Denver II (DDST) Screening
Jennifer Fisher
March 30, 2011
NUR 314
Professor Lutrell
Introduction
Mental health, intelligence, motor skills, language, and social skills all of these are skills identified in the Denver II Screening (DDST) (“Denver developmental materials,,” 2002). The DDST is a group of tests given to children in order to view a brief look at their current development, identifying areas in which the child has strengths or weakness (“Denver developmental materials,,” 2002). The tests developed were standardized using over 2000 children and includes norms that are specified for subgroups within the population (“Denver developmental materials,,” 2002). The DDST is a wonderful way to be able to see where a child measures in the norms of other children on the developmental scale.
DDST Screening
On March 27, 2011 a beautiful little girl by the name of Jordyn was tested using the DDST. On August 15, 2010 Cassandra gave birth to Jordyn at Paradise Valley Hospital in Phoenix, Arizona. Her age calculation according to the Denver II guidelines is seven months and twelve days old. She was not born prematurely; therefore no adjustments to the calculations are necessary. Shown below is the age calculation:
Year Month Day
Date of Test: (2011 – 1=) 2010 (3 + 12=) 15 27
Date of Birth: -2010 -8 -15
Age of child: 0 7 12
When performing the Denver II Screening on Jordyn, she was extremely pleasant and happy baby. Going over the Personal – Social section of the testing Jordyn passed every test until she attempted Play Pat – A – Cake. When she is placed on her back and smiled at she gets the biggest smile, passing the smile responsively test. She also smiles spontaneously without being touched, sounds being made, or without someone else smiling first. Jordyn was caught staring at her hands momentarily for several seconds before her attention was distracted with something else in the room, passing the regard own hand test. Her favorite toy was then placed in front of her, just out of immediate reach. Upon seeing this she reached out for the doll, attempting to grab the doll and bring it into her. She also does great with finger foods and crackers. When crackers are placed in front of her Jordyn immediately grabs them and starts to eat the food. Her mother stated that this milestone was accomplished just before six months. During the Play Pat – a – Cake section she seemed like she wanted to play, however, she did not play or attempt to. When her mother was asked whether Jordyn played any clapping games, it was reported that she does not. Next was the Indicate Wants test, this one Jordyn indicates what she wants but it is through crying that it is known she wants something. When leaving after spending the afternoon with Jordyn and Cassandra upon waving to Jordyn and saying bye – bye she just smiled and got giddy but no attempt to wave was made. Cassandra also commented that her daughter was not waving goodbye to people just yet. Having three consecutive failures in a section we moved to testing Jordyn in the Fine Motor – Adaptive section.
Following to Midline, Past Midline and 180 degrees all were passed by Jordyn. It took a little time since she kept getting distracted, so the test would be stopped in order to get her focus back on the string. Her grasp is strong especially when a rattle is allowed to be in her hands. A rattle was touched to the tips of her fingers, upon feeling this she grabbed the rattle and held on for several moments. According to her mother Jordyn was able to accomplish this at three months of age. When Jordyn was placed on her back without her mother holding her she would bring her hands together at her mouth. By doing this she passed the Hand Together test in the Denver II Screen. Another test that was performed to test her development in the fine motor adaptation was placing a raisin on the table and seeing if Jordyn would clearly look at the object. She clearly looked at the raisin for several minutes, when the raisin was picked up and moved closer to her, Jordyn picked up the raisin using a raking motion. This raking motion uses the whole hand to pick an object up. Bringing back the rattle, from previous tests, placing it on the table just out of Jordyn’s immediate reach she reached out to grab the toy. She also looked for the red yarn that was dropped in front of her. Another test that was performed was Pass Cube, this test in order to pass the child had to pass a block form one hand to the other. In passing the block the child is not allowed to use his body, mouth, or the table that is there. Jordyn at first was unsure of what to do with the block, but after presenting a second block to that same hand she transferred the first block in order to obtain the second block. When two blocks were placed in front of her, she picked up both blocks. It took a lot of encouragement to get her to attempt this, but she did so after a while. She was able to pass all of these tests until the Thumb – Finger Grasp was attempted, she can pick up the raisin. However, Jordyn can still only pick up the raisin through a raking phase. Upon testing her on banging the two cubes together, she failed. Jordyn is able to bang the pots or lids that her mom places in front of her but not the small objects that are presented. She is still not able to place a block in the cup, even after her mother demonstrated for Jordyn. After having these three consecutive fails we attempted the Language section of the Denver II Screening.
Jordyn is quite the talker as soon people were present she started verbalizing, oohing, and aahing. The oohing and aahing started when she was about three to four weeks old. She was constantly laughing or squealing throughout the afternoon. Her mother states that: “Jordyn is constantly laughing, giggling, and smiling.” When the rattle sound was made out of her immediate sight she turned towards the sound, this occurred for both ears. She also responded by turning to the sound of her name being called out softly behind her head. She speaks single syllables and imitates speech sounds. She imitated kissing sounds that her mother was making towards her. While being present and testing Jordyn she never said mama or dada. When Cassandra was asked if she says either name it was reported that Jordyn says both. She is also able to combine her syllables as reported by her mother. She is also the queen of jibberish. While her parents and I were speaking she was having her very own conversation with herself, but no words were distinguishable with her. Listening to Jordyn speak her jibberish she passed the Jabbers test. During the test she never spoke the words mama or dad but when Cassandra was asked if she used the words specifically with them Cassandra stated that her daughter does. As of right now Jordyn is not able to speak actual words other than mama and dada, therefore she failed the next three blocks of the test. Having finished testing her on her language development her Jordyn’s gross motor skills were test next.
Jordyn’s gross motor skills are in tact. She has equal movements in her extremities when placed on her back. She also is capable of lifting her from a flat surface through to 90 degrees. Her mother states that she was starting to lift her head to 90 degrees at three months of age. When she is placed in a sitting positions her head is able to stay upright and steady. In a standing position when her hands are held loosely allowing her weight to be placed on her legs and feet Jordyn is able to hold her weight. Further more when Jordyn is placed lying on her stomach she lifts her head and chest off of the floor with her arms. During the testing it was seen that Jordyn is able to roll from her back to stomach. Upon placing Jordyn on her back, grasping her hands and gently pulling her upward to sit, no head lag was present. This was accomplished at five months of age for Jordyn. She also had no problem with sitting on her own with no support for approximately eight seconds. While she was in a sitting position she had her hands placed on her legs for support until she was placed in a standing position. For this standing position she used a chair to help steady herself and was able to hold this position for just over five seconds. Upon placing a toy on a chair in front of Jordyn she was unable to pull herself to a standing position to obtain the toy. Having failed this she then failed the Get to Sitting position and Stand – 2 seconds test as seen and stated by her mother.
The setting of the DDST occurred at Jamie’s house, Cassandra’s older sister. It was a single story house off of 42nd Street and Thunderbird. Located in a residential area, the home has a pool and decent size yard for Jordyn to play in. The pool has a locked fence surrounding it and she is never allowed to be outside unless an adult is present. The room in which the testing occurred was Jamie’s room. In this room was a twin size bed on which the testing was performed. Those who were in the room during the testing included: Jamie (aunt), Cassandra, and the tester. Jordyn’s father is no longer a part of their family and was not present for the testing. Some of the distractions that affected the testing were the presence of the family dog, fan, and the child being an infant with a short attention span. All of these made the test duration longer, however, these distractions did not inhibit the testing or its results.
The results of this Denver II Screening show that Jordyn is within the normal and appropriate developmental growth for her age (Archer et al, 1992). Jordyn was able to pass all of the blocks on the left side of her vertical growth line. This exact line is set at seven months and twelve days old, can be seen at Appendix A. All the blocks to the left of the vertical line are skills that Jordyn should be able to pass at her age. The skills to the right are skills that her mother should anticipate her achieving in the next couple of months to years. Having not failed any of the tasks to the left of her age line, Jordyn is growing developmentally appropriately for her age group (Archer, et al 1992). She is continuing to grow, becoming more curious about her surroundings and testing her limitations.
All of these results were explained to Cassandra, the mother. Explaining that Jordyn is growing and developing at an age appropriate level based off of the DDST results and its previous research data. Cassandra was curious about the blocks to the right of the vertical age line. It was explained to her that the DDST itself is a test that ranges for children starting at one month old and goes through to six years old. The tasks that are to the right of her age line are for children who are older than the seven-month-old marker. These tasks are much more of a challenge and not appropriate for her age as of now. Once this was explained to Cassandra she was much happier, stating that she had been worried that Jordyn was not developmentally where she needed to be for her age.
Seeing that Jordyn passed the Denver II Screen with no problems, there are no apparent concerns for her development. There are several resources though, that are available to Cassandra if she has any concerns or is in need of assistance during Jordyn’s growth. If there are any questions that Cassandra has in regards to the DDST and its results she can go to the DDST website at http://www.denverii.com/DenverII.html. The CDC, Center for Disease Control and Prevention also has a link that would benefit both Cassandra and Jordyn. This site http://www.cdc.gov/growthcharts/who_charts.htm allows for Cassandra to view recommendations for where Jordyn should be growth wise and developmentally. Cassandra should be anticipating Jordyn crawling and standing on her own soon. With these new steps in growth Cassandra should start enforcing safety measures that will reduce the likely hood of Jordyn becoming injured. These safety measures can be, child proof locks on cupboards and toilets, storing chemicals and medications out of reach for Jordyn, door locks in place, doggy doors shut, small objects removed from the floor or out of her reach, and ensure that appliances that can be pulled of the shelf are out of reach or put away.
Growth Assessment
On March 18, 2011 Jordyn had a wellness check up with her pediatrician. At this appointment her measurements were: length 25.2 inches, or 64 centimeters. Her weight was 16.3 pounds, or 7.4 kilograms. Her head circumference was 17.1 inches, or 43.4 centimeters. These measurements, along with the DDST measurements are all appropriate for her growth based off of the CDC recommendations. Please see Appendix B in order to view the chart.
Jordyn’s weight of 16.3 pounds falls within about the 75th percentile for children her age in the national average (CDC, 2010). Her weight and head circumference also fall within the 10th – 90th percentile for the national average of children her age. Seeing that these are all within the appropriate ranges recommended by the CDC for her age group there are no immediate concerns that there is an unhealthy growth pattern existing for Jordyn (CDC, 2010).
Jordyn is a bright and healthy infant, however, she should still be monitored in order to prevent complications that could happen later in her life. As a nurse it is important to emphasize the necessity for Jordyn to continue obtaining healthy and good nutrients. Since she is able to feed herself finger foods, slicing bananas or string cheese would be a great option for snacks. Since her weight is close to the 90th percentile it is important to monitor her weight making sure that she does not become overweight or obese. By becoming obese or overweight future complications would be a concern (Hockenberry & Wilson, 2007). Cassandra stopped breasting feeding her just before six months of age because of her busy schedule with work and school. Due to this it is important that Cassandra enforces giving Jordyn iron-fortified formula and continues to encourage healthy foods in the future. Cassandra should be further encouraged/taught what healthy foods are appropriate to be given now to Jordyn and what snacks and foods should be given to her in the future. Other concerns would be to have Cassandra start exercising and eating healthy. As Jordyn continues to grow what she sees her mother doing she will do as well. Watching her mother exercise, eat healthy, and being active will be an encouragement to Jordyn when she is older and can understand what is happening in her surroundings. Further more, it is recommended that Jordyn continue with her wellness visits to the pediatrician. It is important to have these regular visits so that her vaccines can be given within an appropriate amount of time, growth, weight, and developmental status can be monitored as deemed necessary. At the physicians office they can also teach Cassandra about child safety in the car and at home. In order to ensure Jordyn’s health and safety it is vital that her mother be taught and encouraged to seek help when necessary.
Conclusion
Based off of the all the information obtained Jordyn has been proven to be a beautiful and healthy infant. Her growth of weight, height, and head circumference are all within the nationally accepted normal age range. As well as, her developmental growth has been proven to be within the age – appropriate development. Cassandra, her mother, was given resources for any future needs or concerns about Jordyn’s health. As Jordyn continues to grow her health, mental, and physical development should be monitored in order to predict any complications that may occur in the future.
References
Archer, P, Bresnick, B, Dodds, J, Edelman, N, Frankenburg, W.K., Maschka, P., &
Shapiro, H. (1992). Denver II Training Manual. Denver: Denver Developmental
Materials, Inc.
Center for Disease Control and Prevention. (2010, September 9). Growth charts.
Retrieved from http://www.cdc.gov/growthcharts/who_charts.htm
Hockenberry, M. J. and Wilson, D. (2007). Wong's Nursing Care of Infants and Children
(8th ed.). St. Louis: Mosby.
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