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Developmental assessment and screening

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developmental assessment and screening in children.

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Developmental assessment and screening

  1. 1. PRESENTED BY Dr.Nasreen Ali GUIDED BY Dr.T.V.Ramkumar
  2. 2.  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 HERE.
  3. 3.  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.
  4. 4.  IT IS A CONTINUOUS PROCESS FROM 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
  5. 5.  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.
  6. 6.  FOLLOW UP OF HIGH RISK NEONATES FOR EARLY DETECTION OF CEREBRAL PALSY ADDOR MENTAL RETARDATION  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
  7. 7. •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. 8.  GROSS MOTOR  FINE MOTOR  PERSONAL AND SOCIAL  LANGUAGE  VISION  HEARING
  9. 9.  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
  10. 10.  WHETHER PARENTS ARE CONCERNED OR NOT  RIGHT QUESTIONS  AGE SPECIFIC QUESTIONS  CHECK DOUBTFUL REPLY  CHECK THE ANSWERS ABOUT ONE MILESTONES BY ANOTHER AND BY EXAMINATION
  11. 11.  FAMILY HISTORY-FIRST, SECOND AND THIRD DEGREE RELATIVE  SOCIAL HISTORY-CAPACITY TO COPE WITH A CHILD WITH DISABILITY
  12. 12.  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. 13.  PLAY,CLIMBING STAIRS,SPEECH,FEEDING  PERFORMANCE- understanding, matching colour  COMPREHENSION OF LANGUAGE
  14. 14.  Test for reading ,arithmatic function  Test for deafness and physical examination  Vision by 3-5 years of age  Intelligence assessment
  15. 15.  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  Patellar hammer  Paper  Pellets(8mm)
  16. 16.  GENERAL EXAMINATION- weight, height and head circumference, malnutrition ,pallor, rickets and dysmorphic facies  SYSTEMIC EXAMINATION-cns  BONES AND JOINTS-deformities and contracture  NEURO MUSCULAR EXAMINATION IN INFANTS- tone, deep tendon reflex , primitive reflex and postural reflex.
  17. 17. -  Adductor angle  Heel to ear  Popliteal angle  Dorsiflexion angle of foot  Scarf sign
  18. 18. 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 CROSS MIDLINE ELBOW CROSS MIDLINE ELBOW REACHES AXILLA ELBOW BEYOND AXILLA
  19. 19.  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
  20. 20.  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
  21. 21.  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
  22. 22.  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
  23. 23.  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
  24. 24.  Object permanence  Causality  Imitation  Colour and shape recognization  Language mainly receptive  Fine motor
  25. 25.  IT IS A BRIEF,FORMAL,STANDARDIZED EVALUATION AID IN THE EARLY IDENTIFICTION OF THE PATIENT WITH DEVELOPMENTALBEHAVIOURAL DELAY  TYPES-  Informal screening  Routine formal screening  Focused screening-more important in high risk infants.
  26. 26. -INFANIB -childhood autism rating scale(CARS)  Modified checklist for autism in toddler(M-CHAT) -Brigance pre school skills test -child behavior check list(CBCL)  Early childhood interventory-3-6 yrs  Child and adolescent symptom inventory>6YRS -conners rating scale(CRS)
  27. 27. talScreening Test II Neuro- developmen tal Screen (BIN S) Developmen tal Status (PEDS) questionnai re (ASQ) II/ III AGE FORMAT 0-6 yearsDirectl y administere d 3- 24 monthDir ectly administere d 0-8 yearsParent- report 1 -66 /3- 66 mParent report 0-9 y/ 12 y11m Parent report SCREENSDO MAINS Expressive & receptivelan guage, gross motor, fine motor, personalsoci al Neurological processes, expressive and receptive functions& cognitive Cognitive, expressive& receptive language fine & gross motor, social- emotional, behavior, self-help& school Communicat ion, gross motor, fine motor,proble m-solving, andpersonal adaptive skills Physical, Self- help/ Adap tive, Social/Social - emotional,A cademic/ cognitiveand Communicat ion ITEMS 125 11-13 10 22-36 186180 SCORINGRE Normalabno High/low/m Low/mediu Pass/fail Total score
  28. 28. FACTORS BARODA DEVELOPMENTA L SCREENING TEST(BDST) TRIVANDRUM DEVELOPMENTA L SCREENING CHART(TDSC) ICMR PSYCHOSOCIAL DEVELOPMENTAL SCREENING TEST DEVELOPED FROM BAYLEY SCALE OF INFANT DEVELOPMENT,N ORMATIVE DATA FROM INDIAN CHILDREN BAYLEY SCALE OF INFANT DEVELOPMENT(B ARODA NORMS) PROGRAMME FOR ESTIMATING AGE RELATED CENTILES USING PIECE WISE POLYNOMIALS AGE 0-30 MONTHS 0-24 MONTHS 0-6 YEARS 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 SCORING/RESUL TS AGE EQUIVALENT AND DEVELOPMENT QUOTIENT WITHIN AGE RANGE 3RD,5TH,25TH,50TH,75T H,95THAND 97TH CENTILE.SIGNIFICANT DELAY IN <3RD CENTILE(2SD)
  29. 29.  Completed 2 months-social smile  Completed 4 months-holds head study  Completed 8 months-sits alone  Completed 12 months-stands alone
  30. 30.  Can be used in large scale community by anganwadi workers
  31. 31. 3% 97%
  32. 32.  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
  33. 33.  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.
  34. 34.  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
  35. 35.  Gold standard for developmental evaluation  Two scales-mental and motor scale  Mental development index –MDI  Psychomotor development index -PDI
  36. 36.  If screening tests or clinical assessment are abnormal  Some common scales  Bayley scale for infant development II  Wechsler intelligence scale for children IV  Stanford-Binet intelligence scales , 5th editn.  Developmental Activities Screening Inventory
  37. 37.  Intelligence testing for ages 2-23 years and beyond  Yields intelligence quotient(IQ) standardized scoring  Composite mean 100 with SD 16
  38. 38.  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
  39. 39.  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
  40. 40.  DQ=developmental agechronological 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
  41. 41.  Rolling prior to 3 months-EVALUATE FOR HYPERTONIA  Persistent fisting for 3 months-NEUROMOTOR DYSFUNCTION  Failure to alert to environmental stimuli- SENSORY IMPAIREMENT
  42. 42.  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,CHILD ABUSE OR NEGLECT
  43. 43. 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
  44. 44.  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

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