Moreover, it should be short and easy to administer and to score, possible for parents with varying education levels to complete, as well as low-cost to pediatricians and amenable to flexible administration, including via computers or paper-and-pencil formats. Ideally, a screening tool should accurately address a range of domains of interest, such as developmental milestones, internalizing and externalizing behaviors, autism symptoms and family risk factors. To be useful to pediatricians, screening tools must be valid indicators of increased risk of developmental and behavioral disabilities, but they must also be feasible in a primary care context (Sheldrick & Perrin, 2009). As a result, use of evidence-based screening instruments (typically in the form of brief questionnaires for parents) are widely recommended in order to improve detection by pediatricians (Council on Children with Disabilities, 2006), and surveys of physicians suggest that use has increased markedly in the past decade (Radecki, Sand-Loud, O'Connor, Sharp & Olson, 2011). Despite evidence for the importance of early intervention, less than one third of children with such disabilities are diagnosed before they enter school (Sand et al., 2005). Estimates suggest that 15-20 percent of children in the United States are affected by developmental and behavioral disabilities (Boyle et al., 2011 Merikangas et al., 2010).
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