Assessing Childhood Problems Practical NEP BA - V Semester SEC

MINI-MENTAL STATE EXAMINATION

School performance is an important economic asset. Persistent learning difficulties are a main cause
of referral for school psychologists and health professionals, as it is associated with negative long-term
outcomes, such as low wages and employability and internalizing and externalizing disorders.

Persistent low achievement is associated with risk factors such as socio-economic-cultural

deprivation, parental involvement, pedagogical inadequacies, emotional disorders, intellectual
disability, genetic syndromes, chronic diseases, such as asthma and diabetes, sensorimotor
impairment and neurological conditions and specific learning difficulties etc. Proper management
depends on accurate diagnosis. Diagnosis should be informed through detailed clinical and
neuropsychological assessments.

Brief cognitive procedures could be useful in the screening of school performance difficulties and
ascertainment of referral need. Quick and accurate screening could optimize time and resource
allocation in busy school psychological and health practices. Cognitive screening has been used
successfully in the case of age-related dementing illnesses. Instruments such as the Mini-Mental State
Examination (MMSE) and the Frontal Assessment Battery (FAB), have been successfully integrated into
geriatric and gerontological practice. Brief cognitive screening instruments have been less successful
in the pediatric setting. Problems with cognitive screening in children relate to the use of poorly
standardized measures, parental report, unknown correlations with IQ, requirements on motor
dexterity, literacy requirements, and lack of developmental sensitivity.

There are numerous neuropsychological batteries for assessing children’s cognitive processes. These
batteries are usually domain-specific, require trained psychologists and long application times. There
is a need for simple cognitive assessment screening tasks that will facilitate screening of a range of
cognitive domains in a short period. Such tasks could be integrated into child care routines, assisting
in the early detection of cognitive deficits.

The Mini-Mental State Examination (MMSE) was designed to screen cognitive dysfunctions, assess the
severity of impairments, and identify changes over time in elderly individuals with suspected
dementing illness. The MMSE is widely used for evaluation of age-related cognitive decline but is
seldom used for cognitive deficits or developmental delays in children. A child adapted MMSE version
had a short application time (5-7 minutes) across a wide age range (3-14 years). Understanding of the
instructions was independent of socioeconomic status and educational level. Paediatric versions of the
MMSE have been used in several countries. A previous investigation of Brazilian children suggests that
the Mini-Mental State Examination for Children (MMC), a child version of the MMSE, is useful for rapid
assessment of children with cerebral palsy, providing evidence of validity and normative values. It is
still not known whether the MMC can reliably distinguish between typically-achieving children and
children referred for learning difficulties in the school context. Establishing MMC accuracy in children
with learning difficulties can help improve cognitive assessment by school psychologists and health
professionals in schools, primary care, and neurorehabilitation centers.

MINI-MENTAL STATE EXAMINATION

Problem:
To assess the level and areas of cognitive deficit of the school students.

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GFGC – SIRSI
Assessing Childhood Problems Practical NEP BA - V Semester SEC

Materials Required:
1. The Mini-Mental State Examination was developed in 1975 (Folstein & McHugh, 1975)
2. Writing materials
3. Norms

Plan:
By using Mini-Mental State Examination was developed in 1975 (Folstein & McHugh, 1975)and giving
proper instruction, we need to assess the level and areas of cognitive deficit of the school students.
The Mini Mental State Examination (MMSE) is a tool that can be used to assess mental status
systematically and thoroughly. It is an 11-question measure that tests five areas of cognitive function:
orientation, registration, attention and calculation, recall, and language. The maximum score is 30. A
score of 23 or lower is indicative of cognitive deficit. The MMSE takes only 5-10 minutes to administer
and is therefore practical to use repeatedly and routinely. The responses of the subject must be
obtained and scored to find the level and areas of his/her cognitive deficit.

Procedure:
Seat the subject comfortably and read out the instructions provided on the front page of the Mini-
Mental State Examination scale. “I present before you certain questions and simple tasks. The following
items ask about aspects of your daily life. Please answer what you feel is right for each question
presented before you.” With these instructions allow the subject to respond to the given scale. Collect
the response and score the scale accordingly.

Precautions:

1. Before giving the test make sure whether the subject has understood what he must do.
2. Before administering the test, create a friendly atmosphere and establish rapport with the
subject. Ensure the subject responds to each statement in the scale.
3. Experimenter should never express their own opinions and should avoid giving cues in their
language, vocal inflection, posture, and facial expressions.
4. Experimenter should not explain questions, misunderstood items should simply be repeated,
and subject should be encouraged to interpret the questions in their own way.
5. Experimenter needs to understand that either the correct answer is given or not. There should
be no partial credit for answers short of the mark.

Scoring and Norms:

Extent of Cognitive Impairment:

SCORE DESCRIPTION
30 – 26 Could be normal
25 – 20 Mild
19 – 10 Moderate
9–0 Severe

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Assessing Childhood Problems Practical NEP BA - V Semester SEC

Areas of functional impairment:

SCORE ACTIVITIES OF DAILY LIVING COMMUNICATION MEMORY
30 - 26 Could be normal Could be normal Could be normal
25 – 20 Playing games, Finding words, Three – item recall,
doing homework, helping parents Repeating, Orientation to time then
elders, Going off topic place,
Following instructions at school
19 – 10 Dressing, grooming, toileting Sentence fragments, Spelling WORLD backward,
Vague terms (eg., this, language and three step
that) command
9-0 Eating, walking Speech disturbances such Obvious deficits in all areas
as stuttering and slurring

(For reference only:

The MMSE begins with a graded assessment of orientation to place and time, for which a maximum of 10 points
is possible.
This is followed by testing two aspects of memory. The first is the immediate recall for three objects presented
orally, followed by a serial sevens task which is interposed to assess attention, concentration, and calculation,
and to prevent the individual from rehearsing the three objects previously learned. A maximum of 11 points may
be obtained in this section of the test.
The final section surveys aphasia by testing functions of naming, repetition, understanding a three-stage
command, reading, writing, and copying a drawing. There is a maximum of 9 points which may be obtained on
this section, for a total possible MMSE score of 30 points.

Maximum Score
Orientation
5 ( ) What is the (year) (season) (date) (day) (month)?
5 ( ) Where are we (state) (country) (town) (hospital) (floor)?
Registration
3 ( ) Name 3 objects: 1 second to say each. Then ask the patient
all 3 after you have said them. Give 1 point for each correct answer.
Then repeat them until he/she learns all 3. Count trials and record.
Trials ___________
Attention and Calculation
5 ( ) Spell “world” backward.
Recall
3 ( ) Ask for the 3 objects repeated above. Give 1 point for each correct answer.
Language
2 ( ) Name a pencil and watch.
1 ( ) Repeat the following “No ifs, ands, or buts”
3 ( ) Follow a 3-stage command:
“Take a paper in your hand, fold it in half, and put it on the floor.”
1 ( ) Read and obey the following: CLOSE YOUR EYES
1 ( ) Write a sentence.
1 ( ) Copy the design shown.

_____ Total Score )

Table showing the score and its interpretation as obtained by the subject on the given scale:
Name Score Interpretation

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Assessing Childhood Problems Practical NEP BA - V Semester SEC

Individual Discussion:
The MMSE is effective as a screening instrument to separate patients with cognitive deficit from those
without it.
The table shows the individual’s score on the MMSE Scale. The subject has obtained a total score of
…….. . This scores suggest that the individual has ………….. cognitive deficit.

(Please write which is applicable:

If the score is 30 – 26, activities of daily living, communication and memory could be considered as
normal.

If the score is 25 – 20 the student is likely to have some problems while Playing games, doing
homework, helping parents elders, Following instructions at school, the communication is affected as
they struggle to Find words, have tendency to Repeat, and sometimes Go off topic. They may have
some problems with Three – item recall and Orientation to time then place.

If the score is 19 – 10, the student is likely to have problems with daily activities of Dressing, grooming,
toileting. They tend to make Sentence fragments, and use Vague terms (eg., this, that). They also have
difficulty with attention and calculation, understanding language properly and following simple
command.

If the score is 9 – 0 the student is likely to have problems with basic daily activities of Eating and
walking. They are likely to suffer with Speech disturbances such as stuttering and slurring and
obviously have deficits in all areas of memory.)

Conclusion & Recommendations:

The scores suggest that the individual has …………... cognitive deficit.

Having a good memory is a useful tool in the child’s development. Good memory skills are helpful for
the child to do better in school and perform tasks well. However, not everyone is gifted with a sharp
memory. While the children are still young, it is best to provide them with proper guidance on how to
enhance their memory. Below are some dos to help boost the child’s memory:
• Employ visualisation while learning: eg., Flash cards that have words or images can also help
practise word meanings.
• Take a multisensory approach: Try to utilise all the senses when learning something. By giving
your child a chance to process information through sight, sound, touch, and movement, they
can achieve better memory retention.
• Add colour: Make use of coloured markers in highlighting important passages in a reading
exercise. Use multi-coloured stick-on notes to list questions before reading a textbook or to
note key learning ideas. It can reinforce good memory and organisational skills.
• Make use of patterns: From learning the alphabet to sorting things into categories, helping
your child recognise patterns is another way of boosting their memory.
• Connect experiences: We should be able to draw from personal experiences to help our child
create a stronger memory. This way, your child will associate fun memories with the lesson
and have a higher probability of remembering it. It will also make your child feel that
memorising things can be fun!

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