WEEK 3: The Denver Development al Screening Test

Question 1

Why do we screen for development?

Answer 1

1. Early Identification of Developmental Delays:

Developmental screening helps identify potential delays or concerns in a child’s development early on. Early intervention is key to addressing and minimizing the impact of developmental delays.

2. Opportunity for Early Intervention:

Early identification allows for prompt intervention and support. Early intervention services, such as speech therapy, occupational therapy, or developmental support programs, can be initiated to help children reach their developmental milestones.

3. Prevention of Long-Term Issues:

Addressing developmental concerns early can prevent or mitigate the long-term consequences of delays. Some developmental issues, if left unaddressed, may lead to more significant challenges in learning, behavior, or socialization.
Parental Education and Support:

Developmental screening provides an opportunity to educate parents and caregivers about typical developmental milestones and ways to support their child’s growth. It fosters a collaborative relationship between healthcare providers and families.

4. Monitoring Progress:

Regular developmental screening allows healthcare providers to monitor a child’s progress over time. It helps track improvements or identify persistent concerns, guiding ongoing interventions and support.

5. Identification of Risk Factors:

Developmental screening may identify risk factors or red flags that could indicate underlying health issues, environmental factors, or genetic predispositions affecting a child’s development.

6. Facilitation of Referrals:

If developmental concerns are identified, healthcare providers can make appropriate referrals to specialists or early intervention programs. This ensures that children receive comprehensive assessments and targeted interventions when necessary.

7.Part of Holistic Healthcare:

Incorporating developmental screening into routine healthcare practices supports a holistic approach to child health. It recognizes that physical, cognitive, and socio-emotional development are interconnected aspects of a child’s well-being.

8. Public Health Planning:

Aggregate data from developmental screening can contribute to public health planning and policymaking. It provides insights into the prevalence of developmental concerns within a population and informs strategies for community-based interventions.

9. Compliance with Guidelines
   Many healthcare organizations and professional societies recommend routine developmental screening as part of well-child visits. Following these guidelines ensures comprehensive and standardized care for all children.

Question 2

State examples of developmental disorders found in children.

how many % of children in the world have developmental disorders?

According to the American Academy of Pediatrics (AAP) statement 2020, how often should developmental monitoring be done?

Answer 2

Developmental / behavioral disorders are common:
5-16% children in the world have an issue:

*Speech & language impairments
*Mental restriction,
*Learning disabilities
*Emotional or behavioral disturbances

American Academy of Pediatrics (AAP) statement 2020:
Do Developmental monitoring at every clinic visit!

Question 3

State the development screening schedule for Botswana.

Answer 3

3 months
6 months
9 months
12 months
18 months
24 months
The milestones are in the Under 5 card.

Question 4

State the 4 main categories monitored for developmental assessment.

Answer 4

*Gross motor
*Fine motor
*Social skills
*Language

Question 5

State the gross motor skills assessed for all the months.

Answer 5

3: Hold weight with forearms
6: Sit momentarily without support
9: Pull to stand
12: Walks with support
18: Climbs stairs or walks up sloping ground with support
24: Run

Question 6

State the fine motor skills assessed for all the months.

Answer 6

3: Spontaneously open hands
6: Transfers objects from one hand to the other
9: Pincer grasp (able to pick objects with thumb and middle finger)
12: Release object on demand
18: Feeds self from spoon
24: Build tower using 6 blocks or cans

Question 7

State the social skills assessed for all the months.

Answer 7

3: Smile appropriately
6: Show likes and dislikes
9: Enjoy games whereby an adult repeatedly shows and hides face with a cloth/ peek- a boo)
12: Comes when called
18: Mimics actions of other word
24: Plays with others

Question 8

State the language skills assessed for all the months.

Answer 8

3: Coos, laughs
6: Babbles
9: Imitates sounds
12: Say 1-2 meaningful words
18: Says at least 6 words
24: Says 2–3-word sentences

Question 9

AAP policy statement
States the need for regular & repeated screening with a validated tool.

State reasons for that.

Answer 9

Regular & repeated screening with a validated tool:

*To detect a problem not identified on a single screen or surveillance

*To avoid late recognition (if one waits till a milestone is missed)

*Important to identify it early so that the child and family can receive needed intervention services and support

Question 10

State the 4 barriers to screening for developmental milestones on a child.

Answer 10

1. Not enough time to screen
2. Busy staff
3. Lack of knowledge by health care workers
4. Perceived misconceptions about development.

Question 11

State the 6 reasons for increased screening for developmental delays.

Answer 11

*Technological advancement
*Access to the internet
*Social media
*Parental concerns
*Increasing cases of children with developmental difficulties
*Rise in Medico-legal cases

Question 12

What does not work for developmental screening?

Answer 12

Informal assessments, e.g.,

*Review gross milestones
*Basic Clinical judgment
*Informal Check lists

Question 13

What Works for developmental screening?

Answer 13

Validated Instruments

1. Professionally administered screening tests
2. Parental concerns/questionnaires

Primary care providers are in a unique position to promote children’s healthy development because they have regular contact with children before they reach school age.

Question 14

What makes an ideal screening test?

State 6 characteristics.

Answer 14

1. High sensitivity
2. High specificity
3. Content validity - does it measure what it is supposed to measure?
4. Similar results by different examiners and on repeat administration
5. Easy to use
6. Quick and inexpensive

Question 15

State the Benefits of Parent Report Measures.

Answer 15

*Eliminates the need for child cooperation
*Data gathering while waiting or at home
*Sensitivity of parent observations are objectively reliable

Question 16

State the 7 Different Developmental Screening Tests

Answer 16

1. Denver
2. Early Screening Inventory
3. Early Language Milestone
4. Clinical Adaptive Test
5. Ages and Stages
6. Pediatric Examination of Educational Readiness
7. Pediatric Early Elementary Education

Question 17

Describe the Denver II.

Answer 17

Uses both parent observation & direct observation:

*Been standard for developmental screening.
Only 50% of those with developmental needs will be identified.

*Most children (up to 99%) who have no needs will pass

*False positive rate is low

Question 18

State the 5 advantages of the Denver.

Answer 18

Advantages
*Easy 1 page format
*No special training required
*Widely used
*Includes milestones from all major areas
*Age group: Birth to 6 years

Question 19

State the 3 disadvantages of the Denver.

Answer 19

Disadvantages
*Limited sensitivity for subtle delays
*Screening test, NOT diagnostic
*Not validated internationally

Question 20

State the characteristics of Test.

Answer 20

*What percentage of a certain age group is able to perform a certain task.

*Administered by a pediatrician or other health or social service professional

*The child’s performance is measured against the regular age distribution.

Question 21

Tasks are grouped into four categories.

State them.

Answer 21

1. Fine motor skill
2. Gross motor skill
3. Language
4. Social contact

Question 22

90% of what age groups are able to do the following:
*Smiles spontaneously
*Able to walk
*Hops on one leg

Answer 22

*Smiles spontaneously
performed by 90% of 3-month-olds.

*Able to walk
90% of 1-year-olds

*Hops on one leg
90% of 5-year-olds

Question 23

Describe How to administer the test.

Answer 23

Draw a vertical line at the child’s chronological age on the charts

Use the corrected age if the child was born premature and is currently under 2 years old.

The more items a child fails to perform, the more likely the child manifests a significant developmental deviation that warrants further evaluation.

Determine if a child is at risk:

The child should be able to do the tasks that are on the left side of the line.

If the child is unable to do any of these tasks, then do additional tasks to the left until the child passes 3 consecutive items.
Each child may be given 3 tries before scoring a fail

To determine ceiling:
Continue to administer items to the right of any passes in each sector until 3 failures are recorded.

Question 24

Describe the scoring system.

P =
F =
NO =
R =

Answer 24

P = Pass
F = Fail
NO =No Opportunity
R = Refusal

Question 25

When do we say the child is normal?

When do we suspect delay?

When do we say the child is untestable?

What is the way forward in the above cases?

Answer 25

Normal if:
*No delays, the child is able to do all the tasks for his age

*Rescreen at next visit

Suspect delay if:
*2 or more cautions and/or one or more delays

Rescreen in 1-2 weeks to rule out fatigue, fear, illness.

Untestable:
*Refusal scores on 1 or more items completely to the left of the age line or on more than one item intersected by age line in 75-90% area

Rescreen in 1-2 weeks

Question 26

What do the terms DELAY and CAUTION mean in relation to the Denver test?

Answer 26

DELAY:

If a child’s performance on a task falls significantly below what is considered typical for their age, it may be labeled as a “delay.”

This suggests that the child is not demonstrating the skills or abilities expected for their age group in that particular area of development.

CAUTION:

The term “caution” is often used when a child’s performance on a task raises concerns but doesn’t necessarily indicate a clear delay.
It suggests that the child’s performance is not entirely typical, and further observation or evaluation may be needed to determine whether there is a significant developmental issue.

Question 27

Summary

Answer 27

We must always do developmental examinations on children at every visit
Identify any delays early for appropriate referal and management.
Listen carefully to the parents’ concerns and address them appropriately.