DEVELOPMENTAL ASSESSMENT
AND SCREENING
PRESENTED BY
Dr.Nasreen Ali
GUIDED BY
Dr.T.V.Ramkumar
CONTENT
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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).
INTRODUCTION
 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.
PRINCIPLES
 IT IS A CONTINUOUS PROCESS FROM
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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
GOAL
 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.
INDICATIONS OF DEVELOPMENTAL
ASSESSMENT
 FOLLOW UP OF HIGH RISK NEONATES FOR
EARLY DETECTION OF CEREBRAL PALSY
AND\OR INTELLECTUAL DISABILITY
 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
FACTORS AFFECTING
DEVELOPMENT
PROTECTIVE
BREAST
FEEDING
MATER
NAL EDU
• MATERNAL
FACTORS
• IUGR
• PREMATURITY
• PERINATAL
ASPHYXIA
GENETIC
FACORS
POST
•INFANT AND CHILD
NUTRITION
•IRON DEFICIENCY
•IODINE DEFICIENCY
•INECTIOUS
DISEASE
NEONATAL
NEONATAL
PSYCHOSOCIAL
•PARENTING
•POVERTY
•LACK OF
STIMULAION
•VIOLENCE AND
ABUSE
•MATERNAL
DEPRESSION
•INSTITUTIONALIS
Domains of development
 GROSS MOTOR
 FINE MOTOR
 PERSONAL AND SOCIAL
 LANGUAGE
 VISION
 HEARING
DEVELOPMENTAL
ASSESSMENT
PROCEDURE
 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
PREREQUISITES
 Should be done in a place free from
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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
Equipment required
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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
DEVELOPMENTAL HISTORY
 WHETHER PARENTS ARE CONCERNED OR
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NOT
RIGHT QUESTIONS
AGE SPECIFIC QUESTIONS
CHECK DOUBTFUL REPLY
CHECK THE ANSWERS ABOUT ONE
MILESTONES BY ANOTHER AND BY
EXAMINATION
 FAMILY HISTORY-FIRST, SECOND AND
THIRD DEGREE RELATIVE
 SOCIAL HISTORY-CAPACITY TO COPE WITH
A CHILD WITH DISABILITY
ASSESSMENT OF NORMAL
DEVELOPMENT
 PLAY,CLIMBING STAIRS,SPEECH,FEEDING
 PERFORMANCE- understanding, matching
colour
 COMPREHENSION OF LANGUAGE
ASSESSMENT OF NORMAL
DEVELOPMENT
 Test for reading ,arithmetic function
 Test for deafness and physical examination
 Vision by 3-5 years of age
 Intelligence assessment
PHYSICAL EXAMINATION
 GENERAL EXAMINATION- weight, height
and head circumference, malnutrition ,pallor,
rickets and dysmorphic facies
 SYSTEMIC EXAMINATION.
 BONES AND JOINTS-deformities and
contracture
 NEURO MUSCULAR EXAMINATION IN
INFANTS- tone, deep tendon reflex ,
primitive reflex and postural reflex.
Red flag signs:birth to 3
months
 Rolling prior to 3 months-EVALUATE FOR
HYPERTONIA
 Persistent fisting for 3 monthsNEUROMOTOR DYSFUNCTION
 Failure to alert to environmental stimuliSENSORY IMPAIREMENT
RED FLAGS FROM 4 TO 6 MONTHS
 Poor head control-HYPOTONIA
 Failure to reach for objects for 5 monthsMOTOR,VISUAL OR COGNITIVE DEFECTS
 Absent smile-VISUAL LOSS,ATTACHMENT
PROBLEMS,MAJOR MATERNAL
DEPRESSION,CHILD ABUSE OR NEGLECT
RED FLAG 6 TO 12 MONTHS
Persistence of primitive reflex after 6 monthsNEUROMUSCULAR DISORDER
Absent babbling for 6 months-HEARING
DEFECT
Absent stranger anxiety by 7 months-MULTIPLE
CARE PROVIDERS
Inability to localize sound by 10 monthsUNILATERAL HEARING LOSS
Persistent mouthing of object by 12 monthsLACK OF INTELLECTUAL CURIOSITY
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
WEAKNESS WITH HEMIPARESIS
 Inability to walk up and downstairs by 24
month-LACK OF OPPPORTUNITY MORE
THAN MOTOR DEFICIT
NEUROLOGICAL EXAMINATION
 Adductor angle
 Heel to ear
 Popliteal angle
 Dorsiflexion angle of foot
 Scarf sign
Neurological assessment
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 ELBOW
CROSS
CROSS
MIDLINE
MIDLINE
ELBOW
REACHES
AXILLA
ELBOW
BEYOND
AXILLA
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
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
Test cognitive and adaptive
milestones
 Object permanence
 Causality
 Imitation
 Colour and shape recognization
 Language mainly receptive
 Fine motor
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
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
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
screening
 It is a brief assessment procedure designed to
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identify children who should receive more
intensive diagnosis or assessment.
TYPESInformal screening
Routine formal screening
Focused screening-more important in high
risk infants.
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.
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.
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.
SELECTION OF A TOOL
 PSYCHOMETRICS: sensitivity and specificity
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should be atleast 70-80%
Time\staffing required
Cost
Parent completed vs directly administered
Cultural and linguistic sensitivity
Screening tests for Indian
infants
1. Phatak`s Baroda screening test: by Clinical
2.
3.
4.
5.
6.
7.
8.
psychologists. Dr. Promila Phatak. Indian
adaptation of Bayley`s development scale.
Trivandrum Development screening test.
ICMR scales
Denver II (0-60 months)
Good Enough Harris Drawing test (4-14yrs)
Goddard formbards (3-8 yrs)
CAT/CLAMS (clinical adaptive test/clinical linguistic
and auditory milestone scale)
NIMHANS Bengaloru learning disability test (2002):
5-15 yrs
1,2,3: 0-30 months
Comparison of
Developmental Screening
Tools of International
Origin
Factors
Denver
Developmen
talScreening
Test II
Bayley Infant
Neurodevelopment
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
1 -66 /3- 66
Parent-report m
Parent report
0-9 y/ 12
y11m Parent
report
SCREENS\DO Expressive &
MAINS
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, socialemotional,
behavior,
self-help&
school
Communicati
on, gross
motor, fine
motor,proble
m-solving,
andpersonal
adaptive
skills
Physical, Selfhelp/ Adapti
ve,
Social/Socialemotional,Ac
ademic/
cognitiveand
Communicati
on
ITEMS
125
11-13
10
22-36
186\180
SCORING\RE
SULT
Normal\abno High/low/mo
rmal\question derate
able
Low/medium
/high
Pass/fail
Total score
gives domain
wise age
Factors
Denver
Developmen
talScreening
Test II
Bayley Infant
Neurodevelopment
al
Screen (BIN
S)
TIME(min)
10-20
10
Parents
Evaluation of
Developmen
tal Status
(PEDS)
Ages and
stages
questionnair
e (ASQ)
Developmen
tal* Profile
II/ III
2-10
10-15
10/20-40
English/spanis English
h
PSYCHOMET sensitivity0.56-0.83
0.75-0.86
RIC
PROPERTIES
Specificity0.43-0.80
0.75-0.86
english
English/hindi
english
0.74-0.79
0.70-0.90
Validity
coefficients
0.70-0.80
0.76-0.91
0.52-0.72
VALIDATED
IN INDIA
NOT
SN 62%
SP 65%
83.3%
74.5%
NOT
Used
extensively
COST$
111
30
249
240
LANGUAGE
NOT
325
Comparison of Indian
Developmental Screening
Tools
FACTORS
BARODA
DEVELOPMENT
AL SCREENING
TEST(BDST)
TRIVANDRUM
DEVELOPMENT
AL SCREENING
CHART(TDSC)
ICMR PSYCHOSOCIAL
DEVELOPMENTAL
SCREENING TEST
DEVELOPED
FROM
BAYLEY SCALE
OF INFANT
DEVELOPMENT,
NORMATIVE
DATA FROM
INDIAN
CHILDREN
BAYLEY SCALE
OF INFANT
DEVELOPMENT(
BARODA
NORMS)
PROGRAMME FOR
ESTIMATING AGE
RELATED CENTILES
USING PIECE WISE
POLYNOMIALS
AGE
0-30 MONTHS
0-24 MONTHS
0-6YEARS
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
FACTORS
BARODA
DEVELOPMENT
AL SCREENING
TEST(BDST)
TRIVANDRUM
DEVELOPMENT
AL SCREENING
CHART(TDSC)
ICMR PSYCHOSOCIAL
DEVELOPMENTAL
SCREENING TEST
SCORING/RESUL AGE
TS
EQUIVALENT
AND
DEVELOPMENT
QUOTIENT
CALCULATED
WITHIN AGE
RANGE
3RD,5TH,25TH,50TH,75TH
,95THAND 97TH
CENTILE.SIGNIFICAN
T DELAY IN <3RD
CENTILE(2SD)
TRAINING
MINIMAL
MINIMAL
NONE
SETTING
COMMUNITY/OF
FICE
COMMUNITY/OF
FICE
COMMUNITY/OFFICE
TIME
TAKEN(MIN)
10
10
MINIMAL
PSYCHOMETRIC
PROPERTIES
SN-65-93%
SP-77.4-94.4%
66.8%
78.8%
NOT GIVEN
COST
INEXPENSIVE
INEXPENSIVE
FREE
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
 INCLEN NEURODEVELOPMENTAL SCREENING
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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
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
Birth to two years
 Can be used in large scale community by
anganwadi workers
Trivandrum development
screening chart
3%
97%
Two to four years
 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
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.
 Assessment of infant and pre school children
 125 items
 4 categories-gross motor\fine motor or
adaptive\language\personal or social
 Items are arranged in chronological order
according to the ages at which most children
pass them
 Performance rated as PASS\CAUTION\DELAY
Gold standard for developmental evaluation
Two scales-mental and motor scale
Mental development index –MDI
Psychomotor development index -PDI
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.
 Developmental Activities Screening Inventory
STANFORD-BINNET INTELLIGENCE
SCALE
 Intelligence testing for ages 2-23 years and beyond
 Yields intelligence quotient(IQ)
standardized scoring
 Composite mean 100 with SD 16
Wechsler intelligence scale
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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
DEVELOPMENTAL ACTIVITIES
SCREENING INVENTORY SECOND
EDITION-DASI 2
 Age range in years-birth to 5 years
 Method of administration/format Individually administered informal screening
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measure,may be presented as non-verbal test
67 tests
Yield development quotient
Time-25-30 min
Sub scales-developmental quotient
Developmental quotient
 DQ=developmental age\chronological 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
DEIC District early
intervention centres
 Interdisciplinary approach
NHM
Conclusion IAP group
Thank you