Comparison of Caretaker Report and Hands-On Neurodevelopmental Screening in High-Risk Infants

Abstract

Caretaker report in developmental screening of high-risk infants has not been investigated adequately. We compare a caretaker-completed neurodevelopmental prescreening questionnaire (NPQ) to a hands-on screener (Bayley Infant Neurodevelopmental Screener; BINS) and attempt to identify factors that influence agreement in a high-risk sample. From 1,436 infants drawn from 5 centers, 471 were prospectively evaluated at 6-months corrected age, 376 at 12-months, and 244 at 24-months. Fifty-five percent were male; 28% African American, 70% Caucasian, 3% other; M gestational age = 31.2 weeks, M birth weight = 1568 g. Caretakers completed the NPQ (based on the BINS) while watching a video depicting infants engaged in items. The BINS was subsequently administered. Sensitivity ranged from 80%-91%, specificity 57%-82%, and overall agreement 70%-83%, depending on age. Mean NPQ summary scores were lower than the BINS. Agreement varied depending on BINS risk status, being best in the high-risk group, and worst in the moderate risk group. Background variables had minimal impact at 6 and 12 months with BINS risk status being the primary influence; at 24-months, race, intraventricular hemorrhage, and respiratory distress syndrome were influential. Caretaker report is useful in a high-risk population, although the infant's neurodevelopmental status influences such early on; ethnic background and biomedical variables become more important at 2 years.

Assessment of Developmental Coordination Disorder in Children Born With Extremely Low Birth Weights

“…Sensitivity and specificity values, as well as positive and negative predictive values for the motor assessment battery, the Perinatal Follow-up Clinic protocol and the DCDQ, using the Movement ABC as the reference standard were derived and the percent agreement among these protocols was investigated. The Movement ABC is a "reference standard" and not a "gold standard"; therefore, sensitivity was considered co-positivity, and specificity, co-negativity (Aylward & Verhulst, 2008).…”

Application of neurodevelopmental screening to a sample of South American infants: The Bayley Infant Neurodevelopmental Screener (BINS)

“…A concurrent validity for the BINS and Bayley Scales of Infant Development II (BSID-II) yielded Pearson correlation coefficients (r) that ranged from 0.43 to 0.82 for the Mental Developmental Index and 0.39 to 0.58 for the Psychomotor Developmental Index (Aylward, 2010). Studies of predictive validity showed that an early classification of an infant in the high-risk category was a strong indicator of future developmental problems (Aylward, 1995, 1998; Aylward & Verhulst, 2008). …”

Developmental Screening and Assessment: What Are We Thinking?

“…Camp 12 underscores the issue of spectrum bias where better or worse identification depends on base rates of problems. Diamond and Squires 13 For example, in a high-risk follow-up population an average 76% agreement was found between a hands-on screening instrument and a parent-completed questionnaire 11 accompanied by video examples. The actual screening risk status of the infant (low, medium, high) was the variable most predictive of agreement at 6 and 12 months; at 24 months, race (a marker for socioeconomic status) was predictive.…”

“…10 Without doubt, caretaker completed questionnaires are attractive because of wide applicability, low cost, and decreased time demands. However, although these questionnaires have been favorably compared with other reference standards, 9,11 little is known as to how these instruments are affected by child-related or environmental factors (aside from parent reading level).…”