BayleyBayley scales of Infant and scales of Infant andToddler DevelopmentToddler Development

Third editionThird editionCarol Andrew, Carol Andrew, EdDEdD, OTR, OTR

Assistant Professor of PediatricsAssistant Professor of PediatricsDartmouth Hitchcock Medical CenterDartmouth Hitchcock Medical Center

Lebanon, New Hampshire, USALebanon, New Hampshire, USA

Revision goalsRevision goals

►►Update the normative dataUpdate the normative data►►Strengthen the psychometric qualityStrengthen the psychometric quality►►Simplify administrative proceduresSimplify administrative procedures►►Update stimulus materialsUpdate stimulus materials►►Develop Develop ““all-domainall-domain”” assessment capability assessment capability

Why revise?Why revise?

►►Improve quality and utility of the instrumentImprove quality and utility of the instrument►►Reflects new research on child developmentReflects new research on child development►►Demographic shifts over the past 15 yearsDemographic shifts over the past 15 years

or so since BSID II was or so since BSID II was normednormed

Update normsUpdate norms

►► Normative data collected in USA from JanuaryNormative data collected in USA from January2004-October 20042004-October 2004

►► Sample was stratified on key demographicSample was stratified on key demographicvariablesvariables Age, sex, race/ethnicity, parent education level,Age, sex, race/ethnicity, parent education level,

geographic locationgeographic location Children with disabilities or delays excluded fromChildren with disabilities or delays excluded from

standardizationstandardization

►► Special data collected on children with specificSpecial data collected on children with specificclinical diagnosesclinical diagnoses

Strengthen Psychometric qualitiesStrengthen Psychometric qualities

►►New items added to strengthen and expandNew items added to strengthen and expandcontent coveragecontent coverage

►►Reliability evaluated for normative andReliability evaluated for normative andclinical groupsclinical groups

►►Validity gathered for internal structures andValidity gathered for internal structures andin comparison to other measures such asin comparison to other measures such asWPPSI III and PLS-4.WPPSI III and PLS-4.

►►Subtest discrepancy analysis availableSubtest discrepancy analysis available

Simplify administrative proceduresSimplify administrative procedures

►►No No ““item setsitem sets””►►Reverse and discontinue criteria same for allReverse and discontinue criteria same for all

subtestssubtests►►Items clearly marked as part of a seriesItems clearly marked as part of a series►►More understandable directionsMore understandable directions►►More sample More sample ““acceptableacceptable”” responses responses

Update stimulus materialsUpdate stimulus materials

►►Materials are more colorful, interesting,Materials are more colorful, interesting,artwork updatedartwork updated

►►Picture book and story book sturdyPicture book and story book sturdycardboardcardboard

►►Stimulus book includes easel and directionsStimulus book includes easel and directionson testeron tester’’s side of the books side of the book

►►Quality of toys improvedQuality of toys improved

Develop all domain capabilityDevelop all domain capability

►► Three Three administeredadministered scales, five subtests scales, five subtests Cognitive scaleCognitive scale Language scaleLanguage scale

►►ReceptiveReceptive►►expressiveexpressive

Motor ScaleMotor Scale►►Fine motorFine motor►►Gross motorGross motor

►► Required for Individuals with Disabilities EducationRequired for Individuals with Disabilities EducationAct (IDEA)Act (IDEA)

Develop all domain capacityDevelop all domain capacity……

►►Two scales derived from Two scales derived from caregivercaregiverquestionnairesquestionnaires Social emotionalSocial emotional Adaptive BehaviorAdaptive Behavior

Item Bias examinedItem Bias examined

►►Experts in cross-cultural research and/orExperts in cross-cultural research and/orchild development conducted formal reviewschild development conducted formal reviewsof items twice during developmentof items twice during development

►►Problematic items were identified andProblematic items were identified anddeleted (13 from cognitive scale, 4 fromdeleted (13 from cognitive scale, 4 fromreceptive language scale, 3 from expressivereceptive language scale, 3 from expressivelanguage scale, 5 from motor scale)language scale, 5 from motor scale)

Evidence for ReliabilityEvidence for Reliability

►►Internal consistency of subtestInternal consistency of subtest Average reliability (Fishers z transformation)Average reliability (Fishers z transformation)

across age groupsacross age groups►►Cognitive scaleCognitive scale .91.91►►Expressive communicationExpressive communication .91.91►►Receptive communicationReceptive communication .87.87►►Gross MotorGross Motor .91.91►►Fine MotorFine Motor .86.86

Special Group ReliabilitySpecial Group Reliability

►► 668 children from668 children fromspecial groupsspecial groups Down syndromeDown syndrome At risk for delayAt risk for delay Language impairmentLanguage impairment Cerebral palsyCerebral palsy PervasivePervasive

developmental disorderdevelopmental disorder Alcohol exposureAlcohol exposure prematurityprematurity

►► Cognitive .96Cognitive .96►► Receptive languageReceptive language

.95.95►► Expressive languageExpressive language

.96.96►► Fine motor .95Fine motor .95►► Gross Motor .98Gross Motor .98

Evidence of ValidityEvidence of Validity

►►Comprehensive literature searches andComprehensive literature searches andexpert reviews conducted to ensure contentexpert reviews conducted to ensure contentvalidity (chapters 2-3 of Technical Manual)validity (chapters 2-3 of Technical Manual)

►►Social emotional scale and AdaptiveSocial emotional scale and AdaptiveBehavior scales derived from existing scalesBehavior scales derived from existing scaleswith extensive research supporting theirwith extensive research supporting theirvalidityvalidity

Correlations with other measuresCorrelations with other measures

►► BSID IIBSID II►► Wechsler PreschoolWechsler Preschool

Primary Scale ofPrimary Scale ofIntelligence IIIIntelligence III

►► Preschool Language ScalePreschool Language Scale––44

►► Peabody DevelopmentalPeabody DevelopmentalMotor Scale Motor Scale –– 2 2

►► Adaptive BehavioralAdaptive BehavioralAssessment System IIAssessment System II

►► Details available inDetails available intechnical manualtechnical manual

Special group studiesSpecial group studies

►► Pervasive developmental disorder/autisticPervasive developmental disorder/autisticspectrum disorder spectrum disorder N=70N=70

►► Down syndrome Down syndrome N=90N=90►► language impairment language impairment N=94N=94►► small for gestational age small for gestational age N=44N=44►► Fetal alcohol exposure Fetal alcohol exposure N=48N=48►► Cerebral palsyCerebral palsy N=73N=73►► Birth asphyxiaBirth asphyxia N=43N=43►► PrematurePremature N=85N=85

Special issues in using BSID-IIISpecial issues in using BSID-IIIinternationallyinternationally

►►Standardized in English: language itemsStandardized in English: language itemsmay not translate wellmay not translate well

►►Many more items Many more items –– better validity but takes better validity but takeslonger (estimate 90 minutes for childrenlonger (estimate 90 minutes for childrenover about 18 months of age)over about 18 months of age)

►►Questionnaires for caregivers very completeQuestionnaires for caregivers very completebut very laborious for parents or otherbut very laborious for parents or othercaregivers to docaregivers to do

Still have all the issues of infantStill have all the issues of infantassessment:assessment:

►►Prognostication poor unless severe delayPrognostication poor unless severe delay(<68)(<68)

►►Child and parent comfort with the situationChild and parent comfort with the situationessential to appropriate sampling ofessential to appropriate sampling ofbehaviorbehavior

►►Only measures current development duringOnly measures current development duringthe time observed the time observed –– does not provide does not providediagnosis or treatment recommendationsdiagnosis or treatment recommendations

Issues for Premature Issues for Premature FollowupFollowup

►► BSID II is quicker to administer and score (60BSID II is quicker to administer and score (60minutes instead of 90 minutes)minutes instead of 90 minutes)

►► In the US, already using BSID II for Vermont-In the US, already using BSID II for Vermont-Oxford data collection and will continueOxford data collection and will continue

►► BSID II does not measure quality of movement soBSID II does not measure quality of movement soMotor Scale (PDI) is not used for Motor Scale (PDI) is not used for ““neuromotorneuromotor””statusstatus

►► Vast majority of our Vast majority of our prematuresprematures are delayed on are delayed onPDI through age 2 but neurologically PDI through age 2 but neurologically ““normalnormal””

When and why to use BSID IIIWhen and why to use BSID III

►► If beginning a research project which requires aIf beginning a research project which requires avery careful evaluation of all aspects of a childvery careful evaluation of all aspects of a child’’ssperformance, where time is no problemperformance, where time is no problem

►► For a complete For a complete ““one-stopone-stop”” evaluation which evaluation whichsuggests need for further assessment in specificsuggests need for further assessment in specificarea (area (egeg, speech pathology referral, occupational, speech pathology referral, occupationaltherapy referral, etc)therapy referral, etc)

►► For early intervention For early intervention ““team assessmentsteam assessments””►►When following a child over time to make aWhen following a child over time to make a

diagnosis or to document change in status (suchdiagnosis or to document change in status (suchas as neurometabolicneurometabolic conditions with potential for conditions with potential forregression)regression)

Subtests can stand aloneSubtests can stand alone

►►Can be utilized for identification of specificCan be utilized for identification of specificissues such as language delay or motorissues such as language delay or motordelay or cognitive delay in a givendelay or cognitive delay in a givenpopulationpopulation

►►Each subtest takes perhaps 15 minutes toEach subtest takes perhaps 15 minutes toadminister at the most, depending on theadminister at the most, depending on theage of the childage of the child

BayleyBayley Screening Test Screening Test

►►Multiple subtestsMultiple subtests►►Abbreviated formatAbbreviated format

Cognitive 33 items instead of 91 itemsCognitive 33 items instead of 91 items Receptive language 24 instead of 49 itemsReceptive language 24 instead of 49 items Expressive language 24 instead of 48 itemsExpressive language 24 instead of 48 items Fine motor 27 instead of 66 itemsFine motor 27 instead of 66 items Gross motor 28 instead of 72 itemsGross motor 28 instead of 72 items**Results are not numeric: instead have Results are not numeric: instead have ““at riskat risk””,,

““emergingemerging””, , ““competentcompetent”” designations designations

Summary of BSID III in comparisonSummary of BSID III in comparisonwith BSID IIwith BSID II

►► Benefits:Benefits:►►More completeMore complete

evaluationevaluation►► Clearer directionsClearer directions►► Better materialsBetter materials►► Subtests can standSubtests can stand

alonealone►► Parent report separateParent report separate

and completeand complete►► PDA scoring availablePDA scoring available

►► Problems:Problems:►► Takes much longer toTakes much longer to

administeradminister►► If research alreadyIf research already

underway with BSIDunderway with BSIDII, canII, can’’t switcht switch

►► Language items mayLanguage items maypresent difficulty forpresent difficulty fornon-English languagenon-English languagestructuresstructures