What is the Denver II? The Denver Developmental Screening Test explained

The Denver II is a "developmental screening" test, a brief standardized check of how a young child's skills compare with those of other children the same age. It covers children from birth to 6 years of age and sorts observed skills into four areas: personal-social, fine motor-adaptive, language, and gross motor. It is one of the oldest and best known tools of its kind, and it is often confused with an IQ test, which it is not. This article explains where the Denver II came from, what it measures, how clinicians interpret it, and why researchers have argued about its accuracy for more than thirty years.

The Denver II contains 125 items, each tied to the age at which most children can perform a specific everyday skill. According to the test's authors, writing in the journal Pediatrics, the final items were chosen for ease of administration, appeal to children, reliability across examiners, and a smooth step-like progression of the ages at which 90% of children could perform each task.

The items fall into four sectors, as described in peer-reviewed studies that use the test:

• Personal-social: skills for interacting with people and caring for oneself, such as smiling at the examiner, waving bye-bye, or dressing.

• Fine motor-adaptive: hand and eye coordination, such as grasping a rattle, stacking blocks, or copying a drawn shape.

• Language: understanding and producing speech, from turning toward a sound to combining words and defining them. The 1992 revision increased the number of language items by 86% compared with the original test.

• Gross motor: whole-body movement, such as sitting without support, walking, and hopping.

A trained examiner presents age-appropriate items directly to the child using simple materials such as blocks and a rattle. In one published hospital study, a full assessment typically took about 20 to 30 minutes.

The original version, the Denver Developmental Screening Test (DDST), was published in 1967 by William K. Frankenburg and Josiah B. Dodds in The Journal of Pediatrics. The name comes from Denver, Colorado; the research team behind the test was based at the University of Colorado's medical campus there.

Over the following decades the DDST spread widely. By the time the revision appeared, the authors reported that the test had been used worldwide and restandardized in more than a dozen countries. Users had also raised concerns about specific items, and the original norms had aged.

The Denver II, published in 1992, was a major revision and restandardization. The research team administered 336 candidate items to more than 2,000 children, with each item given an average of about 540 times, and used the results to build new age norms. Besides the expanded language sector, the Denver II added two articulation items, a new age scale, a new interpretation category designed to catch milder delays, and a behavior rating scale. Adaptations and restandardizations have continued internationally; a 2022 Brazilian study, for example, reported good reliability for a translated version.

The Denver II does not produce a score. There is no "developmental quotient," no percentile, and no number on the familiar IQ scale. Instead, the examiner uses a chart with an age line drawn through it and records how the child performs on items near that line.

Two item-level flags drive the interpretation, as described in the screening literature:

• Caution: the child fails or refuses an item that 75% to 90% of children the same age can perform.

• Delay: the child fails or refuses an item that 90% of children the same age can perform, meaning the item sits entirely to the left of the child's age line.

The pattern of cautions and delays places the overall result into a screening category. Researchers who use the test describe three: "normal," meaning no delays and at most one caution; "suspect," meaning two or more cautions or one or more delays, which calls for rescreening and possibly referral; and "untestable," meaning the child refused so many items that no judgment is possible, which also calls for rescreening. A suspect result is a signal to look closer, and nothing more. Many children flagged as suspect turn out to be developing typically once a fuller evaluation is done, or once they are rescreened on a day when they are less tired, hungry, or shy.

The Denver II was published without accompanying evidence about how accurately it separates children with real developmental problems from children without them, and independent researchers moved quickly to test it. A 1992 study led by Frances Page Glascoe at Vanderbilt University examined 104 children aged 3 to 72 months, giving each child both the Denver II and a full diagnostic battery. About 17% of the children had genuine developmental problems. The Denver II correctly flagged 83% of them, a respectable "sensitivity" (the share of true cases a screen catches). Its "specificity" (the share of typically developing children it correctly passes) was only 43%, because more than half of the children with normal development received abnormal, questionable, or untestable results. When the researchers tried an alternative scoring rule that counted questionable results as normal, specificity rose to 80% but sensitivity fell to 56%. The authors concluded that neither scoring method reached acceptable accuracy and suggested clinicians consider other instruments.

Not everyone agreed the tool should be retired. A 2014 analysis in SAGE Open Medicine by Peggy Dawson and Bonnie Camp argued that sensitivity and specificity alone do not capture a screen's value in day-to-day practice and reported that Denver II results in their clinic matched or exceeded published results from parent-questionnaire screens. The honest summary is that the Denver II casts a wide net: it misses relatively few children with true delays under standard scoring, and the price is a high rate of "overreferral," meaning many flagged children who are actually fine.

Professional guidance has since moved toward tools with published accuracy figures and toward screening as a routine, not an exception. The American Academy of Pediatrics recommends developmental surveillance at every well-child visit and formal standardized screening for all children at the 9-, 18-, and 30-month visits, with extra attention around ages 4 to 5 before school entry. In many settings the parent-completed Ages and Stages Questionnaires, Third Edition (ASQ-3), which covers ages 1 to 66 months in about 10 to 15 minutes, has taken over the routine screening role the Denver test once filled.

It helps to be clear about what developmental screening does. A screen like the Denver II asks one question: is this child's development far enough outside the typical range that a professional should take a closer look? It is deliberately brief, it labels results rather than people, and a concerning result leads to a diagnostic evaluation rather than to any conclusion on its own. Formal intelligence tests for young children, such as the WPPSI for preschoolers and the WISC for school-age children, sit at that next stage: they are longer, individually administered instruments that yield normed scores on the mean-100 scale. Our guide to IQ tests for kids walks through how those measures differ from quick checklists.

Measuring adult reasoning is a different task again. Adults are past the stage where milestone checklists carry meaning, so adult assessment focuses on measured reasoning ability against adult norms. That is what the RIOT IQ test (the Reasoning and Intelligence Online Test) is built for: developed by RIOT IQ with psychometrician Dr. Russell T. Warne for adults 18 and older, it includes 15 subtests across six cognitive indices (verbal reasoning, fluid reasoning, spatial ability, working memory, processing speed, and reaction time), takes about 52 minutes, and reports scores on the familiar mean-100, standard-deviation-15 scale. Like any online measure, it does not replace an individually administered diagnostic evaluation, just as a Denver II result never replaces one for a child. If you want a carefully normed picture of your own reasoning ability, you can take the RIOT IQ test at riotiq.com.

No. The Denver II is a developmental screening tool. It produces a category (normal, suspect, or untestable) rather than a score, and it checks everyday skills such as walking, stacking blocks, and combining words rather than measuring reasoning ability.

It is designed for children from birth to 6 years of age. The 1992 revision drew its age norms from a standardization sample of more than 2,000 children.

It means the child showed two or more cautions or at least one delay. It is a signal to rescreen in a few weeks and, if the pattern persists, to refer the child for a full diagnostic evaluation. On its own it is not a diagnosis of anything.

A peer-reviewed 1992 study found that while the test caught 83% of children with true developmental problems, its specificity was 43%, so it also flagged more than half of typically developing children. Later guidance from the American Academy of Pediatrics emphasizes screening tools with stronger published accuracy.

Yes, particularly outside the United States, where translated and restandardized versions remain common in research and clinics. In American primary care it has largely given way to parent-completed questionnaires such as the ASQ-3.

A trained examiner, typically a clinician, nurse, therapist, or trained assistant. Training matters because interpretation depends on precise item administration and correct placement of the child's age line.

1. Frankenburg, W. K., & Dodds, J. B. (1967). The Denver Developmental Screening Test. The Journal of Pediatrics, 71(2), 181-191. pubmed.ncbi.nlm.nih.gov

2. Frankenburg, W. K., Dodds, J., Archer, P., Shapiro, H., & Bresnick, B. (1992). The Denver II: A major revision and restandardization of the Denver Developmental Screening Test. Pediatrics, 89(1), 91-97. pubmed.ncbi.nlm.nih.gov

3. Glascoe, F. P., Byrne, K. E., Ashford, L. G., Johnson, K. L., Chang, B., & Strickland, B. (1992). Accuracy of the Denver-II in developmental screening. Pediatrics, 89(6 Pt 2), 1221-1225. pubmed.ncbi.nlm.nih.gov

4. Dawson, P., & Camp, B. W. (2014). Evaluating developmental screening in clinical practice. SAGE Open Medicine, 2. pmc.ncbi.nlm.nih.gov

5. Özkan, S. (2025). Impact of the COVID-19 pandemic on early childhood development assessed with the Denver II developmental screening test in a single center. Scientific Reports, 15. pmc.ncbi.nlm.nih.gov

6. Lipkin, P. H., Macias, M. M., & AAP Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. (2020). Promoting optimal development: Identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics, 145(1), e20193449. pubmed.ncbi.nlm.nih.gov

7. Santos, J. A. T., Ayupe, K. M. A., Lima, A. L. O., Albuquerque, K. A., Morgado, F. F. D. R., & Gutierres Filho, P. J. B. (2022). Psychometric properties of the Brazilian version of the Denver II: Developmental screening test. Ciência %26 Saúde Coletiva, 27(3), 1097-1106. pubmed.ncbi.nlm.nih.gov

8. Paul H. Brookes Publishing Co. (n.d.). ASQ-3: Ages %26 Stages Questionnaires, Third Edition.. agesandstages.com

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