Paediatrics: Developmental Assessment Flashcards
Developmental screening
Developmental surveillance scheme
- performed in MCHC at time of vaccination
- additional visits to be arranged if required
- if suspected to have developmental problems —> referral to Child assessment centre for developmental assessment
Development stage
Infancy: 0-12 months
Toddler: 12-36 months
Pre-schoolers: 3-5 years
Primary school and beyond: >5 years
(Adolescence: 10-19 years (SpC Paed)
Young people: 15-24 years
Youth: 10-24 years)
Normal development
- Gross motor + Fine motor
- Speech and Language
- Cognitive
- Social / Personal
- Activities of daily living
Gross + Fine motor skills
Gross motor skills:
1. Lying
2. Sitting
3. Standing
4. Walking
- cruising
- walking independently
- walking up / downstairs
- running
- jumping
- stand with 1 leg
- hop
- kicking a ball
Fine motor skills:
1. Playing with bricks
- transfer
- casting (throwing)
- building bricks
- Playing with beads / small object
- palmer grasp
- pincer grip
- threading beads - Paper / Crayons (preschool children >3yo)
- scribbling
- copy / draw straight lines
- copy / draw shapes
Speech and Language development
- Verbal comprehension
- understand simple commands with gestures
- understand verbal commands without gestural cues
- understand more complex commands with 1 / multiple steps - Verbal expression
- cooing / babbling
- imitating words
- meaningful words
- word combination
- phrases / sentences - Articulation (usually apply to older children)
- speaking clearly
Social and Personal skills
- Social skills
- social smile
- stranger anxiety
- parallel play
- interactive play - Personal skills
- feeding
- toileting
- brushing teeth / bathing
- dressing / undressing
Behavioural and Learning observation
Behaviours:
- Social interactions: eye contact, intent to communicate (peers / adults), social reciprocity (whether can take social cues and react appropriately)
- Attention (attention span)
- Disruptive behaviours
Learning concerns (K2 onwards)
***Developmental milestones
Gross motor:
Fine motor:
Hearing, speech, language:
Social:
6 weeks:
- head **level with body in ventral suspension
- **fixes + follows
- becomes ***still in response to sound
- smiles
3 months:
- hold head **90o in ventral suspension
- **hold object placed in hands
- ***turns to sound
- hand regard, laughs, squeals
6 months:
- no head lag on pull to sit, **sits with support (may begin to sit without support)
- **palmer grasp of objects, transfer object hand to hand
- ***vocalisation
- may finger feed self
9 months:
- crawls, **sits steadily when unsupported and pivots around
- **pincer grasp, index finger approach, bang two cubes together
- **2 syllable babbles, non-specific-consonant-vowel such as “mama”
- **wave “bye-bye”, indicates wants, ***stranger anxiety emerging
12 months:
- pulls to stand, cruises, may **stand alone briefly, may **walk alone
- puts block in cup, casts about
- **1 / 2 words, imitates adults sounds
- imitates activities, **object permanence (looking for disappeared objects, “peek-a-boo”, understanding that objects still exist when cannot be seen) established
18 months:
- **walks well, runs
- builds tower of 2-4 cubes, hand preference emerges
- **6-12 words
- uses spoon, ***symbolic play “talking on telephone”, domestic mimicry e.g. helps in household chores like wiping surfaces
2 years:
- **kicks ball, climb stairs **2 feet per step
- build tower of 6-7 cubes, does circular scribbles
- join **2-3 words, knows some body parts, identify objects in picture
- can **remove some clothes
3 years:
- stand briefly on 1 foot, climbs stairs **1 foot per step
- build tower of 9 cubes, copes a circle
- talk in **short sentences that stranger can understand
- eats with fork and spoon, ***put on clothing, may be toilet trained
***History taking
- Reason for referral
- concern from parent / teacher / doctor - History of presenting complaint
- who raised concerns regarding developmental problems
- when to start to notice
- developmental progress / ***regression
- severity, effects on daily life and family / school life - Birth history
- perinatal insult (e.g. hypoxic ischaemic encephalopathy, complicatiosn during birth)
- pre-term / full-term - Past medical history
- Family history
- intellectual disability (e.g. ASD, ADHD)
- psychiatric conditions (e.g. Schizophrenia, Depression, Post-natal depression) - Schooling and Training (from 2 yo onwards, formal schooling from 3 yo)
- mainstream school
- mainstream with SEN (special education needs) support
- special school
- other special trainings: speech therapy, occupation / physiotherapy - Social history
- usual carer / any change in carer - Parenting style
- authoritative - Vision
- fine motor skills affected - Hearing
- language skills affected
Developmental assessment tools
Different diagnostic tools available used in different countries
- US: Bayley tool
- HK / UK: Griffith Mental Development Scales (GMDS)
- Best tools will be standardised + validated developmental assessment tools using local language + design according to local culture
- Need to be age-appropriate
HK:
1. Griffith Mental Development Scales (GMDS)
- Extended revised 0-8 yo
- Chinese Griffiths (GDS-C) 0-8 yo
- Griffiths 3 0-6yo
- HKCAS-P (HK comprehensive assessment scales for preschool children) from 3.5 yo onwards
Additional tools (for diagnosing Behavioural + Learning problems):
- Disease specific (e.g. for Autism, ADHD, Childhood anxiety, Dyslexia, Learning problems)
Developmental assessment tools specific to different disciplines (Physiotherapy / Occupational therapy / Speech therapy)
Cognitive assessment:
- done by Psychologist from 4 yo onwards
- Wechsler Intelligence Scale for Children (Wechsler preschool and primary scale of intelligence 4th edition)
***Physical examination in Developmental assessment
- Dysmorphism
- e.g. Down’s - Neurocutaneous markers
- e.g. NF (associated with ADHD) - Neurological examination
- e.g. cerebral palsy - General examination
Calculation and Interpreting developmental profiles
- For babies born prematurely (i.e. <37 weeks), need to adjust for age before chronological age of 24 months
—> if a baby was a 24 weeker (40-24 = 16 weeks / 4 months earlier) with chronological age of 17 months
—> Real age = 17-4 = 13 months (i.e. 當佢正常出生時間去計) - Mental age: developmental ability / milestones achieved (according to developmental assessment tools)
- Developmental quotient (DQ) = MA (Mental age) / CA (Chronological age) x 100
—> only reflect developmental ability of child compared to peers
—> does not equal IQ - Intelligence quotient (IQ): assessed after 4 yo (done by Psychologist)
Developmental delay
Global developmental delay:
- Significant delay in >=2 developmental domains (Gross/Fine motor, Speech/Language, Cognitive, Social/Personal, ADL)
Developmental delay:
- Significant delay: DQ < 70 / < -2 SD
- Borderline delay: DQ 70-80 / DQ between -1.5 to -2 SD
Intellectual disability
- Based on IQ scores
- Cognitive assessment by psychologist
