developmental assessment and screening
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DEVELOPMENTAL ASSESSMENT
AND SCREENINGPRESENTED BYDr.Nasreen Ali
GUIDED BYDr.T.V.Ramkumar
CONTENT INTRODUCTION PRINCIPLES OF DEVELOPMENT GOALS OF DEVELOPMENTAL ASSESSMENT DIFFERENT DOMAINS OF DEVELOPMENT ASSESSMENT OF DEVELOPMENT SCREENING TESTS DEFINITIVE TESTS DEVELOPMENT QUOTIENT CONCLUSION NORMAL DEVELOPMENTAL MILESTONES
NOT DISCUSED HERE.
INTRODUCTION DEVELOPMENT SPECIFIES MATURATION
OF FUNCTIONS.IT IS RELATED TO MATURATION AND MYELINATION OF NERVOUS SYSTEM AND INDICATES ACQUISITION OF A VARIETY OF SKILLS FOR OPTIMUM FUNCTIONING OF THE INDIVIDUAL.
DEVELOPMENTAL ASSESSMENT INCLUDES EARLY IDENTIFICATION OF PROBLEMS THROUGH SCREENING AND SURVILLANCE.
PRINCIPLES
IT IS A CONTINUOUS PROCESS FROM CONCEPTION TO MATURITY
DEVELOPMENT IS INTIMATELY RELATED TO THE MATURATION OF CENTRAL NERVOUS SYSTEM
THE SEQUENCE OF DEVELOPMENT IS IDENTICAL IN ALL CHILDREN BUT THE RATE OF DEVELOPMENT VARIES FROM CHILD TO CHILD
PROCESS OF DEVELOPMENT PROGRESSES IN A CEPHALO CAUDAL DIRECTION
PRIMITIVE REFLEXES HAVE TO BE LOST INITIAL DISORGANIZED MASS ACTIVITY IS
REPLACED BY SPECIFIC AND USEFUL ACTIONS
GOAL THE GOAL OF DEVELOPMENTAL
ASSESSMENT IS NOT ONLY TO GENERATE A DIAGNOSIS BUT ALSO TO ANALYSE THE PATTERN OF STRENGTHS AND WEAKNESS IN ORDER TO DIRECT TREATMENT.
INDICATIONS OF DEVELOPMENTAL ASSESSMENT FOLLOW UP OF HIGH RISK NEONATES
FOR EARLY DETECTION OF CEREBRAL PALSY ADD\OR MENTAL RETARDATION
COMPLETE EVALUATION OF CHILDREN WITH DEVELOPMENTAL,CHROMOSOMAL OR NEUROLOGICAL DISORDERS
TO DIFFERNTIATE CHILDREN WITH RETARDATION IN SPECIFIC FIELDS OF DEVELOPMENT AS OPPOSED TO THOSE WITH GLOBAL RETARDATION
FACTORS AFFECTING DEVELOMENT
•PARENTING•POVERTY•LACK OF STIMULAION
•VIOLENCE AND ABUSE
•MATERNAL DEPRESSION
•INSTITUTIONALIS
•INFANT AND CHILD NUTRITION
•IRON DEFICIENCY•IODINE DEFICIENCY•INECTIOUS DISEASE
• IUGR• PREMATURITY• PERINATAL
ASPHYXIA
• MATERNAL FACTORS
GENETIC FACORS
NEONATAL
PSYCHO-SOCIALPOST
NEONATALPROTECTIVEBREAS
T FEEDINGMATERNAL EDU
DOMAINS OF DEVELOPMENT GROSS MOTOR FINE MOTOR PERSONAL AND SOCIAL LANGUAGE VISION HEARING
DEVELOPMENTAL ASSESSMENT
PROCEDURE DEVELOPMENTAL MILESTONES SERVE
AS AN IMPORTANT BASIS OF MOST STANDARDIZED ASSESSMENT AND SCREENING TOOLS
TWO SEPARATE DEVEVELOPMENTAL ASSESSMENT OVER TIME ARE MORE PRODUCTIVE THAN A SINGLE ONE
DEVELOPMENTAL HISTORY WHETHER PARENTS ARE CONCERNED
OR NOT RIGHT QUESTIONS AGE SPECIFIC QUESTIONS CHECK DOUBTFUL REPLY CHECK THE ANSWERS ABOUT ONE
MILESTONES BY ANOTHER AND BY EXAMINATION
FAMILY HISTORY-FIRST, SECOND AND
THIRD DEGREE RELATIVE SOCIAL HISTORY-CAPACITY TO COPE
WITH A CHILD WITH DISABILITY
PREREQUISITES Should be done in a place free from
distractions Child should not be – hungry, tired, ill or
irritated Playful mood with mother around Adequate time to make child & family
comfortable Carry a development kit
ASSESSMENT OF NORMAL DEVELOPMENT PRE SCHOOL AGE- PLAY,CLIMBING STAIRS,SPEECH,FEEDING PERFORMANCE- understanding,
matching colour COMPREHENSION OF LANGUAGE
SCHOOL AGE Test for reading ,arithmatic function Test for deafness and physical
examination Vision by 3-5 years of age Intelligence assessment
EQUIPMENT REQUIRED
Ten one inch cubes Hand bell Simple formboard Goddard formboard Coloured and uncoloured geometric
forms Picture cards Cards with circle,cross,sqare,triangle
and diamond drawn on them Patellar hammer Paper Pellets(8mm)
PHYSICAL EXAMINATION GENERAL EXAMINATION- weight, height
and head circumference, malnutrition ,pallor, rickets and dysmorphic facies
SYSTEMIC EXAMINATION-cns BONES AND JOINTS-deformities and
contracture NEURO MUSCULAR EXAMINATION IN
INFANTS- tone, deep tendon reflex , primitive reflex and postural reflex.
NEUROLOGICAL EXAMINATION AMIEL TISONS ANGLES-- Adductor angle Heel to ear Popliteal angle Dorsiflexion angle of foot Scarf sign
NEUROLOGICAL ASSESSMENTANGLES 1-3
MONTHS4-6MONTHS
7-9MONTHS
10-12MONTHS
ADDUCTOR
40-80 70-110 100-150 130-150
HEEL TO EAR
80-100 90-130 120-150 140-170
POPLITEAL
80-100 90-130 120-150 140-170
DORSI FLEXION
45 45 45 45
SCARF SIGN
ELBOW NOT CROSS MIDLINE
ELBOW CROSS MIDLINE
ELBOW REACHES AXILLA
ELBOW BEYOND AXILLA
ASSESSMENT OF GROSS MOTOR DEVELOPMENT The acquisition of gross motor skills
precedes the development of fine motor skills
Both process occur in cephalocaudal fashion
-head control precedes arm and hand control
-followed by leg and foot control
PLAY AND SOCIAL INTERACTION Observe exploration and free play and
initiation of response to social games like peek a boo
Note initiating interaction and responding to parent/examiner/other children and use of eye contact and gestures
LANGUAGE AND COMMUNICATION Observe vocalization and gestures to
attract others attention, to indicate needs . in response to others vocalization and to share emotion
Note speech quality ,use of language to express and responding to conversation
HEARING DEVELOPMENT BERA hearing test done at birth Ability to hear correlates with ability to
pronounce words properly Ask about the h/o otitis media Repeat hearing screening test Speech therapist if needed
ASSESSMENT OF VISION New born-Follows red ring through 45* 4 weeks-Follows red ring through 90* 3 months--Follows red ring through 180* 4months- Follows red ring through 360* 3-5months-hand regard 5 months-excitement to see food being
prepared
TEST COGNITIVE AND ADAPTIVE MILESTONES Object permanence Causality Imitation Colour and shape recognization Language mainly receptive Fine motor
SCREENING IT IS A BRIEF,FORMAL,STANDARDIZED
EVALUATION AID IN THE EARLY IDENTIFICTION OF THE PATIENT WITH DEVELOPMENTAL\BEHAVIOURAL DELAY
TYPES- Informal screening Routine formal screening Focused screening-more important in
high risk infants.
SPECIFIC SCREENING TOOLS Neuromotor-INFANIB Autism-childhood autism rating scale(CARS) Modified checklist for autism in toddler(M-
CHAT) Preschool skills-Brigance pre school skills
test Behavioral problems-child behavior check
list(CBCL) Early childhood interventory-3-6 yrs Child and adolescent symptom
inventory>6YRS ADHD-conners rating scale(CRS)
COMPARISON OF DEVELOPMENTAL
SCREENING TOOLS OF INTERNATIONAL ORIGIN
Factors Denver DevelopmentalScreening Test II
Bayley Infant Neuro-developmental Screen (BINS)
Parents Evaluationof Developmental Status (PEDS)
Ages and stages questionnaire (ASQ)
Developmental* Profile II/ III
AGE FORMAT
0-6 yearsDirectly administered
3-24 monthDirectly administered
0-8 yearsParent-report
1 -66 /3- 66 mParent report
0-9 y/ 12 y11m Parent report
SCREENS\DOMAINS
Expressive & receptivelanguage, gross motor, fine motor, personalsocial
Neurological processes, expressive and receptive functions& cognitive
Cognitive, expressive& receptive language fine & gross motor, social-emotional, behavior, self-help& school
Communication, gross motor, fine motor,problem-solving, andpersonal adaptive skills
Physical, Self-help/ Adaptive, Social/Social-emotional,Academic/ cognitiveand Communication
ITEMS 125 11-13 10 22-36 186\180SCORING\RESULT
Normal\abnormal\questionable
High/low/moderate
Low/medium/high
Pass/fail Total score gives domain wise age equivalents
TIME(min) 10-20 10 2-10 10-15 10/20-40LANGUAGE English/
spanishEnglish english English/
hindienglish
PSYCHOMETRIC PROPERTIES
sensitivity- 0.56-0.83 0.75-0.86 Specificity- 0.43-0.80 0.75-0.86
0.74-0.79
0.70-0.80
0.70-0.90
0.76-0.91
Validity coefficients
0.52-0.72
VALIDATED IN INDIA NOT
NOT SN 62%SP 65%
83.3%74.5%
NOTUsed extensively
COST$ 111 325
30 249 240
COMPARISON OF INDIAN DEVELOPMENTAL
SCREENING TOOLS
FACTORS BARODA DEVELOPMENTAL SCREENING TEST(BDST)
TRIVANDRUM DEVELOPMENTAL SCREENING CHART(TDSC)
ICMR PSYCHOSOCIAL DEVELOPMENTAL SCREENING TEST
DEVELOPED FROM
BAYLEY SCALE OF INFANT DEVELOPMENT,NORMATIVE DATA FROM INDIAN CHILDREN
BAYLEY SCALE OF INFANT DEVELOPMENT(BARODA NORMS)
PROGRAMME FOR ESTIMATING AGE RELATED CENTILES USING PIECE WISE POLYNOMIALS
AGE 0-30 MONTHS 0-24 MONTHS 0-6 YEARS
FORMAT 54 ITEMS 17 ITEMS PARENTS INTERVIEW64 ITEMS
DOMAINS MOTOR AND COGNITIVE
MENTAL AND MOTOR
GROSS MOTOR.VISION,HEARING,FINE MOTOR AND SOCIAL SKILLS
SCORING/RESULTS
AGE EQUIVALENT AND DEVELOPMENT QUOTIENT CALCULATED
WITHIN AGE RANGE
3RD,5TH,25TH,50TH,75TH,95THAND 97TH CENTILE.SIGNIFICANT DELAY IN <3RD CENTILE(2SD)
TRAINING MINIMAL MINIMAL NONE
SETTING COMMUNITY/OFFICE
COMMUNITY/OFFICE
COMMUNITY/OFFICE
TIME TAKEN(MIN)
10 10 MINIMAL
PSYCHOMETRICPROPERTIES
SN-65-93%SP-77.4-94.4%
66.8%78.8%
NOT GIVEN
COST INEXPENSIVE INEXPENSIVE FREE
BIRTH TO ONE YEAR DEVELOPMENTAL OBSERVATION
CARD Completed 2 months-social smile Completed 4 months-holds head study Completed 8 months-sits alone Completed 12 months-stands alone
BIRTH TO TWO YEARS TRIVANDRUM DEVELOPMENTAL
SCREENING CHART Can be used in large scale community
by anganwadi workers
TRIVANDRUM DEVELOPMENT SCREENING CHART
3%
97%
TWO TO FOUR YEARS DEVELOPMENTAL ASSESSEMENT
TOOLS FOR ANGANWADI(DATA) BRIEF,SIMPLE AND PSYCHOMETRICALLY
STRONG FOR ANGANWADI TO DIFFERENTIATE THOSE WHO
ALREADY HAVE DELAYS AT 2.5 YEARSFROM THOSE WHO ARE AT RISK OF DEVELOPMENTAL DELAY
REGULAR DEVELOPMENTAL ASSESSMENT AT 3.5YRS,4.5YRS
FOUR TO SIX YEARS NURSERY EVALUATION SCALE
TRIVANDRUM(NEST)-ABRIDGED This tool has been developed and
validated at Child Development Centre, Thiruvananthapuram, Kerala. It is a functional assessment of pre-school children between 4 – 6 years. It is a guideline to pre-school teachers as to the individual child’s holistic development. It serves as a screening tool to identify pre-school children who needs one-to-one instructions.
DENVER DEVELOPMENTAL SREENING TEST 2
Assessment of infant and pre school children
125 items 4 categories-gross motor\fine motor or
adaptive\language\personal or social Items are arranged in chronological order
according to the ages at which most children pass them
Performance rated as PASS\CAUTION\DELAY
DEVELOPMENTAL ASSESSMENT SCALE FOR INDIAN INFANTS
Gold standard for developmental evaluation
Two scales-mental and motor scale Mental development index –MDI Psychomotor development index -PDI
DEFINITIVE TESTS If screening tests or clinical assessment are
abnormal Some common scales
Bayley scale for infant development IIWechsler intelligence scale for children IVStanford-Binet intelligence scales , 5th editn.Developmental Activities Screening Inventory
STANFORD-BINNET INTELLIGENCE SCALE Intelligence testing for ages 2-23 years
and beyond Yields intelligence quotient(IQ) Scoring-standardized scoring Composite mean 100 with SD 16
INTERPRETATION- Boderline MR-70-79 Mild MR-65-69 moderateMR-40-64 Severe MR-30-39 Profound<30
WECHSLER INTELLIGENCE SCALE DESCRIPTION Intelligence testing Mean score-100 with SD 15 Gives verbal and performance score Broken into subsets each with a mean of 10 AGE SPECIFIC WECHLER TEST Wechsler preschool primary scale
intelligence(WPPSI-R)-3-7 YEARS Wechsler intelligence scale for children(WISC
3)-6-16 YEARS Wechsler adult intelligence scale(WAIS-R)->16
YEARS
DEVELOPMENTAL ACTIVITIES SCREENING INVENTORY SECOND EDITION-DASI 2 Age range in years-birth to 5 years Method of administration/format- Individually administered informal
screening measure,may be presented as non-verbal test
67 tests Yield development quotient Time-25-30 min Sub scales-developmental quotient
DEVELOPMENTAL QUOTIENT DQ=developmental age\chronological
age*100 For The infants who were born
prematurely should the chronological age should be corrected during the gestational age till 2yrs of life
Interpretation- >=85-normal 71-84-mild to moderate <=70-severe delay
CONCLUSIONTHERE SHOULD BE A CHILD DEVELOPMENT AND EARLY
INTERVENTIONAL CLINIC-CDEIC
RED FLAG SIGNS:BIRTH TO 3 MONTHS Rolling prior to 3 months-EVALUATE FOR
HYPERTONIA Persistent fisting for 3 months-
NEUROMOTOR DYSFUNCTION Failure to alert to environmental stimuli-
SENSORY IMPAIREMENT
RED FLAGS FROM 4 TO 6 MONTHS Poor head control-HYPOTONIA Failure to reach for objects for 5 months-
MOTOR,VISUAL OR COGNITIVE DEFECTS Absent smile-VISUAL LOSS,ATTACHMENT
PROBLEMS,MAJOR MATERNAL DEPRESSION,CHILD ABUSE OR NEGLECT
RED FLAG 6 TO 12 MONTHSPersistence of primitive reflex after 6
months-NEUROMUSCULAR DISORDERAbsent babbling for 6 months-HEARING
DEFECTAbsent stranger anxiety by 7 months-
MULTIPLE CARE PROVIDERSInability to localize sound by 10 months-
UNILATERAL HEARING LOSSPersistent mouthing of object by 12
months-LACK OF INTELLECTUAL CURIOSITY
RED FLAG 12 TO 24 MONTHS Lack of consonant production by 15
months-MILD HEARING LOSS Lack of imitation by 16 months-HEARING
OR COGNITIVE OR SOCIALIZATION DEFECT
Hand dominance prior to 18 months-C/L WEAKNESS WITH HEMIPARESIS
Inability to walk up and downstairs by 24 month-LACK OF OPPPORTUNITY MORE THAN MOTOR DEFICIT
THANK YOU
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