IMPORTANCE OF DEVELOPMENTAL

ASSESSMENT:
1) Promote understanding of behavior of children –
implications for parents, doctors, teachers

2) Avoid unfairly treating children and inappropriate

punishment

3) Detect any early signs of diseases, as developmental

milestones will be affected in a sick child

4) Allow early intervention of disturbed developmental

achievements

5) Optimize potential of children and allowing some

prediction of future potential

Developmental assessment must be done to cover all areas of

development. One useful thinking frame to avoid missing any
developmental milestones is to use the COMEL METHOD

Ie assessing development by the COGNITIVE

ACHIEVEMENT, OPTIC (Vision), MOTOR, EMOTION
AND PSYCHOSOCIAL and LANGUAGE/HEARING

Zabidi Hussin

Oct 2013

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REASSURING SIGNS OF DEVELOPMENTAL PROGRESS
Gross motor achievements

Walking by 10–14 months

Climbing by 2½ years

Throwing and kicking a ball by 2 years

Pedaling a tricycle by 3 years

Hopping by 4 years

Skipping by 6 years

Fine motor achievements

Stacking three or four blocks by 18 months

Completing simple form boards by 2 years

Threading beads by 3½ years

Cutting a piece of paper by 3 years

Copying geometric shapes by 4 years

Tying shoelaces by 5 years

Printing legibly by 6 years

Speech and language achievements

Speaking single words by 12 months

Making word combinations by 2 years

Making clear, simple sentences and being interested in books and stories by 3 years

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Making conversation clear to others by 3 or 4 years

Reading by 5 to 6 years

Social achievements

Dressing by 2 years

Self-feeding using cutlery by 3 years

Being toilet-trained by 3½ years

Playing cooperatively in groups by 3 years

Playing team games by 7 years

Selected features suggesting the possibility of developmental difficulties

Skills Birth to 3 years 3–5 years 5–8 years

Gross motor Bottom shuffling Delayed or awkward Not skipping (after
skills running 6 years)
Delayed walking
Not pedalling a tricycle Inability to throw, catch
Not climbing or fear or kick a ball
of climbing Bumping into objects
Inability to ride a bicycle
Excessive falling
Tripping over or falling
Not hopping
Not being picked for
team activities
Fine motor Delayed pincer grip Difficulties with cutting Avoiding drawing or
skills (after 10 months) or threading immature drawing

Not stacking blocks Avoiding puzzles and Inability to colour in

constructional toys shapes
Avoiding form boards
and constructional Difficulties with Inability to do up
toys dressing and buttons shoelaces

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 Avoiding pencil tasks Finger feeding rather Messy or illegible
(after 2 years) than using utensils handwriting

Low output of written

work (in terms of both
quantity and quality)
Speech and Absence of single Not using developed Unclear or limited
language skills words (by 18 months) simple sentences (by sentences
2 years)
No interest in books Speech unclear to family
Speech unclear to
Reduced imaginative strangers No interest in books or
play (after 2 years) stories
Use of gestures or mime
more than words (by Delay in reading and
3 years) spelling
Behaviour and Unsettled or sleeping Unsettled sleep Difficulty making friends
social skills poorly
Persistent tantrums Emotional lability
Irritability
Inability to play with Delayed dressing and
Excessive tantrums peers feeding skills
(after 2 years)
Inability to self-dress Reluctance or refusal to
and unawareness of attend school
toileting skills

Block and pencil tests

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The test corresponding to the child’s age is used to screen cognitive and perceptual
development. For the block test, build the structure behind a screen, remove the screen
and then ask the child to copy it. For the pencil test, draw the shape on a piece of paper,
without the child watching, and then ask the child to draw the same shape.

The Goodenough Draw-a-Man Test

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The child is asked to draw a man, and receives a point for each item drawn, with four
points equating to 1 year of age. As children draw circles at 3 years, the basic score is
3 and the formula is: 3 + n/4, which give the child’s approximate mental age (‘n’ is the
number of parts drawn).

Denver Developmental Screening Test

http://www.patient.co.uk/showdoc/40000554/

Dr Hayley Willacy

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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 1992.1
It was originally designed at the University of Colorado Medical Center, Denver USA.

Developmental delay

Developmental delay occurs in up to 15% of children under 5 years of age.2 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.3
 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.
 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.4

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 minimise possible negative consequences.(Although parental concern
may be just as good a predictor for some problems.5)

The move to targeted examinations at ages 2 and 3.5 years, rather than routine, has raised
concerns that some conditions e.g. pervasive developmental disorder may be missed.6
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 characterised by spurts, plateaus and, sometimes regressions.
Gradually screening has been replaced by the concept of developmental surveillance.7
This is a much broader concept. It involves parents, allows for context and should be a
flexible, continuous process.

The Denver II© Development Screening Test

Test design

The test consists of up to 125 items, divided into four parts:

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  Social/personal: aspects of socialisation inside and outside the home
 Fine motor function: eye/hand co-ordination, and manipulation of small objects
 Language: production of sounds, ability to recognise, understand, and use of
language
 Gross motor functions: motor control, sitting, walking, jumping, and other
movements

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 125 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.

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

Referral

Concerns should prompt referral to a general or developmental paediatrician.

 Most paediatricians would prefer to see children early rather than late.
 If development appears normal, then reassuring anxious parents is always
rewarding. On the other hand if there is developmental delay, intervention at the
earliest possible time can make a significant difference to outcome.8

Sensitivity rates are reported between 56-83% for the Denver II©, but specificity may be
as low as 43%, rising to 80%.9 There is a danger of unnecessary referral.
However, research has shown that children over-referred (false positives) because of
developmental screens perform substantially lower on measures of intelligence, language,
and academic achievement - the 3 best predictors of school success - than children with
true negative scores. These children may also carry more psychosocial risk factors, such

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as limited parental education and minority status. Thus, children with false-positive
screening results are an at-risk group for whom diagnostic testing may not be an
unnecessary expense, but can serve as a sign post to focus necessary interventions e.g.
Head Start programmes - intensive, supported nursery places.10

What differentiates the Denver II© from other screening tests?

 It enables the tester to compare a child's development with that of over 2,000
children who were in the standardised population, like a growth curve.
 It consists of items in which a sub-sample (race, less educated parents, gender and
place of residence) which varied a clinically significant amount from the
composite sample, are identified and their norms are provided in the Denver II©
Technical Manual.
 It provides a broad variety of standardised items to give a quick over-view of the
child's development.
 It also contains a behaviour rating scale.

Items necessary to perform test

These include:

 Bell
 Glass bottle
 Set of 10 blocks
 Rattle
 Pencil
 Tennis ball
 Wool
 Raisins
 Bag with zip top
 Cup
 Doll
 Baby bottle
 Interpretation card

Test examples

 When prone lifts head up, using forearm support (with or without hands).
 Throws balls overhand 3 feet to within your reach.
 Bounce a ball. He must catch it. Allow up to three tries.
 Child grasps raisin between thumb and index finger
 "Copy this" (circle). Do not name or demonstrate
 "Give the block to Mum". "Put it on the table". No gestures
 Answer 3/3: "What is a spoon/shoe/door made of?" (no others).
 While he plays with a toy, pull it away. Pass if he resists.

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References

1. Frankenburg WK, Dodds J, Archer P, et al; The Denver II: a major revision and
restandardization of the Denver Developmental Screening Test. Pediatrics. 1992
Jan;89(1):91-7. [abstract]
2. National Health and Medical Research Council. Child health screening and
surveillance: a critical review of the evidence. Canberra: NHMRC, 2002.; 2002
3. Glascoe FP, Dworkin PH; Obstacles to effective developmental surveillance:
errors in clinical reasoning. J Dev Behav Pediatr. 1993 Oct;14(5):344-9. [abstract]
4. Glascoe FP, Dworkin PH; The role of parents in the detection of developmental
and behavioral problems. Pediatrics. 1995 Jun;95(6):829-36. [abstract]
5. Glascoe FP; Parents' evaluation of developmental status: how well do parents'
concerns identify children with behavioral and emotional problems? Clin Pediatr
(Phila). 2003 Mar;42(2):133-8. [abstract]
6. Tebruegge M, Nandini V, Ritchie J; Does routine child health surveillance
contribute to the early detection of children with pervasive developmental
disorders? An epidemiological study in Kent, U.K. BMC Pediatr. 2004 Mar 3;4:4.
[abstract]
7. Oberklaid F, Efron D; Developmental delay--identification and management.
Aust Fam Physician. 2005 Sep;34(9):739-42. [abstract]
8. Shonkoff JP, Meisels SJ, editors. Handbook of early childhood intervention. UK:
Cambridge University Press, 2000
9. Developmental Screening Toolkit. Website
10. Glascoe FP; Are overreferrals on developmental screening tests really a problem?
Arch Pediatr Adolesc Med. 2001 Jan;155(1):54-9. [abstract]

BAYLEY SCALES OF INFANT DEVELOPMENT

Monique Laberge, Ph.D

Definition

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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.

Purpose

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.

Cognitive Development

Cognition can be defined as a process by which knowledge is gained from perceptions or

ideas. Cognitive development refers to how an infant perceives, thinks, and gains an
understanding of the world. Within the history of developmental psychology, the work of
Jean Piaget (1896–1980), the Swiss psychologist, has had the greatest impact on the
study of cognitive development. Piaget's theory is focused on the processes of cognitive
development and states that the child is born with an innate curiosity to interact with and
understand his/her environment. It is through interaction with others that the child
actively constructs his/her development.

Motor Development

During the first two years of life, infants grow and develop in many ways. Two types of
motor development occur at this stage. Cephalocaudal development occurs in the
following sequence: head before arms and trunk and arms and trunk before legs.
Proximodistal development occurs as follows: head, trunk, arms before hands and
fingers. Motor development has a powerful impact on the social relationships, thinking,
and language of infants. Large motor development allows infants to have more control
over actions that help them move around their environment, while small motor
development gives them more control over movements that allow them to reach, grasp,
and handle objects. The sequence of these developments is similar in most children;
however, the rate of growth and development varies by individual.

Behavioral Development

Temperament is the set of genetically determined traits that organize the child's approach
to the world. They are instrumental in the development of the child's distinct personality
and behavior. This behavioral style appears very early in life—within the first two
months after birth—and undergoes development, centered on features such as intensity,
activity, persistence, or emotionality.

Besides measuring normal cognitive, motor, and behavioral developmental levels, the
BSID are also used in cases in which there are significant delays in acquiring certain

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skills or performing key activities in order to qualify a child for special interventions.
Specifically, they are also used to do the following:

* identify children who are developmentally delayed

* chart a child's progress after the initiation of an intervention program
* teach parents about their infant's development
* conduct research in developmental psychology

Description

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. 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).

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.

Precautions

BSID data reflect the U.S. population in terms of race, ethnicity, infant gender, education
level of parents, and demographic location of the infant. The BSID was standardized on
1,700 infants, toddlers, and preschoolers between one and 42 months of age. Norms were
established using samples that did not include disabled, premature, and other at-risk

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children. Corrected scores are sometimes used to evaluate these groups, but their use
remains controversial.

The BSID has poor predictive value, unless the scores are very low. It is considered a
good screening device for identifying children in need of early intervention.

Preparation

Before giving the BSID test to a child, the examiner explains to the parents what will
happen during the test procedure. This is to allow the examiner to establish a focused
rapport with the child once the procedure has started and avoid diverting attention from
the child to the parents during the test. The parents are also asked not to talk to the child
during the BSID test to avoid skewing results.

Risks

There are no risks associated with the BSID test.

Parental Concerns

As of 2004 it was recognized that parental involvement in the developmental assessment

of their children is very important. First, because parents are more familiar with their
child's behavior, their assessment may indeed be more indicative of the child's
developmental status than an assessment that is based on limited observation in an
unfamiliar clinical setting. The involvement of parents in their child's development
testing also improves their knowledge of child development issues and their subsequent
participation in required intervention programs, if any. In cases of developmental
problems, parents should bear in mind that the scoring and interpretation of the test
results is a highly technical matter that requires years of training and experience. Besides
the BSID, parents should be aware that three other infant development scales are
commonly used:

Brazelton Neonatal Behavioral Assessment Scale: This scale tests an infant's

neurological development, interactive behavior, and responsiveness to the examiner, and
need for stimulation. This test is administered during the newborn period only.
Gesell Developmental Schedules: These schedules test for fine and gross motor skills,
language behavior, adaptive behavior including eye-hand coordination, imitation, object
recovery, personal-social behavior such as reaction to persons, initiative, independence,
and play response.

References

Books

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Amiel-Tison, Claudine, et al. Neurological Development from Birth to Six Years: Guide
for Examination and Evaluation. Baltimore, MD: Johns Hopkins University Press, 2001.

Sattker, Jerome M. Assessment of Children: Behavioral and Clinical Applications, 4th

ed. Lutz, FL: Psychological Assessment Resources Inc., 2001.

Assessment of Children: Cognitive Applications, 4th ed. Lutz, FL: Psychological

Assessment Resources Inc., 2001.

Periodicals

Glenn, S. M., et al. "Comparison of the 1969 and 1993 standardizations of the Bayley
Mental Scales of Infant Development for infants with Down's syndrome." Journal of
Intellectual Disability Research 45, no. 1 (February 2001): 55–62.

Provost, B., et al. "Concurrent validity of the Bayley Scales of Infant Development II
Motor Scale and the Peabody Developmental Motor Scales in two-year-old children."
Physical and Occupational Therapy in Pediatrics 20, no. 1 (2000): 5–18.

Voigt, R. G., et al. "Concurrent and predictive validity of the cognitive adaptive
test/clinical linguistic and auditory milestone scale (CAT/CLAMS) and the Mental
Developmental Index of the Bayley Scales of Infant Development." Clinical Pediatrics
(Philadelphia) 42, no. 5 (June 2003): 427–32.

Organizations

American Academy of Child & Adolescent Psychiatry (AACAP). 3615 Wisconsin Ave.,
N.W., Washington, DC. 20016–3007. Web site: www.aacap.org.

American Academy of Pediatrics (AAP). 141 Northwest Point Boulevard, Elk Grove
Village, IL 60007–1098. Web site: www.aap.org.

American Psychological Association (APA). 750 First Street, NE, Washington, DC

20002–4242. Web site: www.apa.org.

Child Development Institute (CDI). 3528 E. Ridgeway Road, Orange, CA 92867. Web
site: www.childdevelopmentinfo.com.

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