4 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
5 ScreeningProcess of testing whole populations of children at various set ages to detect those at high risk for significant, unexpected deviations from normal.
6 ScreeningProcess of identifying children with an atypical development.About 16% of children have disabilities.Early identification will improve outcome.
7 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.
9 Surveillance Components: Eliciting/attending to parents’ concerns Obtaining a relevant developmental historySkillfully observing children’s development (not estimating)
10 When to screen? At least 3 times before age 3: 9 month18 month24-30 monthScreening tests should be done when suspicions of delay arise
11 DDST-R Revised, re-standardized in 1988 Sensitive, 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 child’s functioning and circumstance.
12 Denver II 0 to 6 years Not an IQ test, not predictor of outcome Cannot generate a diagnosisNot a substitute for testingJust compares children of the same age
13 Denver II 4 Areas of function: Personal-Social, Fine Motor-Adaptive, Language,Gross motor.
14 Calculating age Date of test year month day Date of birth year month dayIf 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)
15 Introduction Reassure caregiver Test is not an IQ test The child is not expected to pass all itemsDetermine developmental status
16 Administration Flexible Score what you see Follow a certain order: First do items (R), less active participation, easier tasks, same materials on the table.
17 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).
18 Administration Up to 3 trials Test behavior Item scoring: P (Passing), F (Fail), N.O. (no opportunity), R (refusal)
19 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.
20 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.