MMDST

Metro Manila Developmental

Screening Test

Presentation
 I. INTRODUCTION
• A. Background of the Study

MMDST (Metro Manila Developmental Test) is an

early detection model that applies to the detection
of developmental disabilities in children aged 6 ½
years and younger. It was developed by Dr. William
K. Frankenburg and was modified and adapted by
Dr. Phoebe D. Williams on Metro Manila children.
This screening test was designed so that
developmental delays may be detected and
referrals can be made. It is intended as a screening
instrument to determine whether a child’s
development is within normal range.
This test is concerned with the four domains of
development: the personal-social, the Language
Skills, the Gross-motor Skills and the Fine-motor
skills. The personal-social skill refers to that of the
child’s ability to interact with other people and to
take care of his self. The language skill refers to
the child’s ability to use the sense of hearing in
grasping and following instructions and the ability
to speak. the Gross motor skills refers to the
ability of the child to perform physical activities
that involves the use of the large muscles like
walking or jumping while the fine-motor skills refer
to the child’s ability to perform physical activities
using the small muscles like picking up or
touching small objects.
 The screening test is made up of 105 items and
is scored as Passed, Failed, Refused, or No
Opportunity. A score of “passed” is given when the
child is able to perform a certain activity
accordingly while a “failed” score indicates a
developmental delay for the child’s age. A score is
labeled as refused when a child gives a stress on
not to perform the activity and “N.O” or no
opportunity when the child does not bother to
participate in a certain activity.
The accurate identification pf the child’s birth
date is important to appropriately graph their age
line and select the test items that are needed to be
assessed and to provide correct interpretation.
 The test though is neither an intellectual test
nor a diagnostic test. It does not give a future
interpretation of the child’s future intellectual
capability but only acts a screening test.
 B. General Objectives

• This study aims to measure the developmental

skills and capacity of the child that is appropriate
to the child’s age and to identify any
developmental delays so that appropriate
interventions could be made as soon as possible
 C. Specific Objectives
• To be able to identify the clients age accurately.
• To be able to draw the clients age line accurately and
give appropriate test items suitable for the child’s age
• To be able to assess the Four Major Aspects of the
Childs development
• To be able to identify any developmental delays in the
child and give appropriate interventions that could help
lessen the severity of the delay or correct the delay.
• To be able to give referral and appropriate therapy to the
patients developmental delay
• To be able to give separate health teachings to the
parents and to the child’s health condition regarding the
clients condition.
•
D. Glossary of Terms
MMDST- (Metro Manila Developmental Screening
Test) a tool used by a health worker to assess any
developmental delays within a child at a certain age.
• Developmental delay- refers to when a child's
development lags behind established normal ranges
for his or her age. Sometimes the term is used for
mental retardation, which is not a delay in
development but rather a permanent limitation. If
most children crawl by eight months of age and walk
by the middle of the second year, then a child five or
six months behind schedule in reaching these
milestones may be classified as developmentally
delayed regarding mobility.
 Passed Score- given when the child is able to
perform the tasks or skills that has been given by
the examiner that is appropriate for the child’s age
Failed- a score given when the child is able to
perform a certain item being tested but does not
manifest or give the appropriate response.
Refused- when the child manifests lack of interest
and does not want to perform the task.
No Opportunity- given when the child does not
bother to participate to answer or cooperate to
perform a specific task or skill.
Personal-Social- one of the four aspects that are tested
in which the child’s ability to interact with others and his
ability to take care of his self is being assessed.
Language- an aspect in the development of a child
which refers to the child’s ability to grasp and perform
instructions and the ability to speak.
Gross-Motor- an aspect in the child’s development in
which the child’s ability to perform physical activities
such as jumping, sitting ore walking using the large
muscles is being assessed.
Fine-Motor- one of the aspects in the child’s
development in which the child’s ability to perform
physical activities such as picking up or touching small
objects using the small muscles and the ability to use
the child’s sense of sight is being assessed.
 E. Significance of the Study
• This study will help the community to be aware
about the developmental abilities of the children
in the area. The results will be significant
especially to the parents in detecting any
developmental disabilities and delays in their
child. It will also help in recognizing slow
development among children so that referrals
may be made and appropriate therapy
prescribed as soon as possible to prevent any
further complication.
 II. PATIENT’S PROFILE
A. Family History

• Christopher T. Retiza (father) – alive and well

• Susan D. Retiza (mother) – DM and HTN
• Mary Bless D. Retiza, 22 (daughter) – alive and well
• Mary Grace D. Retiza, 20 (daughter) – alive and well
• Christopher D. Retiza, 17 (son) – alive and well
• Mary Joy D. Retiza, 16 (daughter) – alive and well
• Christian D. Retiza, 11 (son) – alive and well
• Bien Joseph D. Retiza, 9 (son) – alive and well
• Mary Chris D. Retiza, 5 (daughter) – aive and well
B. Maternal and Pre-natal History
Mrs. Retiza carried the baby for the seventh time
and there are no histories of miscarriages or pre-
term labors. During pregnancy she had UTI. She
completed her pre-natal check-ups at Monteire &
Well Family Midwife Clinic at Visayan Village,
Tagum City. Throughout the start of her
pregnancy, she experienced presumptive signs
and symptoms of pregnancy such as nausea,
breast tenderness and fatigue. As the set out,
these signs and symptoms are well-supported
by probable signs which are the
ballottement, Hegar and Goodle’s sign. Then
these evidences were well-established when
the fetal heart tone of the fetus was heard and
the visualization of the fetus through
ultrasound.
Mrs. Retiza eats lots of fruits and
vegetables during her pregnancy that help the
baby’s development inside her womb. After 9
months of carrying the baby, she gave birth to
a healthy baby girl at Monteire & Well Family
Midwife Clinic.
 C. Medical History
• Developmental History
Type of Stage Appropriate Actual
Development Findings
Jean Piaget Intuitive Speech
(Cognitive Thought becomes more
development) social, less
egocentric. 
The child has
an intuitive
grasp of logical
concepts in
some
areas.decrease
, disappearance
 .  However,
there is still a
tendency to
focus attention
on one aspect
of an object
while ignoring
others. 
Concepts
formed are
crudeand
irreversible.Eas
y to believe in
magical
increase,
decrease,
disappearance.
  Reality not
Perceptions
dominate
judgment.
In moral-ethical
realm, the child
is not able to
show principles
underlying best
behavior. 
Rules of a
game not
develop, only
uses simple
do's and don'ts
imposed by
authority.
Sigmund Phallic Stage The pleasure
Freud zone switches
(psychosexual to the genitals.
development) During this
stage girl
develop
unconscious
sexual desires
for their father.
Because of
this, she
becomes rivals
with his mother
and sees her as
competition for
the father’s
affection.
Girls also
develop a fear
that their
mother will
punish them for
these feelings.
This group of
feelings is
known as
Electra
Complex.
Erik Erikson Initiative vs. Children are
capable of
(Psychosocial Guilt learning, creating
development) and accomplishing
numerous new
skills and
knowledge, thus
developing a
sense of industry.
This is also a very
social stage of
development and if
children
experience
unresolved
feelings of
inadequacy and
inferiority among
the peers, they can
have serious
problems in terms
of competence and
self-esteem.
Lawrence Preconventio The earliest stage
Kohlberg nal Morality of moral
development is
(Moral especially
development) common in young
Stage 1 -
children, but
Obedience
adults are capable
and of expressing this
Punishment type of reasoning.
At this stage,
children see rules
as fixed and
absolute. Obeying
the rules is
important because
it is a means to
avoid punishment
Stage 2 -

At this stage of
Individualism moral
development,
and Exchange children account
for individual
points of view and
judge actions
based on how
they serve
individual needs.
In the Heinz
dilemma, children
argued that the
best course of
action was
whichever best-
served Heinz’s
needs. Reciprocity
is possible, but
only if it serves
one's own
interests
 Nutritional History

• The child prefers to eat fried dishes such

as fried egg, fish, chicken and meat. She
doesn’t eat vegetables. She often eat junk
foods and chocolates.
 Immunization
Agents 1st dose 2nd dose 3rd dose
BCG (at birth) 3-16-04

DPT (6 wks, 10 5-10-04 6-20-04 7-26-02

wks, 14 wks
old)
OPV (6 wks, 10 5-10-04 6-20-04 7-26-04
wks, 14 wks
old)
Hepatitis B (6 3-16-04 6-20-04 7-26-04
wks, 10 wks, 14
wks old)
Measles (9 12-21-04
months)
 Physical Examination
Body Parts / Actual Normal Interpretation
Technique Findings Findings

HEENT
• Head Proportion to the Head
Normocephalic
size of the body,
with no lesions round, with symmetry is
or tenderness. prominences in normal. Child
Face is the frontal area has a good
symmetrical. interior and the head control
occipital are
posterior,
symmetrical in all
planes.
Eyes Eyes are round Round, equal, Child has no
with blinking constrict when problem in the
reflex, pupils
dilate and
light is pointed eyes, nose,
constrict as to the eyes and ears and
reaction to light, object is close throat. All are
and lashes are to the eyes and considered as
directed outward. dilated when Norman
Parallel and
evenly placed,
light is findings as
symmetrical, non- removed and development
protruding. Both object is is appropriate
eyes are bright removed away. with the
and clear. Eyebrows are child’s age
Eyebrows have
fine quality and
black,
black in color. symmetrical,
Eyelids are evenly
symmetrical distributed and
without presence parallel with
of swelling. . each other.
Ears Clean, smooth Symmetrical
Ears are and at eye
symmetrical level of outer
without canthus of the
presence of eyes, no
discharges and lesions,
lesions. The consistent with
upper point of skin color.
attachment is
in a straight
line with the
outer cantus of
the eyes.
Nose Nose is Midline,
symmetrical to symmetrical
the midline of and patent. No
the face; no lesions,
discharges and consistent with
lesions noted. skin color.

Throat Tonsils indicate Mucosa pink,

no signs of no lesions.
inflammation.
Swallowing is
easily done
without difficulty.
Mouth has no
lesions. Dental
carries present
and absence of
one incisor tooth
noted.
Integumentary
System

Skin Brown in color; Consistent in Child has a

no lesions color; no healthy skin
noted; warm lesions, and has no
and dry; has swelling and potential
good skin inflammation. problem with
turgor. the hair and
the nails
Hair She has a fine Evenly Child has a
well-distributed distributed. healthy skin
hair; shiny and and has no
short. potential
Presence of problem with
lice noted. the hair and
the nails
Nail Nails are clean Clean and
and short. The smooth nails.
cuticles are intact,
smooth and no
Normal
inflammation capillary refill,
noted. Has a good no lesions or
capillary refill of swellings
less than 3 present
seconds.
Pulmonary Respiratory rate is Lungs clear,
System recorded as 25 bronchial to
breaths per
minute. Lungs are
bronchovesicul
clear upon ar sounds
auscultation. audible
Wheezes, rales
and other
abnormal sounds
were not noted.
There equal rise
and fall of the
chest with regular
rate and rhythm
and normal
depths of
respiration.
Cardiovascular Pulse rate is Heart sounds
System recorded as 85 in normal
beats per rhythm with
minute. No respiratory
murmurs variations, no
noted. Normal chest pain or
“lubdub” sound abnormal
heard upon sounds present
auscultations
and no chest
pain felt as
verbalized by
the client.
Gastrointestin The patient has a Abdomen Performs
fundic height of 34
al System cm. with symmetric round, positive regular bowel
contour. It was bowel sounds, movement.
slightly protruded. liver edge Abdominal
Hypogastric sounds
were audible. palpable 2-3 contour
cm. normal with
age
Musculoskelet Shoulders and No unusual normal
al System arms can be
movements
moved easily. No
swelling found in such as
the elbow and can tremors, .
flex forearm. Legs
are strong and
can be moved
easily. Toes and
fingers are
complete. No
lesions noted, skin
is intact.
Genitourinary Increased fluid Should be able The increased
System output due to to urinate at times of
increased fluid regular voiding may
intake of intervals with be considered
toddler, voids no pain felt, normal as a
regularly response to
the increased
fluid intake of
the child.
Previous Illness and Medications
Taken
No previous illness noted and no medications
were taken. Takes ‘Ceelin’ as a vitamin C
supplement.
 III. METHODOLOGY
This chapter presents the
different procedures that were
used in this case study as well
as the statistical procedures
utilized in the conduct of the
said study.
 A. Case Locale
The MMDST (Metro Manila
Developmental Screening Test) was
conducted at the house of the
client, located at Purok Calachuchi,
Visayan Village, Tagum City on
October 9, 2009, Friday.
 B. Methods Used
The methods used for acquiring the MMDST (Metro
Manila Developmental Screening Test) results were:

•Interview Method – Some of the data, specifically the

patient’s profile (family history, medical history, etc.)
were obtained by the tester through interview method of
the parents.
•Questionnaire Method – The tester used series of
questions to collect information about the client.
•Used of Test Materials – the tester used the MMDST
Kit and its contents in performing the test procedure in
obtaining the test results.
•Legal Documents – other information such as
marriage and birth certificate were obtained from legal
documents of the family.
 C. Instruments Used
The instruments used in this test are the following:

• The test form/sheet

• The MMDST kit which contains of the ff.:
Bond paper
Pencil
Eight pieces 1-inch wooden colored blocks
(red, yellow, green, blue)
Rubber bal 12 ½ inch in diameter
 D. Test Procedures
The following are the test procedures being
performed:
• First, the tester must state to the parent/s or guardian
the reason of visit, what the test is all about, and how
they can help while the test is going on.
• Next, establish a rapport with the parent/s or
guardian, especially with the child, to gain
cooperation and trust.
• Make the child as comfortable as possible to attain
the best possible result.
• Calculate the child’s age to determine the tests that
are applicable to the child in relation to his/her age.
Note: if the child is premature and his/her age during
the test is 2 yrs. old and below, make adjustments
by subtracting the number of weeks of prematurity.

•Draw the age line. The tests that are hit by the
drawn line are the tests that the tester must perform.

•Administer the test. Take time in administering the

test to attain the best possible result.

•Score and interpret test results. This is to know if

the child has developmental delays.
Explain overall interpretation of the test result to
the parent/s or guardian. This is for the parent/s
or guardian to know if their child has a
developmental delay and for them to address the
problem immediately. The MMDST result is
interpreted as :
NORMAL
QUESTIONABLE
ABNORMAL
UNTESTABLE

Test Results:
Passed (P)
Failed (F)
Refused (R)
No Opportunity (NO)
 E. Presentation of Computation
of Child’s Age
Date of Test: October 9, 2009
Date of Birth: March 16, 2004

Year Month Day

Date of Test 09 10 09
Date of Birth 04 03 16
05 06 23
The age of the child is 5 years 6 months and 23
days.
 RESULTS, ANALYSIS AND
JUSTIFICATION
SCORING:

P- Pass
F- Failed
NO- No Opportunity
R- Refuse
Test Score Analysis Interpretation
Procedure
PERSONAL-
SOCIAL
-pass - pass if the child -the child does
1.Separates does not become not become to
from mother too upset when upset when the
easily the mother is out mother is out of
of sight. sight. She can be
-the child can
2. Dresses dress herself
without
-pass - pass if the can
completely and
dress herself
supervision completely and correctly without
correctly without help as evidence
by the mother’s
help verbalization and
child’s
demonstration.
FINE MOTOR -pass -pass if the -the child
ADAPTIVE child can draw draws a figure
1.Copies a figure with with straight
rectangle straight lines lines and with 4
and with 4 square corners
square corners without being
without being shown how to
shown how to draw it.
draw it.

2.Imitates - pass if the - the child

demonstrates -pass child can draw draws a figure
square a figure with with straight
straight lines lines and 4
and 4 square square
corners. corners.
3. Draws man- -pass -pass if the -the child
3 parts child can draw draws a figure
3 or more with nine parts.
parts. One
point is given
to each pair
(ears, eyes,
etc.) as well as
each part
which is not
pair.

- pass if the
4. Draws man- - pass - the child
child can draw
6 parts draws a figure
6 or more body
with 9 parts.
parts.
LANGUAGE

1.Comprehend -pass -the child gives

s cold, tired
-pass if the a logical
child gives a
and hungry answer for 2
logical answer
out of 3
for 2 out of 3
questions.
questions.

- the points 3
2.Recognize -pass if the
-pass out of 4 colored
color child picks 3 wooden blocks
out of four correctly.
colors
correctly.
3.Defines word -Pass -pass if the -the child
child defines 7 defined
out of nine appropriately
words in terms the terms of
of use, shape, the things
what it is made asked to her.
if, and its
general
category.
4.Compositi
- pass - the child replies
on of - pass if the that:
child replies “Spoon is made
that spoon is up of metal.”
made of metal; “Door is made up
shoe is made of wood.”
of leather; door “Shoe is made up
is made of of plastic.”
wood, or glass.
GROSS -pass -pass if the -the child can
MOTOR child can stand stand on 1 foot
1.Balance on on either foot for 10 seconds
1 foot for 10 10 seconds or on the first trial.
seconds more in 2 or 3
trials.

2.Heel-to-toe
walk
- pass -pass if the - the child can
child can walk walk in straight
in straight line line for 4 steps
for 4 or more placing her
steps placing heel 1 inch in
her heel 1 inch front of her toe.
or less in front
of her toe, 2
out 3 trials.
3. Backward -pass - pass if the - the child can
heel-to-toe child can walk walk backward
in straight line in straight line
backward for 4 for 4 steps
or more steps placing her toe
placing her 1 inch in back
toes in the of her heel.
back of her
heel, 2 out of 3
trials.
• SUMMARY,
CONCLUSION AND
RECOMMENDATION
Summary

The testers assess a certain family

with 5 to 6 ½ years old children. The
testers assessed the child’s personal-
social, fine-motor adaptive, language
and gross-motor. MMDST is a
screening test for the children 6 ½
years old and younger and it is not a
diagnostic test or an intelligence test.
 The tester conducted different test procedures to
the child such as copying a rectangle, imitating and
demonstrating a square, drawing a man with 3 and 6
parts; defining words, recognizing 3 color; walking
heel-to-toe forward and backward and balancing on 1
foot for 10 seconds.

The testers also gave significance to the client’s

profile such as family and medical histories to have an
overview which may help in assessing the client’s
condition. At the end part of the test, pertinent
documents were gathered and compiled to prove the
validity of the conducted tests and the persons
involved.
 Conclusion
An over-all finding reveals that Mary Chris
exhibits normal development in relation to
her age. She passed all the test procedures
which means that her developmental skill is
within normal range. It is typical for a child to
divert her attention to other activities while
conducting the test that’s why the tester
should master the procedures so that the
administration of these test procedures will
be fast and easy.
 Recommendation
It is very essential to monitor the developmental
skills of the child to prevent serious developmental
delays. The support mechanism of the primary care
provider is important at this age because they will
guide their children in the right path and it can affect
the development of the child throughout her life.
Parents are the one who will mold the child into a
good individual. Parents should conduct close
guidance to monitor the child’s developmental
abilities so that early referrals may be made in case
developmental delays are recognized.
 BIBLIOGRAPHY

• http://www.scribd.com
• Maternal and Child Health Nursing: Care of
the childbearing and Childbearing Family,
Lippincott Williams and Wilkins
• http://www.childdevelopmentinfo.com
• http://www.wikipedia.org
• Nursing Health Assessment, 2nd edition,
Patricia M. Dillon