A
DEVELOPMENTAL
SCREENING
INVENTORY
FOR
INFANTS
Hilda Knobloch, M.D., Dr. P. H., Benjamin Pasamanick, M.D.,
and Earl S. Sherard, Jr., M.D.
Hilda Knobloch, M.D., Dr. P. H., Benjamin Pasama nick, M.D., and Earl S. Sherard, Jr., M.D. From the Department of Pediatrics, Universitj of Illinois College of Medicine, and the Department of
Mental Health, State of illinois, Chicago, Illinois, and from the Dieision of Child Development of the
Department of Pediatrics, the Ohio State Universits,, and the Children’s hospital, Columbus, Ohio
ADDRESS: (H.K.) 1640 West Roosevelt Road, Chicago, Illinois 60608.
This investigation was supported in part by Department of Health, Education, and \Velfare Grant
No. 12 llS402 from The Children’s Bureau and in part by funds froni the Department of Mental
Health, State of Illinois.
PEDIATRICS, Vol. 38, No. 6, Part II, December 1966
A
DEVELOPMENTAL
SCREENING
INVENTORY
FOR
INFANTS
p
REDICTIVE diagnosis of development ispossible because behavior matures in an orderly fashion, but it is not a simple matter. Unlike most other diagnostic prob-lems in medicine, disturbances in neuropsy-chologic functioning involve integration on many different levels, from the biologic to the sociocultural. Analysis of something as complex as behavior thus is not without difficulties, and extensive training in mak-ing, and interpreting, observations is neces-sary for accurate diagnosis.1
The number of children in whom abnor-mal development is suspected is enormous, the need for service great and the supply of specialists limited. Under these circum-stances an adequate screening procedure which will detect infants in need of referral for a complete diagnostic evaluation is of great value. A number of devices and lists
of behavior have been offered; when they have been tested at all it has not been for their correlation with an examination that has predictive ability. They have consisted for the most part of a few behavior patterns at widely separated ages and most have fall-en into disuse because of their apparently unsatisfactory nature.
CRITERIA FOR AN ADEQUATE
SCREENING DEVICE
In evaluating development one is
con-cerned with both present and future func-tioning, and the complete examination from
which the screening inventory is derived
must be an adequate predictor of later ab-normality. First, then, it must have validity. Since this predictive value can be
deter-mined only by longitudinal studies, such
data must derive from follow-up correla-tions between complete infant examina-tions and those at later ages. Further, for prediction as well as for present manage-ment, intellectual defect aiid motor disabil-ity must be distinguished. Behavior must be evaluated separately in the different areas of functioning, since only adaptive and lan-guage behavior are closely related to later intellectual function.
Secondly, since a screening inventory does not include all the behavior patterns evaluated by a complete examination, the results achieved by it must correlate with those of the full developmental evaluation. Ideally, no child called abnormal by the complete examination should be called
nor-mal on screening (underscreening), and
there should be a minimum of normal
in-fants called abnormal (overscreening). The
first approach to determining if screening gives the same results as a complete devel-opmental examination is to use the history and observations obtained at a full
evalua-tion to complete the screening inventory. If tile same diagnostic classification is not
achieved when this is clone, tile inventory is
not likely to give satisfactory results under
other circumstances. When we first became interested in screening some years ago, we showed that at 40 weeks of age a question-naire answered from examination findings did in fact achieve this goal.2 Consequently,
it was used as the base on which to build tile present inventory, and we proceeded directly to the more rigorous test of com-paring the results of screening by observers
not trained in developmental diagnosis
develop-mental and neurologic examination by a skilled examiner.
Thirdly, the inventory should yield repro-duicible results when used by different mdi-vidtials observing the same examination; that is, it must he reliable. In order that this can be achieved, the behavior items in the
inventors’ must be stated as precisely as possible so that 1)0th the observers and the person giving the history know what is meant in each instance.
Finally, the age intervals must he small enough so that correct diagnostic clas-sification can l)e achieved even if the chro-nologic age of tile infant lies between two inventory age levels.
THE INVENTORY
The Developmental Screening Inventory (D.S.I.) is not a new instrument. It consists of selected items from the Cesell Develop-mental Schedules1 in each of the five fields of adaptive, gross motor, fine motor, lan-guage, and personal-social behavior at 4-week intervals from the ages of 4 to 56 weeks and at 15 and 18 months. The total number of items, therefore, appears large,
but only a few questions and observations are necessary to determine if an infant is normal and acting at his age. For each of these areas of behavior a level of function (maturity level) is assigned and an evaluia-tion then made of whether this is normal, questionable, or abnormal. There are ac-companying instructions concerning the procedures to be used in obtaining the his-tory, making the observations, and re-cording and interpreting the information obtained; in addition, there is amplification on certain of the behavior patteriis which are not clearly self-explanatory. The Devel-opmentai Screening Inventory (D.S.I.) is arranged so that serial recordings can be made of the behavior of an individual in-fant in the course of routine supervision. For infants less than 16 weeks of age behavior is difficult to interpret unless it is clearly normal, but younger ages are included in order that the abnormal 16-week-old infant can be identified.
METHODS OF TESTING THE INVENTORY
The reproducibility of an inventory such as tlus must be tested under conditions comparable to those in which it will he em-ployed by individuals who have had no prior experience with its use. If trained ex-aniiners achieve reliable observations and
make the same diagnoses, this does not mean similar results would be obtained when the D.S.I. is used by people who
voulcl have to rely on tile written instruic-tions accompanying it, with or without sup-plementation from teaching films.
Two different methods were employed in conducting such tests. Tile first was a comparison between individual screening evaluations done by junior medical stu-dents and subsequent complete develop-mental examinations by two of the authors (ilK. and E.S.S.). The second consisted of independent hut simultaneous individuial recording by groups of students of the ob-servation of a screening examination done by one of their peers, followed immediately by a complete formal evaluation by one of tile above staff members.
examina-TABLE I
COMPARISON OF DIAGNOSTIC CATEGORIES ASSIGNED BY
STAFF EXAMINERS FROM A COMPLETE GESELL
Extai-INATION AND BY JUNIOR MEDICAL STUDENTS WITH THE
DEVELOPMENTAL SCREENING INVENTORY
1097
tions were done at irregular times not known in advance by the students, or even by themselves, since free time usually be-came available when an appointment was broken by a patient. Hence, it is unlikely that bias resulted from the selection of the cases that were checked by the staff.
The students involved were those in the first, third, and fourth clinical quarters of their junior year, so that at least one group had had virtually no previous contact with any patients. When the staff member did the examination the student was notified; he could observe it and later discuss it in detail if he wished to avail himself of the opportunity to do so. No other instruction in the techniques of developmental diag-nosis was given during this testing period.
RESU LTS
Individual Case Examinations
The two staff members examined 58 pa-tients who were evaluated by 44 different students. The cases were fairly evenly dis-tributed between the ages of 16 and 52
weeks, with four patients below 16 and a few over 65 weeks of age. On the basis of the complete developmental examination by the staff they were divided into four groups: (1) marked neuromotor abnormali-ty and mental deficiency (AN-Al), (2) marked neuromotor abnormality with nor-mal intellectual potential (AN-NI), (3) minor motor disabilities and normal intel-lectual development (QN-NI), and (4) nor-mal in both areas (NN-NI).#{176} Comparisons were made with the same classifications by the students.
The screening examination was expected to identify as abnormal any infant placed by the staff in Group 1 or 2 and any infant who was either in status epilepticus or was having such frequent seizures that his be-havior exhibited considerable variability from time to time during the course of the examination. None of the 20 patients called abnormal on the basis of these criteria by
Only 2 of the 48 cases with normal intellectual potential were called dull normal.
Sta.ffGeseU
Examina-tion
Diagnostic C
(1)()
AN-Al AN-NI
olegory-Stu (3)
QN-NI
dent Screening (4)
NN-NI Total
(1) AN-Al 10’ - - - 10
(2) AN-NI 1
:
s - - 10(3) QN-NI 3 2 1 4 10
(4) NN-NI 2 - 2 24 28
Total 20 7 3 28 58
AN Major neuromotor abnormality.
QN =Minor neuromotor abnormality.
NN =Normal neuromotor development.
Al ‘=Mentai deficiency.
NI “Normal intellectual potential.
‘Five patients with 8eizures; two blind in addition.
the complete developmental examination was called normal or even questionable by the student screening, as is shown by the upper right boxed area in Table I. Thus, no underscreening occurred and one of the goals of the inventory was fulfilled. The diagonal in the table shows that there is complete agreement in 70% of the total number of cases. In clinical practice, the infants thus detected by the screening pro-cedure are those who would be in need of serial screening observations or referral for a complete developmental evaluation.
he is also called mentally defective by being placed in Group 1. When the five in-fants (in the dotted box in the table) so cat-egorized are added, then 25% of the 48 in-fants at risk were overscreened. However, these same figures could be interpreted to indicate that in half of the cases where the problem was primarily motor and not intel-lectual (staff Groups 2 and 3), the junior medical student did make this distinction correctly.
More detailed analysis of the data offers some explanation for this amount of over-screening and indicates that it is not inher-ent in the inventory, but rather is related primarily to the lack of experience of a ju-nior medical student. The problem can be approached from two points of view-the adequate use of the screening inventory by the students or the disagreements between students and staff on the diagnostic cat-egories. The use of the inventory was con-sidered adequate if the student recorded observations completely and systematically and if the maturity levels and diagnostic categories he assigned were appropriate to his own recorded observations, regardless of whether or not there was agreement with the staff diagnosis. In 37 of the cases the use of the inventory met these criteria for adequate use, but in 6 of them there was disagreement with the staff diagnosis.
In the remaining 21 patients the use of the inventory was considered unsatisfactory for the following reasons: in three cases, the maturity levels assigned were too high for the derived diagnostic category (e.g., a de-velopmental quotient of 90 was called ab-normal); in two cases, the student neglect-ed to correct for prematurity; in one case, items were recorded as negative because more advanced behavior was present and these negatives were incorrectly inter-preted; and in two cases, in addition to fail-ure to correct for prematurity, the observa-tions were sprinkled haphazardly over the sheets with no evidence of any attempt to record or interpret systematically. In all eight of these cases there was disagreement
with the staff diagnosis. In the remaining 13, where use was considered unsatisfac-tory, the observations the student himself had recorded were ignored and the maturi-ty levels he assigned bore no apparent re-lationship to his own data. In only four of the cases, however, was there disagreement with the staff diagnostic category.
Thus, in two fifths of the cases in which use of the D.S.I. was considered unsatisfac-tory the cases were correctly placed by the students; in both areas of function, all of these were called either markedly abnormal or normal by the staff (Groups 1 and 4). Conversely, in one third of the 18 missed diagnoses, use of the inventory was ade-quate. Three of these cases were among the 12 previously described in Table I as placed incorrectly in Groups 1 and 2. The other three infants were among the six where the student-staff disagreement was between Groups 3 and 4; the infants were diagnosed by both students and staff as ei-ther fully normal or as having only a minor motor disability.
Table II shows the staff-student compari-sons for the 37 cases where the screening was considered adequate. Overscreening in the 28 patients at risk in Groups 3 and 4, who were without any major abnormality, as indicated again in the lower left box, was reduced to 11%. Since no patients with major motor, but without intellectual, handicaps were called abnormal in both areas of behavior, the total overscreening in 33 was 9%. The diagonal shows complete agreement in 85%. The corresponding fig-ures for the unsatisfactory use of the in-ventory were 40% and 60% for the two types of overscreening and 43% for com-plete agreement.
screen-TABLE 11
37 CHILDREN WITH ADEQUATE USE OF
DEVELOPMENTAL SCREENING INVENTORY
COMPARISON OF DIAGNOSTIC CATEGORIES ASSIGNED BY
STAFF EXAMINERS FROM A COMPLETE GESELL
EXAM-INATiON AND BY JUNIOR MEDICAL STUDENTS WITH THE
DEVELOPMENTAL SCREENING INVENTORY
Diagnostic Category-. tudent Screening Staff Gesell (1) (9) (3) (4)
Examina- AN-Al AN.NI QN-N NN-NI
tion
Total
TABLE 111
1099
(1) AN-Al
(2) AN-NI 4’
- 5
-4
5
(3) QN-NI 1 1
J
1 2 .5‘
I
:
::
:
AN =Major neuromotor abnormality.
QN =Minor neuromotor abnormality.
NN =Normal neuromotor development. Al =Mental deficiency.
NI =Normal intellectual potential.
* One patient with seizures.
ing, 20% of whom received a C grade. The four A grades were all in the adequate group. These grades were not given in con-sultation with the two staff members in-volved in the study.
Pearson product-moment and Spearman rank order correlations were calculated for
the developmental quotients assigned by the students and by the staff members in adaptive, gross motor and fine motor be-havior, and are indicated in Table III. Be-havior in these areas is observed during the course of the examination, while in the other two areas its assessment is often de-pendent on the history obtained from the parents. Since the staff members usually did not see the parents, the maturity levels they assigned in language and personal-so-cial behavior depended on the history ob-tained by the student rather than on their own independently gathered observations. When use of the inventory was adequate, the product-moment correlations were .67 in adaptive, .88 in gross motor, and .70 in fine motor behavior; the comparable rank order values were .51, .85, and .54. These values are comparable to those obtained by Caldwel1 between a screening inventory and standardized tests when two skilled ex-aminers working closely together per-formed all the evaluations. Twelve of the 15 correlations are significant at less than the .01 level; the remaining three are all in the unsatisfactory use group.
Since the two examiners were not both present for all of the staff examinations and did not record independently, no correla-tions between them could be done for the Gesell examinations on these patients. A
PEARSON PRODUCT-MOMENT AND SPEARMAN RANK ORDER CORRELATION COEFFICIENTS FOR DEVELOPMENTAL
QUOTIENTS ASSIGNED BY STAFF EXAMINERS FROM A COMPLETE GESELL EXAMINATION AND BY JUNIOR
MEDICAL STUDENTS WITH TIlE DEVELOPMENTAL SCREENING INVENTORY
Area of Behavior
Pearson Product-Moment Spearnan Rank Order
Adequate D.S.I. Use
Unsatisfactory
D.S.I. Use Total
Adequate D.S.1. Use
Unsatisfactory D.S.I. Use
Number 37 l 38 37 2l
Adaptive
Gross motor
Fine motor
0.67 .88 0.70
0.71 .60
041N5
0.72
.81 0.630.51
.85 0.54
0.66
.50* O.36N3.
N.S. = Not significant.
* Significant at <.05 level.
TABLE IV
COMPARISON OF DIAGNOSTIC CATEGORIES ASSIGNED BY
STAFF EXAMINERS FROM A COMPLETE GESELL
EXAM-INATION AND BY DEVELOPMENTAL SCREENING
INVEN-TORIES COMPLETED FROM THE FINDINGS OF THE
GESELL EXAMINATION BY ONE STAFF MEMBER
Staff Gesell
Examina-tion
(1) AN-Al
Developme
(2) AN-NI
nEal Screenin
(3) QN-NI
g Inrentory (4)
NN-NI
Total
1) AN-Al 9’ - - - 10
(2) AN-NI
r’
I 1 l--J
9
-II
J
10(3) QN-NI - 1 6 3 10
(4) NN-NI - 1 1 26 28
Total 10 11 7 30 58
AN Major neuromotor abnormality.
QN “Minor neuromotor abnormality. NN = Normal neuromotor development. Al = Mental deficiency.
NI “Normal intellectual potential.
* Five patients with seizures.
correlation could, however, be studied by a technique which would also answer the question of whether completing this D.S.I. from the findings of the full developmental examination yields similar quotients and diagnoses. It makes unavailable to the ex-aminer all knowledge of the neuromotor abnormalities or of the qualitative aspects of the child’s behavior, both of which con-tribute to his skill in evaluating what he ob-serves. Two years after the cases were seen a clerk transferred the information re-corded on the Gesell Developmental Schedules to the comparable items on a copy of the D.S.I. Without knowing the age of the child, one of the staff members as-signed maturity levels in each area of be-havior. The information on age was then supplied and diagnostic categories were as-signed. The comparison of diagnostic cat-egories is shown in Table IV. It indicates that one abnormal infant shown in the upper right box (5%) was called normal on screening and three infants (6% of 48) were
overscreened. The 36-week-old infant who was underscreened was having innumera-ble seizures and was grossly ataxic from di-lantin intoxication.0 In spite of this, it was possible to give him a rating close to his age in his seizure-free intervals and his gross deviation in motor behavior was not apparent in the bare recording of his ac-complishments. The infant called normal on the complete examination but assigned an abnormal motor status on screening was an 18-week-old baby with a severe cardiac dis-order and marked malnutrition. At the time
of the examination it was felt that the ex-tremely poor head control was a result of the other diseases and not an expression of involvement of the central nervous system, particularly since fine motor behavior was normal. In the other two subjects who were overscreened the numerical differences in quotients were slight and qualitative judg-ments at the time the child was seen influenced the diagnostic categories.
Table V shows the Pearson product-mo-ment and the rank correlations between the developmental quotients assigned on the D.S.I. and on the complete developmental examination for the five areas of behavior. They range from .90 to .98 and are all high-ly statistically significant at less than the .001 level of confidence. Most of the values are as high as those obtained between two trained examiners who have the benefit of observing simultaneously the total behavior of the infants.5
Group Observations
One abnormal and one normal infant were screened by a student to test the reproducibility of the D.S.I. itself when a single history and examination was re-corded by multiple observers. A staff mem-ber also designated maturity levels and di-agnostic categories on the basis of the
stu-#{176}Four of the remaining five patients with
seizures were placed in the same category by the
D.S.I. as by the complete examination, but they are tabulated in Group 1 for comparability with
TABLE VI
PER CENT CORRECT CLASSIFICATION AT SCHOOL
AGE BY INFANT NEUROMOTOR STATUS
STEP-WISE MULTIPLE REGRESSION ANALYSIS USING
ARBITRARY CUT-OFF TO MAXIMIZE PREDICTION
CASES PERFORMING ON ALL TESTS
Multiple correlation with infant neuromotor status
for 18 variables is .81.
N=58.
SUPPLEMENT
All values significant at <.001 level.
dent’s screening, and the percent of stu-dents assigning the correct diagnostic cat-egory and a developmental quotient agree-ing within 10 points with that of the staff member was determined.
Among the 34 junior medical students evaluating a normal 25-week infant all but one called her normal in adaptive, gross motor, fine motor and personal-social be-havior while three called language ques-tionable. Although the students knew the infant’s age, they evaluated her accelerated performance correctly, and in adaptive be-havior 90% assigned maturity levels for which the quotients deviated less than 10 points.
The abnormal infant’s physical appear-ance was compatible with his developmen-tal age of about 1 year rather than his chro-nologic age of 20 months, and the medical students were not told how old he was until after they had assigned their maturity lev-els. All 29 then correctly called him abnor-mal in all areas of behavior. In adaptive be-havior 85% gave quotients agreeing within 10 points with the staff member’s.
These results indicate that the items are stated specifically enough so that the inven-tory yields reliable and reproducible re-sults, even in the hands of untrained ob-servers.
TABLE V
PEARSON PRODUCT-MOMENT AND SPEARMAN Rxx
ORDER CORRELATION COEFFICIENTS FOR
DEVELOP-MENTAL QUOTIENTS ASSiGNED BY STAFF EXAMiNERS
FROM A COMPLETE GESELL EXAMINATION AND BY
DEVELOPMENTAL SCREENING INVENTORIES COMPLETED
FROM THE FINDINGS OF THE GESELL EXAMINATION BY
A STAFF MEMBER
Area of Behavior
Pearson Product-Moment
Spearman Rank Order
Adaptive
Gross motor
Fine motor Language Personal-social
0.97 .98 .94 .97 0.97
0.93 .98
.90 .90 0.96
Infant N
Status
% Correct Classification
Unscreened Controls
Screened Normals
Abnormals Total
8 30 24 82
100
96 84 94
THE PREDICTIVE VALUE OF
INFANT EVALUATIONS
The validity of infant examinations in predicting later behavior is, as has already been indicated, germane to the problem of screening. Data relating to this is there-fore important, even though it is not the focus of the present investigation.
The most recent data6 obtained in a fol-low-up at school age of a group of 66 chil-dren who had a complete Gesell Develop-mental and Neurologic Examination done previously between 16 and 52 weeks of age, and 28 randomly selected controls, supports our earlier findings.5’7 A step-wise multiple regression analysis (Table VI) shows that at school age, when an extensive battery of psychological tests is used, the multiple correlation with the infant neurologic diag-nosis is .81. When the 12 cases too defective to perform on all of the tests are arbitrarily assigned zero scores and the same analysis done, the results are essentially the same as for the smaller group. The same children are misclassified and the multiple correla-tion is .87. Thus, almost 95% of infants are correctly identified at school age, on the basis of their infant neurologic status, as still normal or still deviant.
TABLE VII
CORRELATION COEFFICIENTS BETWEEN INFANT DEVELOPMENTAL QUOTIENTS AND
STANFORD-BINET INTELLIGENCE QUOTIENTS
Infant N5 Spearman
Rank Order
Pearson Product-Moment
r for D.Q.-I.Q.
Multiple r weighted for
.
socioeconomic status and Convulsive Seizures
Total Group
Infant D.Q. less than 80; total
Infant D.Q. less than 80; no modifying factors
Infant D.Q. 80 or above
123
‘28 18 88t
.64
.66 .68 .46
.70
.68 .71 .48
.84
.87
.90
.75
* Cases for whom socioeconomic data was incomplete omitted.
t Cases of cretinism and Down’s syndrome with infant D.Q. 80 or more omitted.
this analysis. The Pearson product-moment correlation coefficient for the entire group is .70. In certain conditions such as Down’s
syndrome the early course of development
is normally one of progressive deceleration, as is the case in inadequately treated hy-pothyroidism. The presence of seizures makes definitive prediction unwarranted until they are controlled. When the infants with these modifying conditions and those with infant quotients less than 80 are re-moved from the sample the correlation falls to .48, but is still significant. The Spearman rank-order coefficients are essentially the same, indicating that the high correlation values are not merely the result of the large number of abnormal cases in the sample.
That the correlations are not 1.0 is not surprising in a dynamically developing complex organism subject to a variety of organic, psychologic and social influences which affect and alter behavior. Two of these major influences are socioeconomic status and the presence of seizures, and it
seems reasonable to assume that the predic-tion from infant performance can be im-proved if they are taken into account. Con-sequently, the education and occupation of the parents and the occurrence of seizures after the infant examination were used in a multiple regression analysis to derive weighted correlations between infant and later performance. In the total group the Pearson correlation rises to .84; in those
with infant quotients below 80 it increases to .87 and .90, and those with normal infant function to .75. The period between infancy and school age is one of relatively rapid de-velopment and of considerably less envi-ronmental stability than the school years themselves, consequently these high cor-relations are even more significant.
COMMENT
Many professional workers maintain that there is no relationship between infant and later behavior, and the psychological litera-ture reports small positive and even nega-tive correlations of - #{216}348 Since later
SUPPLEMENT
other physicians9”#{176} between infancy and ages varying from 18 months to 7 years. Even higher ones, obtained more recently, have been summarized in this report.6 When high positive correlations are obtained and confirnwd, the failure of other observers to find them and their negative results are most likely due either to the use of inade-quate methods of evaluation or to incorrect execution and interpretation of a proper procedure. The correlations reported are as substantial as, or higher than, correlations over a similar age span at later ages.11
Since almost all of the infants who are abnormal when evaluated by a complete developmental examination continue to be so at later ages and since such abnormal in-fants are also detected by the screening in-ventory, it seems reasonable to assume that they too will continue to be abnormal in later life. It is not necessary to wait until these infants are re-evaluated at school age in order to draw the conclusion that the re-sults of the screening inventory are also valid and that it is an adequate tool.
The student groups used in testing the reliability of the Developmental Screening Inventory were probably the least experi-enced and most naive that could be found in the health area. Furthermore, their inter-est was variable; at times screening was viewed as an assigned chore rather than a valuable learning experience or an impor-tant method for evaluating a patient. The maturity levels on the individual examina-tions that were assigned by the students were almost always lower than those as-signed by the staff examiner, even though the diagnostic categories assigned were the same. This could be explained in large part by the fact that the staff examiners unques-tionably had greater skill in eliciting behav-ior than that possessed by the junior medical student. The fact that there was mis-screen-ing in 15% of the cases when the staff mem-ber compared the examination and the in-ventory, although the correlations between the developmental quotients were extreme-ly high, only serves to emphasize that cor-rect interpretation of findings depends also
on other aspects of behavior and compe-tence in evaluating these factors is more difficult to acquire. This discrepancy be-tween assigning numbers and interpreting their meaning has been shown to exist even for more advanced students working in a one-to-one supervised situation.1 Correct interpretation comes only with experience. It is also clear from reviewing the screening sheets that one of the major factors in mis-interpretation is ignoring the history given by the parents, a failing common to many physicians.
However, the analysis reveals that, even when the D.S.I. is used by untrained stu-dents, careful and interested application results in high levels of reliability, detection of all abnormal infants and discrimination between neuromotor and intellectual ab-normalities. It could be expected that in the hands of the practicing physician even bet-ter results might be obtained. He is un-questionably more concerned than is the junior medical student since his patients, his reputation, and even his economic inter-ests are affected. In addition, he must take further steps when he finds that screening reveals abnormality.
THE USEFULNESS OF A DEVELOPMENTAL
SCREENING INVENTORY
In medicine most situations are rightly judged against a normative background. Practical experience in the evaluation of development has been a minor part of pedi-atric training, and attention usually has been directed only towards a few land-marks of motor behavior. Development is supposed to be the special province of the pediatrician and the effects of maturation on changes in biologic functioning the rea-son for the existence of pediatrics as a spe-cialty. The physician, and particularly the pediatrician, needs more than a superficial acquaintance with development. The prob-lem of meeting adequately the demands for service in the evaluation of suspected ab-normal development can be solved only by increased emphasis on development in the training of physicians and nurses and by new teaching methods. These would be di-rected towards sharpening diagnostic acu-men by comparing behavior with estab-lished norms and systematizing the obser-vations that are being made.
The use of an effective developmental screening inventory would do much to raise the present level of evaluation. In the two common patterns of medical care there would be an initial level of screening by general practitioners or by well-baby clinic nurses. In the teaching center, the medical student could, with use of the inventory, acquire an acquaintance with development in the day-to-day care of his patients. The pediatric resident during his training would establish a firm knowledge of normal growth and development as the basis for detecting deviations. For the practicing pediatrician the D.S.I. could provide the short-cut he desires, making it possible for him to apply systematically the knowledge that he already has. This would be accom-plished by surveying behavior at frequent intervals and not by selecting only a few items of behavior at widely spaced ages,
which has been the erroneous approach used to date. A few minutes at each visit would suffice to determine if an infant is acting at his age level, provided they were
devoted to asking the proper questions and observing the necessary behavior during examination of the child. Adequate screen-ing would permit the developmental con-sultant to function more effectively in a shorter period of time because he could be provided with a satisfactory history of the pregnancy, newborn period and course of development. The family physician would be in a better position to provide the con-tinuing support and counseling that parents need for long-term care of a child with a significant deviation from normal develop-ment. Finally, the D.S.I. could be used in large scale research; it could prove most useful at the present time in the evaluation of the programs of maternal and infant care now under way.
REFERENCES
1. Knobloch, H., and Pasamanick, B.: Predicting
intellectual potential in infancy: Some vari-ables affecting the validity of developmental
diagnosis. Amer. J. Dis. Child., 106:43,
1963.
2. Knobloch, H., and Pasamanick, B.: A
Devel-opmental Questionnaire for Infants Forty
Weeks of Age: An Evaluation. Monograph
of the Society for Research in Child
Devel-opment, Vol. XX, Serial No. 61, No. 2.
Lafayette, Indiana: Child Development
Pub-lications, 1955.
3. Gesell, A. L., and Amatruda, C. S.:
Develop-mental Diagnosis, ed. 2. New York: Paul B.
Hoeber, Inc., 1954.
4. Caidwell, B. M., and Drachman, R. H.:
Com-parability of three methods of assessing the
developmental level of young infants.
PE-DIATRICS, 34:51, 1964.
5. Knobloch, H., and Pasamanick, B.: An
evalu-ation of the consistency and predictive
value of the 40 week Gesell developmental
schedule. In Child Development and Child
Psychiatry. Washington, D.C.: Psychiatric
Research Report 13, American Psychiatric
Association, pp. 10-31, 1960.
6. Knobloch, H., and Pasamanick, B.: Prediction
from the assessment of neuromotor and
in-tellectual status in infancy. In Zubin, J., ed.:
Psychopathology of Mental Development.
New York: Grune and Stratton, in press.
Presented at the 56th annual meeting of the
American Psychopathological Association,
New York City, February 18-20, 1966.
7. Knobloch, H., and Pasamanick, B.:
Environ-mental factors affecting human development
8. Maurer, K. M.: Intellectual status at maturity
as a criterion for selecting items in
pre-school tests. University of Minneapolis In-stitute of Child Welfare Monograph Series No. 21, Minneapolis: University of
Minne-sota Press, 1953.
9. Drillien, C. M.: Longitudinal study of growth and development of prematurely and
ma-turely born children: VII. Mental
Develop-ment 2-5 Years Arch. Dis. Child., 36:233, 1961.
10. Illingworth, R. S.: The predictive value of
de-velopmental tests in the first year, with
spe-cial reference to the diagnosis of mental
subnormality. J. Child. Psychol. Psychiat., 2:210, 1961.
11. Terman, L. M., and Merrill, M. A.: Measuring
Intelligence: A Guide to the Administration
of the New Revised Stanford-Binet Tests of Intelligence. Cambridge: Houghton Muffin
Company, 1937.
LIST OF INSTRUCTIONAL FILMS
An instructional 16 mm black and white
sound film, entitled Developrnen tal Evaluation
in Infancy, is available. Two important
be-havior patterns at 15 months have been
se-lected and the complex integration of the
separate components traced from 4 weeks of age to the 15-month culminating patterns. All of the adaptive, fine motor and gross motor
items which appear on the Developmental
Screening Inventory are included. The
beha-vior patterns are presented longitudinally to illustrate developmental mechanisms.
A film showing a cross-sectional view of the characteristic l)ehavior patterns and the gen-eral technique of the examination in four nor-mal infants is entitled The Gesell Develop-mental and Neurologic Examination at 16, 28,
40 and 52 Weeks of Age.
A film on Normal and Abnormal Neurologic
Function in Infancy, which demonstrates a va-riety of deviations, chronologically or function-ally, from normal in infants approximately 40 weeks of age is available.
These films may be obtained from The
Di-vision of Motion Picture Photography, Ohio State University, Columbus, Ohio 43210.
GENERAL INSTRUCTIONS FOR USE OF THE D.S.I.
Development proceeds in an orderly pre-dictable manner, with the same variability in behavior for normal infants found in all biologic measurements. By asking some questions of parents, observing the infant’s behavior and recording this information systematically, an estimate of the level of function in various areas of behavior can be made which correlates very highly with the maturity age assigned on the basis of a com-plete Gesell Developmental and Neurologic Examination, from which the items are adapted.
This screening inventory will be of value for serial observations in vell-baby supervi-sion as well as for diagnostic problems re-ferred for evaluation. READ THE EN-TIRE INVENTORY BEFORE AT-TEMPTING TO USE IT.
DO NOT BE ALARMED BY THE LARGE NUMBER OF QUESTIONS. They cover the age range from 1 to 18 months and any one infant can usually he evaluated by 2 or 3 consecutive age levels at most. We have tried to phrase the items
for some are listed in the instructions. It will help to understand them if you look at
the ad/acent age levels, e.g., lift vs. hold at
8 and 12 weeks in Gross Motor Behavior; offer the parents both alternatives. ASK THE QUESTIONS AS THEY ARE STATED.
START by asking questions appropriate
to the chronologic age of the child. If the answers are negative, drop to a lower age level; then work back up. It is best to cover ONE AREA OF BEHAVIOR AT A TIME rather than one age level at a time. Remem-ber that the infant may be slow in one area and normal in other areas. Keep asking
(1uestiOns above the child’s chronologic age
until no more positive answers are ob-tained. When you start your interview TELL THE PARENTS SOME QUES-TIONS ASKED WILL BE ABOVE THE CHILD’S LEVEL OF ABILITIES.
Record the parents’ answers [H His-tory Col.] and your observations [0 =
Ob-served Col.] on each visit, to the left of
is blocked out. Record responses + [Pres-ent], - [Absent], or X [Unknown]. If an infant is seen every 4 weeks there may be some overlap in l)ehavior; confusion can be avoided 1w recording in different colors. Failure to progress normally will be obvious if significant overlap between visits persists.
Blocks are provided at the upper left and lower right of the form for recording the age level at which the child is functioning and tl#{236}ediagnoses. In each of the five areas
of i)ehavior, assign maturity levels in
weeks, or months, based on your clinical judgment of the age levels your recorded history and observations describe best. You can interpolate between the adjacent age columns. e.g., 35 weeks, since a 32 week in-fant adds 36 weeks behavior gradually over the next 4 weeks. DO NOT FORGET TO TAKE THE PARENTS’ HISTORY INTO ACCOUNT. This is particularly true in lan-guage behavior, which may not be cx-lubited during the examination. We have found parents’ reports to be very accurate
when clear-cut specific questions are asked.
Assign a diagnostic category in each area on the basis of your age levels. With just these items, expect to be able to divide the infants into three diagnostic categories: [A] definitely abnormal,
[Q]
borderline or questionably abnormal, and [N] normal, or advanced. Do not expect to make a pre-cise diagnosis. REMEMBER THAT THERE IS NORMAL VARIATION AROUND THE AVERAGE OF 100 AND THAT THE ACE PLACEMENT OF AN ITEM IS THAT AT WHICH ROUGHLY 50% OF INFANTS ACHIEVE SUCCESS. If an infant has a history of normal Ian-guage behavior, at least at 36 weeks and beyond, it is dangerous to make a diagnosisof mental deficiency, even though adaptive
behavior is retarded. Be suspicious of tile
presence of abortive grand mal convulsive
seizures.
Age in weeks must be counted on the
cal-endar; there are 13 4-week periods per year. Don’t forget to. SUBTRACT THE WEEKS OF PREMATURITY from the chronological age.
CONDUCT OF THE DEVELOPMENTAL SCREENING EXAMINATION
Test Objects.-In the actual examination the test objects are very specific, but they
can be approximated and should consist of the following, which can be purchased in most supermarkets:
A round embroidery hoop 4” in diame-ter with a string about 8” long no more than 1/16” diameter
an aluminum cup 3.5” in diameter a plastic bottle in use in most pharma-cies, 2” high and 1” in diameter
round cinnamon candies used in cake decoration [for the 8 mm. pellet, or “crumb”]
a childs picture book
a large crayon and paper
10-1” wooden cubes [those readily
available are usually 13”, but Childplay
of New York, Inc., or the Milton Bradley Company usually have 1” cubes; the
stir-face should not have embossed designs] “Small toy” usually refers to the 1” cube, but the plastic bottle also qualifies and is more appropriate at 40-48 weeks in connection with the crumb [pellet]
1107
attendant, can support the young infant in
a sitting position.
General Comments on Conducting the Examination.-Note that at the age of 20 weeks and below the Adaptive Behavior items are observed when the baby is lying
on his back in supine. At 24 weeks and over
he is expected to do similar things when in
a sitting position; initially lie will need to
be held supported or tied into a high chair so that his hands will be free to manipulate
the test objects. ALL INFANTS SHOULD
BE EVALUATED IN SUPINE, SITTING,
PRONE, AND STANDING, except that
ai)Ove 32 weeks a normal infant need not
be placed on his hack. Start in the supine
position routinely up to 20 weeks of age and up to 32 weeks if the infant happens to
be in that position; after 32 wecks start the examination in sitting. If a younger infant
happens to be in his mother’s lap, he may
not want to lie down and the examination can he started in sitting.
The infant must cooperate if information
useful in assessing behavior is to be
ob-tained, and his degree of cooperation is
often directly related to the manner of the examiner. If you talk to the infant before and during the examination in a friendly manner and do not push him to perform, good rapport is usually established. The ex-amination is often more successful if it does not follow immediately some painful or up-setting procedure you have performed, but even in such situations presenting the toys will usually secure his cooperation. OFFER SOME TOY OTHER THAN A TEST OB-JECT BEFORE HANDLING THE IN-FANT. WHEN HE TAKES IT HE USU-ALLY HAS ACCEPTED YOU AND WILL LET YOU PICK HIM UP.
Presentation of Test Objects
-Supine-start with the object in the midline at the
infant’s feet and bring it up toward eye
level. Hold it about 15-20” from the infant
for visual responses and within reach if he
is mature enough to grasp.
Sitting-tap the object at the edge of the table in the midline with clear up and
down motions of the arm. When the infant
has fixated on the object slide it within
reach with a smooth horizonal motion; do not jerk your arm up and down on the way in. When presenting ring and string, put
string down in reach, tap ring up and down and put ring on table, but out of rcach.
MOST BEHAVIOR IN INFANCY IS SEEN DURING SPONTANEOUS PLAY
AND NOT ELICITED ON COMMAND.
Present one cube, then the second, add the
third, add the rest of the cubes and then the
cup and observe what lie does. ALWAYS
GIVE THE INFANT AN OPPORTUNITY
FOR SHOWING THE MOST
AD-VANCED BEHAVIOR FIRST: e.g., spon-taneous behavior when given an object;
verbal request and/or pointing before
demonstration, as in putting cube into cup;
reach and grasp before visual following or
placing in the hand, at younger ages.
REMOVE THE OBJECT[S] at the end
of each situation or group of related
situa-tions before presenting the next one, but HAVE THE NEXT OBJECT READY be-fore trying to take away what the infant is
holding. IF HE OBJECTS STRONGLY,
PRESENT THE NEXT ONE BEFORE TRYING FURTHER. This procedure
usu-ally works. DO NOT USE FORCE.
Talk to the infant or, better, describe
what he is doing while you are doing the
examination.
SPECIFIC BEHAVIOR PATTERNS
Postures Lying on Back in Supine:
4 weeks: asymmetrical or
tonic-neck-reflex [TNR]-the fencing stance with head turned to side, arm and leg extended
on that same side, other hand fisted at occi-put.
16 weeks: symmetrical-head usually in
12 weeks: head more apt to he
asymmet-ric than body.
head Control in Silting.- [Needs full trunk
support.]
4 weeks: head sags against the chest once it is brought forward.
8 weeks: it sags but can bob to an erect position.
12 weeks: head set forward between hunched shoulders; infant looks ahead, but head bobs down at times.
16 weeks: still hunched; does not bob
for-ward unless turned away to side.
20 weeks: head is in line with tile tipper trunk, no longer hunched, and no bobbing.
Pivot: to move about in a circle in one spot.
32 weeks: infant does this lying on his
abdomen by crossing one arm over tile
other.
Sitting:
28 weeks + : must be (lone on hard
sur-face, not bed.
40 weeks: goes to prone-controlled, not
falling; straight over, not to side first. Must be able to sit steadily before he can do this.
Grasp: reach out aiid take protptly in one
motion; differs from approach with eventu-al prehension. Progresses from ulnar side of hand to radial digits.
12 weeks: hold an object actively;
obvi-Otis if lie lifts it off bed. Otherwise knuckles whiten, which they (10 not do if toy rests
passively in his hands.
20 weeks: can’t reach out and pick tip toy
but shows lie is trying by scratching at the table when he sees it. May scratch without toy being present.
Small toy [cube] grasp:
24 weeks: has whole hand palmar grasp
and all fingers press toy agaiiist center of palm.
28 weeks: is still in the palm, but is held
at the radial side, primarily by the index
and third fingers and is pressed against the thumb too.
36 weeks: there is a space between toy
and palm and it is held with thumb and
ends of index and third.
“Crumb” [pellet] grasp:
28 weeks: can pick up small toy but not
crunib-sized object-can only land on this
with his whole hand or try to get it with raking movement of whole arm.
Grasp of small objects then proceeds in
same way as grasp of larger
objects-to-vards the radial digits, with suppression of movements of whole arm and hand.
40 weeks: Pluck-grasp promptly
be-tween ventral surfaces of thumb and index finger.
Miscellaneous:
40 weeks: Put toy down-controlled re-moval of hand from object, not just drop-ping.
40 and 44 weeks: plays with cube in, or
removes from cup, when the rest are left beside it [may have to take a cube from his hand if he is holding two].
18 months: pulls toy on string after him-self as walks or crawls around; not just pulling it towards himself.
Language:
4 weeks: sounds are made but have no definite form-are just noises in the throat.
36 weeks: he puts consonant sounds
to-gether without meaning: da-da, ba-ba.
A “word”: a sound used consistently to
mean something-a person, an object, a group of objects.
A nursery trick: wave “bye-bye,” play “pat-a-cake,” “peek-a-boo,” “so-big,” etc.
15 months: “Talking” a foreign language is “jargoning,” i.e., making voice go up and down, pausing as though at end of a phrase, etc., in conversation, and expecting you to understand what he is saying. It is
A DEVELOPMENTAL
SCREENING
INVENTORY
From
4 weeks
to
18 months
Based on the work of Arnold L. Gesell and Catherine S. Amatruda
by
Hilda Knobloch, M.D., Dr. P.H., Benjamin Pasamanick, M.D.,
and Earl S. Sherard, Jr., M.D.
This inventory is a screening procedure and a definitive diagnosis should not be made on the basis of a single screening by itself. Infants identified as deviant should have se-rial observations to determine if referral to a consultant or a center for a complete diagnostic
8 Weeks
12 Weeks
4 WEEKS
OR
LESS
ASYMMETRIC TONIC-NECK-REFLEX
c:
--j:j#{149}
:
-Regard toy only when it s brought
in front of eyes
Delayed regard of toy you hold in
midline over chest
-Prompt regard of toy dangl.d hi
midline at chest level
Can follow dangled toy only to
midline,notpastit
Drop toy put in hand at once
Follow dangled toy past midline Follow toy, or Ex’s hand, in 180’
continuous arc, side to side
- Rrtain briefly toy put in hand
Glance at toy when put kito hand
Head sag forward if held sitting
#{149}
Head bob erect if held sitting Head bob forward if h.ld sittingAsymmetric tonic-neck-reflex posture
predominate
No head droop if suspended prone Symmetric posture head, body seen
Li/t head to 45#{176}in prone [on
abdomen] recurrently
Hold head up 450 when in prone
[on abdomen] sustain.dly
Clear nose from bed in prone
Both hands held tightly fisted Hold hands open or close loosely
Hold toy put in hand with active
grasp
Hand clench as toy touched to it
Impassive face Alert expression Coo and chuckle
Vague indirect regard Direct definite regard
-“Talk” back just if you nod head
and talk to him
Make small throaty noises Make single vowels-”ah, eh,uh”
Regard examiner’s face and
decrease activity
Smile back just if you nod head
and talk to him
Look at examiner predominantly
Hold up and look at own hand
Indefinite star. at surroundings Eyes follow moving person around Pull at clothes
KEY AGE
28 Weeks 40 Weeks
-Transfer Objects Index Finger Poking
44 Weeks
48 Weeks
40
WEEKS
PICKS UP CRUMBS
& THREADS
PLAYS NURSERY TRICKS
Play mud. cup with toy you put
there, touch and manipulate it
Take toy out of box or cup Play with one toy after another
of a group in same way, In
-sequence [e.g., drop to #{248}oor,
move to another spot on table)
Put small toy inside cup or box
if shown, but not let go of it
Hold small toy and try to or pick
up crumb at same time
I
Poke at crumb inside bottleExploit crumb only, Ignore bottle
Poke with index finger at things
Sit erect and steady indefinitely Stand at furniture without leaning
against it, lift one foot up and
down
Hold furniture and walk around It
Go. not fall, forward to prone Walk if both hands held at
shoulder height for balance
Crawl [creep] on hands and knees
Pull self to standing
Put small toy down, take hands off Pluck crumb easily with thumb and
index finger, not resting arm
or hand on tabletop
Pluck crumb up promptly, usually
with thumb and index finger
Say and mean “ma-ma” and “da-da’
Have one other “word”
Play nursery trick just if asked
Play nursery trick only if you do it
first; doesn’t understand meaning
Hold out toy to you, but not let
go of it
Take toys off table to another
DATE
HO AGE
Dump crumb out of bottle-may show
MATURITY LEVEL
-
-Scribble when you hand him
crayon, i.e., spontaneously
Imitate stroke on paper after you
draw vertical stroke
I
DIAGNOSIS
Run stiff-legged MATURITY LEVEL
-
-Rarely fall when walking
Climb into adult chair
DIAGNOSIS
Walk upstairs if you hold one hand
- - Turn pages of book 2-3 at once MATURITY LEVEL
Stack up 3 small toys [tower 3)
DIAGNOSIS
Point to picture, if ask: dog, baby
-MATURITY LEVEL
Look back and forth as you point
from 1 picture to other in book DIAGNOSIS
Walk or crawl, pulling string toy MATURITY LEVEL
-
-Hug and love doll, stuffed animal
KEY AGE 28 WEEKS
SUPPORTED SITTING
ONE HAND APPROACH
& GRASP 32 Weeks
II
Reach and pick up or take toy
with one hand only
Pick up one small toy and then
second one
Transfer toy easily, hand to hand Hold these two prolongedly
-Bang toy up and down when
sitting supported
-Secure toy by string if string
contacted by hand
-
-Lift head from bed if on back
-
-Sit 1 minute erect unsteady on
hard surface -
-Sit if put on hard surface
leaning on hands - - Stand, hands held shoulder height
Stand if chest held under arms Pivot in circle, prone, using arms
I
Pick up small toy, hold to radial side
palm with 2nd and 3rd finger
Try to pick up crumb by raking with
thumb, 2nd and 3rd fingers,
usually little arm movement
Put whole hand on crumb, rake it
Say “Mum-mum-mum” especially
crying
Make single consonant sounds,
“da, ba, ga, ko”
-
-Make same vowel sound in series:
“ah-ah-ah, uh-uh-uh, oh-oh-oh”
- - Feet to mouth when lying on back
Reach out and pat self if put
- Bite and chew toys, not just lick
Persist in reaching for toys out of
H = HISTORY
0 = OBSERVATION
DIAGNOSTIC CATEGORIES:
N = Normal or Advanced
Q = Questonable
A = Abnormal
KEY AGE 18 MONTHS
LOOKS SELECTIVELY AT AND IDENTIFIES PICTURES
18 Months
20 Weeks 24 Weeks
Wave arms, move body at sight of
toy; dangled if on back, or put
on table if held in sitting
Bring both hands up towards toy,
on back or if supported sitting Reachwith andbothpickhandsup or take toy
-Grasp toy only if held near hand
[approximately one inch away]
1Reach for toy dropped within reach
- Put toy in mouth when held
supported in sitting
Regard [look at] toy in hand -
-Take toy to mouth when on back Look after toy dropped in sight
Head steady, set forward, sitting - Head erect, steady, held sitting Grasp foot when lying on back
[in supine]
Symmetric postures predominate No head lag when held by hands
and pulled to sitting
-
-Roll to abdomen, get both arms
out from under chest
Hold head 90#{176},look directly
ahead in prone [on abdomen] - Push whole chest off bed, prone
Scratch, finger, clutch at clothes Scratch on tabletop, or on bed in
prone [toy in sight not essential]
Pick up small toy and hold in
center of palm with all fingers
Bring hands together in midline
and play with own fingers
Laugh out loud Squeal like a little pig, voice up
high
Grunt and growl [deep sounds]
Initiate “conversation” with toys
or people
Excite, breathe heavily, in play
Initiate smile just when people
come up and stand beside him
Smile at self if close to mirror Know strangers from family
Put both hands on bottle when
feeding
Smile and talk to self if put
close to mirror
Recognize bottle just on sight
16 WEEKS SUPINE
REGARDS TOY IN HAND
---\
KEY AGE 52 Weeks 15 Months
52 WEEKS Dangles Toy by Its String Builds Tower of Two
TRIES TO PILE OBJECTS
GIVES TOY ON REQUEST 56 Weeks 15 Months
Try piling one small toy on 2nd
just presses or it falls off
Put toy in cup or box if you show
him first each time
Dangle toy by string, deliberate
Put toy into cup or box just if
you point and ask him to
Imitate scribble with crayon
after you do it
#{149}
Pile 1 small toy on 2nd [tower 2]
Get 5-6 [of 10] small toys in cup
or box; doesn’t put all 10 in
Stroke crayon in air imitatively
after you draw vertical stroke
Walk with only one hand held Forget to hold on, stand alone
momentarily
If standing up, take few steps
alone, fall headlong
No longer creep or crawl
Get up in middle of floor and
walk alone
Collapse and catch self when falls
Pick up two small toys in one hand
at same time, deliberately
Drop crumb into bottle just if you
point and ask him to
Help turn pages of book
- Say 2 “words” plus ma-ma and da.d - Say 3 or 4 “words” - - 4-6 words, including first names
Let go of toy into your hand if When asked to, look at object: “Talk” foreign language-jargon
you hold hand out for it ball, shoe, light, T-V set, etc. - - Pat at pictures in book
Help in dressing-push arm thru
sleeve if you get it started
Use slight casting motion and play
ball with you, throwing it
Indicate wants by pointing or
DATE
AGE H
MATURITY LEVEL
- - ADAPTIVE
1
DIAGNOSIS
MATURITY LEVEL
DIAGNOSIS
GROSS MOTOR
MATURITY LEVEL
FINE
MOTOR DIAGNOSIS
MATURITY LEVEL
LANGUAGE DIAGNOSIS
MATURITY LEVEL
- - -
- PERSONAL-SOCIAL
DIAGNOSIS
Reference text:
GeselI, A. L., and Amatruda, C. S. Developmental Diag-nosis. Hoeber, New York, 1954.
Instructional films available from Division of Motion Pic-ture Photography, Ohio State University, Columbus, Ohio, 43210:
1- Developmental Evaluation in Infancy
2. The GeseIl Developmental & Neurologic Examina-tion at 16, 28, 40 and 52 Weeks.
3. Normal and Abnormal Neurologic Function in In-fancy.
16 Weeks
36 Weeks AREA OF
BEHAVIOR
Toy to Mouth In Supine
Last Name
First Name
Birth Weight:
E.D.C.:
Days Prematurity Assigned: Case #:
Birth Date:..
AREA
ADAPTIVE
H
I 0
Drop one of two toys picked up
to take third one offered
H
Hit toy in hand at toy on table
Hold toy in one hand and play with
attached string with other
GROSS
MOTOR
Sit 10 plus minutes steady on
hard surface
Stand at furniture and not lean
against it if put there
FINE MOTOR
Pick up small toy in ends of fingers
I I
Pi up crumb, thumb and index
#{149}
LANGUAGE
Say da-da, ba-ba, without meaning
Imitate cough, tongue click, etc.
Know own name
PERSONAL- Hold own bottle, pick up if dropped
