Updated October 2025

Pediatrics | Development

Developmental Delay: Evaluation and Early Intervention

Early, structured screening combined with timely, family-centered intervention improves cognitive and functional outcomes for children at risk of developmental delay. Use validated parent-completed tools, confirm concerns with targeted assessment, and refer immediately to Early Intervention while concurrently addressing etiologic factors and social needs.

Clinical question

What is the evidence-based approach to evaluating developmental delay in infants and young children, and which early interventions improve outcomes?

PediatricsDevelopmental DelayScreeningEarly InterventionPrimary CareNeurodevelopment

Key points

Screen early and often

Use validated, brief tools at recommended intervals; parent-completed screeners like the ASQ efficiently identify risk and prompt further evaluation ^[4], ^[5], ^[2], ^[6].

Confirm and characterize delay

When a screen is positive, perform targeted developmental and play-based assessment, check hearing/vision, and evaluate for medical or environmental contributors ^[6], ^[7].

Refer immediately to EI

Do not wait for definitive diagnosis; early intervention is associated with improvements in cognitive, academic, and functional outcomes, though effect sizes vary by risk and program fidelity ^[1], ^[8], ^[9], ^[3], ^[6], ^[10].

Use evidence-based parent coaching

Home-based, caregiver-mediated programs and structured goal-directed therapy (e.g., GAME) can improve developmental domains and parent–child interactions ^[3], ^[10].

Sustain and monitor

Benefits can attenuate without ongoing support; integrate longitudinal monitoring and school transitions to maintain gains ^[1], ^[9].

Evidence highlights

17.8% with developmental disorders ^[1]

US prevalence (age 3–17)

Parent-completed, low-cost tool with acceptable accuracy in primary care ^[2]

ASQ diagnostic accuracy

Improves cognitive scores in 0–36 months in pooled trials ^[3]

Home-visiting ECD effect

Bedside to systems

Practical Workflow for Evaluation and Early Action

A concise pathway from first concern to intervention that minimizes time-to-services and maximizes family engagement.

Elicit concerns and risk

Document parent/caregiver concerns, perinatal history, prematurity, NICU stay, genetic syndromes, chronic illness, lead exposure, and psychosocial risks (poverty, caregiver depression). Use developmental surveillance at every visit ^[4], ^[5], ^[6].

Screen with validated tools

Administer a standardized, age-appropriate screener. Parent-completed tools like the Ages & Stages Questionnaire (ASQ) are brief, low-cost, and feasible in primary care; positive screens indicate risk and require follow-up assessment ^[5], ^[2], ^[6].

Confirm delay and define domains

Perform targeted developmental and play-based assessment to characterize gross motor, fine motor, language, cognitive, and social domains; ensure hearing and vision evaluation; consider labs or imaging when indicated by history and exam ^[6], ^[7].

Refer now—don’t wait

Initiate Early Intervention referral at first confirmed concern; discuss expectations, service types (PT/OT/SLP, special instruction), and frequency. Provide caregiver handouts and track referral completion ^[1], ^[8], ^[6], ^[11].

Address modifiable drivers

Optimize sleep, nutrition, iron status, and caregiver mental health; assess and mitigate environmental risks (lead, low stimulation). Connect families to home visiting and evidence-based caregiver coaching programs ^[3], ^[6], ^[11].

Set goals and monitor

Use SMART, function-focused goals and re-screen at defined intervals. Coordinate with EI educators and therapists; reassess progress every 3–6 months and plan transitions to preschool services to sustain gains ^[1], ^[9], ^[6].

Core tools and triggers

Screening, Red Flags, and When to Escalate

Efficient selection of tools and clear criteria for urgent action.

Validated screening tools

Ages & Stages Questionnaire (ASQ): parent-completed, feasible, acceptable accuracy for primary care risk identification ^[2], ^[6].

Global overview: numerous validated tools exist; selection should fit age, setting, and purpose; pooled analyses characterize performance across tools ^[12], ^[4].

CDC developmental monitoring resources support caregiver engagement and early recognition ^[5], ^[11].

Red flags for urgent evaluation

Loss of previously acquired skills (regression).

No babbling/gestures by 12 months; no single words by 16 months; no two-word phrases by 24 months.

Persistent hypotonia or asymmetric motor findings; hand preference before 18 months.

Feeding/swallowing dysfunction, failure to thrive, seizures.

Any concern for abuse/neglect or profound social communication deficits ^[6], ^[7].

Targeted diagnostics

Audiology and vision assessment for any language or global delay ^[6], ^[7].

Lead level, iron studies when exposure risk or anemia is suspected.

Genetic testing when syndromic features, family history, or global delays present; metabolic testing when suggested by history/exam.

Neuroimaging reserved for focal neurologic signs, seizures, or abnormal head growth ^[6], ^[7].

Early intervention that works

Home-visiting, health-care platform early childhood development (HCP-ECD) interventions improve cognitive scores in 0–36 months in pooled RCTs; effects are modest-to-moderate and context-dependent ^[3].

Structured parent coaching and goal-directed therapy (e.g., GAME) improve developmental domains and parent–child interaction in RCTs ^[10].

Overall, EI improves developmental, academic, and social outcomes, though not all children attain age-appropriate skills; sustained supports are often required ^[1], ^[8], ^[9], ^[6].

Timing and follow-up

Immediate referral to EI at first confirmed risk—no need to wait for a definitive diagnosis ^[6], ^[11].

Re-screen every 3–6 months if concerns persist; increase intensity if progress plateaus.

Plan transitions to Head Start/school-based services; monitor for fade-out and reinforce home supports ^[1], ^[9].

References

Source material

Primary literature that informs this article.