The Denver Developmental

Screening Test

A Normative Study
KEITH E. BARNES
ANNETTE STARK

The developmental norms of preschoolers from an urban

population, collected for the Denver Developmental
Screening Test, were compared with norms of
preschoolers from a Canadian rural and semirural
population.

Introduction The South Okanagan Health Unit has long been

In 1967 Frankenburg and Dodds introduced a new
developmental screening test for infants and preschoolers
between the ages of 2 weeks and 6.4 years.' The major
purpose of this new screening instrument was to detect
slow development in four functional areas of development:
gross motor, fine motor, language, and personal-social. The
test was devised as a clinical tool simple enough in fornat
that it could be administered and scored by people who had
no prior training in psychological testing. Essentially, it was
to be used in order to alert professional personnel to the
possibility of developmental delay and the need for special
professional diagnostic investigation. A delay in any one of
the four subtest areas was indicated when the child was not
able to pass an item which more than 90 per cent of
children his chronological age were able to do.*
The test was standardized "on 1,036 presumably
normal children (2 weeks to 6 years of age) whose families
reflect the occupational and ethnic characteristics of the
population of Denver."'
Dr. Barnes is with the South Okanagan Mental Health
Centre, and Ms. Stark is with the South Okanagan Health
Unit, Kelowna, British Columbia, Canada. Requests for
reprints should be sent to Dr. Barnes.
* Since the present study was carried out the scoring
method has been revised2 ; however, the criteria for scoring
"delay" have remained unchanged.
concerned with the problem of screening preschoolers in a
variety of functional areas (vision, hearing, general personal
development). When the Denver Developmental Screening
Test (DDST) became available in Canada, the professional
staff at the Health Unit quickly recognized that it could
provide an important addition to their screening program.
However, as the DDST had been standardized on an urban
population and as much of the South Okanagan Health
Unit covers a rural or semirural population which is
significantly different (occupationally) from the Denver
population (X2 = 53.40, df = 4, p < 0.001), it was necessary
to look at the need for local norms in order to determine
the validity of using the DDST in the South Okanagan
region. The need for standardization has been emphasized
further by the recent study of Bryant et al.,3 who reported
on age/performance differences found between Denver
children and Newcastle (England) children in the subtest
areas of gross motor and language development.
Method
Subjects
Subjects consisted of 122 male and 104 female,
caucasian preschoolers ranging in age from 2 weeks to 6.4
years. There were 25 age categoriest all together; subjects
t Age categories were taken from the Frankenburg and
Dodds study.'

DENVER DEVELOPMENTAL SCREENING TEST 363

TABLE 1-intercorrelations between the Denver Norms of the Table 3 includes the means and standard deviations for
DDST and Norms Collected in the South Okanagan the four subtest areas by occupational class.
Health Unit Region (N = 226) The distribution of scores according to mean, standard
deviations, and range for each subtest area by age groups is
Denver Region
presented graphically in Figures 1 to 4.
South Okanagan
Health Unit Gross Fine Personal-
Region Motor Motor Language Social Discussion
Gross Motor 0.996* In the present normative study it has been demon-
Fine Motor 0.998*
Language 0.996*
strated that the DDST can validly be used on a rural and
Personal-Social 0.996* semirural Canadian population. The correlations between
the two sets of norns (Denver and South Okanagan
*
Significant at the p < 0.005 level. regions) were of very high magnitude in each of the four
subtest areas. Such a finding generally indicates very good
were selected on the basis of a stratified random sample of separation across age groups; however, as can be seen from
the general population residing in the South Okanagan Figures 1 to 4, there is enough overlap between age groups
Health Unit region. All those children who were considered that the DDST does appear to be serving a useful function
to be of high risk developmentally (premature, breech in measuring preschool child development, i.e., the test
deliveries, etc.) were excluded from the study. does seem to be differentiating something over and above
The sample population was stratified according to the simple chronological age.
occupational status of the head of the family as indicated in
the 1966 Canadian census. The occupational breakdown TABLE 2-Correlational Matrix by Age and Subtest Area
was as follows: professional, 8.00 per cent; managerial,
16.44 per cent; sales, 7.56 per cent; craftsman, 28.89 per Subtest Areas
cent; and semi- and unskilled, 39.11 per cent. A representa- Fine Personal-
tive sample for each of these occupational groups was Ages No. Motor Language Social
selected from each of the six school district areas in the
South Okanagan region. months
Gross Motor
Procedure 1-3 28 0.820 0.790 0.572
4-6 28 0.465 0.277 0A20
7-9 25 0.398 0.436 0.482
Each subject was assessed on the DDST by a trained 10-12 26 0.239 OA87 0A94
and experienced examiner. Inter-rater reliability for the five 13-16 25 0.607 0.337 0.324
examiners varied between 0.93 and 0.95. 17-26 27 0.438 0.535 0.732
The norms were computed by determining the mean 27-45 31 0.538 0.387 0.553
scores for each age category in the sample population and 46-78 36 0.376 0.510 0A92
then comparing these scores with the mean scores for the All ages 226 0.972 0.961 0.971
same age categories collected by Frankenburg and Dodds in
the original standardization study. Fine Motor
1-3 0.708 0.665
4-6 0.299 0.803
7-9 OA34 0.516
Results 10-12 0.445 0.506
13-16 0.596 0.629
The correlations between the two sets of norms for the 17-26 0.534 0.627
four major functional areas of the DDST are shown in 27-45 0.602 0.794
Table 1. 46-78 OA94 0.161
Table 2 includes the intercorrelations of the four All ages 0.962 0.970
subtest areas for the South Okanagan Health Unit sample
by age groups. Frankenburg and Dodds' do not report the Language
1-3 0.747
subtest intercorrelations nor the intercorrelations between 4-6 0.303
subtest scores and occupational class, school district, and 7-9 0.379
sex; hence, it was not possible to compare the two sets of 10-12 0.598
norms in these areas.* 13-16 0.448
17-26 0.572
* The computer program for the original Denver 27-45 0.512
sample is no longer available so this information cannot be 46-78 0.690
recalled. Frankenburg, W. K., personal communication, All ages 0-955
1970.

364 AJPH APRIL, 1975, Vol. 65, No.4

 TABLE 3-Means and Standard Deviations for the Four Subtest Areas by Occupational Class
Gross Motor Fine Motor Language Personal-Social

Occupational Class No. X S.D. X S.D. X S.D. X S.D.

1. Unskilled 23 17.39 8.07 16.87 7.27 10.09 5.19 13.04 6.78

2. Semiskilled 67 17.28 721 17.05 7.09 10.45 5.16 13.63 6.84
3. Craftsman 62 17.93 9.88 17.87 9.02 11.35 6.47 1327 7_86
4. Sales 16 14.56 7.03 15.00 6.36 9.50 4.50 11.75 6.69
5. Managerial 37 17.16 8.51 17.00 7.69 10.40 6.15 13.16 7.09
6. Professional 21 13.81 6.88 14.24 6.72 8.09 4.84 10.A3 6.27

Gross Motor Scores

Ages
(in months)
0 5, 10 15 20 25 A30

1- 3

4- 6

7- 9

10 - 12
_- --~

13 - 16

17 - 26

27 - 45

46 - 78 Mean 'II
1cr +l s .j

lowes aihet
score score

FIGURE 1 Distribution of Gross Motor scores by age groups.

The intercorrelations of the four subtest areas are quite
substantial across most of the age groupings, which raises
the question as to whether there is sufficient differentiation
to justify four separate scores.
Unfortunately, it was not possible to compare the two
normnative samples in other areas such as occupational class
or sex. However, in the present investigation, except for the
age category 10 to 12 months (t 2.20, df = 24,p < 0.05),
=
there were no significant sex differences, nor were there
any significant differences between the six school districts
in the geographic region studied. This lack of significant
differences across school districts is rather an interesting
finding when one realizes that the six school districts differ
on such factors as suburb conditions, population density,
small town autonomy, wage levels, rural school support,
community growth, social malaise, and tax rates.4 The lack
of sex differences, especially in the language area in the first
3 years of development, is particularly puzzling when one
takes into account the variety of studies in which strong
support has been found for superior performance in
girls.510 This finding could be a reflection on the
educational program being emphasized in the South
Okanagan region by the Public Health Unit; for the past 7
years fathers of preschoolers have been strongly encouraged
to involve themselves more with their children, especially
their sons, and the attendance by future fathers at the
prenatal clinics now runs between 70 and 75 per cent.
In the analysis of occupational class differences, there

DENVER DEVELOPMENTAL SCREENING TEST 365

 Age3 Fine M5otor Scores
(in nmnths) 5 10 15 20 25 30

1 - 3

4- 6
_~ ~ ~ ~ ~ ~ ~ ~ ~
i-LZ4ZH
*-E4Zii

7 - 9

10 - 12

13 - 16

17 - 26

27 - 45

46 - 78 i ~ ~ ~ ~ ~ oI -
Mean

lowest -ig ieat

score score

FIGURE 2 Distribution of Fine Motor scores by age groups.

were some rather surprising results. For example, in all four
subtest areas, children of professional families consistently
obtained the lowest mean scores of all the occupational
groups in the study while children of craftsman families
consistently scored the highest. Although this finding was
not significant statistically for a number of the occupa-
tional classes, it was true in all four subtest areas between
professional and craftsman families (t = 2.11, df = 81,p <
0.025 for Gross Motor; t = 1.95, df = 81,p < 0.05 for Fine
Motor; t = 1.81, df = 81, p < 0.05 for Language; and t =
1.82, df = 81,p < 0.05 for Personal-Social). A similar result
was found in the personal-social area between the children
of professional and those of semiskilled families (t = 2.00,
df = 86, p < 0.025).
These findings suggest that, contrary to popular
opinion, children of working class and lower middle class
parents may well be developmentally equal or superior to
children of professional and managerial parents. This
relationship is particularly surprising in the language area,
for most reports on the development of language show a
marked positive relationship between language skills and
middle and upper class occupations.' 1-19
These findings also differ substantially from the results
reported by Sandler et al.20 In that study considerable
differences were found in the language and fine motor areas
for black and Puerto Rican preschoolers when compared
with the Denver DDST norms, and the authors recommend
the use of caution when using published norms for lower
class preschoolers located in urban areas.
The fact that the present study did not find significant
differences in either the language or fine motor areas
between middle and lower class children could be attribut-
able to two possible factors: one is that all of the
preschoolers were caucasian (there are no black or Puerto
Rican preschoolers living in the South Okanagan region);
the other factor is that the South Okanagan Valley has no
urban areas within its boundaries. Hence, the relatively
poor levels of language and fine motor functioning found in
the Sandler et al. study may be due primarily to conditions
of urban living and ethnic characteristics rather than lower
socioeconomic class.
One possible explanation of these present findings may
have something to do with the changes in occupational
conditions and educational levels for the average working
class person that have taken place in the last 20 years.
There appears to be little doubt that educational level has
risen substantially for the average working person in the last
two decades; furthermore, the work week for these same
people has been reduced substantially, while the work week
for professional and managerial occupations has increased
substantially.
As Milner's2l findings on the relationship of language

366 AJPH APRIL, 1975, Vol.65, No.4

 Ages
(in months) 0 10
1- 3
4 - 6
7 - 9
10 - 12
13 - 16
17 - 26
~~~~~~-i4m~~~~~~~~~~~~~~~~~~i
27 - 45
45 - 78
-1 Mean
lowes
score
FIGURE 3 Distribution of Language scores
development and length of time spent with parents in
conversation and at meal times are probably as valid for
nonblack families as for black ones, and since Irwin S222
findings indicate that working class mothers can be
educated to help develop their preschool children's lan-
guage through reading, then the present findings are not
necessarily contradictory to the results of studies carried
out 20 and 30 years ago. Certainly, practically all mothers
are better educated in infant care than mothers were two
decades ago, and in this particular geographic region the
educational program offered by the public health depart-
ment to young mothers is especially comprehensive and
intensive.
It is indeed unfortunate that the normative data from
the original DDST study were not retrievable, especially the
sex and occupational class variables. However, in an internal
analysis of the test's ability to discriminate across age levels,
it stood up exceedingly well. Only one subtest area failed to
discriminate adequately and that was in the fine motor area
for age groups 7 to 9 versus 10 to 12 months (t = 1.268, df
= 49, N.S.). All other age groupings in all four subtest areas
were significantly different from each other. It is possible
that this one nonsignificant finding is due to a chance
factor only.
In general, the DDST appears to be an adequately
constructed screening device in that it discriminates across
the age groupings in all four subtest areas with one
Language Scores
M 201
+i r
hghst
score
by age groups.
exception as noted above. That there are essentially no sex
differences in any of the four subtest areas and that there
are some unexpected significant differences between chil-
dren of different occupational classes are both findings
contrary to previous studies on early child development.
Furthermore, how well the DDST actually predicts signifi-
cant developmental delay needs further investigation, for
although Frankenburg et al.3 report relatively high levels
of agreement between the revised method of scoring and
the DDST and such external criterion measures as the
Bayley Infant Scale for Children and the Stanford Binet
Form LM, these comparisons are essentially concurrent
validation studies and do not indicate the longitudinal
predictability of DDST scores, especially where the
abnormal and questionable ones might be compared to
pediatric and neurological follow-up studies, i.e., to
deternine exactly how many false positives and false
negatives might actually exist over an extended period of
time.* Furthermore,, although the comparison between
DDST scores and scores on the Bayley Infant Scale for
Children constitutes a reasonably appropriate concurrent
validity test, the comparison between DDST and Stanford
Binet Form LM scores does not, if it is indeed true that
* The present authors are currently involved in such a
follow-up study and will report on the results at a later
date.
DENVER DEVELOPMENTAL SCREENING TEST 367
 Ages
(in months) 0 5
1-3
4-6
7 -9
10 -12
13 - 16
17 - 26
46 -78
Mean
lowes g est
score
FIGURE 4 Distribution of Personal-Social scores by age groups.
"the D.D.S.T. is not an intelligence test" (p. 190 in
Reference 1).
ACKNOWLEDGMENTS
The authors wish to express their sincere appreciation
to Lucille Amundsen, Stella Barnes, Pat Brown-Clayton,
Betty Found, and Rosemarie Yates for their invaluable
assistance in assessing all of the children in the present
study on the DDST. The authors also wish to express their
appreciation to Dr. Lorne Kendall of Simon Fraser
University for his statistical guidance in the analysis of the
data and for his careful evaluation of the manuscript
preparation.
References
1. Frankenburg, W. K., and Dodds, J. B. The Denver
Developmental Screening Test. J. Pediatr.
71:181-191, 1967.
2. Frankenburg, W. K., Dodds, J. B., and Fandal, A. The
Revised Denver Developmental Screening Test Manual.
University of Colorado Press, Denver, 1970.
3. Bryant, G. M., Davies, K. J., Richards, F. M., and
Voorhees, S. A Preliminary Study of the Use of the
Denver Developmental Screening Test in a Health
Department. Dev. Med. Child Neurol. 15:33-40, 1973.
4. Macurdy, B. A. An Ecological Study of Hospitalized
Mental Disorder in British Columbia. Master's thesis,
Simon Fraser University, 1971.
368 AJPH APRIL, 1975, Vol.65, No.4
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10 15 2,0
p_j
t
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,
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the Performance of Young Children on Intelligence
Scales and Tests of Speech Development. J. Genet.
Psychol. 94:3-22, 1959.
6. Irwin, 0. C., and Chen, H. P. Development of Speech
during Infancy: Curve of Phonemic Types. J. Exp.
Psychol. 36:431-436, 1946.
7. Irwin, 0. C., and Chen, H. P. Infant Speech: Vowel and
Consonant Frequency. J. Speech Disord. 11:123-125,
1946.
8. McCarthy, D. A. Language Development in Children.
In Manual of Child Psychology, Ed. 2, edited by
Carmichael, L. Wiley, New York, 1954.
9. McCarthy, D. A. Research in Language Development:
Retrospect and Prospect. Monogr. Soc. Res. Child Dev.
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10. Moore, T. Language and Intelligence: A Longitudinal
Study of the First Eight Years. I. Patterns of
Development in Boys and Girls. Hum. Dev.
10:88-106, 1967.
11. Beckey, R. E. A Study of Certain Factors Related to
Retardation of Speech. J. Speech and Hear. Disord.
7:223-249, 1942.
12. Bernstein, B. Social Class and Linguistic Development:
A Theory of Social Learning. In Economy, Education
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New York, 1961.
13. Davis, E. A. The Development of Linguistic Skill in
Twins, Singletons with Siblings, and Only Children
from Age Five to Ten Years. In Institute of Child
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14. Fisher, M. S. Language Patterns of Preschool Children.
 In Child Development Monographs, No. 15. Teacher's
College, Columbia University, New York, 1934.
15. Irwin, 0. C. Infant Speech: The Effect of Family
Occupational Status and of Age on Use of Sound
Types. J. Speech Hear. Disord. 13:224-226, 1948.
16. Sampson, 0. C. A Study of Speech Development in
Children 18-30 Months. Br. J. Educ. Psychol.
26:194-202, 1956.
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Institute of Child Welfare Monographs, Ser. No. 26.
University of Minnesota Press, Minneapolis, 1957.
18. Van Alstyne, D. The Environment of Three Year Old
Children: Factors Related to Intelligence and Vocabu-
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Teacher's College, Columbia University, New York,
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19. Young, F. M. An Analysis of Certain Variables in a
Developmental Study of Language. Genet. Psychol.
Monogr. 23:3-141, 1941.
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and Weismar, R. Responses of Urban Preschool
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77:775-781, 1970.
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A TRIBUTE TO DR. SCHLESINGER

The Maternal and Child Health Section Council of the American Public Health Association, at its
annual meeting in New Orleans October 22, 1974, prepared a resolution, published below, in eulogy
to their esteemed colleague, Edward R. Schlesinger, MD, MPH.
A fellow of APHA, Dr. Schlesinger was past Chairman of the Program Area Committee on Child
Health, and had served as Secretary and Vice-Chairman of the Maternal and Child Section. He had
been a member of APHA since 1940.
Born in New York City in 1911, Dr. Schlesinger was a graduate of Columbia University, received
his MD from that University, and his MPH from the Johns Hopkins School of Hygiene and Public
Health. At the time of his death, Dr. Schlesinger was Professor and Head of Maternal and Child
Health, and Associate Dean for Academic Affairs, at the University of Pittsburgh Graduate School of
Public Health. The Edward R. Schlesinger Memorial Fund has been established at the University of
Pittsburgh.
RESOLUTION
At this, the annual meeting of the American Public Health Association, the Maternal and Child
Health Section takes formal note of the untimely loss of our esteemed colleague, Dr. Edward R.
Schlesinger.
Dr. Schlesinger had a profound influence on health workers in maternal and child health. Many
members of the section and of the APHA have been inspired, encouraged, trained, and so enabled to
improve the public health because of their valuable association with him.
Throughout his long career, Dr. Schlesinger was a loyal and devoted member of the section and
added substantially to its strength. During his many years as a member he held a number of positions
of responsibility, including that of Chairman. He was instrumental in the production of a number of
basic studies and contributed extensively to the literature. He was the author, together with Dr.
Pauline Stitt, of The Maternal & Child Health Section: A Political & Social History, which is being
distributed for the first time today.
Administrator, investigator, author, and teacher, Ed Schlesinger made a most significant impact
on the health of mothers and children. We shall miss him.

DENVER DEVELOPMENTAL SCREENING TEST 369

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