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DEVELOPMENTAL ASSESSMENTDr. Prachi S. Karnik
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Principles of Development
Cephalo → Caudal
Proximal → Distal
Simple → Complex
General → Specific
Involuntary → Voluntary
Continuous
Sequence same, Rate varies
Maturation AND Environment
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To begin with…
A detailed history:Prenatal, Perinatal, Postnatal
Milestones including self-help and play skills
ConvulsionsConvulsions
Sleep, appetite
School history (academics and social skills)
Behavioral history
Medical history
Family history
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Examination…
General physical examination
head circumference, malnutrition,
pallor, rickets, dysmorphic facies
Systemic examination
central nervous systemcentral nervous system
Bones and joints
deformities and contractures
Neuromuscular examination
in infants
Hearing and vision
Milestone assessment
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Neuromuscular examination
Tone
Deep tendon reflexes
Primitive reflexes
Postural reflexes
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Assessment of tone
Passive tone (Amiel Tison’s angles)Scarf sign
Heel to ear
Popliteal anglePopliteal angle
Adductor angle
Angle of dorsiflexion
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)
Supine positionPull to sit
Sitting
Standing
Axillary suspension
Ventral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sitSitting
Standing
Axillary suspension
Ventral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSittingStanding
Axillary suspension
Ventral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSitting
StandingAxillary suspension
Ventral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSitting
Standing
Axillary suspensionVentral suspension
Prone position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspensionProne position
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Assessment of tone
Active tone (180⁰ flip)Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position
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Hearing assessment
Tools
Rattle or Bell
Prerequisites
Child sitting erect in mother’s lap
Stimulus delivered out of child’s visual field
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Hearing assessment
Newborn
Startle OR Crying OR Quieting OR Blinking
3 months
Turns head in the direction of sound
4 months
Turns head and eyes in the direction of soundTurns head and eyes in the direction of sound
5 months
Indirect orientation downwards
6 months
Indirect orientation upwards
7 months
Orientation in an arc
8-10 months
Direct orientation
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Assessment of vision
Tools
Red ring or Examiner’s face
Prerequisite
Child in supine position
Stimulus 8-10 inches away
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Assessment of vision
Newborn
Follows red ring through 45⁰
4 weeks
Follows red ring through 90⁰
3 months 3 months
Follows red ring through 180⁰
4 months
Follows red ring through 360⁰
3-5months
Hand regard
5 months
Excitement on seeing food being prepared
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9 to 12 months….
Pointing
Joint attention
Social referencing
Showing and Giving on request
Waves bye-bye
Peek-a-boo
Understands simple commands
Understands ‘no’
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How to test cognitive - adaptive milestones
Object permanence
Causality
Imitation
Color and Shape recognitionColor and Shape recognition
Language, mainly receptive
Fine motor Cube
Pellet
Pegboard
Formboard
Paper
Crayon and paper
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Who should be screened…
Ideally, all children periodically
At least: 1. All high risk newborns
2. Parental concerns
3. Delayed milestones
4. Poor scholastic performance
5. Behavioral problems
6. Medical disorders associated withdevelopmental delay
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Screening tools
General screening tests
Specific screening tests
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General Screening Tools
Caregiver based questionnairesAges and Stages Questionnaire (ASQ)
Vineland Social Maturity Scale (VSMS)
Child performance based testsTrivandrum Developmental Screening Chart (TDSC)
Baroda Developmental Screening Test (BDST)
Denver Developmental Screening Test (DDST)
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Trivandrum Developmental Screening Chart
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Specific Screening Tools
Neuromotor INFANIB
AutismChildhood Autism Rating Scale (CARS)Modified Checklist for Autism in Toddlers (M-CHAT)Modified Checklist for Autism in Toddlers (M-CHAT)
Preschool skillsBrigance’s Preschool Skills’ Test
Behavioral problemsChild Behavior Checklist (CBCL)Early Childhood Inventory: 3-6 yearsChild and Adolescent Symptom Inventory (CASI): >6 years
ADHDConner’s Rating Scale (CRS)
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Developmental screening
Normal Development Delay/DeviationNormal Development Delay/Deviation
Surveillance Diagnostic assessment
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Developmental Surveillance
Longitudinal developmental follow-up in:
• A child with risk factors
• Who has been screened
• And has normal development for age onscreening
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Developmental screening
Normal Development Delay/DeviationNormal Development Delay/Deviation
Surveillance Diagnostic assessment
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Diagnostic Tests
Early developmental delayDevelopmental Assessment Scale for Indian Infants
(DASII)
Bayley’s Scale of Infant Development (BSID)Bayley’s Scale of Infant Development (BSID)
Early Intervention Developmental Profile (EIDP)
Language delayClinical Language Auditory Milestone Scale (CLAMS)
Receptive Expressive Emergent Language Scale(REELS)
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Diagnostic Tests
AutismAutism Diagnostic Interview-Revised (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
Sensory problems Sensory problemsSensory Profile
ADHDVanderbilt’s ADHD Scale (Parent based and Teacher
based)
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Diagnostic Tests
IntelligenceBinet Kamat Test (BKT): 3-6 years
Malin’s Intelligence Scale for Indian Children (MISIC):≥ 6 years≥ 6 years
Learning DisabilitiesNimhans’ SLD Battery
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Thank you..