1. Developmental Screening and Surveillance DENVER II
Paola Carugno, MD
7/27/2010

2. 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.

3. Development in WCC
Surveillance
Screening
DDST II

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

6. Screening
Process 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.

8. Screening
ASQ
PEDS
PEDS:DM
DDST

9. Surveillance Components: Eliciting/attending to parents’ concerns
Obtaining a relevant developmental history
Skillfully observing children’s development (not estimating)

10. 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

11. 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 child’s functioning and circumstance.

12. 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

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 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)

15. Introduction Reassure caregiver Test is not an IQ test
The child is not expected to pass all items
Determine 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. 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 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 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.