"Tots Guide - Track and Act", an Online Early Developmental Screening Tool for Parents

Background:  Early identification of developmental disorders is critical for the well-being of children and their families. It is the responsibility of primary care professionals to improve developmental outcomes through early surveillance and appropriate referral of children with developmental delays. However, factors such as limited consultation time in busy office practice, inappropriate methods of screening, high threshold for referral and negligence of parent’s concern diminish the effectiveness of early surveillance. Therefore, it is important to develop a tool that is systematic, easy, and convenient for primary care practitioners to improve the effectiveness of developmental surveillance and referral patterns.

Objectives:  To develop and test the accuracy of a web-based developmental screening tool “Tots guide – Track and Act” for long-term monitoring of milestones in young children.

Methods:  In a pilot study, 80 children (4–30 months of age) visiting our centre and fulfilling the inclusion criteria were enrolled. The inclusion criteria were children between the ages of 4 months to 30 months presenting with concerns in their development, and born at term gestation with no antenatal or post-natal complications. The exclusion criteria were children born at pre-term gestation, and those with physical deformities/syndromes. Parents were informed about the online screening tool “Track and Act” in www.totsguide.com at the initial meeting. The scores were automatically sent to the center’s mail account when parents completed the online screening. The online screening tool assessed 4 domains of development – language and communication, movement and physical, cognitive, and socio-emotional, through a series of “Yes/No” questions corresponding to the age of the child [Score: 61–100 (normal development), 41–60 (developmental concern/borderline delay), <40 (developmental delay)]. The children also underwent a formal developmental assessment using the Developmental Assessment Scales for Indian Infants (DASII) that consisted of 230 items to test the motor and mental development in children less than 30 months [Score: >85 (normal development), 70–85 (developmental concern/borderline delay), <70 (developmental delay)]. The results obtained from this screening were compared with those of DASII in these 80 children.

Results:  According to our analysis, the online screening tool scoring showed similar results to DASII scoring in 74% of children (59/80) in the mental domains, and in 85% children (68/80) in the motor domain, which indicates significant comparability.

Conclusions:  Based on our pilot results, we can conclude that the online screening tool may be a reliable initial screening tool that parents can use for preliminary assessment of developmental milestones in their children. In cases of lower and borderline scores, parents can consult their pediatrician for further required and recommended assessments and interventions. This is an ongoing study and we are continuously recruiting more eligible subjects to this study to increase the sample size to conduct domain-specific statistical analyses. The online screening tool is also available in three regional Indian languages to facilitate usage by non-English speakers, and is being developed as an App. We hope that this tool will help in increasing the early detection and diagnosis of developmental disorders such as autism spectrum disorder, leading to timely intervention.