Developmental screening involves the use of standardized screening tests to identify children who require further diagnostic assessment. The American Academy of Pediatrics recommends the use of validated standardized screening tools at three of the health maintenance visits: 9 months, 18 months, and 30 months. Clinics and offices that serve a higher risk patient population (children living in poverty) often perform a screening test at every health maintenance visit. A child who fails to pass a developmental screening test requires more comprehensive evaluation but does not necessarily have a delay; definitive testing must confirm. Developmental evaluations for children with suspected delays and intervention services for children with diagnosed disabilities are available free to families. A combination of U.S. state and federal funds provides these services.
Screening tests can be categorized as general screening teststhat cover all behavioral domains or as targeted screens thatfocus on one area of development. Some may be administered in the office by professionals, and others may be completed athome (or in a waiting room) by parents. Good developmental/behavioral screening instruments have a sensitivity of 70% to80% in detecting suspected problems and a specificity of 70% to80% in detecting normal development. Although 30% of children screened may be over-referred for definitive developmentaltesting, this group also includes children whose skills are belowaverage and who may benefit from testing that may help addressrelative developmental deficits. The 20% to 30% of children whohave disabilities that are not detected by the single administration of a screening instrument are likely to be identified onrepeat screening at subsequent health maintenance visits.
2 mo Lifts shoulder while prone Tracks past midline Smiles responsively Cooing Searches for sound with eyes 6 mo Sits alone Transfers object hand to Feeds self Babbles hand Holds bottle 15 mo Walks backward Scribbles Uses spoon and fork Says three to six words Stacks two blocks Helps in housework Follows commands
Mo, Month; sec, second; wk, week; yr, year.
Chapter 8 u Disorders of Development 17
The Denver Developmental Screening Test II was the norms across subgroups and cultures. The Denver II is a use-classic test used by general pediatricians (Figs. 8-1 and 8-2). ful screening instrument, but it cannot assess adequately the The Denver II assesses the development of children from birth complexities of socioemotional development. Children with to 6 years of age in the following four domains: suspect or untestable scores must be followed carefully.
1.
Personal-social The pediatrician asks questions (items labeled with an “R” 2.
Fine motor–adaptive may be asked of parents to document the task “by report”) 3.
Language or directly observes behaviors. On the scoring sheet, a line is 4.
Gross motor drawn at the child’s chronologic age. Tasks that are entirely to
The advantage of this test is that it teaches developmen-the left of the line that the child has not accomplished are contal milestones when administered. Items on the Denver II sidered delayed. If the test instructions are not followed accuare carefully selected for their reliability and consistency of rately or if items are omitted, the validity of the test becomes
Examiner: Name: DDM, INC. 1-800-419-4729 Date: Birthdate: CATALOG #2115 ID No.:
Percent of children passing 2550 75 90 (Check boxes for 1st, 2nd, or 3rd test) ©1969, 1989, 1990 W. K. Frankenburg and J. B. Dodds ©1978 W. K. Frankenburg ©2009 Wilhelmine R. Frankenburg