vol. 31, no. 1, pp. 69–90 c developmental assessment with...

Infants & Young ChildrenVol. 31, No. 1, pp. 69–90Copyright C© 2018 Wolters Kluwer Health, Inc. All rights reserved.

Developmental AssessmentWith Young ChildrenA Systematic Review of BattelleStudies

Ana C. B. Cunha, PhD; Michelle D. Berkovits, PhD;Karolina A. Albuquerque, MD

Developmental assessment scales are important tools for determining developmental delays andplanning preventive interventions. One broad assessment scale used to evaluate child develop-ment is the Battelle Developmental Inventories (BDIs). The BDI-2 has a standardized version inEnglish with good psychometric properties and a translated version in Spanish; however, despitewidespread clinical use, there has been limited early childhood development research focused onthis assessment tool in the past 10 years. The purpose of this systematic review was to evaluatethe literature about the BDIs and their screening test and analyze their use for child assessment.Seven databases were used to retrieve articles in English, Portuguese, and Spanish. Overall, 34articles were evaluated for general features, salient findings, and key methodological issues, suchas target population, objectives, research design, and main results. Authors’ considerations aboutthe psychometric properties and utility of the BDIs were also examined. Results indicated that41.17% of studies with the BDIs were from the United States, and the most common target popu-lation was children with autism spectrum disorders. Generally, the articles highlighted the broadapplications of this measure and robust psychometric properties cited in the BDIs examiner’smanual as reasons for their use. This review suggests that it is important to conduct independentanalyses of the psychometric properties of the BDIs as well as validation studies to ensure ap-propriate applications of the BDI, including for use with non-American populations. Key words:child behavior, developmental disabilities, psychometric assessments, risk factors, systematicreview

Author Affiliations: Department of ClinicalPsychology, Institute of Psychology, UniversidadeFederal do Rio de Janeiro, Rio de Janeiro, Brazil (DrCunha); Department of Pediatrics, University ofMiami, Miller School of Medicine, Miami, Florida(Dr Berkovits); and Programa de Pos-graduacao emPsicologia, Universidade Federal do Espirito Santo,Espirito Santo, Brazil (Dr Albuquerque).

This article is part of the postdoctored studies of thefirst author, Ana C. B. Cunha, supported by the CAPESFoundation, Ministry of Education of Brazil, Brasılia,DF—Brazil (Proc. number 99999.001420/2014-0).

The other authors declare no conflict of interest.

Correspondence: Ana C. B. Cunha, PhD, Departmentof Clinical Psychology, Universidade Federal do Riode Janeiro, Av Pasteur, 250, Pavilhao Nilton Campos,Campus da Praia Vermelha, Urca, Rio de Janeiro, RJ,Brazil, 22290-240 ([email protected]).

DOI: 10.1097/IYC.0000000000000106

D EVELOPMENTAL assessment scales area useful tool for early childhood re-

searchers, clinical professionals, and policyresearchers who may use these scales to iden-tify risk factors, plan interventions, and imple-ment programs for young children at risk fordevelopmental difficulties. These scales havebeen used for early detection of developmen-tal difficulties and to monitor children’s devel-opmental progress and outcomes (Barreno,Lopez, & Menendez, 2011; Barreno, Lopez,& Menendez, 2013; Goldin, Matson, Beighley,& Jang, 2014). These tools can also facilitatetherapeutic interventions to reduce risk of se-vere disabilities for children with specific di-agnoses, such as autism spectrum disorders(ASDs; Turygin, Matson, Beighley, & Adams,2013a). Also, developmental assessment

Copyright © 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.

69

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70 INFANTS & YOUNG CHILDREN/JANUARY–MARCH 2018

scales provide a useful indicator used to com-pare child development across a variety of do-mains as well as providing information aboutskill levels in specific areas, such as currentcognitive abilities (Turygin et al., 2013a).

In general, conventional tests, which arestandardized and norm-referenced, are usedto meet the early intervention eligibility stan-dards of the Individuals with Disabilities Edu-cation Act (IDEA, 2004; Macy, Bagnato, Macy,& Salaway, 2016). One commonly used con-ventional test is the Battelle Developmen-tal Inventory (BDI), originally published in1984 (Newborg, Stock, Wnek, Guidubaldi, &Svinicki, 1984) and revised as the Battelle De-velopmental Inventory, 2nd Edition (BDI-2)in 2005 (Newborg, 2005a). To ensure clar-ity, the original BDI will be referred to asBDI-1 throughout this article. For both edi-tions of the BDI, this is a normed and stan-dardized measure with a Spanish translationversion available (Newborg, Stock, & Wnek,1996; Newborg, 2005b). When all versionsof the BDI are referred to collectively withinthis article, they will be referred to as “BattelleDevelopmental Inventories” or “BDIs,” whichincludes the Screening versions.

Comparing conventional tests used to meetthe IDEA standards (2004), the BDIs, as wellas the Bayley Scales of Infant and Toddler De-velopment (BSID) and other cognitive mea-sures, such as the Stanford-Binet IntelligenceScales and the Wechsler Preschool and Pri-mary Scales of Intelligence, have current edi-tions developed to facilitate meeting of IDEAstandards by including parent participation inthe evaluation process (Macy et al., 2016).Domains assessed within current versions ofthe BDI and BSID correspond with areas ofcomprehensive assessment required by IDEA.Macy et al. (2016) affirm that the manuals ofthe BDI-2 and BSID-3 emphasize the impor-tance of cultural diversity, include childrenwith disability within the normative sample,and allow examiners to make careful, minorchanges on test items when assessing chil-dren with disabilities. However, these mod-ifications should not alter scoring criteria.Although the BDI-2 requires standardized ad-

ministration, compared with other conven-tional measures, the BDI-2 has greater flexibil-ity in its inclusion of a choice of administrationmethods for individual items and graduatedscoring criteria.

The BDIs measure developmental skills forchildren from birth to 8 years of age across thefollowing domains: personal–social, adaptive,motor, communication, and cognition. How-ever, the number of subtests has been reducedfrom 22 to 13 from the BDI-1 to the BDI-2. TheStandard Scores for each domain are referredto as developmental quotient scores, with amean of 100 and SD of 15. Each domain com-prised subdomains, with mean scaled scoresof 10 and SD of 3. Lower scores indicategreater impairments. There is also a screen-ing version of the BDI-2 that includes a subsetof test items from the full test item pool. TheBDI-2 Screening Test has similar proceduresfor item scoring, and the cutoff scores aid inidentifying children who may need additionalfollow up (Newborg, 2005a).

Each BDI item offers from one to threemodes of administration: structured, obser-vation, and/or interview. For all modes, theadministrator rates the child’s developmentalskills on the basis of a 3-point Likert scale: 0means “milestone not yet evident”; 1 means“milestone emerging”; and 2 means “mile-stone achieved.” The BDI-2 has been shownby the test developers to have robust psycho-metric properties, with acceptable contentand criterion validity, as well as acceptabletest–retest reliability (above 0.80), and excel-lent internal consistency (ranged from 0.98to 0.99; Newborg, 2005a). In a systematic re-view on validation studies of neurodevelop-mental screening tests for children 5 yearsof age or younger in the United States andLatin American from 1980 to 2012, the Bat-telle Development Inventory Screening Testwas considered the best sensitivity screen-ing inventory (Roma-Pardo, Liendo-Vallejos,Vargas-Lopez, Rizzoli-Cordoba, & Buenrostro-Marquez, 2012).

Recent research to provide social validityevidence for specific early childhood mea-sures compared the qualities and patterns of


Developmental Assessment With Young Children 71

using authentic assessments and conventionaltests among professionals in the early child-hood intervention field (Lee, Bagnato, Pretti-Frontczak, 2015). Social validity of assess-ment measures is a recent paradigm in theearly childhood assessment area in the UnitedStates, which refers to the acceptability ofand satisfaction with an intervention or as-sessment procedure based on the judgmentsof individual consumers, participants, and im-plementers of the procedures (e.g., parents,children, and professionals; Bagnato, Goins,Pretti-Frontczak, & Neisworth , 2014). Ac-cording to a survey by Lee et al. (2015),the BDI-2 was the most commonly used con-ventional test among interdisciplinary profes-sionals in early childhood education settingsbecause of its relatively short administrationtime and utility in determining eligibility forspecial education services. The validity andreliability of conventional tests, such as theBDI-II, were identified as a primary reason forinterdisciplinary professionals’ use of thesetests (Lee et al., 2015). In addition, the BDI-2 was rated highly and identified as havingseveral characteristics more commonly associ-ated with authentic assessment tools becauseof the emphasis on ensuring developmentallyappropriate assessment. Specifically, the BDI-2 includes functional content that follows adevelopmental sequence, relies on informa-tion from multiple sources, allows for testingadaptations, includes graduated scoring crite-ria, and has utility in natural settings.

In clinical settings, the BDI-2 has been usedby qualified personnel who work with earlychildhood populations, like the Early StepsProgram in Florida. Under the IDEA, Part C,this early intervention program provides ser-vices to infants and toddlers and their fami-lies from birth to 36 months. For children toenroll in the Early Steps Program, the childmust have either a developmental delay or adiagnosed physical or mental condition thatplaces him or her at high risk for a develop-mental delay. For Early Steps, the BDI-2 is oneof the recommended tools to evaluate chil-dren’s development for evaluation purposes(Florida Early Intervention System, 2015).

Moreover, researches have used the BDIsfor a variety of purposes and concluded thatthe BDIs are a useful measure to identify anddescribe risk factors associated with devel-opmental outcomes in specific populations,such as autism spectrum disorders (ASD)(Goldin et al., 2014; Sipes, Matson, & Tury-gin, 2011; Turygin et al., 2013a; Turygin, Mat-son, Konst, & Williams, 2013b). Moreover,these inventories are also useful to determinespecific domains of developmental skills forchildren with specific diagnoses, like cere-bral palsy (CP; Barreno et al., 2011; Barrenoet al., 2013; Mancıas-Guerra et al., 2014). Inaddition, the BDIs have been used for otherresearch purposes, such as to test the effi-cacy of specific interventions or to screenfor potential developmental delays. In sum-mary, the proposal of this study was to review,synthesize, and evaluate the literature aboutBDI, BDI-2, and BDI Screening tests to analyzetheir use for early childhood developmentalassessment.

METHODS

This systematic review was written in ac-cordance to the Preferred Reporting Itemsfor Systematic Reviews and Meta-Analysesguidelines. To retrieve articles for this re-view, a search was done using the follow-ing databases: MEDLINE; SCOPUS, Cochrane,LILACS, IBECS, SciELO. The following twosets of key words were used for each search:(1) Children AND Assessment; (2) ChildrenAND Assessment AND Battelle Inventory. Thefilters used for determining which studiesfound with these key words were selectedfrom the electronic databases for this system-atic review were as follows: (1) studies pub-lished in the past 10 years and (2) studies writ-ten in one of the following three languages:English, Portuguese, or Spanish. From the ini-tial search, 120 articles were found, and af-ter the filters were applied, 51 articles wereincluded in the next phase. After duplicateswere removed, 34 articles were screened byreading each title and abstract to confirminclusion for the review.



All 34 articles were read extensively to ex-tract pertinent data regarding outcomes fromeach study and identify key methodologicalissues. This following information was ex-tracted from each article: (a) language andnationality of the study; (b) target populationand characteristics; (c) research design; (d)objectives of the study related to the BDIs;and (e) main results related to the BDIs. Theauthors’ considerations about the psychome-tric properties of the BDIs and reasons forusing the BDIs for specific purposes werealso examined. Observational studies (cross-sectional, case–control, and cohort), experi-mental studies (randomized controlled trials,randomized or quasi-randomized trials), andcase reports were included.

RESULTS

Nationality, research design, andauthors’ considerations about the BDIs

Results from the total sample of articlesretrieved for this review are summarized inTable 1.

The majority of the 34 articles (79.41%, 27articles) were in English. The remaining sevenarticles were in Spanish. There were no ar-ticles found written in Portuguese, althoughthere were three articles from Brazil. In regardto the nationality, 41.17% of the articles werefrom research conducted in the United States.Most of the other research was conducted inSpain or Latin America (n = 15), but two ar-ticles were found from Canada and one eachfrom Israel, Pakistan, and Russia.

Regarding the research design, four vali-dation studies were found using the BDIsas a secondary measure, and one case re-port study was found. The majority of articles(85.2%) were observational studies: 14 cohortstudies; 6 group–control research studies; 6cross-sectional studies; and 3 articles with sec-ondary data analysis from prospective studies.

Related to the authors’ descriptions aboutthe psychometric properties and utility of theBDIs, the tools were identified as a “gold stan-dard” measure for child development. Except

for three articles in which the authors did notidentify any specific reasons for selecting theBDIs, 91.1% of articles considered the BDIsas good assessment tools with robust psycho-metric properties. In most of them, authorshighlighted psychometric properties of theBDI-2 from the examiner’s manual, includinghaving acceptable test–retest reliability (0.80)as well as an excellent internal consistency(0.98–0.99).

Some authors also highlighted that the in-ventories cover a wide age range, facilitatinglongitudinal comparison using the same clin-ical measure to determine developmental tra-jectories and outcomes, as well as support-ing the diagnosis of a specific disability con-dition, such as ASD. Also, the BDIs were usedin distinct settings because of the administra-tion time and different procedures availableto gather information.

Target population and main purposes ofstudies with the BDIs

The results for target population groups andthe main purposes for using the BDIs are sum-marized in Tables 2 and 3, respectively.

Four groups of children were found astarget populations in studies using the BDIs(see Table 2). More than half of those stud-ies (58.8%) were conducted with childrenidentified as at risk or diagnosed with devel-opmental disorders for a variety of researchobjectives.

Variability was found in the use of differentversions of the BDIs (see Table 3). The authorsretrieved and reviewed articles published onlyfrom 2005 to 2015, after the BDI second edi-tion was published; however, 44.12% of thetotal of articles used the original BDI-1. Al-most half the studies (44.12%) used the BDIsas assessment tools to identify developmen-tal outcomes in children with developmentaldisorders due to diagnosed conditions. TheBDIs were also used to identify developmen-tal outcomes in typically developing childrenand at-risk children. In four articles, the BDIswere used as a convergent and divergent va-lidity measure in a mixed sample of childrenor in typically children sample. The BDIs were


Developmental Assessment With Young Children 73T

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inte

rven

tio

nan

daf

ter

afo

llow

-up

per

iod

of

app

rox

imat

ely

6ye

ars

Th

eo

vera

llm

ult

ivar

iate

resu

lts

ind

icat

edth

atth

eth

ree

inte

rven

tio

nco

nd

itio

ns

mai

nta

ined

thei

rd

iffe

ren

ces

acro

ssth

ese

thre

efo

llow

-up

tim

es(B

DI-1

sco

res

ten

ded

toin

crea

seb

etw

een

thes

ep

erio

ds)

Th

eB

DI-1

was

sele

cted

bec

ause

(a)

the

item

sw

ere

rele

van

t(“

auth

enti

c”)

toth

eo

rph

anag

es’

con

tex

t,(b

)it

isb

ette

rsu

ited

tom

ildd

isab

iliti

esch

ildre

nth

ano

ther

gen

eral

beh

avio

ral/

dev

elo

pm

ent

test

s,(c

)it

isap

pro

pri

ate

for

child

ren

fro

mb

irth

to95

mo

nth

s,an

d(d

)p

rovi

des

ato

tals

core

plu

ssu

bsc

ales (c

on

tin

ues

)



Tab

le1

.A

rtic

leSu

mm

arie

sIn

clu

din

gN

atio

nal

ity,

Res

earc

hD

esig

n,P

op

ula

tio

n,O

bje

ctiv

es,M

ain

Res

ult

s,an

dA

uth

ors

’Co

nsi

der

atio

ns

Ab

ou

tth

eB

atte

lleD

evel

op

men

talI

nve

nto

ries

’Psy

cho

met

ric

Pro

per

ties

and

Usa

ge(C

on

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

9.R

izzo

li-C

ord

ob

aet

al.(

2013

)/M

exic

o

Mix

edsa

mp

le;N

=43

8ch

ildre

n(a

tri

sk,

n=

344;

typ

ical

lyd

evel

op

ing,

n=

104;

<5

year

so

fag

e)

To

eval

uat

eth

ep

sych

om

etri

cp

rop

erti

eso

fth

e“E

valu

acio

nd

elD

esar

rollo

Infa

nti

l”(E

DI)

asa

scre

enin

gto

olf

or

child

ho

od

dev

elo

pm

enta

lpro

ble

ms

Th

em

od

ified

vers

ion

of

EDI

sho

wed

ase

nsi

tivi

ty,

spec

ifici

ty,a

nd

con

cord

ance

com

par

edw

ith

BD

I-2as

aco

nve

rgen

tva

lidit

ym

easu

re

Th

eB

DI-2

was

con

sid

ered

ago

ldst

and

ard

mea

sure

for

child

dev

elo

pm

enta

las

sess

men

t

10.T

ury

gin

etal

.(2

013a

)/U

nit

edSt

ates

To

dd

lers

wit

hA

SDan

dth

ose

atri

skfo

rd

evel

op

men

tald

elay

fro

mth

eLo

uis

ian

aEa

rly

Step

sP

rogr

am;

N=

2054

(ASD

n=

559;

atyp

ical

dev

elo

pm

ent

(AD

),n

=14

95;1

7–36

mo

nth

s)

To

inve

stig

ate

wh

eth

erth

eu

seo

fD

SM-5

crit

eria

for

ASD

sw

ou

ldre

sult

inm

ore

dev

elo

pm

enta

llyd

elay

edo

rco

gnit

ivel

yim

pai

red

po

pu

lati

on

asco

mp

ared

wit

hth

ose

dia

gno

sed

wit

hA

SDs

acco

rdin

gto

DSM

-IV

-TR

crit

eria

Ove

rall

BD

I-2D

Qw

ere

low

erin

alld

om

ain

sfo

rch

ildre

nw

ho

qu

alifi

edfo

rth

eA

SDd

iagn

osi

sac

cord

ing

toD

SM-5

crit

eria

com

par

edw

ith

tho

sew

ho

met

crit

eria

acco

rdin

gto

the

DSM

-IV

-TR

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es,a

nd

its

valid

ity

has

bee

nes

tab

lish

edfo

rh

igh

-ris

kgr

ou

ps

such

asth

ose

wit

hA

SDan

do

ther

dev

elo

pm

enta

ldel

ays

11.T

ury

gin

etal

.(2

013b

)/U

nit

edSt

ates

To

dd

lers

atri

skfo

rd

evel

op

men

tald

elay

,fr

om

the

Lou

isia

na

Earl

ySte

ps

Pro

gram

;N

=31

73(1

7–36

mo

nth

s)

To

inve

stig

ate

vari

able

sm

ost

rela

ted

toth

ep

rese

nce

of

par

enta

lco

nce

rno

fea

rly

com

mu

nic

atio

nd

efici

tsan

dit

sre

lati

on

ship

wit

hsy

mp

tom

so

fA

SD

Sign

ifica

nt

resu

lts

wer

eo

bse

rved

rela

ted

toea

rly

com

mu

nic

atio

nfi

rst

con

cern

s,ge

nd

er,a

nd

DQ

s(o

vera

llan

din

div

idu

ald

om

ain

sco

res)

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es

(con

tin

ues

)


76 INFANTS & YOUNG CHILDREN/JANUARY–MARCH 2018T

able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

12.B

assa

net

al.

(201

2)/I

srae

lC

hild

ren

wit

hb

irth

risk

s(p

rete

rmin

fan

tsw

ith

po

sth

emo

rrh

agic

hyd

roce

ph

alu

s;fo

llow

ing

intr

aven

tric

ula

rh

emo

rrh

age;

N=

32(3

mo

nth

s)

To

del

inea

teth

eim

pac

to

fea

rly

(∼25

day

so

flif

e)vs

late

(>25

day

s)EV

Do

nth

en

euro

dev

elo

pm

enta

lo

utc

om

eo

fp

rete

rmin

fan

ts

Mu

ltip

lere

gres

sio

nan

alys

issh

ow

edth

atth

eea

rly

EVD

was

asso

ciat

edw

ith

bet

ter

sco

res

than

late

EVD

inad

apti

ve,

per

son

also

cial

,co

mm

un

icat

ion

,an

dco

gnit

ive

do

mai

ns

No

con

sid

erat

ion

sab

ou

tth

eB

DI-2

or

test

ing

lan

guag

elis

ted

13.B

ow

enet

al.

(201

2)/

Pak

ista

n

Typ

ical

lyd

evel

op

ing

child

ren

wh

ow

ere

enro

lled

ina

tria

lof

ho

use

ho

ld-le

vel

han

dw

ash

ing

pro

mo

tio

n;

N=

461

(5–7

year

s)

To

eval

uat

eas

soci

atio

ns

bet

wee

nh

and

was

hin

gp

rom

oti

on

and

child

gro

wth

and

dev

elo

pm

ent

To

talB

DI-2

DQ

amo

ng

child

ren

enro

lled

inth

ein

terv

enti

on

gro

up

aver

aged

6.1

po

ints

(0.4

SD)

hig

her

than

child

ren

inth

eco

ntr

olg

rou

p

Th

eB

DI-2

vers

ion

was

no

tva

lidat

edfo

ra

Pak

ista

ni

po

pu

lati

on

;th

eat

tem

pts

totr

ansl

ate

and

adap

tth

ein

stru

men

tw

asca

refu

l,b

ut

itis

no

ta

guar

ante

efo

rac

cura

teD

Qs

amo

ng

that

po

pu

lati

on

14.G

om

ez-

Arr

iaga

etal

.(2

012)

/Sp

ain

Ch

ildre

nw

ith

con

gen

ital

mal

form

atio

n(m

ildve

ntr

icu

lom

egal

y-V

M);

N=

18(1

–8ye

ars)

To

anal

yze

mid

term

neu

rod

evel

op

men

to

utc

om

ein

child

ren

Th

eB

DI-1

Scre

enin

gT

est

sho

wed

that

the

neu

rod

evel

op

men

tal

del

ayw

asw

ors

ein

som

ed

om

ain

s(s

oci

al–p

erso

nal

,gro

ssm

oto

r,ad

apti

veb

ehav

ior,

and

fin

em

oto

r)th

ano

ther

s(c

om

mu

nic

ativ

ean

dco

gnit

ive)

.G

ener

altr

end

tow

ard

wo

rse

ou

tco

mes

wer

eo

bse

rved

inth

egr

ou

po

f≥4

year

s,al

tho

ugh

sign

ifica

nt

dif

fere

nce

sw

ere

fou

nd

on

lyfo

rgr

oss

mo

tor

skill

s

Th

eau

tho

rsad

apte

dth

eB

DI-1

Scre

enin

gte

stto

con

du

ctth

eas

sess

men

tb

yte

lep

ho

ne

inte

rvie

ww

ith

par

ents

inSp

anis

h.T

he

auth

ors

did

no

tre

po

rtan

yp

sych

om

etri

cco

nsi

der

atio

ns

of

this

adap

tati

on

)

(con

tin

ues

)



able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

15.J

on

es,M

cEw

en,

and

Nea

s(2

012)

/Un

ited

Stat

es

Ch

ildre

nw

ith

seve

rem

oto

rim

pai

rmen

ts;N

=28

(14–

30m

on

ths)

To

iden

tify

any

effe

cts

of

po

wer

wh

eelc

hai

rso

nth

ed

evel

op

men

tan

dfu

nct

ion

of

you

ng

child

ren

wit

hm

oto

rim

pai

rmen

ts

Th

eB

DI-2

sco

res

and

oth

ers

asse

ssm

ent

sco

res

(e.g

.,m

ob

ility

,fu

nct

ion

alsk

ills,

mo

bili

tyca

regi

ver

assi

stan

ce,a

nd

care

give

ras

sist

ance

for

child

self

-car

e)w

ere

imp

rove

dsi

gnifi

can

tly

mo

refo

rth

eex

per

imen

talg

rou

ps

than

for

the

con

tro

lgr

ou

p.O

ther

fin

din

gssh

ow

edan

add

itio

nal

dif

fere

nce

bet

wee

nth

egr

ou

ps’

BD

I-2to

tals

core

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lw

ith

rob

ust

psy

cho

met

ric

pro

per

ties

and

valu

efo

rm

easu

rin

gd

evel

op

men

tal

chan

gein

lon

gitu

din

alst

ud

ies

wit

hyo

un

gch

ildre

n

16.M

edei

ros,

Ko

zlo

wsk

i,B

eigh

ley,

Ro

jah

n,

and

Mat

son

(201

2)/U

nit

edSt

ates

Ch

ildre

nw

ith

ASD

and

child

ren

wit

hd

evel

op

men

tal

del

ays

bu

tn

oA

SDfr

om

the

Lou

isia

na

Earl

ySte

ps

Pro

gram

;N=

1509

(17–

36m

on

ths)

To

exam

ine

the

effe

cto

fD

Q(t

ota

lDQ

and

DQ

do

mai

ns)

on

chal

len

gin

gb

ehav

ior

pre

sen

tati

on

into

dd

lers

wit

hva

ryin

gle

vels

of

ASD

sym

pto

mat

olo

gy,

acco

rdin

gto

dia

gno

sis

Th

eB

DI-2

DQ

do

mai

ns

that

wer

em

ost

infl

uen

tial

on

chal

len

gin

gb

ehav

iors

vari

edb

yd

iagn

osi

s,w

ith

com

mu

nic

atio

nan

dm

oto

rd

om

ain

sp

layi

ng

grea

ter

role

sfo

rto

dd

lers

wit

hA

SD,a

nd

per

son

al–s

oci

alan

dco

gnit

ive

do

mai

ns

pla

yin

ggr

eate

rro

les

for

atyp

ical

lyd

evel

op

ing

tod

dle

rsw

ith

no

ASD

dia

gno

sis

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lw

ith

rob

ust

psy

cho

met

ric

pro

per

ties

;als

o,t

he

BD

I-2au

tho

res

tab

lish

edac

cep

tab

lele

vels

of

con

ten

tan

dcr

iter

ion

valid

ity

thro

ugh

exp

ert

revi

ewan

dco

rrel

atio

nal

com

par

iso

ns

17.S

egu

elet

al.

(201

2)/C

hile

Typ

ical

lyd

evel

op

ing

child

ren

;N=

611

atth

eb

egin

nin

g;n

=31

1af

ter

4ye

ars

of

stu

dy

(3m

on

ths

to4

year

so

fag

e)

To

anal

yze

the

effe

cto

fn

urs

ery

sch

oo

lat

ten

dan

ceo

nth

ele

arn

ing

and

dev

elo

pm

ent

of

child

ren

ina

lon

gitu

din

ald

esig

n

Nea

rly

80%

of

child

ren

sho

wed

lear

nin

gan

dd

evel

op

men

tp

erfo

rman

ceac

cord

ing

toth

eir

age,

rega

rdle

ssw

het

her

they

wer

eat

ten

din

ga

nu

rser

ysc

ho

olo

rst

ayin

gat

ho

me

No

con

sid

erat

ion

sab

ou

tth

eB

DI-1

(con

tin

ues

)



able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

18.B

arre

no

etal

.(2

011)

/Sp

ain

Ch

ildre

nw

ith

CP

,an

dty

pic

ally

dev

elo

pin

gch

ildre

n;N

=10

0(C

P,n

=50

;typ

ical

,n=

50;4

–70

mo

nth

s)

To

dem

on

stra

teth

atd

evel

op

men

tald

efici

tsca

nb

ed

etec

ted

atan

earl

yag

eu

sin

gth

eB

DI,

asa

bri

efd

evel

op

men

tsc

ale

Th

eB

DI-1

det

ecte

dd

iffe

ren

ces

bet

wee

nth

ecl

inic

alan

dco

ntr

olg

rou

ps.

Th

ese

dif

fere

nce

sw

ere

sign

ifica

nt

atal

lage

leve

lsan

db

etw

een

tetr

aple

gia

and

oth

erm

oto

rd

iso

rder

s.T

her

ew

ere

no

dif

fere

nce

sb

yge

nd

er

Th

eB

DI-1

was

con

sid

ered

ago

od

asse

ssm

ent

too

lb

ecau

seit

cove

rsa

wid

eag

era

nge

,it

isea

syto

adm

inis

ter,

and

off

ers

imp

ort

ant

info

rmat

ion

abo

ut

dev

elo

pm

enta

lpro

ble

ms

19.D

eves

aet

al.

(201

1)/S

pai

nC

hild

ren

wit

hC

Pw

ith

gro

wth

ho

rmo

ne

defi

cien

cy;N

=11

(4.1

2m

on

ths

to1.

31ye

ars)

To

asse

ssth

eef

fect

so

fgr

ow

thh

orm

on

etr

eatm

ent

com

bin

edw

ith

psy

cho

mo

tor

and

cogn

itiv

est

imu

lati

on

inth

en

euro

dev

elo

pm

ent

of

child

ren

Psy

cho

mo

tor

and

cogn

itiv

est

atu

sd

idn

ot

chan

ged

uri

ng

cogn

itiv

est

imu

lati

on

per

iod

;ho

wev

er,

sign

ifica

nt

imp

rove

men

tsin

BD

I-2Sc

reen

ing

Tes

tsc

ore

sw

ere

ob

serv

edaf

ter

the

com

bin

edtr

eatm

ent

per

iod

Th

eB

DI-2

Scre

enin

gT

est

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es

20.I

vers

on

and

Bra

dd

ock

(201

1)/U

nit

edSt

ates

Ch

ildre

nw

ith

lan

guag

eim

pai

rmen

t(L

I),a

nd

typ

ical

lyd

evel

op

ing

child

ren

(TC

);N

=37

(LI=

11;T

C=

16(2

year

s,7

mo

nth

sto

6ye

ars,

1m

on

th)

To

exam

ine

gest

ure

and

mo

tor

abili

ties

inre

lati

on

tola

ngu

age

inch

ildre

nw

ith

LI

Th

ech

ildre

nw

ith

LIp

erfo

rmed

mo

rep

oo

rly

on

the

BD

I-1Sc

reen

ing

Tes

tm

easu

res

of

fin

ean

dgr

oss

mo

tor

abili

ties

.R

egre

ssio

nan

alys

esin

dic

ated

that

the

po

ore

rex

pre

ssiv

ela

ngu

age

of

the

LIgr

ou

pw

asre

late

dto

mo

refr

equ

ent

gest

ure

pro

du

ctio

n

Th

eB

DI-1

Scre

enin

gT

est

was

con

sid

ered

inte

rest

ing

for

clin

ical

sett

ings

bec

ause

of

the

sho

rtti

me

for

adm

inis

trat

ion

and

the

easy

eval

uat

ion

task

san

dsc

ori

ng

(con

tin

ues

)



able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

21.M

atso

n,

Wilk

ins,

and

Fod

stad

(201

1)/U

nit

edSt

ates

Mix

edsa

mp

lech

ildre

n(a

uti

stic

dis

ord

er-A

SD;a

nd

no

n-A

SD)

fro

mth

eLo

uis

ian

aEa

rlyS

tep

sP

rogr

am;N

=10

07(A

SD,n

=33

0;N

on

-ASD

,n=

677;

17–3

7m

on

ths)

To

inve

stig

ate

the

psy

cho

met

ric

pro

per

ties

of

the

Bab

yan

dIn

fan

tSc

reen

for

Ch

ildre

nw

ith

aUtI

smT

rait

s(B

ISC

UIT

)b

atte

ry,u

sin

gth

eB

DI-2

asa

con

verg

ent

and

div

erge

nt

mea

sure

Th

eB

ISC

UIT

-Par

t1

dem

on

stra

ted

goo

dco

nve

rgen

tva

lidit

yw

ith

the

BD

I-2P

erso

nal

Soci

ald

om

ain

;ad

dit

ion

ally

,div

erge

nt

valid

ity

was

dem

on

stra

ted

by

its

smal

lco

rrel

atio

nw

ith

the

Ad

apti

vean

dM

oto

rd

om

ain

sfr

om

the

BD

I-2

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es,a

sw

ella

sac

cep

tab

lete

st–r

etes

tre

liab

ility

22.N

ip,G

reen

,an

dM

arx

(201

1)/U

nit

edSt

ates

Typ

ical

lyd

evel

op

ing

child

ren

;N=

23(3

–21

mo

nth

s)

To

det

erm

ine

the

asso

ciat

ion

bet

wee

no

rofa

cial

mo

vem

ent

spee

dan

dst

and

ard

ized

mea

sure

so

fco

gnit

ive

and

lan

guag

ed

evel

op

men

td

uri

ng

the

earl

yst

ages

of

com

mu

nic

atio

nd

evel

op

men

t

Sign

ifica

nt

asso

ciat

ion

sw

ere

iden

tifi

edb

etw

een

oro

faci

alki

nem

atic

and

the

BD

I-2la

ngu

age

and

cogn

itiv

esk

ills

sco

res,

even

wh

enag

ese

rved

asco

vari

ate

Th

eB

DI-2

was

con

sid

ered

asa

too

lth

atis

mea

nt

top

rovi

de

agl

ob

alsn

apsh

ot

of

ach

ild’s

dev

elo

pm

ent

23.S

ipes

etal

.(2

011)

/Un

ited

Stat

es

Infa

nts

and

tod

dle

rsw

ith

ASD

san

dA

Dfr

om

Lou

isia

na

Earl

ySt

eps

Pro

gram

;N=

1668

(ASD

,n=

604;

AD

,n

=10

64;b

irth

to36

mo

nth

s)

To

dev

elo

pcu

toff

sco

res

for

the

BD

I-2,w

hic

hco

uld

be

use

das

asc

reen

ing

too

lto

dif

fere

nti

ate

you

ng

child

ren

wit

hp

oss

ible

ASD

Bas

edo

nth

e1

SD)

fro

mth

em

ean

of

the

ASD

gro

up

,th

ecu

toff

sco

reo

f89

was

fou

nd

(wit

h0.

84o

fse

nsi

tivi

tyan

d0.

55o

fsp

ecifi

city

);w

hen

the

1.5

SDw

asch

ose

n,t

he

cuto

ffsc

ore

of

96w

asd

eter

min

edw

ith

hig

hse

nsi

tivi

tyo

f0.

94an

da

spec

ifici

tyo

f0.

31.T

he

last

cuto

ffsc

ore

has

hig

hse

nsi

tivi

tyan

dca

nb

eu

sed

for

the

scre

enin

gm

easu

re

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es,a

sw

ella

sac

cep

tab

lete

st–r

etes

tre

liab

ility

(con

tin

ues

)



able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

24.T

ern

era

(201

1)/

Co

lom

bia

Typ

ical

lyd

evel

op

ing

child

ren

;N

=31

2(3

–7ye

ars)

To

des

crib

ein

fan

tad

apti

ved

evel

op

men

tch

arac

teri

stic

sre

late

dto

the

self

-hel

psk

ills

and

the

task

sre

qu

ired

by

thes

esk

ills

Th

eB

DI-1

resu

lts

rela

ted

toad

apti

veb

ehav

ior

reve

aled

that

the

girl

san

db

oys

are

dif

fere

nt

inp

erfo

rmin

gso

me

task

sef

fect

ivel

yb

yth

emse

lves

.C

orr

elat

ion

sw

ere

fou

nd

bet

wee

nad

apti

veb

ehav

ior

skill

s(d

ress

ing,

feed

ing,

and

self

-car

e)an

dco

gnit

ive

do

mai

ns

Th

eB

DI-1

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

esth

atis

easy

toad

min

iste

r

25.B

arro

s,M

atija

sevi

chSa

nto

s,an

dH

alp

ern

(201

0)/B

razi

l

Typ

ical

lyd

evel

op

ing

child

ren

;N

=38

69(2

4m

on

ths)

To

inve

stig

ate

psy

cho

soci

ald

eter

min

ants

of

child

dev

elo

pm

ent

wit

hin

ab

irth

coh

ort

and

its

inte

ract

ion

sw

ith

mat

ern

alsc

ho

olin

gan

dec

on

om

icp

osi

tio

n

Ch

ildd

evel

op

men

tsc

ore

sev

alu

ated

by

the

BD

I-1Sc

reen

ing

Tes

tw

asst

ron

gly

asso

ciat

edw

ith

soci

oec

on

om

icp

osi

tio

n,m

ater

nal

sch

oo

ling,

and

stim

ula

tio

n(e

.g.,

low

per

form

ance

was

asso

ciat

edw

ith

low

mo

ther

’ssc

ho

olin

g,em

plo

ymen

t,an

dst

imu

lati

on

)

Th

eB

DI-1

Scre

enin

gT

est

was

con

sid

ered

asas

sess

men

tto

olw

ith

rob

ust

psy

cho

met

ric

pro

per

ties

;ho

wev

er,

itd

oes

no

th

ave

valid

atio

nfo

ra

Bra

zilia

np

op

ula

tio

n

26.M

atso

n,H

ess,

Sip

es,a

nd

Ho

rovi

tz(2

010a

)/U

nit

edSt

ates

Ch

ildre

nw

ith

bir

thri

sk(p

rem

atu

re)

and

dev

elo

pm

enta

ldis

abili

ties

(Do

wn

syn

dro

me,

or

dia

gno

sed

wit

hG

lob

alD

evel

op

men

talD

elay

)fr

om

the

Lou

isia

na

Earl

ySte

ps

Pro

gram

;N=

28(1

7–34

mo

nth

s)

To

com

par

ein

fan

td

evel

op

men

talp

rofi

les

of

child

ren

atd

evel

op

men

talr

isk

Th

ech

ildre

nw

ith

Glo

bal

Dev

elo

pm

enta

lDel

ayo

rD

ow

nsy

nd

rom

esc

ore

dsi

gnifi

can

tly

low

ero

nth

eB

DI-2

than

pre

mat

ure

child

ren

,sp

ecifi

cally

on

the

per

son

al–s

oci

alan

dm

oto

rd

om

ain

s

Th

eB

DI-2

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es

(con

tin

ues

)



able

1.

Art

icle

Sum

mar

ies

Incl

ud

ing

Nat

ion

alit

y,R

esea

rch

Des

ign

,Po

pu

lati

on

,Ob

ject

ives

,Mai

nR

esu

lts,

and

Au

tho

rs’C

on

sid

erat

ion

sA

bo

ut

the

Bat

telle

Dev

elo

pm

enta

lIn

ven

tori

es’P

sych

om

etri

cP

rop

erti

esan

dU

sage

(Con

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

27.M

atso

n,N

eal,

Fod

stad

,an

dH

ess

(201

0b)/

Un

ited

Stat

es

Ch

ildre

nw

ith

anA

SDfr

om

the

Lou

isia

na

Earl

ySte

ps

Pro

gram

;N=

153

(22–

36m

on

ths)

To

anal

yze

the

rela

tio

nsh

ipb

etw

een

soci

aliz

atio

nan

dch

alle

ngi

ng

beh

avio

rsin

tod

dle

rsw

ith

ASD

Low

erle

vels

of

adu

ltin

tera

ctio

nan

dp

eer

inte

ract

ion

wer

eas

soci

ated

wit

hh

igh

erle

vels

of

ster

eoty

pic

beh

avio

r,ag

gres

sive

/des

tru

ctiv

eb

ehav

ior,

and

toa

less

erex

ten

tse

lf-in

jury

Th

eB

DI-2

Scre

enin

gT

est

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es

28.M

ou

raet

al.

(201

0a)/

Bra

zil

Typ

ical

lyd

evel

op

ing

child

ren

;N=

3907

(12

and

24m

on

ths)

To

des

crib

eth

ein

cid

ence

and

per

sist

ence

of

susp

ecte

dd

evel

op

men

tald

elay

(SD

D)

and

asso

ciat

edri

skfa

cto

rs

Inci

den

ceo

fSD

Db

etw

een

12an

d24

mo

nth

sw

as1.

8%.M

ult

iple

anal

yses

sho

wed

that

the

SDD

inci

den

cew

asas

soci

ated

wit

hso

me

risk

fact

ors

(e.g

.,lo

wA

pga

r,p

rete

rmd

eliv

ery)

,an

dso

me

fact

ors

wer

eas

soci

ated

wit

hth

ep

ersi

sten

ceo

fSD

D(e

.g.,

low

Ap

gar,

low

soci

oec

on

om

icle

vel,

inte

rges

tati

on

alin

terv

al,b

reas

tfee

din

gd

ura

tio

n<

6m

on

ths)

Th

eB

DI-1

Scre

enin

gT

est

was

con

sid

ered

asan

easy

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es;

and

the

adm

inis

trat

ion

form

ato

ffer

so

pp

ort

un

ity

toge

tth

eb

est

child

per

form

ance

.Ho

wev

er,i

td

oes

no

th

ave

valid

atio

nfo

rB

razi

lian

po

pu

lati

on

29.M

ou

raet

al.

(201

0b)/

Bra

zil

Typ

ical

lyd

evel

op

ing

child

ren

;N=

3869

(24

mo

nth

s)

To

iden

tify

risk

fact

ors

for

SDD

atag

e2

year

s3.

3%ch

ildre

nsc

reen

edp

osi

tive

for

SDD

.Reg

ress

ion

anal

ysis

sho

wed

that

som

eri

skfa

cto

rsw

ere

mo

rere

late

dto

SDD

atag

e12

mo

nth

s,lik

em

ater

nal

soci

od

emo

grap

hic

vari

able

s(f

ewye

ars

of

sch

oo

ling)

,rep

rod

uct

ive

and

gest

atio

nal

char

acte

rist

ics

(e.g

.,ge

stat

ion

ald

iab

etes

),o

rch

ildan

den

viro

nm

enta

lch

arac

teri

stic

s(l

ow

bir

thw

eigh

t,an

ten

atal

care

app

oin

tmen

ts),

etc.

Th

eB

DI-1

Scre

enin

gT

est

was

con

sid

ered

asan

asse

ssm

ent

too

lwit

hro

bu

stp

sych

om

etri

cp

rop

erti

es;

ho

wev

er,i

td

oes

no

th

ave

valid

atio

nfo

ra

Bra

zilia

np

op

ula

tio

n

(con

tin

ues

)



Tab

le1

.A

rtic

leSu

mm

arie

sIn

clu

din

gN

atio

nal

ity,

Res

earc

hD

esig

n,P

op

ula

tio

n,O

bje

ctiv

es,M

ain

Res

ult

s,an

dA

uth

ors

’Co

nsi

der

atio

ns

Ab

ou

tth

eB

atte

lleD

evel

op

men

talI

nve

nto

ries

’Psy

cho

met

ric

Pro

per

ties

and

Usa

ge(C

on

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

30.T

ern

era

(201

0)/

Co

lom

bia

Typ

ical

lyd

evel

op

ing

child

ren

;N=

312

(3–7

year

s)

To

det

erm

ine

the

rela

tio

nsh

ipb

etw

een

mo

tor

dev

elo

pm

ent

and

the

evo

luti

on

ary

pro

cess

of

lan

guag

ean

dco

gnit

ion

Age

-ap

pro

pri

ate

dev

elo

pm

enta

lle

vels

wer

efo

un

dfo

rth

em

ajo

rity

of

child

ren

;alt

ho

ugh

som

eo

fth

emsh

ow

edre

sult

slo

wer

than

the

no

rmat

ive

sam

ple

.Po

siti

veco

rrel

atio

ns

amo

ng

mo

tor,

cogn

itio

n,a

nd

lan

guag

ed

evel

op

men

tsc

ore

sw

ere

fou

nd

Th

eB

DI-1

was

con

sid

ered

asan

adeq

uat

eto

olt

oev

alu

ate

esse

nti

alch

ildh

oo

dsk

ills

ind

iffe

ren

td

om

ain

so

fd

evel

op

men

t

31.S

nid

er,

Maj

nem

er,

Maz

er,

Cam

pb

ell,

and

Bo

s(2

009)

/C

anad

a

Mix

edsa

mp

le(a

t-te

rman

dp

rete

rmch

ildre

n),

N=

100

(12

mo

nth

s,ad

just

edag

e)

To

com

par

efo

ur

dif

fere

nt

asse

ssm

ent

app

roac

hes

(Alb

erta

Infa

nt

Mo

tor

Scal

es,

Pea

bo

dy

Dev

elo

pm

enta

lM

oto

rSc

ales

-2,V

inel

and

Ad

apti

veB

ehav

ior

Scal

es—

Dai

lyLi

vin

gSk

ills,

and

Bat

telle

Dev

elo

pm

enta

lIn

ven

tory

)to

pre

dic

tm

oto

ran

dfu

nct

ion

alo

utc

om

eso

fat

-ter

man

dp

rete

rmin

fan

ts

Res

ult

sfr

om

the

thre

eo

ther

mea

sure

sp

rese

nte

da

mo

rem

od

erat

ep

rofi

leth

anB

DI-1

resu

lts.

Pre

term

surv

ivo

rsd

emo

nst

rate

dd

evel

op

men

tal

del

ays

asm

easu

red

by

the

dif

fere

nt

do

mai

ns

of

the

BD

I(3

7%–8

9%).

Clin

ical

risk

fact

ors

(e.g

.,d

ura

tio

no

fve

nti

lati

on

)ra

ther

than

oth

erin

fan

tte

sts

exp

lain

ed5%

–16%

of

the

vari

ance

of

BD

Isc

ore

s

Th

eB

DI-1

allo

ws

for

vari

abili

tyo

fre

spo

nse

sam

on

gp

arti

cip

ants

and

isre

spo

nsi

veto

ind

ivid

ual

dif

fere

nce

sat

that

age

32.G

arci

a-Fi

lion

etal

.(20

08)/

Un

ited

Stat

es

Ch

ildre

nw

ith

visu

alim

pai

rmen

t;N

=73

(5ye

ars)

To

det

erm

ine

the

dev

elo

pm

enta

lou

tco

mes

of

child

ren

wit

ho

pti

cn

erve

hyp

op

lasi

aan

dth

eco

rrel

atio

no

fd

evel

op

men

tw

ith

neu

rora

dio

grap

hic

,en

do

crin

olo

gic,

and

op

hth

alm

icfi

nd

ings

BD

I-1re

sult

sco

nfi

rmed

dev

elo

pm

enta

ldel

ays

in71

%o

fch

ildre

nat

5ye

ars;

grea

ter

than

for

child

wit

hb

ilate

ralo

pti

cn

erve

hyp

op

lasi

a

Th

eB

DI-1

was

sele

cted

du

eto

the

no

rmat

ive

dat

aav

aila

ble

,ta

rget

edag

era

nge

,an

dad

apta

tio

ns

for

and

pre

vio

us

use

wit

hvi

sual

lyim

pai

red

po

pu

lati

on

s

(con

tin

ues

)



Tab

le1

.A

rtic

leSu

mm

arie

sIn

clu

din

gN

atio

nal

ity,

Res

earc

hD

esig

n,P

op

ula

tio

n,O

bje

ctiv

es,M

ain

Res

ult

s,an

dA

uth

ors

’Co

nsi

der

atio

ns

Ab

ou

tth

eB

atte

lleD

evel

op

men

talI

nve

nto

ries

’Psy

cho

met

ric

Pro

per

ties

and

Usa

ge(C

on

tin

ued

)

Ref

eren

ce\

Nat

ion

alit

y

Res

earc

hD

esig

nan

dP

op

ula

tio

n(G

ener

alC

hil

dC

har

acte

rist

ics)

Ob

ject

ives

Mai

nR

esu

lts

Au

tho

rs’

Co

nsi

der

atio

ns

Ab

ou

tth

eB

DI-

2

33.L

op

ez,

Gra

nad

os,

and

Vaz

qu

ez(2

007)

/Sp

ain

Ch

ildre

nw

ith

ASD

;N

=11

(38–

58m

on

ths)

To

anal

yze

the

adeq

uac

yo

fth

eB

DI-1

toas

sess

ASD

child

ren

BD

I-1re

sult

sco

nfi

rmed

dat

afr

om

oth

erst

ud

ies

wit

hA

SD(l

ow

sco

res

no

to

nly

inD

Qb

ut

also

insp

ecifi

cd

om

ain

s(c

om

mu

nic

atio

n,m

oto

ran

dad

apti

veb

ehav

ior)

Th

eB

DI-1

was

con

sid

ered

ago

od

asse

ssm

ent

too

lto

hel

pin

the

dia

gno

sis

of

ASD

34.R

ydz

etal

.(2

006)

/Can

ada

Typ

ical

lyd

evel

op

ing

child

ren

;N=

101

(18

mo

nth

s)

To

test

the

accu

racy

of

two

par

ent-

com

ple

ted

scre

enin

gm

easu

res

(th

eA

SQan

dC

DI)

com

par

edw

ith

the

BD

I-1as

ast

and

ard

ized

mea

sure

Co

mp

ared

wit

hth

eB

DI-1

resu

lts,

nei

ther

qu

esti

on

nai

re(C

DI

or

ASQ

)p

rove

dto

be

anid

eal

scre

enin

gin

stru

men

t(p

oo

rp

sych

om

etri

cp

rop

erti

eslik

ese

nsi

tivi

ty,s

pec

ifici

ty,p

osi

tive

and

neg

ativ

ep

red

icti

veva

lue)

Th

eB

DI-1

was

con

sid

ered

asa

“go

ldst

and

ard

”fo

rth

est

ud

yp

urp

ose

s

Note

.ASD

=au

tism

spec

tru

md

iso

rder

;ASQ

=ag

esan

dst

ages

qu

esti

on

nai

re;B

DI=

Bat

telle

Dev

elo

pm

enta

lIn

ven

tory

;CD

I=

Ch

ildD

evel

op

men

talI

nve

nto

ry;C

P=

cere

bra

lp

alsy

;DQ

=d

evel

op

men

talq

uo

tien

t;D

SM-5

=D

iagn

ost

ican

dSt

atis

tica

lMan

ual

;EV

D=

exte

rnal

ven

tric

ula

rd

rain

age;

SA=

seve

reac

adem

ia.



Table 2. Target Population of Studies Using the Battelle Developmental Inventories

Population Types References

Typicallydevelopingchildren(n = 10)

– Barros et al., 2010; Bowen et al., 2012;Moura et al., 2010a; Moura et al., 2010b;Nip et al., 2011; Rydz et al., 2006; Seguelet al., 2012; Ternera, 2010, 2011;Valenzuela et al., 2015.

At-risk children(n = 5)

Biological risk (n = 4)Social risk (n = 1)

Bassan et al., 2012; Chmait et al., 2015;Gonzalez et al., 2013; McCall et al., 2013;Vanderbilt et al., 2014.

Children withdevelopmentaldisorders(n = 15)

Autism spectrum disorders(n = 6)

Cerebral palsy (n = 4)Down syndrome (n = 1)Congenital malformation

(n = 1)Visual impairment (n = 1)Language impairment (n = 1)Severe motor impairments

(n = 1)

Goldin et al., 2014; Lopez et al., 2007;Matson et al., 2010b; Medeiros et al.,2012; Sipes et al., 2011; Turygin et al.,2013a.

Barreno et al., 2011; Barreno et al., 2013;Devesa et al., 2011; Mancıas-Guerra et al.,2014.

Matson et al., 2010a.Gomez-Arriaga et al., 2012.Garcia-Filion et al., 2008.Iverson & Braddock, 2011.Jones et al., 2012

Mixed sample ofchildren(n = 4)

Autism spectrum disorders andatypically developingchildren (n = 2)

At-risk and Typicallydeveloping children (n = 2)

Matson et al., 2011; Turygin et al., 2013b.Rizzoli-Cordoba et al., 2013; Snider et al.,

2009.

used as assessment tools to analyze the influ-ence of a specific medical procedure or theefficacy of a developmental intervention. TheBDIs were used to measure intervention ef-ficacy across studies focused on typically de-veloping children, at-risk children, childrenwith birth complications, and children withdevelopmental disorders. Finally, the BDI-2was used to investigate associations betweenrisk factors and suspected developmental de-lays in three studies.

DISCUSSION

Considering that developmental assess-ment scales are important tools to identifydevelopmental delays and investigate associ-ations between developmental risks and out-comes for young children, the purpose of thisstudy was to conduct a systematic review of

the literature about the BDIs. This inventoryhas been considered an important assessmenttool with appropriate features for use in clini-cal settings and research studies. Overall, theBDIs have been used for a variety of purposesand objectives in the last 10 years, includingdifferential diagnosis, longitudinal follow-up,program eligibility, treatment efficacy, exam-ination of developmental trajectories, and in-vestigation of the psychometric properties ofother infant assessment measures. These stud-ies provide support for the variety of poten-tial research and clinical applications for theBDIs. It is interesting to note that despite thepositive view of the psychometric propertiesof the BDIs established by the test develop-ers, which were often highlighted in the re-viewed studies, none of these studies focusedon conducting independent examination ofthe psychometric properties of the BDIs



Table 3. Main Purpose for Using the BDIs, According to BDI Versions

Purposes BDI Versions References

To identify developmentaloutcomes (n = 18)

BDI-1 Garcia-Filion et al., 2008; Lopez et al., 2007;Ternera, 2010, 2011.

BDI-2 Goldin et al., 2014; Gonzalez et al., 2013;Matson et al., 2010a, 2010b; Medeiros et al.,2012; Nip et al., 2011; Sipes et al., 2011;Turygin et al., 2013a, 2013b.

Screening Barreno et al., 2011, 2013; Gomez-Arriagaet al., 2012; Iverson & Braddock, 2011;Moura et al., 2010a.

As a convergent and divergentvalidity measure (n = 4)

BDI-1 Rydz et al., 2006; Snider et al., 2009.

BDI-2 Matson et al., 2011; Rizzoli-Cordoba et al.,2013.

To analyze the influence of aspecific medical procedureor to test efficacyintervention (n = 09)

BDI-1 Jones et al., 2012; McCall et al., 2013; Seguelet al., 2012; Valenzuela et al., 2015

BDI-2 Bassan et al., 2012; Bowen et al., 2012; Chmaitet al., 2015; Mancıas-Guerra et al., 2014.

Screening Devesa et al., 2011.To investigate associations

between risk factors andsuspected developmentaldelay (n = 3)

BDI-2 Vanderbilt et al., 2014.

Screening Barros et al., 2010; Moura et al., 2010b.

Note. BDI = Battelle Developmental Inventory.

beyond citing information provided by thepublishers within the instrument manuals.There is a clear need for this independent re-search on the psychometric properties of theBDIs.

Although the BDIs have had extensive usefor general assessment and screening, it is im-portant to emphasize that current researchis not sufficient to validate their use for crit-ical decision-making in early intervention ingeneral, and especially for children with se-vere developmental disabilities. It was notedthat in this review, 44% of the studies usedthe BDIs to identify developmental outcomes,highlighting the commonplace use of theBDIs for this purpose. However, the 6 cross-sectional studies that used the BDI-2 for spe-cific purposes (compared the BDI-2 to another

measure or to the accuracy for program eligi-bility by independent expert judgments) donot provide sufficient evidence that the BDI-2 is usefull to determine developmental out-comes or eligibility within the natural contextof a US state or international territories. It willbe crucial for more independent research tobe conducted within the fields of Early Child-hood Special Education (ECSE) and Early In-tervention (EI) to determine the appropriate-ness and effectiveness of BDIs for specific pur-poses within these programs. Overall, thereis a lack of robust psychometric studies aboutmany standardized measures to support theirvalidity in accomplishing each of the majorpurposes for assessments in EI/ECSE (Bag-nato et al., 2014). Considering that the BDI-2was recently identified as the most popular



instrument used for assessing early child de-velopment in the United States (Lee et al.,2015), it is important to conduct indepen-dent studies attesting to the BDIs’ validityand reliability to meet all IDEA standards,especially for children with developmentaldisorders.

There were a few studies identified thatwere conducted with children with develop-mental disorders that discuss the validity ofBDIs for assessment in ECSE/EI for eligibilitydetermination. Lopez et al. (2007) affirmedthat the BDI-1 is a good assessment tool toaide in the diagnosis of ASD supported by datafrom other studies of children with ASD. An-other Spanish study demonstrates the validityof the screening version of the BDI to identifychildren with developmental delay, even be-fore 12 months (Barreno et al., 2011). Finally,two studies were conducted in an IDEA PartC early intervention program that supportedthe validity of the BDI-2 as a tool for screen-ing, eligibility, and monitoring children withASD (Goldin et al., 2014; Sipes et al., 2011).Sipes and colleagues conducted research withinfants and toddlers with ASD and atypical de-velopment to develop cutoff scores for theBDI-2 in order to use this measure as a screen-ing tool to differentiate young children withpossible ASD. Based on a psychometric study,those authors found a cutoff score with highsensitivity that can be used for screening chil-dren with developmental disorders, such asASD. We can conclude that those studies arean initial attempt to investigate the validityand reliability of using the BDIs to meet IDEAstandards for at-risk and children with devel-opmental disorders, but further research isstill needed.

Results also revealed that relatively fewstudies have been published focused on useof the BDI-2 in the last 10 years, despite fre-quent use of this test in clinical practice. Ofthe 34 articles found, 44.12% of them usedthe first version of BDI, even though the BDI-2 has been published since 2005 (Newborg,2005a, 2005b). Considering that this reviewfocused on articles from 2005 to 2015, afterthe publication of the BDI-2, it was expected

to find primarily articles that had used the newversion of this test, but this has not occurred.This may be partially due to lag times betweenresearch studies being conducted and stud-ies being published or decisions to keep anoriginal version of a measure in a longitudi-nal study. However, it is also noted that themajority of studies with continued use ofthe original BDI-1 were conducted outsideof the United States. This suggests a gap be-tween the revised measure being published inthe United States and it being put into regu-lar use in other countries, with the use of theoutdated version of the BDI continuing longafter the BDI-2 was published. Likewise, thishighlights the fact that the 34 studies foundin the last 10 years, mostly on the first edi-tion of BDI, are not sufficient to assert thereliability, validity, and utility of the BDI-2 forECSE/EI purposes and appropriateness of spe-cific items for these populations. Therefore, itis important to conduct well-designed inde-pendent studies on the English and Spanishversions of the BDI-2 and BDI-2 screener todetermine the appropriateness of this assess-ment instrument for their current usages inthe ECSE/EI field.

Many of the reviewed studies were con-ducted with children with developmental dis-orders and those at risk for developmentaldelays. However, it is important to note thatwhile the manual for the BDIs provides someguidance on allowable accommodations forchildren with specific impairments (e.g., hear-ing, vision, significant neuromotor impair-ments), the BDIs have shown limited involve-ment in the “universal design” movement toimprove the appropriateness and adaptabilityof the scale for use with children with signif-icant disabilities. It will be important to con-sider how the BDIs fit with state policies andprocedures such as those of the California De-partment of Education to develop assessmentmeasures that incorporate universal design,such as the Desired Results Developmental As-sessment and Desired Results Access versions(California Department of Education, Early Ed-ucation and Support Division, 2015). Bagnatoet al. (2014) identify the BDI as a conventional



test that has relatively low consumer social va-lidity for ECSE/EI purposes, despite being themost popular among interdisciplinary profes-sionals and teachers (Lee et al., 2015). It willbe important for further research to examineways that conventional tests such as the BDIscan better incorporate the need for enhancedsocial validity and universal design to be usedeffectively for ECSE/EI purposes while main-taining the practical and psychometric bene-fits that make the measures popular for use inthese settings.

A number of articles that focused on in-dividuals with developmental delays and dis-abilities were from studies conducted in theLouisiana Early Steps Program (IDEA PartC Program) using the BDI-2, with the ob-jective to investigate relationships betweenASD symptoms and developmental variables(Goldin et al., 2014; Matson et al., 2010a, Mat-son et al., 2010b; Medeiros et al., 2012; Sipeset al., 2011; Turygin et al., 2013a, 2013b).These recent studies are of particular impor-tance to examine because they target a pop-ulation of children in the United States withwhom the BDI-2 has widespread clinical use,namely, those children seeking eligibility forand receiving services through IDEA Part C. Inthese studies from Louisiana, the BDI-2 stan-dardization sample included a small numberof children with disabilities. Despite the factthat the BDI manual allows examiners to makeminor modifications on the test items for as-sessing children with disabilities (Newborg,2005a), none of those studies from LouisianaEarly Steps Program cited any adaptation ormodification to adjust the test for their spe-cific population. According to the Louisiana’sEarly Intervention System (2014), the BDI-2is commonly used to evaluate the develop-ment of children from birth to 3 years to de-termine eligibility for services in IDEA Part CEarly Intervention Systems, such as is done inLouisiana. However, the articles reviewed inthis paper showed how the BDI-2 evaluationsconducted in that program could be used forresearch purposes. These research findingsfrom the Louisiana Early Steps Program pro-vide scientific evidence about the utility of the

BDI-2 for infants and toddlers with develop-mental delays. On the contrary, it is importantto discuss that the articles from the LouisianaEarly Steps Program are not independent stud-ies, because they were conducted with a pop-ulation from the same database.

In addition, we found that 41.17% of thestudies were being conducted in the UnitedStates, whereas 35.29% were studies with His-panic populations in other countries (Spain,Colombia, Chile, and Mexico). This is notsurprising given that both versions of theBDI are normed using an English-speakingAmerican population, and the publishersdeveloped translated versions, but withoutvalidation standards, of the BDIs in Spanish(Newborg et al., 1996; Newborg, 2005b). Inseveral articles, the authors highlighted theavailability of a Spanish version of the test asa reason to choose the BDIs (Gomez-Arriagaet al., 2012; Ternera, 2010, 2011; Valenzuelaet al., 2015; Vanderbilt et al., 2014). Althoughthere is not a standardized version or transla-tion of the BDI-1 or BDI-2 for a Brazilian pop-ulation, we found three articles from Brazil(Barros et al., 2010; Moura et al., 2010a,2010b). Articles with research conducted inIsrael, Pakistan, and Russia were also found(Bassan et al., 2012; Bowen et al., 2012; Mc-Call et al., 2013). Except for the Israeli study,where the authors did not mention any con-siderations about the BDI (Bassan et al., 2012),the authors of the other articles discussed theneed for validation studies for the BDI usingnon-American populations. The validity of us-ing the BDI in other languages and cultures,while only English norms are currently avail-able is an important area for further research.One of the critical first steps in this processwill be research focused on standardizationof the Spanish translation of the BDI-2 with anormative sample of Spanish speakers.

In several articles reviewed (Barros et al.,2010; Bassan et al., 2012; Moura et al.,2010a, 2010b), the authors highlightedthe need to interpret results of the BDIscarefully when the scales were used with anonnormed population, such as the Pakistaniand Brazilian population studies. In spite of



the fact that all of those articles reportedcareful attempts to translate and adapt theBDIs (Bowen et al., 2012; Moura et al., 2010a,2010b), this is not a guarantee for accuratedevelopmental quotients among those pop-ulation. Psychometric validation studies withnon-American, non-English–speaking popu-lations are needed to ensure the reliabilityand validity of data obtained from BDI assess-ments and their applicability in these settingsfor identifying developmental status andplanning future interventions with diversepopulations. It was interesting to note thatthe strong psychometric properties of theBDIs were identified as a reason for selectingthis tool in studies outside the United States,despite the lack of norms for non-American,non–English-speaking populations.

This review found that published researchincluding the BDI, BDI-2, and Screening test of

both versions of the BDI in the past 10 yearshas focused on using these tools to screenfor developmental delays and to identify de-velopmental outcomes in typically develop-ing children, those deemed to be at risk, andchildren with established developmental de-lays and disabilities. Overall, according to thisreview, the BDIs are considered importantand reliable assessment tools with good psy-chometric properties and sensitivity to eval-uate general child development and specificdomains. However, much additional indepen-dent research is needed to validate these as-sertions about the BDIs. Finally, it is importantto point to the necessity of more validationstudies to improve the use of BDI-2 in non-American and non–English-speaking popula-tions, in order to ensure accurate results fromdevelopment assessment in those populationsfor future studies and clinical purposes.

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