Examination, Evaluation, and Diagnosis
What the exam expects
You must select and interpret pediatric examination tools and reason toward a differential. Know the purpose of standardized measures: the Bayley Scales, Peabody (PDMS-2), Bruininks-Oseretsky (BOT-2), Gross Motor Function Measure (GMFM), and pediatric balance/gait tools. Understand reliability versus validity, sensitivity versus specificity, and when a screening tool versus a diagnostic tool is appropriate.
Examination skills
Demonstrate knowledge of age-appropriate handling, tone assessment (hypotonia vs spasticity vs rigidity), reflex testing and primitive reflex integration, range of motion, strength testing in children, and gait observation. Know when to modify a test (e.g., cannot complete standardized testing due to age or cognition) and how to document that limitation.
Evaluation and diagnosis
Evaluation synthesizes examination data into a functional problem list and a therapy diagnosis-not a medical diagnosis. Differentiate impairments, activity limitations, and participation restrictions using the ICF framework.
Traps
Questions often confuse screening with diagnosis, or ask you to interpret a score without acknowledging its standard error. Another trap is choosing a test that is not valid for the child's age or condition. Watch for stems that reward documenting limitations rather than forcing a test.
Rule of thumb: A test is only as good as its match to the child's age, diagnosis, and the construct you need to measure.
Worked example: A 3-year-old with suspected autism is referred for motor testing. BOT-2 norms begin at age 4, so selecting it is a trap; choose a measure valid for this age (e.g., PDMS-2) and note the rationale.