PRESENTATION ON

DEVELOPMENTAL ASSESSMENT

Presented by:-
NAND LAL GORIA
MSc.Pediatrics Nursing
SINPMS,BADAL
OBJECTIVES
 Developmental assessment .
 Causes of developmental delay.
 The goal.
 Purposes of assessment.
 Assessment of development.
• Developmental milestones.
• Developmental history.
• Developmental assessment.
• Levels of achievement with different test
materials.
• Interpretation of developmental
assessment.
• Surveillance tools in development.
INTRODUCTION
 Growth and Development usually refer to
as a unit , express the sum of numerous
changes that take place during the life
time.
 Development refers to a progressive

increase in skills and capacity to function.

 It is qualitative change .
DEFINITION

 It is a process of mapping a child’s

performance compared with children of a
similar age from similar population.
 It includes early identification of problems

through screening and surveillance.

CAUSES
 Antenatal causes
 STORCH Infection
 Chromosomal anomalies
 Brain defect
 Maternal Alcoholism
 Intra uterine ischemia
 Natal causes
 Hypoxia
 Neonatal sepsis
 Birth trauma
 Postnatal causes
 Cerebral palsy
 Meningitis
 Nutritional disorder
 Autism
GOAL
 Togenerate a diagnosis and analyze the
pattern of strength and weaknesses in the
child, family, in order to direct treatment.
PURPOSES OF ASSESSMENT

 To understand the behavior of child so that

the child can be handled intelligently.
 Test may reassure parents or detect

problems in early infancy.

 To learn what to expect from a child at any

age.
 To assess whether there is impairment or
not in development
 To make diagnosis if possible.
 Plan and provide comprehensive care to

child.
ASSESSMENT OF DEVELOPMENT

1. Developmental milestones.
2. Developmental history.
3. Developmental assessment
4. Levels of achievement with different test
materials
5. Interpretation of developmental
assessment
6. Surveillance tools in development
1. DEVELOPMENTAL MILESTONES

 Set of functional skills or age specific

tasks that children can do at a certain age
range.
 Assessed in 4 separate domains-
 Gross Motor
 Fine Motor
 Personal Social Development
 Language Development
2. DEVELOPMENTAL HISTORY

 Family history
 Social history
3. DEVELOPMENTAL EXAMINATION

Observe for -
At age 1-3 months
 Note shape and size of head.
 Look for eye abnormalities.
 Brings hand to mouth.
 Open and close hand loosely.
 Hold object in hand.
 Smile at people.
 Copy facial expressions.
 Follows moving objects with eyes.
 At age 3-6 months
 Turns head to sound.
 Rolls from front to back.
 Eye and hand coordination
 Bubbling.
 Communicate by using sounds, actions,

and facial expressions.

 Recognizes familiar people
 At age 6-12 months
 Rolls on both sides.
 Stand with support.
 Can sit.
 Responds to own name.
 Begins to say letter.
 Understands “no”.
 Look into the eyes for a squint .
 At 1-2 year
 Observe interest, alertness, concentration

and gait.
 Take a few steps without support.
 Sitting position without help.
 Cries when mom or dad leaves.
 Says “mama” and “dada”.
 Copies gestures.
 At 2-5 year
 Observe, interest, alertness, gait and

concentration.
 Kicks a ball.
 Begins to run.
 Copies others.
 Dresses and undresses self
 Knows names of body parts.
 Recognize shapes and colors.
 Name self.
 Watch hand movements for tremor and

ataxia.
 Ask to make circle ,triangle.
4. LEVELS OF ACHIEVEMENT WITH
DIFFERENT TEST MATERIALS
4 months.-A child grasps a cube
voluntarily
 5 months-Drop it voluntarily.
 6 months - Transfers to another hand by.
 7 months- reaches for an out of reach

cube
 9 month- approach cube with its index

finger
1 year - put a cube into container.
 1 ½ year- built Tower of cube .
 2year- 6-7 cubes.
 2 ½ year - 8 cubes .
 3 year- 9 cubes is by.
Drawing
 At 2 year- child copies stokes.
 3 year - He can copy a circle.
 4 year - cross .
 4 ½ year – square.
 5 year- triangle.
5. INTERPRETATION OF DEVELOPMENTAL
ASSESSMENT

Record your observations which include-

 A complete evaluation of history of

developmental milestones.
 Developmental examination.
 Compare your observations to the normal

range of milestones for each age.

 Factors that interfere with exact
interpretation of developmental
assessment are-
• prematurity,
• birth weight,
• head circumference,
• physical illness,
• emotional and
• cultural factors
 Always follow up in a borderline or a

doubtful case.
6. SURVEILLANCE TOOLS IN
DEVELOPMENT

 Developmental surveillance is defined

as a flexible, longitudinal, continuous
process through which potential risk
factors for developmental and
behavioral disorders can be
identified.
Five components :
•Eliciting and attending to the parents
concerns about their child’s development,
• Documenting and maintaining a
developmental history,
• Making accurate observations of the child.
•Identifying risk and protective factors.
• Maintaining an accurate record of
documentation of the surveillance process
and findings.
• Developmental Quotient

DQ= Developmental age *100

Chronological age
Interpretation maximum score
100> = 85 normal
71-84 mild-moderate delay
<= 70 severe delay
Developmental Screening

When to screen:
 At least 3 times before age 3:

• 9 month • 18 month • 24-30 month

 Children suspected to be abnormal on a screening

test should undergo specific tests assessing

intelligence.
DEVELOPMENTAL ASSESSMENT
TOOLS
 Denver development screening test
(DDST)
 Brazelton Neonatal behavioral

assessment
 Bayley’s scale of infant development
 Phatak’s Baroda screening test
 Trivandrum developmental screening

chart.
1. Denver development screening test (DDST)

 Itwas first developed in 1967 .

 later revised in 1992 and presented as

DDST II.
 Administered to children ages birth to six

years.
 Consists of 125 tasks, or items. Includes

four areas:
1. Gross Motor
2. Fine Motor
3. Language
4. Personal –Social
Calculation of chronological
age
Item scoring
. The following scores are used for the Denver II:
1. “P” for pass
2. “F” for Fail
3. “N.O” for No Opportunity-
4. “R” for Refusal
2. Brazelton Neonatal behavioral assessment Scale

 Developed by Dr. Berry Brazelton for

assessing newborn behaviour between
the age of 3 days to 4 weeks old.
 The scale produces a total of 47 scores,

27 are behavioral related and 20 are

reflexes.
 Organized in 6 categories:
 Habituation: length of time it takes a

neonate to reduce response.

 Orientation : time taken to focus and

respond to auditory and visual stimuli.

 Motor Maturity : degree of control of

motor activities and coordination.

 Variation: amount of changes in color,
activity when alert and at peak of
excitement during testing.
 Self quieting Abilities: consoling self

when upset.
 Social Behaviour: Smiling and cuddling

response to caregiver.
3. Bayley’s scale of infant
development
 (BSID) measure the mental and motor
development and test the behavior of
infants from 1- 42 months of age.
 It evaluates three domains:
 cognitive,
 motor, and
 behavioral.
 Two additional tests may or may not be
administered. They include:
The Social-Emotional Scale
The Adaptive Behavior Scale
 It contained three components—

MDI,
Psychomotor Developmental Index (PDI),
Infant Behavior Record.
4. Denver articulation Screening
Examination
 It was introduced in 1967 to evaluate
clarity of pronunciation of young children,
up to age six.
 It evaluate four domains :

• Personal-social,
• fine motor and adaptive,
• language and
• gross motor.
5. Nursing Child Assessment
Satellite Training Scale
 Itwas developed by Dr. Kathryn Barnard.
 Currently 4 standardized scales are

available –
• Nursing child assessment sleep/ activity

(NCASA)
• Nursing Child assessment feeding scale

(NCAFS)
• Nursing child assessment teaching
scale(NCATS)
• Home observation for measurement of
environment(HOME)
6. Good Enough Harris Drawing Test
 Itwas developed by Florence good
enough in 1926 is called as draw –A- man
test.
 Details that are considered as point:
 Gross details
 Attachment
 Head Detail
 Clothing
 Hand Detail
 Joints
 Proportion
 Motor coordination
 Fine head details
 Profile
7. The Gesell Developmental
Schedule
 It was first published in 1925 developed by
Dr. Arnold Gesell.
 It estimate four major areas –

motor,
adaptive,
language and
personal social.
 During the 1 year, development is
assessed every week,
 every 2 weeks till 2 years and
 every 6 months till 5 years of age.
 Scale gives development quotient (DQ) for

each area separately and it also gives

overall DQ.
8. Phatak’s Baroda screening test
 It
was developed by Dr. Promila phatak
in 1991 at, University of Baroda with 25
test items.
 Screening test for motor-mental

assessment of infants, developed from

Bayley Scales of Infant Development.
 The test is relevant for age 0 to 30
months.
 Domains evaluated are :

Gross motor,
fine motor and
cognitive aspects
 10 mints test,suitable for indian children.
9. Trivandrum developmental
screening chart
 It was designed and developed at child
development centre, SAT hospital, college
Trivandrum.
 It has 17 test items from BSID (Baroda

Norms) relevant for 0 to 2 years of age.

 evaluated in three domains :
gross motor,
fine motor and
cognitive
 5 minutes test .
Intelligence Test

 Itassess the problem solving ability.

 The common tests used to assess

intelligence are-
 Standford Binet test (for 2 year onwards)
 Wechsler intelligence scale for children.
 Ravens progressive matrix
Standford Binet test
 In 1905 two French psychologist binet
and simen discover this intelligence test &
was modified by American psychologist
Termon with Binet at Standford
university.
 In 1986 it is known as Standford binet

intelligence test form.

 It can useful for 2- 45 year. It was only

effective only to 16 year.

 Foradult the test result is not accurate or
satisfactory.

IQ=Mental age *100

Chronological age
IQ Interpretation
Below 20 Profound Mental retardation

20-35 Severe MR
35-50 Moderate MR
50-70 Mild MR
91-110 Slow Learner
111-120 Average
121-140 Superior
140 and above Gifted
Wechsler Intelligence test

 American psychologist Wechsler.

 For age 5-16 year.
 Verbal scale is used to assess the

intelligence which involves use of words,

concepts and numbers.
 Itconsist of 6 subsets-
 Test of general information.
 Test of general comprehension
 Test of arithmetic reasoning
 Test of digit span
 Test of distinction between similarity
 Test of vocabulary
Ravens progressive matrix
 Developed by J.C. Raven’s British
psychologist in 1938.
 A nonverbal test typically used to

measure general human intelligence

and abstract reasoning
 for 6-65 years.
 It comprises 60 multiple choice

questions, listed in order of increasing

difficulty.
The Matrices are available in three
different forms
 Standard Progressive Matrices:
It has five sets (A to E) of 12 items each
(e.g., A1 through A12), with items within a
set becoming increasingly complex.
 Colored Progressive Matrices
This test has sets A and B ,with a further
set of 12 items inserted between the two,
as set Ab. presented on a coloured
background, the last few items in set B are
presented as black-on-white
 Advanced Progressive Matrices
It contains 60 items, presented as one set
of 24 (set I), and another of 36 (set II).
Items are again presented in black ink on
a white background, and become
increasingly complex as progress
NURSING RESPONSIBILITY
 Theirprimary responsibility is to organize
and manage the health assessment
process as well as the caregivers
administering assessments.
 Evaluate child’s achievement of expected

developmental level.
 Provide education to client about expected

age-related changes and age-specific

growth and development
 Compare child’s development to expected
age and report any deviations.
 They may also provide training to younger

nurses that lack experience with

assessments.
 Provide education and support .
CONCLUSION

 The period of growth and development

extends throughout the life cycle; however,
the period in which the principle change
occurs is from conception to the end of
adolescence .Growth and development
are continous. Development means that
children of all abilities.
 RESEARCH ARTICLE
Research Statement: Preschool Developmental Screening with Denver
II Test in Semi-Urban Areas
Author : Eratay, Emine; Bayoglu, Birgül; Anlar, Banu
Purpose :To assess the feasibility and reliability of screening
semi-urban preschool children with Denver II, developmental and
neurological status was examined in relation with one-year outcome.
Methodology : Denver II developmental screening test was applied to
583 children who visited family physicians or other health centers in a
province of Turkey. Children with abnormal and suspect results were
evaluated by neurological examination, Development Profile-3 (DP-3),
repeat Denver II or Wechsler Intelligence Scales for Children-Revised
(WISC-R) depending on the age of the child, and teacher's perception
of school performance and behavior within one year of the first
screening. Relationships were investigated between the initial
 Denver II screening test results and neurological
examination findings, neurological risk factors, DP-3,
repeat Denver II test results for children < 6 years old,
WISC-R results for children > 6 years old; domains of
failure in the first and second Denver II tests; and data
obtained from families and teachers regarding school
performance, behavior and attention. No intervention but
routine schooling was given.
Results : DP-3 results were average or above (4/6) or low
average (2/6) in the abnormal Denver II group and
average (9/12) or below average (3/12) in the suspect
Denver II group (p: n.s.), both different from the "normal
Denver II" sample who rated average or above.
 Children with abnormal and suspect Denver II results had
similar rates of abnormality or neurological risk factor in their
histories. They were more likely to score "under average
classroom level" compared to a children attending the same
schools who had normal initial Denver II. WISC-R results
were average or below average in children with abnormal
initial screening with Denver II, and average or above in
those with suspect Denver II.
 Conclusions: In this population with high mobility, more
than half (56%) of the target population could be reached for
follow-up. Suspect or abnormal initial screening results
persisted after 1 year but a small group (2/12 and 2/6
respectively) improved to normal, possibly due to "catching-
up", adverse factors being corrected in the interim period, or
just a false-positive initial result.
REFERENCE
 Gupta Piyush. Essential Pediatric nursing: 2nd ed. New
Delhi: CBS publisher;2010. PP-102-109.
 Ball Jane and blinder Ruth. Pediatric nursing: 2nd ed.
Appleton and Lange Stamford, connecticut.PP-213-214.
 Ghai OP, Paul, Vinod, Bagga, Arvind. Essential Pediatrics:
7th ed.New delhi: CBS Publishers;2009. PP. 22-41.
 Marlow R Dorothy, Redding A Barbara.Textbook of
pediatrics,6th ed.Elsevier publisher;2010.PP-66,974.
 Eratay, Emine; Bayoglu, Birgül; Anlar, Banu. Preschool
Developmental Screening with Denver II Test in Semi-
Urban Areas. journal of Pediatrics &Child Care
(INTERNET) Nov 2015[cited on: 4 Apr];1(2) available from
https://eric.ed.gov/?id=ED563248
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