Assessment of
development and Growth
What are developmental
milestones?
 Defined by Illingworth in his milestone theory as
Set of functional skills or age-specific tasks
that most children can do at a certain age range
 Milestone = standard for skill acquisition
 Defines the child’s “developmental age”
 NB norms are based on children of full gestational age
 Although each milestone has an age level, every child is
unique, and the impact of intrinsic and extrinsic factors may
vary Therefore it is accepted that standard deviation/variation
of one month on either side is allowed
Milestones vs.
developmental sequence
 Both are important components to consider when assessing and
treating children with developmental concerns
 Developmental sequence refers to the typical pattern or
development , of the components of movement & timing thereof
 Need to understand the components and the sequencing of the
components in the developmental sequence
 Whilst when looking at milestones your are assessing the skills or
tasks a child has achieved for his age
Developmental Screening tests
1- Screening Tests
 Milani- comparetti motor development screening test
 Denver II
2-Tests of motor performance
 Alberta Infant Motor Scale (AIMS )
 Bruininks-Oseretsky test of motor proficiency
 Movement assessment of infants
 Peabody Developmental motor scales
 Gross motor functional measure (GMFM)
 Test of Infant Motor Performance
Denver Developmental
Screening Test - 2
Very commonly used screening tool
Birth to 6 years old
Poor sensitivity and specificity (40-60%)
10-20 minutes to administer
Normed on diverse population sample
Multiple languages
Domains: fine and gross motor, language,
and social skills
DDST (continued)
Identifies children at 25,75, and 90%
completion of task
Scored as concern if child completing task in
shaded area (75-90%)
Scored as failure if not completed by time 90%
complete
Referrals warranted for one failure or two
concerns
Correct for prematurity till 2 years old
chronological age
Bayley Screener
Ages 3 to 24 months
Direct observation of skills by provider
Assesses three domains (more neuro focused)
11-13 items at each age group (3-6 month
breaks)
Specificity and sensitivity 75-86%
10-15 minutes to administer
Not standardized in Spanish
Peabody Developmental
Motor Scales – Second
Edition (PDMS-II)
Purpose
Provides a comprehensive sequence of
gross and fine motor skills from
which the developmental skill level
can be obtained
Peabody Developmental Motor Scales
– II
PDMS-II
Advantages
Norm-referenced
Valid and highly reliable measure
Discriminates motor problems from normal
developmental variability i.e. those known to
be “average” and those expected to be low or
below average
PDMS-II
Disadvantages
Assesses only motor areas
Not responsive to change in children with
severe physical disabilities
Not necessarily valid for planning
intervention
Test of Infant Motor Performance
TIMP
Purpose
A test of functional motor behavior in infants
between the ages of 34 weeks postconceptional
age and 4 months post-term.
Constructed to assess postural control needed in
age-appropriate functional activities involving
movement
Intended to signal developmental deviance at an
early stage so that effective intervention can
prevent serious impairment.
TIMP
Advantages
Discriminates among infants with varying degrees
of risk for poor motor outcome
Predicts 12-month motor performance with
sensitivity 92%
Can be used in the special care nursery and in
community-based programs
Looks at quality of movement in a functional
context versus just skills
Useful for planning interventions for high risk
infants or infants with neurological conditions
TIMP
Disadvantages
Targets a very finite population
Designed to be administered by
therapists with close contact and
personal emotional involvement with the
babies.
GMFM: Gross Motor
Function Measure, Part I
Kathy McKellar, “Knowledge Broker”
January 2007
 Based on a presentation by Dianne Russell, CanChild
Centre for Childhood Disability Research, Knowledge
Broker project co-investigator
GMFM
Criterion-referenced test: evaluates
performance of motor skills on that day;
useful for comparison over time
Measures how much of a task the child
can accomplish, rather than how well the
task is completed (quantity, not
movement quality)
Who is the GMFM
appropriate for?
Children with CP: original validation
sample included kids 5 mo- 16 yrs
May be appropriate for children with other
diagnoses
GMFM is appropriate for children whose
motor skills are at or below those of a
typical 5 year old.
Time required
GMFM 88: approx. 45-60 minutes
GMFM 66: faster, allows for some missing
data (items that are not tested)
Can be completed in more than 1 session
(ideally complete all items within 1 week)
GMFM-88
88 items in 5 gross motor dimensions (for
ease of administration):
lying and rolling
crawling and kneeling
Sitting
Standing
walking, running and jumping
Why use the GMFM?
Reliable, valid
Internationally accepted: Translated into
several languages, including Dutch, French, German,
Icelandic, Japanese
Considered best practice
Used as an outcome measure
Used as an outcome measure
 Surgery (rhizotomy, pallidal stimulation, muscle tendon)
 Drugs (botulinum toxin, intrathecal baclofen)
 Physical therapy (including ambulatory aids & orthoses)
 Horseback riding
 Strength training & physical fitness
Use of the GMFM in other
populations
Osteogenesis imperfecta (Ruck-Gibis et al.
2001)
Lymphoblastic leukemia (Wright et al.
1998)
Down syndrome (Russell et al. 1998)