MMDST

Metro Manila Developmental

Screening Test

Shezel Jheane M. Matel, RN

 Screening - the presumptive identification
of an unrecognized disease or defect by
the application of tests, examinations, or
other procedures that can be applied
rapidly

 Screening test – sort out apparently well

persons who probably have the problem
from those who probably do not,
permitting those with positive or suspicious
findings to be referred for diagnosis and
appropriate treatment as early as possible.
MMDST
 an early detection model that applies
to the detection of developmental
disabilities in children aged six & a half
(6 ½) years old and younger

 a simple, clinically useful tool used in

the early detection of children with
serious developmental delays,
modified & adapted by Dr. Phoebe D.
Williams on 6006 Metro Manila children
ages 2 weeks to 6 ½ years old.
DDST
 Denver Developmental Screening Test
 Developed by Dr. William K. Frankenburg
& associates in 1967 for the Denver
children.
 the basis for the modification and
standardization of the MMDST
 Design for health professionals such as
nurses, doctors and health workers so
that slow development may be
recognized, referrals made &
appropriate therapy prescribed as soon
as possible.

 It is a SCREENING test.
 It is intended as a screening instrument
to determine whether a child’s
development is within normal range.
 MMDST
 It is NOT an intelligence test

 It is NOT a diagnostic test

 It is NOT a predictor of future adaptive

or intellectual ability.
 MMDST
Evaluates 4 aspects of child’s development

 Personal-Social
 Fine-Motor Adaptive
 Language
 Gross Motor Behavior
4 aspects of child’s development
evaluated by MMDST
(1) Personal – Social

 Task which indicate the child’s ability to

get along with people and to take care
of himself/ herself.
 4 aspects of child’s development
evaluated by MMDST

(2) Fine Motor Adaptive

 Task which indicate the child’s ability to

see and to use his hands to pick up
objects and to draw.
 4 Aspects of child’s development
evaluated by MMDST

(3) Language

 Task which indicate the child’s ability to

hear and follow directions and to
speak.
 4 Aspects of child’s development
evaluated by MMDST/DDST
(4) Gross Motor

 Task which indicate the child’s ability to

sit, walk and jump.
 MMDST Kit
 Manual
 Sample test form
 Test materials
 MMDST bag

 Test Materials – standards and these consist of the

following:
 Bright red yarn (pom-pom)
 Rattle with a narrow handle
 Eight 1-inch colored wooden blocks (red, blue,
yellow, green)
 Small clear glass/bottle with 5/8 inch opening
 Small bell with 2 ½ inch-diameter opening
 Rubber ball 12 ½ inches in diameter
 Cheese curls
 Pencil and bond paper
The Test Form
 Made of 105 items written in the range of
development of children between birth
and six years of age
 Across the top and bottom of form are
age scales
 Age is marked in months for 1-24, and in
years from 2 ½ to 6.
The Test Form
 The BAR representing the item is located
between the age scale to show when
25%, 50% (indicated by the hatch mark),
75% and 90% of the normal children are
able to pass the item.
 The bar representing the item, WALKS
WELL, is located between the ages less
than 12 months and 17 months.
 The LEFT END of the bar denotes that 25%
of normal children walk well at less than
12 months.
 The HATCH MARK denotes that 50% of
normal children walk well at 13 ¼ months.
 The LEFT END OF SHADED AREA shows 75%
do so at 15 months.

 The RIGHT END of the bar shows 90% walk

well at about 17 months.
 Some items have a SMALL FOOTNOTE NUMBER at the
left end of the bar. This number indicates the
corresponding instructions for administering the item
that is found at the back of the test form.

 Some items may be passed by REPORT of the

parent.

 Only items with an R on the form may be passed by

report.

 However, whenever possible, the tester should

observe what the child can actually perform rather
than ask the parent, even though the item may be
passed by report.
 The item EQUAL MOVEMENTS has an
asterisk (*) at the right end of its bar
 This indicates that 100% of normal
children pass this item at birth.
 This is only the item with an * and is
located in the fine-motor adaptive sector
of the test form.
 Nine items have arrows at the right end of
these bars.
 The arrows indicate that normal children
may pass these items even beyond 6 ½
years of age.
 Administering the Test
 Establish rapport with the mother/ caregiver
 State that this is a screening test and not an IQ
test.
 Make the child as comfortable as possible
 Calculate the child’s age
 Draw the age line
 Select the items to be administered
 Administer the test
 Score the results
 Interpret test results
 Explain overall interpretation of test result to
parent or caregiver
 Administering the Test
 Sitting on the mother’s or caregiver’s lap is the
best position for the infant or toddler.
 The table on which the test materials are set
should be easily accessible to the child.
 A mat on the floor with the test administrator in
a kneeling position is recommended for testing
the young infants or even older children who
live in poorer homes where tables and chairs
are not common fixtures in the houses.
 Avoid testing the child when he is sleepy, tired,
ill, hungry, or upse.t
 Administering the Test
 Generally the test starts with:
 Personal-social
 Fine-motor adaptive
 Language
 Gross motor
 Although the above sequence is
recommended, there are instances when you
may vary the sequence of some items in order
to take advantage of the child’s interest.
 In general, clearing the table/floor of all
materials except for the task at hand minimizes
distractions.
Steps in Administering the Test
1. Draw a vertical line on the examination
sheet through the four sectors (gross motor,
fine motor-adaptive, language, and
personal-social) to represent the child’s
chronological age.
2. Place the examination date at the top of
the age line.
*For premature children, subtract the months
of prematurity from the chronological age.
After 2 years of age, it is no longer necessary
to compensate for prematurity.
Steps in Administering the Test
3. The items to be administered are those
through which the child's chronological age
line passes unless there are obvious
deviations. ln each sector, one should
establish the area where the child passes all
of the items and the point at which the child
fails all of the items.

4. ln the event that the child refuses to do

some of the items requested by the
examiner, it is suggested that the parent
administer the item provided he or she does
so in the prescribed manner.
Steps in Administering the Test
5. If a child passes on item, a large letter P is
written on the bar at the 50% passing point.
F designates a failure, and R designates a
refusal.

6. Note how the child adjusted to the

examination and how the child related to
the parent, the examiner, and the test
materials.
7. Ask the parent if the child’s performance
was typical of performance at other times.

8. To retest the child on the same form, use

a different colored pencil for the scoring
and age line.

9. Instructions for administering footnoted

items are on the back of test form.
Test Scores
 Passed ( P )

 Failed ( F )

 Refused ( R)

 No Opportunity ( NO )

 Failure of an item that is completely

to the left of the child’s age line is
considered as a developmental
delay and is therefore referred in
MMDST as a delay.
 Calculating the child’s age
 The child’s age will be the basis for
drawing the age line and determining
the test items to be administered.

DATE OF TEST – BIRTH DATE = AGE OF CHILD

 calculate first the days, then months

and then years.
Calculating the child’s age
○ Example:
Birth date : January 05, 2017
Date of Test: February 20, 2019

Year Month Day

Date of test 19 02 20

Birth Date 17 01 05
_______________________________________
Age of Child 02 01 15

Therefore the age of the child is 2 YEARS, 1 MONTH, 10 DAYS

 Calculating the child’s age
Borrowing
○ Make sure that 30 days are borrowed from the
month and 12 months from the year column.

Date of test: February 20, 2019

Birth date: March 10, 2017
Year Month Day
Date of test 19 02 20

Birth Date 17 03 10
_______________________________________
Age of Child 01 11 10

Therefore the age of the child is 1 YEAR, 11 MONTHS, 10DAYS

Adjustment for prematurity
 Prematurity may affect the ability of the child to
perform or demonstrate items that other normal
children pass at the same age.

 Make adjustments if the child is 2 years or

younger. Subtract the number of weeks of
prematurity.
 If more than 2 years, it is no longer necessary to
compensate for prematurity.
 No adjustment should be made for children
born later than expected.

ACTUAL AGE – NUMBER OF WEEKS OF PREMATURITY

= ADJUSTED AGE
Adjustment for prematurity
A child born 5 weeks premature has an actual age
of 13 months.

ACTUAL AGE – NUMBER OF WEEKS OF PREMATURITY =

ADJUSTED AGE

13 months – 5 weeks = 11 ¾ months

Therefore, the actual age of the child is 11 ¾ months.

Selecting Items to be Administered
 Items to be administered first are those through
which the child’s chronological age line passes.

 If a failure occurs in any of these items, proceed

to administer items to the left of the age line
until you obtain 3 passes, then stop.

 In items passed, continue testing to the right

where the items become progressively more
difficult until the child fails three times in that
sector.
Keep in mind
1. All items crossing the age line should be
administered.
2. The child should have a minimum of 3
passes to the left of any failure.
3. Each sector should have at least three
passes and three failures.
Selecting Items to be Administered
 The number of items to be
administered will vary with the age
and ability of the child.
 Normally, a child is tested on only 20
simple tasks or items.
 The child may accomplish some of the
tasks on his own without being asked.
Test Scores

 Passed ( P )

 Failed ( F )

 Refused ( R)

 No Opportunity ( NO )
Scoring delays in development

 An example of no opportunity is in the item –

pedals tricycle. If the child has never had an
opportunity to try a tricycle then the item should
be scored as no opportunity and not failed or
refused.
Scoring delays in development

 Scores is to be written on the 50% hatch mark.

 A test item that is failed and which falls

completely to the left of the age line is
considered a delay.
Scoring delays in development
 Delays on the test form are emphasized by
shading the right end of the bar of the delayed
item.

 If the age line touches the right end of the bar,

the item is not considered a delay.
Interpreting test results

*The MMDST result is interpreted as:

NORMAL
QUESTIONABLE
ABNORMAL
UNTESTABLE
 Criteria Interpretation
2 or more sectors with 2 or more
Abnormal
delays
1 sector with 2 or more delays plus
1 or more sectors with 1 delay and
Abnormal
in that same sector, no passes
intersecting the age line.
1 sector with 2 or more delays Questionable
or more sectors with 1 delay and in
that sector, no passes intersecting Questionable
the age line
When REFUSALS occur in
numbers large enough to cause the
test result to be QUESTIONABLE Untestable
or ABNORMAL if these were scored
as failures
Discussing test result

 Overall interpretation of test results should be

given to parent in general terms.

 If the child has done well – praise and reassure

the parent the child is developing as he/she
should be.

 If the child has a number of delays remind them

it is a screening test and you would like to test
the child again within approximately 2 weeks.
Follow these simple steps:
 Step 1 – Mark each delay by heavily shading
the right end of the bar;
 Step 2 – Count the number of sectors that have
2 or more delays;
 Step 3 – Count the number of sectors that have
1 delay with no passes intersecting the age line
in the same sector;
 Step 4 – Interpret the result using the following
criteria.
Interpretation

 Failure to pass an item passed by 90% of

the children should be considered
significant. Such a failure may be
emphasized by coloring the right end of
the bar of the failed item.
Interpretation
 Several failures in one sector are considered to
be developmental delays. The delays may be
due to;
1. Unwillingness of the child to use his or her ability
due to:
a. Temporary phenomena such as illness, fatigue,
separation from parent, fear, hospitalization,
and so forth.
b. General unwillingness to do most things that
are asked, such as condition may be just as
detrimental as an inability to perform.
Interpretation
2. An inability to perform due to:
a. General retardation
b. pathological factors such as
deafness or neurological impairment
c. familial pattern of slow
development in one or more areas.
END OF DISCUSSION.