What is the Denver test, which areas of development does it screen and how is it done? Learn what normal and suspect results mean and how to help at home.
The neighbour's baby started walking at ten months, your mother-in-law says "My son was already talking at this age", and according to the development charts online your baby seems to be a month behind. One of the feelings parents experience most in the early years is the uncertainty that comes with the question "Is everything all right?" At this point your paediatrician or a specialist may suggest a Denver test. This suggestion reassures some families and makes others even more anxious. In this article we explain what the Denver developmental screening test is, which areas it looks at, how it is administered, what the results really mean and how you can support your baby's development at home.
What Is the Denver Test?
The Denver Developmental Screening Test is a developmental screening tool first developed in the 1960s in the US city of Denver and later updated under the name Denver II. It aims to assess the development of children from birth to six years of age by comparing them with their peers. A standardisation study has also been carried out in Turkey, and the test has been widely used in child health for many years.
The test's most important feature is that it is a screening tool. Screening tests are used not to determine with certainty whether a problem exists, but to identify early the children who may need a more detailed assessment. In other words, the Denver test is neither a diagnostic tool nor an intelligence test; it gives an initial idea of whether the child's development is progressing within the expected range.
The test is short and consists largely of tasks that look like play. This means it is not tiring for children, and parents can stay with their child during administration.
Which Areas of Development Does the Denver Test Assess?
Denver II examines the child's development in four main areas:
- Personal-social: The child's skills in relating to others and in self-care. A baby looking at a face and smiling, waving goodbye, drinking from a cup and beginning to dress themselves are examples of this area.
- Fine motor-adaptive: Hand-eye coordination and the skills of holding and using small objects. Such as a baby reaching for a toy, grasping a small object between two fingers, building a tower of blocks or copying a line by drawing.
- Language: The skills of noticing sounds, making sounds, understanding and speaking. Turning towards a sound, babbling, using "mama" and "dada" meaningfully, pointing to body parts and combining two words fall within this area.
- Gross motor: The skills of using the body's large muscles. Such as holding the head up, sitting without support, crawling, walking, kicking a ball and standing on one foot.
On the test form, each skill appears with bars showing the ages at which a certain percentage of children acquire that skill. For example, a skill's bar shows that some children acquire it earlier and others later. This structure shows visually that development is not tied to a single "right age" but is spread over a wide time range even among healthy children.
During the test the specialist also notes the child's general behaviour: whether they cooperate, how long their interest lasts, how they adapt to the setting and how they respond to stimuli.
How Is the Denver Test Administered?
The Denver test is administered by health and child development professionals trained in this area. Administration usually takes between fifteen and thirty minutes. The process roughly works as follows:
- Calculating age: The child's age is calculated in days, months and years, and an age line is drawn on the test form. For babies born prematurely, up to the age of two the corrected age, calculated from the expected due date rather than the date of birth, is usually used. This way the baby is not held responsible for skills they are not actually ready for.
- Trying out skills: The specialist tries out the skills near the age line together with the child. Simple materials are used, such as small blocks, a ball, a ball of coloured yarn, a rattle and picture cards.
- Parent report: Some skills, for example eating with a spoon or brushing teeth at home, cannot be observed in the test setting and so rely on the parent's report.
- Evaluation: Each skill is scored by comparing it with the level expected for the child's age, and the result is shared with the family.
Choosing a time when your baby is not sleepy or hungry before the test makes the result more realistic. A baby who is ill, teething or has just been vaccinated may perform below their usual level on that day. If your child cries during the test or does not want to do a skill, don't worry; the specialist notes this and, if necessary, tries the skills again at another time. Letting them behave as they do at home is more helpful than pushing them with "Go on, show us".
What Do Denver Test Results Mean? Normal, Suspect and Untestable
Denver II results are usually interpreted in three ways:
- Normal: The child's skills are within the range expected for their age. In this case, routine developmental monitoring continues.
- Suspect: Some of the child's skills have not yet been observed even though the great majority of their peers have long since acquired them, or there is a borderline picture. This result does not necessarily mean the child has a developmental problem. Usually a repeat of the test after a certain period, or a more detailed assessment in the relevant area, is recommended.
- Untestable: A reliable result could not be reached because the child was unable to cooperate sufficiently during the test. In this case, the test is repeated at a time that suits the child better.
Let's imagine an eighteen-month-old whose gross and fine motor skills are appropriate for their age, but who shows delays in several language skills: they do not yet speak beyond a few meaningful words and do not always follow simple instructions. In this case the specialist may assess the result as suspect and recommend that the family first have a hearing assessment, followed by a more detailed assessment of language and speech. Steps such as talking more with the child at home, looking at picture books together and reducing screen time are also discussed during this process. Perhaps in a few months the child will make rapid progress in language, or perhaps extra support will be needed; but either way, having noticed early is an advantage. You can find detailed information about delayed speech in the article on speech delay.
If more than one language is spoken at home
In Turkey, many children grow up hearing Kurdish, Arabic or another language at home alongside Turkish. When assessing the language skills of children growing up bilingual, this must always be taken into account. Such a child may have a vocabulary similar to their peers when words in both languages are counted together, yet appear behind when assessed only in the language of the test. For this reason, sharing with the specialist which languages are spoken at home, by whom and how often helps the result to be interpreted correctly.
The task of a screening test is not to give a child a label but to keep open the door to early help when it is needed.
The Difference Between a Screening Test and a Diagnosis
One of the common sources of confusion for parents is perceiving a screening test result as a diagnosis. Knowing the difference between the two prevents both unnecessary anxiety and unwarranted reassurance.
A screening test is a short, easy-to-administer tool that can be given to a large group of children. Its purpose is to pick out children who may need a detailed assessment. For this reason, it is possible for some children to be flagged as "suspect" and later found to be developing typically, or conversely for some difficulties to be missed in screening.
A diagnostic assessment, on the other hand, is far more comprehensive. It may include a detailed developmental history, family interviews, observation in different settings, standardised developmental scales and, where necessary, assessments from different specialist fields such as paediatric neurology, child psychiatry, audiology, physiotherapy or speech and language therapy. Conditions such as autism spectrum disorder, developmental delay or hearing loss are diagnosed at the end of a comprehensive process of this kind.
So even if you have received a normal Denver result, if your observations about your baby's development persist, do not hesitate to share them. Your everyday observations may contain details that a short test cannot capture. If you are curious about the signs of autism that can be noticed early on, you can take a look at the article on signs of autism.
Supporting Development at Home: Suggestions for Parents
Babies do not need expensive toys or special programmes to develop. The most powerful support lies within everyday interaction:
- Talk to your baby. Describe what you are doing while bathing them, preparing food or walking down the street. Respond to the sounds your baby makes; this back-and-forth "conversation" is the foundation of language development.
- Look at books together. Even if they do not yet understand, looking at picture books together, naming objects and reading with a changing voice is very valuable.
- Put them on the floor. Placing them on their tummy while awake and letting them move freely on the floor in a safe area supports gross motor development. Hours spent constantly in arms or in a pushchair reduce opportunities for movement.
- Limit screens. In the early years, time spent in front of a screen can get in the way of the baby interacting directly with human faces, voices and objects. Habits such as letting them watch a tablet during meals reduce opportunities for talking and interaction.
- Play with simple materials. Saucepan lids, wooden spoons, large beads and cardboard boxes are often the most engaging toys for a baby to explore.
- Avoid comparisons. Comparisons with siblings, cousins or the neighbours' children increase parental anxiety. Every child develops at a different pace; what matters is that the child progresses along their own developmental path.
- Look after yourself too. It is hard for a sleep-deprived, tired and lonely parent to find the energy to play with their baby. Asking for support from your extended family or your partner is also an indirect contribution to your baby's development.
When Should You Seek Professional Support?
Although every child develops at a different pace, some signs call for consulting a specialist rather than waiting. It is advisable to talk to your paediatrician or a child development specialist in the following situations:
- If your baby is six months old but does not make eye contact and smile at you or respond to sounds,
- If they are twelve months old but do not point, wave or respond to their name,
- If they are sixteen months old but use no meaningful words at all,
- If they have reached two years of age but do not form meaningful two-word phrases,
- If they are eighteen months old but do not walk without support,
- If, at any age, they have started to lose skills they had previously acquired, such as words or play skills.
Having one or more of these signs does not necessarily mean there is a serious problem. However, early assessment ensures that support, if needed, begins early. Brain development is very rapid in early childhood, and support offered during this period can make a valuable difference.
You can find information about the effects of developmental concerns on family life and about play-based work with children on the child and play therapy page.
How Are Developmental Concerns Addressed in Therapy?
Families who come with a developmental concern often bring not only a test result but also intense emotions: guilt, uncertainty, the question "Did I do something wrong?", and differences of opinion with partners or grandparents. Working with a psychologist offers a space where these emotions can also be addressed.
Psychological work with young children is usually play-based and involves the parent's active participation. The interaction between parent and child is observed; the parent is supported in noticing the child's cues, following their interests and creating opportunities for language and communication within play. This approach ensures that therapy does not stay in the session room but spreads into everyday life at home.
Work on developmental difficulties is mostly multidisciplinary. The paediatrician, paediatric neurology, child psychiatry, the speech and language therapist, the physiotherapist, the special education specialist and the psychologist each contribute from a different angle. Making sure the family does not get lost among these different specialists, that information is brought together and that the process is planned in a way that does not drain the family's strength is at least as important as the assessment itself.
Frequently Asked Questions
Is the Denver test an intelligence test?
No. The Denver test is a tool that screens whether a child's development in four areas is within the range expected compared with their peers. It does not give a score for intelligence and is not used to predict the child's future school performance.
Up to what age can the Denver test be done?
The test is designed for children from birth to six years of age. In children over six, concerns about development and learning are addressed with other age-appropriate assessment tools.
Who administers the test, and where can I go?
The Denver test can be administered by paediatricians, child development specialists, psychologists and other health professionals trained in this area. As a first step, describing your observations to the paediatrician who follows your baby or to your family doctor makes it easier for you to be referred appropriately.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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