120 or above

From American Psychiatric Association (1987) by permission.

From American Psychiatric Association (1987) by permission.

motivation, education, and social and vocational opportunities. Adaptive behavior is more likely to improve with remedial efforts than is IQ, which tends to remain more stable.

The Expanded Interview of the Vineland Adaptive Behavior Scales II assesses the personal and social skills of disabled and nondisabled individuals, ranging in age from birth to 90 (Sparrow et al., 2004).

Developmental Screening

Developmental screening is viewed as a necessary strategy in the primary prevention of developmental disabilities and their sequelae. Screening is "the presumptive identification of unrecognized disease or defects by the application of tests, examinations, or other procedures which can be applied rapidly." Early detection can be adequately met only by the use of standardized, valid, reliable instruments to assess the developmental status of young children. If one relies on a developmental history and a child's performance in a clinical situation, mild developmental delay is frequently overlooked. This situation may be compounded by denial by the physicians or parents.

Because of a need for standardized screening for early detection of developmental delay, in order that the suspected child may then have further detailed investigation and increased opportunities for effective treatment, the Denver Developmental Screening Test (DDST) was devised in 1967. It was revised in 1981. The test is simple to administer, easy to score and interpret, and useful for repeated evaluations. A graphic format was designed so that the user could easily compare the individual with the standard for age. Each item was represented by a horizontal bar marked to indicate the 25th, 50th, 75th, and 90th percentiles. Four categories were designated: gross motor, fine motor-adaptive, language, and personal-social. The results were validated by good correlation with the Yale Developmental Schedule.

Failure to pass a particular item may represent inability to pass or unwillingness to pass secondary to illness, fatigue, or fear of separation from the parent. The separation of items into developmental domains has important prescriptive, diagnostic, and predictive value. The normally developing infant may demonstrate uniformity across all domains of growth, but the delayed or handicapped infant exhibits unique patterns and inconsistencies. A single global score will not provide enough information to indicate the direction of further assessment and intervention.

The revised DDST (R-DDST) is easy to use (Fig. 14.6). Through its agreement with diagnostic tests such as the Stanford Binet or the revised Bayley, the R-DDST attains predictive validity. More than 78 percent of the children who initially fail a DDST have educational retardation and low intelligence or learning problems in school. The R-DDST is a valid and reliable developmental screening instrument. It requires that the clinician be trained to proficiency in the administration and interpretation of the R-DDST. Improper administration or interpretation of test items invalidates the R-DDST norms. The DDST and its abbreviated modifications tap only a limited number of developmental aspects. For instance, it does not evaluate the young child's home environment, which is a major determinant of later development. Thus, nonsuspect DDST scores for a particular child who seems to be having a developmental problem should not lull the clinician into a false sense of assurance, since the test does not tap all aspects of development and the results may be in error. Furthermore, even if a child's development seems to be progressing appropriately, it is important to realize that development is an ongoing, dynamic process which requires periodic rescreening.



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