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Developmental assessment and screening

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assessment by screening and survillance

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Developmental assessment and screening

  1. 1. DEVELOPMENTAL ASSESSMENT AND SCREENING PRESENTED BY Dr.NasreenAli GUIDED BY Dr.T.V.Ramkumar
  2. 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. 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. 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. 5. GOAL  THE GOAL OF DEVELOPMENTAL ASSESSMENT IS NOT ONLYTO GENERATEA DIAGNOSIS BUT ALSOTO ANALYSETHE PATTERN OF STRENGTHSANDWEAKNESS IN ORDERTO DIRECTTREATMENT.
  6. 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. 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. 8. Domains of development  GROSS MOTOR  FINE MOTOR  PERSONALAND SOCIAL  LANGUAGE  VISION  HEARING
  9. 9. DEVELOPMENTAL ASSESSMENT
  10. 10. PROCEDURE  DEVELOPMENTAL MILESTONES SERVE AS AN IMPORTANT BASIS OF MOST STANDARDIZEDASSESSMENTAND SCREENINGTOOLS  TWO SEPARATE DEVEVELOPMENTAL ASSESSMENTOVERTIME ARE MORE PRODUCTIVETHAN A SINGLE ONE
  11. 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
  12. 12. 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
  13. 13. DEVELOPMENTAL HISTORY  WHETHER PARENTS ARE CONCERNEDOR NOT  RIGHT QUESTIONS  AGE SPECIFIC QUESTIONS  CHECK DOUBTFUL REPLY  CHECKTHE ANSWERSABOUT ONE MILESTONES BY ANOTHERAND BY EXAMINATION
  14. 14.  FAMILY HISTORY-FIRST, SECOND AND THIRD DEGREE RELATIVE  SOCIAL HISTORY-CAPACITYTO COPEWITH A CHILDWITH DISABILITY
  15. 15. ASSESSMENT OF NORMAL DEVELOPMENT  PLAY,CLIMBING STAIRS,SPEECH,FEEDING  PERFORMANCE- understanding, matching colour  COMPREHENSIONOF LANGUAGE
  16. 16. ASSESSMENT OF NORMAL DEVELOPMENT  Test for reading ,arithmetic function  Test for deafness and physical examination  Vision by 3-5 years of age  Intelligence assessment
  17. 17. 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.
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. NEUROLOGICAL EXAMINATION -  Adductor angle  Heel to ear  Popliteal angle  Dorsiflexion angle of foot  Scarf sign
  23. 23. 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
  24. 24. 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
  25. 25. 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
  26. 26. Test cognitive and adaptive milestones  Object permanence  Causality  Imitation  Colour and shape recognization  Language mainly receptive  Fine motor
  27. 27. 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
  28. 28. 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
  29. 29. 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
  30. 30. 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.
  31. 31. 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.
  32. 32. 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.
  33. 33. 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.
  34. 34. 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
  35. 35. 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
  36. 36. Comparison of Developmental Screening Tools of International Origin
  37. 37. 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
  38. 38. 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
  39. 39. Comparison of Indian Developmental Screening Tools
  40. 40. 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
  41. 41. 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
  42. 42. 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
  43. 43.  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
  44. 44. 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
  45. 45. Birth to two years  Can be used in large scale community by anganwadi workers
  46. 46. Trivandrum development screening chart 3% 97%
  47. 47. 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
  48. 48. 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.
  49. 49.  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
  50. 50. Gold standard for developmental evaluation Two scales-mental and motor scale Mental development index –MDI Psychomotor development index -PDI
  51. 51. 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
  52. 52. 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
  53. 53. 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
  54. 54. 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
  55. 55. 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
  56. 56. DEIC District early intervention centres  Interdisciplinary approach NHM
  57. 57. Conclusion IAP group
  58. 58. Thank you

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