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.

1. DEVELOPMENTAL ASSESSMENT
AND SCREENING
PRESENTED BY
Dr.NasreenAli
GUIDED BY
Dr.T.V.Ramkumar

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

9. DEVELOPMENTAL
ASSESSMENT

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

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

23. NEUROLOGICAL EXAMINATION
-
 Adductor angle
 Heel to ear
 Popliteal angle
 Dorsiflexion angle of foot
 Scarf sign

25. Neurological assessment
ANGLES 1-3
MONTHS
4-6
MONTHS
7-9
MONTHS
10-12
MONTHS
ADDUCTOR 40-80 70-110 100-150 130-150
HEELTO
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

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

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.

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

40. Comparison of
Developmental Screening
Tools of International
Origin

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

43. Comparison of Indian
Developmental Screening
Tools

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

45. SCORING/RESUL
TS
AGE
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
FACTORS BARODA
DEVELOPMENT
AL SCREENING
TEST(BDST)
TRIVANDRUM
DEVELOPMENT
AL SCREENING
CHART(TDSC)
ICMR PSYCHOSOCIAL
DEVELOPMENTAL
SCREENINGTEST

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

50. Trivandrum development
screening chart
3%
97%

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

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

58. 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

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

63. DEIC District early
intervention centres
 Interdisciplinary approach
NHM

66. Conclusion IAP group

68. Thank you