development assessment-171030175207.pptx

regarding developmental assessment

1. Developmental Assessment

2. Development It is acquisition of qualitative and quantitative skills in a social environment FOUR AREAS Gross motor development Fine motor development Personal /social development Language development

3. Normal development Pattern is constant Skills acquired sequentially Rate varies from child to child Later goals depend on achieving earlier goal in same field eg . sit before stand, then walk Genetic and environmental factors contribute positively and negatively

4. ‘Milestones ’ Acquisition of a key skill –  Median age – age at which half population acquire the skill –  Limit – age at which a skill should have been achieved, - 2SD from the mean Remember , some are constant ( eg . smile by 8/52), some are not (crawling)

5. Terminology DEVELOPMENT DELAY Discrepancy 25% or more OR 1.5 to 2 SD from normal GLOBAL DEVELOPMENT DELAY Delay in 2 or more domains of development DEVELOPMENT DEVIANCE When child develop milestone or skill outside typical acquisition of sequence DEVELOPMENT DISSOCIATION When child has widely differing rates of development in different domains of development DEVELOPMENT REGRESSION When child loses previously acquired skills or milestone

6. Developmental assessments Process of mapping a child’s performance compared with children of a similar age from similar population – Part of comprehensive medical care

7. Why is it necessary? Reassure if normal development pattern and timings, discuss good parenting Spot regression Any genetic disorder to make? Identify those with specific areas of impairment or global concerns Allows early support or interventions eg . hearing aids, physiotherapy, ? Give Parents time to adjust

8. Developmental assessment Screening brief ,formal ,standardized evaluation aid in the early identification children who should receive more intensive assessment. Surveillance Is flexible , longitudinal , Documenting and maintaining a developmental history Making accurate observations of child

9. Time of Assessment Developmental surveillance - every well child visit Developmental screening- May be completed by parent or clinician Using standardized tool at 9, 18 and 30 months Example- Denver II developmental screening test Phatak ’ s Baroda Screening Test Trivandrum Development Screening Chart CAT/Clams ( Clinical adaptive test/ clinical linguistic and auditory milestone scale) Goodenough - Harris Draw-a-person test

10. Examination: Observations and Interactive Assessment Should take in place in a room with toys appropriate for child With one or both parents, but no prompting and helping Chair and table Child ’ s behavior and interaction with parents during history taking should be observed prior to physical examination Normal functioning of motor, vision and hearing should be assessed

11. Prerequisites Infant or child in a good temper Should not be hungry, tired, unwell, had convulsion prior, under influence of sedative or antiepileptic drugs

12. Equipment Required Ten 1- inch cubes Hand bell Colored and uncolored geometric forms Picture cards Cards with circle, cross, square, triangle, diamond drawn on them Patellar hammer Paper Pellets (8 mm )

13. Ages and Stages Questionnaire (ASQ) - 2nd Ed. Birth to 60 months ~ 15 - 20 minutes A 2 SD below the mean OR a 75 developmental quotient - cutoff score U sed as a first level screening tool to determine which children need further evaluation to determine their eligibility for early intervention. A lso be used to monitor the development of children at risk for disabilities or delays.

14. Definitive Tests These tests are required once screening tests or clinical assessment is abnormal. They are primarily aimed to accurately define the impairments in both degree and sphere. Bayley Scales of Infant and Toddler Development-Third Edition ( Bayley -III) Stanford- Binet Intelligence Scale Wechsler Intelligence Scale Developmental Activities Screening Inventory-SECOND EDITION (DASI-II)

15. Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) Age Range (in years) - Birth to3.5 years Method of Administration/Format Individually administered in play-based format for Cognitive, Language , and Motor Scales; caregiver questionnaire for Social-Emotional and Adaptive Functioning. Yields scaled scores, composite scores, and percentile ranks. Approximate Time to Administer – 50 min. for 1-12 mos.; 90 min. for 13-42 mos. Subscales Cognitive; Language (Receptive, Expressive, Total); Motor (Fine-Motor, Gross-Motor, Total); Social-Emotional; Adaptive Behavior (Communication, Community Use, Functional Pre-Academics, Home Living, Health & Safety, Leisure, Self-Care, Self-Direction, Social, Motor, Total)

16. Stanford-Binet Intelligence Scale Description Intelligence Testing of ages 2 to 23 years and beyond Yields Intelligence Quotient (IQ) Scoring Standardized Scoring Composite mean of 100 with standard deviation of 16 Interpretation: Mental Retardation IQ Definitions Borderline mental retardation: 70 -79 Mild mental retardation: 65-69 Moderate mental retardation: 40-54 Severe mental retardation: 30-39 Profound mental retardation: <30

17. Wechsler Intelligence Scale Description Intelligence Testing Mean score of 100 with standard deviation of 15 Gives verbal and performance scores Broken into subtests each with a mean of 10 Age specific Wechsler tests Wechsler Preschool Primary Scale Intelligence (WPPSI-R) Used for ages 3 to 7 years Wechsler Intelligence Scale for Children (WISCIII) Used for ages 6 to 16 years Wechsler Adult Intelligence Scale (WAIS-R) Used for ages 16 years and older  

18. Take Away Message Best tests (in our setting) For infant: Phatak ’ s Baroda Screening Test For pre school child: Bayley Scales of Infant and Toddler Development-Third Edition ( Bayley -III) For school going child: Wechsler Intelligence Scale

19. Developmental Quotient (DQ) Ratio of the functional age to the chronological age. It is a means to simply express a developmental delay. DQ= ((developmental age) / (chronological age)) * 100 • If the infant was born prematurely the chronological age should be corrected for the gestational age at birth during the first year of life. • The adaptive developmental quotient uses a development measure such as the Gesell scales. Similar quotients may use IQ or other measures. Interpretation maximum score =100 > = 85 normal 71-84 mild-to-moderate delay <= 70 severe delay

20. Red Flags: Birth to three month Rolling prior to 3 months Evaluate for hypertonia Persistent fisting at 3 months Evaluate for neuromotor dysfunction Failure to alert to environmental stimuli Evaluate for sensory Impairment

21. Red Flags: 4 to 6 months Poor head control Evaluate for hypotonia Failure to reach for objects by 5 months Evaluate for motor, visual or cognitive deficits Absent Smile Evaluate for visual loss Evaluate for attachment problems Evaluate maternal  Major Depression Consider  Child Abuse  or child neglect in severe cases

22. Red Flags: 6 to 12 months Persistence of primitive reflexes after 6 months Evaluate for neuromuscular disorder Absent babbling by 6 months Evaluate for hearing deficit Absent stranger anxiety by 7 months May be related to multiple care providers Inability to localize sound by 10 months Evaluate for unilateral  Hearing Loss Persistent mouthing of objects at 12 months May indicate lack of intellectual curiosity

23. Red Flags: 12 to 24 months Lack of consonant production by 15 months Evaluate for Mild  Hearing Loss Lack of imitation by 16 months Evaluate for hearing deficit Evaluate for cognitive or socialization deficit Hand dominance prior to 18 months May indicate contralateral weakness with  Hemiparesis Inability to walk up and down stairs at 24 months May lack opportunity rather than motor deficit

24. Red Flags: 12 to 24 months Advanced non-communicative speech (e.g.  Echolalia ) Simple commands not understood suggests abnormality Evaluate for  Autism Evaluate for pervasive developmental disorder Delayed Language Development Requires  Hearing Loss  evaluation in all children

25. Early Stimulation Infants who show suspect or early signs development delay need to be provided opportunities that promote body control, acquisition of motor skills, development and psychosocial maturity . making additional efforts to make the child sit or walk, giving toys to manipulate, playing with the child, showing objects, speaking to the child and encouraging him to speak and prompting the child to interact with others, etc.