Running head: BAYLEY TEST REVIEW

Test Review of the Bayley Scales of Infant and Toddler Development, Third Edition Meagan Keashly University of Calgary

BAYLEY TEST REVIEW Test Review of the Bayley Scales of Infant and Toddler Development, Third Edition Descriptive Information The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) was

developed by Nancy Bayley (Bayley, 2006a). There are two types of kits available for purchase. The complete kit costs $950.00 and contains: the administration manual, technical manual, stimulus book, picture book, manipulative set, rolling case, package of 25 Social-Emotional and Adaptive Behavior Questionnaires, package of 25 Caregiver Report Forms, and package of 25 Cognitive, Language, and Motor Record Forms. The comprehensive kit costs $1059.00 and includes all materials from the complete kit with the addition of a PDA administrative assistant and Fundamental Administration DVD. Both are available for purchase from the publisher, Pearson. Pearson can be contacted either online (http://www.pearsonassessments.com) or directly at the following address: Pearson Customer Service, 19500 Bulverde Road, San Antonio, Texas 78259-3701 (Phone: 800-627-7271 Fax: 800-2321223) (Pearson, 2009). Introduction The Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) is a standardized assessment of infant and toddler developmental functioning. It is organized into 16 subtests, which form five scales. The subtests in the Cognitive, Language, and Motor scales are administered directly to the child, while whereas the Social-Emotional and Adaptive Behavior scales are composed of questionnaires that are completed by the childs primary caregiver. The Cognitive subtest forms its own scale, as does the Social-Emotional subtest. The Language scale is comprised of Receptive Communication and Expressive Communication subtests. The Motor scale is formed from Fine Motor and Gross Motor subtests. Ten subtests form the General

BAYLEY TEST REVIEW

Adaptive Composite (GAC). The Communication, Functional Pre-Academics, and Self-Direction subtests form the Conceptual part of the GAC. Self-Direction, Leisure, and Social subtests form the Social component. While Community Use, Home Living, Health and Safety, and Self-Care subtests form the Functional component of the GAC. There is also a Motor subtest that contributes to the GAC (Bayley, 2006a). The Bayley Scales of Infant Development (BSID) were first developed in 1969 and have been revised twice. The Bayley-III is the revision of the previous version of the test, the Bayley Scales of Infant Development, Second Edition (BSID-II), which was published in 1993 (Bayley 2006b). There are a number of improvements made in the current edition, which include: a simplified administration process, improved treatment utility of the instrument, improved psychometric properties, and updated normative data (Pearson, 2009). Additionally, the Bayley-III has five distinct scales compared to three in the previous edition. Other improved features include: updated item administration, a less bulky kit, a built-in easel on the stimulus book, and Windowsbased scoring software which eliminates the need for paper versions of the record forms and manual. The Bayley-III also allows for increased involvement by caregivers (Bayley, 2006a). Purpose/Recommended Use The construction of the Bayley Scales (BSID, BSID-II, and Bayley-III) has been informed by research in child development and includes many concepts of early cognition including: play, information processing, number concepts, and preverbal intelligence. Items included are based on behaviours typical of normal development in children. However, the Bayley-III is best described as being based on an eclectic theoretical foundation where no one theory has driven the content (Bayley, 2006b). Historically, the Bayley Scales have been used

BAYLEY TEST REVIEW

to chart childrens progress after initiation of an intervention program. According to Bayley, it has long considered to be the instrument of choice for documenting a childs development periodically through the course of intervention (2006b, p. 6). The Bayley Scales have also been extensively used in research to examine students performance in a particular diagnostic group or to track the effects of intervention on childrens development (Bayley, 2006b). The Bayley-III is an instrument designed to assess the developmental functioning of infants and children between the ages of one and 42 months. It is intended to measure the infant or young childs level of development in the cognitive, motor, and behavioural domains. It is a level C test; therefore most examiners who use the Bayley-III will have had formal graduate or professional training in assessment (Bayley, 2006a). The Bayley-III is used for the following purposes: to identify children who are developmentally delayed; to chart a childs progress after initiation of an intervention program; to teach parents about their infants development; and to conduct research in developmental psychology (Bayley, 2006b). The Bayley-III is a unique test in that there is a flexible administration format. The examiner can administer the subtests in any order based on the childs interest and level of engagement. The only exception is that the Receptive Communication subtest must be administered before the Expressive Communication subtest (Bayley, 2006a). The Bayley-III also encourages caregiver involvement as it helps to facilitate testing and provides caregivers with insight into their childs skills and capabilities (Bayley, 2006b). Additionally, caregivers fill out Social-Emotional and Adaptive Behaviour ratings for their child. Items in the Bayley-III are grouped into subtests according to content. This makes it easier for caregivers to recognize

BAYLEY TEST REVIEW

their childs delays and facilitates discussions about specific concerns. The Bayley-III is a useful tool in multi-disciplinary assessment teams because the Cognitive, Language, and Motor Scales can be administered independently (Bayley, 2006a). Major Features of the Test The Bayley-III is composed of items that form five scales. The Cognitive Scale assesses object relatedness;, sensory-motor development;, concept formation, exploration and manipulation;, memory;, and other aspects of cognitive processing. It reflects the role of play, information processing, and number concepts in cognitive development. There are 91 items in this scale. The first item assesses whether a child calms when being picked up while whereas the last item asks a child to complete a pattern using a pegboard (Bayley, 2006a). The Language scale is comprised of receptive and expressive communication items. The Receptive Communication subtest assesses preverbal behaviours; vocabulary development, such identifying pictures and objects;, vocabulary related to morphological development, (including pronouns and prepositions);, understanding of morphology, (such as possessives, plurals, and tense markings);, social referencing;, and verbal comprehension (Bayley, 2006a). It contains 49 items. Earlier items assess auditory acuity while later items assess the childs ability to understand and appropriately respond to words and requests. The first item of the subtest assesses whether the child fixes his gaze on a person for at least two seconds, while the final items asks the child to correctly identify all items within six categories (Bayley, 2006a). The Expressive Communication subtest is composed of items which that assess preverbal communication, including babbling, gesturing, joint referencing, and taking turns;, vocabulary development, (including naming objects, pictures and attributes);, and morpho-syntactic development, (including using two-word combinations, plurals and verb tense). There are 48 items

BAYLEY TEST REVIEW

in this subtest. Early items assess a young infants vocalization ability, while whereas later items measure the childs ability to form combinations between words and gestures. The first item assesses whether a child is able to produce soft and throaty gurgling sounds while the last item assesses whether a child uses at least three examples of future tense when describing a picture series (Bayley, 2006a). The third scale is the Motor Scale, which is composed of Fine Motor and Gross Motor subtests. The Fine Motor subtest includes skills related to prehension, perceptual-motor integration, motor planning, and motor speed. The 66 items of this subtest measure visual tracking, reaching, grasping, object manipulation, functional hand skills, and tactile information responses. Early items assess eye movement coordination and control while later items assess the ability to grasp and utilize small objects. The first item of the subtest assesses whether a childs hands are fisted the majority of the time while the last item checks for whether a child can copy a square (Bayley, 2006a). The Gross Motor subtest mainly measures torso and limb movements. The 72 items on this subtest assess static positioning, such as sitting and standing;, dynamic movement, (such as locomotion and coordination);, balance;, and motor planning (Bayley, 2006a). The Bayley-III places emphasis on the childs movement quality rather than simply whether the child has accomplished the motor skill. The Developmental Risk Indicators and Behavior Observation Inventory can be used to measure the quality of movement relative to the Gross Motor items (Bayley, 2006b). The first item of this subtest assesses whether a child thrusts legs several times in play while the last item assesses whether a child is able to jump forward at least 24 inches in any one of three trials (Bayley, 2006a). The fourth scale is the Social-Emotional Scale. This is assessed through a questionnaire

BAYLEY TEST REVIEW

completed by the primary caregiver. The questionnaire is an adaptation of the Greenspan SocialEmotional Growth Chart: A Screening Questionnaire for Infants and Young Children (Bayley, 2006a). This scale assesses the achievement of social and emotional milestones in infants and young children (Bayley, 2006a). Six stages are identified which mark the major developmental milestones that should be achieved by children between birth and 42 months of age. Stage one occurs by three months of age. In it children show increasing self-regulation and interest in the world. Stage two occurs by five months of age and is when children can engage in relationships. By nine months of age, children enter into stage three where they can purposefully use emotions in an interactive manner. Stage four is broken up into two parts. The first part occurs by 14 months of age where the child is able to communicate using a series of interactive emotional signals or gestures. The second part of the stage occurs by 18 months of age where the child is able to uses these signals or gestures to solve problems. Stage five is also broken up into two parts. By 24 months of age, the child is able to convey feelings or intentions using symbols or ideas. The second part of the stage occurs by 30 months of age, where the child can express more than basic needs using symbols or ideas. The final stage occurs by 42 months, where the child is able to make logical connections between ideas and emotions (Bayley, 2006b). The Social-Emotional Scale also includes items, which assess the childs sensory processing, as differences in sensory processing can largely impact a childs emotional responses (Bayley, 2006b). There are 35 items in the Social-Emotional Scale. The first item has the caregiver rate the frequency with which the child displays a calm and enjoyable awareness of most sounds. The final item assesses the frequency that the child has conversations that make sense with peers and adults using four or more back-and-forth exchanges (Bayley, 2006a). The fifth scale of the Bayley-III is the Adaptive Behaviour Scale. It is formed based on the

BAYLEY TEST REVIEW

Adaptive Behaviour Assessment System-Second Edition (ABAS-II) (Bayley, 2006a). The Adaptive Behaviour Scale is based on the principle that each individual needs a range of skills to effectively meet the daily demands and expectations of the environment. This scale evaluates the achievement of functional skills essential for increasing the infant and young childs independence. It measures what the child actually does and what the child may be able to do. It focuses on behaviours that the infant or toddler completes independently (Bayley, 2006b). The Adaptive Behaviour Scale is comprised of ten subtests, which form a series of composites, as mentioned previously. All of the composites contribute to the General Adaptive Composite (GAC), which is an overall measure of the childs adaptive development (Bayley, 2006a, p. 4). The caregiver rates the child on a variety of behaviours depending on the subtest. For example, the first item in Community Use has the caregiver rate the frequency with which the child is able to recognize his or her home in the immediate neighborhood, while Home Living assesses the frequency with which a child removes food from a bag or box. The final item in the Motor subtest rates the frequency that a child uses scissors to cut shapes with curved lines, while the final item for Self-Care assesses the frequency that a child cuts food into bite-size pieces (Bayley, 2006a). The five scales of the Bayley-III are clinically significant because they can be used to identify developmental delays and give information to plan and assess interventions. A childs development relative to typically developing peers can be determined through developmental age equivalents. Additionally, growth scores allow a childs individual progress to be compared over time. The Bayley-III also encourages the caregivers involvement in the assessment process, which enables insight into the strengths and weaknesses of the child (Bayley, 2006b). Administration Administration time for the Bayley-III depends on the age of the child. For children

BAYLEY TEST REVIEW

between birth and 12 months of age, the entire battery takes approximately 50 minutes. For those aged 13 to 42 months, it takes approximately 90 minutes to administer the test (Pearson, 2009). It is important for the examiner to be familiar with the administration and scoring procedures of the Bayley-III to fully understand the standard procedures (Bayley, 2006a). In order to reliably assess a childs abilities, it is important to have a distraction free testing environment. The room should be comfortable, quiet, and well lit. There must be a large enough testing area so that the child has enough room to demonstrate the gross motor skills required. The room should also have a small table and two chairs for administration of some items. Access to a set of stairs is also necessary for older children. Ideally, only the examiner, the child, and a primary caregiver will be present in the room during testing. It is also important for the examiner to take time to establish and maintain rapport. Approaching the child in a positive way, attempting to put the child at ease, having a positive tone, and keeping the child as actively engaged in the tasks as possible all promote a cooperative relationship between the examiner and the child (Bayley, 2006a). When administering the test, the examiner should use a clipboard placed in his or her lap to hold the record form. It is important that the examiner is familiar with item administration so it is not necessary to constantly refer to the administration manual. The examiner can enlist the caregivers help to get a response from the child in many of the play-based items. Additionally, to help with administration and scoring, the comprehensive kit includes PDA administration software, which combines the record form and administration manual into an electronic format (Bayley, 2006a). The Bayley-III kit comes with a number of materials. However, the examiner must also provide some supplies. Examiner supplied materials include: facial tissue, five small coins, food pellets, unlined blank index cards, safety scissors, stopwatch, unlined paper, and photocopies of

BAYLEY TEST REVIEW

10

blackline masters. It is important that children are supervised carefully at all times and that they are not left unattended with the testing materials. After each session, it is important that all nonpaper materials are cleaned so that infections are not spread. New food pellets should be used for each administration of the test (Bayley, 2006a). During administration, it is important that the examiner pays attentiond to the additional information provided for each test item. Some items require a stopwatch, multiple responses from the child in order to receive a score, and/or administration to the left and right side of the child. Also indicated is the starting position the child should be in for the item. The positions are: level supine, elevated supine, cradled, supported sitting, seated, social sitting, floor sitting, prone, standing, supported at shoulder, and upright. Some items have multiple trials in order to allow children to practice unfamiliar tasks and display their best performance during testing. Notably, several items on the Bayley-III are series items that require varying levels of performance by the child to meet the scoring criteria. The Bayley-III also contains some training items, which are to be completed before scored items are administered. The intent of the training items is to familiarize the child with novel tasks and ensure that the child understands the task (Bayley, 2006a). All of these scales have a reversal rule where basal is achieved by a score of one on the first three items based on the age-specific start point. If a zero is obtained on any of the first three items, the examiner must go back to the start point for the previous age and administer those items. The reversal rule is applied until a score of one on the first three items of an age start point is reached. Items may not be re-administredadministered. However, the Bayley-III does allow a child to obtain a score on a previous item if, during subtest administration, the examiner observes a behaviour that was not elicited earlier. Testing on a subtest is discontinued when the ceiling has

BAYLEY TEST REVIEW

11

been reached, which is five consecutive scores of zero on items, or the examiner has come to the end of the subtest (Bayley, 2006a). Items within each subtest are ordered based on difficulty; when administering it is important to follow the order of items as closely as possible. However, the subtests may be administered in any order the examiner chooses based on the childs temperament, interests, and level of rapport established. This flexibility is beneficial as it allows the examiner a better opportunity to get the childs normal performance while administering a standardized test. The only required testing order is that Receptive Communication must be administered before Expressive Communication (Bayley, 2006a). Scoring and Interpretation Each of the items in the Cognitive, Motor and Communication scales is scored either zero or one. For the Social-Emotional Scale, caregivers rate behaviour frequency of the child according to a scale ranging from zero to five: 0 - can notcannot tell, 1 - none of the time, 2 some of the time, 3 - half of the time, 4 - most of the time, and 5 - all of the time. The Adaptive Behaviour Scale items are rated for behaviour frequency from zero to three: 0 - is not able, 1 -never when needed, 2 - sometimes when needed, and 3 - always when needed. Additionally, there is a box for caregivers to check if they guessed on the rating (Bayley, 2006a). Prior to administering the Bayley-III, the examiner must determine which of the 16 agespecific start points is appropriate for the child. The childs age in months and days is calculated and adjusted for prematurity for children up to 24 months of age. For the Social-Emotional Scale, the caregiver completes all items regardless of the childs age. However, for on the

BAYLEY TEST REVIEW Adaptive Behavior Scale, Community Use, Functional Pre-Academics, and Home Living

12

subtests are completed only by caregivers of children one year of age or older. The other seven subtests are completed regardless of the childs age (Bayley, 2006a). Raw scores are calculated for each of the subtests, which can be converted to scaled scores. Composite scores can be determined for each of the five scales. These scores can be converted into percentile ranks and developmental age equivalents. While Although these normative scaled scores provide information about a child compared to his or her peers at a given time, the scores themselves may not change very much over time. In addition to these scores, the Bayley-III also allows for calculation of growth scores, which have an equal-interval scale so the childs development can be measured over time. Growth scores give an ability estimate for the child, which is separate from that of the childs peers (Bayley, 2006a). Standardization of the Test The Cognitive, Language, and Motor Scales were standardized on 1700 children between the ages of one and 42 months. There were 17 age groups in total, with 100 participants in each age group. Ten percent of children in the sample were developmentally delayed (e.g. Down Syndrome and Cerebral Palsy). The Social-Emotional scale was standardized on 456 children, which was representative of the United States population. The Adaptive Behavior Scale was normed on 1350 children between the ages of 0 and 71 months. For all of the scales, equal numbers of males and females were included for each age group. The 2000 United States census served as the basis for stratification according to parent education, race/ethnicity and geographic region (Bayley, 2006b).

BAYLEY TEST REVIEW Technical Characteristics / Psychometric Properties

13

Technical characteristics for the Bayley-III can be found in the Technical Manual (Bayley, 2006b). For the Cognitive, Language, and Motor scales, internal consistency reliability was obtained on the normative sample using the split-half method corrected using the Spearman-Brown formula correction. The average reliability coefficient for scale composites ranged from .91 for the Cognitive scale to .93 for the Language composite. The average reliability coefficients for the subtests ranged from .86 for the Fine Motor subtest to .91 for the Expressive Communication and Gross Motor subtests. For test-retest stability, corrected correlation coefficients ranged from .67 for the Fine Motor subtest to .80 for the Expressive Communication subtest for the age group between 2 to 4 months; and from .83 for the Gross Motor subtest to .94 for the Expressive Communication subtest and Language composite for the group aged 33 to 42 months. Across all age groups, the average stability coefficients were .80 or higher (Bayley, 2006b). The internal consistency for the Social-Emotional scale was estimated using coefficient alpha, with coefficients ranging between .83 and .94 for social-emotional items and .76 to .91 for sensory processing items. The average reliability coefficients across each of the skill areas, adaptive domains, and GAC of the Adaptive Behaviour Scale ranged from .79 to .98. Regarding test-retest reliability, the mean stability coefficients for the GAC and Adaptive Behaviour domains were 0.80 or higher. However, coefficients were slightly lower for specific skill areas. The interrater reliability coefficient for the GAC was .82. The adaptive domain coefficients averaged . 79 while the adaptive skill area coefficients averaged .73 (Bayley, 2006b). Evaluation The Bayley-III is an instrument designed to assess the cognitive, motor, and developmental functioning of infants and children between one and 42 months of age. It is a

BAYLEY TEST REVIEW

14

useful tool for identifying children who are developmentally delayed and for charting a childs progress after an intervention program. The Bayley-III has a number of strengths. It is a relatively easy to administer assessment that includes manipulatives that appeal to children. The record forms and scoring software are easy to follow and understand. Caregiver involvement and flexibility in the order of subtest administration allow for a more accurate representation of the childs abilities during the assessment process. Caregiver involvement also facilitates better insight by the caregiver of his or her childs areas of strength and weakness (Bayley, 2006b). Another strength of the Bayley-III is that the scales can be separated so that psychologists, speechlanguage pathologists, occupational therapists, and other professionals can administer different areas of the test. This assessment therefore lends itself for use in child assessment within a multidisciplinary team (D. Creighton, personal communication, February 19, 2010). Limitations of the Bayley-III include that it does not give a Mental Development Index Score and a Psychomotor Development Index score, which were available in the Bayley-II; comparisons between the different versions of tests can be problematic. It can be difficult to get a good assessment of language with the Bayley-III if the child is not engaged in testing. Language assessment can also be especially problematic is the childs first language is not English (D. Creighton, personal communication, February 19, 2010). An important consideration when using the Bayley-III is that it is not used to measure deficits within a specific area or to obtain normreferenced scores for children with severe sensory or physical impairments. Additionally, the Bayley-III should not be used to predict academic achievement or as a measure of intellectual functioning (Bayley, 2006b).

BAYLEY TEST REVIEW References Bayley, N. (2006a). Bayley Scales of Infant and Toddler Development-Third Edition: Administration manual. San Antonio, TX: Harcourt Assessment. Bayley, N. (2006b). Bayley Scales of Infant and Toddler Development-Third Edition: Technical manual. San Antonio, TX: Harcourt Assessment. Pearson (2009). Product summary: Bayley Scales of Infant and Toddler Development-Third Edition. Retrieved from http://www.pearsonassessments.com/HAIWEB/Cultures/enus/Productdetail.htm?Pid=015-8027-23X

15