Lesson 2- MMDST.pdf

1 MMDST (Metro Manila Developmental Screening Test) MA. FRANCHEZKA ALLYSON L. CASTRO PALAWAN STATE UNIVERSITY COLLEGE OF NURSING AND HEALTH SCIENCES FEBRUARY 2021 ...

1 MMDST (Metro Manila Developmental Screening Test) MA. FRANCHEZKA ALLYSON L. CASTRO PALAWAN STATE UNIVERSITY COLLEGE OF NURSING AND HEALTH SCIENCES FEBRUARY 2021  2 Republic of the Philippines PALAWAN STATE UNIVERSITY Puerto Princesa City COLLEGE OF NURSING AND HEALTH SCIENCES MODULE CONTRACT Module Contract between __________________________________ (Student) and MA. FRANCHEZKA ALLYSON L. CASTRO, RN (Instructor) for this module. Metro Manila Developmental Screening Test of the course NCM 106 B – Care of Mother, Child and Adolescent (Well Client), offered to BSN II in 1ST SEMESTER, SY 2021-2022. TERMS & CONDITION Learning resources required: You need to obtain or access the following resources: 1. Pillitteri, A. (2014) 7th Edition. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family 2. Google, Google classroom & Google meet. 3. Youtube 4. PSU Corporate Email Requirement: You should complete this module on or before the deadline Metro Manila Developmental Screening Test (MMDST) September 1, 2021 Course availability and completion assessment: This module will be available for you online in google classroom or email address. Online supplemental materials and useful links will be provided. Virtual class meeting will be scheduled when necessary on the day and time of the class as reflected on your certificate of registration (COR). Any concern or queries for this course will be entertained through email, google classroom or scheduled google meeting. Completion of all or the required modules for this course will be one of the basis for the computation of your grade. Type your name here as your Signature: __________________________________________________ Date: __________________________________________ Mobile Number: _________________________________ E-mail address: __________________________________ Anything I should know or you would like to share with me? _________________________________ _________________________________________________________________________________ MA. FRANCHEZKA ALLYSON L. CASTRO, RN, MSNc Instructor  3 Lesson 2: Metro Manila Developmental Screening Test (MMDST) OVERVIEW This lesson will give you, the learner the basic knowledge on terms and definition used in the course Care of Mother, Child and Adolescent (Well client). This will also help you to properly assess the child with developmental disabilities and facilitates early referral and treatment. LEARNING OUTCOMES Upon completion of this lesson, you will be able to: TOPIC 1. Define Metro Manila Screening Test (MMDST) TOPIC 2. Understand the purpose of MMDST and identify materials needed for the screening. TOPIC 3. Understand the use of the Test Form and calculate child’s age. TOPIC 4. Enumerate Test Directions TOPIC 5. Explain overall interpretation of test result of growth and developmental status. REMINDER! Before we continue to discuss the concept please make sure that you have Read the Lesson 1: Developmental Stages and you have your materials with you.  4 What is Metro Manila Developmental Screening Test (MMDST)? Developmental Screening Test was developed by Dr. William K. Frankenberg and his associate in the year 1967 intended for the Denver children and was named Denver Developmental Screening Test. It was modified and adapted by Dr. Phoebe D. Williams on Metro Manila Children and was named Metro Manila Developmental Screening Test (MMDST). This is a type of test that is used for early detection of developmental disabilities to children that belongs to the range of age 6 ½ years old and below. It is designed to recognize the slow development, so referrals will be made and appropriate therapy will be prescribed as soon as possible. It is also intended to determine whether a child’s development is appropriate within the normal range. MMDST is a screening test. This is not an intelligence test, or a diagnostic test and it is not a predictor of the future adaptive or intellectual ability. In the care of pediatric clients, growth and development are not in isolation. Nurses being competent in the aspects of growth and development particularly principles, theories and milestones are in best position to counsel clients on these aspects. Having background knowledge on growth and development, nurses are equipped with assessment skills to determine developmental delays through the aid of screening tests. MMDST Evaluates four (4) sectors of development: Personal-Social – Task which indicate the child’s ability to get along with people and to take care of himself. Fine – Motor Adaptive – Tasks which indicate the child’s ability to see and use his hands to pick up objects and to draw. Language – Tasks which indicate a child’s ability to hear, follow directions and to speak. Gross Motor – Tasks which indicate the child’s ability to sit, walk and jump. Source: https://www.rnpedia.com/nursing-notes/metro-manila-development-screening-test-mmdst/  5 Purpose of Metro Manila Developmental Screening Test (MMDST) This test serves as a tool for early detection of developmental delays of the child. Through this early referrals and treatment will be made as early as possible to prevent the severity of the identified delays. If these delays will not be treated, the child may suffer and this may hinder the proper growth of child on the aspects of development. One of the purposes of this screening test is to measure and to evaluate the developmental delays manifested by the child, and to give assessment according to the scored items and results of the four aspects of development as performed by the child. Glossary of Terms A. MMDST (Metro Manila Developmental Screening Test) – it is an early detection model that applies to detection of developmental disabilities in children aged six and half years old and younger. B. Developmental Delay – test item that is failed and which falls completely to the left of the age line considered a delay. C. Passed – when the child can perform a certain item tested to him/her that manifests an appropriate response to his/her age. D. Failed – when the child can perform a certain item tested to him/her but does not manifest an appropriate response to his/her age. E. Refused – when the child stresses not to perform a certain item. F. No opportunity – when the child does not bother to participate to answer or to cooperate on a certain item. G. Personal-Social – task which indicate the child’s ability to get along with people and take care of himself/herself H. Fine Motor – task which indicates the child’s ability to see and to use and to use his hands to pick up objects and draw. I. Gross Motor – task which indicates the child’s ability to sit, walk, and jump. Source: http://riziannlabastilla.blogspot.com/2012/05/my-exam.html  6 MMDST Kit and Test Materials MMDST KIT MMDST bag Manual Sample test form Testing Materials A rubber ball 12 ½ inches in circumference Cheese curls A pencil A bright red yarn pom-pom A rattle with narrow handle Eight 1-inch-colored wooden blocks (red, yellow, blue green) A small clear glass/bottle with 5/8-inch opening A small bell with 2 ½ inch-diameter mouth Bond Paper Interview Form Sheet  7 Calculating Child’s Age FORMULA: Date of test minus the child’s birthdate equals age of the child. STEP 1: Convert the Date of the Test and Date of birth to Year, Month and Day as seen as below. Example #1: Computation of Child’s Age. Date of Test: February 09, 2021 Date of Birth: January 11, 2019 Year Month Day Date of Test 2021 02 01 09 +30= 39 Date of Birth 2019 01 11 2 0 28 The age of the child is 2 years and 28 days, or 2 years, 0 month, and 28 days. STEP 2: Start by subtracting the “Day” of the test from the “Day” of birth. (example 09-11=?). Note: Follow the rules of subtraction. If the top number of the “Day” column is smaller than the bottom number. Deduct 1 from the top number of the “Month” column and carry over to the top number of the “Day” column. If taken from the column of the “Month” and transferred to “Day”, then add 30 to the top number of the “Day” column before subtracting since there are 30 days in a month. The “30” is constant for all future solutions. (See example # 1) STEP 3: Then subtract the “Month” of the test from the “Month” of birth. (example 01-01=0). Note: if the top number of the “Month” column is smaller than the bottom number, deduct 1 from the top number of the “Year” column and add 12 to the top number of the “Month” column. The “12” is constant since there are 12 months in a year. (See next page for example # 2)  8 Calculating Child’s Age STEP 4: Lastly, subtract the “Year” of the test from the “Year” of the birth. The answer of the child’s actual age should be in years, months and days like the sample above. Example # 2: Date of Test: March 23, 2019 Date of Birth: April 25, 2017 Year Month Day Date of Test: 2019 2018 03 02+12=14 23 + 30= 53 Date of Birth: 2017 04 25 1 10 28 Answer: The age of the child is 1 year old, 10 months and 28 days Let’s Have Student Activity! Calculate the Child’s Age being guided by the examples above. Write your solutions and answers in a piece of paper. This activity is going to be graded and recorded. DATE OF THE TEST: MARCH 15, 2021 1. Birth date – August 12, 2017 2. Birth date – September 5, 2015 3. Birth date – July 1, 2018 4. Birth date - December 18, 2019 5. Birth date – March 5, 2015 6. Birth date - November 11, 2017 7. Birth date - October 3, 2018 8. Birth date – January 20, 2016 9. Birth date - February 28, 2019 10. Birth date - April 10, 2016  9 Calculating Child’s Age ADDITION INFORMATION: ADJUSTING FOR PREMATURITY Prematurity affect ability to perform that normal child pass at the same age. Adjust for children 2 years or younger. After 2 years, it is no longer necessary to compensate (Frankeburg, et al) No adjustment is made on post term. Ask the mother if child was born prematurely. For two or three weeks earlier, subtract the number of weeks from actual age. Draw age line based on adjusted age. Example: Computing Child’s Actual age. The Child was born prematurely 35 weeks. (37 week is considered full term) Year Month Day Date of test: 2020 2019 08 +12= 20 12 Date of Birth: 2018 09 05 1 11 10 07 + 30= 37 14 days (2 weeks) 1 10 23 Answer: The actual age of the child is 1 year, 10 months and 23 days  10 The Test Form Across the top and bottom of form are age scale. Age is marked in Months 1-24, and age in Years from 2 ½ to 6. Each item is represented in the test form by a bar. The bar is placed along the age scale to show when 25%, 50% (indicated by the hatch mark), 75% and 90% of normal children are able to pass the item. AGE SCALE HATCH MARK 25% 50% 75% 90% Percentage of normal children RESPOND TO BELL passing the item BAR  11 The Test Form Some items have a small footnote number at the left end of the bar. Footnote indicates corresponding instruction for administering the item found at the test form. (Please check Test Directions Page 16) Items which can be passed by report R PICKS LONGER LINE Footnote number 10 Some of the items may be passed by report of the parent (R). Only items with an R on the form can be passed by report. However, whenever possible tester should observe what the child can perform. 9 Items have arrows ( ) at the right end of these bars. This includes the items, defines words and composition. Arrow indicate that normal children may pass these items even beyond 6 ½ years old.  12 MMDST FORM  13 Drawing the Age Line PLEASE REFER TO PAGE 9, example # 1 FOR THE CHILD’S AGE. Mark the age and draw a line through all four sectors. Location of age must be accurate interpretation depends on correct placement of the line. The Age of the child in this sample is 2 years, 0 month, and 28 days or. 2 years and 28 days old.  14 Test Directions REMINDER! Make sure to seek consent of the Parent/ guardian before administering any test item to the child. 1. Try to get the child to smile by smiling, talking or waving at him. Do not touch the child. 2. When the child is playing with toy, pull it away from him. Pass if he resists. 3. Child does not have to be able to tie shoes or button in the back. 4. Move yarn slowly in an arch from one side to other, about 6 inches above the child’s face. Pass if the eyes follow 90 degrees to midline (Past midline; 180 degrees). 5. Pass if the child grasps rattle when it is touched to the backs or tips of fingers. 6. Pass if the child continues to look where yarn disappeared or tries to see where it went. Yarn should be dropped quickly from sight from the tester’s hand without arm movement. 7. Pass if the child picks up cheese curl with any part of the thumb and finger. 8. Pass if the child picks up cheese curl with the ends of thumb and index finger using an over hand approach. 9. Pass any enclosed form. Fail continuous round motion. (use a bond paper for this test and see if the child can a circle or any enclosed form). 10. Ask the child which line is longer (not bigger)? Turn the paper upside down and repeat 3/3 0r 5/6.  15 Test Directions 11. Pass any crossing line (use a bond paper for this test and see if the child can draw a crossing line). 12. Have the child copy first. If failed, demonstrate it. REMINDER! When giving the items 9, 11 and 12 do not name the forms. Do Not demonstrate 9 and 11.  16 Test Directions 13. When scoring, each pair (2 arms, 2 legs, and etc.) counts as one part. 14. Point to the picture and have the child name it. (No credit is given for sounds only) 15. Tell the child to: give the block to mommy; ask the child to put block on the table; and put the block on the floor. Passing score 2/3. (Do not help child by pointing, moving head or eyes). 16. Ask child: Passing score 2/3 What do you do when you are cold? When you are hungry? When you are tired? 17. Tell the child to: Put the block on the table; under the table; in front of the chair and behind the chair. Pass if score ¾. (Do not help child by pointing, moving head or eyes). 18. Ask the child: Pass if score 2/3 If fire is hot, then ice is? Mother is a woman, Dad is a? A Horse is big, a mouse is? 19. Ask the child: Pass if score 6/9 What is a ball? River? Desk? House? Banana? Curtain? Roof? Fence? Street? Pass if defined in terms of use, shape, what is it made of or its general category (such as banana is a fruit, not just color yellow).  17 Test Directions 20. Ask the child: Pass if score 3/3 (no other objects can be substituted) What is spoon made of? What is shoe made of? What is door made of? 21. When placed on stomach, child lifts chest off table with support of forearms and/or hands. 22. While child is on back, grasp his hands and pull him sitting. Pass if head does not hang back. 23. Child may use wall or rail only, not person. May not crawl. 24. Child must throw ball overhead 3 feet to within arm’s reach of tester. 25. Child must perform standing broad jumps over width of test sheet (8 ½ inches). 26. Tell the child to walk forward heel within 1 inch of toe. Tester may Demonstrate. Child must walk 4 consecutive steps, 2 out if 3 trials. 27. Bounce ball to child who should stand 3 feet away from tester. Child must catch balls with hands, not arms, 2 out of 3 trials. 28. Tell the child to walk forward, starting from heel to toe (heel toe walk) 29. Tell child to walk backward toe within 1 inch of heel. Tester may demonstrate. Child must walk 4 consecutive steps, 2 out if 3 trials. IMPORTANT! Date and Behavioral Observations How the child feels at the time of test? Relation to the tester? Attention Span of the child, his verbal behavior and self-confidence.  18 Scoring the Test and delays in development Passed (P) – when the child is able to perform the task or skills that has been given by the examiner that is appropriate for the child’s age. Failed (F)– when the child can perform a certain item tested to him/her but does not manifest an appropriate response to his/her age. Refused (R) – when the child stresses not to perform a certain item or when the child manifest lack of interest and does not want to perform the task. No opportunity (NO) – when the child does not bother to participate to answer or to cooperate to perform a specific task or skill. NO, pedals tricycle. Child never had any opportunity to try a bicycle. Never failed nor refused. Items scored NO are not considered in the overall test scores. Delays on the test form are emphasized by shading the right end of the bar of the delayed item. If age line touches the right end of the bar, the item is not considered a delay.  19 Selecting Items to be administered 1. All items crossing the line should be administered. 2. The child should have a minimum of 3 passes to the left of any failure. 3. Each sector should have at least 3 passes and 3 failures. 4. If failure occurs in any items, proceed to administer items to the left of the age line until you obtain 3 passes then stop. PRELIMINARY PHASE 1. Establish rapport. Emphasize this is not a screening test, not an IQ test. Estimate the child’s level of development. Child is not expected to pass all items administered. Make child as comfortable as possible (sitting on lap – infant/ toddler or on mat) Avoid testing if child is ill, sleepy, tired, hungry or upset. 2. Every effort is made to observe what the child can actually do rather than simply asking the parent. Administering the Test 1. Start with personal – social sector To give the child a chance to get used to the tester while the tester asks the parent items scored based on Report ( R ) but also directly observe.  20 Administering the Test 2. Fine motor – adaptive sectors follow. Essential warming up period. The child can perform task at hand without directly talking to the tester yet. 3. Then Language sector This time child is more comfortable with the tester and will talk as much. 4. Gross motor sector Last because child may be too shy to do items at beginning of the test. WHAT MAY NOT BE CHANGED? 1. Manner which each is administered. Words or directions may not be changed because the test will not be standardized. 2. Avoid asking questions that will suggest answers. 3. For each sector, start with items easily performed. Motivate the child to perform more difficult task later; praise the child. Provide the parent some satisfaction. 4. 3 failures in 1 sector, move on to the next. 5. 3 trials / test item before a score of failure is given. 6. To minimize refusals, do the following as suggested; tell child what to do and not ask “can He or “will he”. If the child refuses, parent / caregiver should ask to administer the item. Parents / caregiver is instructed to do exactly how to do it. If the child still refuses, score the item “R” 7. Once completed, note on the following: child’s cooperation, attention span, verbal behavior, self-confidence, nervous habits, parent-child relationship and tester’s overall feeling about the testing. (a child may have normal test results but may present some problems in certain areas that need to be addressed by the Health care worker)  21 Interpretation of Test Results Interpreted as NORMAL, QUESTIONABLE, ABNORMAL or UNTESTABLE. Steps: 1. Mark each delay by shading right end of the bar. 2. Count number of sectors that have 2 or more delays. 3. Count number of sectors that have 1 delay without no passes intersecting the age line in the same sector. Bottom of age line, indicate test result and interpretation. Example: Abnormal, reason: 2 sectors have 2 delays. Criteria Interpretation 2 or more sectors with 2 or more delays abnormal 1 sector with 2 or more delays plus 1 or abnormal more sectors with 1 delay and in that same sector, no passes intersecting the age line. 1 sector with 2 or more delays Questionable 1 or more sectors with 1 delay and in Questionable that sector, no passes intersecting the age line When REFUSALS occur in numbers Untestable large enough to cause the test result to be QUESTIONABLE or ABNORMAL if these were scored as failures  22 EVALUATION Student will conduct an interview with a parent, and assess 1 child using the MMDST form. The form should be fully accomplished based on the calculated age of the child. A case study (guided by the format given to the students) will be submitted as part of the evaluation and will be graded accordingly. Deadline for submission of requirement is at the end of the rotation in the area. REFERENCES Text book of Pillitteri, A. (2014) 7th Edition. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family - Denver II Developmental Screening Test page 992 unit 5 Retrieved from: https://www.scribd.com/document/477920608/REVIEWER-MMDST https://www.rnpedia.com/nursing-notes/metro-manila-development-screening-test-mmdst/ http://riziannlabastilla.blogspot.com/2012/05/my-exam.html MMDST.Child-Age-Calculation.ForgetMeNots.pdf 23 

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