Figure 8-1 Scoring form for Denver II. (From Frankenburg WK: Denver I Training Manual. ©1967, 1970 William K. Frankenburg and Josiah B. Dodds; 1975, 1976, 1978 William K. Frankenburg; 1990, 1992 William K. Frankenburg and Josiah B. Dodds; © 2009 Wilhelmine R. Frankenburg -Contact DDM, Inc. 1-800-419-4729 or Info@denverii.com.)
Figure 8-2 Instructions for the Denver II. Numbers are coded to a scoring form (see Fig. 8-1). “Abnormal” is defined as two or more delays (failure of an item passed by 90% at that age) in two or more categories or two or more delays in one category with one other category having one delay and an age line that does not intersect one item that is passed. (From Frankenburg WK: Denver I Training Manual. ©1967, 1970 William K. Frankenburg and Josiah B. Dodds; 1975, 1976, 1978 William K. Frankenburg; 1990, 1992 William K. Frankenburg and Josiah B. Dodds; © 2009 Wilhelmine R. Frankenburg Contact DDM, Inc. 1-800-419-4729 or Info@denverii.com.) worse. To assist physicians in using the Denver II, the scoring of development. Parent-reported screens have good validity sheet also features a table to document confounding behaviors, compared to office-based screening measures. such as interest, fearfulness, or an apparent short attention span. Autism screening is recommended for all children at 18 Repeat screening at subsequent health maintenance visits often to 24 months of age. Although there are several tools, many detects abnormalities that a single screen was unable to detect. pediatricians use the Modified Checklist for Autism in Tod-
Other developmental screening tools include parentdlers (M-CHAT). M-CHAT is an office-based questionnaire completed Ages and Stages Questionnaires (also milestone that asks parents about 23 typical behaviors, some of which driven), and Parents’ Evaluation of Developmental Status. The are more predictive than others for autism or other pervasive latter is a simple, 10-item questionnaire that parents complete developmental disorders. If the child demonstrates more than at office visits based on concerns with function and progression two predictive or three total behaviors, further assessment with an interview algorithm is indicated to distinguish normal variant behaviors from those children needing a referral for definitive testing. The test is freely distributed on the Internet (see Chapter 20).
Language screening correlates best with cognitive development in the early years. Table 8-2 provides some rules of thumb for language development that focus on speech production (expressive language). Although expressive language is the most obvious language element, the most dramatic changes in language development in the first years involve recognition and understanding (receptive language).
Whenever there is a speech and/or language delay, a hearing deficit must be considered. The implementation of universal newborn hearing screening detects many, if not most, of these children in the newborn period, and appropriate early intervention services may be provided. Conditions that present a high risk of an associated hearing deficit are listed in Table 8-3. Dysfluency (stuttering) is common in a 3and 4-year-old child. Unless the dysfluency is severe, is accompanied by tics or unusual posturing, or occurs after 4 years of age, parents should be counseled that it is normal and transient and to accept it calmly and patiently.