Related Experiment Video
Updated: May 6, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Predicting neurodevelopmental outcomes in Australian First Nations infants: The transdiagnostic utility of early
Carly Luke1,2, Katherine A Benfer1, Leeann Mick-Ramsamy1
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.
Insights
Evidence-based screening tools accurately predict neurodevelopmental outcomes in Australian First Nations infants. These tools identify infants on track for development and those at high risk for cerebral palsy (CP), autism, and fetal alcohol spectrum disorder (FASD).
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Indigenous Health Research
Background:
- Early identification of neurodevelopmental conditions in infants is crucial for timely intervention.
- Culturally adapted screening programs are essential for equitable healthcare access among diverse populations.
- Predictive screening tools can improve diagnostic accuracy and long-term outcomes for infants at risk.
Purpose of the Study:
- To evaluate the predictive accuracy of evidence-based screening tools for neurodevelopmental outcomes in Australian First Nations infants.
- To determine the relationship between early motor assessments and later diagnoses of cerebral palsy (CP), autism, and fetal alcohol spectrum disorder (FASD).
- To assess the utility of the Motor Optimality Score-Revised (MOS-R) and Hammersmith Infant Neurological Examination (HINE) in a First Nations cohort.
Main Methods:
- Prospective cohort study involving 156 First Nations infants.
- Culturally adapted screening using Prechtl's General Movements Assessment (MOS-R) at 3-5 months and HINE at 4-9 months corrected age.
- Standardized assessments at 12 months corrected age classified infants as 'on track', NDD (including autism, FASD), or CP.
Main Results:
- At 12 months, 43% were 'on track', 47% had NDD, and 10% had CP.
- Both MOS-R and HINE scores predicted NDD and CP; lower scores increased odds of these conditions.
- Combined trajectories from MOS-R and HINE showed high sensitivity and specificity for predicting CP, autism, and FASD.
Conclusions:
- Evidence-based screening tools show promise in predicting diverse neurodevelopmental outcomes in First Nations infants.
- These tools can identify infants at high risk for CP, autism, and FASD, facilitating early intervention.
- Culturally adapted screening programs utilizing MOS-R and HINE can improve early detection and management of neurodevelopmental delays.
Aim:
To determine the predictive relationship between evidence-based screening tools and neurodevelopmental outcomes in Australian First Nations infants.
Method:
This prospective cohort study invited First Nations families to participate in a culturally adapted early developmental screening programme. A total of 156 infants (55.1% male, mean gestational age = 33.6 weeks, SD = 4.6) were screened using the Prechtl's General Movements Assessment, with optimality scoring using the Motor Optimality Score-Revised (MOS-R) at 3 to 5 months and the Hammersmith Infant Neurological Examination (HINE) at 4 to 9 months. Participants completed 'baby movement (BM) checks' at two time points (BM1, 3-5 months corrected age; BM2, 4-9 months corrected age), with final movement and learning checks at 12 months corrected age. At 12 months corrected age, standardized motor, cognitive, and communication assessments, neurodisability-specific symptomology, or a diagnosis made by a paediatrician classified infants as developing typically ('on track') or (1) with a high chance of or confirmed cerebral palsy (CP) or (2) non-CP neurodevelopmental delay (NDD), including autism and fetal alcohol spectrum disorder (FASD). Predictive relationships were investigated using logistic regression and diagnostic statistics.
Results:
At 12 months, 127 of 147 (86%) eligible infants (n = 9 withdrawn or deceased) were classified as 'on track' (n = 55, 43%), NDD (n = 59, 47%), or CP (n = 13, 10%). MOS-R (≥ 14 weeks) and the HINE distinguished infants as 'on track', CP, or NDD. [Correction added on 1 November 2025 after first online publication: In the preceding sentence, "MOS-R (≥ 14 weeks). The HINE distinguished infants…" has been updated to "MOS-R (≥ 14 weeks) and the HINE distinguished infants…".] Each 1-point decrease on both tools increased the odds of NDD (ORMOS-R = 1.40, 95% confidence interval [CI] = 1.00-1.96; ORHINE = 1.12, 95% CI = 1.05-1.21) and CP (ORMOS-R = 1.47, 95% CI = 1.08-2.01; ORHINE = 1.41, 95% CI = 1.21-1.65,). The MOS-R (cut-off of less than 23) and HINE (moderate to severely reduced) were best for identifying any NDD and CP (MOS-R: sensitivity = 84%, specificity = 38%; HINE: sensitivity = 64%, specificity = 63%). Combined trajectories across both tools were the strongest predictors of CP (sensitivity = 73%, specificity = 96%), autism (sensitivity = 59%, specificity = 95%), and FASD (sensitivity = 89%, specificity = 93%).
Interpretation:
Evidence-based screening tools demonstrate promising transdiagnostic prediction of 'on-track' development and not only high chance of CP but also autism, FASD, and other NDDs.
