Cocca : RrACKNOWLEDGEMENTS, The authors wish to express their appreciation to Brigitte Curtis, Jinhua Chen, Georgia Athearn, Sandra Harris, Sharon Brainard, Pamela Haglund, Clara Perez-Mendez, Gwedolyn Marler, Lucille Johnson, Helen Mcintosh, Rose Hosmer, Bradley Samuel, Judy Retior, Reid Reynolds, Denver Department of Health and Hospitals, Denver Department of Social Services, Colorado county health departments and local nursing services, Kaiser Permanente, Plan de Salud del Valle, many private physicians’ offices, Mile-Hi Child Care centers, Head Start centers, Cheryl J. Mamdu and Renee M, Cowan for the typing of this manual, and the parents ‘and children who participated in the standardization. In addition, the authors wish to express their appreciation to Paul Levy, Professor and Chairman of the Department af Epidemiology, University of llinois, Schoo! of Public Health, for his consultation in the design of the standardization project. Published by Denver Developmental Materials, Inc. © 1967, 1970 William K. Frankenburg and Josiah 8, Dodds; 1975, 1976, 1978 William K. Frankenburg; 1990, 1992 William K, Frankenburg and Josiah B. DoddsDENVER II TRAINING MANUAL Contents |. Introduction AB. Objectives... B. Historical Background. ©. Description of the Test D. Training of Examiners... E. Clinical and Research Applications. Standardization ‘A. Selection of Potential items. B. Design of the Sample ..n. ©. Collection of Data. D. Computation of Norms... E. Reliability orn F. Validity Ill, Administration and Interpretation ‘A. Test Materials... B. Test Form ©. Calculating the Child's Age & Drawing the Age Line 1, General Instructions... canrrecmianmennmenmrnomnernammcancald 2. Adjusting for Prematuty ....n:snsnnnnmnnnnnninsnnn i 8 preowoe ee 8. Drawing the Age Line... 8 D. Test Administration 1. General Instructions... . 7 3 lit 9 2. Building Rapport....nnm ee 3. Introduction ct cate eter etait aa eaten 4. Order of Testing irri ica : 40 5, Number of Items to be Given. . ce etree eee IU: 6. Test Behavior Ratings ' ee 11 Ze MteM SCOFING. se Se eee Salt E. Interpretation 1. Interpretation of Individual IteM$ ....scennnnnmnnnnninnnnnennnmennennnneed 2. Interpretation of the Test se ee ea 3. Referral Considerations... : 5 3 13 4, Profiles of Various Test Results 13 Directions for Administration of Specific Items A. Porsonal ~ Social. eer 7 ee Berg B. Fine Motor - Adaptive os 20) ¢. Language. i eee ciseanisceree ae ain D. Gross Motor... : 30 V. Self-Evaluation A. Short Answer. B, Multiple Choice . Interpretation of Results, D. Answers . Vi. Self-Administered Checklist VII. Appendices ‘A. Age When Given Percentage of Standardization Sample Passed Items 1. Personal - Social 43, 2. Fine Motor - Adaptive..... 44 Be Language nnn ese ees) 4, Gross Motor . uranaAG) B. Now, Changed, and Omitied Items: Compared to Original Test 4. New Items ! aT 2. Changed Items cece nese sear AB 3. Omitted Items te sai a; err’,1. INTRODUCTION A. OBJECTIVES This manual was developed to provide instruction in testing and scoring procedures of the DEN- VER II, to describe standardization data, and to clarify potential clinical and research applications. The manual is designed to accompany a video training program. Screeners are advised to study both the manual and the videotape. to practice testing, and to take the proficiency test to assure that they administer and interpret the test correctly. After studying the instructional materials and practice-testing a dozen children, the screener should be able to: ‘* Accurately prepare for the administration ofthe test, including calculating the child's age and drawing the age line on the test form * Reliably perform the test procedures and identify variations of pass/fail status * Subjectively assess and rate the childs overall behavior during the test * Identify scores as “advanced,” “normal,” “caution,” or “delayed” * Interpret test results as “normal,” “suspect,” or “untestable” + Pass the proficiency examination 8B. HISTORICAL BACKGROUND ‘The Denver Developmental Screening Test (DDST) was first published in 1967 to help health providers detect potential developmental problems in young children. Since its original publication, the DDST has been widely used. It has been adapted for use and standardized in aver a dozen countries and thus has been used to screen more than 50 million children throughout the world. As a result of such wide-spread usage much has been leamed, and this has prompted a major revision in the test, culminating in the DENVER I Four concerns raised by past use are: the need for additional language items; the appropri- ateness of 1967 norms in 1990; specific test item characteristics (such as difficulty in administra~ tion andjor scoring), and the appropriateness of the test for various subgroups (such as ethnic groups, sexes, maternal education levels, and places of residence when clinically significant differ- ences exist in subgroup norms; see DENVER Il Technical Manual) Another concern raised has been the lack of test sensitivity in predicting later status, such as school performance. ‘A concern raised primarily by the developers of the test was the occasional well-intentioned but inaccurate way in which the test was sometimes administered and/or interpreted. ‘The aforementioned concerns were fundamental in the decision to revise the test, restandard- ize it, modify its interpretation, develop a new training videotape, and emphasize taining and per odie proficiency evaluation in the administration of the test. ©. DESCRIPTION OF THE TEST ‘The DENVER 1I is designed to be used with apparently well children between birth and six years of age and is administered by assessing a child's performance on various age-appropriate tasks. The testis valuable in screening asymptomatic children for possible problems, in confirming intuitive suspicions with an objective measure, and in monitoring children at risk for developmental problems, such as those who have experienced perinatal difficulties. The DENVER II is not an IQ test, nor is ita definitive predictor of future adaptive or intellectual ability, tis not designed to generate diagnostic labels such as learning disability, language disor- der, or emotional disturbance, and it should never substitute for a diagnostic evaluation or physical examination. Rathor, the test is designed to compare a given child's performance on a variety of tasks to the performance of other children the same age ‘The DENVER II consists of 125 tasks, or tems, which are arranged on the test form in four sectors to screen the following areas of function: - Personal-Sacial — getting along with people and caring for personal needs - Fine Motor-Adaptive - eye-hand coordination, manipulation of small objects, and problem-solving - Language - hearing, understanding, and using language ~ Gross Motor ~ siting, walking, jumping, and overall large muscle movement Also included are five “Test Behavior” items for completion after administration of the test. Rating the chila’s behavior in this way helps the screener subjectively assess the child's overall behavior and obtain a rough gauge of how the child uses his or her abiities.D. TRAINING OF EXAMINERS ‘The DENVER II was designed to be used in a clinical setting by a variety of professionals and paraprotessionals. Testing should only be undertaken by individuals whe are thoroughly familiar with the DENVER II materials and procedures as well as the problems associated with testing ‘young children. The test must be administered in the standardized manner, and screeners should be carefully trained and should pass the proficiency test before using the test for clinical purposes Study of this manual, especially the administration and scoring sections, a review of the videotape, and practice testing children of various age groups should help the potential user develop the fun- damental skils for proper administration and interpretation of the DENVER It Persons who previously administered the DDST — as well as those who have not - are advised to go through the entice training program and proficiency evaluation since there are many differences between the two tests. Persons wishing information regarding training, proficiency testing, or materials should contact William K. Frankenburg, M.D., M.S.PH., ©°O Denver Developmental Materials, Inc., PO. Box 371075, Denver, CO 80237-5075, (303) 355-4729 or 1-800-419-4729 E. CLINICAL AND RESEARCH APPLICATIONS Tho principal value of the DENVER I is to provide an organized, clinical impression of a child's overall development and to alert the user to potential Gevelopmentel difficulties. The DEN- VER Il should be used primarily to determine how a child compares to other children. It is not rec~ ‘ommended as a predictor of later development. The DENVER Ii Technical Manual prosents oxton- sive data on the test's revision and restandardization as well as detailed information about all of the items included in the DENVER liI. STANDARDIZATION A. SELECTION OF POTENTIAL ITEMS In the process of revising and restandardizing the DDST, several modifications were made in the original 105 items. This included omitting items due to their limited clinical value or difficulty in ‘administration or scoring. Some DDST iterns were revised for clarification, and many new items were added, especially in the language sector. The pool of potential items for the standardization numbered 336, Scoring criteria for each item and for the child's general behavior were established prior to initiating data collection B. DESIGN OF THE SAMPLE A quota sample design was used that controlled for maternal education, residence, and eth- nicity within age groups. To facilitate field sampling, the testing age range of 2 weeks to 6-1/2 years was split ito 10 age groups, as follows 0 to 2 months 18 to 18 months 2104 months 18 to 24 months 4107 months 24 to 40 months 7 to 10 months 40 to 87 months, 10 to 13 months 87 10 78 months ©. COLLECTION OF DATA Data on the normative sample were collected during 1988 by 17 screeners. Before data col lection, oxtensive training procedures were conducted to assure high inter-rater reliability. Post- screening reliability data were also gathered for the seven soreeners who tested over 80% of the normative sample Screeners tested children who met the basic criteria for inclusion in the study, and whose ‘age. race, place of residence, and mother 's educational level wore needed to meet the quota sample. Testing locetions were throughout the Denver metropolitan area, and in several urban, semi-rural, and rural regions in the state of Colorado The children wore located through the Denver Department of Social Services, the Denver and Colorado Departments of Public Health well-cnild clinics, pediatricians, family physicians, hospital birth records, child care centers, and private sources. Only full term children without obvious defects - and oniy one child per family ~ were included in the sample of 2,096 children. The sarn- ple finally obtained is described in the DENVER 1! Technical Manual D. COMPUTATION OF NORMS The data were analyzed by logistic regression to determine the ages at which the children tested passed each of the items. A large number of observations per item were available for analy- sis, as each item was administered at least 440 times and up to 1,309 times (mean=783, $D=190.7). The analysis made it possible to determine when 25%, 50%, 75% and 90% of the chik dren passed a test item, The variables of sex, maternal education, ethnicity, and place of resi- dence were also analyzed with regard to differences in the ages at which children passed the item. (The norms for items demonstrating clinically significant differences are discussed in the DENVER I Technical Manual.) In addition to the quantitative data analysis, several qualitative factors were subjectively eval uated for each item, such as ease of administration and scoring, interest value for the child being tested, and practicality. This information was used to help select items for the DENVER Il from the pool of potential items on which data were obtained.RELIABILITY Thirty-eight children from 10 age groups were recruited and scheduled for two evaluations ‘on each of two occasions separated by an interval of seven to 10 days. Four trained screeners examined or observed the testing of each child. Testers and observers scored the children inée- pendently, and results from the frst evaluation were not available during the second week's evalua- tion. Two types of reliably assessed were concurrent examiner-observer reliability and 7 to 10 day test-retest stability. The percentage of agreement in the observed evaluations was compuled for each of the items administered. The mean examiner-observer reliability for the items included in the DENVER Il is .99 with a range of 96-1,00 and a standard deviation of .016. The mean 7 to 10 day test-retest reliability for the same items is 90 with a range of .50-1.00 and a standard deviation of 12, VALIDITY Content validity of the original DDST items has been recognized through the test's accep- tance all over the world. The naw items were written and selected by professionals specializing in child development and pediatric screening, The validity of the test rests upon its standardization, rot on its correlation with other tests since all tests are constructed slightly differently. Even tests such as IQ tests, which are purported to measure the same function, do not totally agree. Persons seeking more detailed information are advised to consult the DENVER II Technical Manual.|. ADMINISTRATION AND INTERPRETATION A. TEST MATERIALS ‘The DENVER It utilizes the following materials ‘+ Red yarn pom-pom (approximately 4” diameter) —_* Tennis ball + Raisins ‘+ Red pencil ‘Rattle with narrow handle ‘+ Small plastic doll with feeding botle 10 1-inch square colored wooden blocks * Plastic oup with handle += Small, clear glass bottle with a 5/8 inch opening Blank paper + Small bell ‘All materials used in testing are provided in the test kit, with the exception of blank sheets of paper (for drawing). Also necessary are a table and enough chairs for the examiner, caregiver, and child (if appropriate), and adequate space to administer the gross motor items. For young babies, a blanket or cushioned examining table is helpful for items in which the infant fies down. The materials provided with the DENVER Il kit have been selected with care, and haphazard sub- stitutions may reduce the reliability in comparing a tested child with the norms. In lieu of raisins, “o'-shaped cereal may be substituted. When items are lost or broken, replacements should be requested from the test publisher Children should always be carefully supervised when test materials are present to prevent injuries such as ingestion, laceration of an eye, etc B. TEST FORM The test form has each of the items arranged within one of four sectors: Personal-Social, Fine Motor-Adaptive, Language, and Gross Motor. A sample DENVER II test form is included on the fol lowing pages as Figures 1 and 2 ‘Age scales across the top and bottom of the test form depict ages in months and years from birth to 6 years. Each space between age marks on these scales represents one month until 24 months; thereafter each space represents 3 months. Each of the 125 test items is represented on the form by a bar that spans the ages at which 25%, 50%, 75%, and 90% of the standardization, sample passed that item, as ilustted in Figure 3. ‘Age scale in months 6 2 12 6 Porcant of normal chiaren passing ier: 50% 75% O0% waxwe In the above oxample for the itern “Walk Well” the left end of the bar indicates that 25% of the sample children walked well ata ittle over 11 months; the hatch mark snows that 50% did this at 12-118 months; the left end of the shaded area shows that 75% walked well at 13-1/2 months: the right end of the bar shows that 90% of the sample children could walk well ata little under 15 months. Some of the items have a small footnote number on the left end of the bar. This number refers to numbered instructions found an the back of the test form that remind the examiner how to administer and/or interpret such items. (See Figure 4.) Some items may be passed by report of the caregiver, and therefore have an “A” located at the left end of the bar. (See Figure 4,) Only those items with an *R* on the test form may be passed by report. Even for the report items, whenever possible the examiner should observe what the child can do. ; | Figure 4 | Risdenteston may bepased byrpot Ramnntaasccncccs El [ Babee te etm For some of the items at the youngest ages, all of the percentiles (25th, 50th, 75th and 90th) are not available, Such iterns, while only rarely failed, are included to alert the user to the child who requires a more detailed evaluation. For example, the item “Equal Movements,” which should be passed by all infants, is included to alert the examiner to the child who may have a weakness (paresis) of one limb or one side of the body, All such items occur at early ages, with more than 20% of children performing the task at birth or shortly thereafter.Figure 1 DENVER 50" tere PERSONAL SOCIAL FINE MOTOR - ADAPTIVE fanietace Ba y _~ ‘Compliance (See Note 31) ‘Always Complies Usually Complies Rarely Comptes LANGUAGE, Interest in Surrounaings Alert Somewhat Dsinterested Seriously Disiterestes ‘GHG, 1085, 1890 WK Frekenburg and. Dodds ©1978. K Fantenbug (ohoss MOTOR.Figure 2 DIRECTIONS FOR ADMINISTRATION 1. Tryto get chia to emie by smiling, taking or waving. De not touch hina 2. Chi must stare ai hang several secones 3. Parent may help guide toothbrush and put totpaco on rush 44 Chia does not have tobe abe otis ehoes or Burton inthe back. 55. Move yam slowly in an ar rom one oie tothe ster, about 8 above child aoe. 6 Passi chia grasps rate when a fouched 0 the Backs of tis o fingers 7 Passi chid ties to see where yard went, Yarn shoul be droped quickly trom sigh om testers han without am raverent 8. Coie must transfer cube Fom hand to hand witho.t hep of body, mouth, orale. 9. Pass cid picks up isin wih any part um ana inger 40. Line can vary ony 30 degrees or less tom estar’ ine. 7 {1 Make a fist with thumb pomning upward anc wiggle onl the thumb. Passi chic imitates and does not move any finger athe han the thumb, 12 Pose any enciosed term, 18. Which ines longer? 14, Posscny ines crossing 15. Have chid eopy frst Fail contnuous round (ot bigot) Tun paper near mopoit Wales, eons maton. upside down snd repeat (pass3 of 3 or 5 of 6) When giving items 12, 14, and 15, do not name the forms. Do not demonstrate 12 and 14. 16. When scoring, each pair (2 arms, 2 lags, et.) counts as one part 17. Place one cube in cup and shake gently near cd's ear, but out of sight. Repeat for ther eer. 18. Point to picture and have chile name it. (No eracitis given for sounds only.) Itless than 4 pictures are named correctly, have child point to picture as each is named by tester. eA wt 19. Using doll, tell chile: Show ma the nose, eyes, 2ars, mouth, hands, feet, tummy, nai. Pass 6 of & 20, Using pictures, ask child: Which one fies?...ays meow?..taks?...barks?...galops? Poss 2 of 5, 4 0f 5 21. Ack child: What do you do when you ara cola?..trea?.hungry? Pass 2 of 3,3 of 3. 22. Ask child: What do you do witn a cup? What is 2 chair used for? What is a pencil used for? ‘Action words must be included in answers. 23. Pass if child correctly places and says how mary blocks are on paper. (1.5) 24. Tell child: Put block on table; under table: in front of me, behind me. Pass 4 of 4 (Do not relp child by pointing, moving head or eyes.) 25, Ask child: What isa bail? ake?...desk?. .house?...banana?...curtain?...enee?...celing? Pase if definad in terms of use, shape, ‘what itis made of, of general catagory (such as banana is fruit, not ust yellow). Pass § of 8, 7 of & 26. Ask chi: a horse is big, a mouse is _? Ife shat, ice is_? If he gun shines during the day, the moon shines during the _ Pass 2 of 3 27. Child may use wal or eal only, nat person. May not craw 28. Child must throw ball overhand 3 feet to within arms reach of tester. 29. Child must perform standing broad jump over wicth of test sheet (8 1/2 inches) 80. Tell child to walk forward, GDEDEIGI-P nee! witnin 1 inch of toe, Tester may demonstrate Child must walk 4 consecutive steps. 31, Inthe second year, half of normal children are non-compliant ‘OBSERVATIONS:©. CALCULATING THE CHILD'S AGE AND DRAWING THE AGE LINE 4. General Instructions General information such as the child’s name, birth date, and test date should be recorded first on the test form, The childs age is computed by subtracting the date of birth from the date of testing. (When it is necessary to "borrow" in the subtraction, 30 days are borrowed from the month column, and 12 months are borrowed from the year column.) Example #1: Year Month Day Date of Test Wincasef coal Date of Birth BBnmasBanisl0 Age of Child Desh Sane) The age of the child in Example #1 is found to be 2 years, 4 months, and 5 days, Example #2: Year Month Day 18 BP econ one Date of Test 96 A ee J Date of Biah 88 3.10 AG Of CHIE cneonrnned nen ‘The age of the child in Example #2 is 1 year, 8 months, and 17 days. The age is caloulated as follows: Step 1. Itis not possible to subtract 28 days from 15. Therefore, borrow 30 days (1 month) from 7 months. Add 20 days to 15 to make 45 days. Six months are left in the month column. Step 2. Subtract 28 days from 45 days = 17 days. Step 3. itis not possible to subtract 10 months from 6. Therefore, borrow 12 months (1 yea) from 90. Add 12 months to 6, to make 18 months: 89 is lettin the year column. ‘Step 4. Subtract 10 months from 18 months = 8 months. ‘Step 5. Subtract 86 from 89 = 1 year. The age of the child in Example #2 is found to be 1 year, & months, and 17 days. Accurate age calculation is very important, and should be checked carefully before proceed- ing with the test, The child's age is used as a reference point against which all item performances are compared. 2. Adjusting for Prematurity For children who were born more than 2 weeks before the expected date of delivery and who are less than 2 years of age, the calculated age must be adjusted. To adjust the age. first divide the number of woeks premature into months and days, using 4 weeks to a month and 7 days to a week. Then subtract the resulting month(s) and days from the calculated age. [ Example #3: Year Month Day Date of Test 80 Bres20 | Date of Birth 780 cae B enn ‘Age of Child : Bonet 6 weeks premature Ane ‘Adjusted Age of Child. 6 ‘The calculated age of the child in Example #3 is found to be 2 months 19 days. The child was ‘born 6 weeks (1 month 14 days) prematurely, so this amount is subtracted from the calculated age {o arrive at the adjusted age of 1 month 5 days. Use this adjusted age to draw the age line. In addition, itis necessary to indicate on the test form that the child’s age was adjusted for prema- {urity. No age adjustment is necessary for children 2 years of age and above or for children born later than expected. (When the child reaches 2 years of age or more itis no longer necessary to adjust for prematurity because the weeks premature represent an increasingly smaller fraction of the child's total age.)3. Drawing the Age Line After correctly calculating the age of the child to be tested (and adjusting for prematurity, if necessary), use the age scales and a straight edge to accurately draw an “age line” from the top to the bottom of the form. Each space between age marks at the top and bottom of the form repre- sents one month until 24 months; thereafter, each space represents 3 months. Use the exact calcu= lated (or adjusted) age to draw the age iine, without rounding off days, weeks, or months. After drawing the age line, write the date of the test above it, as shown in Figure 5. Figure 5 ‘Age scale in months 8-15-92 6 2 6 ‘The chidis 13% months ole: he date ofthe testis August 15, 1992. As test interpretation depends on the correct placement of the age line, the age scale should bbe carefully checked to assure that the line has been drawn in the correct location. D. TEST ADMINISTRATION 4. General Instructions The DENVER II can be used to screen a child repeatedly from birth to six years of age. To Use the samo test form on more than one occasion, itis suggested that a new age line (with the date Of testing entered above it) be drawn each time the child is screened, and that the scoring of items bbe done in such a manner as to distinguish the scores for each administration, For example, this may be accomplished by using a different colored pencil Allitems must be tested in accordance with standardized administration procedures described in this manual; otherwise, the norms depicted by the bars will not be applicable. Examiners should review the directions for administration of the test periodically to guard against Unintentional deviations. Building Rapport In the testing situation, the examirier’s efforts should be directed toward obtaining the best test performance possible from the child and obtaining accurate information from the caregiver. Rapport with the child and caregiver is essential The testis to be given with the child's parent or primary caregiver present. To elicit the most natural actwvitios from the child, every effort should be made to make the caregiver and child corr fortable. Itis best to administer the test while the child is dressed. Boots or shoes that restrict the child's performance of motor tems should be removed before these items are administered. & young child may sit on the caregiver’ lap. An older child may sit alone on a chair if he or she is ‘comfortable and can reach the test materials easily, Ideally, the child will sit so that his or her arms can rest upon the table. The child's elbow should be level with the table top. la child siting on a lap Is too low, ask the person holding the child to put a folded bianket on the lap to raise the child ‘Atable that can be adjusted for height, or a chiid-sized table and chair is ideal for testing preschool-aged children. Infants may be evaluated on the floor ifa safe table is not available. 3. Introduction The caregiver should be asked when the child was born and whether the child was born pre rmaturely. The examiner should then calculate the child's test age and determine ifthe calculation is, correct. Since the testing may cause anxiety for the child's caregiver, itis essential to explain that the DENVER Il is administered to determine the child's current developmental status, thatthe test ig not an IQ test, and that the child is not expected to pass all ofthe items administered,10 4, Order of Testing The order of presenting the items should be flexible, and the sequence should be adjusted according to the responsiveness of the child. itis generally helpful to piace one or more age- appropriate test iteris (such as a rattle for the infant, blocks for a toddler, paper and pencil for a preschooler) on the table so that the child can amuse him- or herself while the examiner asks the parent the reportable items of the Personal-Social sector. The child's free activity while “report” items are being asked of the caregiver is considered part of the evaluation, and the examiner should be attentive to the child's spontaneous behavior. Test items may be scored on the basis of any relevant behavior observed by the examiner even if it occurs before or after the formal testing. For example, if child runs into the testing room, the item "Runs" may be scored as a pass. ‘Although flexibility is very important, there are general guidelines for the order of acminis- tering the items that are favorable for most children. The following points are suggested a. In general, items requiring less active participation of the child should be administered first (such as the “report” items in the Personal-Social sector). These should be followed by the Fine Motor-Adaptive items, which do not require the child to speak; next, the Language iter and finally, the Gross Motor items. For most children itis best to administer the Gross Motor items last, since they require a sense of confidence which generally increases as testing pro- gresses. in adcition, some children become excited when performing the Gross Motor items and subsequently are reluctant to return to the examining table to perform items in other test sectors. bb. Tasks that the child can perform easily should be administered first. The child's efforts should bee praised, even on items that are failed. This builds the child's confidence and may encourage him or her to attempt more difficult tems. ¢. Items that use the same materials in the test kit, such as blocks, may be administered consecu- tively to save time. This helps to avoid continued removal and retrieval of materials during the testing, which can disrupt the “flow” of the session. d. Itis recommended that only materials used for the specific item be placed on the table to avoid distractions. Testing may also progress more smoothly if the test kit is Kept out of sight and reach of the child (perhaps on the examiner's lap), fe. For infants, itis recommended that all tems administered with the baby lying down be tested together. Regardless of the age of the child, in each sector testing should begin with items that fall com- pletely to the left of the child's age line, and continue to the right. 5. Number of Items to be Given ‘The number of items to be given varies with the age and abilities of the child being tested, In practice the number of iteris administered may depend on: ‘= The time available for testing, and: ‘= Whether the goal is to identify developmental delays andlor the relative strengths of the. child a. To determine if the child is developmentally at risk, administer the test as follows. Step 1: In cach sector, administer at least three items nearest to and totally to the left of the age line and every item that is intersected by the age line Step 2: Ifthe child is unable to perform any item in Step 1 (fails, refuses, has had no opportunity), administer additional items to the leit in the appropriate sector until the child passes three consecutive items. 'b, To determine a childs relative strengths (a ceiling), administer the test as follows: Step 1: In cach sector, administer at least three items nearest to and totally to the left of the age line and every item that is intersected by the age line. ‘ontinue to administer items to the right of any passes in each sector until three failures are recorded The child may be given up to three trials to perform each item, when appropriate, before scoring a failure. More than three trials may teach the child an item not previously accomplished. Such “leaching’ would also extend the testing time. Step6. Test Behavior Ratings ‘The “Test Behavior" ratings are scored after the completion of the test. Using the rating scale provided, the screener can compare the behavior of the child during the test with the child's previ- ‘ous performance. Always ask the caregiver ifthe child's performance was typical of his or her abil- ity and behavior at other times. Sometimes a child may be 100 il, tired, hungry, or upset when test- ed to display actual capabilities. In such cases, the test may be rescheduled on a different day at a time the child is likely to be more cooperative, 7. Item Scoring The score for each item should be recorded on the ber near the 50% hatch mark The following scores are used for the DENVER II: "P" for Pass— the child successfully performs the item, or the caregiver reports (when appro- priate) that the child does the item. “F for Fail— the child does not successfully perform the item, or the caregiver reports (when appropriate) that the child does not do the item. “N.O." for No Opportunity - the child has not had the chance to perform the item, due to restrictions from the caregiver or other reasons, This score may only be used on “report” items “A” for Refusal the child refuses to attempt the tern. Refusals can be minimized by telling the child what to do rather than asking. If given instruction in proper administration, the care- giver may administer the item. Report items cannot be scored as refusals. E, INTERPRETATION ‘The DENVER Il is used to identify the child whose development appears to be delayed in ‘comparison to the development of other children. It can also be used to identify changes in devel- ‘opmental rates or patterns aver time. Individual items are interpreted first, and then the entire test is interpreted, 4. Interpretation of Individual Items a. “Advanced” Items If a child passes an item that falls completely to the right of the age line, the child's develop- ment is considered advanced on that item. This is because the child has passed an item that most children do not pass until an older age. This is illustrated in Figure Sa. "Advanced" items are not considered for purposes of interpreting the overall test Figure 5a — An “Advanced” item (Net considered for purposes of interpreting the overall est) | b. “Normal” Items Failure or refusal of individual items do not necessarily indicate a delay in development. For example, if@ child fails or refuses an item that falls completely to the right of the age line, the child's development is considered normal, This is because the child is younger than the age at which 25% of children in the standardization sample cauld do the item; the child is not expected to pass such an item until an older age. This is illustrated in Figure 5b. Figure 5b ~ ‘Normal” Items (Not considered for purposes of interpreting tho over tsi) ‘Age Line ‘Ago Lino EF 7 |12 AAs shown in Figure Sc, a child can pass, fal. or refuse an item on which the age line falls, between the 25th and 75th percentile, and the child's development on that item will be considered normal, “Normal” iterns are not considered for purposes of interpreting the overall test. Figure 5¢ - "Normat” Items (Not considered for purposes of interpreting the overall test) Age Line ‘Age Line Age Line ; ; ‘A ‘Caution’ on an individual item is considered when interpreting the entire test. A “Caution” can be determined in one of two ways, as shown in Figure 5d. A “Caution” is scored when a child falls or refuses an item on which the age line falls on or between the 75th and 90th percentile. This, is because more than 75% of children in the standardization sample can do the item at a younger age than the child being tested. A "Caution" is indicated on the test form by writing a °C" just to the right of the bar. Figure Sd - *Caution’ Items (-Caution” tems are considered for purposes of interpreting the overall test) Age tine ‘Age Line ‘Age Line Age Line 1 iE R I R “Delayed” Items Like "Cautions," “Delays” on individual items are considered when interpreting the entire test. “Delays” are indicated in Figure Se . As can be seen, a "Delay" results when a child fails or refuses an item that falls completely to the left of the age line. This is because the child has failed or refused an iter that 90% of children in the standardization sample passed at an earlier age. "Delays" are incicated by coloring in the right end of the bar. Figure 5e ~ “Delayed” Items ("Delayed items are considered for purposes of interpreting the overall est) Age Ling ‘Age Line 7 _ e. “No Opportunity” Items Report items which the parent says the child has not had an opportunity to try are scored as 'N.O." for “No Opportunity” (Figure Sf) . These items are not considered in interpretation of the entire test. Figure 5f — "No Opportunity” Items. (Not considered for purposes of interpreting the overal test) ‘Age Line ‘Age Line NO jo Note: The exact ages at which 25%, 50%, 7596, and 90% of children in the standardization sample passed each item are listed in Appendix A (p. 43) and may be consulted when scoring individual items.interpretation of the Test (These are suggested guidelines.) ‘The DENVER Il is interpreted as follows: Normal + No Delays and a maximum of 1 Caution, * Conduct routine rescreening at next well-child visit, Suspect: + Two or more Cautions andor One or more Delays. + Since communities’ and programs’ priorities differ in types or severity of problems they seek to identify in screening, itwill be necessary to adjust Suspect oriteria to most efficiently achieve their goals. Tables of percentages of Cautions and Delays that may be expected for different demographic groups are provided in the DENVER 1) Technical Manual, pages 19-21, ‘* Rescreen in 1-2 weeks to rule out temporary factors such as fatigue, fear, iliness, Untestable: ‘= Refusal scores on one or more items completely to the left of the age line or on more than one item intersected by the age line in the 75%-90% area. * Rescreen in 1-2 weeks. 3. Re ral Considerations If, upon rescreening, the test result is again Suspect or Untestable, whether or not to refer should be determined by the clinical judgement of the supervising professional based upon: - profile of test results (which items ere Cautions and Delays) - number of Cautions and Delays, rate of past development - other clinical considerations (clinical history, examination, etc.) - availability of referral resources ‘Monitoring the screening program is discussed in the DENVER 1! Technical Manual, pages 18-22. The use of such monitoring is strongly recommended to assist the supervising professional in establishing and adjusting referral criteria. 3. Profiles of Various Test Results Pages 14-16 provide examples of Interpreting tests that are Normal, Suspect, and Untestable. 13reso 03 g Fal Normal 4. There are no Delays. Since there is only ‘one Caution (Throw Ball Overhand), the test is Normal. Normal 2. There are no Delays and no Cautions. Failures are to the right of the age line or inter- sect between the 25th percentile and the 75th percentile. This test is Normal.‘sin Rano Suspect 3. There are one Delay (Hops), and 3 Cautions, (Pick Longer Line, Know 3 Adjectives, and Balance Each Foot-3 Seconds), which makes the test Suspect. ‘Suspect 4, There are 2 Delays (Work for Toy and Reaches), yielding a Suspect test result.Untestable 8. There are 2 Cautions (Feed Doll and Tower of 2 Cubes), Since these items are Refusals, the test is Untestable. Untestable 6. There are 4 Delays (Thumb Wiggle, Use of 3 Objects, Use of 2 Objects, and Name 1 Color) Since these items are Refusals, the test is UniestableIV. DIRECTIONS FOR ADMINISTRATION OF SPECIFIC ITEMS Follow the described procedures exactly, and carefully check the scoring criteria before passing oF failing an item, Some items may be passed by report of the caregiver. These items are distinguished by “R’ in the item bars on the test form and by (R) after item names in the following directions for administration. When scoring an item by report of the caregiver, itis helpful to circle the “R’ in the distribution bar on the form to distinguish reported behavior from behavior actually seen. When administering report items, avoid asking “leading questions” that may suggest an answer to the caregiver. For example, instead of asking, “Your child can drink from a cup, right?” ask, "Does your child drink from 2 cup?" Take care to ask questions that require the caregiver to supply the necessary information to score the item (more details and/or examples), rather than prompting the caregiver to give the desired response. In adaition, asking if a child does something yet, may help the caregiver feel more comfortable in reporting failures. A. PERSONAL-SOCIAL Regard Face Hold the child or place the child on his/her back and put your face about 12 inches above the child's face, Pass if the child actually looks at you. je Responsively \With the child lying on the back, smile and talk to the child. Do net tickle the child, or touch his/her face. Pass if the child smiles in response. The objective is a social response rather than a physical response ‘Smile Spontaneously (R) During the test watch for the child to smile at you or the parent without any stimulation, either by touch or sound. If this is not seen, ask the parent if the child ever smiles at someone first, before being smiled at, talked to, or touched. Pass if the child smiles spontaneously at you or the parent during the test or reportedly at home. ‘The objective is for the child to initiate social interaction. Regard Own Hand (R) During the test, notice if the child stares at one of his/her own hands for at least several seconds, rather than glancing at it leetingly, If you do not see this, ask the parent ifthe child has done this, Pass if the parent reports that the child does this or if you see the child do this during the test. Work for Toy Place a toy which the child seems to enjoy on the table a little out of reach. Pass if the child tries to get the toy by reaching or stretching his/her arm or body toward the toy. The child does not have to actually pick up the toy. Feed Self (R) ‘Ack the caregiver if the child actually feeds himself/herself a cracker, cookie, of any finger food. Pass if the parent reports that the child does this. Score “No Opportunity” if the child has not been given such food 718 Play Pat-a-Cake (R) Without touching the child's hands or arms, demonstrate the pat-a-cake game by clapping your hands together and ask the child to ‘play pat-a-cake" with you. If the child does not do this, ask the parent to try it. Ifthe child stil does not do it, ask the parent if the child does this at home. Pass if you observe the child clapping his/her hands or ifthe parent reports that the child does this. Also pass any other clapping game in which the child participates. The objective is interaction with another person. Indicate Wants (R) During the test, notice if the child lets you or the parent know that he/she wants something, without crying. If this cannot bo seen, ask the parent how the child lets someone know what he/she wants. Pass i you see the child do something other than ory to communicate a specific desire, or if the parent reports that the child does this. Examples of passes are: pointing, reaching and making sounds, putting arms up to be picked up, pulling, and saying a word. Wave Bye-Bye (R) Hf possible, itis best to administer this item as the parent and child are leaving, of as you are leav- ing the room. Face the child and say “bye-bye” while waving to the child. Do not touch or allow the parent to touch the child's hands or arms. Ifthe chile! does not respond, ask the parent if the child “waves bye-bye.” Pass if the child responds by raising his/her arm or waving with hand or fingers, or ifthe parent reports that the child does this. Play Ball with Examiner Roll the ball to the child and try to get the child to roll it or toss it back. You may need to roll the ball back and forth several times. Pass if the child rolls or tosses the ball purposefully toward you. (Handing the ball to you is not a pass.) Imitate (Household) Activities (R) ‘Ask the parent ifthe child imitates activities around the house such as dusting, wiping up, sweep- ing, vacuuming, or talking on the telephone. Pass if the parent reports thet the child imitates any type of adult household activity Drink From Cup (R) ‘Ask the parent ifthe child can hold a regular cup or glass and drink trom it without help. spilling less than half of the liquid. The cup or glass may not have a lid or spout, Pass if the parent reports that the child does this. Help in House (R) ‘Ask the parent if the child helps at home by doing simple tasks like putting toys away, throwing trash away, or geting something for a parent when asked. Pass if the child actually helps rather than just imitates. The objective is to determine if the child understands and carries out a request to help. Use Spoon/Fork (R) ‘Ask the parent if the child uses a spoon or fork to eat. If so, how much does he/she spill? Pass if the child uses a spoon andior fork and gets most of the food into the mouth, spilling litle. The objective is to determine if the child is essentially self-sufficient in feedingRemove Garment (R) Ask the parent if the child can remove any of his/her clothing, and if so, what items of clothing Pass if tho child can remove items such as shoes that take some effort to remove, jacket, pants, or Tshirt. Do not pass hat, socks, diaper, slippers, or shoes that slip off easily. The objective is to see if the child can purposefully remove a garment in an effort at self-care, Feed Doll Place the doll and toy bottle on the table in front of the child, Tell the child to “feed the baby” and/or "give the baby the bottle.” Pass if the child places the bottle to the dolls mouth or obviously tries to put it to the mouth. If the child imitates breast-feeding, encourage him/her to use the bottle, as breast-feeding alone is not apass. Put on Clothing (R) Ask the parent If the child can put on any of his/her own clothing, and if so, which items, Pass if the child puts on any clothing, such as underpants, socks, shoes, jacket, etc, Shoes do not have to be tied, fastened, or on correct feet. A cap placed haphazardly on the head does not ass. Brush Teeth with Help (R) ‘Ask the parent ifthe child brushes his/her teeth with some help. If so, ask the parent to describe how this is done. Pass if the child is reported to hold the toothbrush and move it across the teeth in a brushing mation. There may be some help from the parent in directing the toothbrush but the child must do mast of the brushing. The parent may oversee and put toothpaste on the brush. Score "No Opportunity” if the parent has not allowed the child to try this. Wash and Dry Hands (R) ‘Ask the parent if the child can wash and dry his/her own hands without help, except for turning on faucets that are out of reach. Pass if the parent reports that the child does this, using soap and rinsing and drying well Name Friend ‘Ask the child to name some of his/her friends or playmates (not living with the child). ass if the child gives the first name of at least one friend. Names of cousins or siblings are accopt- able if they do not live with the child. Names of pets or imaginary friends are not acceptable. Put on T-Shirt (R) Ask the parent if the child can get hisher T-shirt or pullover on without help, Pass if the child can pull the shirt over his/her head and get his/her arms in the sleeves. The shirt may be on backwards or inside out Dress, No Help (R) Ask the parent ifthe child can dress without any help, Pass if the child can dress completely and correctly without help. He/she must usually pick out hisher own clothes (at least piay clothes), and may have help only for tying shoelaces, and button- ing oF zipping the back of a dress. ‘A pass of Dress, No Help also passes Put on Clothing and Put on Shir. 19Play BoardjCard Games (R) ‘Ask the parent ifthe child plays simple board or card games, such as “Candy Land” or “Old Maid.” Specify that the child must really play and understand the game. Pass if the parent reports that the child understands and plays board or card games with others, sitting and taking turns. Brush Teeth, No Help (R) ‘Ask the parent i the child brushes his/her own teeth without help or supervision some of the time, including putting toothpaste on the brush and brushing all teeth with back and forth strokes at the gum line. Pass if the parent reports that the child brushes his/her teeth without help or supervision at least some of the time. (The parent should be advised to brush the child's teeth some of the time to ensure proper cleaning.) A pass of Brush Teeth, No Help also passes Brush Teeth with Help. ‘Ask the parent ifthe child can prepare a bow! of cereal without helo (other than being given items that are hard to reach), including getting the bowl, spoon, cereal, and milk, and pouring the cereal and milk into the bow without spilling much. If the parent says the child cannot do this because the container of milk is too large, ask ifthe child could pour it from a nearly empty container, a small pitcher, or @ glass. Pass if the paront reports that the child can do this, including pouring milk from any kind of con tainer. B, FINE MOTOR - ADAPTIVE Follow to Midline With the child lying on hisyher back, hold the red yarn above the child's face at a height where he/she focuses on it (usually about 8 inches). Shake the yarn to attract the child's attention and move it slowly in an arc from one side of the child's body to the other several times. The movement of the yarn may be stopped to reattract the child's attention, and then continued, Pass if the child follows the yarn to the midpoint of the arc with ayes alone, or with head and eyes. Start Past Midline 180 degrees Follow Past Midline (Refer to Follow to Midline for administration procedure.) Pass if the child follows the yarn past the midpoint of the arc with eyes alone, or with head and eyes. A pass of Follow Past Midline also passes Follow to Midline. Grasp Rattle While the child is lying on his/her back or is boing held by the parent, touch the backs or tigs of the child's fingers with the handle ofthe rattle, Pass if the child grasps the rattle for @ few secondsHands Together During the test while the child is lying on his/her back (not while cradled in the parent's arms), Notice if the hands are brought together at the midline of the body over the chest or at the mouth. Pass if you see the child bring his/her hands together in this manner. Follow 180 Degrees (Refer to Follow to Midtine for administration procedure.) Pass if the child follows the yarn with head and eyes through the complete arc from one side of the body to the other. A pass of Follow 180 Degrees also passes Follow to Mialine and Follow Past Midiine. Regard Rai: With the child sitting on the parent's lap at the table, place a raisin directly in front of the child. The raisin should be placed on a surface that gives good contrast, such as a piece af white paper. You ‘may paint to oF touch the raisin to attract the child's attention to it. °O"-shaped cereal may be used in place of a raisin Pass if the child clearly looks at the raisin, Reaches With the child sitting on the parent's lap so that the child's elbows are level with the table top and higher hands are on the table, place an object such as the rattle or the red yarn within easy reach and encourage the child to pick it up. Pass if you see the child reach toward or at least move his/her hands or arms in the direction of the object on the table. Look for Yarn While the child is sitting on the parent’ lap, hold the red yarn high and attract the child's attention to it. When the child is looking at the yarn, drop it so that it falls out of sight. Do not move your hand or arm except to release the yatn. Repeat if the child's response is unclear. Pass if the child definitely looks for the yarn by looking down or toward the floor. Rake Ri With the child sitting on the parent's lap so that his/her elbows are level with the table top and hisfher hands are on the table, drop a raisin directly in front of the child within easy reach. If neces- sary, you May point to ar touch the raisin to attract the child's attention. “O"-shaped cereal may be used in place of a raisin. Pass if the child picks up the raisin, using a raking motion with the entire hand. Make sure the raisin did not merely stick to the child's hand but was actually picked up. This item is also passed it the child passes Thumb-Finger Grasp. aa Notice whether the child passes a block from one hand to the other. To encourage this, give the child a block; then present a second block to the same hand. The child will often pass the frst block to the other hand so that he/she can take the second block Pass if you see the child transfer a block from one hand to the other without using hisher body, mouth, or the table, 2422, ‘Take 2 Cubes Place 2 blocks on the table in front of the child. Encourage himyher to pick up the blocks, but do not hand them to the chit. Pass if the child picks up the 2 blocks and holds one in each hand at the same time, ‘Thumb-Finger Grasp (Refer to Rake Raisin for administration procedure.) Pass if the child picks up the raisin by bringing tagether any part of the thumb and one or several fingers. ‘A pass of Thumb Finger Grasp also passes Rake Raisin. Bang 2 Cubes Held in Hands (R) Place a block in each of the child's hands and encourage him/her to bang them together. You may encourage the child to hit the blocks togethor by demonstrating with blocks nel in your own hands. Do not touch or allow the parent to touch the child's hands or arms. If the child does not bang the blocks together, ask the parent i the child hits small objects together in this manner. Pass ifthe child holds one block in each hand and hits the blocks together, or if the parent reports that the child hits small objects together. Pots, pans, lids, or other large abjects do not pass. Put Block in Cup Place 3 blocks and the cup on the table in front of the child. Encourage the child to put the blocks in the cup by demonstration and words. This demonstration may need to be repeated several times. Pass if the child places at least one block in the cup and releases it. Scribbles Place a piece of plain paper and a pencil on the table in front of the child. You may place the pen- cilin the child's hand and encourage himjher to scribble, but do not show himjher how to scribble. (Watch the child carefully and be prepared to prevent him/ner from putting the pencil in mouth or eye.) Pass if the child makes purposeful marks on the paper. Fail accidental marks or stabbing with the pencil Dump Raisin, Demonstrated Show the child 2 or 3 times how to dump the raisin out of the bottle. Then ask the child to get it out (Do not use the word “dump.") Pass if the child dumps the raisin out of the bottle or rakes the raisin close to the opening and then dumps it out. Do not pass if the child removes the raisin with a finger.‘Tower of Cubes - 2, 4, 6,8 With the child siting high enough at the table so that elbows are level with table top and hands are con the tablo, place the Blocks on the table in front ofthe child. Encourage the child to stack them by demonstration and words. It may be helpful to hand the dlocks to the child, one ata time. Three trials may be given Pass Tower of 2 Cubes if the child puts one block on top of another so that it does not fall when he/she removes his/her hand. Pass Tower of 4, 6, or 8 Cubes, depending upon the greatest number of blocks the child stacks in three trials A pass of 4, 6, or 8 cubes also passes the lower tower items (for example, passing Tower of 6 Cubes also passes Tower of 2 and 4 Cubes) Imitate Vertical Line ‘The child should be seated at the table at a comfortable writing level. Place a pencil and a piece of plain paper in front of the child and tell him/ner to draw lines like yours. On that paper, demonstrate how to draw vertical lines, drawing toward the child. Do not guide the child's hand. Three trials may be given. Pass if the child makes 1 line or more on the paper, atleast 2 inches long, and not varying from your vertical ine by more than 30 degrees (see example). Lines do not have to be perfectly, straight. 20 Dagree Angle Less than 30 Degraes More than 20 Degree pass Fall ‘Thumb Wiggle Demonstrate with one or both hands by making a fist with your thumb pointing upward. Wiggle only your thumb. Tell the child to wiggle his/her thumb (or thumbs) the same way. Do not help put the child’s hand into position. You may tell the child to make a “thumbkin". Pass if the child moves the thumb of either or both hands without moving any other fingers. Copy O Give the child a pencil and piece of plain paper. Show him/her the circle on the back of the test form. Without naming it or moving your finger or pencil to show how to draw it. tel the child to draw cone like the picture. Three trials may be given, Pass any form approximating a circle that is closed or very nearly closed. Fail continuous spiral motions 600 @0O640 23,Draw Person - 3 Parts, 6 Parts Give the child a pencil and a piece of plain paper. Tell himner to draw a picture of a person (boy. irl, Mommy, Daddy, etc.) Be sure the child has finished before scoring the drawing. 3 Parts— Pass if the child has drawn 3 or more body parts. A pair (ears, eyes, arms, hands, legs feet) is considered one part. To get credit, both parts of the pair must be drawn unless the drawing is in profile (in which case one eye, ear, etc., gets credit.) Make note in your test abservations of ‘any unusual drawing, even though the child has identified the acceptable parts. i I~ _ a 3- aa a- C2, PASS -3 parts FAIL-3 paris 6 Parts — Pass if the child has drawn 6 or more body parts. (See criteria under 3 parts.) A pass of Draw Person - 6 Paris also passes Draw Person - 3 Parts. i 4 I~ ee Ze 2 i a St ik G4 2 { Ye 3 6 oe Bhs PASS -6 parts, 9 pans FAIL —6 parts PASS -3 pars Copy + Give the child a pencil and a piece of plain paper. Show himjher the cross on the back of the test form. Without naming it or moving your finger or pencil to show haw to draw it, tell the child to “draw one like the picture.” Three trials may be given. Pass if the child draws 2 lines which intersect at least somewhat near the midpoint. The lines do not need to be exactly straight, but the intersecting lines do need to be drawn using only 2 strokes, + a PASS FAIL, Pick Longer Line Making sure they are presented vertically, show the child the parallel ines on the back of the test form and ask the child, “Which line is longer?" (Do not say “bigger.”) Atter the child has pointed to a line, turn the paper upside down and ask the question again. Turn the paper upside down again and repeat this a third time. I he child does not answer correctly all three times, repeat the ques tion three more times, turning the paper each time. Pass if the child picks the longer line 3 out of 3 times or 5 out af 6 times, 24Copy (] Note: Administer Copy (] before Copy] Demonstrated. Give the child a pencil and a piece of plain paper, Show him/her the square on the back of the test form, Without naming it or moving your finger or pencil to show how to draw i, tell the child to “draw one like the picture.” Three trials may be given. Pass if the child draws a figure with straight lines and 4 square corners. The corners may be formed by lines that intersect but the corners must be approximately right angles (not rounded or pointed). The length should be less than 2 times the width, A pass of Copy[_] also passes Copy["] Demonstrated. ae If the child is unable to copy the square irom the picture, show him/her how to draw it by drawing two opposite (parallel) sides first and then the other two opposite sides (rather than drawing the square with a continuous mation),Three demonstrations and trials may be given. Pass by the same criteria as Copy) Pass C. LANGUAGE Respond to Bell Hold the bell so that the child cannot see it (to the side and a littie behind the child's ear). Ring the bell softly Ifthe child does not respond, try again later in the test session Pass if the child responds in any way, such as eye movement, change in expression, change in breathing rate, or any other change in activity. Voealizes (R) During the test, listen for sounds other than crying, such as small throaty sounds or short vowel sounds ("uh," "eh”) Itnrone are heard, ask the parent ifthe child makes these sounds. Pass if you hear the child make such sounds or i the parent reports that the child doss this, Pass this item also if any other vocalization items are passed “O00"/“Aah” (R} Listen for the child to make vowel sounds, such as "ooo" or “aah.” If these sounds are not heard ask the parent if the child has made these sounds. Pass if you hear vowel sounds or ifthe parent reports that the child does this. Laughs (R) - Listen for the child to laugh aloud. If this is not heard, ask the parent if the child does this. Pass if you hear the child laugh aloud or if the parent reports that he/she does this, ‘Squeals (R) Listen for the child to make high-pitched, happy squealing sounds. If this is not heard, ask the par- ent ifthe child does this. Pass if these sounds are heard or if the parent reports that the child does this.Turn to Rattling Sound Stand behind the child while he/she is facing the parent, siting either on the parent's lap or on the table. necessary, ask the parent to use the red yarn to get the childs attention. Put one block in the cup and hold it with your hand covering the top. Being careful to keep the cup quiet while mov- ing into position, bring the cup 6-12 inches from the child's ear but out of the child's line of vision. Shake the cup gently, making a soft, ow sound. Repeat with the other ear. Pass if the child responds by turning toward the sound on both sides. Turn to Voice While the child is facing the parent, either seated on the parent's lap, seated on the table, or held in the parent's arms, approach the child from behind to within 6-12 inches of either ear. Placing your hand between your mouth and the child so that the child does not respond to feeling your breath rather than to the sound, whisper the child's name several times. Repeat with the other ear Pass if tho child turns to the direction of your voice on both sides. Single Syllables (R) Listen for the child to use single syllables consisting of a consonant and a vowel, such as "ba," “da,” “ga,” or “ma.” If this is not heard, ask the parent if the child does this. Pass if you hear such sounds or if the parent reports that the child does this, Imitate Speech Sounds (R) Repeat a sound several times (such as a cough, clicking of the tongue, or kissing sound) and see if the child imitates you. If the child does not respond, ask the parent ifthe child imitates any speech sounds. Emphasize that the sounds must be initiated by the other person, not the child Pass if you hear the child imitate your sound or if the parent reports that the child imitates the speech sounds of others, Dada/Mama, Nonspecific (R) Listen for the child to say “dada” or “mama” during the test. If this is not heard, ask the parent ifthe child has said this. The words do not necessarily have to refer to a parent. Pass if the child says either “dada” or “mama,” or if the parent reports that the child does this. Combine Syllables (R) Listen for the child to repeat the same syllable 3 or more times, such as “dadadada” or ga.” If this is not heard ask the parent ifthe child does this, Pass if the child does this or ifthe parent reports that the child does this. Jabbers (R) During the test, listen for the child to make uninteligible “conversation” to himselt herself, using inflection and pauses. (This is a “jibberish” in which voice patterns vary and few or no real words are distinguishable.) If this is not heard, ask the parent ifthe child "talks" to himsetfherself in this ‘way or in what sounds like 2 foreign language. Pass if you hear the child “jabber,” or if the parent reports having heard the child do this. Dada/Mama, Specific (R) Listen for the child to say “Dada” to the father or "Mama' to the mother during the test. If this is not heard, ask the parent t the child does this. Pass if the child uses either “Dada” or “Mama” meaningfully, or it the parent reports thet the child does this. Also pass other words for mother and father used by various cultures, such as “Papa.” A pass of this item also passes Dada/Mama Nonspecific‘One, 2, 3, 6 Words (R) ‘Ask the parent how many words the child says and what those words are. Pass One, 2, 3, or 6 Words depending upon the number of acceptable words the parent reports. Acceptable words are any words other than “Mama.” “Dada,” or names of family members and pets. A pass of 2, 3, or 6 Words also passes the lower itern(s) (for example, a pass of 3 Words also passes One and 2 Words) Point to Pictures - 2, 4 Bo sure to administer the Name Pictures items frst. If the child names less than 4 pictures correct- ly, administer this item. Snow the child the pictures on the back of the form. Tel the child to “Point to the bird man ~ dog - cat (kitty) horse.” Name only ane picture at a time, and wait forthe child to point before naming the next picture. Pass Point to 2 Pictures if the child correctly points to (or names) 2 or 3 pictures. Pass Point to 4 Pictures if the child correctly points to (or names) 4 or 5 pictures. A pass of Point fo 4 Pictures also passes Point fo 2 Pictures. Combine Words (R} Listen for the child to combine at least 2 words to make a meaningful phrase that indicates an action. If this is not heard, ask the parent if the child does this. Pass if you hear the child do this, orif the parent reports that the child does this. Examples: Pass - ‘play ball,” “want drink, Fail - “thank-you,” “peek-a-boo, 2€ that,” “go bye-bye.” ‘bye-bye," “uh-oh.” Name Pictures - 1, 4 ‘Show the child the pictures on the back of the form, Point to the cat, bird, horse, dog, and man one ata time, and ask “What is this?” Pass Name 1 Picture or Name 4 Pictures according to the number of pictures correctly named, Pass if the child uses the name of a pet, providing itis the same animal as pictured. ‘Daddy’ or “poy” are acceptable answers for the man. ‘A pass of Name 4 Pictures also passes Name 1 Picture, Point to 2 Pictures, and Point to 4 Pictures. Body Parts -6 ‘Show the doll to the child, Tell the child, “Point to the doll's nase ~ eyes ~ ears ~ mouth ~ hands ~ feet — tummy — hai,” naming them one at a time, Pass if the child correctty points to at least 6 body parts. If the parent indicates “storiach” or telly" are used, pass either of these if itis correctly identified. “Belly-button’ is not a pass. Speech - Half Understandable, All Understandable ‘Throughout the test, notice the intelligibility of the child's speech (pronunciation, enunciation, actu- al words as opposed to “jibberish,” etc.) Pass Half Understandable if you have understood at least half of the child's speech Pass All Understandable if you have understood all or nearly all of what the child has said. A pass of All Understandable also passes Half Understandable. arKnow Actions - 2, 4 ‘Show the child the pictures on the back of the form. Instruct the child to point to the correct picture as the following questions are asked: “Which one flies?” "Which one says meow?" “Which one talks? gallops?” Pass Know 2 Actions if 2 or 3 pictures are pointed to correctly Pass Know 4 Actions if 4 or 5 pictures are pointed to correctiy, A pass of Know 4 Actions also passes Know 2 Actions “Which one barks?" "Which one Know Adjectives - 2, 3 Ask the child the following questions, one at a time: "What do you do when you are cold?” “What do you do when you are tired?” ‘What do you do when you are hungry?” Pass Know 2 Adjectives and/or Know 3 Adjectives depending upon the number of questions answered correctly. Examples of correct answers: Cold - Put on coat, go inside, cover up. (Do not pass an answer about having a cold, such as “cough” or “take medicine.") Tired - Go to bed, lie down, sleep. Hungry - Eat, have lunch, ask for something to eat A pass of Know 3 Adjectives also passes Know 2 Adjectives. Name Colors - 1, 4 Place a red, a blue, a yellow, and a green block on the table in front of the child, Point to one block and ask the child, “What color is this?” After the child answers, move the blocks around and ask the child to tell you the color of another block. Repeat for all four colors. Pass Name 1 Colorif the child correctly names 1, 2, or 3 colors. Pass Name 4 Colors if the child correctly names 4 colors, A pass of Name 4 Colors also passes Name 1 Color Use of Objects - 2, 3 ‘Ask the child the following questions, one at a time: “What do you do with a cup?" “What is a chair used for?" “What is a pencil used for?" Pass Use of 2 Objects or Use of 3 Objects depending upon the number of questions answered correctly. Action words such as “drink,” “sit,” and “write” must be included in the answers. Unconventional uses such as “pour” for cup or “climb on” for chai are acceptable. Answers such as “milk” for cup or “table” for chair are unacceptable. A pass af Use of 3 Objects also passes Use of 2 Objects Count 1 Block Put 8 blocks on the table in front of the child, Place a piece of paper next to the blocks. Tell the child, “Put one block on the paper.” When the child appears to be finished, ask "How many blocks are on the paper?” Pass if the child places one block and says that one block is on the paper. Understand 4 Prepositions While you and the child are standing, give him/her a block. Give the following directions to the child, one at a time: “Put the block on the table.” “Put the block under the table.” "Put the block in front of me.” “Put the block behind me.” Pick up, or have the child pick up the block between directions, Pass if the child performs all four tasks correctly.Define Words - 5, 7 Make sure the child is listening to you and then say: “Lam going to say a word and | want you to tell me what itis.” Ask each word one at a time: “What is a ball ~ lake — desk — house ~ banana ~ curtain ~ fence — ceiling?” Each word may be asked 3 times if necassary. You may say "Tell me something about it,” but do not ask the child to tell you what the object is for or what to do with it. Pass Define 5 Words if the child defines 5 or 6 words acceptably in terms of. 1)use, 2) shape, 3) what itis made of, or 4) general category. Pass Define 7 Words it the child defines 7 or 8 words acceptably. Examples of cotrect answers: Ball - bounces, circle, toy, play with Lake - water, fish in tt Desk - write on it, put papers in, wood House - to live in, made of wood (oricks, etc.) Banana - fruit, to eat ‘Curtain - to cover the window, so people can't see in Fence - to keep the dog in, to climb on, around the yard Ceiling - top of the room, to keep the rain off ‘A pass of Define 7 Words also passes Define 5 Words. ‘Count 5 Blocks Put 8 blocks on the table in front of the child. Place a piece of paper next to the blocks. Tell the child, “Put five blocks on the paper.” When the child appears to be finished, ask, “How many blocks are on the paper?” Pass if the child places 5 blocks and says that 5 blocks are on the paper. The child does not have to count ach black out loud. Only counting (“1, 2, 3, 4, 5°) does not pass; the child must state “5" separately. A pass of Count 5 Blocks also passes Count 1 Block. Opposites - 2 Say each of the following sentences slowly and distinatly, one ata time, and wait for the child to fil in the blank. Each sentence may be repeated 3 times if necessary. Ifa horse is big, a mouse is : if fire is hot, ice is “If the sun shines during the day, the moon shines curing the Pass if the child completes two sentences correctly. Examples of correct answers: Big - litle, small, tiny Hot - cold, cool, freezing, frozen (wet, melting, or water are incorrect) Day - night, dark, black, evening 29D. GROSS MOTOR Equal Movements While the child is lying on hisjher back, watch the activity of the child's arms and legs. Pass if tho child moves arms and legs equally. Fail if one arm and/or leg does not move as much as the other. Lift Head (R) Place the child on his/her stomach on a flat surface. Pass if the child at least momentary ifs his/her head so that the chin is off the surface without being turned to either side or if the parent reports that the child can do this. Head Up 45 Degrees Place the child on hisjher stomach on a flat surface. Pass if tho child lifts his her head so that his/her face makes an approximate 46 degree angle with the surface for at least several seconds. The child will be looking at the table in front of himmer. Apass of Head Up 45 Degrees also passes Lift Head. \, Head Up 90 Degrees Place the child on his/her stomach on a flat surface. Pass ifthe child lifts head and chest up so that his/her face makes a 90 degree angle with the sur- face for at least several seconds. The child will be fooking straight ahead and will usually be sup- ported on his/her forearms. A pass of Head Up 90 Degrees also passes Head Up 45 Degrees and Lift Head. Sit, Head Steady Hold the child in a sitting position. Pass if the child holds his/her head upright and steady with no bobbing motion for at least several seconds. Bear Weight on Legs Hold the child in a standing position so that his/her feet rest on the table. Slowly loosen your hand support to allow the child's weight to be supported on hisyher legs and feet Pass if the child supports hisiner weight on the legs for several seconds.Chest Up, Arm Support Roll Place the child on his/her stomach on a fiat surface. Pass if the child lis hisfher head and chest off the surface using the support of outstretched arms, so thet he/she is looking straight ahead or up. 5 Over (R) During the test, notice if the child rolls from back to stomach or from stomach to back. If this is not seen, ask the parent ifthe child has rolled completely over, from back to stomach or from stomach to back, at least twice Pass if you see the child roll completely over or if the parent has seen the child do this at least twice. to Sit, No Head Lag Place the child on hisher back. Grasp the child's hands and wrists and gently and slowly pull him/her to a sitting position. If there is immediate head lag, do not continue to pull the child all the way to the sitting position, Pass if the chilo’s head does not lag at any time while the body is being pulled up. The child will also “pull” with you, using shoulder and neck muscles, FAIL, No Support Hold the child in a sitting position on the table. Making sure the child does not fall, slowly remove your hands. Pass if the child sits alone for 5 seconds or more. The child may put hands on legs or on the table for support. Stand Holding On Place the child in a standing position holding on to a solid object (not a person) Pass if the child stands holding on for 5 seconds or more. Pull to Stand Place the child sitting on the floor beside a chair or low table. Encourage him/her to stand up by putting a toy on the seat of the chair or on the table. Pass if the child pulls himselt/nersel to a standing position, Get to Sitting (R) While the child is tying down (on back or storiach), crawling, or standing holding on, encourage himyher to get into a sitting position. I this is not seen, ask the parent ifthe child can get into a sit ting position by himself herself. Pass it you soe the child co this or if the parent reports that the child can do this. 31‘Stand - 2 Seconds Place the child standing on the floor. After the child seems balanced, try to remove the support. Pass if you see the child stand without any support for 2 or more seconds, Stand Alone Administration procedure is the same as for Stand - 2 Seconds. Pass if the child stands alone 10 or more seconds, pass of Stand Alone also passes Stand - 2 Seconds, and Stand Holaing On. Stoop and Recover While the child is standing on the floor away from all support, place a toy or ballon the floor and encourage the child to pick it up. Pass if the child stoops to pick up the object and retums to standing without holding on or sitting down. Walk Well Watch the child walk Pass if the child has good balance, rarely falls, and does not tip from side to side. Walk Backwards (R) Encourage the child to walk backwards by demonstration, or notice if the child does this during the test. If you do not see the child do this, ask the parent if the child walks backwards, possibly when pulling a toy or opening a door or drawer. Pass if the child takes several steps backwards without sitting down, or if the parent reports that the child can do this. Runs Encourage the child to run, possibly by throwing the ball for himyher to chase. Pass ifthe child can run (not fast walk) smoothly without falling or tripping Walk Up Steps (R) Ask the parent how the child gets up steps. Pass if the child walks up steps. The child may use a rail or wall for support, but may not hold on toa person. Kick Ball Forward Place the ball about 6 inches in front of the standing child, Tall him/her to kick it. You may show the child how to do this, Pass if the child kicks the ball forward without holding on ta any support. Sliding or pushing the ball with the foot, hitting the ball on the back swing, or stepping on the ball are failures. Jump Up Tell the child to jump. You may show the child how to do this. Pass if the child jumps, getting both feet off the floor at the same time. The child does not have to land in the same spot. The child may not run before jumping, or hold on to any support. 32Throw Ball Overhand Give the child the ball and stand at least 3 feet from him/her. Tell the child to throw the ball to you using an overhand throw. You may show the child how to throw overhand. Three trials may be given Pass if the child throws the bal within arm's reach of you between your knees and head, using an overhand throw (not sideways, or undarhand). The ball may bounce before it reaches you if it was between your knees and head before beginning the downward arc. Throwing the ball directly downward or away from you are failures, Broad Jump Place a piece of paper (8-1/2" by 11°) on the floor and show the child how to do a standing broad jump across the width of the paper (8-1/2"). Then tell the child to do it. You may give 3 trials, i necessary. Pass if the child jumps, with both feet together, over the paper without touching it. Balance-Each Foot 1, 2, 3, 4, 5, 6 seconds Have the child stand away from all support. Show the child how to balance on one foot. Tell him/her to do this as long as he/she can, giving 3 trials (unless he/she balances for 6 seconds or more on the frst trial). Record the longest time of these three trials. Then tell the child to balance cn the other foot, giving 3 trials if necessary, Record the longest time of these three trials. Pass the appropriate balancing item or items according to the shortest of these 2 recorded times. (Example: Ifthe longest time for the right foot is 8 seconds and the longest time for the left foot is 5 seconds, the child passes balancing items for 1, 2, and 3 seconds.) A pass of 2, 3, 4, 5, or 6 seconds also passes all lower items. (For example, a pass of Balance- Each Foot—-3 Seconds also passes Balance - Each Foot 1 Second and Balance - Each Foot 2 Seconds.) Hops With the child away from all suppor, tell him/her to hop on one foot. You may show the child how to do this, Pass if the child hops on one foot 2 or more times in a row, either in place or over a distance, with- out holding on to anything, Heel-to-Toe Walk ‘Demonstrate how to walk ina straight line placing the heel of one foot in front of and touching the toe of the other. Walk about 8 steps like this and then tell the child to do it. (You may compare this, toa tightrope walk.) If necessary, give several demonstrations. Allow 3 tia it needed. Pass if the child can walkin a straight line for 4 or more steps placing the heel no more than 1 inch in front of the toe, without holding on to any support 33V. SELF-EVALUATION The purpose of this self-evaluation is to let you know what material in the DENVER II Training Manual you may need to review. On another sheet of paper, write the answers to the questions below. ‘Check your answers with those on page 40. If you are unsure of any answer or if any of your answers are incorrect, you should reread the appropriate section A. SHORT ANSWER 41. How many items should be administered to a child to identity @ developmental delay? 2. How can the examiner avoid a child's refusals? 3. What significance do the shaded ends of the bars for DENVER Il items have? 4. What indicates a Delay on the DENVER Il form? '5. When is the test result interpreted as a) Normal or b) Suspect? 6. The date of the test is April 15, 1990. The birthdate of the child is June 23, 1987. The child was born three weeks before the expected date of delivery. Determine placement of the age line. 7. The date of the test is April 15, 1990. The birthdate of the child is December 16, 1988. The child was four weeks premature. Determine placement of age line. 8. Interpreting individual items (Advanced, Normal, Caution, Delay) ‘Age Line Age Line Interpreting Test (Normal, Suspect, Untestable) a. Caution in each of 2 different sectors b, 3.Cautions in 1 sector ©. 1 Delay and 2 Cautions on entire test 34B, MULTIPLE CHOICE 4. Age Line Weeks should be rounded to the nearest month when drawing the age line. a. Tue b, False Report” Items The examiner must score by the report of the caregiver. a. True b. False 3. Test Interpretation ‘A test with 4 Advanced items (passed items completely to the right of the age line) and 2 Caution items is: a. Suspect 'b. Normal 4. Name 1 Color To pass, a child must: ‘a. Point to one color correctly when exarminer names it 'b, Name one color correctly when examiner points 10 it 5. Heel-to-Toe Walk To pass, a child must walkin a straight line with heel and toe close together for at least a. 4 steps b. 3 steps 6. Scribbles ‘The child does not attempt to scribble and the parent reports that the child has never been given a pencil before. a. No Opportunity b Fail 7. Balance - Each Foot Child balances on right foot 4 seconds and left foot 5 seconds, a. Pass 1, 2, 3, 4, § Seconds bb. Pass 1, 2,3, 4 Seconds 8. Count § Blocks Child puts 6 blocks on the paper and states that there are 5 blocks on the paper. Pass b. Fail 9. Thumb Wiggle Child can wiggle the thumb of only one hand, a. Pass Fail 10. Puton Clothing Mother reports child can put on shoes but doesn't always get them on correct foot. Pass b, Fail 41. Wash and Dry Hands Mother reports child washes hands but mother must finish drying them. a. Pass b. Fail 412. Pick Longer Line Child correctly selects longer line 4 out of 6 times. Pass b. Fail 13. Hops Child nops twice for @ distance of two feet a. Pass b. Fail 14, Copy 7] Child's square has corners that intersect at approximately right angles. a. Pass Fail 3536 415. Name 4 Picture Child gives his pet's name as a response to item, - Pass b. Fail 46, Combine Words Mother reports child says thank you, a. Pass b. Fail 47. Rall Over Mother reports child rolls only from stornach to back. a. Pass b. Fail 18, Walk Backwards Child correctly walks backward for two steps only. a. Pass b. Fail 419, Take 2 Cubes ‘The tester hands 2 cubes to the child. a. Correct bb, Incorrect 20. Turn to Rattling Sound ‘The tester shakes a rattle 6-12 inches from the child's ear, but out of the child's line of vision, a. Correct b. Incorect 21. Know Actions The tester asks which one talks... says bow-wow.. ies... says meow... gallops, a. Cortoot b. Incorrect 22, Feed Doll ‘The tester places the doll and bottle in front of the child and tells the child, “Feed the baby.” a. Correct b. Incorrect 23, Regard Raisin Tester touches raisin to attract child's attention, a. Correct bb. Incorrect 24, Dump Raisin, Demonstrated Tester tells the child to dump raisin out a. Correct bb, Incorrect 25. Kick Ball Forward Tester demonstrates item. a. Correct b. Incorrect 26. Define Words Tester asks, “What do you do with a ball?" a. Correct , Incorrect INTERPRETATION OF RESULTS On the following three pages are six examples of administered tests. Score each of the tests as Normal, Suspect, or Untestabie.FINE MOTOR - ADAPTIVE TEST BEHAVIO! * [eek bobs tort, andor rate) LaNQuage 2. Test ResultTEST BEHAVIOR TEST BEHAVIOR (Ged bes fr Fa, 2nd, or rest (Grascafos tor tt 2nd or Sas) a ‘Compliance (See Nete 31) Interest in Surroundings Lo ‘Somafynat Disntreeted ‘Seriously isinterested ‘Somewhat Oisvacbio Somefnat Distractibe (©1969, 1089, 1650 W.K Frenenburg and J 8, Oodds 1978 W.. Frankanburg 1 10 (See Nate 3) ‘Complies ‘Comalies comoties ot Surroundings iy Disintrested = 1 T ddd Span Fi isractble San 4 3 Sans, 6. Test Result,D. ANSWERS Short Answer 1. In each sector, administer at least three consecutive items totally to the left of the age line and every item intersected by the age line. if the child scores F, R, or N.O. on any item, administer additional items to the left in that sector unt the child passes three items. (Page 10) Refusals may be avoided by: taling rather than asking the child to do the tasks; and/or instructing the caregiver to administer the item. (Page 11) ‘The left end of the shaded area shows where 75% of the children in the standardization sample did the Item; the right end represents where 90% did it. (Page 5) ‘Delay is any item failed that is completely to the left of the age line. (Page 12), a. A test is considered Normal f there are no Delays, and no more than 1 Caution 'b. A test is considered Suspect if there are 2 or more Cautions and/or 1 or more Delays. (Page 13) ‘The child is 2 years, 9 months and 22 days old, which is where the age line is drawn. There is no adjustment for prematurity because the child is more than 2 years of age. (Page 8) ‘The child is + year, 3 months and 29 days. The age line is drawn at 1 year 2 months and 29 days because a 4 week (1 month) adjustment is made for prematurity. (Page 8) ‘a. Caution (Pages 11-12), ib. Caution (Pages 11-12) a. Suspect Page 13) 'b. Suspect (Page 13) ¢. Suspect [Page 13) Multiple Choice 1. b Page 9} 10. a (Page 19) 19. b (Page 22) 2. Page 5) 11. b (Page 19) 20. b (Page 26) 3. a (Page 13) 12. b (Page 24) 21. b (Page 28) 4. b (Page 28) 18. a Page 33) 22. a Page 19) 5. a Page 33) 14, a Page 25) 23. a (Page 21) 6. b (Page 22) 18. a (Page 27) 24, b (Page 22) 7. b (Page 33) 16. b (Page 27) 25. a (Page 32) 8. b (Page 29) 17. a (Page 31) 26. b (Page 29) 9. a (Page 28) 418. b (Page 32) Interpretation of Results 40 1. Suspeat (Page 13) 2. Suspect (Page 13) 8. Normal (Page 13} Suspect (Page 13) 5. Untestable Page 13) 6. Normal Page 13)VI. SELF-ADMINISTERED CHECKLIST Purpose This check list should be used regularly until these points become habits when using the DENVER II Instructions: To check the accuracy of your own testing ability, read over the check list immediatly after you have finished giving a test. To check the acouracy of another person's test administration, score your observation below. BEFORE TEST: 4. Can child see and reach test materials easily? 2. Did examiner explain that the DENVER Il is not an IQ test? 3. Did examiner explain that child is not expected to perform everything asked? 4. Did examiner calculate age of child ater asking caregiver the child's birthdate? 5. For children less than two years of age, did examiner ask if child was born prematurely? 6. Was age line drawn correctly? 7. Did examiner indicate date test was administered at top of age line? DURING TEST: Did examiner assure cooperation of child by: 8. Giving child a chance to become used to examiner? 9. Starting each sector of test with items child could pass? 410, Tolling child what to do rather than asking?. : 11. Was table clear of materials that were not being used? ... 412. When asking for parents report, did examiner refrain from suggesting an answer by the way question was worded? (leading question)... 13. When scoring an item by report, did the examiner circle the small fi on the bar? . 44. Did examiner praise child for his her efforts? 415. At the end of test, did examiner ask parent if behavior of child was typical of his/her usual behavior? 416, Did examiner administer enough items? (At least 3 items. to left of age line, and 3 passes and 3 failures in each sector) AFTER TEST: 17. Were Delays emphasized by coloring in right end of ar? 18. Were Delays indicated only on those items failed that were completely to lat of age line? 49. Were Caution iterns emphasized by marking aC to the right of the bar? 20. Were Cautions indicated only on those items where the age line intersected on ar between the 75th and 90th percentiles?, 21. Was test porformance interpreted correctiy?... 22. Did examiner score observations in box on form? Correct ones Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Nes Nes .. Yes Yes Yes Yes Yes Yes Yes Yes Incorrect Seated too high, {00 low or too far from table No No No NO No No No No, sometimes ..No, sometimes No, sometimes No, sometimes No, sometimes ..No, sometimes No No No No No No No No a42.Age When Given Percent of Standardization Samp! 4. Personal-Soci: Regard Face. ‘Smile Responsively ‘Smile Spontaneously Regard Own Hand Work for Toy. Feed Self Play Pat-a-Cake. Indicate Wants Wave Bye-Bye Play Ball with Examiner ..... imitate Activities . Drink from Cup Help in House. Use Spoon/Fork Remove Garment Feed Doll Put on Clothing Brush Teeth Help, Wash & Dry Hands Name Friend Put on T-Shirt Dress, No Help Play Board/Card Games, Brush Teeth, No Help Prepare Cereal APPENDIX A 2.1 weeks... 3.4. AA months, 48m 7am 72m. 67m 95m 10.1: 88m 126m 128m 13.3m 14.8m 205m 16.1m.. 19.2m 2.2 years. 23y. 30 y. 27y. 2.8y. a.0y. 50% 75% 3.5 weoks ......1.2 months. 26w. 14m 2A MOMS 3.4 Mw arm 53am 5.4m 59m 9.2m 104m a.m 44.0m 77m 92m 10.6 m 1.9m 41.0 m 125m 12.7m 162m 14.2m 168m 15.2m 17.5m 168m 20.4m 469m 19.2 Mn 235m 2.2 years. 213M 22y. 21.8m 23y. 2.5 OATS. ein2BY. 26y. 30y. Sy. 4.0y. By. AB Yorn Bay. 42y. a7y. aay. Table for Translating Percentiles into Months and Days eNoanrenr 4 9 ie, 17.5 months 4.9 years Months 3 days 6 days 9 days 12 days 18 days 18 days 21 days 24 days 27 days 17 months and 15 days 4 years, 10 months and 24 days Years month and 6 days 2 months and 12 days 3 months and 18 days 4 months and 24 days 6 months and 0 days 7 months and 6 days 8 months and 12 days 9 months and 18 days 10 months and 24 days Passed Items 90% Birth 1.5 months 24m 4om 59m 65m 114m 129m 44.0 m 16.7 m 16.0m 171m 173m 19.9m 23.9 2.0 years 25y ary aty aty say asy son 9 5.0y S1y 43,44 2. Fine Motor - Adaptive Follow to Midline... Follow Past Midline.. Grasp Rattle Hands Together Follow 180 Degrees. Regard Raisin. Reaches Look for Yarn Rake Raisin Pass Cube. Take 2 Cubes. Thumb-finger Grasp Bang 2 Cubes Held in Hands Put Block in Cup... Scribbles s Dump Raisin, Demonstrated Tower of 2 Cubes. Tower of 4 Cubes. Tower of 6 Cubes. Imitate Vertical Line... Tower of 8 Cubes. ‘Thumb Wiggle Copy Circle. Draw Person 3 Parts, Copy + Pick Longer Line. a Copy Square Demonstrated, Draw Person 6 Parts. Copy Square. 25% 2.7 WEEKS. . 2.6 months. 2.2m 22m. 28m 43m 49m 5.7m 5.1m. 57m 7.2m 67m 98m 117m 12.8m 135m 165m 196m 12.1 years. 23.7 months. 25 years... 3.ty. 339. aay. 29y. 40y. arty. AT Yon 50% 3.8 weeks, 3.3 months. 25m 3.0m 3.6m. ATM oe 57m 6.0m 60m 6.2m 8.2m 76m.. 4.1m 43.2m 14.3m.. 148M ou 19.2m 220m 2.4 years, 22y. 299. nB4 Yo 37y. B5y. Bay. Sy. By. 52y. 75% 1.7 weeks. 1.9 months. 37m. 29m 28m 4am 52m 65m 6.6m 68m 7Am son. 2M 10.0 m 124m 148m 16.7 Mn ATA Ms 22.0m 2.0 years. 2By. ary. aay. ary 42y Ady. 4.0 Yon 50y. Sly Bry. 90% 1.3 montns 2.8m 3.9m 40m 45m 52m 56m 72m 7.3m 77m 91m 2M 109m 13.8m 163m 9.4m 20.6 m 23.8m sn 2.6 Years 3.2y ay 36y Aoy 46y Ary 53y Say 56y 61Y3. Language Respond to Bell... Vocalizes... “Ooojaah” Leughs. ‘Squeals. srr Turn to Rattling Sound... Tum to Voice Single Syllables Imitate Speech Sounds Dada/Mama Non-specitic Combine Sylables. Jabbers Dada/Mama Specific. One Word 2.Words 3.Words.... 6 Words... Point 2 Pictures. Combine Words. Name 1 Picture. Body Parts-6. Point 4 Pictures. Speech-Half Understandable.... Name 4 Pictures Know 2 Actions, Know 2 Adjectives Name 1 Color Use of 2 Objects Count 1 Block Use of 8 Objects... Know 4 Actions Speech-All Understandable Understand 4 Prepositions Name 4 Col0rs. Define 5 Words. Know 3 Adjectives Count 5 Blocks Opposites-2.. Define 7 Words 25% 2.7 weeks 1.3 months. 12m 28m 36m Atm 08.0. son 87m Sam STM 69m 97m 107m 115m 437m 17.4m.. WA7.2M.. 183m... 185m 20.0 M 172m 23.3. 235m 28 years. aay, 26y. 28y.. 28y. 25y. 23.4 months. 2.7 yoars. 30y. 33y. 29y. Ary. 36y. aay 50% 4.4 months. 4.9m 1.7m 3.8m 46m 56m 5.2m 65m 65m 6.9 sree 093 Ms 41.5 m 126m 1.6m 163m 19.0m 9 9.8 Ms 199m 19.8m 218m 20.0m 2.3 years. 24y, ei You 28y. 30y. 32y. BAy. 27y. 23y, Boy. 36y. aay aay fh Yon ABY 0 Aly. 73% 4.6 months.. 25m 28m ATM cos 5.6m 66m 6.0 M on 77m 74m 8.3 M 11.0 m.... 133m 14.6m 168m 188m 209m 22.4, 23.9m 226m 21 Years... 2Ay. 26y. 28... 3.0y. 33y. B4y. 38y. ay. 3.2y. 33y. B8y. Ay. 46y. aay. 105.0 Yo Oy. B4y. 90% Birth 3.3 weeks 2.7 months 3.1m 43am 5.6m 66m 75m 8.8m 2.4m 10.1m ot 133m 16.0m 165m 18.0m 214m 236m 2.1 years oo 23Y aay 28y 2ay 29y a2y a6y ary asy aay Aty 42y 42y ATTY oo BY 53y Say W5AY sy ety4. Gross Motor 25% 50% 75% 90% Equal Movements oe A Binh Lift Head csc eran . aararaemaeoreaesmeeee BRE Head Up 45 Degre@s...urnninmnnnnmnenesnannsnnnnen 7 WEEKS soe B MONNS...u.-.2.7 months Head up 90 Degrees... sone & MOMMNS. 22 MOMS 02.9 M seen 8.6 M Sit Head Steady .... : 1.6m 23m 30m 37m Bear Weight on Legs. . 17m 26m 108.6 M nner AM Chest Up-Arm Support 26m 33m 4.0m 46m Roll Over. 241m 32m ABM ceennS 4M Pull to Sit-No Head Lag 28m 3.4m 4AM cosnrnrenB.2T SitNo Support 5.4m 5am 63m 68m Stand Holding On oe 65m 7.2m 7am asm Pull to Stand zs 78m a4m 3.1m 97m Get to Siting 7.6m BAM cco M 2.9m Stand-2 Seconds. ne 9.4 40.2 soevneet0.9m 11.6m Stand Alone: 104m 115m 12.5 css. Stoop and Recover sonnel .OM 122m 13.4m 146m Walk Well 4m 123m 13.6m 149m Walk Backwards : 3M 18.8 M wrens 2M snore .6M Runs Sess 13.8 M sree 5.8. 178m 19.9 Walk Up Steps. eA Mn FBO M vcs IDA M sneer 21.6M Kick Ball FORTE sn sol 5.9 sosneel 3M 2OBM rrrenBB.2M JUMP UP oases ari) 238m 0 2.2 YORE rnin 4 YORE Throw Ball Overhand. se ATA IM sss 203M srsern 23.8 MORNE 2-9 Broad Jump . sen BA ORB nin YORI nin 29 YAS nrc B2Y Balance-Each Foot 1 Second. seer YenmneeynemsD. BY, we 2BY. Bay Balance-Each Foot 2 Seconds. PE Yor cD Vinrsasneenn OLY. Ady Hops B.2Y om 35 Yon BB Yernnnein AY Balance-Each Foot 3 Seconds... 127 Yoon B3y. Bay. Ary Balance-Each Foot 4 Seconds. 35y. oy. woh BY. BAY Balance-Each Foot § SECONGS .sncnneenB-7 Y. 4B Yenc A BY, BAY Heel-To-Toe Walk. we DY. AB YcaracimalBly soon TY Balance-Each Foot 6 Seconds. 42y. 4B Yonnnnne 5A Yosser 58APPENDIX B New, Changed, and Omitted Items: Compared to Ori 1. New Items Personal-Social Regard Own Hand (R) Wave Bye-Bye (R) Feed Doll Brush Teeth with Help (R) Name Friend Puton Tshirt (R) Play Board/Card Games (R) Brush Teeth, No Help (R) Prepare Cereal (R) Fine Motor-Adaptive Put Block in Cup Thumb Wiggle Language “OooiAah” (R) Turn to Rattling Sound Single Syllables (R) Combine Syilables (R) Jabbers (R) (One Word (R) 2 Words (FR) 3 Words () 6 Words (R) Body Parts ~ 6 Point to 2 Pictures Point to 4 Pictures ‘Speech Half Understandable ‘Speech All Understandable Namo 4 Pictures Know 2 Actions Know 4 Actions Name 1 Color Name 4 Colors Use of 2 Objects Use of 3 Objects Know 3 Adjectives Count 1 Block Count § Blocks Gross Motor Runs2. Changed Items Personal - Social Smile Responsively ~ Observe only Play Pat-a-Cake (R) ~ Wave Bye-Bye is separate item Imitate (Household) Activities (R) ~ Includes talking on phone or other activities of adults Fine Motor - Adaptive Hands Together - Observe only Reaches ~ Observe Only Pass Cube — Observe only Take 2 Cubes - Observe only Scribbles ~ Observe only Language Understand 4 Prepositions — In front of and behind me instead of Mommy’ chair, 4 instead of 3 correct to pass Opposites-2 - Sun/Moon instead of Mother/Dad Define Words-5,7 - Fence added; pavement and hedge oliminated; 5, 7 of 8 instead of 6 of 9 correct 10 pass Gross Motor Stand Holding On - Observe only Pull to Stand - Observe only Stand-2 Seconds ~ Observe only Stand Alone - Observe only Stoop and Recover ~ Observe only Walk Woll - Obsorve only Kick Ball Forward - Observe only Balance-Each Foot - Each foot instead of either foot 3. Omitted Items Personal Social Plays Pook-a-B00 Resists Toy Pull Initially Shy with Strangers (R) Plays Interactive Games (R) Buttons Up (R) Separates fromm Mother Easily (R) Fine Motor-Adaptive Neat Pincer Grasp of Raisin ‘Dumps Raisin Spontaneously imitates Bridge Language Points to 1 Named Body Part (R) Follows Directions Uses Plurals (R) Gives First and Last Name (R) Recognizes Colors (R) Composition of Gross Motor Walks Holding on to Furniture (R) Pedals Tricycle (R) Catches Bounced Balt Backward Heel-to-Toe WalkBeer eee ree Petree retro ry Pebteteetiteetet eet) betceteeeteerttece ihe rte ret Rete teee reer hee Peececheeetcecectecrees Rete tee tet r Rstereheetreee bet be ret ret rs Biter hee hee tre beer ree rhe Baobab beh ek hort bee eee ee eet Be eteteetee titer Bebe eee aeeateteata tte beer eter erred