Developmental Screening and Surveillance DENVER II

1. Developmental Screening and SurveillanceDENVER 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: 12 30 • 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.