developmental assessment and screening in children.

1. PRESENTED BY
Dr.Nasreen Ali
GUIDED BY
Dr.T.V.Ramkumar

2.  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.

3.  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.

4.  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

5.  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.

6.  FOLLOW UP OF HIGH RISK NEONATES FOR
EARLY DETECTION OF CEREBRAL PALSY
ADDOR 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

7. •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-
SOCIAL
POST
NEONATAL
PROTECTIVE
BREAST
FEEDING
MATER
NAL EDU

8.  GROSS MOTOR
 FINE MOTOR
 PERSONAL AND SOCIAL
 LANGUAGE
 VISION
 HEARING

10.  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

11.  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

12.  FAMILY HISTORY-FIRST, SECOND AND THIRD
DEGREE RELATIVE
 SOCIAL HISTORY-CAPACITY TO COPE WITH A
CHILD WITH DISABILITY

13.  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

14.  PLAY,CLIMBING STAIRS,SPEECH,FEEDING
 PERFORMANCE- understanding, matching
colour
 COMPREHENSION OF LANGUAGE

15.  Test for reading ,arithmatic function
 Test for deafness and physical examination
 Vision by 3-5 years of age
 Intelligence assessment

16.  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)

17.  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.

18. -
 Adductor angle
 Heel to ear
 Popliteal angle
 Dorsiflexion angle of foot
 Scarf sign

20. ANGLES 1-3
MONTHS
4-6
MONTHS
7-9
MONTHS
10-12
MONTHS
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

21.  The acquisition of gross motor skills
the development of fine motor
skills
 Both process occur in fashion
-head control precedes arm and hand control
-followed by leg and foot control

25.  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

27.  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

29.  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

31.  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

32.  Object permanence
 Causality
 Imitation
 Colour and shape recognization
 Language mainly receptive
 Fine motor

33.  IT IS A BRIEF,FORMAL,STANDARDIZED
EVALUATION AID IN THE EARLY IDENTIFICTION
OF THE PATIENT WITH
DEVELOPMENTALBEHAVIOURAL DELAY
 TYPES-
 Informal screening
 Routine formal screening
 Focused screening-more important in high
risk infants.

35. -INFANIB
-childhood autism rating scale(CARS)
 Modified checklist for autism in toddler(M-CHAT)
-Brigance pre school skills test
-child behavior check
list(CBCL)
 Early childhood interventory-3-6 yrs
 Child and adolescent symptom inventory>6YRS
-conners rating scale(CRS)

37. talScreening
Test II
Neuro-
developmen
tal
Screen (BIN
S)
Developmen
tal Status
(PEDS)
questionnai
re (ASQ)
II/ III
AGE FORMAT 0-6
yearsDirectl
y
administere
d
3-
24 monthDir
ectly
administere
d
0-8
yearsParent-
report
1 -66 /3- 66
mParent
report
0-9 y/ 12
y11m Parent
report
SCREENSDO
MAINS
Expressive &
receptivelan
guage, gross
motor, fine
motor,
personalsoci
al
Neurological
processes,
expressive
and
receptive
functions&
cognitive
Cognitive,
expressive&
receptive
language
fine & gross
motor,
social-
emotional,
behavior,
self-help&
school
Communicat
ion, gross
motor, fine
motor,proble
m-solving,
andpersonal
adaptive
skills
Physical,
Self-
help/ Adap
tive,
Social/Social
-
emotional,A
cademic/
cognitiveand
Communicat
ion
ITEMS 125 11-13 10 22-36 186180
SCORINGRE Normalabno High/low/m Low/mediu Pass/fail Total score

39. FACTORS BARODA
DEVELOPMENTA
L SCREENING
TEST(BDST)
TRIVANDRUM
DEVELOPMENTA
L SCREENING
CHART(TDSC)
ICMR PSYCHOSOCIAL
DEVELOPMENTAL
SCREENING TEST
DEVELOPED
FROM
BAYLEY SCALE
OF INFANT
DEVELOPMENT,N
ORMATIVE DATA
FROM INDIAN
CHILDREN
BAYLEY SCALE
OF INFANT
DEVELOPMENT(B
ARODA 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 INTERVIEW
64 ITEMS
DOMAINS MOTOR AND
COGNITIVE
MENTAL AND
MOTOR
GROSS
MOTOR.VISION,HEARI
NG,FINE MOTOR AND
SOCIAL SKILLS
SCORING/RESUL
TS
AGE
EQUIVALENT
AND
DEVELOPMENT
QUOTIENT
WITHIN AGE
RANGE
3RD,5TH,25TH,50TH,75T
H,95THAND 97TH
CENTILE.SIGNIFICANT
DELAY IN <3RD
CENTILE(2SD)

40.  Completed 2 months-social smile
 Completed 4 months-holds head study
 Completed 8 months-sits alone
 Completed 12 months-stands alone

41.  Can be used in large scale community by
anganwadi workers

42. 3%
97%

43.  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

44.  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.

45.  Assessment of infant and pre school children
 125 items
 4 categories-gross motorfine motor or
adaptivelanguagepersonal or social
 Items are arranged in chronological order
according to the ages at which most children
pass them
 Performance rated as PASSCAUTIONDELAY

46.  Gold standard for developmental evaluation
 Two scales-mental and motor scale
 Mental development index –MDI
 Psychomotor development index -PDI

48.  If screening tests or clinical assessment are
abnormal
 Some common scales
 Bayley scale for infant development II
 Wechsler intelligence scale for children IV
 Stanford-Binet intelligence scales , 5th editn.
 Developmental Activities Screening Inventory

50.  Intelligence testing for ages 2-23 years and
beyond
 Yields intelligence quotient(IQ)
standardized scoring
 Composite mean 100 with SD 16

51.  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

52.  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

53.  DQ=developmental agechronological 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

56.  Rolling prior to 3 months-EVALUATE FOR
HYPERTONIA
 Persistent fisting for 3 months-NEUROMOTOR
DYSFUNCTION
 Failure to alert to environmental stimuli-
SENSORY IMPAIREMENT

57.  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

58. Persistence of primitive reflex after 6 months-
NEUROMUSCULAR DISORDER
Absent babbling for 6 months-HEARING DEFECT
Absent stranger anxiety by 7 months-MULTIPLE
CARE PROVIDERS
Inability to localize sound by 10 months-
UNILATERAL HEARING LOSS
Persistent mouthing of object by 12 months-
LACK OF INTELLECTUAL CURIOSITY

59.  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