Developmental Screening 1

Developmental Screening
DDST II
Betsy Johnson, MSN, CRNP
Developmental delays
• 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.
• Only 50% delays are picked up prior to
attending school
Purpose of Testing
• Pick up neurologic issues in early infancy
• Reassure parents of developmental
appropriateness or identify early issues
• Identify social or cognitive issues prior to
school and initiate early intervention
DDST II
• The DENVER II (1992) is a revision and timely
update of the Denver Developmental
Screening Test, DDST (1967).
• The tests cover four general functions:
personal social (such as smiling), fine motor
adaptive (such as grasping and drawing),
language (such as combining words), and
gross motor (such as walking).
Advantages
• Not just reports from parents: actual

observations from examiner used to evaluate.
• Boxes with R in left corner can be assessed by
report.
• Numbers in box have footnote on back.
rR
1
Advantages
• Since the test depicts in graphic form the ages
at which 25%, 50%, 75% and 90% of children
performed each item, it enables the examiner
to visualize at any age from birth to six years
how a given child's development compares
with that of other children.
25% 50% 75% 90%
Application
• No special training is required.
• The test takes approximately 20 minutes to
administer and interpret.
• 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
marked with an R, the caregiver’s report on whether
the child is capable of performing a given task.
Application
• Young children sit on parents lap or have
parent close by.
• Give exam slowly.
• Results depend on cooperation of child.
• Results may be influenced by the child’s
health, stress and fears or behavior.
Test Categories
• Social/personal: aspects of socialization inside
and outside the home
-smiles spontaneously
-wave bye-bye
-feed doll
-dress self
Test Categories
• Fine motor function: eye/hand co-ordination,
and manipulation of small objects
– Grasp rattle
– Thumb-finger grasp
– Tower of cubes
– Copying shapes
Test Categories
• Language: production of sounds, ability to
recognize, understand, and use of language.
– Squeals
– Mama/dada specific
– Words and word combinations
– Knows actions
– Knows adjectives
– Knows definitions
Test Categories
• Gross motor functions: motor control, sitting,
walking, jumping, and other movements
– Holds head up
– Stand/walk
– Throws
– Jumps
– Balance
Kit contains:
• Bell
• Glass bottle
• Set of 10 blocks
• Rattle
• Pencil
• Tennis ball
• Wool
• Raisins
• Bag
• Cup
• Doll
• Baby bottle
Determining Age Line
• Take date today.
• Subtract date of birth.
• Borrow days from months and months from
years if needed.
• Round up or down to months for age line: <15
days down, >16 days up
• Adjust for prematurity of less than 37 weeks.
Subtract weeks premature from current age.
Practice
• Date Today-
• Child born February 7, 2007

• Child born October 28, 2008
• Child born at 32 weeks on December 15, 2008
Interpretation
• 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.
Interpretation
• Assess for any items that falls on the age line
to the left and right.
• Place a P (Pass) or F (Fail) for each item
assessed.
• Fail for item is if F falls completely to the right
of the box. Caution for item if fail falls within
blue shaded area of box (90% peers can
perform)
Interpretation
Interpretation
• 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
• If child refuses a number of items, have them
return in week or two to retest.
• May get number of refusals in hospital setting.
Referral
• 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.
Referral
• Refer back to pediatrician or to specialist in
area.
• Howard County Child find is early intervention
program who send specialists out to home
and evaluate/treat any developmentally
delayed children in Howard County
Clinical development assessment
• See handouts in syllabus book.
Questions???

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Developmental Screening

• Not just reports from parents: actual

• Child born February 7, 2007

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