As the survival rates of very preterm infants have improved with advances in perinatal and neonatal intensive care over the last 30 years, there has been increasing interest in the neurodevelopmental outcomes of preterm and high-risk infants. Assessment of neurodevelopmental and behavioral outcomes has also become a component of most randomized controlled trials of various therapies in the NICU. As such, there is a need to understand the neurodevelopmental tests that are used most commonly in the assessments of infants after discharge from the NICU, the ages at which they are appropriate, the information that they provide, and their predictive value for future outcomes. Properties such as reliability and validity, and specificity and sensitivity for diagnostic tests are also important to understand when interpreting results.
Typically developing infants
Motor development in typically developing infants moves from reflexive movements to purposeful movements in a predictable pattern.
Similarly, language comprehension and language production, problem-solving skills, and self-help skills develop in a stepwise fashion over the first years of life.
Infants who are premature or high-risk
Many of these skills may not be attained in the same timeframe as with typically developing children.
Preterm infants should be assessed according to his/her corrected age for the first 2 years of life.
Identifying delays in these infants is essential to making sure that proper therapies are instituted as soon as possible in order to maximize the abilities of the child.
Assessment of preterm or high-risk infants at several time points over the first years of life will ensure that as new skills are emerging, delays are identified in a timely fashion.
The skills that should be evaluated after discharge include
Gross motor skills
Fine motor skills
Cognitive and developmental skills
Self-help skills
Language abilities
Behavior and adjustment
There are a variety of tools that are used to assess high-risk infants. These can be further broken down by the age at which they should be administered and the types of skills that they are designed to evaluate. This chapter does not include the full list of possible assessments; however, many of the tools used commonly in neonatal follow-up clinics and early intervention programs are described.
Assessment of the neonate
Neurologic
The Amiel-Tison neurological assessment at term (ATNAT)
Valid for both term infants and preterm infants at term equivalent.
Takes about 5 to 10 minutes to complete.
It works under the assumption that the upper and lower motor control systems develop individually and that injury in an infant most often occurs in the cerebral hemispheres and basal ganglia. Therefore, predictors of injury would be found in those responses that represent the upper motor control, including passive and active tone.
It includes 36 items that are clustered in 10 domains and graded on a three-level system (mild, moderate, or severe) based on the presence or absence of tone abnormalities, central nervous system depression, or seizures.
Inter-rater reliability has been assessed using a sample of 100 children and found to be good, with a kappa of 0.57 for the first examination and of 1 for a second serial examination.
The predictive validity has been reported and findings correlated well with outcomes on the Bayley Scales of Infant Development-II at 1 year and with Griffiths Mental Scales at a mean of 3.5 years.
Prechtl assessment of general movements
The nervous system of the fetus and infant generates a variety of movement patterns spontaneously called general movements. General movements progress from writhing movements, to fidgety movements, and finally to intentional movements from fetus to 6 months postterm.
Prechtl assessment relies on detecting abnormalities in the quality and complexity of the general movements of the infant.
This assessment can be performed at multiple time points up to 3 to 5 months postterm.
Requires a training course and video equipment for recording the infant, and takes approximately 30 to 60 minutes to capture three general movements for scoring.
The interobserver reliability is good with agreement between 89% and 93% and an average kappa of 0.88.
Sensitivity and specificity both have been reported to be up to 95% for predicting cerebral palsy at 2 years for specific characteristics of general movements.
Specifically, persistence of “cramped-synchronized” general movements and the absence of “fidgety” movements are the most predictive of future outcome.
Infant neurobiological international battery (INFANIB)
The INFANIB is 20-item scoring method that combines four assessment methods (Milani-Comparetti and Gidoni, Amiel Tison, primitive reflexes method, and Paine and Oppe method) into one tool.
It is used to assess the neuromotor status of infants who were born prematurely at the age 4 to 18 months.
The scores on spasticity and on the head and trunk subscales at 6 months are highly predictive of cerebral palsy at 12 months (87% for spasticity and 87% for head and trunk subscales).
Motor
Alberta Infant Motor Scale (AIMS)
The AIMS is a normed, discriminative measure of infant gross motor development from 40 weeks’ postconception to approximately 18 months.
It takes 10 to 20 minutes to administer and special training is not required.
It is composed of a total of 58 items divided into four subscales—prone (21 items), supine (9 items), sitting (12 items), and standing (16 items).
Scoring includes raw scores, percentile ranks, age equivalent, and growth scores.
A score at the 10th percentile or below at 4 months (sensitivity 77% and specificity 82%) or at the 5th percentile or below at 8 months (sensitivity 86% and specificity 93%) is predictive of motor delay at 18 months by pediatrician assessment.
Test of Infant Motor Performance (TIMP)
The TIMP is administered at age 32 weeks’ postconception through 4 months postterm, and is used for assessment of infant motor function.
It requires 25 to 35 minutes to administer and includes 28 observed and 31 elicited items, which are designed to assess postural and selective control of movement.
The test has 92% sensitivity at 3 months for predicting delayed performance on the AIMS at 12 months. It is also a good predictor of a diagnosis of cerebral palsy, with delayed performance at 3 months predicting a diagnosis of cerebral palsy by school age in 75% of children tested.
Neurobehavioral
Neonatal Behavioral Assessment Scale (NBAS)
The NBAS was first developed by T. Berry Brazelton in 1973, and is used in infants from birth to 2 months.
It was developed as an instrument to assess the behavior of the newborn in an interactive manner, with the examiner supporting and assisting the infant to get the best possible score, and requires a training program.
The assessment focuses on four dimensions of development.
Infant state
Autonomic system
Motor system
Social interactive system
It includes 28 behavioral items and 18 reflex items, which must be administered while the infant is in the appropriate state for each item, and can be organized into five “packages”:
Habituation package
Motor-oral package
Truncal package
Vestibular package
Social-interactive package
The raw scores have been used in research in a clustered format; however, the tool can also be used to give a behavioral summary of the infant’s strengths and areas of needed support that can be used by caregivers to guide their interactions with the baby.
Inter-rater agreement data with trained assessors have been collected, and have ranged between 0.84 and 0.99.
In predicting outcomes, one study showed that 94% to 97% of the normal group, 50% to 78% of the mild impairment group, and 71% to 85% of the severe impairment group were correctly classified.
NBAS clustered scores for neonatal state behaviors were found to account for 24.8% of the variance in total intelligence quotient scores at 6 years.
NICU Network Neurobehavioral Scale (NNNS)
The NICU NNNS is a standardized neurobehavioral assessment of the high-risk neonate. It has been used extensively to evaluate infants with a history of in utero substance exposure, but is also intended for use with preterm infants.
It was designed to provide a comprehensive assessment of neurologic integrity, behavioral functioning, and stress behavior.
The neurologic examination includes assessment of active and passive tone, primitive reflexes, and items that assess the integrity of the central nervous system.
The behavioral component is based on the NBAS and includes assessment of state, sensory, and interactive responses.
The stress component is a checklist of observations based on the work of Finnegan, as used to assess infants with neonatal abstinence syndrome.
The NNNS has been validated in large groups of term and preterm infants.
The NNNS summary scales are significantly correlated with the Bayley psychomotor motor index at 12 months corrected age in term neonates. Specific NNNS motor function scores are significantly correlated with motor scales performed at 4 and 18 months in term neonates.
Assessment of the infant, toddler, and preschool child
Mixed development assessments
Quick screening tests/parent questionnaires
Ages & Stages Questionnaire, 3rd Edition (ASQ-3)
The ASQ is a series of 21 parent or caregiver questionnaires that evaluate developmental milestones for children ages 1 to 66 months.
The areas of development covered by the questions include
Gross motor
Fine motor
Communication
Problem solving
Personal-social
They require 10 to 15 minutes to complete and have excellent validity (0.82 to 0.88), test-retest reliability (0.91), and inter-rater reliability (0.92).
There is also a separate series of eight social-emotional questionnaires (ASQ-SE) that evaluate self-regulation, compliance, communication, adaptive behaviors, autonomy, affect, and interaction with people.
Child development inventories
The child development inventories include multiple instruments available in the form of parent questionnaires that evaluate developmental milestones for children ages birth to 6 years.
Included is the Infant Development Inventory (IDI) for ages 3 to 18 months, the Early Childhood Development Inventory (ECDI) for ages 18 to 36 months, the Preschool Development Inventory (PDI) for ages 36 to 60 months, and the Child Developmental Inventory (CDI) for ages 15 months to 6 years.
In addition, the Child Development Review-Parent Questionnaire (CDR-PQ) was developed to replace the ECDI and the PDI to evaluate skills in the domains of social, self-help, gross motor, fine motor and language skills.
The CDI is a more comprehensive, 300-item parent questionnaire and interview, which gives information on the following domains: social, self-help, gross motor, fine motor, expressive language, language comprehension, letters, numbers, and general development.
It is appropriate for ages 15 months to 6 years and requires 30 to 50 minutes to administer.
The CDI developmental scales correlate closely with age: median (r = 0.84).
CDI results identified all the norm group children who were enrolled in early childhood/special education (N = 26) and correlated with reading achievement for children in kindergarten as follows: general development (0.69); letters (0.56); language comprehension (0.42); expressive language (0.36); and self-help (0.35).
Bayley Infant Neurodevelopmental Screener (BINS)
The BINS is a screening tool, which is administered by a trained professional and is appropriate for ages 3 to 24 months.
It takes about 5 to 10 minutes to administer and a few minutes to score and is designed to identify infants with delay or neurological impairment.
There are 11 to 13 elicited items per 3- to 6-month age range to identify basic neurological functions (reflexes and tone), receptive functions, expressive functions, and cognition.
Cut scores are used to identify children as high, moderate, or low risk for developmental delay.
Specificity and sensitivity are 75% to 86% across age ranges.
Denver Developmental Screening Test (DDST-II)
The DDST-II is a screening tool for identifying developmental delays in children from ages 1 month to 6 years.
It requires 10 to 20 minutes to administer and uses a visual scale that reflects what percentage of a certain age group (25%, 50%, 75%, or 90%) is able to perform a certain task.
The number of items upon which the child scores below the expected age range determines whether the child is classified as normal, suspect, or delayed.
Comprehensive assessments
Battelle Developmental Inventory, 2nd Edition (BDI-2)
The Battelle Developmental Inventory is a normed test that is appropriate for birth through 7 years 11 months.
It is widely used for eligibility assessments in early intervention programs and takes approximately 1.5 hours to complete.
It has a three-point scale that includes mastery of skill (2), emerging skill (1), and skill is absent or response is incorrect (0). Five domains are assessed
Adaptive Domain (including self-care, personal responsibility)
Personal-Social Domain (including adult interaction, peer interaction, and self-concept and social role)
Communication Domain (receptive communication and expressive communication)
Motor Domain (including gross motor, fine motor, and perceptual motor)
Cognitive Domain (including attention, memory, reasoning, academic skills, perception, and concepts)
The BDI-2 yields composite scores for each domain, scaled scores for each subdomain, percentiles, and age equivalents.
There is also BDI Screening Test that only includes two items at each of 10 age levels for each of the five domains.
Bayley Scales of Infant and Toddler Development, 3rd Edition (BSID-III)
The BSID-III is appropriate for use in children 1 to 42 months and takes approximately 30 to 90 minutes to complete, depending on the age of the child.
Many follow-up programs for NICU graduates use the Bayley-III for developmental assessments, including the NICHD Neonatal Research Network.
It must be administered by a school psychologist, clinical psychologist, or related professional trained in the administration of psychological tests.
The newest version of the Bayley Scales of Infant and Toddler Development (Bayley-III) includes scaled scores, composite scores, percentile ranks, growth scores, and age equivalents (with confidence intervals) for
Cognition
Language (divided into receptive and expressive communication)
Motor skills (divided into fine and gross motors)
Also included in the Bayley-III are social-emotional and adaptive behavior interviews.
The correlation between the BSID-III Language Composite and the BSID-II MDI is 0.71 and the Cognitive Composite and the MDI is 0.60. The BSID-III Motor Composite and BSID-II PDI correlation is 0.60. The benefit of the Bayley-III over the Bayley-II is that the cognitive and language scales are now independent of each other; however, there is concern that the Bayley-III in comparison to the Bayley-II may tend to overestimate developmental outcomes.
Although there are currently no data on the BSID-III, the predictive validity of a low MDI on the BSID-II for cognitive function at school age has been shown to be low.
McCarthy Scales of Children’s Abilities (MSCA)
The MSCA is intended for children ages 2.5 to 8.5 years and includes several tests, which are divided into five categories.
Verbal (5 tests)
Perceptual-performance (7 tests)
Quantitative (3 tests)
Memory (4 tests)
Motor (5 tests)
The combination of the Verbal, Perceptual-Performance, and Quantitative scales comprises the General Cognitive Index.
Reliability and concurrent validity with other tests of intelligence are good.
Mullen Scales of Early Learning (MSEL)
The MSEL is a normed assessment that is appropriate from birth to 68 months and requires 15 to 60 minutes depending on age of child.
Included are five scales: Gross Motor, Visual Reception, Fine Motor, Expressive Language, and Receptive Language.
For each scale, there is a T score, percentile, and age equivalent score.
Internal reliabilities exceed 0.80 on all subscales with the exception of Visual Reception (.79) and Fine Motor (.75), and inter-rater reliabilities range from 0.91 to 0.99.
Motor
Gross Motor Function Classification System (GMFCS)
The GMFCS is a five-level classification system for children with cerebral palsy, which helps describe the severity of cerebral palsy, based on the child’s abilities and limitations.
The classification includes
Level-I walks without restriction, but may have limitations in speed, balance, or coordination.
Level-II walks without assistive device, but may have difficulty on uneven surfaces or in crowds, and minimal ability to jump or run.
Level-III walks with an assistive device, may need a wheelchair for long distances or on uneven surfaces.
Level-IV relies on wheeled mobility, but may be able to use a powered wheelchair.
Level-V self-mobility is severely limited.
The GMFCS is reliable and validated and has been shown to be stable between 2 and 12 years.
Peabody Developmental Motor Scales, 2nd Edition (PDMS-2)
The PDMS is a normed evaluation that is designed to assess motor skills in children 0 to 5 years old.
It takes approximately 45 to 60 minutes to complete.
It gives a Gross Motor Quotient, Fine Motor Quotient, and Total Motor Quotient based on six subtests of the emerging motor skills of reflexes, body control and equilibrium, locomotion, object manipulation, grasping, and visual-motor integration.
It also includes suggested exercises for helping a child attain gross and fine motor skills based on the evaluation.
Validation studies have reported good concurrent validity of the Total Motor Quotient with the Bayley-III Motor Composite Score.
Cognition
Differential Ability Scales, 2nd Edition (DAS-II)
The Differential Ability Scales-II is a normed assessment designed for children ages 2.5 to 17 years and takes approximately 45 to 90 minutes to complete.
The focus of the assessment is on cognition and learning abilities.
There are 20 cognitive subtests of the DAS-II and they are divided into two batteries based on age, the early years and the school age.
A variety of cognitive abilities are measured, including visual recognition and matching, verbal and visual working memory, immediate and delayed recall, processing and naming speed, phonological processing, and understanding of basic number concepts.
The DAS-II provides five types of scores: ability scores, T scores, cluster scores, composite scores, and percentile ranks.
The core battery includes the General Conceptual Ability score, which comprises verbal, nonverbal, and spatial composite scores for School Age.
The Early Years battery does not include the spatial composite score.
The choice of subtests to be administered can be altered in instances where verbal or oral responses are not appropriate (ie, deaf, not fluent in English).
It has been validated using a variety of other assessments (BSID-II, WISC-IV, WPPSI-III).
Language
MacArthur-Bates Communicative Development Inventories (CDI)
The MacArthur-Bates Communicative Development Inventories is a parent report instrument that consists of two separate inventories: the CDI/words and gestures for children 8 to 18 months and the CDI/words and sentences (CDI/WS) for children 16 to 30 months.
It is a normed and validated test that prompts parents to indicate from a list of 400 (8 to 18 months) to 700 words (16 to 30 months), the number of words understood and produced by their child.
It also measures the number of gestures used to communicate and for older children, the use of word endings and putting words together to form sentences.
There is also a shorter version available called the MacArthur Bates Communicative Development Inventory Short Form.
Raw scores are obtained and percentile scores are derived.
Advantages are that there is a normed Spanish version and if signed vocabulary is understood or used by the child, it can be counted.
Studies have shown moderately high concurrent validity for the MacArthur CDI and vocabulary production in typically developing toddlers and those with language delay. Studies on the validity of the CDI for children with language impairments and for children with hearing loss have found that parent reports show high concurrent validity with other measures of early language behavior.
The Preschool Language Scale, 5th Edition (PLS-5)
A standardized, normed assessment appropriate for children ages birth to 7 years 11 months.
It requires 20 to 45 minutes to administer and includes two subscales—Auditory Comprehension and Expressive Communication, which are designed to assess attention, vocal development, social communication, semantics, language structure, and integrative thinking skills.
The most recent version was released in 2011 and a Spanish version is also available.
The Peabody Picture Vocabulary Test, 4th Edition (PPVT-IV)
A multiple-choice test that measures receptive vocabulary and can be used from 2 years 6 months to adult.
It takes approximately 10 to 15 minutes to administer and does not require the child to be verbal, as responses are indicated by pointing to pictures.
Standard scores can be converted to percentiles, stanines, and age or grade equivalents.
Sequenced Inventory of Communication Development, Revised edition (SICD-R)
A normed diagnostic test that evaluates the communication abilities of children who are between 4 months and 4 years of age.
It takes approximately 30 to 75 minutes to complete depending on the ability of the child and can be used successfully with children with sensory impairments and varying degrees of intellectual disability.
Assessment of the school-aged child
Motor
Movement Assessment Battery for Children, 2nd Edition (Movement-ABC2)
The Movement ABC can be used with children aged 3 to 16 years and takes approximately 20 to 40 minutes to administer.
It includes assessment of both fine motor skills (manual dexterity, paper and pencil) and gross motor skills (ball handling and balance).
Handwriting is not directly assessed with this test.
Reliability is good and the concurrent validity with other motor assessments shows moderate correlation.
Intelligence and cognition
Stanford-Binet Intelligence Scales for Early Childhood, 5th Edition (Early SB5)
The Early SB5 is an intelligence assessment designed for ages 2 to 7.25 years, which must be administered by qualified, masters-level or above psychologists.
It consists of 10 subtests, each of which requires approximately 5 minutes to complete, and the combination of scores comprises the full-scale intelligence quotient.
Nonverbal IQ, Verbal IQ, and FSIQ scores are obtained as well as factor index scores for fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working memory.
Scores are based on a mean of 100 with standard deviation of 15.
Wechsler Preschool and Primary Scale of Intelligence, 4th Edition (WPPSI-IV)
The WPPSI-IV is a normed intelligence test with two age ranges: 2 years 6 months to 3 years 11 months (administration time 30 to 45 minutes) and 4 to 7 years 7 months (45 to 60 minutes).
For each age range, FSIQ scores are obtained in addition to Primary Index Scores and Ancillary Index scores.
The FSIQ for the younger version is composed of Receptive Vocabulary, Information, Block Design, Object Assembly and Picture Memory Subtests.
Additional subtests of Similarities, Matrix Reasoning, and Bug Search are included on the FSIQ for the 4 to 7-7 year version with the deletion of Receptive Vocabulary and Object Assembly.
Both age ranges include the index scores of Verbal Comprehension, Visual Spatial, and Working Memory with the addition of Fluid Reasoning and Processing Speed index scores at the older range.
Scores are based on a mean of 100 with standard deviation of 15.
Wechsler Intelligence Scale for Children, 4th Edition (WISC-IV)
The WISC-IV is applicable for children ages 6 years to 16 years 11 months and contains 15 subtests (10 core and 5 supplementary).
It requires approximately 60 to 90 minutes to administer and gives an FSIQ in addition to scores of Verbal Comprehension, Processing Speed, Working Memory and Perceptual Reasoning.
All scores are based on a mean of 100 with a standard deviation of 15.
Kaufman Assessment Battery for Children, 2nd Edition (K-ABC)
The KABC is a normed assessment that is applicable for children aged 3 to 18 years.
It takes approximately 25 to 55 minutes to complete and consists of 18 core and supplementary subtests, divided into five scales, which include simultaneous processing, sequential processing, planning, learning, and knowledge.
Scoring includes a Mental Processing Index, Fluid Crystallized Index, and Nonverbal Index for all ages.
Index scores have a mean of 100 with standard deviation of 15.
Beery-Buktenica Developmental Test of Visual-Motor Integration, 6th Edition (Beery VMI)
The Beery VMI is appropriate for ages 2 through adult and requires 10 to 15 minutes to complete.
Children under age 6 begin by imitating a figure drawn by the examiner. All remaining items, for all ages, are printed on the form in order of increasing complexity. Children copy each design to best of their ability.
The test assesses the extent to which children can integrate their visual and motor abilities.
Standard scores, percentiles, and age equivalents can be derived.
Behavior Rating Inventory of Executive Function (BRIEF) and Preschool Version (BRIEF-P)
The BRIEF is a parent or teacher questionnaire designed for children ages 5 to 18 and the BRIEF-P is for children 2 to 5 years.
It requires 10 to 15 minutes for the parent or teacher to complete and includes abilities such as behavioral regulation (ability to control emotions, ability to shift to different activities, and ability to control impulses) and metacognitive abilities (working memory, ability to initiate activities, ability to plan and organize activities and materials, and ability to check one’s own work and performance).
It provides T scores and percentiles and includes a Behavioral Regulation score, Metacognition score, and a Global Executive Composite.
A Developmental NeuroPSYchological Assessment, 2nd Edition (NEPSY-II)
The NEPSY-II is applicable for ages 3 to 16 years and includes 36 subtests, which requires 45 minutes to 3.5 hours to complete depending on the number of subtests administered.
Subtests can be administered independently of each other to tailor the assessment to the specific individual based on the referral question.
It assesses six domains: Attention and Executive Functions (auditory attention and response, inhibition), Language (speed naming, phonological processing), Sensorimotor Functions (fingertip tapping, visuomotor precision), Visuospatial Functions (design copying, arrows, block construction), Learning and Memory (memory for faces, names, sentence repetition), and Social Perception (affect recognition, theory of mind).
Each subtest gives a scaled score with mean of 10 and standard deviation of 3.
Language
Clinical Evaluation of Language Fundamentals, 4th Edition (CELF-4)
The CELF-4 is a normed language assessment, which is appropriate for ages 5 to 21 years (English and Spanish), and is also available in a preschool version for ages 3 years to 6 years 11 months (English only).
It requires 30 to 60 minutes to complete (preschool version 15 to 20 minutes) and includes a Core Language Score, Receptive Language Score, Expressive Language Scores, Language Structure, Language Content, Language Memory, and Working Memory.
The two memory scores are not available on the preschool version.
Standard scores, percentile ranks, and age equivalents are derived.
Assessment of functional skills
Functional independence measure for children (WeeFIM)
The WeeFIM is a questionnaire for ages 0 to 3 years, which measures functional skills in three domains: Motor, (16 items), Cognitive (13 items), and Behavioral (Self-Care, 7 items).
The administration time is 15 to 30 minutes, has 18 items, and the items in each domain are arranged in order of increasing difficulty of skill.
The parent is asked if the child is rarely (Level 1), sometimes (Level 2), or usually (Level 3) able to complete the skill.
The motor domain includes items such as ability to lift head, transfer objects, and scoop food.
The cognitive domain includes items such as looking at people, looking at objects, and joint attention.
The behavioral domain includes items such as bathing, sleeping, mealtimes, and cuddling.
Vineland Adaptive Behavior Scale, 2nd Edition (VABS)
The Vineland-II is a normed tool, which is appropriate for all ages and provides a varied assessment of the functional abilities of an individual.
Four versions of the VABS are available. The Survey Interview requires 20 to 60 minutes, Parent/Caregiver Rating Scale (20 to 60 minutes), Teacher Rating (20 minutes), and Expanded Interview (25 to 90 minutes).
The scale is organized into five domains: Communication, Daily Living Skills, Socialization, Motor Skills, and an optional Maladaptive Behavior Domain.
Each domain and the Adaptive Behavior Composites yield standard scores with a mean of 100 and a standard deviation of 15, percentile ranks, and adaptive levels.
There are 14 subdomains, 2 or 3 per domain, which yield a scaled score, with adaptive levels and age equivalents.
Pediatric Evaluation of Disability Inventory (PEDI)
The PEDI is appropriate for ages 6 months to 7 years and is a structured interview that is completed with the primary caregiver and requires 45 to 60 minutes to complete.
It is an assessment of self-care, mobility, and social function in children with disabilities, and has been validated.
Behavior assessments
Child Behavior Checklist (CBCL)
The CBCL is a parent questionnaire designed to identify problem behaviors in children.
The questionnaire requires about 15 minutes to complete and there are two versions: the preschool checklist (CBCL/ 1.5-5) is intended for use with children aged 18 months to 5 years and has 100 questions and the school-aged version (CBCL/6-18) is for children aged 6 to 18 years and has 120 questions.
T scores are reported for internalizing behaviors (anxiety, depression, somatic complaints), externalizing behaviors (attention and aggression), and total problems, which include the above listed as well as sleep and “other” problems.
Reliability and validity has been demonstrated to be excellent.
Infant-Toddler Social-Emotional Assessment Scale (ITSEA) and Brief version (BITSEA)
Both the ITSEA and the BITSEA are appropriate for ages 12 to 36 months and include an evaluation of emerging social- emotional development.
Both forms are parent questionnaires with the ITSEA requiring 25 to 30 minutes to complete, and the BITSEA requiring 7 to 10 minutes.
Both include four main domains.
Externalizing behavior (activity/impulsivity, aggression/defiance, peer aggression)
Internalizing behavior (depression/withdrawal, general anxiety, separation distress, inhibition to novelty)
Dysregulation (sleep, negative emotionality, eating, sensory sensitivity)
Competence (compliance, attention, imitation/play, mastery motivation, empathy, prosocial peer relations)
Both scales are nationally standardized.
Autism Diagnostic Observation Schedule (ADOS)
The ADOS is an interactive assessment of social ability used to evaluate for autism spectrum disorder symptoms.
It is designed for toddlers to adults and takes 30 to 60 minutes to administer.
Some of the activities included are response to name, response to and initiation of joint attention, responsive social smile, make-believe play, telling a story from a book, and creating a story.
The test provides cutoff scores for a diagnosis of autism or pervasive developmental disorder.
Pervasive Developmental Disorder Screening Test, 2nd Edition (PDDST-II)
The PDDST-II is a screening tool for autism spectrum disorders (ASD) and is used to evaluate children ages 12 to 48 months.
This parent questionnaire requires 10 to 20 minutes to administer.
It is not a diagnostic assessment, so a child with a positive screen will need to undergo further assessment if there is clinical concern for ASD.
Conners Parent & Teacher Ratings Scales, 3rd Edition
The Conners is a set of normed questionnaires for the assessment of symptoms of attention-deficit hyperactivity disorder (ADHD).
Extended and short versions of the questionnaire are available for both the parent and the teacher.
These instruments are appropriate for ages 3 to 18 years and require 10 to 20 minutes to complete.
T scores are provided for four indices:
Oppositional
Cognitive Problems/Inattention
Hyperactivity
ADHD
The scales have good test-retest reliability (0.52 to 0.94) and internal consistency (0.77 to 0.97).
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