SUPPLEMENTAL HANDOUT # 2: DEVELOPMENTAL ASSESSMENT

Principles of Development:

A continuous process closely linked to the maturation of the central nervous system progresses in a
cephalo-caudal and proximo-distal pattern. Responses proceed from generalized reflexes to discrete
voluntary actions. Developmental sequence is orderly and predictable rate varies from child to child. Though
an age level is assigned to each milestone, the actual age at which a milestone is achieved by a normal
child may range within 2 months of this age level in the first year of life to 4 months from the 2nd year
onwards.

Developmental History

1. Gross motor
a. Sit without support
b. Crawl
c. Pull to stand
d. Walk alone
e. Ascent/descend stairs

2. Fine motor
a. Visual tracking
b. Reach for objects
c. Drink from cup
d. Scribble

3. Receptive Language
a. Turn to sound
b. Respond to name calling
c. Understand “no”
d. Follow commands with gestures
e. Follow commands without gestures

4. Expressive Language
a. Babble
b. Discriminate “mama and “papa”
c. Utter 2-ward sentences

5. Personal/Social
a. Do “close-open/bye-bye”
b. Eat with spoon
c. Toilet trained
d. Dress/undress self
e. Help in domestic activities

DEVELOPMENTAL PROFILE BY AGE

 GROSS MOTOR FINE MOTOR RECEPTIVE EXPRESSIVE PERSONAL/
LANGUAGE LANGUAGE SOCIAL
4 wks.  Holds chin off  Follows dangling  Quiets when  Cries  Stops crying
table object bell is rung when picked
up or spoken
 Head to one to
side
6 wks.  Chin raised off  Eyes fixate on  Smiles in
couch objects response to
 Follow moving overtures
persons
2 mons  Holds chest on  Follows moving Social smile  Vocalizes
table person and toys
 Heads up 450 to midline
 Head mostly  Follows a ring
midline 180
 Slight grasp
reflex
3 mos  Supports self  Follows a ring Turns eyes  Coos and
on forearms in circle and/or head to squeals
 Face up 45-90  Hands together sound
 Pulls to sit with  Holds rattle for Quiets to
little head lag a few seconds sound
4 mos  Supports self  Plays with rattle Orients self to  Laughs aloud
on wrists placed in hand voice
 Face 90 to Excited at sight
couch of food and
 Sits with head toys
steady
5 mos.  Rolls over  Grasps cube Orients self to  Ah-Goo
 Pulls to sit with and takes to bell
no head lag mouth Turns to
 Transfers an rattling sound
object Smiles at
mirror image
6 mos.  Supports  Palmar grasp Looks to see  Babbling
weight on  Drops one cube where dropped
hands when another is toy is
 Prone to given
supine  Reaches for
 Sits with and shakes rattle
support  Holds bottle
 Bears weight
 Bounces
7 mos  Sits with hand  Retains cube Orients self  Single syllables  Pats image
on couch for when another is toward bell of self in
support offered upward mirror
 Transfers cube indirectly
and bangs on
table
8 mos.  Sits  Takes two Responds to  Combines  Imitate
momentarily cubes ‘no’ syllables sounds
without support  Inspects a ball Looks for  Indiscriminate
dropped toy ‘mama’, ‘dada’

9 mos  Pulls self to  Thumb-finger Orients self  Gesture  Peek-a-boo

stand approach toward bell language  Feeds self
 Stands, holding  Bangs two directly upward with crackers
on to furniture cubes together Understands
‘no, bye’
Imitates verbal
and other
playful sounds
10 mos.  Pulls self to  Index finger Responds to  Discriminates  Waves ‘bye’
sitting position approach words ‘mama’, ‘dada’  Pat-a-cake
 Crawls on  Combines cube Pulls clothes of
abdomen and cup another to
attract
attention
 GROSS MOTOR FINE MOTOR RECEPTIVE EXPRESSIVE PERSONAL/
LANGUAGE LANGUAGE SOCIAL
11 mos.  Creeps  Mature Holds object to  One word other  Holds arm
overhand pincer examiner but than ‘mama’, out for
 Puts objects in will not release ‘dada’, or other sleeve and
and out of family members foot out for
container  shoe
 Helps with
dressing
12 mos.  Walks holding  Drops and Follows one  Two or three  Kisses on
on to furniture throws toys step command words with request
or with hands deliberately with gestures meaning
held  Points with
 Bear crawl index finger
 Bottom  Releases one
shuffling cube into cup
15 mos  Creeps  Tower of two Asks for  Several  Drinks from
upstairs cubes objects by intelligible cup
 Scribbles pointing words  Takes off
spontaneously Imitates  Jargoning shoes
mother in  Indicates wet
household pants
activities
Follows one
step command
without
gestures
18 mos.  Walks upstairs,  Tower of three Points to two  Many intelligible  Holds spoon
one hand held to four cubes or three body words  Imitates
 Seats self on  Spontaneous parts everyday
chair scribbling Two simple activities
 Palmar or orders
primitive tripod One common
grasp object
One picture
card
2 yrs.  Walks, upstairs  Tower of six to Points to four  Two word  Spoon feeds
and down, 2 seven cubes body parts sentences without
fee per step  Imitates train of Two step  50 word spilling
 Kicks ball cubes command vocabulary  Washes and
 Throws small  Imitates vertical Four simple  Echolalia dries hands
ball overhand and circular orders  Joins in nursery  Verbalizes
 Climbs on strokes Three to five rhymes and toilet needs
furniture  Turns doorknob common songs  Usually dry
 Unscrews lids objects through day
Points to five,  Puts on
names three socks, shoes
picture cards  Imitates
Refers to self domestic
by name activities
2.5 yrs.  Walks upstairs  Tower of eight Knows full  200 or more  Eats skillfully
confidently, cubes name and sex words with spoon
downstairs  Holds pencil Two digits  Used ‘I’, ‘me’,  Attends to
holding rail with improved forward ‘you’ needs
 Walks on tiptoe tripod  Asks ‘what?’, without help
 Run well ‘who”?  Usually dry
 Jumps on both through night
feet  Puts on
 Casts ball at clothes
body level  Brushes
teeth with
help
3 yrs.  Upstairs, one  Tower of nine Names one to  Three word  Eats with
foot per step cubes two colors sentences spoon and
 Downstairs,  Copies circle Names eight  250 words fork
two feet per  Imitates cross picture cards vocabulary  Dry through
step  Draws a man Obeys two  Asks ‘what’, the night
 Jumps off with head and prepositions ‘where’, ‘who’  Dresses and
bottom step one or two other Repeats three questions undresses
body parts digits
 GROSS MOTOR FINE MOTOR RECEPTIVE EXPRESSIVE PERSONAL/
LANGUAGE LANGUAGE SOCIAL
 Can stand and  Thumb wiggle Knows some  Plurals, fully if helped
walk on tiptoe  Matches two or nursery pronouns, and with buttons
 Stands three primary rhymes prepositions  Helps in
momentarily on colors Briefly  May count by doing
one foot describes rote 1-10 activities
 Kicks ball present
forcibly activities and
 Rides tricycle past activities
 Throws ball and past
overhand experiences
3.5 yrs.  Copies bridge Names ten
picture cards
Repeats three
digits
Obeys three
prepositions
4 yrs.  Walks or runs  Tower of ten or Gives full  Tells tall and  Eats
up and down more cubes name, long stories skillyfully
the stairs  Builds three address, age  Knows several with spoon
 Can stand, steps with six Enjoys jokes nursery rhymes and fork
walk, run on cubes Appreciates  Speech  Attends to
tiptoe  Imitates gate past, present, grammatically own toilet
with cubes future correct, needs
4.5 yrs.  Copies gate Repeats four
 Copies square digits,
and cross Gives full
name, age,
and birthday
5 yrs.  Walks easily on  Copies square Gives address  Speech fluent  Uses knife
narrow line and triangle Acts out stories  Defines and for
 Runs lightly on  Copies letters Repeats four concrete nouns completely
toes V, H, T, O, X, L, digits by use  Washes and
 Skips, alternate A, C, U, Y Distinguishes completely dries face
feet  Writes a few AM from PM intelligible and hands
 Hops two or letters compares two  Asks why,  Dresses
three yards spontaneously weights when, how, and alone
 Can stand on  Draws a man Knows three word meaning  Character is
one foot 8-10 with head, trunk, adjectives  Counts by rote more
seconds legs, arms, and Defines five up to 20 or independent,
 Stands on features words time more protective,
preferred foot  Draws a house Obeys four  Counts objects comforting,
with arms  Holds and uses prepositions in and
folded pencil in adult Knows three correspondence cooperative
 Stands on one fashion adjectives up to four or five  Can button
foot 3-5  Copies cross, Repeats three clothes fully
seconds V, H, T, O digits  Can dress
 Hops on  Draws a man Right and left and undress
preferred foot with head, legs, discrimination except for
 Expert rider of trunk Distinguishes laces, back
tricycle  Threads beads larger of two buttons
 Climbs ladders  Matches and lines  Brushes
and trees names four teeth
 Stands on one colors  Takes turns
foot 3-5  Holds and uses or shares
seconds pencil in adult  Shows
 Hops on fashion concern for
preferred foot  Copies cross, younger
 Expert rider of V, H, T, O sibling,
tricycle  Draws a man sympathy for
 Climbs ladders with head, legs, playmates
and trees trunk  Imaginative
 Bends and  Threads beads play with doll
touches toes  Matches and
names four
colors
 Colors neatly
 Counts fingers
 GROSS MOTOR FINE MOTOR RECEPTIVE EXPRESSIVE PERSONAL/
LANGUAGE LANGUAGE SOCIAL
 Names four
colors
 Matches 10-12
colors

6 yrs.  Copies Names

diamond weekdays
Knows right
from left
Knows number
of fingers
Repeats five
digits

A patient’s development quotient (DQ) may be computed as follows:

1. Compute for the actual age: Present Date (Year/Month/Day) – Birthdate (Year/Month/Day)

e.g. 2009 6 10 (Present Date: June 10, 2009)

1998 4 8 (Birthdate: April 8, 1998)

11 2 2 (Actual age: 11 years and 2 months

2. Using the table above, note the age of the patient (in months) for each domain, according to what
they can already perform

3. For each domain, compute for the DQ by dividing the determined age (#2) by the actual age (in
months).

RED FLAGS OF DEVELOPMENTAL DISORDERS

Key Points in Child Development

A child’s development generally follows a predictable pattern or course and often uses developmental
milestones. The acquisition of specific skills at various ages serves as milestones to monitor a child’
developmental progress. These milestones however appear at various ages in children and for purposes
of monitoring or surveillance, the concept of “limit age” is crucial.

Limit age refers to the age of which the majority of children already show the skill or ability. Hence a child
who has not yet shown the ability for that particular milestones constitutes a “red flag sign”.

What are red flag signs?

Red flag signs refer to developmental milestones not appearing at the expected age. It can serve as warning
signs when a child cannot do something by a certain age, the presence of which should alert the parent or
physician of a potential delay and warrant further developmental screening or evaluation by a professional
or a specialist.

Why is early detection important?

Detection of children with developmental delays is crucial as it leads to further evaluation, diagnosis and
treatment or intervention. It has been shown that for these children, maximal gains are achieved if early
intervention services are initiated. It is therefore important for parents and professionals handling children
in their growing up years to be familiar with the “red flag signs” for the various developmental milestones
for early detection and prompt evaluation as

What are the Developmental Red Flags?

1. Motor delay
a. Poor head control by 3 months
b. Hands fisted by a 4 months
c. Unable to hold objects by 7 months
d. Does not sit independently by 10 months
e. Cannot stand on one leg by 3 years old
2. Language delay
a. Does not turn to sound by 6 months
b. Does not babble or use gestures by 12 months
c. No single word utterances by 16 months
d. No 2 word phrases by 2 years
e. No 3 word phrases by 3 years

3. Psychosocial delay
a. No social smile by 3 months
b. Not laughing in playful situations by 6 months
c. Hard to console, stiffens when approaches by 1 year
d. In constant motion, resists discipline
e. Does not play with other children at 3 years old

4. Cognitive delay
a. Not alert to mother at 2 months
b. Not searching for dropped objects at 6 months
c. Does not categorize similarities at 2 years
d. Does not know full name at 3 years
e. Cannot count sequentially at 4-5 years
f. Does not know letters or colors at 5 years
g. Does not know birthday or address at 5.5 years