Avaliação do Desenvolvimento Neuropsicomotor – Rastreio

Developmental screening tests — There are several brief and accurate developmental screening tests that make use of information provided by the parents or direct observation or elicitation of developmental skills. Additional factors to consider when choosing a developmental screening test for use in primary care practice include ease of administration, cost, and time needed for scoring and interpretation skills. Screening tests that draw on information that is reported by the parents may be more suitable for primary care than those that require direct observation or elicitation of developmental skills.
Parent report screens: Screening tests that draw on information that is reported by the parents may be more suitable for primary care than those that require direct observation or elicitation of developmental skills. Such tests can be self-administered in waiting or examination rooms, attached to an appointment letter, administered online before an appointment, or delivered by interview in person or over the telephone. Such tests are usually less expensive, take only a few minutes of professional time to interpret, eliminate the challenge of directly eliciting skills from children who, for whatever reason (illness, sleepiness, anxiety, fear), may not demonstrate their best effort on the day of testing. In addition, parent-report screening tests provide a family-focused and collaborative approach to monitoring development and addressing developmental problems.
Direct elicitation screens: Screening tests that rely on direct observation or elicitation of skill may require several attempts to optimize test conditions. Tests involving direct observation or elicitation of skills require more time than tests that rely on parent report and may not be adequately reimbursed if performed by the primary care provider.
Direct elicitation screening tests typically are used by pediatric healthcare providers who have a particular interest in developmental problems. Direct elicitation screening tests may be used as the only screening test, to complement the results of parent-report instruments, or to explore an area of concern in greater depth (eg, gross motor skills). Many healthcare providers who use direct elicitation screening tests find that it enhances their relationship with the family and child and provides valuable information to make appropriate referrals.
Ex: Denver Developmental Screening Test-II (DDST-II) – The DDST-II is a directly administered tool that is designed to screen expressive and receptive language, gross motor, fine motor, and personal-social skills in children zero to six years of age. It takes 10 to 20 minutes to administer. The results indicate a risk category (normal, questionable, abnormal).
In a study comparing the performance of the DDST-II to individual measures of intelligence, speech-language, achievement, and adaptive behavior in 104 children (3 to 72 months), the DDST-II correctly identified 83 percent of children with neurodevelopmental problems, but specificity was limited at 43 percent. When children with questionable results are grouped with normals (a more common approach), sensitivity drops to 56 percent and specificity rises to 80 percent. Although the DDST-II has been the most widely used developmental assessment tool in pediatrics, it was not intended to identify developmental delay in asymptomatic children (ie, as a screening test in the most traditional sense), but rather to demonstrate the rate of achievement of milestones, with the results interpreted in the context of the child's overall functioning and circumstance (ie, to aid in making skilled observations for developmental surveillance). Research suggests that its use as a screen will lead to either under- or overdetection.
Behavioral screening tests: The use of broad-band behavioral screening instruments in primary care practice may facilitate detection of developmental, as well as behavioral problems. Children with undetected developmental problems often present with behavioral issues. Temper tantrums or disruptive behavior, as an example, may be the manifestation of frustration in communication for a child with language delay. Developmental delays should be excluded before screening for behavioral problems. Behavioral screening tests may be broadly or narrowly focused:
• Broad-band instruments — Broad-band behavioral screens rely on parent- or child-completed questionnaires that, when scored, have subsets that include multiple mental health categories to rule out a broad range of possible diagnoses. Broad-band behavioral screening tests that can correctly identify 70 to 80 percent of children with and without behavioral problems
Ex: Conners Rating Scale-Revised Long Form (CRS-R) – The Conners Rating Scale-Revised Long Form (CRS-R) can be used as a behavioral/emotionalscreen in children 3 to 17 years. There are three versions: teacher report, parent report, and youth self-report (for ages 12 to 17 years). It is available in English and French and takes about 20 minutes to administer. The scoring system yields seven factor scores: Cognitive problems/inattention, Hyperactivity, Oppositional, Anxious/shy, Perfectionism, Social problems,Psychosomatic. The CRS-R detects 78 to 92 percent of children with social/emotional/behavioral problems and correctly identifies 84 to 94 percent of children without such problems
• Narrow-band instruments — Narrow-band behavioral screens are directed toward a specific diagnosis (eg, autism, ADHD). For screening purposes, broad-band screening should precede narrow-band screening. Although a complete discussion of the wide range of narrow-band behavioral screening instruments that are available is beyond the scope of this topic review, examples of three that are commonly used in primary care are provided below.
Ex: Conners Rating Scale-Revised Short Form (CRS-R) – The Conners Rating Scale-Revised Short Form screens for symptoms of ADHD (Attention deficit hyperactivity disorder): inattention, cognitive problems, hyperactivity, and oppositional behaviors in children 3 to 17 years of age.

Screening for behavioral problems may facilitate the detection of developmental, as well as behavioral problems. Behavioral screening tests may be broadly or narrowly focused. Broadly focused screens rely on parent-, teacher-, or child-completed questionnaires that, when scored, have subsets that include multiple mental health categories to screen for a broad range of possible diagnoses. Narrowly focused screens are directed toward a specific diagnosis (eg, autism, attention deficit disorder). For screening purposes, broad-band screening should precede narrow-band screening.


Referências:
1- Developmental and behavioral screening tests in primary care. UpToDate. Acesso em 05 de julho de 2013.