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 Thought Speech becomes
(Cognitive more social, less
development) 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.Easy
to believe in
magical
increase,
decrease,
disappearance.
Reality not firm.
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 Freud Phallic Stage The pleasure
(psychosexual zone switches to
development) the genitals.
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.
(Psychosocial Guilt
development)
Children are capable
of learning, creating
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 PreconventionaThe earliest stage
Kohlberg l Morality of moral
development is
(Moral especially common
development) in young children,
Stage 1 -
but adults are
Obedience and capable of
Punishment expressing this 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,
children account for
and Exchange 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 FindingsNormal Interpretation
Technique Findings

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

Throat Tonsils indicate no Mucosa pink, no

signs of 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 lesions,healthy skin
noted; warm and swelling and and has no
dry; has good inflammation. potential
skin turgor. problem with
the hair and the
nails
She has a fine Evenly
Hair well-distributed distributed. Child has a
hair; shiny and healthy skin
short. Presence and has no
of lice noted. potential
problem with
the hair and the
nails
Nail Nails are clean and Clean and
short. The cuticles smooth nails.
are intact, smooth
and no Normal capillary
inflammation noted. refill, no lesions
Has a good or swellings
capillary refill of less present
than 3 seconds.
Pulmonary Respiratory rate is Lungs clear,
System recorded as 25 bronchial to
breaths per minute.
Lungs are clear bronchovesicula
upon auscultation. r sounds 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 in
System recorded as 85 normal rhythm
beats per with respiratory
minute. No variations, no
murmurs noted. chest pain or
Normal “lubdub” abnormal
sound heard sounds present
upon
auscultations
and no chest
pain felt as
verbalized by
the client.
Gastrointestina The patient has a Abdomen round, Performs
fundic height of 34
l System cm. with symmetric positive bowel regular bowel
contour. It was slightly sounds, liver movement.
protruded. edge palpable 2- Abdominal
Hypogastric sounds
were audible. 3 cm. contour normal
with age
No unusual normal
Musculoskeleta Shoulders and armsmovements
l System can be moved
such as tremors,
easily. No swelling
found in the elbow .
and can 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 intervals voiding may be
intake of toddler, with no pain felt, considered
voids regularly normal as a
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 Procedure Score Analysis Interpretation

PERSONAL-
SOCIAL
-pass - pass if the child -the child does not
1.Separates does not become become to upset
from mother too upset when the when the mother is
easily mother is out of out of sight. She
sight. can be
-the child can dress
2. Dresses herself completely
without -pass - pass if the can
and correctly
dress herself
supervision completely and without help as
correctly without evidence by the
mother’s
help verbalization and
child’s
demonstration.
FINE MOTOR -pass -pass if the child -the child draws
ADAPTIVE can draw a a figure with
1.Copies figure with straight lines
rectangle straight 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 draws

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

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

1.Comprehends -pass -the child gives a

cold, tired and
-pass if the child logical answer
hungry gives a logical for 2 out of 3
answer for 2 out questions.
of 3 questions.
- the points 3 out
-pass if the child of 4 colored
2.Recognize picks 3 out of
color -pass wooden blocks
four colors correctly.
correctly.
3.Defines word -Pass -pass if the child -the child
defines 7 out of defined
nine words in appropriately the
terms of use, terms of the
shape, what it is things asked to
made if, and its her.
general
category.

4.Compositio - pass if the

- pass - the child replies
n of child replies that that:
spoon is made “Spoon is made up
of metal; shoe is of metal.”
made of leather; “Door is made up of
door is made of wood.”
wood, or glass. “Shoe is made up of
plastic.”
GROSS -pass -pass if the child -the child can
MOTOR can stand on stand on 1 foot
1.Balance on 1 either foot 10 for 10 seconds
foot for 10 seconds or more on the first trial.
seconds in 2 or 3 trials.

2.Heel-to-toe -pass if the child

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