DNB PEDIATRIC

1. DEVELOPMENTAL ASSESSMENT
Dr. Prachi S. Karnik

2. Principles of Development
 Cephalo → Caudal
 Proximal → Distal
 Simple → Complex
 General → Specific
 Involuntary → Voluntary
 Continuous
 Sequence same, Rate varies
 Maturation AND Environment

3. To begin with…
 A detailed history:
Prenatal, Perinatal, Postnatal
Milestones including self-help and play skills
ConvulsionsConvulsions
Sleep, appetite
School history (academics and social skills)
Behavioral history
Medical history
Family history

4. 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

5. Neuromuscular examination
 Tone
 Deep tendon reflexes
 Primitive reflexes
 Postural reflexes

6. Assessment of tone
 Passive tone (Amiel Tison’s angles)
Scarf sign
Heel to ear
Popliteal anglePopliteal angle
Adductor angle
 Angle of dorsiflexion

8. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

9. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
Sitting
Standing
Axillary suspension
Ventral suspension
Prone position

12. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
Sitting
Standing
Axillary suspension
Ventral suspension
Prone position

14. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

16. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

17. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

18. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

19. Assessment of tone
 Active tone (180⁰ flip)
Supine position
Pull to sit
SittingSitting
Standing
Axillary suspension
Ventral suspension
Prone position

21. Hearing assessment
 Tools
Rattle or Bell
 Prerequisites
Child sitting erect in mother’s lap
Stimulus delivered out of child’s visual field

22. 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

23. Assessment of vision
 Tools
Red ring or Examiner’s face
 Prerequisite
Child in supine position
Stimulus 8-10 inches away

24. 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

29. 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’

36. 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

37. 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 with
developmental delay

38. Screening tools
 General screening tests
 Specific screening tests

39. General Screening Tools
 Caregiver based questionnaires
Ages and Stages Questionnaire (ASQ)
Vineland Social Maturity Scale (VSMS)
 Child performance based tests
Trivandrum Developmental Screening Chart (TDSC)
Baroda Developmental Screening Test (BDST)
Denver Developmental Screening Test (DDST)

40. Trivandrum Developmental Screening Chart

41. Specific Screening Tools
 Neuromotor
INFANIB
 Autism
Childhood Autism Rating Scale (CARS)
Modified Checklist for Autism in Toddlers (M-CHAT)Modified Checklist for Autism in Toddlers (M-CHAT)
 Preschool skills
Brigance’s Preschool Skills’ Test
 Behavioral problems
Child Behavior Checklist (CBCL)
Early Childhood Inventory: 3-6 years
Child and Adolescent Symptom Inventory (CASI): >6 years
 ADHD
Conner’s Rating Scale (CRS)

42. Developmental screening
Normal Development Delay/DeviationNormal Development Delay/Deviation
Surveillance Diagnostic assessment

43. Developmental Surveillance
Longitudinal developmental follow-up in:
• A child with risk factors
• Who has been screened
• And has normal development for age on
screening

44. Developmental screening
Normal Development Delay/DeviationNormal Development Delay/Deviation
Surveillance Diagnostic assessment

45. Diagnostic Tests
 Early developmental delay
Developmental 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 delay
Clinical Language Auditory Milestone Scale (CLAMS)
Receptive Expressive Emergent Language Scale
(REELS)

46. Diagnostic Tests
 Autism
Autism Diagnostic Interview-Revised (ADI-R)
Autism Diagnostic Observation Schedule (ADOS)
 Sensory problems Sensory problems
Sensory Profile
 ADHD
Vanderbilt’s ADHD Scale (Parent based and Teacher
based)

47. Diagnostic Tests
 Intelligence
Binet Kamat Test (BKT): 3-6 years
Malin’s Intelligence Scale for Indian Children (MISIC):
≥ 6 years≥ 6 years
 Learning Disabilities
Nimhans’ SLD Battery

48. Thank you..