Evaluation of child development: beyond the neuromotor aspect

Eickmann, Sophie Helena; Emond, Alan Martin; Lima, Marilia

doi:10.1016/j.jped.2016.01.007

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Review articles • J. Pediatr. (Rio J.) 92 (3 Suppl 1) • May-Jun 2016 • https://doi.org/10.1016/j.jped.2016.01.007 copy

Evaluation of child development: beyond the neuromotor aspect^☆ ☆ Please cite this article as: Eickmann SH, Emond AM, Lima M. Evaluation of child development: beyond the neuromotor aspect. J Pediatr (Rio J). 2016;92(3 Suppl 1):S71–83.

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Abstract

Objective:

To review the epidemiology and update the scientific knowledge on the problems of development and behavior in childhood, and the recommendations for the role of the pediatrician in identifying and managing delays and disturbances in child development and mental health.

Sources:

A search for relevant literature was performed in the PubMed and Scopus databases and publications of the National Scientific Council on the Developing Child.

Summary of the findings:

With the decline in the incidence of communicable diseases in children, problems with development, behavior, and emotional regulation are increasingly becoming a part of the work of pediatricians, yet many are not trained and feel uncomfortable about this extension of their role. The available screening tools for child development and behavior are reviewed, and a ‘school readiness’ checklist is presented, together with recommendations on how the pediatrician can incorporate developmental surveillance into routine practice, aware of the need for children to acquire social, emotional, and cognitive skills so that they can develop their full potential.

Conclusions:

The pediatrician's role in the future will include both physical and mental health, recognizing that social development, resilience, and emotional maturity are as important as physical growth and neuromotor skills in a child's life course.

Keywords
Child development; Mental health; Behavior disorders; Screening tests; Toxic stress; School readiness

Multi-domain screening tools filled in by parents
Name of tool	Domains of development and description	Age range	Time for administration	Scoring system	Psychometric information	Who applies the tool
Ages and Stages Questionnaire, 3rd ed. (ASQ-3)⁴⁷47 Squires J, Twombly E, Bricker D, Potter L. The ASQ-3™ user’s guide. Baltimore, MD: Paul H. Brookes Publishing; 2009.	Communication, gross motor skills, fine motor skills, personal/social problem solving. Each domain contains six questions about important milestones of development appropriate for each age group, totaling 30 items. It comprises 21 questionnaires for each age interval (2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, and 36 months). The ASQ-3 has been translated into Portuguese and validated in Brazil.⁴⁸48 Filgueiras A, Pires P, Maissonette S, Landeira-Fernandez J. Psychometric properties of the Brazilian-adapted version of the Ages and Stages Questionnaire in public child daycare centers. Early Hum Dev. 2013;89:561-76. Product Information: www.brookespublishing.com	1-66 months	10-20 min	The answers to each question may be: "Yes" (10 points), "Sometimes" (5 points) and "Not yet" (0 points). Responses are converted into scores for each of the five domains and are compared to standard values for age. Scores equal to or below the cutoff indicate developmental delay	Sensitivity: 82-89%; specificity: 77-92%	Parents/caregivers. Scoring of the questionnaire should be carried out by healthcare professionals

Ages and Stages Questionnaires: Social-Emotional (ASQ:SE-2)⁴⁹49 Squires J, Bricker D, Twombly E. The ASQ:SE user’s guide for the Ages & Stages Questionnaires®: Social-Emotional: a parent-completed, child-monitoring system for social-emotional behaviors. Baltimore, MD: Paul H. Brookes Publishing;2002.	It was designed to identify children that need further evaluation in the area of social and emotional development, including self-regulation, communication, autonomy, coping, and relationship. It consists of nine questionnaires for ages 2, 6, 12, 18, 24, 30, 36, 48 and 60 months. English and Spanish versions are available. Product Information: www.brookespublishing.com	1-72 months	10-15 min	Each questionnaire generates a single score, which, if above the cutoff, differently from the ASQ-3, indicates developmental delay	Sensitivity: 71-85%; specificity: 90-98%	The same as above

Bayley Scales of Infant and Toddler Development, Screening Test III, 3rd ed.⁵⁰50 Bayley N. Bayley scales of infant and toddler development. Screening test manual. 3rd ed. Oxford: PsychCorp; 2006.	Cognition, language (expressive and receptive), motor skills (gross and fine). The questions were selected from the Bayley Scales of Infant and Toddler Development (3rd ed.). In each item, there are two response options, depending on the observation of the behavior: "1" if present and "0" if absent. English and Spanish versions are available. Product Information: www.harcourtassessment.com	1-42 months	15-25 min	The evaluation of each domain produces scores, allowing the examiner to compare them with the cutoff for each age and classify the child's development as "Risk", "Emerging" and "Competent"	Accuracy ranged from moderate to good in relation to the Bayley Scale of Infant and Toddler Development III	Direct administration by trained professional

Denver Developmental Screening Test II, 2^a ed. (DDST-II)⁵¹51 Frankenburg WK, Dodds J, Archer P, Shapiro H, Bresnick B. The Denver II: a major revision and restandardization of the Denver Developmental Screening Test. Pediatrics. 1992;89:91-7.	Motricity (gross and fine), language and personal-social competence. It presents 125 items divided into four domains and four age groups. It also has a pre-screening developmental questionnaire (PDQ-II), consisting of 91 questions extracted from the DDST-II. A Portuguese version of the Denver II test is available.⁵²52 Souza SC, Leone C, Takano OA, Moratelli HB. Development of children enrolled in preschools in Cuiabá, Mato Grosso State, Brazil. Cad Saude Publica. 2008;24:1917-26. Product Information: www.denverii.com	1-72 months	10-20 min	The child is categorized as "Approved/Not approved" at each question and the answers are checked whether they are within the expected range of normal development for each age. The child is classified as "Normal," "Suspected," or "Delayed"	Sensitivity: 56-83%; specificity: 43-80%	Direct administration by trained professional and interview with parents about some items

Modified Checklist for Autism in Toddlers (M-CHAT)⁵³53 Robins DL, Fein D, Barton ML, Green JA. The Modified Checklist for Autism in Toddlers: an initial study investigating the early detection of autism and pervasive developmental disorders. J Autism Dev Disord. 2001;31:131-44.	To identify children at risk for autism spectrum disorder. It has a mean of 23 items with "Yes" and "No" responses. It addresses social interaction, communication, shared attention, symbolic play and social referencing. The M-CHAT scale has been translated and validated into Portuguese.⁵⁴54 Lopásio MF, Pondé MP. Tradução para o português da escala M-CHAT para rastreamento precoce de autismo. Rev Psiquiatr Rio Gd Sul. 2008;30:221-9. There is a new version of the M-CHAT-R/F that has not been translated into Portuguese yet. Product Information: www.firstsigns.org or www.mchatscreen.com	16-30 months	5-10 min	Children who fail a total of 3 or more items or in two or more critical items should be referred for diagnostic assessment by a specialist in evaluating ASD in very young children	Sensitivity: 85-87%; specificity: 93-99%	Parents/caregivers

Swanson, Nolan and Pelham Scale (SNAP-IV), abridged version⁵⁵55 Swanson JM. School-based assessments and interventions for ADD students. Irvine, CA: KC Publishing; 1992.	It assesses the severity of inattention and hyperactivity/impulsivity through quantitative scores. There are 18 items (nine symptoms of inattention, six of hyperactivity and four of impulsivity) with 4 levels of severity: "Not at all," "Just a little," "Enough," and "Too much". There is a translated and adapted version for the Portuguese language.⁵⁶56 Mattos P, Serra-Pinheiro MA, Rohde LA, Pinto D. Apresentação de uma versão em português para uso no Brasil do instrumento MTA-SNAP-IV de avaliação de sintomas de transtorno do déficit de atenção/hiperatividade e sintomas de transtorno desafiador e de oposição. Rev Psiquiatr Rio Gd Sul. 2006;28:290-7. Product Information: www.tdah.org.br	6-18 years	5-10 min	If at least six items from items 1-9 are marked as "Enough" or "Too much," there are more symptoms of inattention than expected. If at least six items from items 10-18 are marked as "Enough" or "Too much", there are more symptoms of hyperactivity/impulsivity than expected	Lack of publications on psychometric properties	Parents/caregivers or teachers

Strengths and Difficulties Questionnaire (SDQ)⁵⁷57 Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40:1337-45.	Screens for mental health problems in five areas: four on difficulties (emotional symptoms, behavioral problems, hyperactivity/inattention, and peer relationship problems) and one on abilities (prosocial behavior). It has 25 items, divided into 5 subscales. Response options for each alternative: "False" (zero), "More or less true" (one point), and "True" (two points). The Strengths and Difficulties Questionnaire has been translated into Portuguese and validated for Brazil.⁵⁸58 Saur AM, Loureiro SR. Qualidades psicométricas do Questionário de Capacidades e Dificuldades: revisão da literatura. Estud Psicol (Campinas). 2012;29:619-29. Product Information: http://www.sdqinfo.com	2-17 years	5-10 min	There is a version to be answered by parents and teachers of children aged 2-4 and 4-17 years. There is also a version for adolescents aged 11-17 years. Total and sub-scale scores are obtained, generating three categories: "Normal," "Borderline," and "Abnormal"	Sensitivity: 85%; specificity: 80%	Parents/caregivers, teachers and the children aged 11-17 years

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E-mail: jped@jped.com.br

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[1] ∗ Corresponding author. E-mail:sophie.eickmann@gmail.com (S.H. Eickmann).

Social skills
•			Uses words to solve problems or conflicts
•			Uses words like please, thank you and excuse me
•			Adjusts to new situations
•			Attempts new tasks knowing it's okay to make mistakes
•			Shows pride in accomplishments
•			Follows a simple direction
•			Stays with an activity to completion
•			Asks for help
•			Interacts appropriately with adults and peers
•			Respects the rights, property and feelings of others
•			Works cooperatively (listens to others, shares and takes turns)
•			Demonstrates increasing self-control
•			Participates in clean-up activities
•			Takes responsibility for own belongings (lunch, coat, etc.)
•			Is able to dress self
•			Adheres to a routine and schedule for personal hygiene, eating meals and going to bed
•			Uses good hygiene habits and table manners
•			Uses appropriate bathroom skills
•			Follows simple safety rules
•			Offers to help peers and family
•			Tries to regulate emotions properly and articulates feelings in words
Motor skills
•			Puts puzzles together
•			Cuts with scissors
•			Holds and uses crayons, markers, pens and pencils correctly
•			Builds using blocks
•			Tries to tie own shoes
•			Bounces, kicks, throws and catches a ball
•			Rides a tricycle
•			Enjoys outdoor activities, like running, jumping and climbing
Reasoning & concept development
•			Matches or groups objects according to size, shape or colour
•			Groups objects that are the same
•			Understands concepts of in/out, under/over, on/off, front/back, etc.
•			Shows an understanding of the passing of time, including concepts of before and after, and today, yesterday and tomorrow
•			Experiments enthusiastically with new games and toys, sometimes in a trial-and-error manner
•			Describes how objects are the same or different
Language skills
•			Talks in sentences
•			Follows one- and two-step oral directions
•			Uses sentences that include two or more ideas
•			Uses descriptive language
•			Knows by heart and recites some common nursery rhymes and songs
•			Pretends, creates and makes up songs or stories
•			Tells or retells stories and/or everyday experiences
•			Asks questions and expresses curiosity
•			Expresses ideas so that others can understand
Reading skills
•			Looks at books or pictures on their own
•			Pretends to read books by reading the pictures
•			Tries to read in everyday situations (signs, labels, etc.)
•			Recognizes rhyming words
•			Blends sounds into words
•			Recognizes some common words in print
•			Recognizes many uppercase and lowercase letters
•			Recognizes some letter sounds
•			Describes characters' actions and feelings in a story
•			Relates stories to personal experiences
•			Puts events of a story in order
Writing skills
•			Tries to write, scribble or draw
•			Asks you to write words or notes to others
•			Attempts to write own name and recognizes own name in print
Mathematics concepts
•			Compares the size of groups of objects using language such as "more," "less" and "same as"
•			Arranges objects in size order (big to small, or small to big)
•			Uses comparison words, like "bigger," "smaller," "heavier," etc.
•			Understands concepts of none, some and all and more than and less than
•			Identifies and draws a square, circle and triangle
•			Correctly counts four to ten objects
•			Knows that the final number counted represents the total number of objects in a set
•			Recognizes some numbers, 1 - 10
•			Can distinguish numbers from letters, and understands that numbers relate to quantity
•			Understands the effects of addition and subtraction
Science
•			Shows interest and asks questions about objects and events observed in their environment
•			Notices common properties and differences among objects and materials
•			Knows some facts about common plants and animals, such as what they eat and baby names
•			Recognizes some objects in the sky such as the sun, moon, clouds and lightning
Creative arts & music
•			Recognizes and names basic colours
•			Draws recognizable shapes and simple objects
•			Tells a story with pictures
•			Moves to a beat
•			Explores with common musical instruments
•			Enjoys improvising or copying musical patterns
Social studies
•			Recognizes basic traditions such as birthdays
•			Understands that people live in different parts of the worlds and have different customs and traditions
•			Ex lores sim Ie ma s and visual re resentations of nei hbourhoods or communities

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Evaluation of child development: beyond the neuromotor aspect☆ ☆ Please cite this article as: Eickmann SH, Emond AM, Lima M. Evaluation of child development: beyond the neuromotor aspect. J Pediatr (Rio J). 2016;92(3 Suppl 1):S71–83.

Abstract

Objective:

Sources:

Summary of the findings:

Conclusions:

Evaluation of child development: beyond the neuromotor aspect^☆ ☆ Please cite this article as: Eickmann SH, Emond AM, Lima M. Evaluation of child development: beyond the neuromotor aspect. J Pediatr (Rio J). 2016;92(3 Suppl 1):S71–83.