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5 PediaTracTM: A Novel Measure for Screening Early Motor Development in Infants Born Preterm and Other At-Risk Populations
- H. Gerry Taylor, Jennifer C. Gidley Larson, Renee Lajiness-O'Neill, Alissa C. Huth-Bocks, Seth Warschausky
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 615-616
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Objective:
Infant motor development is a robust predictor of long-term developmental outcomes, especially in infants at high risk for neurodevelopmental impairments, such as those born preterm (PT, gestational age [GA] <37 weeks). Although direct assessments of motor development are available, they are infrequently applied by pediatricians in routine screening of the broader population of infants born preterm. Parent ratings, such as the Ages and Stages Questionnaire, 3rd Ed., can be used to screen for motor delays. However, this and other existing screening measures focus on whether children have reached milestones based on pre-established cutoffs, rather than on assessing development along a continuum of ability. The present study examined the validity of the Motor domain of the recently developed caregiver report screening tool, PediaTracTM, in distinguishing infants born PT from infants born full term (FT, GA ^37 weeks) across the first 6 months of life. The reliability and factor structure of this motor scale were also evaluated.
Participants and Methods:PediaTracTM is a web-based caregiver report assessing infant development across multiple domains, including motor functioning. This study reports on results from the PediaTracTM Motor domain for the study sample of 571 caregiver-infant dyads (240 PT, 331 FT). Caregivers rated their infants on age-targeted motor skills during the newborn period (NB, defined as term equivalent for the PT group) and at 2-, 4-, and 6-months after the NB period. Item Response Theory (IRT) methods were applied to assess the reliability (i.e., information) of caregiver-reported motor skills at each age. Using the IRT item parameters of discrimination and difficulty, items were selected for inclusion and to estimate theta, an index of the latent trait, motor ability, for each infant. Analyses conducted at each age assessed the effects of group, sex, and group x sex on the motor trait. Scale reliabilities and factor structure were also examined.
Results:The PT group had significantly higher scores than the FT group on the motor trait at the NB period but significantly lower scores by 4 and 6 months, suggesting slower development of motor skills in the PT group. Means (SD) theta scores (similar to z scores) for the PT and FT groups, respectively, were .14 (.88) and -.05 (.91) for the NB period, -.01 (.90) and .01 (.91) for 2 months, .20 (.90) and .36 (88) for 4 months, and .46 (78) and .66 (.89) for 6 months. Effects for sex and group x sex interactions were not significant. Reliabilities, estimated at a point close to mean theta, were .94, .93, .96, and .98 at the NB, 2-, 4-, and 6-month periods, respectively. Exploratory factor analyses revealed evidence for a single primary motor factor and multiple second-order factors at each age.
Conclusions:Findings provide strong support for applications of the caregiver reported PediaTracTM motor scales in screening infants born PT and other at-risk populations for early delays or abnormalities in motor development. Advantages of this method include its ease of administration, sensitivity to developmental change, and promise in assessing subdomains of motor skill.
2 Infant Imitation: Detecting Risk in the First Year with PediaTrac™
- Samantha Levick, Michelle Lobermeier, Angela D. Staples, Jennifer C. G. Larson, Renee Lajiness-O’Neill
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 510-511
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Objective:
Imitation has pervasive associations with social and communicative development. However, few methods have been developed to measure this construct in typically developing infants, and even less is available for at-risk populations, such as infants born preterm. Autism spectrum disorder (ASD), a particular risk of premature birth, is associated with atypical imitation and social communication. Although imitation emerges in infancy, most current screening and diagnostic tools for ASD cannot be utilized prior to 12 months. The present study aimed to develop and validate a caregiver-report measure of infant imitation, characterize imitation profiles at 4, 6, and 9 months in term and preterm infants, and explore the relationship between imitation and scores on an ASD screening questionnaire at 18 months.
Participants and Methods:Participants (N = 571) were recruited from a larger multi-site study of PediaTrac™ v3.0, a web-based tool for monitoring and tracking infant development, and were surveyed longitudinally at birth, 2, 4, 6, 9, 12, 15, and 18 months. Participants completed the online PediaTrac™ survey and several reliable and validated questionnaires via pen-and-paper format. For the purposes of this study, only the Ages and Stages Questionnaire (3rd ed.; ASQ-3), Communication and Symbolic Behavior Scales-Developmental Profile (CSBS-DP), Brief Infant Sleep Questionnaire (BISQ), and the Modified Checklist for Autism in Toddlers - Revised with Follow-Up (M-CHAT-R/F) were examined. The following hypotheses were tested: (1) proposed imitation items will represent a unitary latent construct, for which convergent and discriminant validity will be demonstrated, (2) there will be measurement invariance between term status groups at each assessment period, (3) preterm infants will obtain lower caregiver-reported imitation scores compared to term infants, and (4) imitation abilities at the assessment period with the most robust imitation factor will predict M-CHAT-R/F scores at 18 months.
Results:Distinct imitation factors at 4, 6, and 9 months were modeled with confirmatory and exploratory factor analyses. Relationships between the factors and established measures of infant communication (CSBS; ASQ) and sleep (BISQ) revealed convergent and discriminant validity, respectively. Strict measurement invariance was demonstrated for the 4- and 9-month factors, and metric invariance for the 6-month measure. Full term infants scored higher on imitation at 9 months, though variance in this outcome was related to term status differences in sensorimotor skills. Lastly, the 9-month imitation factor, coupled with 6-month sensorimotor skills, predicted 18-month ASD risk over and above gestational age.
Conclusions:This study provides support for the assessment of infant imitation, utilizing imitation to detect risk in preterm infants, and extending the age of identification for ASD risk into the first year. PediaTrac™ imitation, in combination with the PediaTrac™ sensorimotor domain, may be useful in detecting developmental risk, and specifically risk for ASD, within the first year, leading to earlier initiation of intervention. Further, with its minimal completion time and ease of dissemination through digital platforms, this measure can expand access to care and improve long-term outcomes for children and families.
69 Psychometric Properties of the PediaTrac Social/Communication/Cognition Domain
- Michelle Lobermeier, Samantha Levick, Trivellore Raghunathan, Patricia Berglund, Seth Warschausky, Alissa Huth-Bocks, H. Gerry Taylor, Angela D Staples, Jennifer Cano, Renee Lajiness-O’Neill
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 744-745
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Objective:
Research has established the importance of early identification and intervention for children with developmental disorders and delays. In striving toward earlier recognition and treatment of developmental concerns, it is crucial to have a universal system to monitor infant and toddler development over time. This system should comprehensively assess the desired areas of development, be based on normative data from large samples, and have strong psychometric properties. While a few developmental monitoring tools are currently in use, they lack many of the aforementioned qualities. The current study reports on the cross-sectional psychometric properties of PediaTrac, which is a novel caregiver-report measure of infant and toddler development. Specifically, this study focuses on psychometric properties of PediaTrac’s social/communication/cognition (SCG) domain during the first 9 months of life.
Participants and Methods:The current sample included 571 caregiver-infant dyads recruited into term (n=331) and preterm (n=240) groups. Participants were from the PediaTrac multisite, longitudinal study and were socioeconomically (41.9% below median income) and racially (33.6% Black, 47.6% White, 11.0% multiracial/other) diverse. Data included caregiver reports of infant development from the SCG domain of PediaTrac at 5 sampling periods (newborn, 2, 4, 6, and 9 months). Item response theory (IRT) graded response modeling was used to estimate theta, an index of the latent trait, social/communication/cognition. Exploratory factor analysis (EFA) was used to further examine the underlying structure of the SCG domain.
Results:Mean theta values could be reliably estimated at all time periods and followed a linear trend consistent with development. At 9 months, theta values were statistically different between the term and preterm groups, indicating that term infants demonstrated more advanced SCG abilities. Item parameters (discrimination and difficulty) could be modeled at each time period across the range of ability. Reliability of the SCG domain ranged from 0.97 to 0.99. Results of the EFA suggested a two-factor solution (affect/emotional expression, social responsiveness) at the newborn period accounting for 43% of the variance, a three-factor solution (affect/emotional expression, social responsiveness, imitation/emerging communication) at the 2-, 4-, and 6-month periods accounting for 43%, 34%, and 34% of the variance, respectively, and a four-factor solution (affect expression, social responsiveness, imitation/communication, nonverbal/gestural communication) at the 9-month period accounting for 34% of the variance.
Conclusions:The PediaTrac SCG domain has strong psychometric properties, including reliability estimates higher than other existing caregiver-report measures of SCG abilities. EFA analyses demonstrated that the structure of affect/emotional expression and social responsiveness remains relatively stable and may reflect affective and regulatory aspects of temperament. Conversely, the quality and type of communication continually develops and becomes more differentiated throughout the time periods of interest. Notably, parents appear to be capable of observing and reliably reporting on their infants’ abilities in these areas. The use of a universal screening tool developed with rigorous psychometric methods, such as PediaTrac, could transform the way that clinicians identify infants in need of early intervention.