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    207 views52 pages

    MMDST Manual 1 1

    Uploaded by

    Bea Abigail Brocal
    mmdst

    Copyright:

    © All Rights Reserved
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    METRO MANILA DEVELOPMENTAL SCREENING TEST MANUAL [PHOEBE DAUZ WILLIAMS, RN, PhD * ADELINA B. ABAD SANTOS, RN, MN LUZ B. TUNGPALAN, RN, MA JOSEFINA A. TUAZON, RN, MN Editors Research and Creative Writing Program ORNURSING =e ‘of the Philippines paanila Kins b FO days befual: ge Lab 5 Ted: Sihdab: 2/e 12 8 # (2 «te panstaty) Metro Manila Developmental serning Test Manual ‘Second Eilon Copyright © 1999 by University ofthe Philipines Manila College of Nursing First Eition, 1985 aitors: Adelina B. Abed Santos Luz B. Tungpalan All rights reserved. No part ofthis work covered by copyright herein may he reproduced or copied in auy form or by any means ‘without written permission of the publisher Published by’ University ofthe Philipines Manila College of Nursing Pedro Gil Sc, Malate, Manila Philippines 523-1472/523-1494, a - 18B0/971-93085-07 wy 9 yole # yO. Foreword /v Preface /vi Overview of the MMDST J 1 Test Form / 4 Preliminary Phase Test Administration ‘Test Items: Administration and Scoring Directions J 15 Scoring Delays in Development / 66 Interpreting Test Results / 67 Discussing Test Results / 68 Retesting / 68 Difficult Test Situations / 69 Practice Testing / 73 References /74 Appendices /16 ‘A. Sample Protocols /77 B. MMDST Administration Checklist / 81 C. Denver Developmental Screening Test / 83 Foreword ‘The Metro Manila Developmental Screening Test (MMDST) devised by Dr. Phoebe Williams as a pediatric Ssorecning test is a milestone in mursing. Being culture based, it has been widely used by nurses, physicians and other workers for nearly two decades now. Indeed, its culture sensitivity makes it easy to use for Filipino children. _. The MOMS T is research-based and, as such, should be inherent 10 nursing practice. Developmental screening should be made an integral part of the nursing curriculum to enhance the competency of professional nurses, specially would-be child health nurses, family nurse practioner and nurse specialists. ‘The publication of this revised edition is part of the UP. College of Nursing's commitment towards professional advancement in nursing and the enhancement ‘of the Filipino nurse’s involvement in promoting wellness, and preventing disability. ‘This project has been made possible with the support of the Commission on Higher Education (CHED) in recognition ofthe UPCN’s role as a center of excellence in nursing education, = lnpiten Wi dared CORN LAURENT Tat Dean UP. Calloge of uring Preface ‘This manual describes a screening process using the Metro ‘Manila Developmental Sereening Test (MMDST). ‘This test was the product of a normative study in 1980 by the author, Dr. Phoebe Dauz Williams, on Metro Manila children to standardize the widely recognized Denver Developmental Screening Test of Prankenburg and his associates: Since then, the MMDST has been validated and well ulilized not only in research but in practice as well by aurses, pediatricians and other health workers. Today, William's MMDST remains to bbe the recognized developmental screening test among Filipino children “The author is a nurse researcher and professor with a BS in ‘Nursing and MA in Psychology from the University of the Philippines, and Masters in Nursing and PhD from the University of Pittsburgh. She was a former professor and hhead of the Department of Research, University of the Philippines College of Nursing. She is currently Professor of the University of Kansas School of Nursing and the only Filipino Fellow of the Americen Academy of Nursing (FAN). Although she has been abrond for almost two decades now, she remains to be an active member of the U.P. College of Nursing. From across the miles, she produced the first edition of the MMDST Manual in collaboration with the “UPCN Department of Research in 1985. Adelina B: Abad Santos and Luz B. Tungpalan edited this first edition, ~~ ‘This second edition of the MMDST Manual isa project of the Research and Creative Writing Program of the UP College of Nursing, just as the fist edition was. This edition promises a format and language that is userriendly. Its ‘more compact size makes it handier that will fit snugly into the MMDST bag with the test materials, The topics have also been rearranged for easier comprehension. Some of the illustrative examples were updated and made consistent with the test form for better integration of learning, ‘This project isthe result ofa collaborative effort of many people. We specially acknowledge the editorial expertise of Prof, Luz B. Tungpalan whose assistance was invaluable, and to the editorial staff, Sheila R. Bonito who prepared the manual for publication with the assistance of Erlinda S. Bilog and Glorie €. Mangalino. Special mention has 10 be sven to Prof. Ma, Estela M. Layug whose expertise in the _MMMNCT nod tuable comments helped direct the revisions ‘undertaken. Lastly, this project would never have reached this stage without the urging and support of Dean Cecilia M. Laurent. ‘The project of writing the second edition is a personal fulfillment because as a young graduste, my first job was as ‘research assistant to Dr. William’s normative study. And itis a privilege for RCWP to be given the chance to be a collaborative partner with the likes of Dr. Williams and Prof. Tungpalan, Josefina A. Angeles Tuazon Head, Research and Creative Writing Program (RCWP) December 1999 An Oversiew Screening is the presumptive identi ‘unrecognized disease or defect by the applicatic ‘examinations or other procedures that can be applied rapidly. Screening tests 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. One such screening tést is the Metro Manila Development Screening Test (MMDST). It is an. carly detection model that applies to the detection of developmental ties in children aged six and a half years old and =T“8-98T is simple-cinically useful tool used in the carly detection of children with serious developmental delays developed by Dr. Phoebe D. Williams. It is a modification and standardization of the original Denver Developmental Screening Test (DDST) by Dr. William K. Frankenburg and his associates (1970) on 6,006 Metro Manila children. It ‘was developed for health professionals such as nurses, doctors and other health workers so that slow development may be recognized, referals made, and approprite therapy prescribed 1s soon as possible. Just like the DDST, the MMDST is not an intelligence test. It is intended as a screening instrument to determine whether 2 child’s development is within normal range, ‘The MMDST is designed to detect developmental delays in children 2 weeks fo 6 4 years old. It evaluates four aspects of 4 child’s development: personal-social, fine motor-adaptive, tos Moret “The test is administered using the MMDST kit which includes the manual, sample test form, test materials and the MMDST bag. The test materials are standard and shown in Figure 1. These consist of the following: +A bright red yarn pom-pom © Aratte with a narrow handle Eight 1-inch colored wooden blocks (fed, blue, yellow, green) +A small clear glass/bottle with 5/8 neh opening, +A small bell with 2 % ineh-diameter mouth + Arubber ball 12 inches in circumference = Cheese curls + Apencil + Bond paper CCaleutating the child's age-and-indicating the age line is crucial, if not the most important, initial step in test ‘administration. The test items that will be administered will ‘depend on the calculated age of the child, Therefore, this will, guide the selection of test items to be administered and the subsequent interpretation of the MMDSTT results. Four kinds of scores may be given for eact test item: ‘passed, failed, refused ot no opportunity. Failure of an item that is completely to the left of the child's age line is ‘considered a developmental delay and is therefore referred to inthe MMDST as a delay ‘The succeeding sections of this manual will describe the test form, steps in administering the MMDST, scoring each test item, and interpreting the test. Difficult test situations are also presented plus the conditions under which retesting is Saceeptable. Figure 1, Test Materials rte ost Mae Like the DDST, the MMDST is made up of 105 items wwttten in the range of accomplishments for children between birth and six years of age, The sample test form is shown in Figure 2. Instructions for administering footnoted items are placed at the back of the test form. These items are ‘categorized in four sectors: I, Personal-Social - tasks which indicate the child's ability to get along with people and to take care of himself. 2. Fine Motor-Adaptive - tasks which indicate the child's ability to see and to use his hands to pick up objects and to draw. ° 3. Language - tasks which indicate the child's ability to hear, follow directions and to speak; and 4. Gross Motor - tasks which indicate the child's ability to sit, walk, and jump, Across the top and bottom ofthe test form are age scales raking ape in moaths frm I 024, and ages in yeas froma | Bite G. Each of the test items i epresented inthe et form bya ba The bar is placed along the age scale to show when Bes, s0% (indicated by the hatch mack) 75% and 90% of oma children ae able to pas the ilem. A sample est item tnd ihe corresponding age sal is shown in Figure 3. AGE SCALE (noitts) i a, 6 18 20 7 atch mask rece et 2506 19% Saat, 2p So Figure 3 Test Directions for Footnoted Items 1. ‘Try to get child to smile by smiling talking or waving to hin, ao nol touch him ‘When child i playing with toy, pli aay ftom him. Pass if he resists Child does not have tobe able to tie shoes or button inthe bac, 4. Move yarn slovily in an arch fram one side tothe othe, about 6” above chile’s fice. Pass if eyes follow 90° to midline. (Past idling; 180°) 5, Pass if the child grasps rate when it is touched to the backs or tips of fingers 6, Passif child continues to look where yam disappeared or tries to see where it went. Yam shouldbe dropped quickly ftom sight fiom tester's hand without arm movement. 7. Pass if child picks yp cheose curl with any part of thumb and finger. 8. Pass if child picks up cheese curl with the ends of thumb and ‘nox finger using an over hand approach, O | 9, Pass any en- 10, Which lite is 11. Passanyeross- 12. Have child loged form. longer (aot ing ine copy Pal comin. bigger. Turn Ir failed, ous round paper upside demon sotoes flown and 10 sete peat GB or 5) Whea giving items 9,11 and 12, do not name the forms, Do not demonstrate 9 snd 11 13, When scoring, cach pair (2 arms.2 legs, ee:) counts as one par 14, Point to picture and have childname it. (No credit i piven. for oer 5 / Sree meee we fae | 15, Tell child to: give block to Mommy; put block on tables put block on floor, Pass 2 of 3. (Do nor help child by pointing. ‘moving head or eyes.) 16, Ask child: What do you do when you are cold? hungry? ied? Pass 2 of 3. 17-Tell child to: Put block om able; under wble; in front of char, behind chair. Pass 3 of & (Do nor help child by pointing, moving head or eyes) 18, Ask child: If fire is hot, ice is?; Mother is a woman, Dad isa; ‘horse isi, a mouse is? Pass 2 of 3. 19, Ask child: What isa ball? iver? desk? house? banana? cuts? roof? fence? street? Pass if defined in terms of use, shape, what itis made of or its general category (such as banana is x rut, ot just yellow). Pass 6 of 9. 20, "Ask ehild: What isa spoon made of? shoe made of rade of? (No other objects may be eubsunued.) Pass 3 of. 21, When paced on stomach, child its chest off table with support, of forearms and/or hands 22, While child is on his back, grasp his hands and pall him to siting. Pass if ead does not hang back. 23, Child may use wal or rail only, net person. May nt craw 24 Child must throw ball overbead 3 fet to within arm's reach of tester. 25. Child must perform standing bread jumps over width of test sheet (8 % inches). 26, Tell eld to walk forward, DEDEDE —P heel within inch of toe. Tester may demonstste, Child must walk consecutive steps, 2 out of 3 tals 27, Bounce ball to child who should stand 3 feet away form tester. (Child mast cate ball with hands, not amas, 2 out of 3 rials 26, Tell child to walk backward @-©DeqeDeqy toe within inch of heel. Tester may demonstrate. Child must walk 4 consecutive steps, 2 out of 3 tials. DATE AND EITAYIORAL OBSERVATIONS (ow il nef ens Tots, aeton posal bow eee ee) “The bar representing the item, waiks well, in Figure 3 is located between ages less than 12 mouths and 17 months. The Jeft end of the bar denotes that 25% of normal children walk ‘well at less than 12 months, 50% (indicated by hatch mark) at 13 V4 months, le end of shaded area shows 75% do so at 15, ‘months, and right end of bar shows 90% walk well at about 17 ‘months. All est tems are represented similarly. + Some test items have a smal footnote number at the left end ‘of the bar. This number indiestes the corresponding instruction for administering the item that is found at the back of the fest form (see Figure 2). For example, the instruction for the item, ‘walks up steps, is #23 at the back of the test form (see Figure 4. Some test items may be passed by report of the parent. ‘The leterR in the bar as shown in Figure 4 indicates this. Only items with an R on the form may be passed by report. Howes, ‘whenever pase the teser shoul obsave vat the child can actually perform rather than ask the parent, even though the item may ‘be passed by report. ne in oe Figure 4 ‘The iter, equal movements, as an asterisk (*) at the right end of ts bar, This indicates that 100% of normal children pass this item at birth. The item is hardly seen in the form but itis the only item wit an * and is located in the fine motor adaptive sector ofthe test form. ‘Nine items have arrows (->) atthe right end of these bars. ‘This includes the items, defines words and composition of _. ‘The-arra atnormia-children-may-pass these items even beyond 6: reas of age. Caleulating the Child’s Age ‘The fist step is to calculate the child’s age. ‘This will be the basis for drawing the age line later and determining the test items to be administered. Check the calculation very well before placing the age line on the form [Ask forthe birth date of the child and calculate the exact age using this formula: date of test minus birth date equals age of child, Caloulate first the days, then months, and then years. To iMustrate, ifthe birth date is Mareh 10, 1997 and the date of test is November 27, 1999; then: . Year ‘Month Day Date of Test 89 4 15 Birth date 7 3 -10 ‘Age of Child z 5 3 ‘Age of this child is therefore 2 years 8 months and 15 As an ieebreaker, offer the child a cheese curl or give him @ block, a bell or a rattle to play with prior to testing. + Start testing with ites that are scored by report. Fo- ccusing attention initially on the parent gives the child a chance to cope with the situation and becomes more familiar with the tester and the test materials. If the child remains shy and wary, ask the parent £0 ‘administer some ofthe test items or show how they are done. Asthe parent demonsrates, you can say, “Tigran fro nga hurg makalalakad ka din ng paurong gaya ng onay mo.” Preschoolers are grest show-offs. This technique ray work and if does, reinforce the child forperforwine TF miggesthe-ui ad U8 TOTES not Complet, retest 2 or 3 weeks ler. -o os Maat The Uncooperative Child ‘The uncooperative child is one who is not shy but refuses to do what is asked of him/her. Approaches for the shiy chile may also be applied t0 the uncooperative child. In addition, the following may be trie: ‘+ Ask the parent to leave the room. The chile may perfonn beter in the pirent’s absence. Anxious felings of a parent are communieted tothe child who in tum acts negatively. + the child becomes upset by the separation, the parent need not leave the oom but is requested to tum away “while staying within seeing distance ofthe child «Ifthe parent says thatthe child can do certain items but js just uncooperative, ask the child to do the opposite. Reverse psychology often works inthe negativistc age You might say, “Sa palagay ko, hind ka marunong magdrawing ng. tao.” The Overactive Child ‘An overactive child is one whose interest shifts rapidly from one test item/material to anothet. He/she may be seated beside you building blocks and as you tura to consult the test form, the child sees the ball in the kit, drops the blocks, gets the ball and runs off with i. Getting him to sit ddovin to continue the testis’ chore. While you may succeed in getting him to perform again, the attention span is short. Dealing with an overactive child may be a difficult experience to the child, the parent and the tester. ‘There are ‘ways, however, of dealing with this situation + Mastery of test items ~ based on the example given above, when the child drops the blocks and picks up the ball, be ready 10 test him on other items: "Spain mo tong bola." Qnoe done, follow with “Saluhin mo ito.” ee ee ae himon 0st Nay recognition of colors. ‘The sequence of testing may be jumbled depending on the situation. If the tester has. mastered the test form, jumping from one sector to an- other is easy Limit the distractions ~ clear the room of al distractions. If this is not possible in crowded places (home, clini oF health center), arrange the table and the child's position on the table in such away that hisher back i tothe distrac- tion Bring out only the tpst materials needed per item. Keep the rest in the bag and do not give the child chance to see its contents or else he/she may not rest until he gets hold of everything. * ‘Another technique to is keep the bag behind you, leave it ‘open, and reach forthe test materials as needed. As you {do this, mainten oye contact with the child at all times to hold his atentian. 2 ‘An older child is usually wiser and may realize that that you are hiding things as you fumble through the bag. If iis happens, tel the child that you have a series of surprises (young children love surprises) for hinvher but {hat helshe has tobe very attentive and follow directions. Direct the child’s etention gain the child’s attention ‘Once obtained, focus iton the task to be performed. If attention lags, cll him by name or touch his arm gently 10 ‘ring him back to the task at hand, Be firm and calm ~ Filipino chiléren, including the ove active, respond to authority. Uniformed people like nurses, doctors and policemen are usually held in awe. Firm bat calm words from these people often work wire parents fail, TELL the child what to do, DO NOT ASK ithe can or if he will perform the task FE PORTIS, ols the-chwlé-on your laps hiner. This way, 11 easier to comry! ‘The Chitd with many Siblings {is sometimes difficult to contol the situation in homes \with many siblings. Each child wants to perform the tasks all at the same time; or, a child already done with the test tells the other what to do. Ascendant behavior or bossiness| begins at around age 3. A desire to excel is manifested as carly:as age 4. In this situation, explain to the mother the need to test each child individually. As each child, prefer- ably starting with the eldest, accomplishes the test, ask the nother to send the child on errands, This technique keeps: hhim put of the way, thus giving the remaining children 2 chance to perform on their own, without comments or prompting from others. z The Interfering Pares ‘The interfering parent is ene who becomes too involved “This parent answers the questions for the child and shows him what to do, ‘The following techniques are suggested: a, Explain to the parent, as inal west situations, that the MMDST is not an intelligence test and that the child is not expected to pass all the items. ‘The test will only show what the child can do at ‘certain age. Be sure the mother understands the purpose ofthe test ‘Administer the test If the parent interferes, repeat the explanation as 4. If the parent still tells the child what to do, Frankenburg suggests that the parent leave the room. A face-saving way is to discontinue the test. Then reset the discontinued test for re sereeging within 2 or 3 weeks. -Score the items by nyport of interfering parents with eare. They may tbe reliable. soos nt “The administration of the MMDST requires practice to develop an acceptable level of competency. The tester should bbe competent 10 obiain valid test results. Its therefore recom mended tat beginning users ofthis screening test ot only practice but also have someone to evaluate their competency using the MMDST ‘Administration Cheeklist provided in Appencix B. Williams’ slide-tape program is availsble that you can view prior to practice and actual administration of the MMDST. If Frankenburg et e.s proficiency training film is available or its equivalent, view this also and compare your performance with the expected answers, Proficiency on the DDST/Denver Il i a requirement for pediatric and family nurse practitioners in the United States. = When you do your practice, perform the test on children with Warioasages eerste; yacte skill: The following has ‘been recommended inthe original DDST: 4 chiléren between | month and 9 months of ages 4 children between 9 months and 2 years of age: and 4 children berweon 2 years and 6 years of age It is helpful to pair off with another person to practice test. [As one person tests, another observes and uses the checklist ‘The observer should discuss anything omitted by the tester and any disagreements in administration or scoring to the manual and/your instructor to settle any difference. ‘After practice testing with at least 12 children, ask your instructor or test partner fora reliability testing session. This is ‘done with you administering the test om one to three children (of the age ranges stated above) and your instructon/partner independently scoring the test as you administer it. You should cobtain-ot Jegst 90% agrooment, with your instruptorpartner, If noi, Tid out Uievareas of disagreement and s, delice in those ‘areas, Repeat the reliability testing session, if deeded. oss Ment References [Abad Santos, AB (1980). An Analsisof Figure Drawing of Mets ‘Manila Preschoo!Chiléen. to P. Wiliams (ed), Development ‘of Norm for the Denver Developmental Sercening Test on ‘Metro Manila Children 046 Years Old, pp115-198 NSDB-UPS a Anasasiow, N., Grimmett, 8 Eggleston, P., and Brown. (197). aciltative Environments Encouraging Development (FEED) =. lsttte for Child Study, Indiana University, Bloomington, Frankenborg, W. & Fandall, A, Dodis, J, (1970). Deaver Developmental Sereening Test Manual " (Revised) Denver University of Colorado Press Frankenburg, W., Goldstein, A, Chabot, A., Camp, B.W, and Fitch, IM. (1970). Traiing the Indigenous Nonprofesiont; The Screening Technician J. Pediatries, 77 564-570. ‘rankenburg, WK, Camp, B.W, VanNets, PAA & Demersseman, 1A (97a) Relihilty & Sabilty of the Denver Developmeatal Screening Tes. Chilé Development, 423475485. Guthrie, G., Tayag A, eobs,P. (1965) "The Philippine Non-Verb Intlignce Test (PNIT) Manual, Philippine Normal College, Manila Layug, F. (1980). Concurrent Validation of the DDST (Meteo- ‘Manita version) Unpublished master's thesis, University ofthe Philippines, Quezon City Williams, PD. & Madiazo, CV. (1983) Early Wentiieation ofthe ‘Child at Risk: A Philippine Perspetive, Paper presented atthe Fourth International “Conference on Early Ldenfcation ‘September 18-23, [983, owas, Colorado / PD, (1982) The Moto Manila Developmental Serening "Testa Normative Sty”, Ip Anassiow, Nl Prankeaborg WK, and Fandall A.W, Hdenifying the Developmentally Delayed ‘Chik, Batre: University Park Press Wiliams, PD, (19803). Development of Norms for the Denver ‘Developmental Serening Test on Metro Manila Children. 0-6 ‘Years Old. NSDB-UPS (A) Projet No. 703 So, Winiams, PD. (1980b).'A. Comparative Study of DDST Norms Developed in Five Locales. In: PD. Willams (Ed), Nursing Reseach i the Philippines: a Sourcebook. IMC Press, Quezon ciy « ‘Wiliams, PD” (1986). The Rellibilty ofthe Denver Developmental Serening Test: Mero Manila version. In P. Willams (E3.) Development of Norms for the Denver Developmental Screening Test on Metro Mauils Chikiren 0-6 Years Old [NSDB- (A) Projet No. 708 Sa, Append Willams, PD. (980d). Predietive Valdty of the Metro Manila Developmental Screening Test. Paper resented a the Philippine Physiologie! Assocation Convention August 26, Manila Wiliams, P1979) Unnarew at Rusk: Perinatal Event and heir “Elects on Development: A Cross-Sectional Study. Unpublished Wiliams, PD. & Williams, AR (1983) “Factors Affecting ‘Development of Filipino at Risk", preseoted at seminar on ‘Children at Risk: Aw International Perspective, University of Colorado Health Ssinoes Contr, Denver. Colorado, September 16,1983, Appendix A SAMPLE PROTOCOLS Normal Test Result Abnormel Tést Result Questionable Test Result Untestable Test Result 1 woos-wnostea NLEYOV HOLOM aN yoi0H ss0us ae wr] Cee T,t.7-$7 tas tials) 6 (0-1-8 sae, t “ ae FINE MOTOR ADAPTAE PERGONAL-SOOIAL "FINE woTOR ADAPTIVE GM sector, 2 delays FMA sector, I delay and in that same sector no pass intersects age line. wicosrwnosuas aniLavay WOUOIN 3s vo1oH ssoun) v Appendix B MMDST ADMINISTRATION.CHECKLIST Purpose: This checklist should be used regularly until the tester becomes proficient in administerhg the ‘MMDST. Instructions: To. check the, accuracy of your own testing ability, go over the checklist immediately after you have finished giving a test. To check the fceuraey of another person's test sidministra- BEFORE THE TEST: CORRECT INCORRECT 1. Can child see and reach test rome ean? Yo at eee 2, Did the examiner expin at Ya Ne fhe MIDST ine an IQs 3. Dit te ermine plas Bt ya, yp childs ot expeced a por form everything asked of him? Epi ts Canker ekisoage ae ts fehl er king pron hiss bia? 5, Bee drag a2 ne, 4 yu txaminer fh wes bom emt? 6. Was age line drawn correctly? Y& ‘No $ Divde emninerindiwe dete yyy test was administered at top of ‘age line? DURING THE TEST: itd the 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? 10.telling child what to do rather than asking? IL. Was table clear of materials which were not being used? 12, When asking for parent's report, did examiner suggest an answer by the way question was ‘worded? (leading question) 13;Did the examiner praise child only when he correctly per- “formed an item? 14, At the ond of test, did the exam- iner ask parent if behavior of child was typical of his usual ‘behavior? 15, Did examiner administer enough items? (At least 3 passes and 3 failures in each sector) AFTER THE TEST, 16, Were delays emiphasized by shading in right end of bar? 17. Were delays indicated only on those items failed which were completely to let of age line? 18, Was test performance interpreted comectly? 19 Did the examiner write observa- “S

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