This document provides an overview of developmental assessment for children. It discusses the goal of developmental assessment as generating a diagnosis and analyzing strengths and weaknesses to direct treatment. It also covers principles of development, value of assessment, common assessment tools, domains of development, developmental milestones, and risk factors. The document aims to guide healthcare providers in conducting developmental assessments and identifying potential developmental delays.

1. Development Assessment
Presentation By:
Binisha Sinha
M.Sc.Nursing
Child Health Nursing
Batch 2013

2. Contents
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Introduction
Goal of Developmental Assessment
Principles of Development
Value of Developmental Assessment
Some Developmental Assessment Tools
Examination: Observation and Interactive Assessment
Basic Bedside Tool for Assessment
Indications for Developmental Assessment
Developmental History
Developmental Milestones
Risk factors for likelihood of Developmental Impairment
Different Domains of Development
Developmental Delay
Target Milestones
Developmental Screening Charts
Interpretation of Findings
References

3. Introduction
• Development specifies maturation of functions. It is related to the
maturation and myelination of the nervous system and indicates acquisition
of a variety of skills for optimal functioning of the individual.
• It is the qualitative and quantitative changes and acquisition of a variety of
competencies for functioning optimally in a social setting.
•
Developmental assessment includes early identification of problems
through screening and surveillance, and more definitive assessment
including both standardized and non-standardized measures, as well as
integration of information from the developmental, social, and family
history and the medical history and examination.

4. Goal of Developmental Assessment
• The goal of developmental assessment is not only to generate a diagnosis,
but equally important to analyze the pattern of strengths and weaknesses in
the child, family, and available developmental, educational, and social
support systems, in order to direct treatment.
• The maturation of central nervous system is characterized by coordination
of motor activity and as infants grow they respond to their environment in a
purposeful manner with the help of special senses (acoustic and auditory
inputs), integrity of labyrinthine, vestibular and musculoskeletal systems.

5. • Children achieve neuro-motor milestones of development at predictable
ages within a narrow range of few weeks or months.
• Development is dependent upon interaction between innate genetic
potential and environmental factors like emotional security, love and
attention, stimulating home environment, optimal nutrition, ethnic and
cultural factors.
• Neuro-motor retardation may occur due to gestational immaturity, perinatal
hypoxia, birth trauma, metabolic disorders (inborn errors of metabolism),
hypoglycemia, kernicterus, intrauterine infections, postnatal CNS
infections, hypothyroidism, developmental and chromosomal disorders.

6. Principles of Development
 It is the most distinctive attribute of childhood and 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.
 The child with odd-looking face does not necessarily have associated
mental sub normality.
 The attributes like creativity, future potentiality, IQ and mental superiority
cannot be predicted in an individual child by developmental assessment.

7.  The generalized mass activity of early infancy is replaced by specific and
subtle individual responses.
 It is a common observation that when shown a bright object, an infant
shows wild excitement by moving trunk, arms, legs and babbling while an
older child merely smiles and reaches for the object.
 The development proceeds in a cephalo-caudal direction. The infant
initially develops head control followed by ability to roll over, grasp,
sitting, crawling, standing, walking etc..
 Certain primitive reflexes like grasp reflex and walking reflex must be lost
before corresponding voluntary movements are required.

8. Value of Development Assessment
For Parents
• If previous pregnancy miscarriage or stillbirth or proved to be
mentally or physically handicapped.
• If there was any antenatal problem or difficult delivery.
• Family history of mental sub normaility, cerebral palsy or
other handicap.

9. For Paediatric Nurse
• When faced with sucking and swallowing problem in neonate,
or child with unusual appearance or behaviour.
• Early diagnosis of defects of hearing or vision.
• Effect of treatment of metabolic disorders, exposure to toxic
substances, convulsions, meningitis.

10. Some Developmental Assessment Tools
1.
Gessel Development Tool
2.
Amiel-Tison Method of Assessment
3.
Vineland Social Maturity Scale
4.
Bayley Scales of Infant Development
5.
Brazelton Neonatal Behaviour Scale
6.
Vojta Technique
7.
Denver Developmental Screening Test
8.
Trivandrum Developmental Screening Chart.
9.
Baroda Developmental Screening Chart.
10. Seguin Form Board

11. Developmental Screening
• The American Academy of Pediatrics recommends that all children be
screened for developmental delays and disabilities during regular well-child
doctor visits at:
1.
2.
3.
9 months
18 months
24 or 30 months
• Additional screening might be needed if a child is at high risk for
developmental problems due to preterm birth, low birth weight, or other
reasons.

12. Developmental Screening
Developmental delay
• Developmental delay occurs in up to 15% of children under 5 years of age.
This includes delays in speech and language development, motor
development, social-emotional development and cognitive development.
• It is has been estimated that only about half of the children with
developmental problems are detected before they begin school.
• Parents are usually the first to pick up signs of possible developmental
delay, and any concerns parents have about their child's development
should always be taken seriously. However, the absence of parental
concern does not necessarily mean that all is well.

13. • Parental recall of their child's developmental milestones has been
demonstrated in a number of studies to be inaccurate, but it is generally
more accurate when milestones are significantly delayed.
The main purpose of developmental assessment depends on the age of the
child:
• Tests may detect neurological problems such as cerebral palsy in the
neonate.
• Tests may reassure parents or detect problems in early infancy.
• Testing in late childhood can help detect academic and social problems
early enough to minimize possible negative consequences (although
parental concern may be just as good a predictor for some problems).

14. • No developmental screening tool can allow for the dynamic nature of child
development. A child's performance on one particular day is influenced by
many factors. Development is not a linear process - it is characterized by
spurts, plateaux and, sometimes regressions.
• Gradually screening has been replaced by the concept of developmental
surveillance. This is a much broader concept. It involves parents, allows for
context and should be a flexible, continuous process.

16. Examination: Observation and Interactive
Assessment
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Should take in place in a room with 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.
Prerequisites
• Infant or child in a good temper.
• Should not be hungry, tired, unwell, had convulsion prior, under influence
of sedative or anti-epileptic drugs.

17. Basic Bedside Tool for Assessment
• The examiner must acquire simple objects and instruments to undertake
bed-side assessment of development whenever indicated.
• These items include torch, dangling red ring of 6.5cm diameter, red ball of
5.0cm diameter, ten 2-5cm sized colorful cubes, temple bells, rattle, cup
with a handle, bunch of keys, pellets or beads, picture book, paper and
crayons and percussion hammer.

18. Indications for Developmental Assessment
1. Follow up of high risk neonates for early detection of cerebral
palsy and or mental retardation.
2. Complete evaluation of children with developmental,
chromosomal and neurological disorders.
3. To differentiate children with retardation in specific fields of
development as opposed to those with global retardation.

19. Developmental History
• Whether or not parents have concern.
• Right question-parents interpretation of what their child does
may be incorrect but observations are usually accurate.
• Age specific question.
• Check doubtful reply with a question kept on a different way.
• Check the answer about one milestones by another and by
examination.

20. • Family examination:
• First and second degree relative
• A diagnosis even if definite should be pursued if it might be
relevant.
• Social history
• Capacity to cope with a child with a disabilty.

21. Cont….Developmental History
• Accurate history of developmental milestones is often difficult to obtain
due to poor observation and educational status of the mother.
• Early events in the life of child’s development may be forgotten by the
parents. The milestones should be asked in a chronological order in a
simple and lucid manner.
• The social smile must be differentiated from spontaneous smile which even
newborn babies may exhibit during sleep or fantasy.
• The mother should be asked whether the child interacts and plays with
children of his age or likes the company of younger children.

22. •
It is equally if not more important to know the quality of head control and whether
he could sit without support with a straight back or in a crouched posture.
•
It is important to ask the mother as to how the development of the index child
compares with his siblings. She can recollect comparison more readily rather than
precise ages for achieving various skills.
•
The effects should be made to identify whether child is globally retarded or
backward only in an individual or specific field e.g. delayed speech in a deaf child,
delayed walking in a child with congenital dislocation of hips etc. the
developmental progress of older children is best evaluated by consideration of
school performance, proficiency in games, motor dexterity and social behavior.

23. Developmental Milestones
• Developmental milestones serve as the basis of most standardized
assessment and screening tools.
• Two separate developmental assessment over time are more
predictive than a single one.
• Developmental monitoring not only should be aimed at identifying
children who have low function, but at directing the focus of
anticipatory guidance to help promote normal development.

24. • Apart from assessing the developmental milestones, the examiner
should undertake a detailed neurological examination, evaluate the
muscle tone (adductor angle, scarf manouvre, Landau reflex,
Parachute reaction etc..) and special senses (vision and hearing). All
high-risk infants must be subjected to detailed assessment of hearing
and vision at the age of 6 months.
• Factors associated with deafness during infancy include prematurity,
meningitis,
cranio-facial
malformations,
hypoxic-ischemic
encephalopathy, congenital viral infections, kernicterus, prolonged
use of aminoglycosides and furosemide, parental consanguinity and
family history of deafness.

25. • The child is placed in different postures and positions
depending upon his chronological age and assessed for
expected developmental responses as given below.
• In preterm babies corrected age (conceptional age) should be
used as the chronological age especially during first year of
life.

26. Risk Factors for likelihood of
developmental impairment
Prenatal factors
• Use of drugs or alcohol, severe toxemia and viral infection.
Perinatal factors
• Prematurity, LBW, obstetric complications.
Neonatal factors
• Neonatal encephalopathy, infection like sepsis or meningitis
and severe hyperbilirubinemia.

27. Postnatal factors
• Injury or meningitis, encephalitis, exposure to toxins, severe
continuous failure to thrive and severe epilepsy.
Family history
• Visual and hearing as well as specific learning.

28. Different Domains of Development
1. Gross motor development.
2. Fine motor development.
3. Social/ cognitive/ intellectual development.
4. Speech and language development.
5. Vision and hearing development.

29. Ventral Suspension
• The examiner suspends the infant in a prone position by
supporting the abdomen of the baby on his palm. The
extension of neck and flexion of the extremities is observed.

30. Ventral Suspension
Newborn
Head hangs completely and back is rounded.
4 weeks
Head momentarily lifted up, elbow flexed.
6 weeks
Head held momentarily in the same plane as rest of the
body.
8 weeks
Head maintained in the same plane as rest of the body
and momentarily lifted beyond this.
12 weeks
Head maintained well beyond the plane of the rest of the
body.

31. Prone Position
Newborn
Head is kept to one side, pelvis is raised, knees are drawn
up under the abdomen.
4-6 weeks
Hips and knees are partially extended, can lift chin off the
couch momentarily.
8 weeks
Head maintained in midline with chin lifted off the couch.
16 weeks
Chest is maintained off the couch, arms are stretched out in
full extension.
20 weeks
The body is supported on forearms.
24 weeks
Weight is supported on hands, and baby rolls prone to supine.
Indian babies first learn roll from supine to prone because they
are usually not nursed in a prone position.

32. Supine Posture and Sitting
• The infant is placed supine on the couch and pulled to sitting
position by lifting at the forearms (traction response).

33. Newborn
Complete head lag.
4 weeks
Head maintained in plane of the body momentarily when baby is held in a
sitting position, back is rounded. Chin may be lifted up momentarily.
12 weeks
Head held up when supported in a position but it tends to bob (bend)
forwards.
16 weeks
When pulled up, there is slight head lag during the beginning and then head
is flexed beyond the plane of the body. When held in sitting position and baby
is swayed (swung), the head wobbles.
20 weeks
No head lag, head is stable without wobbling (shaking) and back is straight.
24 weeks
When about to be pulled up, lifts head off the couch in anticipation. Can sit
supported in a pram (baby carriage) or high chair.
28 weeks
Can sit on the floor with hands forward for support.
32 weeks
Can sit momentarily on the floor without support.
36 weeks
Sits steadily without support and can lean forward and recover his balance.
40 weeks
Can sit up from supine position.
48 weeks
Can turn side ways and twist around to pick up an object.

34. Ventral Suspension Standing and Walking
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Newborn
8 weeks
24 weeks
28 weeks
36 weeks
44 weeks
48 weeks
1 year
15 months
Walking reflex for 2 to 3 weeks.
Can hold head up more than momentarily.
Puts almost all weight of the body on the legs.
Bounces with pleasure.
Pulls self to stand, can stand with support.
Lifts one foot while standing.
Walks two hands held or on holding the furniture.
Walks few steps independently.
Creeps upstairs, can kneel without support.

35. • 18 months
• 2 years
• 2 ½ years
• 3 years
• 4 years
• 5 years
Can get up and down the stairs without help, pull a wheeled
toy.
Walks up and down the stairs with two feet on each step,
walks backwards on imitation, picks up objects from floor
without falling, runs, can kick a ball.
Can walk tiptoes, jumps on both feet.
Goes upstairs with one foot on each step, jumps off the
bottom step.
Comes down stairs with one foot on each step, can skip on
one foot.
Skips on both feet.

36. Social Mental and Language
4 weeeks
Watches mother intently when she speaks to him. Follow a dangling object upto 900,
quietens on sound of bell.
6 weeks
Social smile, follows moving person.
8 weeks
Fixes and focuses gaze, eye-to-eye contact, vocalizes.
12 weeks
Hand regard, recognizes mother, can follow an object upto 1800 , babbles when spoken to,
squeals with pleasure and gets excited on seeing a toy.
16 weeks
Demonstrates excitement when feed is being prepared, laughs loud, turns head towards
sound of bell/ rattle.
20 weeks
Smiles at mirror image, dry during day time if toilet trained.
28 weeks
Imitates actions and sounds, enjoys ‘peek-a-boo’ and ‘pat-a-cake’ games, responds to
name, pats mirror image, says monosyllables like ba, da, ma.
32 weeks
Imitates sounds, responds to ‘no’, produces disyllables like ma-ma, ba-ba, da-da etc
40 weeks
Pulls clothes of mother to attract attention, waves bye-bye, repeats performance which is
laughed at.
1 year
Gives toy to examiner, interested in picture book, shakes head for ‘no’, says 2-3 words with
meaning.
1.5 year
Jargon speech, indicates the need for pottie and when parts are wet.
3 year
Normal speech, attends to toilet needs except for wiping, can dress and undress.

37. Developmental Milestones: Gross Motor
Development
Age
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3 months
5 months
8 months
9 months
10 months
11 months
12 months
13 months
18 months
24 months
36 months
Milestone
Neck holding
Sitting with support
Sitting without support
Standing with support
Walking with support
Crawling (creeping)
Standing without support
Walking without support
Running
Walking upstairs
Riding tricycle

38. Fine Motor
Age
Milestone
4 months
Grasps a rattle or rings when placed in hand
5 months
Reaches out to an object and holds it with both hands (intentional
reaching with bidextrous grasp)
7 months
Holding objects with crude grasp from palm (palmar grasp)
9 months
Holding small object, like a pellet, between index finger and thumb
(pincer grasp).

39. Language
Age
Milestone
1 month
Turns head to sound
3 months
Cooing
6 months
Monosyllables (‘ma’, ‘ba’)
9 months
Bisyllables (‘mama’, ‘baba’)
12 months
Two words with meaning
18 months
Ten words with meaning
24 months
Simple sentence
36 months
Telling a story

40. Personal Social
Age
Milestone
2 months
Social smile
3 months
Recognizing mother
6 months
Smiles at mirror image
9 months
Waves ‘bye-bye’
12 months
Plays a simple ball game
36 months
Knows gender

41. Developmental Delay
• During periodic visits of the child to the physician for health assessment
and immunization, the child should always be screened for behavioral
development by a relatively simple method which could be performed
rapidly and accurately even by a non-professional clinical assistant.
•
If this behavioral assessment indicates delayed development, the child
should be examined in detail to determine the cause for such delay.
• Lewis R First and Judith S Palfrey (1994) outlined several risk factors in
developmental delay that can be easily identified in routine clinical and
developmental examination.
• A developmental delay should be suspected if a child is not able to perform
the given tasks by the indicated ages.

42. Developmental delay should be suspected if the child is not able to :
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Pull up to sit by 4 months.
•
Roll over by 5 months.
•
Sit without support by 7-8 months.
•
Stand holding on by 9-10 months.
•
Walk by 15 months.
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Climb up or down the stairs by 2 years.
•
Jump with both feet by 2.5 years.
•
Stand momentarily on one foot by 3 years.
•
Hop (step) by 4 years and walk in a straight line back and forth
or balance on one foot for 5-10 seconds by 5 years.

43. Target milestones
The developmental milestones are achieved by healthy normal children within
a narrow range of several weeks. The recommended corrected ages (calculated
from the expected date of delivery) for undertaking developmental assessment
are 4 months, 8 months, 12 months and then every 6 months till 3 years of age.
The upper age limits for achievement of some of the target milestones are
given below:
1.
2.
3.
4.
Lack of social smile by 2 months.
Absence of stable head control by 4 months.
Inability to recognize the mother by 6 months.
Inability to sit when pulled to sit by 6 months and
lack of independent sitting without support by 8 months.

44. 5.
6.
7.
8.
9.
10.
Lack of creeping by 9 months.
Inability to stand without support by one year.
Inability to walk without support by 18 months.
Absence of syllabic babbling by the age of one year and
to make meaningful sentences by 3 years of age.
Lack of pincer grasp by the age of one year.
Inability to play interactive games by the age of one year.
failure
These children should be subjected to a detailed developmental assessment by an
experienced developmental psychologist. The developmental milestones are achieved
by healthy normal children within a narrow range of several weeks. The recommended
corrected ages (calculated from the expected date of delivery) for undertaking
developmental assessment are 4 months, 8 months, 12 months and then every 6 months
till 3 years of age.

45. Developmental Screening Charts
• Sophisticated developmental testing instruments are time
consuming and requires the services of a trained
developmental psychologists.
• They are useful for detection of borderline abnormalities s well
as research purposes.
•
There is a need to develop reliable simple developmental
charts which can be used by a medical health worker or
clinician of the related field.

47. Bayley Developmental Screening Chart
• The Bayley Scales of Infant Development (BSID) measure the
mental and motor development and test the behavior of infants
from one to 42 months of age.
• The BSID are used to describe the current developmental
functioning of infants and to assist in diagnosis and treatment
planning for infants with developmental delays or disabilities.
•
The test is intended to measure a child's level of development
in three domains: cognitive, motor, and behavioral.

48. • The BSID were first published by Nancy Bayley in The Bayley Scales of
Infant Development (1969) and in a second edition (1993).
• The scales have been used extensively worldwide to assess the
development of infants. The test is given on an individual basis and takes
45–60 minutes to complete. It is administered by examiners who are
experienced clinicians specifically trained in BSID test procedures. The
examiner presents a series of test materials to the child and observes the
child's responses and behaviors.
• The test contains items designed to identify young children at risk for
developmental delay .

49. BSID evaluates individuals along three scales:
• Mental scale: This part of the evaluation, which yields a score called the
mental development index, evaluates several types of abilities:
sensory/perceptual acuities, discriminations, and response; acquisition of
object constancy; memory learning and problem solving; vocalization and
beginning of verbal communication; basis of abstract thinking; habituation;
mental mapping; complex language; and mathematical concept formation.
• Motor scale: This part of the BSID assesses the degree of body control,
large muscle coordination, finer manipulatory skills of the hands and
fingers, dynamic movement, postural imitation, and the ability to recognize
objects by sense of touch (stereognosis).

50. • Behavior rating scale: This scale provides information that can be used to
supplement information gained from the mental and motor scales.
• This 30-item scale rates the child's relevant behaviors and measures
attention/arousal, orientation/engagement, emotional regulation, and motor
quality.
• The BSID are known to have high reliability and validity. The mental and
motor scales have high correlation coefficients (.83 and .77 respectively)
for test-retest reliability.

51. Trivandrum Developmental Screening
Chart (TDSC)
• It is suitable for developmental screening of children below 2
years by a paramedical health worker.
• The range of each test item has been taken from the norms
obtained on the Bayley scales of infant development.
•
It is based on 17 simple test items carefully chosen from
among 67 motor items of Bayley scales of infant development
(Baroda norms).

52. • The left hand side of each horizontal dark line represents age at which 3
percent of children passed the item and the right edge represents the age at
which 97 percent of the children passed the item in studies conducted at
Trivandrum.
• A plastic ruler or pencil is kept vertically at the level of chronological age
of the child being tested. If the child fails to pass any item that lies to the
left side of the age marker, the child is considered to have developmental
delay.
• It is simple to use and takes 5 to 7 minutes to administer. It is best suited to
use in infants around one year of age because most of the test items are
concentrated around that age period.

53. Baroda Developmental Screening Test
(BDST)
• To simplify the Bayley scales of infant development, 22 motor items and
31 mental items, not requiring any standardized equipment have been
retained. These items were grouped age wise, one monthly in the first 12
months and 3 monthly thereafter till 30 months.
• The 50 percent and 97 percent age placement of each item has been plotted
on a graph and joined to have two smooth curves. The total number of
items passed by a child is plotted against his chronological age (or
corrected age if preterm).
• When this point falls below 97 percentile curve, the child is considered to
have developmental delay and is subjected to detailed assessment.

54. Vineland Social Maturity Scale (VSMS)
• The Vineland Social Maturity Scale measures social competence, self-help
skills, and adaptive behavior from infancy to adulthood. It is used in
planning for therapy and/or individualized instruction for persons with
mental retardation or emotional disorders.
•
The Vineland Social Maturity Scales (VSMS), published by Edgar Doll in
1935, measures social maturity or social competence in individuals from
birth to adulthood.
• The Vineland scale, which can be used from birth up to the age of 30,
consists of a 117-item interview with a parent or other primary caregiver.
(There is also a classroom version for ages 3-12 that can be completed by a
teacher.)

55. •
Doll classified eight categories of items on the VSMS (Doll, 1935): selfhelp general, self-help dressing, self-help eating, communication, selfdirection, socialization, locomotion, and occupation.
• Although there is some difference of opinion as to whether Doll's
categorization is the best, the perception of adaptive behavior as
multidimensional has survived from one generation to the next.
• The test is untimed and takes 20-30 minutes. Raw scores are converted to
an age equivalent score (expressed as social age) and a social quotient.

56. • Personal and social skills are evaluated in the following areas:
1. daily living skills (general self-help, eating, dressing);
2. communication (listening, speaking, writing);
3. motor skills (fine and gross, including locomotion);
4. socialization (interpersonal relationships, play and leisure, and coping
skills);
5. occupational skills;
6. and self-direction. (An optional Maladaptive Behavior scale is also
available.)

58. Denver Developmental Screening Test
(DDST)
• The Denver Developmental Screening Test (DDST) is a widely used
assessment for examining the developmental progress of children from
birth until the age of six, devised in 1969.
•
There were concerns raised from that time about specific items in the test
and, coupled with changing normal values, it was decided that a major
revision of the test was necessary in 1992. It was originally designed at the
University of Colorado Medical Center, Denver, USA.

59. Test design
The test consists of up to 125 items, divided into four parts:
• Social/personal: aspects of socialisation inside and outside the home, eg
smiling
• Fine motor function: eye/hand co-ordination, and manipulation of small
objects, eg grasping and drawing
• Language: production of sounds, ability to recognise, understand, and use
of language, eg ability to combine words
• Gross motor functions: motor control, sitting, walking, jumping, and other
movements
• Ages covered by the tests range from birth to six years.

60. Application
• No special training is required.
• The test takes approximately 20 minutes to administer and interpret.
• There may be some variation in time taken, depending on both the age and
co-operation of the child.
• Interviews can be performed by almost anyone who works with children
and medical professionals.
• The items are recorded through direct observations of the child plus, for
some points, the mother reports whether the child is capable of performing
a given task.
• Younger infants can sit on their mother's lap.
• The test should be given slowly.

61. Interpretation of the test
• The data are presented as age norms, similar to a growth curve.
• Draw a vertical line at the child's chronological age on the charts; if the
infant was premature, subtract the months premature from chronological
age.
• The more items a child fails to perform (passed by 90% of his/her peers),
the more likely the child manifests a significant developmental deviation
that warrants further evaluation.

63. Seguin Form Board (SFB)
• The Seguin Form Board Test is based on the single factor theory of
intelligence, measures speed and accuracy.
•
It is useful in evaluating a child's eye-hand co-ordination, shape-concept,
visual perception and cognitive ability. The test primarily used to assess
visual-motor skills.
• It includes Gesell figures where in the child is ask to copy ten geometrical
figures to evaluate visual-motor ability. Test materials consist of ten
differently shaped wooden blocks and a large form board with recessed
corresponding shapes.

65. Interpretation of Findings
1.
2.
3.
4.
5.
6.
The global developmental delay in all the spheres (motor, adaptive, social,
language etc..) is suggestive of mental retardation.
Isolated delay in gross motor development may occur due to poor physical
growth due to protein energy malnutrition.
Lack of environmental stimulation and poor interaction by parents may
adversely affect neuromotor development.
Delay in an isolated sphere of motor development like walking may be
due to congenital dislocation of hips.
Isolated delay in the development of speech is most commonly due to
deafness.
Autistic children must be differentiated from children with mental
retardation. Autistic children may have normal development upto certain
age and then regress especially in their social and communication skills.

66. • The childhood autism rating scale and autism behavior checklist are useful
assessment tools. Patients with fragile X syndrome, congenital rubella
syndrome, tuberous sclerosis and Rett syndrome may have some autistic
mannerisms.
• Children with attention deficit hyperactivity disorder (ADHD) may have
learning disability and school problems due to hyperactivity and poor
attention span.

67. • They may have antisocial behavior like disobediency, defiance, lack of
discipline, destructiveness, fire setting and inflicting harm to others.
• They have associated language and learning disability due to distractibility
and short attention span.
• The diagnosis is facilitated by using Connors questionnaires which are
comprised of 28 items for teacher and 48 items for parents for objectivized
evaluation of children with ADHD.

68. References
•
•
•
•
•
•
•
•
•
Singh M. Paediatric Clinical Methods.2nd ed. New Delhi. Sagar Printers and publishers, New
Delhi.
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