Developmental Assessment

Developmental Assessment Dr. Vivian Yu

Why is there a need for early identification of developmental disorders? • critical to the well-being of the child o delay may be due to a medical condition o delay may indicate an increased risk of behaviour/ psychiatric disorders or other developmental disorders o early detection may prevent further deterioration and improve future outcomes of those identified • responsibility of every primary care physician Common Presentation of Developmental Delay • Newborn o Dysmorphism o Major organ system dysfunction (feeding/ breathing) • Early Infancy (2-4 mo) o Failure to interact with the environment o Vision and hearing impairment • 6-18 months o gross motor delay • Toddler o Language delay • Preschool o Language difficulties or delays o Behaviour difficulties o Delays in fine motor skills • School Age o Academic underachievement o Behaviour difficulties History • History of illness/ Past medical history • Maternal history • Family history o Relatives with same illness o Consanguinity of parents o Functioning and intellectual capacity of parents • Emotional tone at home Developmental History • The Philippine Society for Developmental and Behavioral Pediatrics states that developmental surveillance is a flexible, continuous and cumulative process Kibbutz 

Psychiatry Third Shifting

• Every well child must be an opportunity for the health care professional to evaluate the overall development of the child • Further developmental evaluation is required whenever the child fails to meet any of the following milestones o Language delay  Turn to sound by 6 months  Babbling and gesturing (pointing, waving bye-bye by 12 months)  Single words by 16 months  2-word spontaneous (not just echolalic) phrases by 24 months  loss of any language or social skills at any age (American Academy of Neurology and Child Neurology Society 2000) o Motor delay  Poor head control by 3 months  Hands still fisted by 4 months  Unable to hold objects by 7 months  Does not sit independently by 10 months o Psychosocial delay  No social smile by 3 months  Not laughing in playful situation by 6 months  Hard to console, stiffens when approached by 1 year  In constant motion, resists discipline  Does not play with other children by 3 years o Cognitive delay  2 months: not alert to mother  6 months: not searching for dropped objects  12 months: no object permanence  3 years: does not know full name  4 ½ years: cannot count sequentially  5 years: does not know letters or colors  5 ½ years: does not know own birthday or address Developmental HistorySCHOOL AGE CHILDREN • Reading skills o slow in learning connection between letters and sounds o confuses basic words 1 of 3

PSYCHIATRY DEVELOPMENTAL ASSESSMENT

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makes consistent reading errors letter reversal (b-d) (p-q) letter inversion ( m-w) transpositions (felt-left) word reversal (was-saw) number reversal (14-41) repeats, omits, or adds words does not like reading at all avoids reading aloud uses fingers to follow a line of print when reading slow to remember facts slow to learn new skills, relies heavily on memorization poor coordination, unaware of physical surroundings and prone to accidents awkward and clumsy, has trouble with fine motor skills

Physical Exam • anthropometric measurements • “Syndromic” appearance • dull facial expression: unreliable • neuro exam: sensory impairments • psychometric testing Screening Test Denver Developmental Screening Test- II (Denver II) o For children ages 0-6 years o 4 domains: gross motor, fine motor, language and social o Materials: bell, set of 10 blocks, glass bottle, rattle, tennis ball, pencil, yarn, raisins, zippered bag, cup, doll, baby bottle o Scoring: P= Pass N= No Opportunity F= Fail R= Refused o Interpretation:  Advance- if child passes item the falls completely to the right of age line  Normal- if child passes, fails, or refuses items where age line falls between the 25th and 75th percentiles  Caution- if child fails or refuses item where the age line falls between the 75th and 90th percentile  Delayed- if child fails or refuses item which falls completely to the left of age line Assessment • Gross Motor, Language, Fine Motor, Social o Either advance, normal, caution, delayed • Pass- if there is no delay OR only 1 caution • Fail- if there are 2 or more delays noted Kibbutz 

• Re-evaluation needed in 3 months if o 1 delay AND/OR o 2 or more cautions • Untestable- there is significant number of refusals or no opportunity test items • Refer to specialist if o Failed test o Classified as untestable on 2 consecutive screening Screening Tools • Assessment tool that gives quantitative DQ for visual-motor/ problem-solving and language abilities • CAT (Clinical Adaptive Test) o Problem-solving items for ages from birth to 36 months • CLAMS (Clinical Linguistic and Auditory Milestone Scale) o Language milestone from birth to 36 months Other test for Visual-motor and Problemsolving Skills • Goodenough-Harris Draw-a-Person test • Gessell figures • Gessell block skills Screening for Language Skills • ELMS (Early Language Milestone Scale) o For 0-3 years o 5-10 minutes to complete o high sensitivity • PEDS (Parent’s Evaluation of Developmental Status) questionnaire o For ages 0-8 years o Structured set of 10 questions about parental concerns in various areas of development • ASQ (Ages and Stages Questionnaires) o for ages 4-48 months o series of 11 questionnaires to be completed at home by parents o multi-domain screen with good sensitivity and specificity For Autism • CHAT ( CHeckilist for Autism in Toddlers) o from 18 months and older, and MCHAT • PDDST (Pervasive Developmental Disorders Screening Test) I and II • STAT (Screening Tool for Autism in Twoyear olds) 2 of 5

PSYCHIATRY DEVELOPMENTAL ASSESSMENT

• SCQ (Social Communication Questionnaire) o Formerly known as Autism Screening Questionnaire (ASQ) For ADHD • Teacher’s ___________ Diagnosis: Labs • Newborn screening • EEG • CT scan • Hearing test Referrals • Pediatrician o Developmental o Genetics • Psychiatrist • Occupational Therapist • Speech Therapist • Special Education Program

Kibbutz 

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