PEDIATRICS Vol. 89 No. 6 June 1992, pp. 1221-1225
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Accuracy of the Denver-II in Developmental Screening

Frances Page Glascoe PhD1, Karen E. Byrne MA1, Linda G. Ashford PhD2, Katherine L. Johnson MA2, Bernard Chang 3, and Bryan Strickland 3

1 From the Child Development Center, Department of Pediatrics, Vanderbilt University School of Medicine
2 From the Department of Psychology, George Peabody College for Teachers of Vanderbilt University
3 From the Vanderbilt University School of Medicine, Nashville, TN.

One of the oldest and best known developmental screening tests was recently restandardized and revised as the Denver-II. Because it was published without evidence of its accuracy, the present study was undertaken with 104 children between 3 and 72 months of age attending one of five day-care centers. To determine the presence of developmental problems, children were administered individual measures of intelligence, speech-language, achievement, and adaptive behavior. A second psychological examiner, blind to the outcome of the diagnostic battery, administered the Denver-II. Developmental problems including language impairments, learning disabilities, mild mental retardation, and/or functional developmental delay were found in 17% of the children. The Denver-II identified correctly 83% and thus had high rates of sensitivity. However, more than half the children with normal development also received abnormal, questionable, or untestable Denver-II scores. Thus the test had limited specificity (43%) and a high overreferral rate. The alternative scoring method, categorizing questionable/untestable scores as normal, caused sensitivity to drop to 56% although specificity rose to 80%. Since neither scoring method produced acceptable levels of accuracy, an effort was made to locate the sources of accuracy and inaccuracy within the test. Only items in the language domain were modestly helpful in discriminating children with and without difficulties. The findings suggest that the authors of the Denver-II need to engage in further development of the instrument including revising scoring criteria and item placement in relation to children's ages. In the interim, test users should employ screening tests which are more accurate such as the Minnesota Inventories or the Battelle Developmental Inventory Screening Test.

Key Words: developmental screening • child development • early identification

Submitted on May 17, 1991
Accepted on January 28, 1992




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