Prof. V Wong

Estimate developmental level in child via observation and simple structured tests

Assess strength and weakness of child in developmental point of view

1. Gross motor
2. Fine motor skills
3. Language (comprehension and expression)
4. Social and behaviour
5. Vision
6. Hearing

• Smiling face
• Red dangling ball
• One-inch cubes (3-4)
• Pellet (eg. Smarties)
• Pencil and paper: older child
• Toy (about 3-4" tall): optional

• Observation is the most important aspect
• Try not to make the child cry, otherwise you may not assess further - do not remove child from parents to perform gross motor
• Suggest not to touch the child at the beginning before you can establish rapport
• Familiarity with normal milestones
• Involve parents and guardians
• Be sensitive to child's attitude and change your tests accordingly: eg. If child is bored, notice at once and change test to draw back child's attention
• Beside developmental assessment is simple and easy
• Assessment of particular area
• Start with milestones the child can achieve - go forward - finish when child cannot perform milestones of a certain age
• If cannot perform milestone at beginning, go backward to younger age skill
• Practice
• Fluent in your assessment
• Develop own style of performing assessment

1. Introduction to parents or guardians: if parent holding child, ask parent to put child on lap and make child sit comfortably
2. Talk to child and observe

• Social behaviour
• Visual response
• Language
• Hearing
• Eg. Syllables, clapping in imitation, respond to name

1. Offer red dangling ball and observe

• Visual response
• Fine motor development
• Eg. Offer ball in several directions, visual following (horizontal, vertical, 360 degrees), offer ball to child, reaching out, hand transfer, get ball and drop suddenly to floor (obj permanence)

1. Offer 1" cube one at a time and observe fine motor development

• Eg. Can hold 2 cubes at same time, imitate banging together (good imitation ability), offer 3rd cube, KK drops the 2nd for the 3rd cube, ask Pt to release cube, he cannot release grasp

1. Offer smarties and observe

• Fine motor development
• Vision in finer aspect
• Eg. Pincer grasp

1. Proceed to gross motor assessment

• Several postures: supine sit, stand, prone
• Eg. Supine: observe for hand and foot reguard, hold hands and pull to sit to observe for head lag, sit without support - back straight? Can baby pull to stand by offering toy, stand with support, Put in prone position - crawl by offering object, crawl using hands with abdomen on bed

1. Finish assessment by waving bye-bye

Vision and hearing can be crudely screened only because formal tests are required

• Eg. Mounted balls test for vision
• Distraction hearing test for hearing (conducted in quiet environment)

Gross motor

• Can sit without support (9m)
• Crawl using hands, abdomen on cough (9-10m)
• Cannot pul self to standing (10m)

Fine motor

• Reach out (4m) with hand transfer (6-7m)
• No definite pincer grasp (9m)
• Can imitate to click 2 cubes (10m)
• Cannot release

Language

• Babbling (6m)
• Respond to name (7m)
• No different consonant
• No meaningful words (11m)

Social and behaviour

• No stranger anxiety 8-9m
• Obj permanence
• Plays patacake
• Cannot wave bye-bye
• Cannot use finger for feeding

Vision and hearing

• Visual follow through 180 (3-4m)
• All directions (6m)
• Respond to name (7m)

Further formal testing required

Dx: Mild global developmental delay