To the Editor.—

I congratulate Sand et al for their report in the July 2005 issue of Pediatrics. The article documents how difficult it is for pediatricians to implement the evidence-based guidelines for developmental screening and surveillance. Why is it so difficult?

Methods and guidelines for developmental screening have changed dramatically in the last 15 years. During this time, the Individuals With Disabilities Education Act (IDEA) increased early education and family support services for children with developmental needs from birth to 3 years of age. Physicians are not yet focusing on early identification of children who will benefit from these services. Approximately half of the physicians in the Sand et al study completed training before IDEA and are using the old tool of clinical assessment (71%). Although some use the Denver II (14%), which was standardized in 1989, they may not be aware of the newer parent-completed...

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