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Which Bayley-III cut-off values should be used in different developmental levels?
Pelin Çelik1, Iclal Ayranci Sucakli1, Halil Ibrahim Yakut2
1Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Ankara City Hospital, Ankara, Turkey
Insights
The Bayley-III developmental assessment tool shows higher scores than its predecessor, the BSID-II, potentially underestimating developmental delays in children. New cut-off points are recommended for the Bayley-III to accurately identify delays.
Area of Science:
- Developmental Pediatrics
- Child Psychology
- Neurodevelopmental Disorders
Background:
- The Bayley Scales of Infant and Toddler Development (Bayley-III) and its predecessor (BSID-II) are standard developmental assessment tools.
- Previous studies indicated higher Bayley-III scores compared to BSID-II, particularly in infants and premature infants.
- This study investigates the generalizability of these inflated Bayley-III scores across various pediatric disease groups and age ranges.
Purpose of the Study:
- To evaluate if Bayley-III scores are inflated across diverse pediatric populations (6–42 months) with different diseases.
- To determine appropriate Bayley-III cut-off points for identifying mild, moderate, and severe developmental delays, calibrated against BSID-II standards.
- To assess the risk of underestimating developmental delays using current Bayley-III scoring conventions.
Main Methods:
- Administered both Bayley-III and BSID-II assessments to 255 children aged 6–42 months with various conditions.
- Collected data between November 2017 and April 2018.
- Utilized Receiver Operating Characteristic (ROC) analysis to establish new cut-off scores.
Main Results:
- Bayley-III Cognitive Composite (CC) and Motor Composite (MC) scores were significantly higher than BSID-II Mental Development Index (MDI) and Psychomotor Developmental Index (PDI) scores, respectively (p < 0.001).
- Cognitive delay prevalence decreased from 49.4% (BSID-II) to 23.1% (Bayley-III CC), and motor delay from 69.3% (BSID-II PDI) to 34.3% (Bayley-III MC).
- ROC analysis yielded recommended Bayley-III cut-off scores: CLC (mild 92.5, moderate 83.2, severe 71.2) and MC (mild 98.5, moderate 86.5, severe 74.5).
Conclusions:
- Bayley-III scores require careful interpretation across all age groups and diagnoses due to potential inflation.
- There is a significant risk of underestimating developmental delays when using standard Bayley-III cut-offs.
- Implementing the derived, lower Bayley-III cut-off scores is crucial for accurate classification of developmental delay severity.
Background/Aim:
Latest version of Bayley Scales (Bayley-III) and its predecessor (BSID-II) are the most widely used standardized developmental tools in infancy and early childhood. Recent studies showed that Bayley-III scores were higher than BSID-II in 18–24 month-old and mostly premature infants. We aimed to evaluate the generalization of inflated scores of Bayley-III to children aged 6–42 months with different disease groups, and to find out which cut-off points should be used in Bayley-III to detect mild, moderate, and severe developmental delay according to BSID-II standard cut-off points.
Materials And Methods:
Two hundred and fifty-five children aged 6–42 months with different diseases and developmental levels were administered both the Bayley-III and BSID-II in the same session between 15 November 2017 and 15 April 2018.
Results:
The mean Bayley-III Cognitive Composite (CC) and Cognitive Language Composite (CLC) scores were respectively 13.1 ± 9.1 and 8.6 ± 8 points higher than BSID-II Mental Development Index (MDI) scores (P < 0.001). The mean Bayley-III Motor Composite (MC) scores were 14.4 ± 10.5 points higher than BSID-II Psychomotor Developmental Index (PDI) scores (P < 0.001). Cognitive delay was found in 126 (49.4%) and 59 (23.1%) children according to BSID-II MDI and Bayley-III CC scores, respectively. Motor delay was found in 174 (69.3%) and 86 (34.3%) children according to the BSID-II PDI and Bayley-III MC scores, respectively. Children had less cognitive (48.6%) and motor delay (54.5%) according to Bayley-III scores. Bayley-III scores were significantly higher than BSID-II scores for all ages (P < 0.001). According to ROC analysis the cut-off scores for mild, moderate, and severe delay were 92.5, 83.2, and 71.2 for Bayley-III CLC; and 98.5, 86.5, and 74.5 for Bayley-III MC, respectively.
Conclusion:
Bayley-III scores should be interpreted carefully for all age ranges and different diagnosis. The risk for underestimation of developmental delays by Bayley-III should be kept in mind. Different Bayley-III cut-off scores should be used to define developmental delay levels.
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