To assess child development

1. - Dr CSN Vittal

2. Development
• It is acquisition of qualitative and quantitative
skills in a social environment
FOUR AREAS
• Gross motor development
• Fine motor development
• Personal /social development
• Language development

3. Normal development
• Pattern is constant
• Skills acquired sequentially
• Rate varies from child to child
• Later goals depend on achieving earlier goal in
same field eg. sit before stand, then walk
• Genetic and environmental factors contribute
positively and negatively

4. ‘Milestones’
Acquisition of a key skill
– Median age – age at which half population
acquire the skill
– Limit – age at which a skill should have
been achieved, - 2SD from the mean
Remember, some are constant (eg. smile by 8/52),
some are not (crawling)

5. Terminology
• DEVELOPMENT DELAY
– Discrepancy 25% or more OR 1.5 to 2 SD from normal
• GLOBAL DEVELOPMENT DELAY
– Delay in 2 or more domains of development
• DEVELOPMENT DEVIANCE
– When child develop milestone or skill outside typical
acquisition of sequence
• DEVELOPMENT DISSOCIATION
– When child has widely differing rates of development in
different domains of development
• DEVELOPMENT REGRESSION
– When child loses previously acquired skills or milestone

6. Developmental assessments
• Process of mapping a child’s performance
compared with children of a similar age from
similar population
– Part of comprehensive medical care

7. Why is it necessary?
• Reassure if normal development pattern and
timings, discuss good parenting
• Spot regression
• Any genetic disorder to make?
• Identify those with specific areas of impairment
or global concerns
• Allows early support or interventions
– eg. hearing aids, physiotherapy, ?
• Give Parents time to adjust

8. Purpose of Assessment
• Whether there is impairment or not in development
• Make a diagnosis if possible
• Seek to intervene positively to improve outcome and
function for the child and family
– Reinforcing acquired skills
– Teach developmentally appropriate skills
– Provide missed experience
– Make use of other skills to overcome difficulties
– Use learning style to promote learning

9. Developmental assessment
1. Screening
– brief ,formal ,standardized evaluation aid in the
early identification children who should receive
more intensive assessment.
2. Surveillance
– Is flexible ,
– longitudinal ,
– Documenting and maintaining a developmental
history
– Making accurate observations of child

10. Time of Assessment
• Developmental surveillance-
– every well child visit
• Developmental screening-
– May be completed by parent or clinician
– Using standardized tool at 9, 18 and 30 months
– Example-
• Denver II developmental screening test
• Phatak’s Baroda Screening Test
• Trivandrum Development Screening Chart
• CAT/Clams ( Clinical adaptive test/ clinical linguistic and
auditory milestone scale)
• Goodenough- Harris Draw-a-person test

11. Examination: Observations and Interactive
Assessment
• Should take in place in a room with toys
appropriate for child
• With one or both parents, but no prompting and
helping
• Chair and table
• Child’s behavior and interaction with parents
during history taking should be observed prior to
physical examination
• Normal functioning of motor, vision and hearing
should be assessed

12. Prerequisites
• Infant or child in a
good temper
• Should not be
hungry, tired,
unwell, had
convulsion prior,
under influence of
sedative or
antiepileptic drugs

13. Equ
Equipment Required
• Ten 1- inch cubes
• Hand bell
• Colored and uncolored
geometric forms
• Picture cards
• Cards with circle, cross,
square, triangle,
diamond drawn on
them
• Patellar hammer
• Paper
• Pellets (8 mm)
Equipment

14. Ages and Stages Questionnaire (ASQ)
- 2nd Ed.
• Birth to 60 months
• ~ 15 - 20 minutes
• A 2 SD below the mean OR a 75 developmental quotient
- cutoff score
• Used as a first level screening tool to determine which
children need further evaluation to determine their
eligibility for early intervention.
• Also be used to monitor the development of children at
risk for disabilities or delays.

15. Denver II Developmental Screening Test
• Most widely used test for screening
• Assesses child development in four domains
– Gross motor
– Fine motor adaptive
– Language
– Personal social behavior
• These domains are presented as age norms,
just like physical growth curves.

16. Phatak’s Baroda Screening Test
• Indian adaptation of Bayley’s
Development scale
• India’s best known development testing
system
• Used by child psychologists rather then
physicians
• The test items are arranged
according to age.

17. Trivandrum Development Screening Chart
• Simplified adaption of Baroda Development
Screening System
• Consist of 17 items selected from BSID Baroda
norms
• Time required- 5 mins
• Good for mass screening

18. Goodenough ‘draw a man test’
• Simple nonverbal
intelligence test
• Useful as a group
screening tool.
• Points are given
for each detail
that the child
draws in the
figure.
• One can then
determine the
mental age by
comparing scores
obtained and
comparing with
normative sample.

20. Definitive Tests
These tests are required once screening tests or clinical
assessment is abnormal. They are primarily aimed to
accurately define the impairments in both degree and
sphere.
– Bayley Scales of Infant and Toddler Development-Third
Edition (Bayley-III)
– Stanford-Binet Intelligence Scale
– Wechsler Intelligence Scale
– Developmental Activities Screening Inventory-SECOND
EDITION (DASI-II)

21. Bayley Scales of Infant and Toddler Development-
Third Edition (Bayley-III)
• Age Range (in years) - Birth to3.5 years
• Method of Administration/Format
Individually administered in play-based format for Cognitive, Language ,
and Motor Scales; caregiver questionnaire for Social-Emotional and
Adaptive Functioning. Yields scaled scores, composite scores, and
percentile ranks.
• Approximate Time to Administer –
50 min. for 1-12 mos.;
90 min. for 13-42 mos.
Subscales
Cognitive; Language (Receptive, Expressive, Total); Motor (Fine-Motor,
Gross-Motor, Total); Social-Emotional; Adaptive Behavior (Communication,
Community Use, Functional Pre-Academics, Home Living, Health & Safety,
Leisure, Self-Care, Self-Direction, Social, Motor, Total)

22. Stanford-Binet Intelligence Scale
• Description
– Intelligence Testing of ages 2 to 23 years and beyond
– Yields Intelligence Quotient (IQ)
• Scoring
– Standardized Scoring
– Composite mean of 100 with standard deviation of 16
• Interpretation:
• Mental Retardation IQ Definitions
– Borderline mental retardation: 70 -79
– Mild mental retardation: 65-69
– Moderate mental retardation: 40-54
– Severe mental retardation: 30-39
– Profound mental retardation: <30

23. Wechsler Intelligence Scale
• Description
– Intelligence Testing
– Mean score of 100 with standard deviation of 15
– Gives verbal and performance scores
– Broken into subtests each with a mean of 10
• Age specific Wechsler tests
– Wechsler Preschool Primary Scale Intelligence (WPPSI-R)
• Used for ages 3 to 7 years
– Wechsler Intelligence Scale for Children (WISCIII)
• Used for ages 6 to 16 years
– Wechsler Adult Intelligence Scale (WAIS-R)
• Used for ages 16 years and older
•

24. Take Away Message
Best tests (in our setting)
• For infant:
Phatak’s Baroda Screening Test
• For pre school child:
Bayley Scales of Infant and Toddler Development-Third
Edition (Bayley-III)
• For school going child:
Wechsler Intelligence Scale

25. Developmental Quotient (DQ)
Ratio of the functional age to the chronological age. It is a means to simply
express a developmental delay.
DQ= ((developmental age) / (chronological age)) * 100
• If the infant was born prematurely the chronological age should be
corrected for the gestational age at birth during the first year of life.
• The adaptive developmental quotient uses a development measure such as
the Gesell scales. Similar quotients may use IQ or other measures.
Interpretation
maximum score =100
> = 85 normal
71-84 mild-to-moderate delay
<= 70 severe delay

26. Red Flags: Birth to three month
– Rolling prior to 3 months
• Evaluate for hypertonia
– Persistent fisting at 3 months
• Evaluate for neuromotor dysfunction
– Failure to alert to environmental stimuli
• Evaluate for sensory Impairment

27. Red Flags: 4 to 6 months
– Poor head control
• Evaluate for hypotonia
– Failure to reach for objects by 5 months
• Evaluate for motor, visual or cognitive deficits
– Absent Smile
• Evaluate for visual loss
• Evaluate for attachment problems
• Evaluate maternal Major Depression
• Consider Child Abuse or child neglect in severe
cases

28. Red Flags: 6 to 12 months
– Persistence of primitive reflexes after 6 months
• Evaluate for neuromuscular disorder
– Absent babbling by 6 months
• Evaluate for hearing deficit
– Absent stranger anxiety by 7 months
• May be related to multiple care providers
– Inability to localize sound by 10 months
• Evaluate for unilateral Hearing Loss
– Persistent mouthing of objects at 12 months
• May indicate lack of intellectual curiosity

29. Red Flags: 12 to 24 months
– Lack of consonant production by 15 months
• Evaluate for Mild Hearing Loss
– Lack of imitation by 16 months
• Evaluate for hearing deficit
• Evaluate for cognitive or socialization deficit
– Hand dominance prior to 18 months
• May indicate contralateral weakness with Hemiparesis
– Inability to walk up and down stairs at 24 months
• May lack opportunity rather than motor deficit

30. Red Flags: 12 to 24 months
– Advanced non-communicative speech
(e.g. Echolalia)
•Simple commands not understood suggests
abnormality
•Evaluate for Autism
•Evaluate for pervasive developmental disorder
– Delayed Language Development
•Requires Hearing Loss evaluation in all children

31. Early Stimulation
• Infants who show suspect or early signs development
delay need to be provided opportunities that promote
body control, acquisition of motor skills, development
and psychosocial maturity.
– making additional efforts to make the child sit or walk,
– giving toys to manipulate,
– playing with the child,
– showing objects,
– speaking to the child and
– encouraging him to speak and prompting the child to
interact with others, etc.