My Premmie Boys Journeys

Referral/Relevant Background Information:
Brendan was born at 30 weeks gestation and weighed 1545 grams. Brendan was previously seen for follow-up at 12 months corrected age and was found to have a mild developmental delay when assessed on the Griffiths Mental Developmental Scale.

Behavioural Observations:
Brendan presented as a friendly child who was keen to sit at the table in readiness for the assessment. However, his initial response to many of the tasks was to throw the pieces of equipment on the floor. He was genuinely inquisitive but didn’t always concentrate for very long and needed to be refocused which usually required the question or instruction to be repeated. When Brendan was refocused on the task he often completed the task quite quickly. Brendan left his seat frequently and was keen to explore the room. His mother reported that this behaviour was fairly typical of what she sees at home where she constantly has to keep an eye on him.

Developmental Assessment Results:
(Results are based on Brendan’s corrected age of 24 months and 10 days)

Today’s assessment was carried out using the Bayley Scales for Infant and Toddler Development, Third Edition (Bayley III), which measures a child’s development across three developmental domains including: Cognitive, Language (receptive and expressive communication) and Motor skills (fine and gross motor skills). A developmental profile for Brendan was derived from his performance across the tasks included in this assessment and is reported below. Scaled scores indicate how Brendan performed compared to similar aged children in the Australian population. The scaled scores for each subtest can range from 1-19, with scores from 8-12 considered to be average, and low scores indicating delay in a particular developmental domain. Test scores can be influenced by a number of factors such as the child’s current state of health and well being, tiredness, motivation, attention and prior opportunities for learning.

Cognitive: 8
Receptive Language: 10
Expressive language: 3
Fine Motor: 10
Gross motor: 7
Social Emotional: 3

Cognitive Development: Borderline Average
The cognitive scale assesses sensory-motor development, exploration and manipulation of objects, concept formation and memory by exploring hoe children think, react and learn from their environment. Children are given tasks that measure their interest in new things, their attention to familiar and unfamiliar objects, and how they play with different kind of toys. Brendan was able to find hidden objects, completed the 9 piece form board and peg board. He attended to a story but had difficulty with the 3 piece shape board and was restricted in his style of play. Brendan achieved a cognitive standard score of 8 which represents a developmental age equivalent of 21 months and is within the range expected for a child his corrected age.

Language Development: Average Receptive Language and Below Average Expressive language

The language scale is made up of receptive and expressive communication skills. Receptive communication tasks assess a child’s ability to understand and respond appropriately to sounds, words and requests (i.e., identifying, listening and comprehending). Expressive communication tasks assess a child’s ability to communicate through sounds, words and gestures (e.g., babbling, taking turns, vocabulary and sentences). In assessing Brendan’s receptive language it was found that he could point to 9 objects in a book (e.g., ball, balloon) and identify 5 actions (e.g., waving, riding). He was able to point to 5 body parts and showed an understanding of the use of objects. Brendan achieved a receptive communication scaled score of 10, approximating a developmental age of 23 months. Brendan was heard to jabber expressively but did not produce identifiable words. He was able to engage in and initiate a play interaction with his mother (i.e., peek-a-boo) and tried to engage the attention of others by showing them objects. His expressive communication scaled score was 3 representing a developmental age of approximately 12 months. The discrepancy between his receptive and expressive language skills is significant and thus the usual practise of combining these scores to provide an estimate of Brendan’s overall language development is meaningless.

Motor Development: Average
The motor scale is made up of fine and gross motor skills. Fine motor skills refer to how a child uses his hands to manipulate objects such as grasping objects, building with blocks and drawing. Gross motor tasks assess a child’s ability to perform large muscle movements including running, jumping, balancing and coordinating. Brendan was keen to participate in these tasks. On the fine motor tasks, Brendan was able to stack 6 blocks, put pellets in a bottle and coins in a slot. He held a crayon using a transitional grasp and made random strokes on the page. Brendan pulled duplo blocks apart but was not yet able to reconnect them. He achieved a fine motor scaled score of 10, representing a developmental age equivalent of 25 months. When his gross motor skills were assessed, Brendan was able to walk up and down stairs with both feet on each step holding on to the rail, walk forward on a designated path and balance briefly on one foot with support. However, he does not run with co-ordination and is not yet kicking a ball or jumping off a step. He achieved a gross motor scaled score of 7, representing a developmental age equivalent of 18 months. The combined fine and gross motor scores indicates Brendan’s overall motor development is in keeping with children his corrected age.

Paed’s Summary

Brendan shows some concerning aspects in his development. He has a significant speech delay as well as an overall delay. His very high activity level, short attention span, high pain threshold, poor sleep pattern and lack of awareness of danger are all high risk factors for later development and learning. He is quite sociable and endearing, but likely to be quite exhausting to manage. he is receiving therapy services (OT and Speech) in Northam. We have encouraged Sally to make as much use as possible of family respite opportunities especially with the near arrival of the next baby. In view of these concerns we have arranged to review Brendan in one year’s time at the State Child Development Centre.