Developmental Screening and Surveillance

DENVER IIPaola Carugno, MD7/27/2010

Why me? MDs have access to young children and families.Familiarity with social, familial factors.Professional guidelines: AAP Committee on Children with Disabilities, Bright Futures.

Development in WCCSurveillanceScreeningDDST II

Surveillance

a flexible, continuous process in which a knowledgeable professional performs skilled observations of children during child health care

USE IT AS A GROWTH CHART

Screening

Process of testing whole populations of children at various set ages to detect those at high risk for significant, unexpected deviations from normal.

ScreeningProcess of identifying children with an atypical development.About 16% of children have disabilities.Early identification will improve outcome.

How to screen?Variety of techniques currently in use: Reviewing developmental milestones. Informal collection of age-appropriate tasks.Clinical judgment based on history, exam.Formal screening with standardized testing.

ScreeningASQPEDSPEDS:DMDDST

SurveillanceComponents:Eliciting/attending to parents concernsObtaining a relevant developmental historySkillfully observing childrens development (not estimating)

When to screen?At least 3 times before age 3:9 month18 month24-30 monthScreening tests should be done when suspicions of delay arise

DDST-RRevised, re-standardized in 1988Sensitive, but with limited specificity and predictive value (high referral rate)Use it to aid monitoringUse in second stage screening (following a parents questionnaire)Interpret the results in context of childs functioning and circumstance.

Denver II

0 to 6 yearsNot an IQ test, not predictor of outcomeCannot generate a diagnosisNot a substitute for testingJust compares children of the same age

Denver II4 Areas of function: Personal-Social, Fine Motor-Adaptive, Language, Gross motor.

Calculating ageDate of testyear month dayDate of birthyearmonth dayIf needed, borrow: 12 30Adjusting for prematurity (if born more than 2 weeks early, and younger than 24 months)Age of the child, - weeks early (in months and days)

IntroductionReassure caregiverTest is not an IQ testThe child is not expected to pass all itemsDetermine developmental status

AdministrationFlexibleScore what you seeFollow a certain order: First do items (R), less active participation, easier tasks, same materials on the table.

Administration3 items to the left andEvery item crossed, OREvery item until 3 failures are recorded (Ceiling).If the child fails, then continue testing items to the left until 3 items are passed (Basal).

AdministrationUp to 3 trialsTest behaviorItem scoring: P (Passing), F (Fail), N.O. (no opportunity), R (refusal)

InterpretationAdvanced items: Child passes an item to the right of the age lineNormal items: Child can pass, fail or refuse an item between the 25th and 75th%Caution: refuses or fails an item between 75th and 90th %Delayed: refuses or fails an item completely to the left of the age line.

Follow upNormal: no delays and a maximum of 1 caution. Routine follow up.Questionable: 1 delay and/or 2 or more cautions. Offer stimulation suggestions and repeat in 3 monthsAbnormal: 2 or more delays, or fails twice 3 months apart. Refer to EI.