Developmental Assessment Psychiatry

Third Shifting
Dr. Vivian Yu

Why is there a need for early identification of • Every well child must be an opportunity for the
developmental disorders? health care professional to evaluate the overall
• critical to the well-being of the child development of the child
o delay may be due to a medical condition • Further developmental evaluation is required
o delay may indicate an increased risk of whenever the child fails to meet any of the
behaviour/ psychiatric disorders or other following milestones
developmental disorders o Language delay
o early detection may prevent further  Turn to sound by 6 months
deterioration and improve future  Babbling and gesturing (pointing,
outcomes of those identified waving bye-bye by 12 months)
• responsibility of every primary care physician  Single words by 16 months
 2-word spontaneous (not just
Common Presentation of Developmental echolalic) phrases by 24 months
Delay  loss of any language or social skills at
• Newborn any age (American Academy of
o Dysmorphism Neurology and Child Neurology
o Major organ system dysfunction Society 2000)
(feeding/ breathing) o Motor delay
• Early Infancy (2-4 mo)  Poor head control by 3 months
o Failure to interact with the  Hands still fisted by 4 months
environment  Unable to hold objects by 7 months
o Vision and hearing impairment  Does not sit independently by 10
• 6-18 months months
o gross motor delay o Psychosocial delay
• Toddler  No social smile by 3 months
o Language delay  Not laughing in playful situation by 6
• Preschool months
o Language difficulties or delays  Hard to console, stiffens when
o Behaviour difficulties approached by 1 year
o Delays in fine motor skills  In constant motion, resists discipline
• School Age  Does not play with other children by
o Academic underachievement 3 years
o Behaviour difficulties o Cognitive delay
 2 months: not alert to mother
History  6 months: not searching for dropped
• History of illness/ Past medical history objects
• Maternal history  12 months: no object permanence
• Family history  3 years: does not know full name
o Relatives with same illness  4 ½ years: cannot count sequentially
o Consanguinity of parents  5 years: does not know letters or
o Functioning and intellectual capacity colors
of parents  5 ½ years: does not know own
• Emotional tone at home birthday or address

Developmental History Developmental History- SCHOOL AGE

• The Philippine Society for Developmental and CHILDREN
Behavioral Pediatrics states that developmental • Reading skills
surveillance is a flexible, continuous and o slow in learning connection between letters
cumulative process and sounds
o confuses basic words

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o makes consistent reading errors • Re-evaluation needed in 3 months if

o letter reversal (b-d) (p-q) o 1 delay AND/OR
o letter inversion ( m-w) o 2 or more cautions
o transpositions (felt-left) • Untestable- there is significant number of
o word reversal (was-saw) refusals or no opportunity test items
o number reversal (14-41)
• Refer to specialist if
o repeats, omits, or adds words
o Failed test
o does not like reading at all
o Classified as untestable on 2
o avoids reading aloud
consecutive screening
o uses fingers to follow a line of print when
reading Screening Tools
o slow to remember facts • Assessment tool that gives quantitative DQ for
o slow to learn new skills, relies heavily on visual-motor/ problem-solving and language
memorization abilities
o poor coordination, unaware of physical
• CAT (Clinical Adaptive Test)
surroundings and prone to accidents
o Problem-solving items for ages from birth to
o awkward and clumsy, has trouble with fine
36 months
motor skills
• CLAMS (Clinical Linguistic and Auditory
Milestone Scale)
Physical Exam
o Language milestone from birth to 36
• anthropometric measurements
months
• “Syndromic” appearance
• dull facial expression: unreliable Other test for Visual-motor and Problem-
• neuro exam: sensory impairments solving Skills
• psychometric testing • Goodenough-Harris Draw-a-Person test
• Gessell figures
Screening Test • Gessell block skills
Denver Developmental Screening Test- II
(Denver II) Screening for Language Skills
o For children ages 0-6 years
• ELMS (Early Language Milestone Scale)
o 4 domains: gross motor, fine motor, o For 0-3 years
language and social o 5-10 minutes to complete
o Materials: bell, set of 10 blocks, glass
o high sensitivity
bottle, rattle, tennis ball, pencil, yarn,
• PEDS (Parent’s Evaluation of
raisins, zippered bag, cup, doll, baby bottle
o Scoring: P= Pass N= No Opportunity Developmental Status) questionnaire
o For ages 0-8 years
F= Fail R= Refused
o Interpretation: o Structured set of 10 questions about
parental concerns in various areas of
 Advance- if child passes item the falls development
completely to the right of age line
• ASQ (Ages and Stages Questionnaires)
 Normal- if child passes, fails, or refuses o for ages 4-48 months
items where age line falls between the o series of 11 questionnaires to be
25th and 75th percentiles
completed at home by parents
 Caution- if child fails or refuses item o multi-domain screen with good
where the age line falls between the sensitivity and specificity
75th and 90th percentile
 Delayed- if child fails or refuses item For Autism
which falls completely to the left of age • CHAT ( CHeckilist for Autism in Toddlers)
line o from 18 months and older, and M-
CHAT
Assessment • PDDST (Pervasive Developmental
• Gross Motor, Language, Fine Motor, Social Disorders Screening Test) I and II
o Either advance, normal, caution, delayed • STAT (Screening Tool for Autism in Two-
• Pass- if there is no delay OR only 1 caution year olds)
• Fail- if there are 2 or more delays noted
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• SCQ (Social Communication

Questionnaire)
o Formerly known as Autism
Screening Questionnaire (ASQ)
For ADHD
• Teacher’s ___________

Diagnosis: Labs
• Newborn screening
• EEG
• CT scan
• Hearing test

Referrals
• Pediatrician
o Developmental
o Genetics
• Psychiatrist
• Occupational Therapist
• Speech Therapist
• Special Education Program

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