Assessment of

development and Growth

What are developmental
milestones?

 Defined by Illingworth in his milestone theory as

Set of functional skills or age-specific tasks

that most children can do at a certain age range

 Milestone = standard for skill acquisition

 Defines the child’s “developmental age”

 NB norms are based on children of full gestational age

 Although each milestone has an age level, every child is

unique, and the impact of intrinsic and extrinsic factors may
vary Therefore it is accepted that standard deviation/variation
of one month on either side is allowed
Milestones vs.
developmental sequence
 Both are important components to consider when assessing and
treating children with developmental concerns

 Developmental sequence refers to the typical pattern or

development , of the components of movement & timing thereof

 Need to understand the components and the sequencing of the

components in the developmental sequence

 Whilst when looking at milestones your are assessing the skills or

tasks a child has achieved for his age
Developmental Screening tests

1- Screening Tests
 Milani- comparetti motor development screening test
 Denver II
2-Tests of motor performance
 Alberta Infant Motor Scale (AIMS )
 Bruininks-Oseretsky test of motor proficiency
 Movement assessment of infants
 Peabody Developmental motor scales
 Gross motor functional measure (GMFM)
 Test of Infant Motor Performance
Denver Developmental
Screening Test - 2

Very commonly used screening tool

Birth to 6 years old
Poor sensitivity and specificity (40-60%)
10-20 minutes to administer
Normed on diverse population sample
Multiple languages
Domains: fine and gross motor, language,
and social skills
DDST (continued)

Identifies children at 25,75, and 90%

completion of task
Scored as concern if child completing task in
shaded area (75-90%)
Scored as failure if not completed by time 90%
complete
Referrals warranted for one failure or two
concerns
Correct for prematurity till 2 years old
chronological age
Bayley Screener

Ages 3 to 24 months
Direct observation of skills by provider
Assesses three domains (more neuro focused)
11-13 items at each age group (3-6 month
breaks)
Specificity and sensitivity 75-86%
10-15 minutes to administer
Not standardized in Spanish
 Peabody Developmental
Motor Scales – Second
Edition (PDMS-II)

Purpose

Provides a comprehensive sequence of

gross and fine motor skills from
which the developmental skill level
can be obtained
 Peabody Developmental Motor Scales
– II
PDMS-II

Advantages

Norm-referenced
Valid and highly reliable measure
Discriminates motor problems from normal
developmental variability i.e. those known to
be “average” and those expected to be low or
below average
PDMS-II

Disadvantages

Assesses only motor areas

Not responsive to change in children with

severe physical disabilities

Not necessarily valid for planning

intervention
Test of Infant Motor Performance
TIMP

Purpose
A test of functional motor behavior in infants
between the ages of 34 weeks postconceptional
age and 4 months post-term.
Constructed to assess postural control needed in
age-appropriate functional activities involving
movement
Intended to signal developmental deviance at an
early stage so that effective intervention can
prevent serious impairment.
 TIMP

Advantages
Discriminates among infants with varying degrees
of risk for poor motor outcome
Predicts 12-month motor performance with
sensitivity 92%
Can be used in the special care nursery and in
community-based programs
Looks at quality of movement in a functional
context versus just skills
Useful for planning interventions for high risk
infants or infants with neurological conditions
TIMP

Disadvantages

Targets a very finite population

Designed to be administered by
therapists with close contact and
personal emotional involvement with the
babies.
GMFM: Gross Motor
Function Measure, Part I

Kathy McKellar, “Knowledge Broker”

January 2007

 Based on a presentation by Dianne Russell, CanChild

Centre for Childhood Disability Research, Knowledge
Broker project co-investigator
GMFM

Criterion-referenced test: evaluates

performance of motor skills on that day;
useful for comparison over time
Measures how much of a task the child
can accomplish, rather than how well the
task is completed (quantity, not
movement quality)
Who is the GMFM
appropriate for?

Children with CP: original validation

sample included kids 5 mo- 16 yrs
May be appropriate for children with other
diagnoses
GMFM is appropriate for children whose
motor skills are at or below those of a
typical 5 year old.
Time required

GMFM 88: approx. 45-60 minutes

GMFM 66: faster, allows for some missing
data (items that are not tested)
Can be completed in more than 1 session
(ideally complete all items within 1 week)
 GMFM-88
88 items in 5 gross motor dimensions (for
ease of administration):
lying and rolling
crawling and kneeling
Sitting
Standing
walking, running and jumping
Why use the GMFM?

Reliable, valid
Internationally accepted: Translated into
several languages, including Dutch, French, German,
Icelandic, Japanese
Considered best practice
Used as an outcome measure
Used as an outcome measure

 Surgery (rhizotomy, pallidal stimulation, muscle tendon)

 Drugs (botulinum toxin, intrathecal baclofen)

 Physical therapy (including ambulatory aids & orthoses)

 Horseback riding

 Strength training & physical fitness

Use of the GMFM in other
populations

Osteogenesis imperfecta (Ruck-Gibis et al.

2001)

Lymphoblastic leukemia (Wright et al.

1998)

Down syndrome (Russell et al. 1998)