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Scand J Public Health. 2018 Dec;46(8):805-816. doi: 10.1177/1403494818772211. Epub 2018 May 4.

International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function.

Author information

1 Centre for Rural Health, University of Aberdeen, Scotland.
2 Centre for Research and Education in General Practice, University of Copenhagen, Copenhagen, Denmark.
3 Women and Children's Health, NHS National Services Scotland, Information Services Division, Edinburgh, Scotland.
4 Research Unit for General Practice, University of Southern Denmark, Odense, Denmark.
5 Department of general practice, University of Oslo, Norway.
6 Department of global public health and primary care, University of Bergen, Norway.
7 THL (National Institute for Health and Welfare), Helsinki, Finland.
8 Department of General Practice, Faculty of Medicine and Life Sciences, University of Tampere, Finland.
9 Local Health Center of Ylöjärvi, Finland.



Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language.


Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness.


Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.


Paediatrics; child development; community nurse; general practice; health surveillance; organisation of care; parents; primary (health) care; screening; well-child checks

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