Assessment tools in current use

Assessment tools in current use (listed alphabetically)

  • Ages and Stages
  • AIMS – Alberta Infant Motor Scale
  • Denver Developmental Screening
  • Neonatal Assessment Scale (Brazelton)
  • PEDS - Parent Evaluation Developmental Score
  • Stycar Developmental Sequences (Sheridan)

Ages and Stages was developed by educationists in USA, to screen infants up to 60 months of age. It is written at a literacy level of Grade 4-6. It is a parent completed format with 19 sequential questionnaires. Each age specific questionnaire contains 6 questions in 5 areas of development: communication, gross motor, fine motor, problem solving, personal social.

* It does not screen for feeding difficulty in infants less than 8 weeks of age.

Red flags: deviations in communication could indicate feeding difficulty.

Efficacy: Test Sensitivity: 72-96% (lower at age 4 months); Test Specificity: 86%

Resources and References:

AIMS – Alberta Infant Motor Scale was developed in Alberta, Canada. It is an observational measure of infant motor performance, assessing the infant’s sequential development of motor milestones from term to independent walking. AIMS assessments at 4, 8, 12 and 16 months corrected age can be compared with Canadian normative data. Infants who have more than one AIMS score falling below 5th percentile will be followed up and assessed.

*It does not screen for feeding difficulty in infants less than 8 weeks of age.

Denver Developmental screening (9-30 months) was developed at University of Minnesota in 1994 by Harold Ireton, PhD. (He also developed the Infant Development Inventory [IDI] in 1994.)

This screening is intended to test for disability in low income families, with low literacy (education) levels and where there are mental health concerns. It is appropriate for single parent families, where the test infant has a lot of siblings. Unemployed parents and low levels of parent concern may also indicate infants at high risk.

*It does not screen for feeding difficulty in infants less than 8 weeks of age.

Red Flags: Birth to three month:

  • Rolling prior to 3 months (Evaluate for hypertonia)
  • Persistent fisting at 3 months (Evaluate for neuromotor dysfunction)
  • Failure to alert to environmental stimuli (Evaluate for sensory Impairment)

Efficacy: Test Sensitivity: 85%; Test Specificity: 77%

Neonatal Behavioural Assessment Scale (NABS)

This was developed in 1973 by Dr T. Berry Brazelton and his colleagues, and was one of the first test designed to detect abnormalities. He stated that: “The Scale gives us the chance to see what the baby’s behavior will tell us” .

The scale identifies four areas of development:

  • Autonomic nervous system – breathing and temperature control
  • Motor system – controlling erratic and random movement
  • State regulation – sleep and cry control
  • Social interaction (the ultimate developmental task) – following, smiling, following

*Unfortunately, it does not include observations related to feeding behaviour – oral motor efficiency, which Sheridan indicates should be achieved by 4 weeks.

PEDS was developed by Frances Page Glascoe, PhD, in 1998, in USA to assist paediatricians who were ‘missing’ early indicators of developmental delay in infants and children under 8 years of age. The parent questionnaire has 10 questions written at 4-5th Grade literacy level.

Efficacy: Test Sensitivity: 75%; Test Specificity: 74%

*It does not screen for feeding difficulty in infants less than 8 weeks of age.

The Stycar Developmental Sequences – Birth to five years.

This screening tool was developed by Mary Sheridan in 1973 to assess deviations from the norm – handicaps. It is the basis of developmental screening for infants and children from birth to 5 years in Western Australia. Sheridan specifically notes that ‘Mother’s suspicions that her child is not seeing, hearing, moving his limbs or taking notice like other children of his age’, is ‘usually right’ and should be given due consideration by the health professional

It covers four areas of assessment:

  • Posture and large movements
  • Vision and Fine movements
  • Hearing and Speech
  • Social Behavior and Play

Sheridan includes ‘feeding skill’ under Social Behaviour and Play and at one month states:

  • Sucks well
  • Stops crying when picked up and spoken to

The symptoms of feeding discomfort, as considered ‘norm’ and not a ‘deviation’:

  • Stops whimpering and turns towards sound of nearby soothing human voice, but not when screaming or feeding,
  • Cries lustily when hungry or uncomfortable

NB. There is no specific screening procedure which is generally used for suck-swallow-breathe efficiency – well, not yet, and with the benefit of hind sight, many babies were bottle fed, so 1970s deviant behaviour at the breast, easily fell off the child development radar. The major focus for feeding was for nutritional outcomes, not feeding efficiency outcomes and comfortable breastfeeding (mother and baby). We have to now ask:

What is baby does not suck well?…………………….dysfunctional or disorganised suck?

What if baby keeps crying regardless of what you do?……… …….pain from…?

Why is baby screaming? ……………………….muscles spasm?..oesophageal irritation?

Why is baby uncomfortable?…………………. …………………………………….postural turn?