Metro Manila Development Screening Test

Definition
* Simple and clinically useful tool
* To determine early serious developmental delays
* Dr. William K. Frankenburg
* Modified and standardized by Dr. Phoebe D. Williams DDST to MMDST * Developed for health professionals (MDs, RNs, etc) • It is not an intelligence test * It is a screening instrument to determine if child’s development is within normal * Children 6 ½ years and below

Purposes
* Measures developmental delays
* Evaluates 4 aspects of development
Aspects of development
In the care of pediatric clients, growth and development are not in isolation. Nurses being competent in the aspects of growth and development particularly principles, theories and milestones are in best position to counsel clients on these aspects. Having background knowledge on growth and development, nurses are equipped with assessment skills to determine developmental delays through the aid of screening tests. The Metro Manila Developmental Screening Test (MMDST) is a screening test to note for normalcy of the the child’s development and to determine any delays as well in children 6 ½ years old and below. Modified and standardized by Dr. Phoebe Williams from the originalDenver Developmental Screening Test (DDST) by Dr. William K. Frankenburg, MMDST evaluates 4 sectors of development: * Personal-Social – tasks which indicate the child’s ability to get along with people and to take care of himself * Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick up objects and to draw * Language – tasks which indicate the child’s ability to hear, follow directions and to speak * Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump

In the care of pediatric clients, growth and development are not in isolation. Nurses being competent in the aspects of growth and development particularly principles, theories and milestones are in best position to counsel clients on these aspects. Having background knowledge on growth and development, nurses are equipped with assessment skills to determine developmental delays through the aid of screening tests. The Metro Manila Developmental Screening Test (MMDST) is a screening test to note for normalcy of the child’s development and to determine any delays as well in children 6 ½ years old and below. Modified and standardized by Dr. Phoebe Williams from the original Denver Developmental Screening Test (DDST) by Dr. William K. Frankenburg, MMDST evaluates 4 sectors of development: * Personal-Social – tasks which indicate the child’s ability to get along with people and to take care of himself * Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick up objects and to draw * Language – tasks which indicate the child’s ability to hear, follow directions and to speak * Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump MMDST KIT. Preparation for test administration involves the nurse ensuring the completeness of the test materials contained in the MMDST Kit. These materials should be followed as specified: * MMDST manual

* test Form
* bright red yarn pom-pom
* rattle with narrow handle
* eight 1-inch colored wooden blocks (red, yellow, blue green)
* small clear glass/bottle with 5/8 inch opening
* small bell with 2 ½ inch-diameter mouth
* rubber ball 12 ½ inches in circumference
* cheese curls
* pencil
EXPLAINING THE PROCEDURE. Once the materials are ready, the nurse explains the procedure to the parent or caregiver of the child. It has to be emphasized that this is not a diagnostic test but rather a screening test only. When conducting the test, the parents or caregivers of the child under study should be informed that it is not an IQ test as it may be misinterpreted by them. The nurse should also establish rapport with the parent and the child to ensure cooperation. AGE & THE AGE LINE. To proceed in the administration of the test, the nurse is to compute for the exact age of the child, meaning the age of the child during the test date itself. The age is the most crucial component of the test because it determines the test items that will be applicable/ administered to the child. The exact age is computing by subtracting the child’s birth date with the test date. After computing, draw the age line in the test form. TEST ITEMS.

There are 105 test items in MMDST but not all are administered. The examiner prioritizes items that the age line passes through. It is however imperative to explain to the parent or caregiver that the child is not expected to perform all the tasks correctly. If the sequence were to be followed, the examiner should start with personal-social then progressing to the other sectors. Items that are footnoted with “R” can be passed by report. SCORING. The test items are scored as either Passed (P), Failed (F), Refused (R), or Nor Opportunity (NO). Failure of an item that is completely to the left of the child’s age is considered a developmental delay. Whereas, failure of an item that is completely to the right of the child’s age line is acceptable and not a delay. CONSIDERATIONS:

* Manner in which each test is administered must be exactly the same as stated in the manual, words or direction may not be changed * If the child is premature, subtract the number of weeks of prematurity. But if the child is more than 2 years of age during the test, subtracting may not be necessary * If the child is shy or uncooperative, the caregiver may be asked to administer the test provided that the examiner instructs the caregiver to administer it exactly as directed in the manual * If the child is very shy or uncooperative, the test may be deferred

Children of 18 months to 3 years starts gaining control over eliminative functions and their motor abilities become better and stronger with every passing day. This is the time when a toddler starts to explore his or her surroundings. This time, the child’s mental and physically abilities areenhancing at a remarkable rate and he constantly tries to explore his environment and learn different things. This can be regarded as the child as an autonomous being. However this new phase of a toddler’s psychosocial development is facilitated by the encouragement and patience of parents. It is worth mentioning here that at this stage of development extra care is required to prevent child from engaging with dangerous items. With the development of mental abilities child starts to develop different interests. He may show interest in playing with a ball or in listening to music. The type of environment also has strong effects on child’s developing interests. For example, if parents frequently take child outdoor then child may develop interests in animals, birds and plants. If parents behave overly restrictive the child may develop a sense of doubt and hesitation.

He may become reluctant to try new things. In the meantime when the child is gaining better control over his body he starts showing better muscular coordination. Parents may observe their toddler doing difficult tasks successfully. Similarly, child starts to fulfill his basic needs autonomously. Toddlers begin to feed themselves and develop neural control over the processes of urination and defecation. If the motivation is lacking on the part of caregivers or the environment is not that conducive then the child may develop the sense of shame and doubt. His self confidences falls and he becomes reluctant in trying new things. Parents must keep a tight balance between encouragements and restraint. So, on one end the safety of child is ensures and on the other end child has optimum chances of learning from his environment. Provision of more complicated toys and initiating different outdoor and indoor activities help a lot in this regard.

Criticizing the child for committing minor accidents like soiling, spilling and breaking things can have strong negative effects upon his mind and reinforces the sense of doubt and shame. Furthermore, parents must keep in mind that toddlers start to identify themselves as a person with his own desires and abilities, that is – independent. He likes to do things without the help of his caregivers. So, parents must give the young kid chance to learn and practice new things. This would not only help in improving his physical capabilities and strength but also helps in mental development and building of self esteem. In addition, it is advised to become clear and specific in explaining different things to them. The Incorporation of negative concepts or colloquial speech must be avoided also.

The test though is neither an intellectual testnor a diagnostic test. It does not give a futureinterpretation of the child’s future intellectualcapability but only acts a screening test. B. General Objectives

•This study aims to measure the developmentalskills and capacity of the child that is appropriateto the child’s age and to identify anydevelopmental delays so that appropriateinterventions could be made as soon as possible

C. Specific Objectives
•To be able to identify the clients age accurately.•To be able to draw the clients age line accurately and giveappropriate test items suitable for the child’s age•To be able to assess the Four Major Aspects of the Childsdevelopment•To be able to identify any developmental delays in the child andgive appropriate interventions that could help lessen the severityof the delay or correct the delay.•To be able to give referral and appropriate therapy to the patientsdevelopmental delay•To be able to give separate health teachings to the parents and tothe child’s health condition regarding the clients condition. MMDST-

(Metro Manila Developmental ScreeningTest) a tool used by a health worker to assess anydevelopmental delays within a child at a certain age.• Developmental delay-refers to when a child’sdevelopment lags behind established normal rangesfor his or her age. Sometimes the term is used for mental retardation, which is not a delay indevelopment but rather a permanent limitation. If most children crawl by eight months of age and walkby the middle of the second year, then a child five or six months behind schedule in reaching thesemilestones may be classified as developmentallydelayed regarding mobility.

Nail
Nails are clean andshort. The cuticlesare intact, smoothand noinflammation noted.Has a goodcapillary refill of lessthan 3 seconds .
Clean andsmooth nails.Normal capillaryrefill, no lesionsor swellingspresent

PulmonarySystem
Respiratory rate isrecorded as 25breaths per minute.Lungs are clear upon auscultation.Wheezes, rales andother abnormalsounds were notnoted. There equalrise and fall of thechest with regular rate and rhythm andnormal depths of respiration.

Lungs clear,bronchial tobronchovesicular sounds audible

Cardiovascular System

Pulse rate isrecorded as 85beats per minute. Nomurmurs noted.Normal “lubdub”sound hearduponauscultationsand no chestpain felt asverbalized bythe client.Heart sounds innormal rhythmwith respiratoryvariations, nochest pain or abnormalsounds present

This study will help the community to be awareabout the developmental abilities of the childrenin the area. The results will be significantespecially to the parents in detecting anydevelopmental disabilities and delays in their child. It will also help in recognizing slowdevelopment among children so that referralsmay be made and appropriate therapyprescribed as soon as possible to prevent anyfurther complication.

Date of Test: October 9, 2009
Date of Birth: March 16, 2004
Year Month DayDate of Test 09 10 09
Date of Birth 04 03 1605 06 23
The age of the child is 5 years 6 months and 23days.

MMDST
Child’s Age: Date of Interview: 2011 02 19 Date of Birth: 2009 11 08 1 3 11 Child’s Age: 1 year, 3 months, 11 days A. Personal Social a. Task intersecting within the line i. Imitates house work – PASSED * 50 % of his age is able to do this task

* According to the mother, the child imitates some house works like sweeping the floor and dusting. ii. Uses spoon spilling a little – FAILED * 25 % of his age is able to this task
* As stated by the mother, the child cannot use spoon in eating.
* Only 25 % of his age is able to do this task. Even though he failed, he has still time to do this task. iii. Play ball with examiners – PASSED * 75 % of his age is able to do this task

* The child played ball with the examiners by fetching the ball when asked to. iv. Helps in house simple task – FAILED * More the 25 % but less than 50 % of his age is able to do this task. * As reported by the mother, the child is not able to comprehend commands. * Even though he failed, he has still time to do it. v. Drinks from cup – PASSED * 75 % of his age is able to pass this task

* The child was able to drink from cup with little assistance from his mother. b. Task on the right of the intersecting line i. Puts on clothing – FAILED * The child was not able to put on clothing by himself.

* This is an advance task. He will be able to do it in the future. ii. Removes garment – FAILED * The child was not able to remove garment.
* The child failed because this is an advance task. He has still time to do this. c. Task on the left of the interesting line i. Indicates wants (not cry) – PASSED * According to the mother, the child tells what he wants by pointing at it without crying. ii. Initially shy with strangers – PASSED * As observed by the examiners, the child was shy at first during the test. ANALYSIS: The child has no delays on his personal social sector. B. Fine Motor Adaptive a. Task intersecting within the line i. Scribbles spontaneously – PASSED * 75 % of his age is able to do this task

* The child was able to draw scribbles spontaneously ii. Tower of two cubes – PASSED * 50 % of his age is able to accomplish this task
* The child was able to make a tower of 2 cubes iii. Dumps cheese curl from bottle demonstration – PASSED * More than 25 % but less than 50 % of his age is able to do this task * The child was able to dump cheese curl from one cup to another b. Task on the right of intersecting line i. Tower of four cubes – FAILED * The child was not able to make a tower of four cubes.

* This is an advance task. Even though he failed, he will learn it later in life. ii. Imitates vertical line – FAILED * The child was not able to imitate a vertical line
* The child failed because this is an advance task. He has still time to do this. c. Task on the left of intersecting line i. Neat pincher grasp – PASSED * The child uses his thumb and index finger when picking up objects. ii. Bangs 2 cubes held in hands – PASSED * The child was able to bang 2 cubes held in hands ANALYSIS: The child has no delays on his fine motor adaptive sector. C. Language a. Task intersecting within the line i. 3 words other than Mama and Papa – FAILED * 50 % of his age is able to do this task

* According to the mother, the child only knows Mama, Papa and Dede * Only 50 % of his age is able to do this task. Even though he failed, he has still time to do it. ii. Points to one named body part – FAILED * More than 25 % but less than 50 % of his age is able to do this task * The child was not able to point to one named body part

* Even though he failed, he has still time to do it. b. Task on the right of intersecting line i. Names one picture – FAILED * The child was not able to name any picture shown.
* This is an advance task which will be learned later in his life. ii. Follow directions – FAILED * The child cannot follow any direction
* This is an advance task. He has still time to do it. c. Task on the left of intersecting line i. Dada or Mama specific – PASSED * The child was able to specify mama ii. Imitates speech sounds – PASSED * The child was able to imitate speech sounds ANALYSIS: The child has no delays on his language sector. D. Gross Motor a. Task on the intersecting line i. Kicks ball forward – REFUSED * 25 % of his age is able to do this task

* The child refused to kick the ball. ii. Stoops and recovers – PASSED * More than 25 % but less than 90 % of his age is able to do this task * As stated by the mother, the child is able to stand up by himself when stooped iii. Walks well – PASSED * 75 % of his age is able to pass this
test

* As observed, the child was able to walk by himself. iv. Walks backward – FAILED * 50 % of his age is able to do this task
* The child was not able to walk backwards
* Only 50 % of his age is able to pass this test. He has still time to do it. v. Walks up steps – FAILED * More than 25 % but less than 50 % is able to pass this task. * The child was not able to walk up the stairs

* Even though the child failed to do this task, he has still time to accomplish it. b. Task on the right of intersecting line i. Throws ball over hand – FAILED * The child was not able to throw ball over hand

* This is an advance task which will be learned later in his life. ii. Jumps in one place – FAILED * The child cannot jump
* This is an advance task. Even though he failed to do it, he has still time to do this task c. Task on the left of intersecting line i. Stands momentarily * The child can stand alone without any support ii. Stands alone well * The child can stand alone without any support or without holding on to somethingANALYSIS: The child has no delays on his gross motor sector. GENERAL ANALYSIS

Based on the result of the MMDST, Argicel is not delayed. He was able to pass all of the activities on the left of the intersecting line. Even though he failed to accomplish some task on the intersecting line, he has still time to do those tasks. He failed to do all activities on the right of the intersecting line. These are advance tasks which he will learn later as he age.