DDST

Lecture on DDST for Children from birth to six years old

1. COLLEGE of NURSING

Development measurement (DDST.)

Sherzad .Kh. Suleman

Msc, pediatric nursing
University of Duhok /College of nursing
Pediatric department

2. Denver Development Screening Test (DDST)

Overview

The Denver is most Way to detect the development problems in children

Administered to children from birth to 6 years
Assess the child's performance on age appropriate tasks
Screens for possible problems

Designed to compare a given child's performance with the performance of other children the
same age

Test is primarily based on examiner's actual observation rather than parent support.

3. What the Denver is not

1. Not an LO. test 2.not a diagnostic tool

4. Consists of 125 tasks, or items. (covering four areas) :

1. Personal -Social: (getting along with people)

2. Fine Motor-Adaptive: (Manipulation of small object )
3. Language: (saying some thing, hearing, understanding)
4. Gross Motor: (sitting, walking, jumping)

U The children are tested on the tasks or items pertinent to

their age
U It must be conducted in a standardized manner

U Kit come with necessary supplies and scoring sheets

5. Value of the Denver Il

To detect the
1. Impression of a child’s overall development
2. potential developmental difficulties

3. compares to other children

Note: It is not a predictor of later development

6. Test Materials:

Note: Children need to be supervised appropriately with test materials to prevent choking or injury

7. FINE MOTOR + ADAPTIVE

LANGUAGE

PERSONAL: SOCIAL

4 6 Li 15 1 y 4 $

Percent of children passing
25 0 75 90

May pass by report — | ©
Footnote no. ZT: Testirem eee

(See back of orem)

Report
= TEST BEHAVIOR

(Check boxes for 1st, 2nd, or 3rd test)
Typical 123
Yes
No
Compliance (See Note 31) 1 2 3
Always Complies 1
Usually Complies
Rarely Complies i
Interest in Surroundings 1.2 3
Alert T
‘Somewhat Disinterested
Seriously Disinterested
Fearfulness 1 2 3
None |

Mild
Extreme

Attention Span 4. 2. 3

Appropriate I
Somewhat Distractable
Very Distractablo t

nm fb 0 HK Fs I Whe etn

MONTHS 2 4 6 9 12 15 18 2 vas 4 5 6
Note: After 24 months, each mark equals 3 month intervals

8. Test Administration

. Should be given with the parent or primary caregiver present

. Make caregiver and child comfortable to elicit most natural response

. Remove boots or shoes that might restrict the child motor movements

. Young child may sit on caregiver’s lap, older child should sit so arms can
rest upon the table & elbows should be level with table top & Infants may
be evaluated on the floor

. It should be shared with parent that the tool is to determine the child’s
current developmental status and that the child is not expected to pass all of

the items.

9. 6. Tasks & Items that the child can perform easily should be administered first

7. Items in Fine Motor-Adaptive next (items that do not require child to speak)

8. Language items next and last the Gross Motor items which is gained as test progresses.
9. Praise child’s efforts even if they fail on an item

10. Keep kit out of sight & only materials being used for current activity on the table

11. For infants (all items be administered with the baby lying down to be tested together)

12. Testing should begin with items that fall completely to the left of the child’s age line,

and continue to the right

10. Age Calculations

Example: Year Month Day

9 30 +17=47
Date of Test 2011 AO at
Date of Birth - 2008 -8 - 20

Age of Child 3 { 77

12. Adjusting for prematurity:

§ Born more than 2 weeks before expected delivery date

§ Are less than 2 years of age

Age of child Year Month Day

Age of Child 2 19

6 weeks premature -1 -14
(30days) (14 days)

Adjusted age of

Child 1 5

14. Number of Items to be tested

Depends on age and ability of child

Step |: in each sector, administer at least three items nearest to and totally to the left of the age line

and every item that is intersected by the age line

Step 2: if the child is unable to perform any item in step | (fails, refuses, has had no opportunity)

administer additional items to left in the appropriate sector until child passes three consecutive

items

D

Continue to administer items to the right of any passes in each sector until three failures are
recorded

The child may be given up to three trials to perform each item, when appropriate, before
scoring a failure

Ask the caregiver or parent if the results are typical of child’s performance.
Note: Consider if the child is ill, hungry, upset, etc.

Rescheduling may be necessary if child is not being cooperative

15. Item scoring

The score for each item should be recorded the bar near the 50% hatch mark. The

following scores are used for the Denver II:

1. “P” for pass — the child successfully performs the item, or the caregivers report
(when appropriate)

2. “F” for Fail- the child does not successfully performs the item, or the
caregivers report (when appropriate) that the child does not do the item.

3. “N.O” for No Opportunity- the has not had the chance to perform the item,
due to restrictions from the caregivers or other reasons. This score may only be
used on “report” items.

4. “R” for Refusal — the child refuse to attempt the item. Refusals can be
minimized by telling the child what to do rather than asking. Report items

cannot be scored as refusals.

16. Interpretation of individual items

Individual items are interpreted first, and then the entire test is interpreted.

a.“ Advanced” Items

If a child passes an item that falls completely to the right of the age

line, the child’s development is considered advanced on that item.

Age Line

po boo

17. b.“Normal” item

Failure or Refusal of individual items do not necessarily indicated a delay in
development. For example, if a child fails or refuses an item that falls completely to

the right of the age line, the child’s development is considered normal.

Age Line Age Line
r DEE r DU

a child can Pass, Fail, or Refuse an item on which the age line falls between the 25% and

75" percentile, and the child’s development on that item will be considered normal.

Age Line Age Line Age Line

18. c. “Caution” Items

Caution when line falls between 75 and 90 percentile and child fails or refuses “C” just to the right of
the bar.

Age Line Age Line Age Line Age Line
T T T T
F R R F

Age Line Age Line

ro == Cc R e) e
d. “Delayed” Items
Age Line Age Line

: Tg | nr (om

A delay is indicated when a child fails or refuses an item that falls completely to

the left of the age line

19. e. "No Opportunity” ltems

Report items which the parent says the child has

not had an opportunity to try are scored as “N.O.”
Age Line Age Line
vo | A No PA

20. Interpretation of the Test

Normal :

D No delay & a maximum of | caution

D Rescreening at next child’s visit.

Suspect:

D Delay (1 ore more) & Caution (2 or more)

D Rescreening after 1-2 weeks to rule out temporary factors such as fatigue, fear,

illness

Untestable:

DD Refusal scores on one or more items completely to the left of the age line or on

more than one item intersected by the age line in the 75" to 90" area.

D Rescreening after 1-2 weeks

21. © Normal

No delay

1 caution

Ruhan 3 months old

There is No any delay & cautions

CHR 10.169) CN ropa Onde OSA K Ft OCOD Wire Ft

22. Referral Considerations

|. After rescreening, test result is suspect or untestable
2.Number of cautions and delays
3.Clinical history, examination

4 Availability of referral resources

23. Ctave you any question