The document covers developmental screening, which is essential for early identification of children at risk for cognitive, motor, communication, or social-emotional delays. It outlines the importance, benefits, characteristics, and various screening tools used for infants and young children, emphasizing that early intervention can minimize long-term disabilities. The American Academy of Pediatrics highlights the critical role of early detection in children's well-being.

1. DEVELOPMENTAL
SCREENING
PRESENTED BY:
Komal Agarwal
MODERATOR:
Mr. Prabhu C

2. OUTLINE:
 Introduction
 Definition of Developmental Screening
 Need & Importance of Developmental Screening
 Characteristics of Developmental Screening
 Benefits of Developmental Screening
 High Risk Babies
 Developmental Diagnosis
 Developmental Screening with Scales
 Conclusion
 References

3. INTRODUCTION:
 Screening tests aim to detect the possible or definite
presence of deviations from the norm & are used to
indicate if further assessment or intervention is
required by comparing children’s abilities to those
of their peers.
 Covers areas of sensory & motor abilities, cognitive
abilities & combined abilities which involves
complex tasks.
 Norm referenced, standardized & individually
administered.

4. DEFINITION:
 Developmental screening is the early identification
of children at risk for cognitive, motor,
communication, or social-emotional delays that
may interfere with expected growth, learning, and
development that may warrant further diagnosis,
assessment, and evaluation.

5. IMPORTANCE OF
DEVELOPMENTAL SCREENING:
 Identify infants who exhibit or who are at risk for a
delay or disorder on one or more areas of
development.
 Early identification & subsequent intervention will
either prevent or minimize long-term disability.

6. CHARACTERISTICS OF A
DEVELOPMENTAL SCREENING TOOL:
 Short (15-20 minutes)
 Inexpensive
 Acceptable to families & infants
A good developmental screening tool is also
standardized, normel & has acceptable reliability &
validity

7. BENEFITS OF SCREENING:
Assists in sorting children into 3 categories:
 Needs additional evaluation - Did not pass screen
 Needs close monitoring/surveillance- Passed screen
but has risk factors
 Needs ongoing monitoring in the context of well-
child care - Passed screen and has no known risk
factors

8. HIGH RISK BABIES:
1. Extremely low birth weight
2. High risk for multi-system disorders
3. Sepsis neonatum
4. Neonatal seizures
5. Maternal substance abuse

9. 9
DEVELOPMENTAL
DIAGNOSIS
PRENATAL
DIAGNOSIS
NATAL
DIAGNOSIS
POSTNATAL
DIAGNOSIS

10. 1.PRENATAL DIAGNOSIS:
 Blood tests
 Maternal serum screening
 Ultrasound scanning
 Chorionic villus sampling
 Amniocentesis
 Fetoscopy

11. 2. NATAL DIAGNOSIS:
 APGAR score
A - Appearance
P - Pulse
G - Grimace
A - Activity
R - Respiration

12. 3. POSTNATAL DIAGNOSIS
 Blood examination
 EMG
 NCV
 Muscle biopsy
 ECG
 Genetic testing
 Lumbar puncture

13. DEVELOPMENTAL SCREENING

14. INFANTS:
1. Alberta Infant Motor Scale (AIMS)
2. Bayley Scales of Infant Development (BSID)
3. Milani- Comparetti Motor Development
Screening Test
4. Movement Assessment of Infants(MAI)

15. NEONATES:
1. APGAR Score
2. Ballard Score
3. Brazelton Neonatal Behavioural Assessment
Scale (BNBAS)

16. YOUNG CHILDREN:
1. Wee Functional Inventory Measure
2. Gesell Developmental Schedules (GDS)
3. Bruininks- Oseretsky Test of Motor Proficiency (BOTMP)
4. Denver II Test
5. Peabody Developmental Motor Scale (PDMS)
6. Gross Motor Function Measure (GMFM)
7. Pediatric Evaluation of Disability Inventory (PEDI)

17. INFANTS

18. 1. ALBERTA INFANT MOTOR SCALE (AIMS)
 Developed by Piper & Darrah (1994)
 Age group: Used from birth to 18 months
 Purpose:
Measures gross motor maturation of infants through
the age of independent walking.
 Motor scales are observed in infants as they move in
& out of the 4 positions (supine, prone, sitting &
standing)

19.  Areas Tested: Fifty-eight gross motor skill items
divided among four positions: prone, supine, sitting,
standing
 The distribution of these items is as follows: 21 prone,
9 supine, 12 sitting, and 16 standing
 Each item observed for the components of: weight
bearing , posture, and anti-gravity movement
 Inter-rater reliability of 0.99 and a test-retest
reliability of 0.99
 Correlation coefficients reflecting concurrent validity
with the Bayley and Peabody scales were determined
to be r = .98 and r = .97, respectively.

20. 2.BAYLEY SCALES OF INFANT DEVELOPMENT
(BSID):
 Developed by Bayley (1993)
 Age group: Used from 1-30 months
 Purpose: Designed to measure physical, motor,
sensory & cognitive development
 Involves interaction between the child & examiner
& observations with tasks ranging from basic to
more complex

21.  Areas Tested: Seventy-two items divided among
six age sets (3, 6, 9, 12, 18, 24 months) each
containing 11-13 items.
 Items are categorized into four “conceptual areas
of ability”:
a. Basic neurological functions/intactness: tone,
reflexes, abnormal signs
b. Receptive functions: visual, auditory, verbal
c. Expressive functions: gross motor, fine motor,
vocalizations
d. Cognitive processes: memory, problem solving,
object performance, attention

22.  Cut scores of low, moderate or high risk for each
of the domains. Items are scored as optimal/non-
optimal. Those performed optimally by the infant
are summed, & the total score is located in relation
to the cut scores to determine the infant's risk
classification.
 Reliability- strong; validity-moderate

23. 3.MILANI-COMPARETTI MOTOR
DEVELOPMENT SCREENING TEST:
 Developed by Milani- Comparetti & Gidoni (1967)
 Age Range: Birth to two years
 Purpose: To identify motor dysfunction in
infants by systematically examining the
integration of primitive reflexes and the
emergence of volitional movement against
gravity

24.  Areas Tested: Twenty-seven items divided into two
groups:
 Spontaneous motor behaviors: locomotion, sitting,
standing
 Evoked responses: equilibrium reactions,
protective extension reactions, righting reactions,
primitive reflexes.

25.  Scoring-
 Normal-81
 Transiently abnormal- 70-80
 Abnormal- <69
Timing- 15-20mins
 Reliability- strong up to 12mths of age
Accuracy higher with reflexes
Lower for equilibrium
Test retest - 0.79-0.98
Inter rater - 89-95%.

26. 4. MOVEMENT ASSESSMENT OF INFANTS
(MAI):
 Developed by Chandler LS, Skillen A and
Swanson MW in 1980
 Age group: Birth to 12 months
 Purpose: To identify motor dysfunction in infants,
especially those considered at-risk and monitor the
effects of physical therapy on infants whose motor
behaviours is at or below one year of age

27.  Areas Tested: Sixty-five items within four areas of
neuro-motor functioning:-
a. Muscle tone: anti-gravity postures, resistance to
passive stretch, and consistency
b. Reflexes: relative presence or absence of primitive
reflexes
c. Automatic reactions: righting, equilibrium,
d. Volitional movement: gross and fine motor
behaviours ,hearing and vision.

28. NEONATES

29. 1.APGAR SCORE:
 Devised by Dr. Virginia Apgar
 The APGAR method is a simple & rapid method for
assessing the new born infant at 1 minute of age & the
need for prompt intervention to establish breathing.
Purpose:
 To assess the clinical condition of neonates
immediately after birth
 Initially used to determine the effects on neonates of
fetal presentation, mode of delivery, type of
anaesthesia, results of obstetrical practice at different
hospitals.

30. Components of APGAR:
 A- Appearance (Colour of skin)
 P- Pulse
 G- Grimace (Reflex Irritability)
 A- Activity (Muscle tone)
 R- Respiration (Respiratory rate)
 Score is reported at 1 and 5 minute after birth
 Rating of 0, 1 ,2 was given to each sign

31. Interpretation of Scoring:
 Values of each item are summed to achieve the total
score
 General appraisal of scores:
 7-10 Satisfactory
 4-6 Infant moderately depressed
 0-3 Infant requires emergency procedures
 A low score at 1 minute test may show that neonate
requires medical attention but not necessarily will
have long term problems.

32.  If APGAR score remains below 3 at later time such
as 10, 20 or 30 minutes there is a risk of child
suffering a long term neurological damage.
Eg: Cerebral palsy
 Though 5 minute APGAR is a valid predictor of
neonatal mortality, using it to predict long term
outcomes was inappropriate
 Such score may be the result of physiologically
immaturity, maternal medications, presence of
congenital malformations.

33. Advantages:
 Associated with delayed congenital anomalies,
developmental delays & hospitalization in first year
 Can be easily measured from abstraction, medical
records or from hospital discharge data
 Easy and rapid administration

34. Limitations:
 Has a limited frame of time & includes subjective
components
 Elements such as tone, color, reflex, irritability
partially depends on the physical maturity of infant
 Factors like preterm birth, trauma, drugs,
infections, influence APGAR
 Scores are difficult to evaluate for preterm infants
 Doesn’t predict long term outcomes (not
appropriate)

35. 2. BALLARD SCORE:
 Used to assess the gestational age & neuromuscular
maturation of the neonate
 Primarily used for the neurological examination of
a preterm infant

36. 3. BRAZELTON NEONATAL BEHAVIORAL ASSESSMENT SCALE:
(BANBAS)
 Developed by Dr. Brazelton & colleagues in 1973
 Age group: 36-40 months
 Purpose: Evaluates the behavioural profile of an
infant up to 2 months of age
 Behavioural stages in the following sequence:
Tight sleep – Alert – Active & crying – Quieter
stage

37. YOUNG CHILDREN

38. 1. WEE FUNCTIONAL INVENTORY MEASURE:
(WEEFIM)
 Developed by Msall (1994)
 Age group: 6mnths- 7 yrs
 Is a family centered questioner consisting of 36
items arranged in 3 domains
Motor (16 items)
Cognitive(14 items)
Behavioural (6 items)
 Purpose: Evaluates degree of dependency
 Administered to parents by interview or self report
 Reliability-<PEDI

39. 2.GESELL DEVELOPMENTAL SCHEDULES: (GDS)
 Developed by Arnold Gesell
 It evaluates the physical, emotional & behavioural
development of infants & young children

40. 3.BRUININKS- OSERETSKY TEST OF MOTOR
PROFICIENCY: (BOTMP)
 Age group: Used from 4.5 through 21 years of age
 Is an individually administered test that uses energy
directed goal oriented activities to measure a wide
array of motor skills
 Highlights motor performance in the broad
functional areas of stability, mobility, strength, co-
ordination, & object manipulation

41. 4.DENVER DEVELOPMENTAL SCREENING TEST:
 Developed by Frankenburg (1970)
 Age group: From 2 weeks to 6 yr
 Purpose: To detect potential developmental
problems in young children and monitor children
at-risk for developmental problems

42.  Areas tested: Consists of 125 items that are divided
into 4 categories:
 Social/Personal : aspects of socialization inside &
outside home
 Fine motor function: hand-eye coordination &
manipulation of small objects
 Language: production of sounds, ability to
recognize, understand & use languages
 Gross motor functions: motor control, sitting,
walking, jumping & other movements
 Reliability- strong; validity-not studied

43. 5.PEABODY DEVELOPMENTAL MOTOR SCALES: (PDMS)
 Developed by Folio (1983)
 Age group: From birth to 6.5 years
 Purpose: Assess both qualitative & quantitative
aspects of gross & fine motor development in young
children
 Timing: 45 to 60 minutes
 Reliability- 72.7-95.3(4mths);
46.1%-60.2%(8mths)

44. Areas Tested: Two hundred forty-nine items divided
into two scales which are further divided into
subtests
Gross Motor Scale: one hundred fifty-one items
divided among three subtests:-Reflexes: primitive,
automatic reactions
Stationary: static, dynamic--Locomotion: walk, run,
jump, hop-Object manipulation: ball handling
Fine Motor Scale: ninety eight items divided among
two subtests :Grasping: basic reach, grasp patterns,
hand use
Visual: motor integration: visual perceptional skills
paired with motor, eye hand coordination

45. 6. GROSS MOTOR FUNCTION
MEASURE: (GMFM)
 Developed by Russell (1993)
 Age group- Birth-16 years
 Purpose- Gross motor function changes over time
 Lying & rolling ; crawling & kneeling ; sitting ;
Standing ; walking, running & jumping
 Reliability- sitting- 0.99; standing-0.99; lying &
rolling-0.98

46. 7.PEDIATRIC EVALUATION OF
DISABILITY INVENTORY: (PEDI)
 Developed by Haley (1992)
 Age group- 6 months to 7.5 yrs
 Areas tested:
Self care- Feeding, dressing, toiletting
Mobility- Transfers, stairs, locomotion
Social function- Communication, peer interaction
 Reliability- 0.79-0.99

47. CONCLUSION:
American Academy of Pediatrics wrote:
"Early identification of developmental disorders is
critically imp. to the well-being of children and
their families. It is an integral function of the
primary care medical home and an appropriate
responsibility of all pediatric health care
professionals."

48. REFERENCES:
 Physical Therapy Assessment in Early Infancy
Irma J. Wilhelm
 Physiotherapy & the growing child
Yvonne R Burns & Julie MacDonald
 Treatment of Cerebral Palsy & Motor Delay
Sophie Levitt
 Developmental Screening Tools: Gross motor/Fine
motor for newborn, infants & children
Nagamani Beligere, Laura Zawacki,
Susan Pennington & Frances p Glascoe

49.  Haley SM, Graham RJ, Dumas HM. Outcome
rating scales for paediatric head injury. J Intensive
Care Med.2004; 19:205-219
 Fiser D. Assessing the outcome of paediatric
intensive care. J Pediatr. 1992;121:68-74
 Utility of the WeeFIM for Assessing Outcomes of
Paediatric Orthopaedic Surgery.
Quwstions asked in classss