MMDST

Metro Manila Developmental

Screening Test

Shezel Jheane M. Matel, RN

 Screening - the presumptive
identification of an unrecognized disease
or defect by the application of tests,
examinations, or other procedures that
can be applied rapidly

 Screening test – sort out apparently

well persons who probably have the
problem from those who probably do not,
permitting those with positive or
suspicious findings to be referred for
diagnosis and appropriate treatment as
early as possible.
MMDST
 an early detection model that applies
to the detection of developmental
disabilities in children aged six & a
half (6 ½) years old and younger

 a simple, clinically useful tool used in

the early detection of children with
serious developmental delays, modified
& adapted by Dr. Phoebe D. Williams
on 6006 Metro Manila children ages
2 weeks to 6 ½ years old.
DDST
 Denver Developmental Screening Test
 Developed by Dr. William K.
Frankenburg & associates in 1967 for
the Denver children.
 the basis for the modification and
standardization of the MMDST
 Design for health professionals such as
nurses, doctors and health workers so
that slow development may be
recognized, referrals made &
appropriate therapy prescribed as
soon as possible.

 It is a SCREENING test.
 It is intended as a screening
instrument to determine whether a
child’s development is within normal
range.
 MMDST
 It is NOT an intelligence test

 It is NOT a diagnostic test

 It is NOT a predictor of future adaptive

or intellectual ability.
 MMDST
Evaluates 4 aspects of child’s development

Personal-Social
Fine-Motor Adaptive
Language
Gross Motor Behavior
 4 aspects of child’s development
evaluated by MMDST
(1) Personal – Social

 Task which indicate the child’s ability to

get along with people and to take care
of himself/ herself.
 4 aspects of child’s development
evaluated by MMDST

(2) Fine Motor Adaptive

 Task which indicate the child’s ability

to see and to use his hands to pick up
objects and to draw.
 4 Aspects of child’s development
evaluated by MMDST

(3) Language

 Task which indicate the child’s ability

to hear and follow directions and to
speak.
 4 Aspects of child’s development
evaluated by MMDST/DDST
(4) Gross Motor

 Task which indicate the child’s ability

to sit, walk and jump.
 MMDST Kit
 Manual
 Sample test form
 Test materials
 MMDST bag

 Test Materials – standards and these consist of the

following:
 Bright red yarn (pom-pom)
 Rattle with a narrow handle
 Eight 1-inch colored wooden blocks (red, blue,
yellow, green)
 Small clear glass/bottle with 5/8 inch opening
 Small bell with 2 ½ inch-diameter opening
 Rubber ball 12 ½ inches in diameter
 Cheese curls
 Pencil and bond paper
The Test Form
 Made of 105 items written in the range
of development of children between
birth and six years of age
 Across the top and bottom of form are
age scales
 Age is marked in months for 1-24, and
in years from 2 ½ to 6.
The Test Form
 The BAR representing the item is
located between the age scale to show
when 25%, 50% (indicated by the hatch
mark), 75% and 90% of the normal
children are able to pass the item.
 The bar representing the item, WALKS
WELL, is located between the ages
less than 12 months and 17
months.
 The LEFT END of the bar denotes that
25% of normal children walk well at less
than 12 months.
 The HATCH MARK denotes that 50% of
normal children walk well at 13 ¼
months.
 The LEFT END OF SHADED AREA shows
75% do so at 15 months.

 The RIGHT END of the bar shows 90%

walk well at about 17 months.
 Some items have a SMALL FOOTNOTE NUMBER
at the left end of the bar. This number indicates the
corresponding instructions for administering
the item that is found at the back of the test form.

 Some items may be passed by REPORT of the

parent.

 Only items with an R on the form may be passed

by report.

 However, whenever possible, the tester should

observe what the child can actually perform
rather than ask the parent, even though the item
may be passed by report.
 The item EQUAL MOVEMENTS has an
asterisk (*) at the right end of its bar
 This indicates that 100% of normal
children pass this item at birth.
 This is only the item with an * and is
located in the fine-motor adaptive
sector of the test form.
 Nine items have arrows at the right
end of these bars.
 The arrows indicate that normal
children may pass these items even
beyond 6 ½ years of age.
 Administering the Test
 Establish rapport with the mother/ caregiver
 State that this is a screening test and not an
IQ test.
 Make the child as comfortable as possible
 Calculate the child’s age
 Draw the age line
 Select the items to be administered
 Administer the test
 Score the results
 Interpret test results
 Explain overall interpretation of test result to
parent or caregiver
 Administering the Test
 Sitting on the mother’s or caregiver’s lap is
the best position for the infant or toddler.
 The table on which the test materials are set
should be easily accessible to the child.
 A mat on the floor with the test administrator
in a kneeling position is recommended for
testing the young infants or even older
children who live in poorer homes where
tables and chairs are not common fixtures in
the houses.
 Avoid testing the child when he is sleepy,
tired, ill, hungry, or upse.t
 Administering the
 Generally the test starts with:
Test
 Personal-social
 Fine-motor adaptive
 Language
 Gross motor
 Although the above sequence is
recommended, there are instances when you
may vary the sequence of some items in
order to take advantage of the child’s
interest.
 In general, clearing the table/floor of all
materials except for the task at hand
minimizes distractions.
Steps in Administering the
Test
1. Draw a vertical line on the examination
sheet through the four sectors (gross
motor, fine motor-adaptive, language, and
personal-social) to represent the child’s
chronological age.
2. Place the examination date at the top of
the age line.
*For premature children, subtract the
months of prematurity from the
chronological age.
After 2 years of age, it is no longer
necessary to compensate for prematurity.
Steps in Administering the
Test
3. The items to be administered are those
through which the child's chronological
age line passes unless there are obvious
deviations. ln each sector, one should
establish the area where the child passes
all of the items and the point at which the
child fails all of the items.

4. ln the event that the child refuses to do

some of the items requested by the
examiner, it is suggested that the parent
administer the item provided he or she
does so in the prescribed manner.
Steps in Administering the
Test
5. If a child passes on item, a large letter
P is written on the bar at the 50%
passing point.
F designates a failure, and R designates
a refusal.

6. Note how the child adjusted to the

examination and how the child related to
the parent, the examiner, and the test
materials.
7. Ask the parent if the child’s
performance was typical of
performance at other times.

8. To retest the child on the same form,

use a different colored pencil for the
scoring and age line.

9. Instructions for administering

footnoted items are on the back of test
form.
Test Scores
 Passed ( P )

 Failed ( F )

 Refused ( R)

 No Opportunity ( NO )

 Failure of an item that is completely to the

left of the child’s age line is considered as
a developmental delay and is therefore
referred in MMDST as a delay.
 Calculating the child’s age
 The child’s age will be the basis for
drawing the age line and determining
the test items to be administered.

DATE OF TEST – BIRTH DATE = AGE

OF CHILD

 calculate first the days, then months

and then years.
Calculating the child’s age

○ Example:
Birth date : January 05, 2017
Date of Test: February 20, 2019

Year Month Day

Date of test 19 02 20

Birth Date 17 01 05
_______________________________________
Age of Child 02 01 15

Therefore the age of the child is 2 YEARS, 1 MONTH, 10

DAYS
 Calculating the child’s age

Borrowing
○Make sure that 30 days are borrowed
from the month and 12 months from the
year column.

Date of test: February 20, 2019

Birth date: March 10, 2017
Year Month Day
Date of test 19 02 20

Birth Date 17 03 10
_______________________________________
Age of Child 01 11 10

Therefore the age of the child is 1 YEAR, 11 MONTHS,

Adjustment for
prematurity
Prematurity may affect the ability of the child
to perform or demonstrate items that other
normal children pass at the same age.

Make adjustments if the child is 2 years or

younger. Subtract the number of weeks of
prematurity.
If more than 2 years, it is no longer necessary
to compensate for prematurity.
No adjustment should be made for children
born later than expected.

ACTUAL AGE – NUMBER OF WEEKS OF

PREMATURITY = ADJUSTED AGE
Adjustment for
prematurity
A child born 5 weeks premature has an actual age
of 13 months.

ACTUAL AGE – NUMBER OF WEEKS OF

PREMATURITY = ADJUSTED AGE

13 months – 5 weeks = 11 ¾ months

Therefore, the actual age of the child is 11 ¾

months.
Selecting Items to be
Administered
 Items to be administered first are those
through which the child’s chronological age
line passes.

 If a failure occurs in any of these items,

proceed to administer items to the left of the
age line until you obtain 3 passes, then stop.

 In items passed, continue testing to the

right where the items become progressively
more difficult until the child fails three times
in that sector.
Keep in mind
1. All items crossing the age 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 three
passes and three failures.
Selecting Items to be
Administered
The number of items to be
administered will vary with the
age and ability of the child.
 Normally, a child is tested on only 20
simple tasks or items.
 The child may accomplish some of the
tasks on his own without being asked.
Test Scores

 Passed ( P )

 Failed ( F )

 Refused ( R)

 No Opportunity ( NO )
Scoring delays in
development

 An example of no opportunity is in the item –

pedals tricycle. If the child has never had an
opportunity to try a tricycle then the item
should be scored as no opportunity and not
failed or refused.
Scoring delays in developmen
 Scores is to be written on the 50% hatch
mark.

 A test item that is failed and which falls

completely to the left of the age line is
considered a delay.
Scoring delays in
development
 Delays on the test form are emphasized by
shading the right end of the bar of the
delayed item.

 If the age line touches the right end of the

bar, the item is not considered a delay.
Interpreting test results

*The MMDST result is interpreted as:

NORMAL
QUESTIONABLE
ABNORMAL
UNTESTABLE
 Criteria Interpretation
2 or more sectors with 2 or more
Abnormal
delays
1 sector with 2 or more delays plus
1 or more sectors with 1 delay and
Abnormal
in that same sector, no passes
intersecting the age line.
1 sector with 2 or more delays Questionable
or more sectors with 1 delay and in
that sector, no passes intersecting Questionable
the age line
When REFUSALS occur in
numbers large enough to cause the
test result to be QUESTIONABLE or Untestable
ABNORMAL if these were scored
as failures
Discussing test result

 Overall interpretation of test results should be

given to parent in general terms.

 If the child has done well – praise and

reassure the parent the child is developing as
he/she should be.

 If the child has a number of delays remind

them it is a screening test and you would like
to test the child again within approximately 2
weeks.
Follow these simple steps:
 Step 1 – Mark each delay by heavily shading
the right end of the bar;
 Step 2 – Count the number of sectors that
have 2 or more delays;
 Step 3 – Count the number of sectors that
have 1 delay with no passes intersecting the
age line in the same sector;
 Step 4 – Interpret the result using the
following criteria.
Interpretation
 Failure to pass an item passed by 90%
of the children should be considered
significant. Such a failure may be
emphasized by coloring the right end of
the bar of the failed item.
Interpretation
 Several failures in one sector are considered
to be developmental delays. The delays may
be due to;
1. Unwillingness of the child to use his or her
ability due to:
a. Temporary phenomena such as illness,
fatigue, separation from parent, fear,
hospitalization, and so forth.
b. General unwillingness to do most things that
are asked, such as condition may be just as
detrimental as an inability to perform.
Interpretation
2. An inability to perform due to:
a. General retardation
b. pathological factors such as
deafness or neurological impairment
c. familial pattern of slow development
in one or more areas.
 END OF
DISCUSSION.