1. Assessment of development and Growth
Abdelhamid Deghidi

2. What are developmental milestones?
Defined by Illingworth in his milestone theory as
Set of functional skills or age-specific tasks
that most children can do at a certain age range
Milestone = standard for skill acquisition
Defines the child’s “developmental age”
NB norms are based on children of full gestational age
Although each milestone has an age level, every child is unique, and the impact of intrinsic and extrinsic factors may vary Therefore it is accepted that standard deviation/variation of one month on either side is allowed

3. Milestones vs. developmental sequence
Both are important components to consider when assessing and treating children with developmental concerns
Developmental sequence refers to the typical pattern or development , of the components of movement & timing thereof
Need to understand the components and the sequencing of the components in the developmental sequence
Whilst when looking at milestones your are assessing the skills or tasks a child has achieved for his age

4. Developmental Screening tests
Milani- comparetti motor development screening test
Denver II
2-Tests of motor performance
Alberta Infant Motor Scale (AIMS )
Bruininks-Oseretsky test of motor proficiency
Movement assessment of infants
Peabody Developmental motor scales
Gross motor functional measure (GMFM)
Test of Infant Motor Performance

5. Denver Developmental Screening Test - 2
Very commonly used screening tool
Birth to 6 years old
Poor sensitivity and specificity (40-60%)
10-20 minutes to administer
Normed on diverse population sample
Multiple languages
Domains: fine and gross motor, language, and social skills
The Denver is a tool that is widely used by many practices and residency programs. It is designed for children from birth to 6 years old, though it is more comprehensive for children under 4 years old. After 4, the language domains are not as complete.
It has poor sensitivity and specificity depending on the type of administration. If the sensitivity is improved, the specificity is dramatically reduced and vice versa. Some reports have shown that the DDST will miss 70% of children with mild MR.
It is relatively quick to administer.
It was normed on diverse populations and is available in multiple languages. It has the major domains covered (language, fine and gross motor, and social skills).

6. DDST (continued)
Identifies children at 25,75, and 90% completion of task
Scored as concern if child completing task in shaded area (75-90%)
Scored as failure if not completed by time 90% complete
Referrals warranted for one failure or two concerns
Correct for prematurity till 2 years old chronological age
The designations of the clear boxes is 25-75% of children at that age will complete the task. The shaded portion refers to the time period in which 75-90% of children will be able to complete the task.
The scoring is relatively simple, with concern for tasks the child is completing during the shaded period and failure for tasks the child is completing after the shaded period.
Referrals are warranted for one failure or if there are 2 domains with concerns.
One should correct for prematurity until 2 years of age (chronologically).

7. Bayley Screener Ages 3 to 24 months
Direct observation of skills by provider
Assesses three domains (more neuro focused)
11-13 items at each age group (3-6 month breaks)
Specificity and sensitivity 75-86%
10-15 minutes to administer
Not standardized in Spanish
The Bayley Infant Neurodevelopmental Screener (BINS) is designed for children 3 to 24 months. It relies on direct observation by the provider. It assesses 3 domains (neurologic processes, neurodevelopmental skills, and developmental accomplishments). It is much more focused on neuro development.
There are items in each domain at each age group, with 3-6 month intervals.
The specificity and sensitivity range from 75-86%.
It takes minutes to administer. It is NOT standardized in Spanish.

8. Peabody Developmental Motor Scales – Second Edition (PDMS-II)
Purpose
Provides a comprehensive sequence of gross and fine motor skills from which the developmental skill level can be obtained
Can be used with able-bodied children and children with developmental disabilities

9. Peabody Developmental Motor Scales – II PDMS-II
Advantages
Norm-referenced
Valid and highly reliable measure
Discriminates motor problems from normal developmental variability i.e. those known to
be “average” and those expected to be low or below average
The PDMS-II is normed on children without delay and valid for determining present level of developmental eligibility.

10. PDMS-II Disadvantages Assesses only motor areas
Not responsive to change in children with severe physical disabilities
Not necessarily valid for planning intervention
It is however not the best tool for for planning intervention.
Has poor concurrent validity with the BSID-II (i.e. there are potential differences in outcome for some children using these tests)
Differing outcomes can affect eligibility in some states;

11. Test of Infant Motor Performance TIMP
Purpose
A test of functional motor behavior in infants between the ages of 34 weeks postconceptional age and 4 months post-term.
Constructed to assess postural control needed in age-appropriate functional activities involving movement
Intended to signal developmental deviance at an early stage so that effective intervention can prevent serious impairment.

12. TIMP
Advantages
Discriminates among infants with varying degrees of risk for poor motor outcome
Predicts 12-month motor performance with sensitivity 92%
Can be used in the special care nursery and in community-based programs
Looks at quality of movement in a functional context versus just skills
Useful for planning interventions for high risk infants or infants with neurological conditions

13. TIMP Disadvantages Targets a very finite population
Designed to be administered by therapists with close contact and personal emotional involvement with the babies.

14. GMFM: Gross Motor Function Measure, Part I
Kathy McKellar, “Knowledge Broker”
January 2007
Based on a presentation by Dianne Russell, CanChild Centre for Childhood Disability Research, Knowledge Broker project co-investigator

15. GMFM
Criterion-referenced test: evaluates performance of motor skills on that day; useful for comparison over time
Measures how much of a task the child can accomplish, rather than how well the task is completed (quantity, not movement quality)

16. Who is the GMFM appropriate for?
Children with CP: original validation sample included kids 5 mo- 16 yrs
May be appropriate for children with other diagnoses
GMFM is appropriate for children whose motor skills are at or below those of a typical 5 year old.

17. Time required GMFM 88: approx. 45-60 minutes
GMFM 66: faster, allows for some missing data (items that are not tested)
Can be completed in more than 1 session (ideally complete all items within 1 week)

18. GMFM-88
88 items in 5 gross motor dimensions (for ease of administration):
lying and rolling
crawling and kneeling
Sitting
Standing
walking, running and jumping

19. Why use the GMFM? Reliable, valid
Internationally accepted: Translated into several languages, including Dutch, French, German, Icelandic, Japanese
Considered best practice
Used as an outcome measure

20. Used as an outcome measure
Surgery (rhizotomy, pallidal stimulation, muscle tendon)
Drugs (botulinum toxin, intrathecal baclofen)
Physical therapy (including ambulatory aids & orthoses)
Horseback riding
Strength training & physical fitness

21. Use of the GMFM in other populations
Osteogenesis imperfecta (Ruck-Gibis et al. 2001)
Lymphoblastic leukemia (Wright et al. 1998)
Down syndrome (Russell et al. 1998)