Presentation on theme: "Developmental Screening and Surveillance DENVER II Paola Carugno, MD 7/27/2010."— Presentation transcript:
Developmental Screening and Surveillance DENVER II Paola Carugno, MD 7/27/2010
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 WCC Surveillance Screening DDST 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.
Screening Process 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.
Screening ASQ PEDS PEDS:DM DDST
Surveillance Components: –Eliciting/attending to parents concerns –Obtaining a relevant developmental history –Skillfully observing childrens development (not estimating)
When to screen? At least 3 times before age 3: –9 month –18 month –24-30 month Screening tests should be done when suspicions of delay arise
DDST-R Revised, re-standardized in 1988 Sensitive, but with limited specificity and predictive value (high referral rate) Use it to aid monitoring Use in second stage screening (following a parents questionnaire) Interpret the results in context of childs functioning and circumstance.
Denver II 0 to 6 years Not an IQ test, not predictor of outcome Cannot generate a diagnosis Not a substitute for testing Just compares children of the same age
Denver II 4 Areas of function: –Personal-Social, –Fine Motor-Adaptive, –Language, –Gross motor.
Calculating age Date of testyear month day Date of birthyearmonth day If needed, borrow: Adjusting for prematurity (if born more than 2 weeks early, and younger than 24 months) Age of the child, - weeks early (in months and days)
Introduction Reassure caregiver –Test is not an IQ test –The child is not expected to pass all items –Determine developmental status
Administration Flexible Score what you see Follow a certain order: First do items (R), less active participation, easier tasks, same materials on the table.
Administration 3 items to the left and –Every item crossed, OR –Every item until 3 failures are recorded (Ceiling). –If the child fails, then continue testing items to the left until 3 items are passed (Basal).
Administration Up to 3 trials Test behavior Item scoring: P (Passing), F (Fail), N.O. (no opportunity), R (refusal)
Interpretation Advanced items: Child passes an item to the right of the age line Normal items: Child can pass, fail or refuse an item between the 25 th and 75 th% Caution: refuses or fails an item between 75 th and 90 th % Delayed: refuses or fails an item completely to the left of the age line.
Follow up Normal: 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 months Abnormal: 2 or more delays, or fails twice 3 months apart. Refer to EI.