On this podcast, we are joined by Dr. Marisa Macy, associate professor at the University of Nebraska at Kearney. She joins us to discuss the purpose of developmental screening tools in the early childhood field.
Natalie Danner: Thanks for joining us for a podcast from the Illinois Early Learning Project. Our project is part of the Department of Special Education at the University of Illinois at Urbana-Champaign and funded by the Illinois State Board of Education. On this podcast, we share information about how young children grow and learn as well strategies adults can use to help them thrive.
Okay, welcome to the Illinois Early Learning Podcast. Today we are talking about developmental screenings. We are joined by Dr. Marisa Macy from the University of Nebraska at Kearney. Dr. Macy is the Cille and Ron Williams endowed chair of early childhood education and associate professor in the Department of Teacher Education. Her research focuses on assessment and screening for young children. Thank you so much for being with us today Dr. Macy.
Marisa Macy: Thank you Dr. Danner, great to be here.
Natalie Danner: We’re excited to have you. So today we’re eager to hear from you as a researcher focused on young children, because our listeners want to know more about developmental screening and how it pertains to young children. So, let’s get right into this topic. So, what are developmental screenings for young children?
Marisa Macy: Well, developmental screenings for young children are to better understand the child and where they are at developmentally. They give us a snapshot of a child’s development and they’re usually brief to administer. So, if a professional is administering it to the child, with the family present, it’s usually around a half an hour. It could be a little longer or a little less but that’s kind of a ballpark.
And then, if the family is completing a developmental screening tool it’s about 15 to 20 minutes give or take of their time, and it’s a snapshot. It’ll tell you some information about the child compared to other children the same age. So, it’s a norm-referenced assessment. So, if the child 24 months old, it’s going to compare that parent’s child to the other 24-month-old children that were in the standardization sample.
Natalie Danner: So, this leads us right into the next question which is: Who gives those developmental screenings to young children? You mentioned parents as part of that, and I would think that most people would not assume that parents are doing screening. Tell us more about that.
Marisa Macy: Great question. So, there are parent-completed measures. It could be a survey, it could be a questionnaire, it could be a milestones checklist. It could be someone asking the parent questions through an interview. So maybe the professional is asking or gathering information from the parent in a back-and-forth way where they’re asking questions and trying to find out more.
So yeah so, the parent could be the one who’s providing the information, and the professionals who work with families could be from education, so it could be a child’s educator, preschool teacher, early childhood educator, so that could be someone from the education field. It could also be someone from the health care field, so it could be the child’s pediatrician or nurse. It could also be a related service provider, so maybe it’s a pediatric occupational therapist or a physical therapist or speech language pathologist. So those could be a school psychologist.
So those are some of the related specialists who might be providing the screening assessment. It could also be social service providers, so maybe it’s a social worker. So those are some of the sectors that are involved in developmental screening so health care, social service, and education.
Natalie Danner: So, I guess it depends on the screening tool that’s chosen to match it to the professional or either the parent that would be completing it.
Marisa Macy: Yes, and this might go with another one of the questions later, but there’s a narrowband and broadband screening tools. So, a broadband would cover multiple areas of development, so it could be gross motor, fine motor, cognitive, adaptive, communication. Or it could be more narrow and very specific. So it could be a social-emotional screening or a developmental behavioral screening tool that mainly focuses on just one area of development.
Natalie Danner: That makes a lot of sense. So, when we’re talking about developmental screenings, how are they different than assessments? And I guess what I mean by assessment is that many families are going through the process for special education services might be going through the process to get an evaluation or a comprehensive assessment. How is a screening different than that?
Marisa Macy: That’s a great question, thank you for asking that. A screening could be an assessment or it could be thought of in different ways, but the purpose of a screening is to answer the question, does the child need more comprehensive evaluation to find out questions related to their development and or behavior? So, an assessment is just a broad term that means “sit beside and get to know,” That’s the origin of the word assessment, “sit beside and get to know.”
And so when we assess, we’re gathering information. So we are all assessing all the time. We’re gathering information, we’re trying to learn more, and a screening, the purpose of a screening is also to gather information. It could lead to more comprehensive in-depth assessment. So, a screening could be thought of as the beginning of a bigger assessment process or evaluation process, depending on the results of the screening.
So, if the screening results show that the child is developing typically compared to the other children in the norm, the normative sample, then there’s a couple different ways we could go. We could discontinue further screening and we could be done, or if we want to, we could track the child’s development over time, and so, if it’s a young child, we could do it every two months. So, two months from now, we could do another developmental screening and see how they’re doing, and if they’re still continuing to do well and not have any concerns, then we could do it again, or we could discontinue then, but that would be if the screening results show no concerns at this time.
But if the screening results show concern at this time, then what we would want to do is make a referral for a more in-depth comprehensive assessment. Depending on the area of concern, the referral would go to the providers that are experts and trained in that specific area. For example, in early intervention with young children and preschoolers, we have the biggest population of children with speech language delays, so it might be a minor articulation disorder. And so, if the screening results showed that that’s the area of concern that we have, we could make a referral to a speech language pathologist or a program that specializes in that, and they can do an in-depth comprehensive assessment.
So, the purpose of the developmental screening is to find out more about the child’s development and also, it could be to follow up on a concern that a parent might have or familiar caregiver might have, or it could just be a fun way for parents and families to just learn more about their child. And different communities do it differently. I’ve lived in different communities where the programs might have a monthly screening fair or maybe once a month or certain time of the year, the service coordinators are at a public location and the families can go there and participate in developmental screening in the community. So those are some different ideas.
Natalie Danner: Sounds like there are lots of different ways to do screenings, different people who are involved in screenings, and then really thinking of that purpose of the developmental screening, and thinking of that beginning stage of the assessment process and really looking at the child’s development, overall. I really like how you described it in that beginning stage, because when we do developmental screening, if you’re a preschool teacher and perhaps you’re screening all of the children that are in your class, you’re screening everyone, not just maybe one or two that you might have concerns about. But what that screening gives you is the understanding that, you know, this particular child is developing on track, this particular child you may need more information about. And that’s when you do that whole process that you explained so nicely about linking up to other professionals who can give a more in-depth evaluation about that particular child’s development.
So, the screening tool, for my perspective, as a former preschool teacher is just such a great way to understand a child’s development and match them up with other children who are around their same age. So, for me, I would think aloud or maybe through my observations look at children and say, “Oh wow yeah they look like they’re on par, check, check, they look great”. But the screening tool is perhaps a little bit more in depth way of looking at particular developmental milestones that are specific to their age group.
And that’s where it gives me a little bit more certainty as a teacher to understand, you know, okay, I feel good about where this child is and what they’re doing in their developmental milestones, and for this particular child, maybe we need more information. So, I think it’s similar for teachers and for parents when they look at screenings in that way, and that gives them a sense of security that their child is developing where they need to be, or it gives them a heads up that maybe there’s something going on and we want more information about their development. So, either way, I think it gives them a sense of gaining more information about the child’s development and that’s the purpose of screening. So, thanks for explaining that.
Marisa Macy: And while we’re still talking about purpose, Dr. Danner can I just mention that there’s three things that a screening cannot do.
Natalie Danner: Perfect
Marisa Macy: One is the screening cannot diagnose a disability or a delay. It’s not a diagnostic assessment. No. 2, a developmental screening is not meant to be used as the sole tool or instrument for determining eligibility for services. So, it’s not used as a diagnostic, it’s not used to determine eligibility. It’s mainly used to find out if a valid referral is needed for further testing or further evaluation.
It’s also not so common to use it to monitor progress either, once a child is in the program. It can be used for developmental tracking and health care they’ll use the term surveillance. Education, we use more the term tracking, but that’s where you continue to use it ongoing with a child or a group of children who may or may not have a concern. So that’s the tracking or developmental surveillance. But for monitoring progress on developmental or academic goals on an IEP or IFSP, a screening tool would not be the best tool to monitor progress over time when a child has specialized individualized goals and objectives.
Natalie Danner: I think that means a lot because we’ve been talking about what it is, but it’s important to also talk about what it isn’t. And I think that piece about it is not a diagnostic tool is the piece that many people have misunderstandings about when we talk about developmental screenings, and sometimes even teachers have misunderstandings about that too when they’re looking at this short quick screening and looking at all those developmental milestones and check this yes, yes, yes, no, no, no, no, yes, no and all of those kinds of things and then looking at the end and seeing that outcome of the screening perhaps be “needs additional assessment.” Many people might jump to the idea of, oh my child might have a delay.
And the key there is may or might, it is not necessarily like they do definitively have a disability or a delay, and I think that’s, that’s the purpose of the full evaluation. The full evaluation that you go on to next is where you find out more about the child and their development and whether they have a disability or a delay. And that’s where you get a potential diagnosis and the screening is just to give you an overall idea of, is this child developing on track, or do we need more support and evaluation to understand where this child is? So, I think that part is really important for teachers and parents to know too, so thanks for bringing that up.
So, now that we’ve talked a little bit about assessments and purposes, and all these kinds of things about developmental screenings, I wanted to ask how screenings are developed and I know you’ve had some input into this with various types of screenings. But when we talk about a really diverse community and we talk about children in that community, including children who might speak languages other than English and or recent immigrants, how do developmental screenings match up with our very diverse population of children in the U.S.?
Are these tools norms to this diverse population or not, and if it isn’t really norm to this population, how can we really look at children in these particular communities who might have developmental concerns? How do we do screening for all the children in our communities? It’s a big question and I had multiple questions there, so I hope you’ve got it all.
Marisa Macy: And that’s an excellent question. Where should I start. There’s so many different things I want to say about this topic. Yes, that’s a great question. Anytime we use an assessment, we want to make sure that it has validity, reliability, and utility. So we want to make sure that the measure actually can give us information about what it purports to say it measures.
So, if it’s a cognitive tool, are we really looking at cognition and does it really give us that kind of information? We also want to make sure that it’s useful, so we want to make sure we’re using tools that have utility. We want to make sure that when we are assessing children that children are included in the standardization sample when it was normed, the children we’re going to be assessing with it.
So, for example, maybe you have a concern that a child might be somewhere on the autism spectrum, we want to make sure that we’re using tools that have children in the sample that had ASD (autism spectrum disorder), because if we use a tool that we know that they weren’t included, it would be really hard to have faith in the results of the assessment if those children were excluded. And so, it takes some detective work to find out if the tool that we want to use has been normed and is effective with all of our children. And so that would be one suggestion to find out if the tool is appropriate for the population that we’re going to be using it with.
Also, a lot of tools have been translated. So maybe they were developed for a certain language and then, once we change it, we have to study it again, we have to continue to do research to find out okay, we’ve changed it it’s not the same tool as it was before, now what do we know about it? And if we find out that it does continue to have good validity and reliability and utility, then we can feel good about using it. But if we don’t really know that much about it, again buyer beware. How can we trust the results if the children that were using it with were not part of the normative sample?
So, those would be some considerations to make when we’re choosing a tool to make sure that we’re using good tools that have evidence behind them. And then also you talked about children with diverse linguistic, children who have other languages that they speak and maybe they don’t speak English and the tool is in English. It might be helpful to find out from your service coordinator or people within your organization, who to go to, to find out what is available for children and their families in your organization.
I’ll just give an example for myself. I was in a situation where someone needed a specific language and we tried to find out from our community resources what was available, and we couldn’t find good tools within our organization. So we kind of had to do some detective work and go outside the organization to find out what was available. And we were able to get a language translation for that family, and for that child, and it turned out we had other families who benefited from it, so that investment and that time and the research to go looking really paid off because we ended up using it again and again, not just for that situation, but for other for other families as well.
Natalie Danner: I think it’s important as we think about the populations that we serve that one tool does not necessarily fit all and I think your advice about really researching and matching the tool, the translation, and considering the reliability and validity and usability of the tool are really important when we think about that because sometimes, at least in my experience as a preschool teacher, you know, working with families who speak multiple languages and sometimes languages that aren’t maybe top of the list of the most frequently spoken languages, then it becomes a little bit more complicated and difficult to find a tool that may be translated and normed within that language and that population.
I think that it’s really important for us to look at that reliability and validity within the community and think about how the tool is normed as well. Because it’s not just that translation process, right, that’s just the beginning of the process, translating the tool is one thing, but norming it with a new population is something very different and important to do because when we talk about developmental norms, that’s something that is a cultural phenomenon, and when we talk about developmental norms in U.S. screening tools, we’re talking about American developmental norms, which may not be the same norms as families who are coming from other countries.
So that’s just something additionally that we have to consider, too, is that we are sometimes imposing American norms on families who do not espouse the same belief system in those specific norms. And the example that I can I always think of is a child who came into my classroom, and he had a lot of trouble during lunch time. He had his lunch too, and we had it all set up, and he would just kind of watch the other children eat, but he wouldn’t pick up the spoon or the fork or feed himself.
And he was 3 or 4 and he didn’t have any fine motor concerns or anything like that, and he did speak English, so we could communicate with him pretty well. But he just wouldn’t eat, and so I talked to his parents afterwards, and they said “Oh yeah that makes a lot of sense because we feed him we hold the fork for him and we feed him, that’s what we do as a family.” And I was like, oh wow, I never even thought that that’s how this family does it, culturally that’s what’s expected for a child of this age.
Because in our American culture we’re thinking about you know, developing independence and being able to hold a fork and do all of those things, and so, if any of those questions were asked in the developmental screening, does the child hold the spoon and feed himself? We would be saying no for that child, but in his culture that’s not a priority or a goal for development for those children in that community. So, it’s just very interesting for us to also think about how diverse our world is in developmental norms across countries as well, when we’re thinking about these kinds of things.
Marisa Macy: Yes, I’m so glad you brought that up, and what a great example from your classroom to show how important cultural and linguistic sensitivity is with the tools we use, the assessments that we use. When we do look to see if screening is appropriate for us, that’s another thing that our screening measures often will report is sensitivity and specificity.
And we want to look at those numbers and interpret those to see if it’s a good match, and like you pointed out, if it has items on the tool that would not be helpful to learning about the child’s development, we can either omit just one single item or find a different tool. Some screening tools allow you to omit items, which is great. And some tools are better than others with cultural and linguistic sensitivity.
And like you said there’s so many ways to include all children and, for example, like mealtime, you talked about mealtime as an example, maybe there’s an item on a screening tool about using a utensil. That could be a broad way to talk about what happens during mealtime. And a specific way would be does the child use a spoon or fork? Well, not all cultures use spoons and forks, they might use chopsticks.
There’s a lot of families that I know that prefer their child not to use mirrors. Because of their culture, looking into a mirror is not something that they do with young children, it’s not part of their cultural beliefs that that’s an activity that they do. And so families who would be offended by that item, we don’t want to have the families feel in any way bad or rejected or not respected, and if we use items that are possibly just disrespectful to families, we are alienating families at the very beginning and we don’t want to do that.
So, we want to really become familiar with the items, know our families, and sometimes we don’t know until it happens, but being able to respond in a caring, respectful way just to best create a positive bond with the family, and that’s going to be really helpful too. So, sensitivity and specificity are two things to look for when we’re trying to find tools that are culturally and linguistically sensitive for our families and children.
There was an important court case that happened in 1970, it was called Diana vs. the Board of Education, and that was before our law that protects students with disabilities. That was before it was passed in 1975, so five years before our law was passed, there was a court case that happened in California, where people were assessing a young child named Diana with a tool that was not in her native language and they made very inappropriate decisions for this child based on results of an assessment that were, the assessment was used in appropriately and not in her native language, and that court case helped us define one of the features in our law.
One of our organizing principles is the assessment process has to be respectful to the child and use high-quality, valid, and reliable tools. And so we’ve known for a very long time that using good tools with high sensitivity and specificity and reliability and validity is going to be very important to the work that we do.
Natalie Danner: And that leads into our next question, which is how can families be a part of the developmental screening process? We know from the beginning that you said that sometimes if you’re using a particular screening, families can respond directly to the questions on the screening or might do a survey to complete a screening. But perhaps with the other screenings where there’s either a teacher who is completing the developmental screening or a social worker or a doctor or nurse, how can families also be a part of that developmental screening process?
Marisa Macy: I think families can be a part of the screening process in many ways. And I think it’s important to individualize for each family and each child. I don’t think we can have a one size fits all for how we screen all children because children need different things, families need different things, and I think it’s really important to learn all we can about the screening tools that we’re using and also about our community resources, because once we get the results from the screening we’re going to need to know where to go next.
And sometimes it takes a lot of planning with the family, good listening, being able to work together and partner with families and have harmony, and those are what we want to try to nurture when we are participating in the screening process. And I’ll just give an example of a study that I did a long time ago. I had a play-based assessment that I created, and I wanted to find out from families which would they prefer, coming to the clinic with their children or us doing a home visit and taking the show on the road and bringing the play-based assessment to their house.
And I just kind of assumed that most people would want us to come to their house, because I thought well what would I want it, would be so much easier they came to me because, then I wouldn’t have to pack everything up, get the car seat, drive to wherever I need to go, find it, pay for parking. You know that sounded to me like a big hassle and I thought well families might prefer us to come to their house.
It was so interesting to learn from families what they preferred, and it was about 50-50. About half of the families did like the home visits and wanted us to come to their home for the project, and about half said no, no, we’ll come to you, we want to get out of the house, we don’t want you coming into our house. This is our home, and you know we prefer not to have you come into the home. This was before COVID too, by the way. And so, I think different families want and need different things.
Some families might want to have a more active role, some families may not prefer to have an active role. Some families may prefer to have a translator or maybe someone from their support system come with them or family members or friends. But I do know one thing that’s really helpful is to let families know ahead of time what to expect. If they can know this is what’s involved, this is how much time you can expect. I think just having the heads up, like this is how we do it in our community or in our agency. I think a lot of parents and families appreciate knowing what to expect.
And also some strategies while they’re waiting, because I’ve had a lot of families tell me, it’s been so long and I’m you know worried, every day that goes by I’m just dreading that phone call. And I think supporting families who wish to have different levels of support is going to be really helpful. And if we say well, we’ll let you know the results within a month, at least that gives them kind of an idea of how long it’s going to take and they’re not just left in limbo wondering about the assessment.
Natalie Danner: I like how you were talking about the family’s preferences, too, and sometimes I think we forget about that, too, as teachers and as educators. It can be just a great idea to just ask a family, like how would you like to be a part of this? Would you prefer, you know, to meet in person to talk about the results. Would you prefer a written report? Like to really ask them how they want to be involved, because some families might want to be very, very involved and then some families might be okay with a report and reading it on their own time and then asking questions later if necessary.
So, I think it’s really important to think about that not one size fits all and asking families what they want out of the process too and how they would like to be involved versus us perhaps thinking this is how family should be involved. It’s a very different mindset when we think about it in that way and we ask families their preference, rather than thinking about our preference educators, or the professionals in the situation.
Marisa Macy: And two things that I always share with my students when I teach screening in my assessment class is to avoid terms like pass/fail when you talk with families. Because I mean if you think about yourself, I want to pass everything, I don’t want to fail anything. Failure is not a word, nobody, that doesn’t feel good, like I don’t want to hear the word fail. So maybe avoid words like pass/fail and just focus on the skills and the score and what the score means.
But try not to use words like pass/fail because it can be really easy to talk about pass/fail when it comes to screening results because it basically is a yes/no question. It’s not, it’s a screening and it’s a snapshot, but we can try to avoid the pass/fail terms. And then also, to focus on the child’s strengths and what we see, and then the last thing to avoid technical words or jargon.
A lot of times professionals can get into a habit of using a lot of professional jargon. I probably have used a lot of it myself with this conversation, but if we can in our writing and in our conversations with our families, use the kinds of words that the average person uses in how we talk. But if we start talking in professional jargon with words that the families might not know what the words mean, it can start getting really difficult to continue to have a bridge and a partnership because families might feel isolated and cut off from the information if we’re focusing on words that they have to ask for a definition for or have to go look it up on Google when they get in the parking lot.
So when we talk with families, we want to use conversation that is accessible and available and easy to understand and clear and avoid any kind of technical jargon that would possibly frustrate family and a parent who may not know what those words mean.
Natalie Danner: Great tips for educators, I love those. So, is there anything else you’d like to add about developmental screenings for young children as we come to a close with this podcast?
Marisa Macy: Well, I think, the one thing I would like to add, is to make it playful, make it fun. It can be a lot of fun if you bring a bag of toys and a fun positive attitude and a way to play with the child and engage the family.
Professionals a lot of times have a lot on their plates, and sometimes we forget to have fun. But it can be a whole lot of fun to get down on the floor and just play with children and have a good time while we’re with them and learn as much as we can, and not forget to giggle and laugh and enjoy the family and the child and maybe siblings.
So that’s I think the last thing I would want to share with people is don’t forget to have fun and play because this can be a whole lot of fun for the child and the family. But if we’re really serious and lacking that joy, it’s going to be really hard to sell it to the parents that this can be a great way to get information. So that’s what I would hope, that it will be playful, fun, the child would enjoy being there, the family would enjoy it also, and it would be a way for them to learn more about their child.
Natalie Danner: Agreed, finding the joy and the fun in screening is essential. Agreed, so just wanted to thank you, Dr. Macy for being our guest on the Illinois Early Learning Podcast.
Marisa Macy: Thank you, Dr. Danner.
Natalie Danner: And until next time, thanks and keep early learning at the forefront.
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