L 3 G - D - MMDST

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FUNDAMENTALS OF NURSING

METRO MANILA DEVELOPMENTAL SCREENING TEST PUROISES


(MMDST) ● Measures developmental delays
○ To determine if there is delay in the child by
evaluating 4 aspects of development
Content Outline ● Evaluates 4 aspects of development
1. Overview
2. MMDST ASPECTS OF DEVELOPMENT
3. Test Form
4. Test Procedure 1 Personal-Social tasks which indicate the child’s
5. Test Items: Administration & Scoring Directions ability to GET ALONG WITH
6. Scoring Delays in Develop PEOPLE and to take care of
7. Interpreting Test Results himself
8. Discussing Test Results
9. Retesting 2 Fine-Motor tasks which indicate the child's
10. Difficult Test Situations Adaptive ability to SEE and USE HIS
11. Test Directions HANDS to pick up objects and to
draw
OVERVIEW OF MMDST
● Created by UP, revised the DST 3 Language tasks which indicate the child's
● Screening is a presumptive identification of ability to HEAR, FOLLOW
unrecognized disease or defect by the application of directions and to speak
tests, exams, or other procedures
○ MMDST is not diagnostic in nature but rather 4 Gross motor tasks which indicate the child's
just a screening test behavior ability to SIT, WALK, AND JUMP
● Early detection model
● Test children with problem
● Facilitates early referral and treatment MMDST KIT
● Manual
METRO MANILA DEVELOPMENT SCREENING TEST ● Sample test form
(MMDST) ● Test materials
● Created by UP ● MMSDT bag
● Adopted by Dr. William K. Frankenburg
○ DST (Denver Developmental Screening TEST MATERIALS
Test) (what’s inside the MMDST bag)
● Modified and standardized by Dr. Phoebe D. Williams ● A bright red yarn pom-pom
DDST to MMDST ● A rattle with narrow handle
● Simple and clinically useful tool ○ Anything na tumutunog
● To determine early serious developmental delays ● Eight 1-inch colored wooden blocks (red, yellow, blue
● Developed for health professionals (MDs, RNs, etc) green)
● It is NOT an intelligence test ● A small clear glass/bottle with 5/8 inch opening
● Detection of developmental disabilities ● A small bell with 2 12 inch-diameter mouth
● Children 6 ½ years and below ● A rubber ball 12 V/2 inches in circumference
● It is a screening instrument to determine if child's ● Cheese curls
development is within normal ● A pencil

Domantay 1
IMPORTANT CONSIDERATIONS

Child’s age is crucial= initial step in test administration


- Know age ng child by the day of testing
- Ano ung age ng child mo ngayon including the day

Test items will be dependent on age of child

Age = guide the selection of test items and subsequent


Pag sa right side nag fail - walang delay pero hindi siya
interpretation of results
advance
- Age is indicated in the top of the MMDST test form
● Some items have a small footnote number at the left
(checklist)
end of the bar
Scoring the Test ● Footnote indicates corresponding instruction for
● P - Passed administering the item found at the test form
● F - Failed
● R - Refused, or
● NO - No opportunity
○ As much as possible, do not write NO
bcuz task should be assigned & done *Sa colored area ilalagay ung P, F, R, NO
○ Lahat ng tatamaan ng line
○ Pag sa left ng line lahat ay pass(P) - no ● Some items may be passed by report of the parent
dvlpmnt delay (R)
○ Pafg sa left may F- may dvlpmnt delay ○ Pag passed by report = ilagay R
○ Pag sa right side puro pass- advance siya ○ R = The child refused to do the activity but
○ From the top na age to the bottom accrd to mother, the child does that at home
Failure of an item that is completely to the left of the child’s ○ Pag nagrefuse = interview the mother
age is considered a developmental delay ● Only items with an R on the form can be passed by
report
TEST FORM ● However, whenever possible tester should observe
● Made of 105 items written in the range of what the child can perform
development of children between birth and six years ○ As much as possible, instruct the child what
of age to do and observe
○ Kung ano lang ung madadaanan nung line, ● The item, equal movements, has an asterisk (*) at
un lang ung gagawin na tasks the right end of its bar
● Across the top and bottom of form are age scales ○ Indicates 100% of normal children pass this
● Age is marked in months 1-24 months and age in item at birth
years from 2 ½ to 6. ○ It is the only item with an * (fine-motor
● Each item is represented in the test form by a bar adaptive sector)
● The bar is placed along the age scale to show when ■ Dapat pasado na ng child ito dahil
25%,, 50% (indicated by the hatch mark) 75% and nadevelop na to simula nung baby
90% of the normal children are able to pass the item palang
● 9 items have arrows (->) at the right end of these bars
● This includes the items, defines words and
composition of
● Arrows indicate that normal children may pass these
items even beyond 6 V2 y.o.
○ Sa may arrow, higher than 6 yrs old pede
pumasa dito

Domantay 2
● Use age scale shown at the top and bottom of the
CALCULATING CHILD'S AGE form
● Formula: Date of Test - Birthdate = Age of Child ● Mark the age and draw a line through all four sectors
● Show acetate
● Location of age must be accurate interpretation
depends on correct placement of the line
● Space between age ---2 weeks until 14 mos, 1 mo
from 14 to 24 mos
● From 24 mos to 5 yrs spaces between represent 3
mos and thereafter 6 mos

ADJUSTING FOR PREMATURITY


Date of test: Nov 15, 1999 ● Prematurity affect ability to perform that normal child
Birthdate: March 10, 1997 pass at the same age
Subtract date of test to birthdate ● Adjust for children 2 years or younger
● After 2 years, it is no longer necessary to compensate
AGE OF CHILD: Aug 5, 2002 (Frankenburg, et al)
● No adjustment is made on postterm
● Ask mother if child was born prematurely
● For two or three weeks earlier, subtract the number of
weeks from actual age
○ Subtract ung tidal sa kung ilang weeks siya
premature
○ In the activity, we test the normal as much as
possible
● Draw age line based on adjusted age

Kung puro P sa left - no delay


If may F sa left - may delay (anong aspect ng dvlmpnt may
delay)
Sa right may P- advance development (nagagwa siya higher
1 year = 12 months than the age)
May F sa right - does not mean na may delay pero hindi niya
pa kaya gawin ung pang advance

SELECTING ITEMS TO BE ADMINISTERED


● Administer first those through which child's
chronological age line passes
● If failure occurs in any items, proceed to administer
items to the left of the age line until you obtain 3
passes then stop
○ May fail sa left ng line at may 3 failed, pwede
umurong sa left then need ng 3 pass before
Ex: you can pass the test
Borrow month not just 1, borrow year not just 1
WHAT TO KEEP IN MIND
DRAWING THE AGE LINE

Domantay 3
❖ items crossing the age line should be administered ❖ Words or direction may not be changed
❖ Child should have a minimum of three passes to the left ❖ Otherwise, test administrator will not be standard
of any failure ❖ Avoid questions in such a way that you suggest the
❖ Each sector should have at least 3 passes and three answer
failures

ADDITIONAL GUIDELINES
THE TEST PROCEDURE
1 PRELIMINARY Establish rapport ❖ - 3 failures in one sector—move to the next sector
PHASE Make the child as comfortable as ❖ -3 trials to perform each item, some items require more
possible trials
● If infant...on mother’s lap ❖ REFUSAL: to minimize refusals, tell the child what to do
● Materials should be “Gawin /Gayahin mo ito”
accessible ➢ Do not ask but TELL child what to do
○ Accessible sayo ❖ If still refuses- parent/guardian can administer
and the child ❖ Still refuses- score the item “R”
○ Itago or set aside ❖ Score “R” instead of “F” if you feel certain that he can
ung materials pag perform (validate to parent)
ginugulo ng child ❖ If not passed by report- score “R”

If child is one year older, put child at


SCORING
ease
● Show toys...etc
SCORING DELAYS IN DEVELOPMENT
TEST ADMINISTRATION P Pass
1. Personal-social sector
● Start with this F Failue
● Gives child chance to get used to tester
● Gives tester chance ask parents which can be scored R Refusal
based on report and can also directly observe it
NO No opportunity (ex: pedals bicycle)
Not considered in the overall test scores
2. Fine motor-adaptive sector
● This is what follows after personal-social sector
● Child can perform tasks even without having to SCORING
directly talk to tester
● Filipino child.....warming up Items FAILED – those which fall completely to the LEFT –
○ Mag bigay muna ng sample DELAY

(child failed to pass an item in which 90% of children


3. Language Sector normally can pass at a younger age
● This time child is more comfortable with you (tester)
● Will talk as much to you NOT a delay – if it is crossed by the age line

NOT a delay – bar touches the age line


WHAT TO MAY NOT BE CHANGED

❖ Manner in which each test is administered INTERPRETING TEST RESULT

Domantay 4
● Depends on the # of delays
○ Questionable, Abnormal, Untestable DISCUSSING THE TEST RESULT
● Give parents the results in GENERAL terms rather
STEPS
than abnormal, questionable etc.
STEP 1 mark, shade heavily right end of baR ○ Child is not abnormal but the results are
abnormal
STEP 2 Count the number of sectors that have 2 or
more DELAYS RETESTING
● If with DELAYS – check after 2 weeks
STEP 3 Count the number of sectors that have 1
DELAY with no passes intersecting the age ● Use same form in retesting, using different color
line in the same sector ● If still ABN, Q, UN –refer to PEDIATRICIAN for
developmental progress, for continuity of care
STEP 4 Interpret the result using the following
criteria DIFFICULT TEST SITUATIONS
SHY CHILD 6-7 mos mark beginning of shy age
until 3 yrs
CRITERIA
● ice breaker, start test items
Interpretation Situation which are scored by report,
ask parent to administer
ABNORMAL 2 or more SECTORS with 2 or more ● If all suggestions FAIL,
DELAYS retest in 2-3 wks later

1 SECTOR with 2 or more DELAYS, UNCOOPERATIVE not shv but refuses


PLUS 1 or more SECTORS with 1 CHILD
DELAY and IN THAT SAME aSk parent to leave room
SECTOR, NO passes intersecting
the age line if upset of separation, parent may not
leave, distance from the child
QUESTIONABLE 1 SECTOR with 2 or more DELAYS
if parent says child can do items, do
1 or more SECTORS with 1 DELAY the opposite, REVERSE
and IN THAT SAME SECTOR, NO PSYCHOLOGY for negativistic age
passes intersecting the age line

CHILD W/ MANY Start w/ the eldest


UNTESTABLE When REFUSALS occur in numbers SIBLINGS
large enough to cause the test result
to be QUESTIONABLE or INTERFERING Parent answers questions and shows
ABNORMAL IF these were scored as PARENT what to do
FAILURES
EXPLAIN - MDST not an IQ test, the
NORMAL Any condition not listed above child is not expected to pass all
items, it only shows what a child can
At the BOTTOM of the age line, indicate the test result and
interpretation do at a certain age, be sure that
● Ex. ABNORMAL, Reason: 2 sectors have 2 mothers understand the purpose
DELAYS

Domantay 5
If still interferes, discontinue, be back
after 2-3 weeks

PRACTICE TESTING 10. Which line is longer (not bigger). Turn the paper
● Acceptable level of competency upside down an repeat (3/3 or 5/6)
● 4 – 1 mo to 9 mos
● 4 - 9 mos to 2 yrs
● 4 – 2 yrs to 6 yrs
● 12 children
● --pairing (one observes, other administers)

OBSERVATIONS
● Observe: child’s cooperation, attention span, verbal 11. Pass any crossing line
behavior, self –confidence, nervous habits,
parent-child relationships, and your over-all feeling
about the testing

TEST DIRECTIONS
1. Try to get the child to smile by smiling, talking or
waving to him. Do not touch him, 12. Have child copy first. If failed, demonstrate
2. When the child is playing with toy, pull it away from
him. Pass if he resists.
3. Child does not have to be able to tie shoes or button
in the back
4. Move yarn slowly in an arch from one side to the
other, about 6’ above child's face. Pass if the eyes Note: when giving items 9, 11, & 12, DO NOT NAME THE
follow 90 degrees to midline. (past midline: 180 FORMS. DO NOT DEMONSTRAT 9 & 11
degrees)
5. Pass if the child grasps rattle when it is touched to the 13. When scoring, each pair (2 arms, 2 legs, etc) counts
backs or tips of fingers as one part
6. Pass if the child continues to look where yarn 14. Point to picture and have the child name it. (No credit
disappeared or tries to see where it went. Yarn should is given for sounds only)
be dropped quickly from sight from tester's hand 15. Tell the child to: give block to mommy; put block on
without arm movement table; put block on floor. Pass 2 of 3. (Do not help
7. Pass if the child picks up cheese curl with anv part of child by pointing, moving head or eyes.)
the thumb and finger 16. Ask child: What do you do when you are cold?
8. Pass if child Dicks up cheese curl with the ends of Hungry? Tired? Pass 2 of 3.
thumb and index finger using an over hand approach 17. Tell child to: Put block on table; under table; in front of
9. Pass an enclosed form, Fail continuous round motion. chair, behind chair. Pass 3 of 4. (Do not help child by
pointing, moving head or eyes.)
18. Ask child: If fire is hot, ice is? Mother is a woman, Dad
is a? A horse is big, a mouse is? Pass 2 of 3.

Domantay 6
19. Ask child: What is a ball? River? Desk? House?
Banana? Curtain? Roof? Fence? Street? Pass if
defined in terms of use, shape, what is it made of or
its general category (such as banana is a fruit, not just
yellow). Pass 6 of 9.
20. Ask child: What is a spoon made of? A shoe made
of? A door made of? (no other objects can be
substituted.) Pass 3 of 3.
21. When placed on stomach, child lifts chest off table
with support of forearms and/or hands.
22. While child is on back, grasp his hands and pull him
to sitting. Pass if head does not hang back
23. Child may use wall or rail only, not person. May not
crawl.
24. Child must throw ball overhead 3 feet to within arm's
reach of tester
25. Child must perform standing broad jumps over width
of test sheet (8½ inches)
26. Tell child to walk forward, heel within 1 inch of toe.
Tester may demonstrate. Child must walk consecutive
steps, 2 out of 3 trials.
27. Bounce ball to child who should stand 3 feet away
from tester. Child must catch ball with hands, not
arms, 2 out of 3 trials.
28. Tell child to walk backward toe within 1 inch of heel.
Tester may demonstrate. Child must walk consecutive
steps, 2 out of 3 trials.

IMPORTANT

Date and Behavioral Observations


● How child feels at time of test, relations to tester,
attention span, verbal behavior, self-confidence, etc)

Domantay 7

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