Preschool Screening: A Review of the Evidence

Abstract

Preschool screening has received considerable attention in the 1970s and 1980s resulting in countless articles, dozens of screening instruments, and a myriad of books. Theoretically, the concept of preschool screening could involve assessments at any time between birth and the beginning of formal education and could cover a variety of physical, cognitive, and behavioral or developmental components. Most studies have focused on children age 3 to 5 years and on specific developmental factors (excluding vision and hearing) that may affect subsequent school performance and behavior. Although most studies have followed school performance for the first two years of formal education, some have included the first five years of school. By virtue of the multicomponent nature of the problem and the fact that children develop at different rates, measurement and prediction are difficult.

The eminent logic of detecting developmental problems as early as possible in childhood incorporates the assumption that early recognition more or less automatically leads to treatment and thereby to net benefit for the children detected. In the fervor for early identification of problems, it is easy to overlook or minimize the potential negative consequences of the screening process. These include family anxiety induced by false positives and by true positives; other potential effects of labeling on attitudes of parents, teachers and peers; the cost of the screening process; and most important of all, the possibility that early intervention may not alter outcome significantly. After weighing the scientific evidence carefully, Dr Feightner finds some evidence that vision screening leads to benefits, at least in terms of improved vision, though the impact on scholastic performance is unknown. For reasons that he elaborates, hearing screening and preschool developmental screening are on much shakier ground.