DDST-II: Denver Developmental Screening Test, 2nd edition

Mar 07 2018

DDST-II: Denver Developmental Screening Test, 2nd edition

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The previously posted information about the Denver Developmental Screening Test, 2nd edition is current and up to date.

Category: Discriminatory

Article Review

Title: Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty: a randomized single-blind controlled trial

Purpose: The purpose of this study was to determine if using guided play (that provides stimulation and activities of developmental growth) weekly in the home setting, specifically with at risk children living in foster homes in extreme poverty, would improve their developmental performance.

Study Population: A total of 78 children participated in this study and their ages ranged from 3.5 months to just under 6 years old. The children lived in Jimma town, South West Ethiopia with a foster family that had at least one maternal figure that had received training from the foster care organization. To be classified in the “extreme poverty” category, the family had to be living under the poverty line of 1.90 USD per person per day. Children were not allowed to participate in this study if they had profound intellectual disabilities, completely blind and/or completely deaf.

Methods and Intervention: For this study, the 78 children were randomly selected into either the intervention or control group in an even split (39 in each group). This was a single-blinded study because those performing the outcome assessments were blinded to which group the children were allocated to, but the children and trained play guiders were aware of the group allocation. The four outcome assessments (see below) were given and completed three times throughout the study, one at baseline, one after 3 months, and one after 6 months. The intervention occurred one time per week for approximately one hour and occurred over a 6-month period for a total of 24 sessions. Basic services from the foster care home and organization were provided to both groups. Experienced nurses that had been trained for over a month in child development and the techniques for play-assisted stimulation ran each session. The nurses would bring different kinds of appropriate play materials based on the child’s age and leave them in the home after the sessions. The nurses would direct the play to help form the developmental skills. Another major focus during the session was to get the foster mothers involved and teach them how to continue this play training throughout the week until the next visit.

Outcome measures: All the children in this study were assessed by four trained nurses in their homes on four different characteristics, developmental performance, social-emotional performance, anthropometrics, and sociodemographic characteristics. For developmental performance this study used the Denver Developmental Screening Test, 2nd Ed (DDST-II) that had been culturally adapted for Jimma and for social-emotional performance used an adapted version of the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). The anthropometrics used in this study were the children’s weight, length (if under 2 years old), and height (if over 2 years old). These values were then used to calculate weight for age, height/length for age, and weight for height/length. The sociodemographic characteristics were assessed using a structured questionnaire that was filled out by the foster mother and family.

Results: Overall, this study found that language, social-emotional, and personal-social outcomes improved significantly. There were not significant changes at any testing point for fine and gross motor skills. This study also found that other factors effected the outcomes. They found that the intervention was more effective for the boys versus the girls for the language domain and that the intervention was more helpful to children’s families that had a lower income in the person-social domain. The intervention was also more helpful in both motor skill domains based on the anthropometrics and maternal education status.

Major Strengths: Includes, all resources (i.e. toys) are easily accessible, 1 session per week is effective for some domains and cost-efficient, easily taught to families for continued use of intervention, the study was partially blinded, and there were a fair number of participants to provide more power and support for statistical significance.

Major Limitations: Includes, a short follow up which means there is no information on the carry over effect of the intervention, difficulty controlling shared information to the control group in the community, and the DDST-II has limited specificity, which indicates that it may not be the most reliable to determine changes in the motor skill domain.

Overall Conclusion: The overall conclusion of this study is that incorporating directed play to assist in stimulation for children that are at risk for developmental delays secondary to their poverty can significantly improve outcomes in language, social-emotional performance, and personal social performance. Basic services provided to these homes may positively affect fine and gross motor skill development as both groups showed improvement in this area over the course of the intervention. Further studies are required to determine the carry over affects and to determine if a greater intervention time is used if there would be a significant change in the development of motor skills using this intervention.


Worku BN, Abessa TG, Wondafrash M, et al. “Effects of home-based play-assisted stimulation on developmental performances of children living in extreme poverty: a randomized single-blind controlled trial.” BMC Pediatrics. 2018; 18:29. doi:10.1186/s12887-018-1023-0.


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