Trial of a developmental screening tool in remote Australian Aboriginal communities: A cautionary tale

Aim: To trial the Brigance developmental screening tool as an instrument for identifying Australian Aboriginal children at risk of developmental disability and requiring diagnostic developmental assessment. Methods: We conducted a cross-sectional study of Australian Aboriginal children, aged 3-7 years, resident in three remote communities in the Northern Territory. Following informed consent, children were screened by a paediatrician using the Brigance screen. Results: There were 195 children identified as eligible, and 124 (64%) participated. All children screened, scored below the cut-off for detecting children likely to have developmental disabilities or academic delays. Furthermore, all children scored below the at-risk cut-offs that indicate high probability of disabilities in at-risk children. Conclusions: The Brigance screen identified all children in these high-risk Aboriginal communities as well behind their age peers. Language and cultural relevance, and the method of administration limit the use of this screening tool. However, we cannot ignore the uniformly poor performance on a mainstream tool used with children expected to succeed in a mainstream educational setting. Recommendations include adapting an appropriate instrument to guide developmental surveillance and monitoring in remote Australian Aboriginal communities. This study further supports the pressing need for quality early childhood services that address the significant risk confronting Aboriginal children and prepare them in a way that ensures school and future success.