MMDST

Lecture by: Madeline N. Gerzon, RN, MM Clinical Instructor

METRO MANILA DEVELOPMENT SCREENING TEST

Overview
• Screening is a presumptive identification of unrecognized disease or defect • Early detection model • Test children with problem • Facilitates early referral and treatment

Overview
• Detection of developmental disabilities • Children 6 ½ years and below

What then is MMDST?

MMDST
• Simple and clinically useful tool • To determine early serious developmental delays

MMDST
• Dr. William K. Frankenburg • Modified and standardized by Dr. Phoebe D. Williams DDST to MMDST

MMDST
• Developed for health professionals (MDs, RNs, etc) • It is not an intelligence test

MMDST
• It is a screening instrument to determine if child’s development is within normal

Purposes
• Measures developmental delays • Evaluates 4 aspects of development

Aspects of development
• • • • Personal-social Fine-motor adaptive Language Gross motor behavior

MMDST Kit
• • • • Manual Sample test form Test materials MMDST bag

Test materials
• A bright red yarn pom-pom • A rattle with narrow handle • Eight 1-inch colored wooden blocks (red, yellow, blue green)

Test materials
• A small clear glass/bottle with 5/8 inch opening • A small bell with 2 ½ inch-diameter mouth

Test materials
• A rubber ball 12 ½ inches in circumference • Cheese curls • A pencil • Cheese curls

Important considerations
• Child’s age is crucial= initial step in test administration • Test items will be dependent on age of child

Important considerations
• Age = guide the selection of test items and subsequent interpretation of results

Scoring the Test
• • • • Passed Failed Refused, or No opportunity

Scoring the test
• Failure of an item that is completely to the left of the child’s age is considered a developmental delay

The Test Form
• Made of 105 items written in the range of development of children between birth and six years of age

Four Sectors
• Personal-Social – tasks which indicate the child’s ability to get along with people and to take care of himself

Four Sectors
• Fine-Motor Adaptive – tasks which indicate the child’s ability to see and use his hands to pick up objects and to draw

Four Sectors
• Language – tasks which indicate the child’s ability to hear, follow directions and to speak; and

Four Sectors
• Gross-Motor – tasks which indicate the child’s ability to sit, walk and jump

Test Directions
1. Try to get the child to smile by smiling, talking or waving to him. Do not touch him. 3. When the child is playing with toy, pull it away from him. Pass if he resists.

Test Directions
• Child does not have to be able to tie shoes or button in the back Move yarn slowly in an arch from one side to the other, about 6” above child’s face. Pass if the eyes follow 90o to midline. (past midline; 180o)

Test Directions
• • Pass if the child grasps rattle when it is touched to the backs or tips of fingers Pass if the child continues to look where yarn disappeared or tries to see where it went. Yarn should be dropped quickly from sight from tester’s hand without arm movement

Test Directions
1. Pass if the child picks up cheese curl with any part of the thumb and finger 3. Pass if child picks up cheese curl with the ends of thumb and index finger using an over hand approach

Test Directions
1. Pass any enclosed form. Fail continuous round motion.

Test Directions
1. Which line is longer (not bigger). Turn the paper upside down an repeat (3/3 or 5/6)

Test Directions
1. Pass any crossing line

Test Directions
1. Have child copy first. If failed, demonstrate

Test Directions
• Note
– When giving items 9, 11 and 12, do not name the forms. Do not demonstrate 9 and 11.

Test Directions
1. When scoring, each pair (2 arms, 2 legs, etc) counts as one part 3. Point to picture and have the child name it. (No credit is given for sounds only)

Test Directions
1. Tell the child to: give block to mommy; put block on table; put block on floor. Pass 2 of 3. (Do not help child by pointing, moving head or eyes.) 3. Ask child: What do you do when you are cold? Hungry? Tired? Pass 2 of 3.

Test Directions
• Tell child to: Put block on table; under table; in front of chair, behind chair. Pass 3 of 4. (Do not help child by pointing, moving head or eyes.) Ask child: If fire is hot, ice is? Mother is a woman, Dad is a?, a horse is big, a mouse is ? Pass 2 of 3.

Test Directions
1. Ask child: What is a ball? River? Desk? House? Banana?, Curtain? Roof? Fence? Street? Pass if defined in terms of use, shape, what is it made of or its general category (such as banana is a fruit, not just yellow). Pass 6 of 9.

Test Directions
• Ask child: What is a spoon made of? A shoe made of? A door made of? (no other objects can be substituted.) Pass 3 of 3. When placed on stomach, child lifts chest off table with support of forearms and/or hands.

Test Directions
1. While child is on back, grasp his hands and pull him to sitting. Pass if head does not hang back 3. Child may use wall or rail only, not person. May not crawl.

Test Directions
1. Child must throw ball overhead 3 feet to within arm’s reach of tester 3. Child must perform standing broad jumps over width of test sheet (8 ½ inches)

Test Directions
1. Tell child to walk forward, heel within 1 inch of toe. Tester may demonstrate. Child must walk 4 consecutive steps, 2 out of 3 trials.

Test Directions
1. Bounce ball to child who should stand 3 feet away from tester. Child must catch ball with hands, not arms, 2 out of 3 trials.

Test Directions
1. Tell child to walk backward toe within 1 inch of heel. Tester may demonstrate. Child must walk 4 consecutive steps, 2 out of 3 trials.

Important
• Date and Behavioral Observations
– How child feels at time of test, relations to tester, attention span, verbal behavior, selfconfidence, etc)

The Test Form
• Across the top and bottom of form are age scales • Age is marked in months 1-24, and age in years from 2 ½ to 6.

The Test Form
• Each item is represented in the test form by a bar • The bar is placed along the age scale to show when 25%, 50% (indicated by the hatch mark) 75% and 90% of the normal children are able to pass the item.

The Test Form
10 11 12 13
Hatch Mark 50% WALKS WELL

14

16

18

Percentage of normal children passing the item

25%

75%

90%

The Test Form
• Some items have a small footnote number at the left end of the bar • Footnote indicates corresponding instruction for administering the item found at the test form
Items which can be passed by report Footnote number R WALKS UP STEPS
23

The Test Form
• Some items may be passed by report of the parent (R) • Only items with an R on the form can be passed by report • However, whenever possible tester should observe what the child can perform

The Test Form
• The item, equal movements, has an asterisk (*) at the right end of its bar • Indicates 100% of normal children pass this item at birth • It is the only item with an * (fine-motor adaptive sector

The Test Form
• 9 items have arrows ( ) at the right end of these bars • This includes the items, defines words and composition of __. • Arrows indicate that normal children may pass these items even beyond 6 ½ y.o.

Calculating Child’s Age
• Formula
Date of test Birthdate Age of child Year 99 -97 2 Month 11 - 3 8 Day 15 -10 5

Calculating Child’s Age
• Formula
Year Date of test Birthdate Age of child 99 -97 1 Month 2 - 3 10 Day 8 -10 25

Calculating Child’s Age
• Formula
Year 98 Date of test Birthdate Age of child 99 -97 1 Month 13 2 - 3 10 Day 35 8 -10 25

Drawing the Age Line
• Use age scale shown at the top and bottom of the form • Mark the age and draw a line through all four sectors • Show acetate

Drawing the Age Line
• Location of age must be accurate interpretation depends on correct placement of the line • Space between age –-- 2 weeks until 14 mos, 1 mo from 14 to 24 mos • From 24 mos to 5 yrs spaces between represent 3 mos and thereafter 6 mos

Adjusting for Prematurity
• Prematurity affect ability to perform that normal child pass at the same age • Adjust for children 2 years or younger • After 2 years, it is no longer necessary to compensate (Frankenburg, et al) • No adjustment is made on postterm

Adjusting for Prematurity
• Ask mother if child was born prematurely • For two or three weeks earlier, subtract the number of weeks from actual age • Draw age line based on adjusted age

Selecting Items to be administered
• Administer first those through which child’s chronological age line passes • If failure occurs in any items, proceed to administer items to the left of the age line until you obtain 3 passes then stop

Selecting Items to be administered
WHAT TO KEEP IN MIND!!!!!

Selecting Items to be administered
• All items crossing the age line should be administered • Child should have a minimum of three passes to the left of any failure; and • Each sector should have at least 3 passes and three failures

The Test Procedure
• Preliminary Phase
– Establish rapport – Make the child as comfortable as possible
• If infant…on mother’s lap • Materials should be accessible

The Test Procedure
• If child is one year older, put child at ease
– Show toys…etc

The Test Procedure
• Start with Personal-social sector • Gives child chance to get used to tester • Gives tester chance ask parents which can be scored based on report and can also directly observe it

The Test Procedure
• Fine motor-adaptive sector follows • Child can perform tasks even without having to directly talk to tester • Filipino child…..warming up

The Test Procedure
• Third is, language sector • This time child is more comfortable with you (tester) • Will talk as much to you

The Test Procedure
• Lastly, gross-motor sector • Many children are too shy at the beginning of the test

The Test Procedure
WHAT MAY NOT BE CHANGED?

The Test Procedure
• Manner in which each test is administered • Words or direction may not be changed •

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