Issues in Neurodevelopmental Testing of Infants Born Prematurely: The Bayley Scales of Infant Development Third Edition and Other Tools

Abstract

Neurodevelopmental assessment of infants and toddlers consists of administration of specific tasks, observation of behavior, and use of caregiver report. It is best done in a serial fashion. Issues that affect neurodevelopmental assessment include secular changes where mean scores increase over time, the need to balance thoroughness of evaluation with pragmatic issues such as length of the test, and what functions can be assessed at specific ages. Prediction is often a long-term goal, but it is difficult due to the tests used, the infant’s current level of function, and the effects of protective or risk environmental factors. There are various levels of follow-up available for infants born prematurely, ranging from mailings/phone interviews to full assessment by a multidisciplinary team. The Bayley Scales have been the reference standard and have undergone several revisions, the latest being the Bayley-III. There is concern that Bayley-III scores are inflated. Numerous attempts at making these scores more comparable to earlier Bayley-II have been minimally successful. The best solutions available for the Bayley-III are to use a control group who receive the same test and use different categorical cutoffs to indicate severity of developmental delays. Other issues that are discussed include correction for prematurity, the relationship between ASD and prematurity, and how best to define neurodevelopmental impairment.

“Developmental assessment is the practice of measuring children’s strange behavior in strange settings with strange people for the briefest period of time possible.”

Urie Brofenbrenner, 1977