems that actu- ally exist. Screening tools that over- or underidentify children whose scores deviate signifi- cantly from the norm may cause more harm than good. Caregivers and educators of children who should be further evaluated may find false assurance in a screen that misses an issue, while scores that raise a red flag may cause unnecessary anxiety. Several factors, including bias, reliability, and validity determine the quality of a screening instrument.

Bias Of significant concern when discussing quality is the chronic failure of screening tools to be designed for children from diverse backgrounds, including minorities, nonnative English speakers, children from low socioeconomic status (SES) families, and cultures other than the dominant European-American culture (Morgan, Farkas, Hillemeier, & Maczuga, 2012). Test- ing bias occurs when the screen or items on the screen unfairly assess a child’s ability based on characteristics of the test itself and not the abilities of a child.

When tests or testing is biased, two things can happen. First, if a screening score indicates that a child has no risk, services may be denied to a child who actually needs intervention. Compared to services for older children, early intervention tends to underrepresent children who are poor, minorities, and ELLs. Tests, testing, and tester bias all play a part in the failure to identify those children who would benefit from early intervention (Morgan et al., 2012; Moxley, Squires, & Lindstrom, 2012).

Tests themselves may have items that favor one culture over another. An example of bias in a test might be a kindergarten screening tool that asks a child to recite his or her address. If a child is homeless, this question is biased against the child’s socioeconomic status and

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Section 5.1Screening in Early Childhood

consequent living situation. Finally, tester bias can occur in the administration and scoring of screening tools. For example, a tester may, without realizing it, administer developmental screenings to more children whose parents are affluent or White than children whose parents are poor or minority. This unintended oversight can result in a failure to identify and serve a specific subset of children early enough to receive the most benefit. It is also possible for a screening administrator to misinterpret children’s behavior and parents’ responses when the administrator is unfamiliar with language and behavioral differences.

Reliability As described in Chapter 3, reliability is a test’s dependability to render the same results when readministered. A screening tool would be considered reliable if a child were screened on two consecutive days and received the same or very similar scores both times. A good example of a reliable test is a bathroom scale; if the first time Jorge stepped on a scale he weighed 45 pounds and 10 minutes later, he still weighed 45 pounds, the scale would be considered reli- able. On the other hand, the scale would lack reliability or consistency if it indicated Jorge weighed 52 pounds the second time he stepped on it. In the same way, screening tools for development must reliably measure children’s development across domains.

Screening assessments’ test reliability tends to be weaker than for more comprehensive assessments. This is largely due to the abbreviated nature of screening tools. In order to design a test that can be quickly administered, there are limits in the number and specific- ity of items that may be included. Many developmental, health, and academic traits must be left out in order to achieve brevity. As a result, abilities that children do not possess may not be assessed, while other skills that they do possess happen to be on the screening test. This mismatch between children’s abilities and test items can result in a failure to recognize delays or disabilities, and consequently, opportunities for the earliest possible intervention may be missed. Such missed opportunities could allow a child to slip increasingly further behind, making later intervention that much more challenging. When a screening tool fails to cor- rectly identify a child who is in need of services, this is called a false negative. The test results say there is no problem (negative) when there actually is one (false).

The opposite problem is a false positive, when a screening tool falsely assesses a child as being delayed. The test score says there is a problem (positive) when the child does not actu- ally have one (false). Compared to more comprehensive evaluation, screening is more likely to generate false positives because the few screening items happen to “catch” more errors than are actually representative of the child’s developmental growth. For example, a screen- ing tool to determine a 3-year-old’s motor ability might measure a child’s ability to bounce a

ball and stand on one foot. If the child cannot do one of these two things—half the items on the test for her age—she may look delayed on the scoring. Yet a more complete measurement of the child might reveal that while she is not able to balance on one foot, she can skip, run 50 yards in 8 seconds, and execute a cartwheel. Clearly, this child is not delayed.

A false positive is less dangerous than a false negative, because the screening will lead to more comprehensive assessments that are likely to correct for the screening error. Still, such errors are not insignificant. At the very least, as mentioned earlier, a false positive will lead to unnec- essary anxiety, loss of time, and wasted resources. Consider the implications of indefinitely

Reflection What might be the benefits of false positives and false negatives?

Section 5.1Screening in Early Childhood

serving a child who does not have a delay. If false negatives persist in the assessment process, a child could be misdiagnosed. Formally labeling a child with a disability can have long-lasting and deleterious effects on expectations for the child (for herself and from others), and on her long-term growth and development (Hornstra, Denessen, Bakker, Van den Bergh, & Voeten, 2010; Shifrer, 2013). For example, when a child is labeled as having ADHD, teachers and other students tend to react negatively and to have less confidence in the child’s ability to learn (Ohan, Visser, Strain, & Allen, 2011).

Validity Test validity is the extent to which a test actually assesses that which it intends to measure. If a screening tool for social and emotional development is valid, it will actually measure the extent to which children are normally developing in their social and emotional behaviors. It makes sense that screening assessments of normal development choose items that accurately reflect the abilities of most children at a particular age (such as motor abilities).

Sometimes, test items appear to measure one thing, but factors other than the intended focus interfere with a child’s performance. For example, older children are often tested using math- ematical story problems that require them to read the item and then complete the calculation. If a child has difficulty reading the item, there is no way of knowing whether he has the ability to solve the problem. This item lacks validity for certain children. Thus, a screening tool may be invalid for a certain child (if the way in which the items are constructed fail to accurately assess a child’s abilities) or, if very poorly constructed, for all children.

In order to be valid, screening tools must accurately identify a problem in a group of children. To validate screening tools, the results of a sample of children are compared to the results from another valid screening tool or comprehensive test that measures the same targeted behaviors. For example, the ASQ screening test may be compared to the Bayley Scale of Infant Development, because both were designed to measure the same thing: early childhood devel- opment. If both tests tend to identify the same children as falling below the norm, it could be said that both have validity. Two measures of validity commonly associated with screening tools are sensitivity and specificity.

Sensitivity In order for a screening tool to be useful, it must accurately identify those chil- dren who actually do have atypical development in relation to age-based norms. For example, the average age at which children in the United States begin to walk independently is 12 months. However, it is also considered normal for a child to begin walking at 9 months or not until 15 months. It is those children outside 9 to 15 months that are considered atypical. EC professionals generally do not worry about early developers, but they should be concerned when a child has not begun to walk independently by 16 months. In this example a screening tool that fails to pick up on a delayed walking concern is said to lack sensitivity and will result in a false negative.

Screening tool sensitivity, or a tool’s ability to correctly identify atypical child development, is established by extensive research. To communicate the results of the research, a percent- age score is used to describe the degree of sensitivity. That is, a sensitivity score reveals the percentage of children who are accurately identified as falling below the cutoff score. While no screening test will have perfect sensitivity, the American Academy of Pediatrics has estab- lished a minimum sensitivity score of 70% to 80% for a test to be considered high quality. Tests that do not meet the minimum standard should be avoided, as lower scores are associ- ated with higher percentages of false negatives.

http://learningdisabilities.about.com/od/intelligencetests/p/bayleyscales.htm

http://pediatrics.aappublications.org/content/118/1/405.full.pdf+html

Section 5.2Purposeful Observation

Specificity A related characteristic of a screening tool is its specificity, or its ability to deter- mine those who do not have special needs. While the sensitivity of a test opens the door to all children who might need special services, specificity closes it by excluding those children who do not have special needs. Specificity guards against false positives. Ironically, the more sensitive a test, the more likely it is that false positives will occur. This is because a poorly con- structed screening test that identifies too many children as developing typically will defeat the purpose of screening itself. For example, suppose Payton, the child in our opening vignette, was found to be typically developing according to the screening tools used by his teachers. But suppose Payton does in fact have serious emotional problems; in this case, the tools used would lack specificity. As with sensitivity, the American Academy of Pediatrics requires speci- ficity to be 70% to 80% for the instrument to be considered high quality.

Challenge Suppose your administrator has asked you to research the Early Learning Observation Rating Scale (ELORS), a commonly administered screening tool, and make a recommendation regarding whether your organization should use it in the future. Report on the ELORS sensitivity and specificity scores. Look at the items for potential bias and make a recommendation for use in ECE screening.

5.2 Purposeful Observation Purposeful observation is a necessary component of the screening process whereby early education professionals collect ongoing and cumulative data or evidence by purposefully observing children and all the factors that may influence their development (Quigley, 2014). Such watchfulness might precede, include, and/or add to standardized screening and evalu- ation. Purposeful observation evidence might include taking anecdotal notes, using informal skills checklists (see Figure 5.1), reviewing student work samples, or making video record- ings that add support to a student’s formal screenings and evaluations. Just as importantly, purposeful observation is a kind of “with-it-ness” where a professional sees, understands, and acts on obvious as well as nuanced changes in children (Boostrom, 2012). Both perma- nent evidence and with-it-ness contribute to purposeful observation.

Although universal screening is conducted to identify present and emerging developmen- tal delays, some children require greater purposeful observation in anticipation of probable emerging delays. Such at-risk children include those with biological risks such as premature birth, metabolic anomalies (such as phenylketonuria and cystic fibrosis, respectively), child abuse, and pre- and postnatal drug exposure. Infants and preschoolers with environmental risks—such as poverty, homelessness, exposure to violence and drug abuse, neglect, and malnutrition—should also be closely watched over time. Even when children with risk fac- tors score within a normal range on a screening tool, purposeful observation must continue unabated for later signs of delay.

http://nieer.org/pdf/Early_learning_scale_tech_report_Sept_2010.pdf

http://www.babysfirsttest.org/newborn-screening/conditions/classic-phenylketonuria-pku

http://www.babysfirsttest.org/newborn-screening/blog/happy-and-healthy

Section 5.2Purposeful Observation

Figure 5.1: Example of a skills checklist ሁ This is an example of a checklist that could be used to easily screen for social skills related to

children’s abilities to get along with others. It can be quickly completed by caregivers or teachers.

Illinois Early Learning Project Children’s Social Competence Checklist

Social competence refers to a person’s ability to get along with others. The checklist below was created to help teachers and caregivers assess preschool children’s social competence. The intent of the checklist is not to prescribe correct social behavior but rather to help teachers observe, understand, and support children whose social skills are still forming. If a child seems to have most of the traits in the checklist, he or she is not likely to need special help to outgrow occasional dif�culties; however, a child who shows few of the traits on the list might bene�t from adult-initiated strategies to help build more satisfying relationships with others.

I. Individual Traits. The child: Is usually in a positive mood. Usually comes to the program willingly. Usually copes with rebuffs or other disappointments adequately. Shows interest in others. Shows the capacity to empathize. Displays the capacity for humor. Does not seem to be acutely lonely.

II. Social Skills. The child usually: Interacts nonverbally with other children with smiles, waves, nods, etc. Expects a positive response when approaching others. Expresses wishes and preferences clearly; gives reasons for actions and positions. Asserts own rights and needs appropriately. Is not easily intimidated by bullying. Expresses frustrations and anger effectively, without escalating disagreements or

harming others. Gains access to ongoing groups at play and work. Enters ongoing discussion on a topic; makes relevant contributions to ongoing activities. Takes turns fairly easily. Has positive relationships with one or two peers; shows the capacity to really care about

them and miss them if they are absent. Has “give-and-take” exchanges of information, feedback, or materials with others. Negotiates and compromises with others appropriately. Is able to maintain friendship with one or more peers, even after disagreements. Does not draw inappropriate attention to self. Accepts and enjoys peers and adults who have special needs. Accepts and enjoys peers and adults who belong to ethnic groups other than his or her own.

III. Peer Relationships. The child: Is usually accepted versus neglected or rejected by other children. Is usually respected rather than feared or avoided by other children. Is sometimes invited by other children to join them in play, friendship, and work. Is named by other children as someone they are friends with or like to play and work with.

IV. Adult Relationships. The child: Is not excessively dependent on adults. Shows appropriate response to new adults, as opposed to extreme fearfulness or

indiscriminate approach.

Source: Adapted from McClellan & Katz, 2003–2004.

Section 5.2Purposeful Observation

Quigley (2014) identified five important components of purposeful observation:

1. ECE professionals need to ask about, listen to, and act on parental expressions of concern. Research suggests that there is a gap of about 20 months between initial parental expression of concern and the onset of intervention (Peixoto, Martins, & Sousa, 2012).

2. ECE professionals should keep records of developmental measures and observations.

3. Purposeful observation should be conducted by trained early childhood professionals.

4. Observations should include risk variables such as family wellness and child health, as well as factors likely to protect children from risk (such as temperament, family cohesion; social skills).

5. Findings should be documented and used in decision making.

Thus, purposeful observation is more than simply being alert; it is purposeful. For example, an alert professional might note that Shayla is a shy child and try to find ways to gradually increase her engagement with other children. A purposeful observer would use these same strategies, but also keep daily notes about instances of social interactions, the frequency and length of such interactions, and circumstances that led up to and followed social engage- ment. These would include specific details such as whether Shayla initiated, recoiled from, or responded to invitations from other children to play. A professional who uses purposeful observation would seek additional information about factors that might influence Shayla’s behaviors; he or she would take particular note of outside risk factors that may be affecting Shayla, such as her parents’ recent divorce. Purposeful observation is a complex set of actions that, when put together, ensure children’s needs are not overlooked.

Observation Skills In purposeful observation of young children, professionals use their observation skills to acknowledge progress and discern emerging developmental differences. Becoming a skilled observer requires two factors: training and experience. A trained observer prac- tices making decisions about child behaviors under the guidance of experienced and skill- ful mentors. Using formal (such as testing) and informal (such as children’s work samples) assessment strategies, an emerging professional will gradually learn to recognize behav- iors that may lead to problems, and to judge the seriousness of such signs. It is also the case that professional expertise in purposeful observation takes time to develop; it also requires a focused commitment to the well-being of young children and their families. A professional’s radar can become finely tuned by carefully observing many children across a variety of situations

In order to hone their observation skills, EC professionals need to be fluent in the language and familiar with the normal progression of developmental milestones. Particularly in pur- poseful observation, teachers cannot make accurate observations without a deep understand- ing of child development; they may be able to see what a child can do, but will be incapable of interpreting the child’s behavior. For example, a professional who serves infants should

http://www.pbs.org/wholechild/abc/

Section 5.2Purposeful Observation

be able to spend a short amount of time observing the infant and quickly identify the child’s approximate language, motor, and social competency. Similarly, an educator of 4-year-olds should be able to describe the general cognitive, social, and language strengths of a child after a week of observation, and recognize any substantial deviations from norms.

It is possible for a teacher to lose the capability to accurately gauge typical development, particularly if he or she works with a special population of children. It is common for educa- tors of young children with special needs to be surprised to find that what they believed to be precociousness was simply typical child development. Therefore, educators can stay sharp and recalibrate their observation skills and ability to recognize growth and gaps by frequently referring to norms charts or developmental standards. In addition to knowing typical devel- opmental milestones, being aware of developmental anomalies is also important for effective purposeful observation. Behaviors that signal the potential for behavioral and learning prob- lems would include:

• signs of differential responses to environmental stimuli (such as a 3-year-old who cries at loud noises);

• responses to human interactions (such as a 4-year-old who turns away when a teacher attempts to enter play);

• means of solving problems (such as a 5-year-old who repeatedly tries to solve a problem using the same failed approach);

• the ability to remember (such as a 6-year-old who takes significantly longer to learn sight words); and

• the ability to process information (such as an 18-month-old who gives up on finding a toy that has been briefly removed from sight).

Environmental Factors Although environmental factors such as poverty, language, and lifestyle differences (such as substance abuse or violence) place children at risk for developmental delays (Zolkoski & Bull- ock, 2012), it is important to avoid letting such factors cloud judgment when engaging in pur- poseful observation. At the same time, these factors do place children at risk, and therefore professionals should be on high alert for early signs of developmental lags. Likewise, while there are cultural differences, typical child development is universal. Though lags in develop- ment may be attributed to a lack of opportunity due to cultural differences, educators should continue to see these lags as a reason to pay greater attention.

As an example, suppose Mr. Speck is a kindergarten teacher at an urban school. Out of the 17 children in his class, 9 attended preschool. Immediately, he can see a difference in these children’s abilities—not only in their scores on the beginning of school universal screening, but also in their abilities to learn. The 9 top kindergarten students had “learned to learn” in preschool. Even though the 8 children who did not attend preschool had no control over their opportunity to attend, their risk of falling behind in kindergarten was notable. Thus, Mr. Speck and other adults need to be particularly purposeful in observing these disadvantaged children without succumbing to the tendency to lower expectations (and thus opportunity). If the early learning gaps appear to widen and children appear to fall further behind peers, it is time for Mr. Speck to take immediate action and conduct new screening for verification and to see if these children require more intensive instruction.

Section 5.3Screening Methods

Challenge In recalibrating the accuracy of purposeful observation, a teacher might collect data on the frequency or accuracy of a child’s behavior, and collect the same observational data on one or two other children who are believed to be developing typically to see if there is a difference. This is particularly helpful if a teacher wants to ensure there is no bias based on gender or culture.

With this in mind, observe two children, one who demonstrates typical development and one who demonstrates some developmental delays. In what ways are the two children similar? In what ways are the developmental differences most noticeable? Did any of the similarities or differences surprise you? Why?

5.3 Screening Methods With or without the benefit of purposeful observation, screening in early childhood is a for- mal process that relies on assessments that have been developed and tested to identify those children whose behavior lies outside the normal range. If purposeful observation raises a red flag for a parent or provider, the next step should be to administer a targeted or global screen- ing test. As mentioned, screening results can indicate a potential problem, and should only be used to determine if further assessment is needed.

Screening tools are abbreviated or short form assessments, such as the Developmental Check- lists Birth to Five, and are administered by a professional or completed by parents. They are brief (they usually take between 5 and 20 minutes), and may be completed by surveying care- givers and parents or by directly observing a child’s behavior using a set of standard ques- tions. For example, the Parents’ Evaluation of Developmental Status (PEDS) (discussed later in this chapter) has only eight questions and can be completed in under 10 minutes. Other screening tools, such as the Bayley Screening Test, are completed by asking children to per- form a set of developmentally relevant tasks, such as building a tower out of blocks to assess fine motor and cognitive imitation skills. For a developmental screening, there are often only one or two items per age level that assess a given domain in order to keep the screening brief.

Based on a child’s performance on the screening tool, an individual professional or team of professionals consult with parents about the next step. To determine what that should be, the child’s scores are compared to a test cutoff score, which is the score determined to be the lowest possible normal score. A score below the test’s cutoff indicates the child may have a problem. For example, the third edition of the ASQ has a possible score of 1 to 30 on each subtest. 30 is the highest score, meaning a child has mastered all items on the subtest. On the gross motor portion of this test, the developers have established that those children who pass 14 or fewer items are at risk and should be further evaluated. In this case the cutoff score is 15.

There are three possible outcomes relative to the cutoff score. First, a child may score in the average range, in which case parents of very young children should be reassured that all is

http://ecdc.syr.edu/wp-content/uploads/2013/01/Developmental_checklists_Updated2012.pdf

Section 5.3Screening Methods

well and children in school programs should continue in the core curriculum. Secondly, a child may score above, but close to the cutoff score (such as scoring a 7 when the cutoff is 6). These children should be under close purposeful observation, and changes to their typi- cal care could be considered. Finally, children whose scores fall below the cutoff score are targeted for further evaluation. At this point, it is important to make clear to parents that a diagnosis is not being made. Further evaluation simply means that more information is neces- sary to get a full picture of the child’s abilities and needs.

Screening Barriers As mentioned at the beginning of this chapter, more than half of all children have not received any type of screening by the time they reach kindergarten. There are a number of barriers to screening that result in uneven and underscreening of children who are at risk. Barriers include lack of health insurance (Sommers, Kenney, & Epstein, 2014), unstable living situ- ations, a lack of community resources, the high cost of quality child care, comprehensive screening (Limbos & Joyce, 2011), scarcity of accurate and affordable screening tools, and underenrollment in compensatory early childhood programs such as Head Start (Pool & Hourcade, 2011).

Because children from minority populations and children who are poor have less contact with agencies (such as health care clinics) that might help families identify developmental delays and conduct screenings, they are underrepre- sented in federally mandated (IDEIA) early interven- tion and preschool programs for very young children with developmental delays (Nelson, Chung, et al., 2011). Consequently, Early Head Start and Head Start are cru- cial to purposeful observation and screening of chil- dren, both in terms of development as well as health related problems.

Although children with clear developmental delays may be identified and well served prior to starting school, children with mild cognitive and behavioral needs are less obvious until they begin formal academic instruction that requires a high degree of self-regulation. Addi- tionally, slight lags in development tend to widen and become more apparent as time passes (Li-Grining, Votruba-Drzal, Maldonado-Carreño, & Haas, 2010). Age 6 is considered late in development, as many critical periods of learning have passed. At this age, it becomes much more challenging to remediate or compensate for delays that have grown more significant than if they had been identified early and benefited from intervention (see Figure 5.2).

As shown in Figure 5.2, early and universal screening practices are necessary, and screen- ing results need to be meaningfully communicated and shared between professionals and with families. For example, pediatricians need to guide parents of children who receive positive screens to appropriate further evaluation. It is encouraging to note that there has been a steady increase in the number of screenings completed by pediatricians. In one 2009 study, nearly 50% of pediatricians said they always or nearly always complete developmen- tal screenings, as compared to only 23% in 2002 (Radecki, Sand-Loud, O’Connor, Sharp, & Olson, 2011).

Reflection Do you think the over/under identification of children based on race or gender is less relevant in ECE than for older children? If so, why? If not, why not?

Section 5.3Screening Methods

Figure 5.2: Percentage of U.S. children at risk of developmental delay

ሁ The data suggest that around 37% of children with a moderate to high risk might be helped by early identification through screening.

11% High risk of

disability

20% Low risk-behavioral

support

26% Moderate risk-need

EC enrichment

43% Low risk-

surveillance

Source: Adapted from PEDStest.com, 2013. http://www.pedstest.com/AboutOurTools/LearnAboutPEDS/ IntroductiontoPEDS.aspx

Administrative Procedures for Screening Tools Although some screening tools require specialized training in a discipline (such as psychol- ogy or nursing), most are relatively easy to complete and generally require little training to reliably score the assessment and use the results to inform decisions. It is important to remember that screening results are only indicators that say “pay attention,” and should not be made to make any important decisions regarding diagnosis or services. For this reason, EC screenings are designed to be widely administered and are intended to be simple and uncomplicated. Nevertheless, most tools offer formal as well as informal training or tutorials to ensure administrators carefully adhere to administration.

ECE professionals often do not select the tools they use; rather, these are selected by their organization or mandated by state or federal organizations. Still, ECE professionals are in a position to understand the quality indicators (specificity, reliability, standardization sample, and so on). Knowing whether a screening tool is of high quality or not should be part of the informed process by which the results are used. For example, suppose a child suspected of having a developmental problem is screened, and her results fall above the cutoff score. No referral is made for further evaluation, but a professional who is aware that a poorly stan- dardized screening tool was used should be cautious about the outcome and gather further

http://www.pedstest.com/AboutOurTools/LearnAboutPEDS/IntroductiontoPEDS.aspx

Section 5.3Screening Methods

evidence to verify results. When purposeful observation methods consistently contradict screening outcomes, this professional should seek further screening. As mentioned, a false negative is worse than a false positive.

Gathering Information From Parents To follow the recommendation by the American Academy of Pediatrics that all children receive developmental screening, parents have been enlisted to help early and often (Bethell et al., 2011). Particularly for very young children, parents are the most important source of information in screening for developmental concerns. If parents can use their unique knowl- edge of their children to complete early screens more quickly and accurately than health care professionals, this increases the likelihood of completion and reduces the cost of screenings.

Parents often complete screening tools about their children via a survey or guided conversa- tion (interview), typically in a face-to-face setting. For the purposes of early childhood screen- ing, there are sets of questions for parents specific to the behaviors that indicate typical devel- opment. As answers are provided, the screener scores the item and may record descriptive information as needed or offered. An obvious disadvantage of this type of screening is the limited amount of information gathered, and typically the limited amount of time allocated to collect it. On the other hand, those sharing may provide more information than is strictly needed to complete the assessment.

When parents complete screenings, children with delays are significantly more likely to receive ECE services (Bethell et al., 2011). Still, parent screenings are completed for just 20% of children under the age of 6 (Bethell et al., 2011). Substantial progress needs to be made before full screening and responsiveness to screening results are realized. The two most widely used screens completed by parents are the third edition of the ASQ and the Parents’ Evaluation of Developmental Status. Both of these tools have been extensively researched and refined to produce screening devices that are easy to administer and score. They are also both available in multiple formats (such as paper or online).

Ages and Stages Questionnaires-Third Edition The Ages and Stages Questionnaires-Third Edition (ASQ-3) is the most frequently used and well-researched screening instrument com- pleted by parents (Hornman, Kerstjens, de Winter, Bos, & Reijneveld, 2012). The purpose of the ASQ-3 is to identify infants and preschoolers who would benefit from a more compre- hensive evaluation. Parents can usually complete the screening questionnaire in about 15 minutes, with scorers able to provide results in less than 5 minutes. The ASQ-3 poses 30 ques- tions on each of the 21 different age-level questionnaires for children aged 1 month to 5½ years. The 30 questions address the five developmental categories of cognitive, gross and fine motor, problem solving, personal and social development, and communication. Each question has three rating options, where parents evaluate the level of mastery of each item. A sample item is as follows:

“Does your child stack a small block or toy on top of another one? (18-mo/fine motor)”

“Yes” 10 points “Sometimes” 5 points “No” 0 points

Section 5.3Screening Methods

Each developmental area will have a composite score based on the sum of each of the respec- tive items. The sum is compared to the domain cutoff score; if a child scores below this, the professional and parent may consider further evaluation. For example, for the 48 months questionnaire, the cutoff score for communication is 30.72, so any score lower than this would be considered a possible risk and would warrant further assessment.

The ASQ-3 has good validity and reliability for many populations, taking into account diver- sity in race, ethnicity, and SES. Sensitivity, or the ability to identify children with develop- mental delays, was 86% overall, with a range of 75% to 100% across the 21 questionnaires. Specificity, or accurately identifying typically developing children, was 85% overall with a range of 70% to 100% across the questionnaires. Although the ASQ-3 is primarily a screening tool, there is an aligned curriculum with developmental activities that may be used in con- junction with it. Performance on the screening items provide general guidance as to the type of developmentally appropriate skills a child possesses and those that are emerging. ASQ-3 curricular activities are designed to facilitate mastery of these emerging skills.

Challenge Suppose that as a child care provider of toddlers, you notice that London, a 19-month-old, is not yet saying words and does not indicate whether she understand simple gestures like pointing and head shaking. Additionally, London is still cruising along furniture, but not walking independently. She also does not seem to take notice of other children at play. In a conversation with London’s parents, you express your concern gently, and recommend that the parents complete the ASQ-3. The parents do not see the point, and they refuse. What should you do?

a. Drop the subject, but continue to purposefully observe London. b. Provide further explanation about the purpose and process of ASQ-3, inviting

parents to ask questions.

Explain the reasoning behind your choice in terms of information needed to proceed, as well as possible steps that may be taken.

The following link provides sample questionnaires and activities for Ages and Stages: http://agesandstages.com/asq-products/asq-3/asq-3-downloads

Parents’ Evaluation of Developmental Status (PEDS) The Parents’ Evaluation of Devel- opmental Status (PEDS) is a widely used and easy to administer screening for children from birth to 7 years 11 months. Parents can use it to evaluate their children’s development in language, motor, self-help, early academic performance, behavior, and social–emotional and mental health. The assessment may be administered by an EC professional via an interview or written questionnaire. Either version should take less than two to three minutes to complete.

PEDS is standardized in English, Spanish, and Vietnamese and has translations available in many other languages such as Russian, French, Chinese, Arabic, and Swahili. PEDS question- naires include 10 items, which are the same for all ages. The questions ask parents to evaluate their child’s status across developmental domains, which include health questions for hearing and vision, as well as eating and sleeping patterns. Scores on the PEDS show practitioners and parents where the child is developing typically and where there might be cause for concern.

http://agesandstages.com/asq-products/asq-3/asq-3-downloads/

Section 5.3Screening Methods

A decision-making format provides recommendations to professionals that might include referral for evaluation, further screening (such as PEDS: DM; see below), careful monitoring, parent counseling, or parental reassurance.

PEDS is also linked to PEDS: Developmental Milestones (PEDS: DM), which is a secondary screening that is triggered by concerns raised by PEDS screening. This screening measures expressive and receptive language, fine and gross motor skills, self-help, reading and math, and social–emotional domains. One item is offered at each age level for each domain, or six to eight total items on the questionnaire.

PEDS: DM may be administered directly by having a trained health care provider observe and score each item of the screening test. Indirect assessment through parental reporting, often while in a medical facility waiting room (for example, by submitting responses to items pro- vided on a kiosk, filling in a laminated form, or answering interview questions) is also com- mon. If a child misses an item, he or she is considered to perform below the 16th percentile and is deemed at risk of delay; a referral for more thorough evaluation is indicated. However, caution is in order with respect to interpreting scores. This tool does not meet field standards for specificity (Limbos & Joyce, 2011). In one large study of PEDS Online, it was found that more than 1 of 5 screens was problematic, with the likelihood of erroneous outcomes increas- ing as children got older (Glascoe, 2014).

Relationships With Families Solid relationships with families can enhance the outcome of screenings conducted with care- givers, in terms of both the accuracy of results and parents’ satisfaction with the process. Trusting and open communication between professionals and families can lead to more thor- ough understandings of children and the contexts within which their scores may be inter- preted. Families whose culture is different from the interviewer’s may react to screening questions in a way that could be misinterpreted. It is important to spend time establishing a connection with these families before broaching questions that may be regarded as intrusive. It is also vital to ensure that the screening tool has been adapted for any cultural and language differences. For example, some terms may need to be defined or illustrated; similarly, the scoring scale should be explained clearly with examples if necessary.

The following guidelines may help gather information from families:

1. Greet families and spend time getting to know caregivers, or renew connections. 2. Explain the purpose and structure of screening (how many items there are, the rat-

ing scale, and so on). 3. Ask if the family has any questions. 4. Get parents’ permission to conduct the screening. Even though in many states, early

developmental screening is mandatory, if parents are resistant to participation, the results are likely to be invalid.

5. Take the time to make families feel as if they are important to you, and there is noth- ing else currently on your mind.

6. Completely answer all questions parents might have about the purpose, administra- tion and outcomes of screenings in order to satisfy family’s need to understand the process. Assessors must be well informed about the instruments used and the pos- sible decisions that might be made depending on the outcome.

Section 5.4Developmental and Health Screenings

7. If needed, modify screening questions to solicit the most complete responses possi- ble from parents (while this invalidates standardized tests, screening tests—unless otherwise specified in administration procedures—are most accurate when the questions are unambiguous). This may mean adapting or embellishing questions to make them clear for parents.

8. Provide feedback as quickly as possible. When possible, families should be given results before the appointment ends.

9. Do not give results unless the scoring is complete. Parents should not be told, “Well, from a glance everything looks fine.” Or, “From the answers to the questions so far, I have some concerns.” These results are important to parents, and misleading infor- mation can undermine the trusting relationship with families. Chapters 7 and 9 both address ways to communicate test result effectively to caregivers.

These procedures for interviewing families can help parents feel more comfortable, but will not mitigate all problems. For example, it can be the case that two parents of the same child will disagree on an answer, which can be uncomfortable. However, by following the guidelines above, many anxious moments that can result from lack of clarity may be avoided.

Scoring and Interpretation Once information is collected from parents or through observations, screens can be scored and interpreted. Every standardized assessment, including screening tools, includes a series of items used to evaluate the child. Some screening instruments use test items that are marked as either “pass” or “fail,” and some tests have items that are marked on a scale that offers a range from low to high performance. Each time an item is completed, scorers make a judg- ment based on both their understanding of the behavior being rated and their evaluation of the child being evaluated on the item. For example, a speech pathologist rating the “expressive use of prepositions” for a 2-year-old will need to have a strong understanding of prepositions and how 2-year-olds normally use them. To accurately score this item, the speech patholo- gist must have spent enough time with the child being assessed to know what prepositions (if any) the child uses and how often prepositions are used expressively in natural contexts.

After a professional or parent completes a screening instrument, the item scores are con- verted to a single overall raw score. For example, suppose a checklist of 15 items related to behavior is marked with 7 pluses (+) and 8 zeros (0). The raw score of this list would be 7. The raw score is then either converted to a standard score (see Chapter 3) using an equation established by the assessment’s developers, or directly interpreted with a summary analysis. This score will suggest the degree to which a child deviates (or not) from expectations based on age or grade, and should be used to make recommendations for action. For example, for a child that scores at or above average, a professional would recommend further purposeful observation or enrichment services; for a child that scores below average, the professional would recommend a referral for evaluation.

5.4 Developmental and Health Screenings Particularly in early childhood, there are a number of broadly administered screenings for developmental and health purposes. For example, children are screened at birth for congeni- tal (present at birth) conditions using the APGAR scale, which is a quick, 10-point scale that

http://www.nlm.nih.gov/medlineplus/ency/article/003402.htm

Section 5.4Developmental and Health Screenings

assesses physiological wellness in five categories. A low APGAR score signals that a child is at immediate health risk, and also portends potential developmental problems later in child- hood. Although high APGAR scores do not indicate immediate physical risk, they do not guar- antee that a child will develop typically.

During the neonatal period (from birth to 2 weeks), there are mandated screenings in all 50 states for metabolic conditions such as phenylketonuria (PKU), hypothyroidism, and galacto- cemia. The Early Hearing Detection and Intervention (EHDI) is required by law or universally administered voluntarily to newborns in all 50 states (ASHA, 2014). Later in early childhood, developmental and health screenings are typically conducted by medical care providers, including nurses and physicians in hospitals or primary care and health clinics. Most are universally administered to children who receive regular health care. Where early childhood programs follow best practices, regular health screenings are conducted that include height, weight, head circumference, nutritional status, vision, and hearing screenings.

Table 5.1: Representative developmental screening tools used in early childhood

Comprehensive developmental or academic screenings

Screening test Brigance Screening (multiple versions)

Gesell Early Screener

Batelle Developmen- tal Inventory Screening Test

Early Screening Inventory Revised (ESI-R)

Developmen- tal Indicators for the Assessment of Learning-4 (DIAL-4); Speed DIAL-3

Ages Various forms: birth to kindergarten

3 to 7 years 0 to 8 years 3 to 6 years 3 to 7 years

Subtests Language, general knowledge, fine and gross motor, preacademic, social emotional, adaptive; K–1 includes reading and writing

Cognitive, fine and gross motor, language

Adaptive behavior, fine and gross motor, language, cognitive abilities, social– emotional

Fine and gross motor, cognition, language, adaptive behavior

Fine and gross motor, concepts, social, self- help, language

Administra- tion

45-item test and teacher rating

Direct testing observa- tion, parent interview

Direct testing by teacher or paraprofes- sional with training

Direct testing by trained professional

Increasingly, early childhood programs for children with and without disabilities are using developmental and academic screening tools like those listed in Table 5.1 to assess individual

http://www.newbornscreening.info/Parents/otherdisorders/CH.html

http://www.newbornscreening.info/Parents/otherdisorders/Galactosemia.html

https://www.youtube.com/watch?v=rJS4KpY9RRo

https://www.youtube.com/watch?v=LNznoAr9SZo

http://riversidepublishing.com/products/bdi2/training.html

http://tas.edu.do/ashtonweb/wp-content/uploads/2011/11/ESI.R-Parent-Questionnaire-PK-2.pdf

http://images.pearsonclinical.com/Images/PDF/Webinar/DIAL-4-Overview-Handout.pdf

http://www.powershow.com/view/10c953-NGFiN/Speed_DIAL_Developmental_Indicators_for_the_Assessment_of_Learning_Test_Administration_Training_Mar_powerpoint_ppt_presentation

Section 5.4Developmental and Health Screenings

progress through the curriculum. When administered frequently (weekly) these data can provide a basis for formative decision making as in response to intervention, which will be discussed in Chapter 7. Less frequent and more universal screening is used to determine whether children are staying on track. Results help teachers determine if they should stay the course. They also provide students who are struggling either academically, functionally, or behaviorally with additional or different services, or that will accelerate their rate of learning through intensive interventions.

Screening for Motor Skill Development Screening for motor development is particularly important in the first year of life, and most particularly in the first months of life (see Table 5.2). In the neonatal period, children are screened for the presence of primitive reflexes and muscle tone. Significant deviations in primitive reflexes or low/high muscle tone raise alarm and should be followed up with more extensive neurological evaluation. In the following months, screening for delays in achieving motor milestones and development of postural reflexes and high/low muscle tone are also helpful in identifying possible neuromotor problems.

Table 5.2: Screening tools for motor skills Motor screenings

Screening test Alberta Infant Motor Screening Test (AIMS)

Harris Infant Neuromo- tor Test (HINT)

Beery-Buktenica Developmental Test of Visual-Motor Integration, Sixth Edition

Ages Birth to 18 months 2½ months to 12½ months

2 to 7 years

Subtests Movement in weight bearing, posture, antigravity movement

Motor (movement, posture, vision, range of motion) and cognitive development (behavior and cooperation)

Supplemental: Motor Coordination Test (5 minutes); Visual Perception Test (5 minutes)

Administration 15- to 20-minute direct testing, 58 items

21-item clinical impression direct observation by PT/OT, medical

15-item visual-motor test where children copy geometric shapes from drawings; administered by teachers or parents

After a child achieves the major early milestones of motor development—which include sit- ting, crawling, walking and running, as well as reaching, grasping and fine pincer grasp— ECE professionals may give this domain less attention. Nevertheless, gross (running, skipping) and fine (drawing, stacking) motor skills should continue to be screened. Very often, signifi- cant differences in motor development are associated with delays in other areas of develop- ment, such as cognition and language. This relationship exists because motor delays are often the result of neurological injury caused by such conditions as anoxia, trauma, or infection that can affect all areas of human development. As with many delays, the earlier motor problems

https://www.youtube.com/watch?v=i0XHmqCIbU8

http://fysio.dk/Upload/Fafo/Fagfestival%2012/Slides/Tors/Harris-tors-Fyn.pdf

http://www.therapro.com/Beery-Buktenica-Developmental-Test-of-Visual-Motor-Integration-6th-Edition-BEERY-VMI-The-P322093.aspx

Section 5.4Developmental and Health Screenings

are identified the earlier intervention can begin, making it easier to mitigate problems that may emerge.

Screening for Language Language-related delays—including expressive and receptive communication delays—are the most prevalent developmental problem in early childhood. Language delays occur in 10% to 30% of infants, with the highest rate among those who were born prematurely (Mossabeb, Wade, Finnegan, Sivieri, & Abbasi, 2012). Signs of expressive and receptive language delay include a child not beginning to make cooing sounds (vowels) by his fourth month, babbling (consonant and vowel sounds) by 6 months, or turning to a speaker who says his name by 9 months. It is critical to use screening to identify language delays early (see Table 5.3), since there is a link between language delays and achievement gaps in reading, academics, and cog- nitive and emotional development (Peixoto et al., 2012). The earlier children with language delays receive intervention, the better their prognosis, as language delays are compounded by delayed intervention (O’Connor, Bocian, Beebe-Frankenberger, & Linklater, 2010).

Table 5.3: Screening tools for language used in early childhood educations

Language screenings

Screening test Fluharty Preschool Speech and Language Screening-2 (Fluharty-2)

Communication and Symbolic Behavior Scales Developmental Profiles

Bzoch-League Receptive-Expressive Language Test (REEL-3)

Ages 3 to 7 years 6 to 24 months 0 to 3 years

Subtests Articulation, repeating sentences, following directions, answering questions, describing actions, sequencing events

Emotion, eye gaze, communication, gesture, words, object use, understanding, sounds

Expressive and receptive language

Administration Graduate coursework in assessment in speech and language required

Parent questionnaire or professional observation for behavioral sample

Parent interview

A screening tool that would be completed by parents before or during a routine health care visit would be the Language Development Survey (LDS), which identifies expressive language delays. Similarly, the Grammar and Phonology Screening Test (GAPS) is a 10-minute assess- ment that can be completed by professionals, paraprofessionals, and parents. The GAPS has some selective validity in identifying children between 3 and 7 years old with language impairments (Van der Lely, Payne, & McClelland, 2011). Professionals and paraprofession- als who administer screenings for language may need to have specialized understanding of terminology and a deep understanding of language development in order to accurately judge a child’s linguistic competency. It is probably better if speech and language specialists admin- ister and score tools such as GAPS, whereas those such as LDS (see Figure 5.3) require less specialized training.

http://firstwords.fsu.edu/pdf/Checklist_Scoring_Cutoffs.pdf

https://prezi.com/hp2h-7tukxhq/copy-of-reel-3/

http://www.spokanecpt.com/zlcms/editor/uploads/files/language_development_survey.pdf

http://www.ucl.ac.uk/chc/events/workshops/2008/sildys/lizpayne.pdf

https://www.youtube.com/watch?v=1aHpju_oXKw

Section 5.4Developmental and Health Screenings

Figure 5.3: Sample language development survey ሁ This easy-to-administer survey can be used to screen for basic language development in children

ages 18 to 35 months.

Please circle each word that your child says SPONTANEOUSLY (not just imitates or understands). If your child says non-English versions of words on the list, circle the English word and write the first letter of the language (e.g., S for Spanish). Please include words even if they are not pronounced clearly or are in “baby talk” (for example: “baba” for bottle).

Other words your child says, including non-English words:

Sam ple

FOODS 1. apple 2. banana 3. bread 4. butter 5. cake 6. candy 7. cereal 8. cheese 9. coffee 10. cookie 11. crackers 12. drink 13. egg 14. food 15. grapes 16. gum 17. hamburger 18. hotdog 19. ice cream 20. juice 21. meat 22. milk 23. orange 24. pizza 25. pretzel 26. raisins 27. soda 28. soup 29. spaghetti 30. tea 31. toast 32. water

TOYS 33. ball 34. balloon 35. blocks 36. book 37. crayons 38. doll 39. picture 40. present 41. slide 42. swing 43. teddy bear

OUTDOORS 44. flower 45. house 46. moon 47. rain 48. sidewalk 49. sky 50. snow 51. star 52. street 53. sun 54. tree

ANIMALS 55. bear 56. bee 57. bird 58. bug 59. bunny 60. cat 61. chicken 62. cow 63. dog 64. duck 65. elephant 66. fish 67. frog 68. horse 69. monkey 70. pig 71. puppy 72. snake 73. tiger 74. turkey 75. turtle

BODY PARTS 76. arm 77. belly button 78. bottom 79. chin 80. ear 81. elbow 82. eye 83. face 84. finger 85. foot 86. hair 87. hand 88. knee 89. leg 90. mouth 91. neck 92. nose 93. teeth 94. thumb 95. toe 96. tummy

VEHICLES 97. bike 98. boat 99. bus 100. car 101. motorcycle 102. plane 103. stroller 104. train 105. trolley 106. truck

ACTIONS 107. bath 108. breakfast 109. bring 110. catch 111. clap 112. close 113. come 114. cough 115. cut 116. dance 117. dinner 118. doodoo 119. down 120. eat 121. feed 122. finish 123. fix 124. get 125. give 126. go 127. have 128. help 129. hit 130. hug 131. jump 132. kick 133. kiss 134. knock 135. look 136. love 137. lunch 138. make 139. nap 140. open 141. outside 142. pattycake 143. peekaboo 144. peepee 145. push 146. read 147. ride 148. run 149. see 150. show 151. shut 152. sing 153. sit 154. sleep 155. stop 156. take 157. throw 158. tickle 159. up 160. walk 161. want 162. wash

HOUSEHOLD 163. bathtub 164. bed 165. blanket 166. bottle 167. bowl 168. chair 169. clock 170. crib 171. cup 172. door 173. floor 174. fork 175. glass 176. knife 177. light 178. mirror 179. pillow 180. plate 181. potty 182. radio 183. room 184. sink 185. soap 186. spoon 187. stairs 188. table 189. telephone 190. towel 191. trash 192. T.V. 193. window

PERSONAL 194. brush 195. comb 196. glasses 197. key 198. money 199. paper 200. pen 201. pencil 202. penny 203. pocketbook 204. tissue 205. tooth brush 206. umbrella 207. watch

PLACES 208. church 209. home 210. hospital 211. library 212. park 213. school 214. store 215. zoo

MODIFIERS 216. all gone 217. all right 218. bad 219. big 220. black 221. blue 222. broken 223. clean 224. cold 225. dark 226. dirty 227. dry 228. good 229. happy 230. heavy 231. hot 232. hungry 233. little 234. mine 235. more 236. nice 237. pretty 238. red 239. stinky 240. that 241. this 242. tired 243. wet 244. white 245. yellow 246. yucky

CLOTHES 247. belt 248. boots 249. coat 250. diaper 251. dress 252. gloves 253. hat 254. jacket 255. mittens 256. pajamas 257. pants 258. shirt 259. shoes 260. slippers 261. sneakers 262. socks 263. sweater

OTHER 264. any letter 265. away 266. booboo 267. byebye 268. excuse me 269. here 270. hi, hello 271. in 272. me 273. meow 274. my 275. myself 276. nightnight 277. no 278. off 279. on 280. out 281. please 282. Sesame St. 283. shut up 284. thank you 285. there 286. under 287. welcome 288. what 289. where 290. why 291. woofwoof 292. yes 293. you 294. yumyum 295. any number

PEOPLE 296. aunt 297. baby 298. boy 299. daddy 300. doctor 301. girl 302. grandma 303. grandpa 304. lady 305. man 306. mommy 307. own name 308. pet name 309. uncle 310. name of TV or story character

http://www.aseba.org/forms/preschoolcbcl.pdf

Section 5.4Developmental and Health Screenings

Screening for Cognition In early childhood the ability of children to process the world around them, remember things, and solve problems is referred to as cognition. Many parents learn about typical cognitive milestones and keep track of their child’s progress, though they have only a vague notion of their child’s rate of learning and are thus dependent on early screenings to identify lags.

Infants and Toddlers Although some children who display exceptional early language development, problem solv- ing, and memory continue to be advanced throughout their schooling, reaching cognitive developmental milestones early does not reliably predict later intelligence (Aylward & Ayl- ward, 2011; Luttikhuizen dos Santos, de Kieviet, Königs, Van Elburg, & Oosterlaan, 2013). Additionally, it is important to remember that some children simply mature at a slower rate. Early screening of cognitive development is recommended to identify and provide interven- tion as early as possible for those children who need it.

There are a number of screening options to use with very young children (as seen in Table 5.4), including the Bayley Screen (a short form of the Bayley Scales of Infant and Toddler Development III), which provides a well-validated option to assess early cognitive develop- ment, the Brigance Infant and Toddler Screen, ASQ-3, and Early Screening Inventory-Revised (ESI-R), all of which screen cognition as well as other domains.

Table 5.4: Cognitive screening assessments for infants and toddlers Cognitive screenings for infants and toddlers

Screening test Bayley Scales of Infant and Toddler Development III

Brigance Infant and Toddler Screen

Early Screening Inventory-Revised (ESI-R)

Ages 1 to 42 months Three levels: 0 to 35 months, 3 to 5 years, K & 1

Two levels: 3 to 4 years, 5 months; 4 years, 6 months to 5 years, 11 months

Subtests Cognitive scale, receptive and expressive language, fine and gross motor

Language, motor, self- help, social–emotional, and cognitive

Visual motor/adaptive, language and cognition, gross motor

Administration Administered by professional

Teacher observation(s) and parent ratings

Administered by professional

Preschoolers Cognitive screening of children from ages 2 to 5 may involve a range of tools that assess IQ (for example, the Early Stanford-Binet V for 2 to 85 years and the Wechsler Preschool and Primary Scale of Intelligence-Revised [WPPSE-R]), developmental abilities, and academic achievement and aptitude. Because the preschool years represent a transitional period between developmental dominance and academic dominance, measures of cognitive abilities

http://www.casamples.com/downloads/screen_inftod.pdf

http://agesandstages.com/asq-online-video-clips/

http://vimeo.com/104670041

http://images.pearsonclinical.com/images/PDF/Bayley-III_Webinar.pdf

http://www.casamples.com/downloads/screen_inftod.pdf

http://vimeo.com/104670041

http://www.stanfordbinet.net

http://testingforkindergarten.com/tag/wppsi-iv-test-prep

Section 5.4Developmental and Health Screenings

are similarly transitional, with gradually increasing emphasis on early academic skills. For example, preschool items might ask children to identify pictures of vocabulary words and concepts, while older children will be asked to read and solve problems, such as pairing syn- onyms and completing math problems.

While the SB-V and WPPSE-R are full-scale IQ tests, EC educators are more likely to mea- sure cognition as part of a broader developmental screening that includes motor, language, and social/emotional development. Screening instruments often used to measure preschool- ers’ cognition and other developmental areas include the Brigance Screening III, Gesell Early Screener, and Developmental Indicators for the Assessment of Learning, 4th edition (DIAL 4).

Early Elementary It is important to screen children’s early academic performance, as early gaps in acquisition of math and reading skills tend to persist and widen if left unaddressed (Herbers et al., 2012). In this era of high-stakes testing, assessment of school readiness and academic progress has become increasingly important, even driving what educators do and how they themselves are evaluated. Consequently, the two primary content areas screened in kindergarten to third grade are math and reading (see Table 5.5).

Table 5.5: Widely used screening tools for reading and mathematics in early elementary

Reading and mathematics screening tools

Screening test Diagnostic Indicators of Basic Early Literacy Skills (DIBELS)

Individual Growth and Development Indicators (MyIGIDs) Early Literacy & Numeracy Assessment

Aimsweb

Ages Pre-K to 9th grade 3 to 4 years K–12

Subtests Reading: phone- mic awareness, fluency, phonics, comprehension Math (K–6): numeracy, computation, problems solving

Reading: Picture naming, rhyming, alliteration, sound identification, which one doesn’t belong?

Math: Counting, number naming, quantity comparison, 1-to-1 correspondence and counting

Early Literacy, Reading, Early Numeracy, Mathematics, Spelling, Writing

Administration Direct testing by trained administrator

Direct testing by teacher or paraprofessional

Direct testing by teacher

Math In these days of high-stakes testing and accountability, mathematical progress has emerged as a national academic priority, as mathematical ability is a good predictor of career success and psychological well-being (Libertus, Feigenson, & Halberda, 2011). Furthermore, kindergarten readiness in mathematics is the best predictor of student achievement in early elementary grades (Roberts & Bryant, 2011). For example, preschool children with poor

http://www.curriculumassociates.com/products/detail.aspx?Title=BrigEC-Screens3

http://bookstore.gesellinstitute.org/index.php?route=product/product&path=49&product_id=123

http://www.pearsonclinical.com/childhood/products/100000304/dial-4-developmental-indicators-for-the-assessment-of-learning-fourth-edition-dial-4.html

https://dibels.org/dibels.html

http://www.myigdis.com

http://www.aimsweb.com/assessments/subscriptions/math

Section 5.4Developmental and Health Screenings

number sense tend to struggle with mathematics later in school (Dyson, Jordan, & Glutting, 2013). Conversely, preschool children who show an early interest in and aptitude toward mathematics tend to have strong math performance later in school (Fisher, Dobbs-Oates, Doc- toroff, & Arnold, 2012). It is important to note that socioeconomic status (SES) is a significant contributor to school readiness and later achievement across mathematical skill, as the more affluent a child, the more prepared he or she is for school and to experience academic success (Roberts & Bryant, 2011).

These three factors (readiness, early interest and aptitude, and SES), highlight the importance of exposing pre-kindergarten children to mathematical concepts. Programs that use an RTI model (see Chapter 7) conduct universal screenings in mathematics and reading three to four times a year. As with all screening, the intent is to catch children who lag behind their peers as early as possible. Schools tend to use commercially available computerized programs such as easyCBM or Aimsweb to screen students in mathematics. Typically, screening tools assess number sense, computational skills, counting, computational fluency, and problem solving (see Figure 5.4).

Figure 5.4: Sample mathematics screen of easyCBM ሁ Math screens can allow EC professionals to quickly assess whether a child is struggling with

developmentally appropriate math concepts and provide early intervention, if necessary.

A. Early geometry

B. Measurement

C. Numbers

Which is the same shape?

What number goes here?

Which pencil is the longest?

10, 11, _____ 12

Source: University of Oregon Center on Teaching and Learning. (2010). easyCBM math test items: Sample math questions for all grades, K-6. © University of Oregon. https://dibels.uoregon.edu/docs/easycbm_math/AllGradesMath_questions.pdf

http://www.easycbm.com

https://dibels.uoregon.edu/docs/easycbm_math/AllGradesMath_questions.pdf

Section 5.4Developmental and Health Screenings

Reading As with mathematical abilities, preschool readiness in reading is a reliable predic- tor of later reading ability. A second predictor of later reading competency is children’s early self-regulatory skills, or their ability to focus and follow directions (Greenwood et al., 2011). The literacy skills learned in preschool are different from but aligned with those learned in elementary school (Greenwood et al., 2011). It is important for preschoolers to have pho- nemic awareness, print knowledge, vocabulary and conceptual knowledge, and be familiar with the alphabet. Early childhood programs may use a tool such as the Individual Growth and Development Indicators (Wackerle-Holman & Bradfield, 2010). This screening mea- sures picture naming, rhyming, phonemic awareness, alliteration (where children identify pictures that begin with the same letter sound), and alphabet knowledge, in a 6- to 10-min- ute session.

From kindergarten through third grade, these early skills are used to learn decoding, pho- nological awareness, reading fluency, and comprehension. Universal screening for reading may involve such tools as easyCBM and Aimsweb, mentioned above. Many schools use some version of the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) (Kaminski, Cum- mings, Powell-Smith, & Good, 2008), though a wide range of tools have been developed and adopted. The Center for Response to Intervention (2014) evaluated a variety of reading screening tools and found the following to be the most adequate in terms of sensitivity and reliability:

Aimsweb

DIBELS

Discovery Education Predictive Assessment

easyCBM

Edcheckup

Formative Assessment System for Teachers (FAST)

iStation Indicators of Progress (ISIP)

Measures of Academic Progress (MAPS)

Phonological Awareness Literacy Screening (PALS)

Predictive Assessment of Reading (PAR)

STAR

As discussed, the main purpose of screening academic performance is to identify lags in achievement early on. Once lags are detected, they can quickly be addressed, making the task of remediation less difficult. These screening tools can also be used once a child has been identified with a lag; they are useful for monitoring weekly progress toward closing achieve- ment gaps. Because early intervention and support can be so beneficial, there is a need to develop more developmentally appropriate tools for screening and monitoring.

http://www.myigdis.com

file:///C:\Users\cherese63\Dropbox\Big%20Textbooks\ECE%20354\2nd%20pass\https\::dibels.uoregon.edu

http://www.rti4success.org/resources/tools-charts/screening-tools-chart

http://www.aimsweb.com/

https://dibels.uoregon.edu/

http://www.discoveryeducation.com/what-we-offer/assessment-resources/explore-assessment-resources/index.cfm

http://www.edcheckup.com/

http://www.fastbridge.org/

http://www.istation.com/

https://www.nwea.org/assessments/map/

http://pals.virginia.edu/

http://childsmindpublishing.org/par/

http://www.renaissance.com/Products/Star-Assessments

Section 5.4Developmental and Health Screenings

Challenge Choose three of the reading screening tools listed earlier (excluding Aimsweb and DIBELS, which have already been completed in Table 5.5) and complete the following chart.

Recommended reading screening tools

Screening test

Ages

Subtests

Administration

Based on the comparison you created, which reading screening tool might be best for your future work? Why?

Social, Emotional, and Behavioral Screens Social and emotional development allows an individual to form meaningful relationships with others. These relationships begin at birth, and are nurtured most effectively by fam- ilies that provide safe contexts to experience and express emotions in ways that are cul- turally and developmentally appropriate (Yates et al., 2008). In the very early years (birth to 2), temperament is considered a predictor of later behavioral problems. Temperament describes a child’s dispositions or their emotional and behavioral responses to environmen- tal conditions. Infants and toddlers may be described temperamentally as irritable, easy to anger, overly sensitive to environmental sounds, or having difficulty in adjusting to changes in schedule (inflexible). Early temperamental problems, which are present in 10% to 15% of infants and toddlers, are predictive of later emotional-social and health problems (Sheldrick et al., 2012).

The Temperament and Atypical Behavior Scale (TABS) Screener and Assessment Tool is com- monly used to assess temperament in early childhood. Measures of temperament tend to label children with significant concerns as “difficult;” however, attention should also be paid to those who are very passive (see Table 5.6). Despite the fact that difficult infants and tod- dlers are at high risk of later problems, they are rarely screened for behavior problems alone, and treated even less often for emotional problems (Sheldrick et al., 2012).

Section 5.4Developmental and Health Screenings

Table 5.6: Early temperament screenings Early temperament screening

Screening test Temperament and Atypical Behavior Scale (TABS)

Early Coping Inventory Infant and Toddler Symptom Checklist

Ages 11 to 71 months 3 months to 7 years 7 to 30 months

Subtests Temperament, attention, attachment, social emotional, vocal, play, sensory

Infant; Toddler; Preschool Scales

Attention, sleep, self-regulation, dressing, movement, eating, listening and language, looking and sight, attachment and emotion

Administration 5-minute 15-item questionnaire completed by parent or professional

36-item short forms 10-minute parent checklist

Later in childhood, behavioral assessments more directly measure behaviors in which chil- dren fail to adhere to contextual expectations or rules. For example, it is common for care- givers to be concerned about bedtime noncompliance, failure to follow simple directions, violent behaviors, and being overly active or socially isolated. However, other traits such as self-concept, self-efficacy, self-regulation, and prosocial behavior are also predictors of school success for which caregivers should be concerned (Fantuzzo et al., 2007). By contrast, it has been found that children who have high levels of social skills in kindergarten tended to have more success in reading (Cooper, Moore, Powers, Cleveland, & Greenberg, 2014).

Screening for behavioral exceptionality has historically been misused. Children from minor- ity populations (Skiba et al., 2006; Sullivan & Bal, 2013) and boys have been overidentified, while girls have been underidentified (Oswald, Best, Coutinho, & Nagle, 2003; Sullivan & Bal, 2013). These differential results are thought to be in part due to teacher bias and not entirely to differences in behavior. For example, many teachers believe boys are more rambunctious. Seeing boys act out strengthens these teachers’ biases, even though the behavior might not actually be any more disruptive than when girls act out. Overreferral appears to be more likely when children struggle both cognitively and behaviorally (Skiba et al., 2006).

Many screening tools are specifically designed to measure social behavior in infants and young children (see Table 5.7). These include the Brief Infant Toddler Social Emotional Assessment (12 to 36 months/BITSEA), Devereux Early Childhood Assessment for Infant and Toddlers (1 to 36 months/DECA-IT), and the Vineland Social Emotional Early Childhood Scales (Birth- 6yrs/Vineland SEEC). Children who are identified as having early social and behavioral prob- lems are at high risk for later academic and social problems (Sektnan, McClelland, Acock, & Morrison, 2010), but the treatment for behavior problems is often quite simple and may avert unnecessary challenges later.

http://www.brookespublishing.com/resource-center/screening-and-assessment/tabs/

http://ststesting.com/COPI.html

http://www.greenbookee.com/infant-toddler-symptom-checklist/

http://www.health.state.mn.us/divs/fh/mch/devscrn/instr/bitsea.html

http://www.centerforresilientchildren.org/infants/assessments-resources/devereux-early-childhood-assessment-deca-infant-and-toddler-program/

http://www.pearsonclinical.com/psychology/products/100000283/vineland-social-emotional-early-childhood-scales-vineland-seec.html

Section 5.4Developmental and Health Screenings

Table 5.7: Screening tools for social and emotional development Social and emotional screenings

Screening test Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R)

Brief Infant Toddler Social Emotional Assessment (BITSEA)

Ages 2 to 16 years 1 to 3 years

Subtests Intensity (of behavior) and (type of behavior) problem

Social skills, communication, behavior, environment

Administration Parent or teacher interview of 36 to 38 items, graduate level training required for interpretation of results

42 items completed by a parent or professional, interpretation required trained professional

Screening for Mental Health Very young children who are exposed to aversive conditions and experiences—such as neglect, chaotic family life, abuse, food insecurity, and homelessness—are at particular risk for social and emotional delays and disabilities that lead to mental health problems. Vincent Felitti (2011), a groundbreaking researcher in the area of traumatic childhood experiences, referred to the harm done by child abuse and other adversity as “turning gold into lead” or “reverse alchemy.” There are several reasons why the early childhood period is so critically vulnerable to early trauma, with severe mental health consequences. For one thing, children’s brains are still immature, which makes them biologically vulnerable (Walker et al., 2011). Second, very young children have few protective responses or coping mechanisms that might help to shelter them from adverse conditions. Their very vulnerability may make them a tar- get for abuse. Infants and young children tend to break the rules that they still do not under- stand, and in doing so may incur the frustration of adults. Because they are small and weak, infants and young children have no ability to resist when adults react to typical childhood behavior irrationally or with excess. Finally, small children tend to be more trusting and less defiant than older children.

As with every area of development, the earlier children are identified for potential mental health concerns, the more likely they are to receive help. Professionals have recently begun using the Adverse Childhood Experiences (ACE) scale to assess mental health risk. Felitti (2011) found that even one ACE event poses a moderate risk for health problems in adult- hood, while four ACE events were associated with high risk of physical, mental, criminal, and developmental problems. Some of the adverse events screened for include:

• parents divorced/separated • unstable residency (frequent moves, homeless) • witness to domestic violence • involvement of Child Protective Services • a jailed family member • a family member who is a substance abuser • insecurity in basic needs (such as food insecurity, lack of health care)

http://www.adapt-fl.com/files/Sutter-Eyberg.doc

http://www.cup.ualberta.ca/wp-content/uploads/2012/06/FINAL_BITSEA_Jun_2012.pdf

http://acestudy.org/yahoo_site_admin/assets/docs/ACE_Calculator-English.127143712.pdf

Section 5.4Developmental and Health Screenings

• family member with a mental disability • family member with a physical disability • exposure to community violence • death of a parent or caregiver

The Child ACE tool includes seven items that measure suspected maltreatment, domes- tic violence, and drug and/or alcohol abuse. By asking family members which, if any, of the seven indicators a child has experienced, an interviewer completes the survey, taking note of any family members with mental illness, whether a child has one or more parents in jail, whether a child is being raised by a single parent, and the level of a child’s mother’s educa- tion (Marie-Mitchell & O’Connor, 2013). High scores on this assessment are associated with childhood behavior problems, developmental delays, and childhood injuries (Marie-Mitchell & O’Connor, 2013).

Challenges exist in administering the Child ACE tool with families, given the sensitive nature of the items. However, Blodgett (2012) found that a large majority of Head Start families vol- untarily completed the assessment once they were given a rationale for doing so and received an explanation of the potential benefits that could be derived from the outcomes. Based on the probability for lifelong problems associated with high ACE scores, Blodgett has advocated for ACE exposure assessments to be used as universal screening for families of children in Head Start and other early childhood programs (see Figure 5.5).

Figure 5.5: Differential risk for severe problems as a multiple of that experienced for children with an ACE score of 0

ሁ The more ACE indicators a child experiences, the more likely he or she will have severe difficulties in multiple areas.

Severe Risk Associated with ACE Score

M u

lt ip

le f

o r

ri s k

o f

s e

ve re

p ro

b le

m s

Academic failure

3 or more ACEs

2 ACEs

1 ACE

Attendance problems Behavioral problems Poor health 0

Source: Adapted from Blodgett, 2012.

http://static1.squarespace.com/static/500ee7f0c4aa5f5d4c9fee39/t/53e90080e4b0447dbee21a50/1407778944059/Adverse+Childhood+Experiences...+Translating+Knowledge+into+Identification+of+Children+at+Risk+for+Poor+Outcomes.pdf

Section 5.4Developmental and Health Screenings

Screening for Autism Many screening tools have been developed specifically to detect autism or autism spectrum disorder (ASD) (see Table 5.8). The characteristics of ASD include deviations in language use and social interactions, along with unusual behavior patterns such as excessive inflexibility and repetitive behaviors. The spectrum refers to the broad range of behaviors that fall under this disability. Because treatment of this disorder is intensive, the earlier the intervention, the better expectations are for developmental outcomes. Consequently, earliest detection should lead to earliest intervention. Given the meteoric rise in incidence of ASD worldwide, the American Academy of Pediatrics has called for universal screening in early childhood (Miller, Pandey, & Berry, 2014). However, current autism screening tools may lack the technical qual- ity to be used routinely or universally to identify children who may fall along the spectrum (Al-Qabandi, Gorter, & Rosenbaum, 2011).

Table 5.8: Screening tools for autism Autism screenings

Screening test Screening Tool for Autism

Pervasive Development Disorders Screening Test-2

Autism Behavior Checklist

Ages 2- to 3-year-olds Birth to 4 18 months to 35 years

Subtests None Autism Spectrum Disorder, Autistic disorder, Pervasive Developmental Disorder, Asperger’s Disorder

None

Administration 12 pass/fail items administered in a play- like context

Parent survey and clinician interpretation, test is done in three stages

57 items scored by parents and/or professionals

For some time, recognition of autism in infancy was imprecise (Volkmar, Chawarska, & Klin, 2005). Indicators along the spectrum were poorly defined, and it was not until later childhood that practitioners felt confident to make a diagnosis. It is now known that even as babies, chil- dren exhibit disruptive social, behavioral, and language patterns that suggest ASD. Though every child with autism is different, these may include differences in responding to being held or touched, avoiding eye-contact, and unusually low or unusually high sensitivity to sounds (Volkmar et al., 2005). Based on these indicators, a number of autism screening tools have been developed for health care and early childhood providers to use (see the feature box titled Screening for Autism).

http://stat.vueinnovations.com/about

http://www.aspires-relationships.com/pddsii.pdf

http://drjenna.net/wp-content/uploads/2013/07/abc_checklist1-3.pdf

Section 5.4Developmental and Health Screenings

Screening for Autism Autism is a developmental disorder with unknown origin. There is a large and growing incidence of autism in the United States. Current estimates suggest that one in every 50 to 100 children is diagnosed with this disorder (Lauritsen et al., 2014). Autism is further defined as a spectrum of disabilities (autism spectrum disorder), all of which include social deviations and language differences (Howard, Williams, Miller, & Aiken, 2014).

Most EC educators (as well as educators of older children) know about ASD, but do not know enough to serve these children well (Daniels, Halladay, Shih, Elder, & Dawson, 2014; Wilson, Dykstra, Watson, Boyd, & Crais, 2012). One of the more significant problems associated with serving these children is accurate diagnosis or, more specifically, accurate assessment (Lauritsen et al., 2014). It is challenging to detect ASD in infants, toddlers and preschoolers, yet important if children and their families are to receive services. Part of the problem in identifying autism is the diversity of behaviors that are considered indicators and the subjectivity in diagnosis. For example, one characteristic of individuals with autism is that they relate to others in an unusual way. This characteristic can and does encompass a vast array of social differences and subsequently envelopes children who may be more socially different than they are alike.

To get a sense of the subjectivity of autism screening and assessment, readers are challenged to assess themselves using an adult screening test. The following link connects readers to a screening tool for adults who may fall somewhere on the autism spectrum. The RAADS-14 Screen (Eriksson, Andersen, & Bejerot, 2013) illustrates the types of behaviors one might look for in autism, and is one example of the brevity and simplicity of a screening tool.

http://www.molecularautism.com/content/supplementary/2040-2392-4-49-s1.pdf

Critical-Thinking Questions

1. Did you feel that you could confidently rank yourself with respect to indicators of adult autism?

2. What behaviors was the assessment attempting to isolate?

3. When working with young children, even infants, what behaviors would raise a red f lag as possible indicators of ASD?

Screening for Physical Health Engaging in purposeful observation of young children for problems in physical development related to vision, hearing, and dental growth is an ongoing duty of ECE professionals. Because of their extensive experience and frequent contact with children, they are in a good position to notice when something is amiss. However, even the best of intentions and dedicated vigilance are insufficient to purposefully observe the health of young children. Educators must possess some knowledge of the symptoms of health issues in order to recognize warning signs.

Consider the story of Carla, who is a second-grade teacher on a reservation, a close commu- nity where most families know each other. Carla was surprised when one of her students,

http://www.molecularautism.com/content/supplementary/2040-2392-4-49-s1.pdf

Section 5.4Developmental and Health Screenings

whom she had known for years, began exhibiting maladaptive behavior. Cassidy had always been a cheerful, engaging, and well-behaved child. Carla knew that Cassidy had done well in school in previous years, but she was now struggling to complete her work. She acted defiant and became more so toward the end of each day.

Other educators at the school noticed the change and assumed that Cassidy had simply suc- cumbed to the influences of peers or family. Yet, Carla knew that Native Americans are par- ticularly vulnerable to diabetes, and also knew the symptoms of this disease. Cassidy exhib- ited the classic symptoms of diabetes, and after recommending to her parents that Cassidy undergo screening for the disease, Carla learned that her hunch was correct. Subsequent medical treatment restored Cassidy to the child Carla had previously known. This example illustrates the connection between professional preparation and purposeful observation. However, observation duties or purposeful observation usually ends the involvement of ECE professionals in screening, as health care providers conduct health screenings.

Table 5.9 lists some of the most common signs an EC professional might observe if a child is experiencing problems with vision, hearing, or dental development.

Table 5.9: Signs of need for health screening Area of development Signs that a child should be referred for screening by a health care provider

Vision • holds items close to their face to see detail • rubs eyes • squints • reaches beyond or just short of an object • jerky eye movements • asymmetrical pupils • failures to look at faces • runs into things

Hearing • does not turn or react to sounds or voices • has difficulty following directions • shows delays in language development

Dentition • has a high-sugar diet • has poor dental hygiene • has white spot lesions where decalcification has taken place

Source: Hamdan, Maxfield, Tüfekçi, Shroff, & Lindauer, 2012.

If EC professionals consistently see numerous signs of a problem, they should contact an appropriate health care provider, such as the school nurse, or refer parents to pursue screen- ing through their pediatrician or community resources such as a clinic that offers free public screenings.

Summary and Resources

Chapter Summary As part of a profile provided by assessment, screening plays an important role in monitoring and identifying children who may need extra support as they develop and learn during their early years. Used to its greatest potential, screening is conducted regularly and universally by informed administrators who use high-quality instruments. The importance of regular screening is connected to early identification and subsequent intervention as needed.

Several cautions are in order with respect to screening. These tools are intended only as indi- cators and are therefore insufficient for making diagnoses or determining eligibility for ser- vices. Making important decisions on the basis of their outcome would constitute a misuse of these tools. Rather, the power of a screening system is to uncover potential problems. Screen- ing instruments tend to be less technically adequate than more comprehensive standardized assessments and are thus more likely to yield false results. Of greatest concern is the ten- dency to provide inaccurate results for children who are ELL, from low-income families, or not White.

Screening of very young children may be broad stroke, encompassing many developmental areas, or may be specialized for a particular domain. In addition to choosing high-quality tools, providers should choose the right tool for the job. That is, if the objective is to mea- sure social and emotional behavior, it is better to choose a specific tool rather than a broad- spectrum instrument, because the former is more likely to provide a greater range of items specific to social and emotional development.

Putting screening into perspective, these instruments are one tool in the assessment box to provide children with a high-quality education that is suited to their needs and serves their long-term interests. The nexus between early childhood education and early identification is not incidental—it is the point.

Posttest 1. A child’s first screens should be provided by .

a. caregivers b. social workers c. Head Start teachers d. medical practitioners

2. A positive screen indicates that a child . a. may need an evaluation b. is developmentally on track c. is developmentally delayed d. may need health care

3. All of the following are levels of screening EXCEPT . a. targeted b. purposeful observation c. basic d. universal

Summary and Resources

4. Which of the following is TRUE of purposeful observation? a. It is conducted by pediatricians. b. It acknowledges parent input. c. It is based on basic observations. d. It should not include risk variables.

5. In order to keep purposeful observation skills sharp, EC professionals should .

a. observe typical children to recalibrate b. attend purposeful observation workshops c. focus on special populations d. build portfolios around target skills

6. Judgments are made about a child’s performance on a screening by comparing his or her score to the score. a. evaluation b. assessment c. cutoff d. baseline

7. More accurate results can be obtained on screenings if the screener has a . a. bachelor’s degree in ECE b. positive relationship with the family c. background in health care d. suspicion that the child is delayed

8. Most children will receive their first screenings . a. at 6 months b. in kindergarten c. in Head Start d. at birth

9. EC professionals can conduct screens for all of the following EXCEPT . a. health b. cognition c. behavior d. language

10. The ACE tool measures . a. academic capability b. suspected maltreatment c. intellectual capability d. social–emotional development

Answers: 1 (d), 2 (a), 3 (c), 4 (b), 5 (a), 6 (c), 7 (b), 8 (d), 9 (a), 10 (b)

Summary and Resources

Critical-Thinking and Discussion Questions 1. Think about your current or future role in ECE. Based on what you now know, how

will you use screening in the future? 2. Imagine that you are a preschool teacher. A parent of a 5-year-old comes to you

wanting to enroll her son. You politely inquire as to why he is not going to kindergar- ten, and the mother responds that she is furious about the kindergarten screening that her son underwent, because she was told her son would need special services. How might you work with this parent?

3. Because one must develop skills to be able to effectively practice purposeful obser- vation, how will you go about working with a mentor or independently to develop the skills necessary?

4. How can you support parents in connecting with health care providers for screening and evaluations? What resources are available in your community?

5. Although all 50 states mandate some infant screenings, why do you think later screenings (like the ones recommended at 9, 18, 24, and 30 months) are not man- dated? What might need to change for these screenings to be mandated?

Additional Resources The NECTAS Developmental Screening and Assessment Instruments with Emphasis on

Social and Emotional Development for Young Children Ages Birth Through Five pro- vides an overview of a number of EC screens. http://www.nectac.org/~pdfs/pubs/screening.pdf

First Signs: Recommended Screening Tools profiles a variety of screening tools, particularly those that address behavior development and autism. http://www.firstsigns.org/screening/tools/rec.htm

This link to a case study of Roger’s screening using PEDS demonstrates a commonly used screen to identify children who are at risk. It shows a score sheet for a child in a case study and explains how the assessment results are used. http://www.pedstest.com/Portals/0/Rogercaseexample2013.pdf

The modules included in the National Infant & Toddler Child Care Initiative: U.S. Department of Health and Human Services—Infant and Toddler Development, Screening & Assess- ment were designed to support EC professionals, particularly those without specific training working with infants and toddlers: http://www.zerotothree.org/public-policy/state-community-policy/nitcci/ multidisciplinary-consultant-module-2.pdf

Answers and Rejoinders to Chapter Pretest 1. False. Screening tools are not designed for this use. They are designed to identify

children who may have lags or deviations in development, and only indicate that further assessment is necessary.

2. True. If a child is identified as scoring outside the norm on a screening assessment, the assessor should make a recommendation or referral for further testing using comprehensive assessment tools that are designed to make an accurate determina- tion of actual delays in development. Only after these more accurate evaluations have been conducted may there be confidence that the outcome is a reliable estima- tion of a child’s ability.

http://www.nectac.org/~pdfs/pubs/screening.pdf

http://www.firstsigns.org/screening/tools/rec.htm

http://www.pedstest.com/Portals/0/Rogercaseexample2013.pdf

http://www.zerotothree.org/public-policy/state-community-policy/nitcci/multidisciplinary-consultant-module-2.pdf

Summary and Resources

3. False. It is important to screen children for developmental or health problems until they are in preschool. A good screening tool is brief but still able to reliably identify children who need further evaluation. This reliability is referred to as screening sensitivity and selectivity should be rated at .80 or higher. The lower the rating, the more likely it is that children will be under- or overidentified, creating false nega- tives and false positives. Sensitivity in a screening tool refers to its ability to accu- rately identify children who are at risk, whereas selectivity refers to a test’s ability to avoid identifying children who are not at risk.

4. False. Although there are many assessment tools available to screen for autism, identification is not easy. This is in part because the definition and characteristics of autism are very broad and subjective. Secondly, many professionals who serve young children do not have a good enough understanding of autism to recognize the disability.

5. False. Many screening tools relevant to professionals serving children in early inter- vention and educational settings are designed specifically for these professionals. One of the characteristics of screening tools is their relative ease of administration and scoring compared to more comprehensive, standardized assessment tools.

Rejoinders to Posttest 1. Medical practitioners should administer health and development screenings at all

check-ups. It is recommended that children be screened at 9, 18, 24, and 30 months. 2. A positive screen indicates that a child fell below the determined cutoff score and

may need to be referred for a full evaluation. 3. Screening progresses from purposeful observation, to universal, to targeted in order

to assess children in a variety of ways before deciding to make a referral for a full evaluation.

4. Purposeful observation should be conducted by trained EC professionals and should take into account parent observations and concerns.

5. EC professionals can lose their purposeful observation abilities if they only see specific special populations. Consequently, it is important that they observe children with typical development in order to acknowledge when a child is displaying non- typical behaviors/development.

6. A child’s score is compared to the predetermined cutoff score in order to decide what additional action may be necessary.

7. Because information is often collected from parents as part of a screening, it is important to establish a positive relationship with the family in order to collect the most accurate information possible about the child.

8. All 50 states mandate basic screens at birth, such as the APGAR. 9. While most screens are designed for and used by EC professionals, health screens

should only be administered by health care professionals. EC professionals should be able to recognize signs that a health screen may be necessary, though.

10. The ACE tool provides a measure of adverse childhood experiences, which often indicate some form of maltreatment experienced early in life.

Summary and Resources

Key Terms autism spectrum disorder (ASD) A devel- opmental disorder characterized by devia- tions in language use and social interactions along with unusual patterns of behavior such as excessive inflexibility and repetitive behaviors.

bias A testing error that occurs when the test or items on a test unfairly assess a child’s ability based on characteristics of the test itself and not the abilities of a child.

congenital Characteristics or conditions that are present at birth.

cutoff score The score below which a child is considered to perform significantly below the norm. A score below the test’s cutoff indicates the child may have a problem.

false negative A testing error in which the test results say there is no problem (negative) when there actually is a problem (false).

false positive A testing error in which the test score says there is a problem (positive) when the child does not actually have a problem (false).

purposeful observation An observation in which trained caregivers and professionals continuously monitor and are aware of the developmental progress of infants, pre- schoolers, and young children.

postural reflexes Reflexes that emerge in infancy and support typical motor develop- ment. The absence of these postural reflexes

at the typical age indicates that there may be a neuromotor problem.

primitive reflexes Reflexes present at birth that signal typical development. These dis- appear in infancy and are replaced by more adaptive reflexes. When they do not disap- pear or they become more pronounced, this is an indication that there may be a neuro- motor problem.

screening The administration of a brief test to assess and identify possible problems that may later be further evaluated using more extensive and more accurate assessment.

sensitivity The ability of a test to accurately identify those children who actually do have atypical development as compared to age-based standards of normal development (norms).

specificity The ability of a test to determine those who do not have special needs.

targeted screening A screening in which assessment of a single developmental (for example, language) or health area (for example, vision) is conducted.

temperament A child’s disposition or emo- tional and behavioral responses to environ- mental conditions.

universal screening A screening in which all children, regardless of specific signs of atypical development, are assessed using a formal testing procedure.