MMDST (Metro Manila Developmental Screening Test)

MMDST

an early detection model that applies to the detection of developmental disabilities in children 6 ½ years old and younger

MMDST

• Simple & clinically useful tool

• A screening instrument to determine if child’s development is within normal.

• To determine early serious developmental delays

• Developed for health professionals

• (MDs, RNs, etc)

MMDST

• To evaluate the four aspects of a child’s development

• To provide referrals to attending physician regarding essential evaluation or patient outcomes of MMDST

4 aspects of child development

personal-social

fine motor-adaptive

language

gross motor development

personal social

ability to take care of himself and get along w/ people

fine motor-adaptive

ability to see and use his hands to pick up objects and to draw

Language

ability to hear, follow directions and to speak

gross motor behavior

ability to sit, walk and jump

MATERIALS NEEDED

Bright red yarn pom-pom

A rattle with a narrow handle

Eight 1 inch colored wooden blocks (red, blue, green, yellow)

A small clear glass/bottle with 5/8 inch opening

A small bell with 2 ½ inch diameter mouth A rubber ball 12 ½ inch in circumference

Cheese Curls

A pencil & bond Pape

PREPARE THE FORM

Date, Name, Address

THE AGE LINE

months… years…

space between age marks represents:

• 2 weeks until 24 months

• 3 months from 24 months to 5 years

• 6 months from 5 years to 6 years

THE LETTER “R”

letter “R” in the bar indicates “Passed by Report” of the parent

-whenever possible, observe what the child can do rather than ask for a report from the parent

FOOTNOTES

• numbers located at the left end of the bar

• indicates corresponding instruction for administering item

• found at the back of the test form

ARROW ITEMS

• 9 items have arrows (→) at the right end of these bars

• indicates that normal children may pass these items even beyond 6 ½ years of age

arrow items types

1. backwards heel-toe 6.8y

2. recognizes 3 colors 8.1y

3. defines 6 words 8.8y

4. composition of… 8.4y

5. copies 8.0y

6. imitates square, demonstrated 6.8y

7. draws man, 3 parts 6.6y

8. draws man, 6 parts 8.1y

9. dresses without supervision 7.6y

HATCH MARKS

• each test item is represented by a bar

• the bar is placed along the age scale to show when 25%, 50%, 75%, and 90% of children pass the item (indicated by a hatch mark)

CALCULATING THE AGE OF THE CHILD

• determines the basis for drawing the age line later

• determines the test item to be administered

AGE CALCULATION

ask the child’s birthday and calculate the exact age using the formula:

DATE OF TEST - BIRTHDAY = age of child

AGE CALCULATION example

test is administered on october 13, 2023. the child’s birthday is on jan 4, 2018

5 years, 9 months, 9 days

FOR KIDS BORN PRETERM (LESS THAN 37 WEEKS AOG)

1. subtract the number of weeks premature from the age of the child and draw the line at this adjusted age (no adjustments should be made for children born later than expected)

2. write under the date the number of weeks adjusted (after two years of age, it is no longer necessary to compensate for prematurity

practice problem for less than 37 weeks AOG

computed age: 1 yr, 2 mos & 13 days (52 weeks + 8 weeks + 1 week)

AOG at birth: 33 weeks (4 weeks premature)

ADJUSTED AGE: 57 WEEKS (14 ¼ months)

DRAW THE AGE LINE

example: 1 year, 2 months, 13 days (14 months)

DRAW THE AGE LINE instructions

1. use age scale shown at the top and bottom of test form as a guide

2. make calculated age of child on the scale and draw a line through the four sectors of the test form

3. write the date of the test at the top of the age line

4. location of age line must be ACCURATE because the test interpretation depends upon correct placement of this line

DRAW THE AGE LINE example

• if actual age of the child is 14 months and the child was born 6 weeks prematurely or 1 ½ months earlier than the due date

• therefore the age line is drawn 6 weeks earlier than the actual age (12 ½ months—not 14 months)

SELECT ITEMS TO BE ADMINISTERED

1. administer first those items on w/c child’s chronological age line passes

2. if a failure occurs in any of these items, proceed to administer items to the left of the age line until you obtain three passes, then stop

3. in items passed, continue testing to the right where the items become progressively more difficult until the child fails three times in that sector.

• personal social

• imitates housework

• plays ball with examiner

• helps in house simple tasks (R)

• drinks from cup

• fine motor adaptive

• scribbles spontaneously

• tower of 2 cubes

• dumps cheese curls from bottle (demonstration)

• language

• 3 words other than mama and papa (R)

• points to one named body part

• Dada or Mama specific (R)

• gross motor

• stoops and recovers (R)

• walks well (R)

• walks backward (R)

• walks upsteps (R) (23)

2. If a failure occurs in any of these items, proceed to administer items to the left of the age line until you obtain three passes, then stop.

3. in items passed, continue testing to the right where the items become progressively more difficult until the child fails three times in that sector

REMEMBER

• the number of items to be administered will vary with age and abilities of the child

• normally, a child is tested on only twenty simple tasks or items

• the child may accomplish some of the tasks on his own w/o being asked

6. ESTABLISH RAPPORT AND ADMINISTER THE TEST

administering the test preparation

have everything you will need ready:

• a quiet room

• test form with the age line drawn

• MMDST materials

ADMINISTERING THE TEST

start testing items

• personal-social sector →

• fine motor adaptive sector →

• language sector →

• gross-motor sector

ADMINISTERING THE TEST

sequence of items may vary but the manner (words and directions) in which each test item is administered may NOT change

begin testing items which you would expect the child can do easily

TELL the child what to do. Do not ask if he can or he will do the task

allow for 3 trials to perform each item before a failure is given

WHEN TO STOP THE TEST

… when items crossing the age line have already been administered

… when the child has a minimum of three passes to the left of any failure

… when each sector should have at least three passes and three failures

REMEMBER

-MMDST is designed to detect developmental delays in children 2 weeks to 6 ½ tears old

-avoid testing the child when he is ill, sleepy, tired, hungry or upset

INTERPRETING THE RESULT

a delay is any item failed which is completely to the left of the age line

-if the age line touches the right end of the bar, the item is not considered to be a delay

delay steps

1. mark each delay by heavily shading the right end of the bar

2. count the number of sectors that have 2 or more delays

3. count the number of sectors that have 1 delay with no passes intersecting the age line in the same sector

DELAY CRITERIA FOR INTERPRETATION

• 2 or more sectors with 2 or more delays → ABNORMAL

• 1 sector with 2 or more delays plus 1 or more sectors with 1 delay and in that same sector with no passes intersecting the age line → ABNORMAL

• 1 sector with two or more delays → QUESTIONABLE

• 1 or more sectors with 1 delay and in the same sector with no passes intersecting the age line → QUESTIONABLE

• when REFUSALS occur in numbers large enough to cause the test result to be QUESTIONABLE or ABNORMAL if they were scored as failures → UNTESTABLE

• any conditions not listed above → NORMAL

DISCUSSING THE TEST RESULTS

1. ask parent if the child’s performance of his ability and behavior at other times

2. avoid testing child if he is ill, sleepy, tired, hungry, or upset

3. overall interpretation of test results should be given to the parent, not the labels abnormal, questionable, or normal

4. praise the child for a job well done, and reassure the parent that the child is developing as he should be

   1. if the child has a number of delays, remind the parent that this is a screening test and a retest is recommended withing approximately two weeks

RETESTING

1. use the same form

2. draw the new age line and score the new test with a different color of pencil

3. write the date of the new test at the top of that age line

4. refer a child with abnormal, questionable or untestable result to a pediatrician for further evaluation, if possible

5. after further assessment, teach parents regarding skills, in developmental stimulation of their children

6. perform continued surveillance and periodic retesting of the children identified to be at risk

HANDLING DIFFICULT SITUATIONS

• the shy child

• the uncooperative child

• child with many siblings

• hyperactive child

• the interfering parent

the shy child

• offer a toy or kit item to pllay with

• give more time to become familiar with tester an test materials

• ask the parent to adminster some items or to show how they are done

the uncooperative child

• approaches for the sky child may also be used

• ask parent to leave the room or to turn away but within seeing distance of the child

• reverse psychology may work

child with many siblings

• explain to the parent the need to test each child individually

• ask the parent to send the siblings on errands

hyperactive child

• bring out only the materials needed for each test item

• do the test in a quiet room

• call the child’s name or simply touch his arm to return his focus'

• master the test items

the interfering parent

• remind the parent that the child is not expected to perform everything asked of him

• have the parent leave the room

• discontinue the test and reset the re-screening within 2-3 weeks

MMDST IN THE CLINICAL SETTING

administer test only to:

• infants and children whose age ranges from 2 weeks to 6 ½ weeks

  • newly admitted patients prior to blood extractions, IV insertions and any other invasive or non-invasive procedures

  • patients without IV lines

  • patients not in any form of distress or cardiopulmonary failure

  • patients awaiting surgery

  • post-operative patients without surgical complications