This document discusses developmental assessment and screening. It provides an overview of principles of child development, domains of development, and factors affecting development. It describes procedures for developmental assessment, including history taking, physical examination, and testing of different developmental domains. The document discusses screening tests versus definitive tests and developmental quotients. It also compares several international and Indian developmental screening tools, noting their ages assessed, domains covered, psychometric properties, validation, costs, and uses. Overall, the document provides a comprehensive overview of assessing child development and identifying developmental delays through screening.
2. CONTENT
INTRODUCTION
PRINCIPLES OF DEVELOPMENT
GOALS OF DEVELOPMENTALASSESSMENT
DIFFERENT DOMAINS OF DEVELOPMENT
ASSESSMENT OF DEVELOPMENT
SCREENINGTESTS
DEFINITIVETESTS
DEVELOPMENTQUOTIENT
CONCLUSION
(NORMAL DEVELOPMENTAL MILESTONES NOT
DISCUSED).
3. INTRODUCTION
DEVELOPMENT SPECIFIES MATURATION
OF FUNCTIONS.IT IS RELATEDTO
MATURATIONAND MYELINATION OF
NERVOUS SYSTEM AND INDICATES
ACQUISITION OF AVARIETY OF SKILLS FOR
OPTIMUM FUNCTIONING OFTHE
INDIVIDUAL.
DEVELOPMENTALASSESSMENT INCLUDES
EARLY IDENTIFICATION OF PROBLEMS
THROUGH SCREENING AND SURVILLANCE.
4. PRINCIPLES
IT IS A CONTINUOUS PROCESS FROM
CONCEPTIONTO MATURITY
DEVELOPMENT IS INTIMATELY RELATEDTOTHE
MATURATION OF CENTRAL NERVOUS SYSTEM
THE SEQUENCE OF DEVELOPMENT IS IDENTICAL
IN ALL CHILDREN BUTTHE RATE OF
DEVELOPMENTVARIES FROM CHILDTO CHILD
PROCESS OF DEVELOPMENT PROGRESSES IN A
CEPHALO CAUDAL DIRECTION
PRIMITIVE REFLEXES HAVETO BE LOST
INITIAL DISORGANIZED MASS ACTIVITY IS
REPLACED BY SPECIFIC AND USEFUL ACTIONS
5. GOAL
THE GOAL OF DEVELOPMENTAL
ASSESSMENT IS NOT ONLYTO GENERATEA
DIAGNOSIS BUT ALSOTO ANALYSETHE
PATTERN OF STRENGTHSANDWEAKNESS
IN ORDERTO DIRECTTREATMENT.
6. INDICATIONS OF DEVELOPMENTAL
ASSESSMENT
FOLLOW UP OF HIGH RISK NEONATES FOR
EARLY DETECTION OF CEREBRAL PALSY
ANDOR INTELLECTUAL DISABILITY
COMPLETE EVALUATION OF CHILDREN
WITH DEVELOPMENTAL,CHROMOSOMAL
OR NEUROLOGICAL DISORDERS
TO DIFFERNTIATE CHILDRENWITH
RETARDATION IN SPECIFIC FIELDS OF
DEVELOPMENTAS OPPOSEDTOTHOSE
WITH GLOBAL RETARDATION
7. FACTORS AFFECTING
DEVELOPMENT
•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. Domains of development
GROSS MOTOR
FINE MOTOR
PERSONALAND SOCIAL
LANGUAGE
VISION
HEARING
10. PROCEDURE
DEVELOPMENTAL MILESTONES SERVE AS
AN IMPORTANT BASIS OF MOST
STANDARDIZEDASSESSMENTAND
SCREENINGTOOLS
TWO SEPARATE DEVEVELOPMENTAL
ASSESSMENTOVERTIME ARE MORE
PRODUCTIVETHAN A SINGLE ONE
11. 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
12.
13. 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 copying or
imitation.
Patellar hammer
Paper
Pellets(8mm)
Spoon
14. DEVELOPMENTAL HISTORY
WHETHER PARENTS ARE CONCERNEDOR
NOT
RIGHT QUESTIONS
AGE SPECIFIC QUESTIONS
CHECK DOUBTFUL REPLY
CHECKTHE ANSWERSABOUT ONE
MILESTONES BY ANOTHERAND BY
EXAMINATION
15. FAMILY HISTORY-FIRST, SECOND AND
THIRD DEGREE RELATIVE
SOCIAL HISTORY-CAPACITYTO COPEWITH
A CHILDWITH DISABILITY
16. ASSESSMENT OF NORMAL
DEVELOPMENT
PLAY,CLIMBING STAIRS,SPEECH,FEEDING
PERFORMANCE- understanding, matching
colour
COMPREHENSIONOF LANGUAGE
17. ASSESSMENT OF NORMAL
DEVELOPMENT
Test for reading ,arithmetic function
Test for deafness and physical examination
Vision by 3-5 years of age
Intelligence assessment
18. PHYSICAL EXAMINATION
GENERAL EXAMINATION- weight, height
and head circumference, malnutrition ,pallor,
rickets and dysmorphic facies
SYSTEMIC EXAMINATION.
BONESAND JOINTS-deformities and
contracture
NEURO MUSCULAR EXAMINATION IN
INFANTS- tone, deep tendon reflex ,
primitive reflex and postural reflex.
19. 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
20. 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,CHILDABUSE OR NEGLECT
21. RED FLAG 6 TO 12 MONTHS
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
22. 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
WEAKNESSWITH HEMIPARESIS
Inability to walk up and downstairs by 24
month-LACK OF OPPPORTUNITY MORE
THAN MOTOR DEFICIT
26. ASSESSMENT OF GROSS MOTOR
DEVELOPMENT
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
27. 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
28. Test cognitive and adaptive
milestones
Object permanence
Causality
Imitation
Colour and shape recognization
Language mainly receptive
Fine motor
29. 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
30. 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
31.
32. 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
33. screening
It is a brief assessment procedure designed to
identify children who should receive more
intensive diagnosis or assessment.
TYPES-
Informal screening
Routine formal screening
Focused screening-more important in high
risk infants.
34. Why Screening?
To aid early intervention services.
Early identification of early co-morbid
development disabilities.
It follows a standardized form.
Advantages
More accurate than informal clinical impressions.
They reinforce importance of development to
the caregiver.
Efficient way to record observations.
35. Limitations of screening
The assessors need some training in following
the instructions and appropriate scoring.
It cannot be used to make diagnosis.
One cannot stop with screening.
36.
37. Reasons for not practicing
development screening in
India
Parents are unaware of its existence
Health care seeking is prioritized for acute
illness which is not an accurate opportunity
for screening
If parents express concerns they are given
false assurance
Lack of such services to provide appropriate
screening and treatment.
38. SELECTION OF A TOOL
PSYCHOMETRICS: sensitivity and specificity
should be atleast 70-80%
Timestaffing required
Cost
Parent completed vs directly administered
Cultural and linguistic sensitivity
39. Screening tests for Indian
infants
1. Phatak`s Baroda screening test: by Clinical
psychologists. Dr. Promila Phatak. Indian
adaptation of Bayley`s development scale.
2. Trivandrum Development screening test.
3. ICMR scales
4. Denver II (0-60 months)
5. Good Enough Harris Drawing test (4-14yrs)
6. Goddard formbards (3-8 yrs)
7. CAT/CLAMS (clinical adaptive test/clinical linguistic
and auditory milestone scale)
8. NIMHANS Bengaloru learning disability test (2002):
5-15 yrs
1,2,3: 0-30 months
41. Factors Denver
Developmen
talScreening
Test II
Bayley Infant
Neuro-
development
al
Screen (BIN
S)
Parents
Evaluation of
Developmen
tal Status
(PEDS)
Ages and
stages
questionnair
e (ASQ)
Developmen
tal* Profile
II/ III
AGE
FORMAT
0-6 years
Directly
administered
3-24 month
Directly
administered
0-8 years
Parent-report
1 -66 /3- 66
m
Parent report
0-9 y/ 12
y11m Parent
report
SCREENSDO
MAINS
Expressive &
receptive,lan
guage, gross
motor, fine
motor,
personal,soci
al
Neurological
processes,
expressive
and receptive
functions&
cognitive
Cognitive,
expressive& r
eceptive
language fine
& gross
motor, social-
emotional,
behavior,
self-help&
school
Communicati
on, gross
motor, fine
motor,proble
m-solving,
andpersonal
adaptive
skills
Physical, Self-
help/ Adapti
ve,
Social/Social-
emotional,Ac
ademic/
cognitiveand
Communicati
on
ITEMS 125 11-13 10 22-36 186180
SCORINGRE
SULT
Normalabno
rmalquestion
able
High/low/mo
derate
Low/medium
/high
Pass/fail Total score
gives domain
wise age
42. TIME(min) 10-20 10 2-10 10-15 10/20-40
LANGUAGE English/spanis
h
English english English/hindi english
PSYCHOMET
RIC
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%
NOT
Used
extensively
COST$ 111 325 30 249 240
Factors Denver
Developmen
talScreening
Test II
Bayley Infant
Neuro-
development
al
Screen (BIN
S)
Parents
Evaluation of
Developmen
tal Status
(PEDS)
Ages and
stages
questionnair
e (ASQ)
Developmen
tal* Profile
II/ III
44. FACTORS BARODA
DEVELOPMENT
AL SCREENING
TEST(BDST)
TRIVANDRUM
DEVELOPMENT
AL SCREENING
CHART(TDSC)
ICMR PSYCHOSOCIAL
DEVELOPMENTAL
SCREENINGTEST
DEVELOPED
FROM
BAYLEY SCALE
OF INFANT
DEVELOPMENT,
NORMATIVE
DATA FROM
INDIAN
CHILDREN
BAYLEY SCALE
OF INFANT
DEVELOPMENT(
BARODA
NORMS)
PROGRAMME FOR
ESTIMATINGAGE
RELATED CENTILES
USING PIECEWISE
POLYNOMIALS
AGE 0-30 MONTHS 0-24 MONTHS 0-6YEARS
FORMAT 54 ITEMS 17 ITEMS PARENTS INTERVIEW
64 ITEMS
DOMAINS MOTOR AND
COGNITIVE
MENTALAND
MOTOR
GROSS
MOTOR.VISION,HEARI
NG,FINE MOTOR AND
SOCIAL SKILLS
46. DEVELOPMENTAL SCREENING
TOOLS OF FUTURE
GUIDE FOR MONITORING CHILD
DEVELOPMENT(GMCD)-parents report
0-3.5 years
Developed in turkey
7 items
5-10 min
Sensitivity-86 & specificity-93
A 5 year project is underway in
India,Turkey,Argentina and South Africa since
2010
Aim is to standardize GMCD for universal use
47. INCLEN NEURODEVELOPMENTAL SCREENING
TEST(NDST)-
Developed by neuro-developmental experts of india
and abroad
Screens 10 neuro developmental disorders
Autism Spectrum Disorders, Learning Disorder,
Attention Deficit and Hyperactivity Disorder,Vision
Impairment, Hearing Impairment, Intellectual
Disability, Speech and Language Disorders, Epilepsy,
Cerebral Palsy and other Neuro-Muscular Disorders.
Diagnostic criteria (Consensus Clinical Criteria) have
been developed for establishing each diagnosis which
are sequentially applied according to an algorithm
when the screening test is positive
48. Birth to one year
Completed 2 months-social smile
Completed 4 months-holds head steady
Completed 8 months-sits alone
Completed 12 months-stands alone
49. Birth to two years
Can be used in large scale community by
anganwadi workers
51. Two to four years
BRIEF,SIMPLE AND PSYCHOMETRICALLY
STRONG FOR ANGANWADI
TO DIFFERENTIATETHOSEWHO ALREADY
HAVE DELAYS AT 2.5YEARSFROMTHOSE
WHO ARE AT RISK OF DEVELOPMENTAL
DELAY
REGULAR DEVELOPMENTALASSESSMENT
AT 3.5YRS,4.5YRS
52. FOUR TO SIX YEARS
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.
53. 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
54. Gold standard for developmental evaluation
Two scales-mental and motor scale
Mental development index –MDI
Psychomotor development index -PDI
55.
56. DEFINITIVE TESTS
If screening tests or clinical assessment are
abnormal
Some common scales
Bayley scale for infant development II
Wechsler intelligence scale for children IV
and Wechsler preschool and primary scale of
intelligence (indian version: Dr. Mahendrika Bhatt)
Stanford-Binet intelligence scales , 5th editn.
DevelopmentalActivities Screening Inventory
59. 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 WECHLERTEST
Wechsler preschool primary scale
intelligence(WPPSI-R)-3-7YEARS
Wechsler intelligence scale for children(WISC 3)-
6-16YEARS
Wechsler adult intelligence scale(WAIS-R)->16
YEARS
60. 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
61. Developmental quotient
DQ=developmental agechronological age*100
ForThe 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