Association Between Family Income and Positive Developmental Screening Using the Infant Toddler Checklist at the 18-Month Health Supervision Visit

Abstract

Objective: Little is known about whether developmental screening tools identify young children at risk for the “double jeopardy” of developmental delay and social disadvantage. Our objective was to examine the associations between several predictors (child biologic, social, and family factors) and a positive screen for developmental delay using the Infant Toddler Checklist (ITC) at the 18-month health supervision visit in primary care. Methods: This was a cross-sectional study of healthy children attending an 18-month health supervision visit in primary care. Parents completed a standardized questionnaire (addressing child, social and family characteristics) and the ITC. Logistic regression analyses were used to assess the associations between predictors and a positive ITC. Results: The number of participants was 2188 (45.5% female, mean age 18.2 months), of which, 285 (13%) had a positive ITC and 1903 (87%) had a negative ITC. The adjusted odds ratio (aOR) for a positive ITC for male compared to female sex was 2.15 (95% CI 1.63, 2.83, p<0.001). The aOR for birthweight was 0.65 per 1 kg increase (95% CI 0.53, 0.80, p<0.001). The aOR for family income of <$40,000 compared to >$150,000 was 3.50 (95% CI 2.22, 5.53, p<0.001); and the aOR for family income between $40,000 to $79,999 compared to >$150,000 was 1.88 (95% CI 1.26, 2.80, p=0.002). Conclusion: Screening positive on the ITC may identify children at risk for the “double jeopardy” of developmental delay and social disadvantage; and allow clinicians to intervene through monitoring, referral, and resource navigation for both child development and social needs.