NCM 109
Laboratory Class
Romina O. Berganio, RN, MAN
Professor/Clinical Instructor
DENVER DEVELOPMENTAL
SCREENING TEST
(DDST II)
Learning Objectives
After the laboratory activities, you are expected to:
• Describe the purpose of the Denver Developmental Screening Test
(DDST II) in assessing child development.
• Identify the four key developmental domains assessed by the DDST II:
personal-social, fine motor-adaptive, language, and gross motor skills.
• Describe the target age range for DDST administration and the
appropriate settings for its use.
• Demonstrate the correct administration and scoring of the DDST,
including proper test item selection based on a child's age.
• Interpret DDST results to identify potential developmental delays or
concerns.
• Explain how to communicate screening results to parents and
caregivers in a clear and supportive manner.
Historical Background
Denver II (1992)
- Previously the Denver Developmental Screening test,
DDST(1967)
- Used to identify developmental problems in young
children.
- Has been used and standardized in over 12 countries.
- Used to screen over 50 million children.
Differences between the Denver II and the Denver
Developmental Screening Test:
1) an 86% increase in language items;
2) two articulation items;
3) a new age scale;
4) a new category of item interpretation to identify milder
delays;
6) a behavior rating scale; and
Overview
1. Administered to children ages birth to six years (0-6
y/o)
2. Assesses a child’s performance on various age-
appropriate tasks
3. Screens for possible problems
4. Designed to compare a given child’s performance
with the performance of other children the same
age
Overview
• Includes four areas:
1. Personal –Social: Getting along with people and caring for
personal needs
2. Fine Motor-Adaptive: Eye hand coordination,
manipulation of small objects, and problem solving •
3. Language: Hearing, understanding, and using language •
4. Gross Motor: sitting, walking, jumping, and overall large
muscle movement
• Consists of 125 tasks, or items.
• Includes five “Test Behavior” items to be completed after
the test.
• Subjectively allows screener to assess the child’s overall
behavior
• Designed to be used in a clinical setting by a variety of
professionals
• Must be administered in the standardized manner
Value of the Denver II
1. Provide an organized clinical impression of
a child’s overall development
2. Alert the user to potential developmental
difficulties .
3. Determine how a child compares to other
children
What the Denver is not ?
• Not an I.Q. test
• Not a diagnostic tool
• It is not a predictor of later
development
Test
1. Test Kit
Materials
• Red yarn pom-pom (4” in diameter)
• Raisins or “O” shaped cereal
• Rattle with narrow handle
• 10 1” square colored wooden blocks
• Small, clear glass bottle with a 5/8 inch opening
• Small bell
• Tennis ball
• Red pencil
• Small plastic doll with feeding bottle
• Plastic cup with handle
• Blank paper
1. Test Form •
2. Access to table and chairs (examiner, caregiver and child if appropriate •
For babies, a blanket or cushioned pad is needed •
*Substituting materials may reduced reliability in comparing a tested child
with the norms • *Children need to be supervised appropriately with test
materials to prevent choking or injury
TEST FORM
• Locate four sections on far left:
1. Personal – Social,
2. Fine Motor,
3. Language, and
4. Gross Motor.
• Locate the age scales on the top of the test form and at the
bottom
• Each mark on the scale from the first mark to the 24 month
mark represents one month •
• After 24 months, each mark equals 3 month intervals.
AGE CALCULATIONS
Example Year Month Day
Date of Test 2025 4 4
3 30+4 = 34
Date of Birth -2023 -2 -17
Age of Child 2 1 17
ADJUSTING FOR PREMATURITY
• Born more than 2 weeks before expected delivery date
• Are less than 2 years of age
Age of Child Year Month Day
Age of Child 8 25
7 Weeks -1 -21
Premature
Adjusted 7 4
Age of Child
Test Administration
● Should be given with the parent or primary caregiver present
● Make caregiver and child comfortable to elicit most natural
response
● Remove boots or shoes that might restrict the child motor
movements
● Young child may sit on caregiver’s lap, older child should sit so
arms can rest upon the table
● Elbows should be level with table top
● Infants may be evaluated on the floor
● It should be shared with parent that the tool is to determine
the child’s current developmental status and that the child is not
expected to pass all of the items. • Allow child to have
appropriate item to manipulate while you ask parent the
“Report” questions.•
● Keep test kit out of sight of child. Keep only materials being used
for current activity on the table •
● For infants, it is recommended that all items be administered with
the baby lying down to be tested together •
Test Administration…
• Testing should begin with items that fall completely to the left of the
child’s age line, and continue to the right.
• Items requiring less active participation & can perform easily should
be administered first
○ Items in Fine Motor-Adaptive next (items that do not require child
to speak)
○ Language items next
○ and last the Gross Motor items Gross Motor requires more
confidence which is gained as test progresses.
• Number of Items to be tested •Depends on age and ability of child
•
Step 1: in each sector, administer at least three items nearest to
and totally to the left of the age line and every item that is
intersected by the age line •
Step 2: if the child is unable to perform any item in step 1 (fails,
refuses, has had no opportunity) administer additional items to left
in the appropriate sector until child passes three consecutive items
Scoring
• P = Pass-child successfully performs item, or caregiver reports that
child does item
• F = Fail-child does not successfully perform item, or report from
caregiver is that child does not do item
• N O = No Opportunity-the child has not had the chance to perform
the item, due to restrictions from the caregiver or other reasons (May
only be used on report items)
• R = For Refusal – the child refuses to attempt the item. You can
minimize this by telling the child to do rather than asking. Report items
cannot be scored as refusals.
Continue to administer items to the right of any passes in each sector until
three failures are recorded • The child may be given up to three trials to
perform each item, when appropriate, before scoring a failure •
Ask the caregiver or parent if the results are typical of child’s performance.
Consider if the child is ill, hungry, upset, etc. • Rescheduling may be
necessary if child is not being cooperative
Advanced Item
• If child passes an item that falls completely to
the right of age line, the child’s development is
considered advanced.
• This is an item that most children of that age do
not pass until they are older
• Advanced items are not considered for overall
interpreting of test
Age Line
P
Normal Items
• Child is not expected to pass items on
right (not considered for purpose of
interpreting)
Age Line
F or R
Caution Item
Caution when line falls between 75 and 90
percentile and child fails or refuses
Age Line Age Line
F or R
Delayed Items
• A delay is indicated when a child fails or refuses an
item that falls completely to the left of the age line
• Child has failed an item that that 90% of children in
the standardization sample passed at an earlier
age.
Age Line
F or R
No Opportunity Item
• These items are not considered in
interpretation of entire test
Age Line Age Line
Age Line
NO
Interpretation of the Test
• Normal: No delays and a maximum of 1 caution
• Suspect: two or more Cautions and /or One or
more Delays ,Rescreen in 1-2 weeks.
• Untestable: Refusal scores on one or more
items completely to the left of the age line or on
more than one item intersected by the age line
in the area of 75% - 90% area
Referral Considerations
1. After rescreening, test result is suspect or
untestable
2. Number of cautions and delays
3. Clinical history, examination
4. Availability of referral resource
RLE ACTIVITY No. 3
TITLE: Assessing A Child using the DENVER II Screening
Tool
Duration of Activity: 2 weeks
Methodology:
1. Divide class into groups (4 or 5 students in a group)
2. Each group will select their child client (0-6 years
old)
3. The Activity must be documented in written and
video format.
4. PRESENTATION OF OUTPUT MUST DISPLAY
CREATIVITY AND ACCURACY OF CONTENT.
• “Nursing is an art; and if it is to be made an art, it
requires as exclusive a devotion, as hard a
preparation, as any painters or sculptors work; for
what is the having to do with dead canvas or cold
marble, compared with having to do with the living
body - the temple of Gods spirit? It is one of the
Fine Arts; I had almost said the finest of the Fine
Arts.” - Florence Nightingale
