DEVELOPMENTAL ASSESSMENTDr. Prachi S. Karnik

Principles of Development

Cephalo → Caudal

Proximal → Distal

Simple → Complex

General → Specific

Involuntary → Voluntary

Continuous

Sequence same, Rate varies

Maturation AND Environment

To begin with…

A detailed history:Prenatal, Perinatal, Postnatal

Milestones including self-help and play skills

ConvulsionsConvulsions

Sleep, appetite

School history (academics and social skills)

Behavioral history

Medical history

Family history

Examination…

General physical examination

head circumference, malnutrition,

pallor, rickets, dysmorphic facies

Systemic examination

central nervous systemcentral nervous system

Bones and joints

deformities and contractures

Neuromuscular examination

in infants

Hearing and vision

Milestone assessment

Neuromuscular examination

Tone

Deep tendon reflexes

Primitive reflexes

Postural reflexes

Assessment of tone

Passive tone (Amiel Tison’s angles)Scarf sign

Heel to ear

Popliteal anglePopliteal angle

Adductor angle

Angle of dorsiflexion

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSitting

Standing

Axillary suspension

Ventral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)

Supine positionPull to sit

Sitting

Standing

Axillary suspension

Ventral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sitSitting

Standing

Axillary suspension

Ventral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSittingStanding

Axillary suspension

Ventral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSitting

StandingAxillary suspension

Ventral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSitting

Standing

Axillary suspensionVentral suspension

Prone position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSitting

Standing

Axillary suspension

Ventral suspensionProne position

Assessment of tone

Active tone (180⁰ flip)Supine position

Pull to sit

SittingSitting

Standing

Axillary suspension

Ventral suspension

Prone position

Hearing assessment

Tools

Rattle or Bell

Prerequisites

Child sitting erect in mother’s lap

Stimulus delivered out of child’s visual field

Hearing assessment

Newborn

Startle OR Crying OR Quieting OR Blinking

3 months

Turns head in the direction of sound

4 months

Turns head and eyes in the direction of soundTurns head and eyes in the direction of sound

5 months

Indirect orientation downwards

6 months

Indirect orientation upwards

7 months

Orientation in an arc

8-10 months

Direct orientation

Assessment of vision

Tools

Red ring or Examiner’s face

Prerequisite

Child in supine position

Stimulus 8-10 inches away

Assessment of vision

Newborn

Follows red ring through 45⁰

4 weeks

Follows red ring through 90⁰

3 months 3 months

Follows red ring through 180⁰

4 months

Follows red ring through 360⁰

3-5months

Hand regard

5 months

Excitement on seeing food being prepared

9 to 12 months….

Pointing

Joint attention

Social referencing

Showing and Giving on request

Waves bye-bye

Peek-a-boo

Understands simple commands

Understands ‘no’

How to test cognitive - adaptive milestones

Object permanence

Causality

Imitation

Color and Shape recognitionColor and Shape recognition

Language, mainly receptive

Fine motor Cube

Pellet

Pegboard

Formboard

Paper

Crayon and paper

Who should be screened…

Ideally, all children periodically

At least: 1. All high risk newborns

2. Parental concerns

3. Delayed milestones

4. Poor scholastic performance

5. Behavioral problems

6. Medical disorders associated withdevelopmental delay

Screening tools

General screening tests

Specific screening tests

General Screening Tools

Caregiver based questionnairesAges and Stages Questionnaire (ASQ)

Vineland Social Maturity Scale (VSMS)

Child performance based testsTrivandrum Developmental Screening Chart (TDSC)

Baroda Developmental Screening Test (BDST)

Denver Developmental Screening Test (DDST)

Trivandrum Developmental Screening Chart

Specific Screening Tools

Neuromotor INFANIB

AutismChildhood Autism Rating Scale (CARS)Modified Checklist for Autism in Toddlers (M-CHAT)Modified Checklist for Autism in Toddlers (M-CHAT)

Preschool skillsBrigance’s Preschool Skills’ Test

Behavioral problemsChild Behavior Checklist (CBCL)Early Childhood Inventory: 3-6 yearsChild and Adolescent Symptom Inventory (CASI): >6 years

ADHDConner’s Rating Scale (CRS)

Developmental screening

Normal Development Delay/DeviationNormal Development Delay/Deviation

Surveillance Diagnostic assessment

Developmental Surveillance

Longitudinal developmental follow-up in:

• A child with risk factors

• Who has been screened

• And has normal development for age onscreening

Developmental screening

Normal Development Delay/DeviationNormal Development Delay/Deviation

Surveillance Diagnostic assessment

Diagnostic Tests

Early developmental delayDevelopmental Assessment Scale for Indian Infants

(DASII)

Bayley’s Scale of Infant Development (BSID)Bayley’s Scale of Infant Development (BSID)

Early Intervention Developmental Profile (EIDP)

Language delayClinical Language Auditory Milestone Scale (CLAMS)

Receptive Expressive Emergent Language Scale(REELS)

Diagnostic Tests

AutismAutism Diagnostic Interview-Revised (ADI-R)

Autism Diagnostic Observation Schedule (ADOS)

Sensory problems Sensory problemsSensory Profile

ADHDVanderbilt’s ADHD Scale (Parent based and Teacher

based)

Diagnostic Tests

IntelligenceBinet Kamat Test (BKT): 3-6 years

Malin’s Intelligence Scale for Indian Children (MISIC):≥ 6 years≥ 6 years

Learning DisabilitiesNimhans’ SLD Battery

Thank you..