METRO MANILA DEVELOPMENTAL
SCREENING TEST
SCREENING
- The presumptive identification of
an unrecognized disease or defect
by the application 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.
ASPECTS OF DEVELOPMENT
- In the care of pediatric clients,
growth and development are not in
isolation
- Nurses being competent in the
aspects of growth and 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.
MMDST—Metro Manila Development
Screening Test
- Is a simple useful tool/ detection
model that applies to the detection
of developmental disabilities in
children aged 6 ½ years and below
- It is developed by Dr. William K.
Frakenburg and associates in 1967
for the Denver children
- Modified and adapted by Dr.
Phoebe D. Williams on Metro
Manila Children
- Designed for healthcare
professionals—nurses, doctors,
and health workers so that slow
development may be recognized
- SCREENING TEST
- Screening instrument to determine
whether a child’s development is
within normal
MMDST
- It is not an intelligence test
- It is not a diagnostic test
- It is not a predictor or future
adaptive or intellectual ability
PURPOSE OF MMDST
- Measures developmental delays
- Evaluates 4 aspects of
development
MMDST KIT
- Manual
- Sample test form
- Test materials
- MMDST bag
TEST MATERIALS
- Bright red yarn pom-pom
- Rattle with narrow handle
- Eight 1-inch colored wooden
blocks
- Small clear glass bottle with 5/8-
inch opening
TEST FORM
- Made of 105 items written in the
range of development of children
between birth and 6 years of age
- Across the top and bottom of form
are age scales
- Age is marked in months for 1-24,
and in ears from 2 ½ to 6.
- The space between ages 2 weeks
to 14 months is equivalent to 2
weeks
- 14 to 24 months is 1 month
- 24 to 5 years is 3 months
- 5 years thereafter is 6 months
TEST FORM:
1. Date
2. Name
3. Address
FOUR SECTORS:
1. Personal-social
2. Fine-motor adaptive
3. Language
4. Gross-motor
Personal-Social
- Tasks which indicate the child’s
ability to get along with people and
to take care of himself
o Plays interactive games
o Buttons up
o Plays ball with examiner
Fine-motor Adaptive
- Tasks which indicate the child’s
ability to see and use his hands to
pick up objects and to draw
o Transfer cube
o Imitates vertical line
Language
- Tasks which indicate the child’s
ability to hear, follow directions,
and to speak
o Turns to voice
o Points one body part
o Gives 1st and last name
Gross-motor
- Tasks which indicate the child’s
ability to sit, walk, and jump
o Sits without support
o Pedals bicycle
o Hops on 1 foot
THE TEST FORM
- Each item is represented in the test
form by a bar
- The bar is placed along the age
scale to show when 20%, 50%,
75%, and 90% of the normal
children are able to pass the item.
- Footnote indicates corresponding
instruction for administering the
item found at the test form
- some items may be passed by
report by the parent
- tester should observe what the
child can perform
- 9 items have arrows at the right
end of these bars
- Arrows indicate that normal
children may pass these items
even beyond 6 ½ years old
TEST PROCEDURE
- Establish rapport with the mother/
caregiver
- Make the child as comfortable as
possible
- Calculate the child’s age
- Draw the age line
- Before starting, obtain consent,
explain the purpose of the MMDST
1. PRELIMENARY PHASE
o Establish rapport
o Make the child as comfortable
as possible
o Avoid testing a child when he
is ill, sleepy, tired, hungry, and
upset
Step 1: Calculating child’s age
- Initial step in test administration
- Basis for drawing the age line
- The test items that will be
administered will depend on the
calculated age of child
- Date of test minus date of birth
o Days, months, years
Step 2: Adjustment for prematurity
- 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
- 2 years or younger
o No adjustment for children
born later than expected
- Children born 2 weeks or more
earlier than expected
o Subtract the number of weeks
of prematurity from the actual
age of the child
Step 3: Drawing the age line
- Use the age scale shown at the
TOP and BOTTOM of the test form
as guide
- Mark the calculated age of the
child on the scale
- Draw a line (age line) through the
four sectors of the test form (use
ruler)
- Write the date of the test at the top
of the age line
STEP 4: Selecting items administered,
all items crossing the age line should be
administered
- If failure occurs in any of these
items, proceed to the items to the
left of the age line until you obtain 3
passes, then stop
- In items passed, continue testing to
the right until the child fails 3 times
- Each sector should have at least
three passes and three failures.
- Start with Personal-social sector
- Gives child chance to get used to
tester
- Gives tester chance ask parents
which can be scored based on
report and can also directly
observe it.
 - Fine-motor adaptive sector follows
- Child can perform tasks even
without having to directly talk to
tester
- Third is, language sector
- This time child is more comfortable
with you
- Will talk as much to you
- Lastly, gross-motor sector
- Many children are too shy at the
beginning of the test
STEP 5: Scoring items
- Four ways of scoring
o P (pass)
o F (failure)
o R (refusal)
o NO (no opportunity)
- Failure of an item that is completely
to the left of the child’s age is
considered a developmental delay
- Whereas failure of an item that is
completely to the right of the
child’s age line is acceptable and
not a delay
Step 6: Interpret results
1. Mark each delay by heavily
shading the right end of the
shaded part
2. Count the number of sectors that
have 2 or more delays
3. Count the number of sectors that
have 1 delay with no passes
intersecting the age line in the
same sector
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
- 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 delay
TEST PROCEDURE:
Four interpretations:
- Abnormal: if 2 or more sectors with
2 or more delays in the
administration of MMDST
- Questionable: if 1 or more sectors
with 1 delay in that same sector, no
passes interacting the age line
- Untestable: when refusal occur in
numbers large enough to cause the
test result to be questionable or
abnormal
- Normal
FOLLOW THESE SIMPLE STEPS:
1. Mark each delay by heavily
shading the right end of the bar
2. Count the number of sectors that
have 2 or more delays
3. Count the number of sectors that
have 1 delay with no passes
intersecting the age line in the
same sector
4. Interpret the result using the
following criteria.
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 approx. 2 weeks
- At the BOTTOM of the age line,
indicate the test result and
interpretation example: Abnormal,
reason: 2 sectors have 2 delays
STEPS IN TEST PROCEDURE:
1. Calculating the child’s age
2. Adjusting for prematurity
3. Drawing the age line
4. Selecting items to be
administered
5. Scoring items
6. Interpret result
CONSIDERATIONS:
- Manner in which test is
administered must be exactly the
same as stated in the manual,
words or direction may not be
changed
- If the child is premature, subtract
the number of weeks of prematurity
- But if the child is more than 2 years
of age during the test, subtracting
may not be necessary
- If the child is shy or uncooperative,
the caregiver may be asked to
administer the test provided that
the examiner instructs the
caregiver to administer it exactly
as directed in the manual
- If the child is very shy or
uncooperative, the test may be
deferred
SHY CHILD
- Ice breaker: cheese curl or give a
block, bell, or rattle to play with
UNCOOPERATIVE CHILD
- Ask parent to leave room
- Let them turn away from screening
test but still in sight
- Reverse psychology
OVERACTIVE CHILD
- Limit distractions
- Bring out only necessary materials
for testing
- Direct the child’s attention
- Be firm and calm
CHILD WITH MANY SIBLINGS
- Explain mother to test each
individually
- send child on errands