Developmental

Assessment
Presented by: Dr.Enas Althaher
 Normal development
• Development : increase in function of processes related to body and mind .
• Developmental assessment : structured evaluation of a child's
development( physical, speech, language, intellectual, social, and
emotional ).

✔Development is a dynamic process that must be monitored throughout

the child’s growing years.
✔It is a shared responsibility of the parents and primary health care team
and pediatric physicians.
✔It’s essential to know the norms and the many variation to trace the
child’s develop.
 Influence of Heredity and Environment
▪ A child's development represents the interaction of Heredity and the Environment on the
developing brain.
▪ Heredity determines the potential of the child, while the Environment influences the extent to
which that potential is achieved.
▪ For optimal development, the Environment has to meet the child's physical and psychological
needs.
❖Factors affecting development :
1.Prenatal insults. e.g. maternal alcohol.
2.Perinatal insults ( hypoxic ischemic encephalopathy )
3.Gestational age.
4.Chronic illnesses ( congenital or other ).
5.Nutrition.
6.Maternal depression.
7.Trauma and accidents.
8.Social factors ( Poverty).
 Adjusting for Prematurity
✔ If a child has been born preterm, this should be allowed for when assessing developmental age by calculating it
from the expected date of delivery.
✔ Thus the anticipated developmental skills of a 9-month baby (chronological age) born 3 months early at 28 weeks'
gestation are more like those of a 6-month baby (corrected age).
❖Example :
• Child aging 6 months , but was born as preterm (28 weeks).
⮚Since 3 months ( 12 weeks) are missing , the corrected age for the 1st year should not include the missed 3 months
, so the age is for adjusting for prematurity is 3 months :
6 - 3 = 3 months.
⮚The corrected age for the 2nd year is minus the half of the missed months :
3 - 1.5 = 1.5 months.
* Child aging 15 months , gestational age 28 weeks , corrected age = 15-1.5=13.5 months

✔ Correction is not required after about 2 years of age when the number of weeks early the child was born no longer
represents a significant proportion of the child's life.
✔ Child aging 26 months , gestational age 28 weeks , coreected age = 26months
 Aim :
Four areas of Development 1- normal or delayed ?
2- if delayed , global or
specific (one element ) ?
3- mild , moderate or
severe ?

1. Gross motor.

1. Fine motor & vision.

1. Speech, language & hearing.

1. Social, emotional & behavioral.

Gross Motor
Prone and supine position only
in Gross motor skill
 Gross motor in Prone

Newborn
▪ Limbs flexed & 3 months
symmetrical posture ▪ Raises half of the chest
while supporting on
forearm and elbow

1.5 – 2 months
▪ Raises head to 45° only
6 months
▪ Raises all the chest while
supporting on palms only
 Gross motor in Supine

1.5 months
Newborn ▪ Starts holding the head
▪ Marked head lag 3 months
3-6 months
▪ No head lag
▪ Pulls to sit , which is a sign of
absent Hypotonia
 Gross motor in Supine

6 months : Lifts head off

couch to look at feet, rolls
from front to back, sits 8-9 months: Crawling : could be
momentarily with round back missed during normal development
8 months : Sits with straight
back
 Gross motor in Supine

10 months 12 months 15 months

▪ Stands with support ▪ Walks unsteadily, broad gait, ▪ Walks alone steadily
▪ Walks around furniture hands apart for balance
Gross motor in Prone & Supine in newborns
 Gross motor

❖Walks unsupported:

✔25% by 11 months

✔50% by 12 months

✔75% by 13 months
18 months
▪ Runs, walks up stairs with hand held ✔90% by 15 months
▪ Stoops and recovers (he can stoop down to pick up an
object and stand back up without falling) ✔97.5% by 18 months ( Red flag)
 Gross motor

2 years
▪ Runs, walks, climbs stairs (2 feet/step)
▪ Kicks ball
▪ Throw ball overhand
▪ Jumps with 2 feet off the floor
 Gross motor

4 years
▪ Goes up- & down-stairs (1 foot/step)
3 years ▪ Balances on one foot
▪ Go downstairs (1
foot/step)
▪ Pedal tricycle
▪ Broad jumps
 Gross motor

5 years 6 years
▪ Skips with alternating feet ▪ Rides a bicycle
 Prone position :

Age skill

newborn Symmetrical flextion of limbs

6-8 weeks Raise head to 45 degree

3 months Raise half of chest

6 months Raise whole chest

Age Skill

Newborn Marked head lag

6 weeks Start holding head

3 months No head lag

3-6 months Pull to sit

6 months Sit with round back

8 months Sit with straight back

8-9 months Crawling ( may be absent )

10 months Stand with support and walk around furniture

12 months Walks unsteadily , broad gait , hands apart

15 months Walks alone steadily

18 months Run , walk up stair with hand held ,stoop and recover

2 years Run and climb stair (2feet / step )

Kick ball , through ball overhand ,jumps with 2 feet off the
floor
3 years Go downstair ,pedal tricycle , broad jumps

4 years Balance on one foot , run upstair

5 years Skip with alternating feet

6 years Ride bike

Fine motor
&
Vision
 Fine motor & Vision
Newborn
▪ Follows faces in midline (
moving eyes only)
1.5 month
▪ Moving objects or face
180°(turning head ).
6 months
▪ Transfers toys from one
hand to the other
▪ Palmar grasp

4 months
▪ Reaches out for toys
▪ Bats at objects
 Fine motor & Vision

9 months
▪ Plays gesture games
(pat a cake)
▪ Understands own 10 months
name ▪ Mature pincer grip
▪ Object permanence
▪ Stranger anxiety
 Fine motor & Vision
12 months
▪ Casting the objects.
▪ Can voluntarily release items.
14-15 months
▪ Scribbles with pencils.
2 years
▪ Uses fork.
▪ Copies a straight line.
3 years
▪ Copies a circle.
4y ears
▪ Copies a cross.
▪ Catches a ball.
5 years
▪ Copies a triangle.
▪ Draws a person with 6 body parts.
6 years
▪ Writes name.
 Fine motor & Vision
❖Pencil Skills: ❖ Hand skills:
✔3 years : Circle ▪ 1.5 year : 3 Cubes
3
▪ 2 years : 6 Cubes
▪ 2.5 years : 8 Cubes
✔4 years : Cross 4 ▪ 3 years : Bridge
▪ 4 years : Steps

✔4.5 years : Square 4.5

✔5 years : Triangle
5
 Fine motor & Vision
⮚Hand skills : Draw man test
( Good enough test)
• The child is asked to draw a
man, and receives a point for
each item drawn,
• The formula is : 3 + n/4
• (‘n’ is the number of parts
drawn).
✔ Which gives the child’s
approximate mental age .
 Fine motor
AGE SKILL

4 months Reach out

6 months Transfer toys & palmar grasp
9 months Pat a cake , know name ,strange anxiety ,object
permenance
10 months Pincer grasp
12 months Casting objects , voluntary relase
14-15 months Scribble
2 years Use fork , straight line
3 years Circle
4 years Cross
5 yeasr Triangle , draw man with 6 body parts
6 years Write name
Fine motor & Vision
 Speech,
Language
&
Hearing
 Speech, Language & Hearing

Newborn
▪ Startles to loud noise
▪ Spontaneous smile

1.5 month
▪ Responsive smile

3 months
▪ Vocalizes, laughs
▪ Coos (one letter ‘’aaaa’’) 6-7 months
▪ Babbles ‘da’, ‘ma’
▪ Turns head to sounds
out of sight “Hearing
Distraction Test”
 Speech, Language & Hearing
9 months
▪ ‘Dada’, ‘Mama’.
▪ Understand no.
12 months
▪ Single words (2-3 words other than ‘dada’/‘mama’).
▪ Commands with gesture.
15months
▪ 4 to 6 words in addition to above.
▪ Uses jargon.
▪ Responds to one step verbal demand.
18 months
▪ 10 single words.
▪ Shows 4 parts of the body.
21 months
▪ Uses two or more words to make simple phrases.
 Speech, Language & Hearing
2 years
▪ Vocabulary 50 words.
▪ 2 to 3 word phrases.
▪ Uses I and me .
▪ 50% of speech intelligible to stranger
3 years
▪ Speech in sentences.
▪ Vocabulary 200 words.
▪ Uses 5 to 8 word sentence.
▪ 75% of speech intelligible to stranger.
4 years
▪ Count to 20 or more.
▪ Tells a story.
▪ 100% of speech intelligible to stranger.
5 years
▪ Grammatical speech.
▪ Asks what words mean.
6 years
▪ Identifies written letters and numbers.
Age skill

newborn Spontaneous smile , startles to noise

6 weeks Responsive smile

3 months Laughs and coos

6 months Babbles (da , ma ) , hearing distraction test

9 months Dada, mama, and understand no

12 months 2-3 words , commands with gesture

15 months 4-6 words , respond to verbal demand

18 months 10 words , sow 4 parts of body

21 months Use two or more words to makee simple phrases

2 year 50 words , 2-3 words phrases , use I and Me

3 years 200 word , use 5 to 8 words sentence , speech in sentence

4 years Count to 20 , tell story

5 years Grammatical speech , ask what word mean

6 years Identifye written letter and number

Social, Emotional
&
Behavioral
 Social, Emotional & Behavioral
9 months
▪ Plays gesture games (pat
a cake)
1.5 month
▪ Responsive smile ▪ Understands own name.
▪ Object permanence
▪ Stranger anxiety

8 months
▪ Puts food in mouth 10 months
▪ Waves bye-bye
▪ Understands “no”
▪ Plays “peek-a-boo”
 Social, Emotional & Behavioral

12 months 18 months
▪ Drinks from a cup ▪ Holds spoon
▪ Casting objects ▪ Symbolic play
▪ Imitates ( Copy actions of ▪ Kisses parents
parents) ▪ Tells mother she/he wants
▪ Comes when called. potty
▪ Cooperate with dressing ▪ Plays near (but not with)
other children

2 years
15 months ▪ Dry by the day
▪ Indicates desires by ▪ Pulls off some clothing
pointing ▪ Listens to stories with
pictures
2.5 year
▪ Knows Full name
Social, Emotional & Behavioral
5 years
▪ Dresses & undresses
alone
▪ Names 4 colors
3 years ▪ Plays cooperative
▪ Interactive play games
▪ Takes turns ▪ Understands rules and
▪ Knows age and gender abides by them

4 years 6 years
▪ Goes to the toilet ▪ Knows right from left
alone ▪ Knows all color names
▪ Brushes teeth
▪ Washes and dries
hands
▪ Imaginary Plays
AGE SKILL

6 weeks Smile responsively

8 months Put food in mouth

9 months Pat a cake

10 months Beek –a – boo, bye bye , understand no

12 months Drink from cup , casting objects

15 months Indicate desire by pointing

18 months Hold spoon ,kiss parents , symbolic play

2 years Dry by day , listen to stories with pictures

2.5 years Full name

3 years Interactive play , take a turn , know age and

gender
4years Go toilet , wash hand , brush hand , imaginary
play
5 years Dress & undress , 4 colors , cooperative play

6 years Right and left , all color

Age Gross motor Fine motor language Social/adaptive

Birth-1 month Raises head Follows with eyes Alerts/startles to Fix on face (at
slightly in prone to Medline only, sound birth)
position hands tightly
fisted

2 months Raise chest and Regards object Coos and Social smile,
head of bed in in and follows vocalize recognize
prone position through 180 reciprocally parents
degree, briefly
retains rattles .

4 months Lifts onto Reaches for Orients to voice, Initiates social

extended elbows objects with both laughs and interaction
in prone position, hands together, squeals
steady head bats at objects,
control with no grabs and retains
head lag, rolls objects
over front to
back.
Age Gross motor Fine motor language Social/ adaptive

6 months Sits, but may Reaches with one Babbles Recognize object
need support, hand, transfers or person as
rolls in both objects hand to unfamiliar
directions hand

9 months Sits without Uses pincer Imitates speech Plays gesture

support, crawls, grasp, finger sounds games (pat a
pulls to stand . feeds (nonspecific cake),
mama, dada), understands own
understand no name, object,
permanence,
stranger anxiety

12 months Cruises, stands Can voluntarily Discriminate use Imitates, comes

alone, takes a release items of mama , dada + when called,
few independent 1 to 4 other cooperate with
steps words , dressing
Follows
commands with
gesture.
age Gross motor Fine motor language Social/adaptive

15 months Walks well Builds a two 4 to 6 words in Begins to use

independently block tower, addition to cup, indicates
throws ball above, uses wants or needs .
underhand . jargon, respond
to one step
verbal demand.

18 months Runs, walks up Builds a three Uses 10 to 25 Plays near (but

stairs with hand block tower , words , points to not with) other
held, stoops and uses spoon, body parts when children
recovers spontaneous asked, uses
scribbling words to
communicate
needs or wants

24 months Walks unassisted Builds a 4 to 6 Uses 50 words, 2 Removes simple

up and down block tower , to 3 word clothing, parallel
stairs, kicks ball , uses fork and phrases , uses I play
throw ball spoon, copies a and me .
overhand, jumps straight line 50% of speech
with 2 feet off intelligible to
the floor. stranger
Age Gross motor Fine motor language Social/ adaptive

36 months Pedal tricycle, Copies a circle Uses 5 to 8 word Knows age and
broad jumps sentences, 75% gender, engages
of speech in group play,
intelligible to shares
stranger

4 years Balances on one Copies a cross, Tells a story, Dresses self, puts
foot catches ball 100% of speech on shoes, washes
intelligible to and dries hands,
stranger. imaginative play

5 years Skips with Draws a person Asks what words Names 4 colors ,
alternating feet with 6 body mean plays cooperative
parts games,
understands
rules and abides
by them

6 years Rides a bike Writes name Identifies written Knows right from
letters and left, knows all
numbers color names
-What is the age ?
Less than 6 weeks

-What is the name of this skill ?

Spontaneous smile

-What does hearing assessment of

this baby show ?
Startle to loud noises
What is the age ?
o 3 months
What is the name of this skill ?
o Raises half of the chest

Masa lefts her head, says goo, ahh

What is the age ?
o 3 months
What is the name of this skill ?
o Vocalizes and coo
What is the age ?
8 months

What is the name of this skill ?

Mouthing

What other skill is seen at this age ?

Sit with straight back
What is the age ?
10 months

What is the name of this skill ?

Mature pincer grasp

What gross motor skill is associated

with this fine motor skill ?
Walk around with support (furniture)
What is the age ?
18 months

What is the name of this skill ?

Shows 4 parts of the body

How many words he can say ?

10 words

Can this kid use spoon or fork ?

He can use a spoon
What is the age ?
4 years

What’s her pencil skill ?

Draws a cross

How many can she kid count ?

Count to 20

How many colors can she name ?

4 colors
At what age would you expect a
child to stand on one foot ?
4 years
What is the developmental age ?
5-6 years or More than 5 years

Formula that you use

3+(n\4)

If child draw man with 20 parts what

is expected age ?
8 years old