Development

Developmentmeasurement
measurement(DDST
(DDST))

Sherzad
Sherzad .Kh.
.Kh. Suleman
Suleman
MSc. pediatric nursing
MSc. pediatric nursing
University
Universityof
ofDuhok
Duhok/College
/Collegeofofnursing
nursing
Pediatric department
Pediatric department
Denver Development Screening Test
(DDST)
Overview

The Denver is most way to detect the development problems

in children

Administered to children from birth to 6 years

Assess the childs performance on age appropriate tasks

Screens for possible problems

Designed to compare a given childs performance with the

performance of other children the same age
Test is primarily based on examiners actual observation
rather than parent support.
What the Denver is not

1. Not an I.Q. test 2.not a diagnostic tool

 DDST
Consists of 125 tasks, or items. (covering four
areas) :
1. Personal Social: (getting along with people)
2. Fine Motor-Adaptive: (Manipulation of small
object )
3. Language: (saying some thing, hearing,
understanding)
4. Gross Motor: (sitting, walking, jumping)

The children are tested on the tasks or items pertinent to their age

It must be conducted in a standardized manner

Kit come with necessary supplies and scoring sheets

 Value of the Denver II
To detect the
1. Impression of a childs overall development
2. potential developmental difficulties
3. compares to other children
Note: It is not a predictor of
later development
 Test Materials:
Red yarn pom-pom (4 in diameter)

Rattle with narrow handle

10 1 square colored wooden blocks

Small, clear glass bottle with a 5/8 inch

Small bell

Tennis ball

Red pencil

Small plastic doll with feeding bottle

Plastic cup with handle

Blank paper

Note: Children need to be supervised appropriately with test

materials to prevent choking or injury

Test Form

Information

Report

Note: After 24 months, each mark equals 3 month intervals

 Test Administration
1.Should be given with the parent or primary caregiver present

2.Make caregiver and child comfortable to elicit most natural response

3.Remove boots or shoes that might restrict the child motor movements

4.Young child may sit on caregivers lap, older child should sit so

arms can rest upon the table & elbows should be level with table top

& Infants may be evaluated on the floor

5.It should be shared with parent that the tool is to determine the childs

current developmental status and that the child is not expected to pass

all of the items.

6. Tasks & Items that the child can perform easily should be administered first

7. Items in Fine Motor-Adaptive next (items that do not require child to speak)

8. Language items next and last the Gross Motor items which is gained as test progresses.

9. Praise childs efforts even if they fail on an item

10. Keep kit out of sight & only materials being used for current activity on the table

11. For infants (all items be administered with the baby lying down to be tested together)

12. Testing should begin with items that fall completely to the left of the childs age line,

and continue to the right

Age Calculations

Example:
Year
Month
Day

9 30 +17= 47
Date of Test 2011 10 17

Date of - 20
- 2008 -8
Birth

Age of Child 3 1 2
7
Left side of age line

Right side of age line

1.At least three items nearest to

and totally to the left of the age
line
2. Three trials to perform each item
Adjusting for prematurity:

Born more than 2 weeks before expected delivery

date
Are less than 2 years of age
Age of child Year Month Day

Age of Child 2 19

6 weeks premature -1 -14

(30days) (14 days)

Adjusted age of
Child 1 5
1.At least three items nearest to
and totally to the left of the age
line
2. Three trials to perform each item
 Number of Items to be tested
Depends on age and ability of child
Step 1: in each sector, administer at least three items nearest to and totally to the left of the age
line and every item that is intersected by the age line

Step 2: if the child is unable to perform any item in step 1 (fails, refuses, has had no opportunity)
administer additional items to left in the appropriate sector until child passes three consecutive items

Continue to administer items to the right of any passes in each sector until three failures are

recorded

The child may be given up to three trials to perform each item, when appropriate, before scoring

a failure

Ask the caregiver or parent if the results are typical of childs performance.

Note: Consider if the child is ill, hungry, upset, etc.

Rescheduling may be necessary if child is not being cooperative

 Item scoring
The score for each item should be recorded the bar near the 50% hatch mark. The

following scores are used for the Denver II:

1.P for pass the child successfully performs the item, or the caregivers report

(when appropriate)

2.F for Fail- the child does not successfully performs the item, or the caregivers

report (when appropriate) that the child does not do the item.

3.N.O for No Opportunity- the has not had the chance to perform the item, due

to restrictions from the caregivers or other reasons. This score may only be used

on report items.

4.R for Refusal the child refuse to attempt the item. Refusals can be

minimized by telling the child what to do rather than asking. Report items cannot

be scored as refusals.
Interpretation of individual items

Individual items are interpreted first, and then the entire test is interpreted.

a. Advanced Items

If a child passes an item that falls completely to the right of the age
line, the childs development is considered advanced on that item.
b.Normal item
Failure or Refusal of individual items do not necessarily indicated a delay in
development. For example, if a child fails or refuses an item that falls completely
to the right of the age line, the childs development is considered normal.

a child can Pass, Fail, or Refuse an item on which the age line falls between the 25th and
75th percentile, and the childs development on that item will be considered normal.
c. Caution Items
Caution when line falls between 75 and 90 percentile and child fails or refuses C just to the right of
the bar.

d. Delayed Items

A delay is indicated when a child fails or refuses an item that falls completely to
the left of the age line
e. No Opportunity Items
Report items which the parent says the child has
not had an opportunity to try are scored as N.O.
 Interpretation of the Test
Normal :
No delay & a maximum of 1 caution
Rescreening at next childs visit.

Suspect:
Delay (1 ore more) & Caution (2 or more)

Rescreening after 1-2 weeks to rule out temporary factors such as fatigue, fear,
illness

Untestable:
Refusal scores on one or more items completely to the left of the age line or on
more than one item intersected by the age line in the 75th to 90th area.
Rescreening after 1-2 weeks
Suspect:
Normal
Delay (1 ore more) &
No delay
Caution (2 or more)
1 caution

Rebar
Ruhan 3 months old
3 month at
calculating
There is No any delay & cautions
1 Delay & 2 Cautions
Referral Considerations

1.After rescreening, test result is

suspect or untestable
2.Number of cautions and delays

3.Clinical history, examination

4.Availability of referral resources

Have you any