CAT/CLAMS: its use in detecting early childhood cognitive impairment

Trends in Preterm Body Composition and Neurodevelopmental Outcomes after Discharge

INTRODUCTION

Body composition, specifically fat-free mass (FFM), of preterm infants is associated with improved neurodevelopmental outcomes. Little is known about body composition of preterm infants after discharge. Preterm body composition was measured by air displacement plethysmography (ADP) at two time points, inpatient (35-40 weeks postmenstrual age [PMA]) and outpatient (48-58 weeks PMA), with neonatal factors and neurodevelopmental testing at 4-6 months corrected age. We hypothesized increased FFM is positively associated with neurodevelopment.

METHODS

From 2007 to 2011, 510 infants admitted to the Medical University of South Carolina's neonatal intensive care unit underwent ADP. A total of 379 of 510 (74%) had anthropometrics at birth, an ADP scan with FFM, fat mass, fat percent z-scores, and an outpatient neurodevelopmental evaluation (CAT/CLAMS, Peabody Gross Motor). Variables were compared using multivariate analyses for body composition measurements.

RESULTS

The infants were 32 ± 4.8 weeks gestational age at birth with an average birth weight of 1,697 ± 932 g. Most (56%) infants received maternal milk at discharge. CAT, CLAMS, and gross motor scores had positive correlations with FFM z-scores at inpatient and outpatient ADP (p < 0.05). Receiving maternal milk at discharge was positively associated with cognitive (β = 0.22, p < 0.05) and language scores (β = 0.26, p < 0.05).

CONCLUSION

Increased FFM is associated with improved cognitive, language, and gross motor testing. Maternal milk was positively associated with language and cognitive scores.

Body Composition and "Catch-Up" Fat Growth in Healthy Small for Gestational Age Preterm Infants and Neurodevelopmental Outcomes

To examine the growth and body composition of small for gestational age (SGA) and appropriate for gestational age (AGA) very low birth weight infants (VLBW) and their outpatient neurodevelopmental outcomes. From 2006-2012, VLBW infants (n = 57 of 92) admitted to the Neonatal Intensive Care Unit (NICU) had serial air displacement plethysmography (ADP) scans and were followed as outpatients. Serial developmental testing (CAT/CLAMS, Peabody Gross Motor Scales) and anthropometrics were obtained from n = 37 infants (29 AGA and 8 SGA) and analyzed via repeated measures analyses of variances. The percentage of body fat, percentage of lean mass, and weight gain were statistically significant between SGA and AGA groups at the first ADP assessment. There was no difference between the two groups in outpatient neurodevelopmental testing. Weight gain as "catch-up" body fat accrual occurs by 67 weeks of PMA. This catch-up growth is associated with normal SGA preterm neurodevelopment as compared to AGA preterm infants.

The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study

Introduction: Clinical guidelines recommend using neuroimaging, Prechtls’ General Movements Assessment (GMA), and Hammersmith Infant Neurological Examination (HINE) to diagnose cerebral palsy (CP) in infancy. Previous studies provided excellent sensitivity and specificity for each test in isolation, but no study has examined the pooled predictive power for early diagnosis. Methods: We performed a retrospective case-control study of 441 high-risk infants born between 2003 and 2014, from three Italian hospitals. Infants with either a normal outcome, mild disability, or CP at two years, were matched for birth year, gender, and gestational age. Three-month HINE, GMA, and neuroimaging were retrieved from medical records. Logistic regression was conducted with log-likelihood and used to determine the model fit and Area Under the Curve (AUC) for accuracy. Results: Sensitivity and specificity for detecting CP were 88% and 62% for three-month HINE, 95% and 97% for absent fidgety GMs, and 79% and 99% for neuroimaging. The combined predictive power of all three assessments gave sensitivity and specificity values of 97.86% and 99.22% (PPV 98.56%, NPV 98.84%). Conclusion: CP can be accurately detected in high-risk infants when these test findings triangulate. Clinical implementation of these tools is likely to reduce the average age when CP is diagnosed, and intervention is started.

Phenotypic characterization of individuals with SYNGAP1 pathogenic variants reveals a potential correlation between posterior dominant rhythm and developmental progression

Background

The SYNGAP1 gene encodes for a small GTPase-regulating protein critical to dendritic spine maturation and synaptic plasticity. Mutations have recently been identified to cause a breadth of neurodevelopmental disorders including autism, intellectual disability, and epilepsy. The purpose of this work is to define the phenotypic spectrum of SYNGAP1 gene mutations and identify potential biomarkers of clinical severity and developmental progression.

Methods

A retrospective clinical data analysis of individuals with SYNGAP1 mutations was conducted. Data included genetic diagnosis, clinical history and examinations, neurophysiologic data, neuroimaging, and serial neurodevelopmental/behavioral assessments. All patients were seen longitudinally within a 6-year period; data analysis was completed on June 30, 2018. Records for all individuals diagnosed with deleterious SYNGAP1 variants (by clinical sequencing or exome sequencing panels) were reviewed.

Results

Fifteen individuals (53% male) with seventeen unique SYNGAP1 mutations are reported. Mean age at genetic diagnosis was 65.9 months (28–174 months). All individuals had epilepsy, with atypical absence seizures being the most common semiology (60%). EEG abnormalities included intermittent rhythmic delta activity (60%), slow or absent posterior dominant rhythm (87%), and epileptiform activity (93%), with generalized discharges being more common than focal. Neuroimaging revealed nonspecific abnormalities (53%). Neurodevelopmental evaluation revealed impairment in all individuals, with gross motor function being the least affected. Autism spectrum disorder was diagnosed in 73% and aggression in 60% of cases. Analysis of biomarkers revealed a trend toward a moderate positive correlation between visual-perceptual/fine motor/adaptive skills and language development, with posterior dominant rhythm on electroencephalogram (EEG), independent of age. No other neurophysiology-development associations or correlations were identified.

Conclusions

A broad spectrum of neurologic and neurodevelopmental features are found with pathogenic variants of SYNGAP1. An abnormal posterior dominant rhythm on EEG correlated with abnormal developmental progression, providing a possible prognostic biomarker.

Electronic supplementary material

The online version of this article (10.1186/s11689-019-9276-y) contains supplementary material, which is available to authorized users.

Test-retest reliability of the Capute scales for neurodevelopmental screening of a high risk sample: Impact of test-retest interval and degree of neonatal risk

AIM

Reliable and valid screening and assessment tools are necessary to identify children at risk for neurodevelopmental disabilities who may require additional services. This study evaluated the test-retest reliability of the Capute Scales in a high-risk sample, hypothesizing adequate reliability across 6- and 12-month intervals.

METHODS

Capute Scales scores (N = 66) were collected via retrospective chart review from a NICU follow-up clinic within a large urban medical center spanning three age-ranges: 12-18, 19-24, and 25-36 months. On average, participants were classified as very low birth weight and premature. Reliability of the Capute Scales was evaluated with intraclass correlation coefficients across length of test-retest interval, age at testing, and degree of neonatal complications.

RESULTS

The Capute Scales demonstrated high reliability, regardless of length of test-retest interval (ranging from 6 to 14 months) or age of participant, for all index scores, including overall Developmental Quotient (DQ), language-based skill index (CLAMS) and nonverbal reasoning index (CAT). Linear regressions revealed that greater neonatal risk was related to poorer test-retest reliability; however, reliability coefficients remained strong.

CONCLUSIONS

The Capute Scales afford clinicians a reliable and valid means of screening and assessing for neurodevelopmental delay within high-risk infant populations.

[Early prediction of the neurological result at 12 months in newborns at neurological risk]

INTRODUCTION

The aim of this study was to evaluate the Amiel-Tison neurological examination (AT) and cranial ultrasound at term for predicting the neurological result at 12 months in newborns with neurological risk.

PATIENTS AND METHODS

The study included 89 newborns with high risk of neurological damage, who were discharged from the Neonatal Intensive Care of the Hospital Zonal Bariloche, Argentina. The assessment consisted of a neurological examination and cranial ultrasound at term, and neurological examination and evaluation of development at 12 months. The sensitivity, specificity, positive and negative predictor value was calculated. The relationship between perinatal factors and neurodevelopment at 12 month of age was also calculated using logistic regression models.

RESULTS

Seventy children completed the follow-up. At 12 months of age, 14% had an abnormal neurological examination, and 17% abnormal development. The neurological examination and the cranial ultrasound at term had low sensitivity to predict abnormal neurodevelopment. At 12 months, 93% of newborns with normal AT showed normal neurological results, and 86% normal development. Among newborns with normal cranial ultrasound the percentages were 90 and 81%, respectively. Among children with three or more perinatal risk factors, the frequency of abnormalities in the neurological response was 5.4 times higher than among those with fewer risk factors, and abnormal development was 3.5 times more frequent.

CONCLUSIONS

The neurological examination and cranial ultrasound at term had low sensitivity but high negative predictive value for the neurodevelopment at 12 months. Three or more perinatal risk factors were associated with neurodevelopment abnormalities at 12 months of age.

Environment as a risk factor in delayed development in premature, low-birthweight and mild asphyxia children

BACKGROUND

Premature infants with low birthweight (LBW) and asphyxia are at high risk of delay of language and visual-motor development. Environmental risk factors contributing to the delay include parents' education, family income, number of children in the family, exclusive breast-feeding, and the mother's parenting time. Lack of research in Indonesia on premature, LBW and mild asphyxia children minimizes information to parents on the importance of an optimal environment. The aim of this study was to observe the role of the environment as a risk factor for delay in language and visual-motor development.

METHODS

A cross-sectional study was carried out from June to December 2011 of 12-24-month-old children born premature, with LBW and mild asphyxia at the Hasan Sadikin, Bandung City, and Muhammadiyah Hospitals. Language and visual-motor development were measured by Capute scales. Risk factors were analyzed using chi-squared test and multivariate logistic regression analysis.

RESULTS

Of the 70 subjects, 49% had language and visual-motor delay. Environmental factors related to the delay were low parental education, low family income, non-exclusive breast-feeding (P < 0.001) and full-time maternal parenting (P < 0.05). On multivariate analysis non-exclusive breast-feeding was associated with a 175-fold risk (prevalence rate [PR], 174.756; 95% confidence interval [CI]: 10.407-2934.516, P < 0.001), and low family income, a 0.042-fold risk (PR 0.042; 95%CI: 0.005-0.321, P < 0.05).

CONCLUSION

Low family income and non-exclusive breast-feeding are risk factors for delay in language and visual-motor development in 12-24-month-old children born premature, with LBW and mild asphyxia.

Pediatric delirium: monitoring and management in the pediatric intensive care unit

This review article updates the pediatric medical community on the current literature regarding diagnosis and treatment of delirium in critically ill children. This information will be of value to pediatricians, intensivists, and anesthesiologists in developing delirium monitoring and management protocols in their pediatric critical care units.

Neurodevelopment in children born to HIV-infected mothers by infection and treatment status

BACKGROUND

We reviewed the impact of HIV, HIV exposure, and antiretroviral therapy/prophylaxis on neurodevelopmental outcomes of HIV-infected and HIV-exposed-uninfected infants and children.

METHODS

A literature search of Medline, Embase, PsychINFO, Web of Science, PubMed, and conference Web sites (1990-March 2011) using the search terms, infant, child, HIV, neurodevelopment, cognition, language, and antiretroviral therapy, identified 31 studies of HIV/antiretroviral exposure using standardized tools to evaluate infant/child development as the main outcome. Articles were included if results were reported in children <16 years of age who were exposed to HIV and antiretrovirals in fetal/early life, and excluded if children did not acquire HIV from their mothers or were not exposed to antiretrovirals in fetal/early life.

RESULTS

Infants who acquired HIV during fetal and early life tended to display poorer mean developmental scores than HIV-unexposed children. Mean motor and cognitive scores were consistently 1 to 2 SDs below the population mean. Mean scores improved if the infant received treatment before 12 weeks and/or a more complex antiretroviral regimen. Older HIV-infected children treated with highly active antiretroviral therapy demonstrated near normal global mean neurocognitive scores; subtle differences in language, memory, and behavior remained. HIV-exposed-uninfected children treated with antiretrovirals demonstrated subtle speech and language delay, although not universally.

CONCLUSIONS

In comparison with resource-rich settings, HIV-infected and HIV-exposed-uninfected infants/children in resource-poor settings demonstrated greater neurodevelopmental delay compared with HIV-unexposed infants. The effects on neurodevelopment in older HIV-infected children commenced on antiretroviral therapy from an early age and HIV-exposed-uninfected children particularly in resource-poor settings remain unclear.

Evaluation of the ability of neurobiological, neurodevelopmental and socio-economic variables to predict cognitive outcome in premature infants

BACKGROUND

When developed in the 1990s, the Neurobiologic Risk Score (NBRS) and Neurodevelopmental Risk Exam (NRE) correlated well with developmental outcomes in premature infants. Given recent advances in neonatology, we assessed their present ability to predict cognitive outcome, alone and combined with socio-economic factors.

METHODS

One hundred and twenty-nine neonates <32 weeks gestational age were assessed at 6, 12 and/or 24 months corrected age with the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). Indices of socio-economic status included maternal education and marital status.

RESULTS

At 24 months corrected age (n= 67), the NBRS (r=-0.5), maternal education (r= 0.46) and marital status (r= 0.37) correlated with the CAT/CLAMS. These correlations increased when NBRS and maternal education were combined (r= 0.63) and when specific NBRS components (intraventricular haemorrhage, periventricular leukomalacia, seizures) and maternal education were combined (r= 0.66).

CONCLUSIONS

In the contemporary neonatal intensive care unit, measures used to predict cognitive outcome should incorporate both neurobiological risk factors and socio-economic variables.

Early clinical indicators of developmental outcome in abusive head trauma

PURPOSE

The purpose of the study was to determine the developmental prognostic significance of early clinical indicators in abusive head trauma.

METHODS

Seventy-one children were diagnosed with abusive head trauma and followed in a post-injury growth and development clinic. A retrospective chart review was completed to gather clinical features at the time of injury, including presence or absence of early post-traumatic seizures, presence or absence of intubation, and presence or absence of pediatric intensive care unit admission. Children then underwent developmental testing with use of the Capute Scales of the Cognitive Adaptive Test (CAT) and the Clinical Linguistic and Auditory Milestone Scale (CLAMS) during follow-up clinic visits. Clinical features at initial injury were compared to developmental outcome.

RESULTS

Thirty-four of 71 patients with seizures during their admission hospitalization scored significantly lower on follow-up developmental testing than patients who did not have seizures. Twenty-one of 71 patients who required intubation scored lower on developmental testing than patients who did not require intubation. Thirty-five of 71 patients who required pediatric intensive care unit admission scored lower on developmental testing than patients who did not require pediatric intensive care unit admission.

CONCLUSIONS

This study demonstrates that clinical factors at the time of injury, such as early post-traumatic seizures and intubation requirement, are associated with poorer developmental outcome. This study also suggests that close developmental follow-up should be obtained for all children with abusive head trauma, regardless of whether or not the child was admitted to the PICU.

Prognostic value of a scorable neurological examination from 3 to 12 months post-term age in very preterm infants: a longitudinal study

AIMS AND STUDY DESIGN: The Hammersmith Infant Neurological Examination proved effective in predicting locomotor function in very preterm infants after 9 months of age. We performed the examination in a cohort of 103 very preterm infants (gestational age below 32 weeks) as early as 3 months' post-term age, and longitudinally at 6, 9 and 12 months. Our aim was to establish the frequency distribution of the optimality scores at each age period, to explore the predictive value of the examination from 3 months onwards as to developmental outcome and locomotor function at 2 years, and to explore its longitudinal consistency.

RESULTS

The results showed that this standardized neurological examination can be performed in preterm infants as early as 3 months' post-term age to predict motor outcome at 2 years, and that its high predictive value is consistent across the first year of life due to an effective combination of different items for each age period.

CONCLUSIONS

We confirm the high predictive value of this neurological examination in very preterm infants after 9 months and extend it to the assessments performed as early as 3 months post-term. This is of great relevance as in very preterm infants early prediction of motor function is essential for a prompt planning of therapeutic interventions.

Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements

OBJECTIVE

To evaluate the possible additional benefit in terms of prognostic accuracy of an integrated application of a traditional scorable method of neurologic examination and the Prechtl's method of qualitative assessment of general movements (GMs) in a large population of 903 consecutive preterm infants.

STUDY DESIGN

Infants were enrolled from the Intensive Care Unit of the University of Catania. Inclusion criteria were a gestational age below 37 weeks and the absence of genetic disorders. All infants underwent serial ultrasound and at 3 months performed both the GMs assessment and the Hammersmith Infant Neurologic Examination (HINE). Outcome was assessed at 2 years by the Touwen neurologic examination and the Clinical Adaptive Test/Clinical, Linguistic and Auditory Milestone Scale.

RESULTS

The integration of the two methods was shown to be more effective than the single assessments in predicting neurologic outcome. The additional benefit of combining the two approaches was particularly clear for the discrimination between unilateral and bilateral cerebral palsy.

CONCLUSIONS

The integrated use of a scorable neurological examination and Prechtl's assessment of GMs can improve early prediction of neurodevelopmental outcome in preterm infants and should complement other clinical and instrumental exams in follow-up programs.

Motor and cognitive development at one-year follow-up in infants with torticollis

BACKGROUND

Clinical experience suggests infants with torticollis are at risk for developmental delay.

AIMS

To examine gross motor (GM) skills at presentation in infants with torticollis; report first-year GM and cognitive outcomes; examine relationship between types of torticollis and above outcomes.

STUDY DESIGN

Prospective follow-up study.

SUBJECTS

Infants referred to 2 regional child development centers from April 2001-December 2002 with torticollis/head tilt and no perinatal complications syndromes were studied.

OUTCOME MEASURES

GM function was measured using the Alberta Infant Motor Scale and classified as normal (>10%), suspect (5-10% inclusive), or abnormal (<5%). Cognitive function was measured at follow-up using CAT-CLAMS-r Developmental Assessment. Follow-up data obtained between 8 and 15 months of age.

RESULTS

One hundred and one infants with torticollis were seen for initial assessment at mean age 2.9 (SD 1.5) months. Eighteen had sternomastoid tumor, 47 muscular torticollis and 36 postural torticollis. At presentation, 35 (35%) of the 101 infants had suspect or abnormal GM function. 19/66 children with normal GM and 17/35 with suspect or abnormal GM function had postural torticollis (p=0.054). All children received physical therapy. Follow-up assessment of 83 participants, mean age 12.8 (SD 3.6) months, showed 75 had normal GM function and 8 had suspect or abnormal GM function; 11/83 still had torticollis. Cognitive assessment on 66 infants, mean age 14.4 (SD 4.8) months, revealed 57 (87%) had normal cognitive function and 9 (13%) were either delayed or significantly delayed.

CONCLUSIONS

Infants with torticollis are at increased risk for early GM delay but most normalize by one year. Torticollis is not associated with delays in early cognitive function.

Comparison of the validity of direct pediatric developmental evaluation versus developmental screening by parent report

To compare the validity of direct pediatric developmental evaluation with developmental screening by parent report, parents completed a developmental screen (the Child Development Review), a pediatrician performed a direct developmental evaluation (Capute Scales), and a psychologist administered the Bayley Scales of Infant Development to a group of 30-month-old children. The agreement between these instruments was tested. All developmental quotient scores derived from the Capute Scales were more highly correlated with concurrent Bayley Mental Development Index scores than developmental quotient scores derived from the Child Development Review. Differences between developmental quotient scores derived from the Capute Scales and corresponding Bayley Mental Development Index scores were significantly smaller than those derived from the Child Development Review. Thus, direct pediatric developmental evaluation more reliably predicted concurrent Mental Development Index scores at 30 months of age than developmental screening by parent report. Increased emphasis on training of pediatric health care providers in direct developmental evaluation should be considered.

Impact of breast-feeding on psychomotor and neuropsychological development in children of diabetic mothers: role of the late neonatal period

AIM

Previous data from our Kaulsdorf Cohort Study (KCS) suggest that early neonatal ingestion (1st week) of breast milk from diabetic mothers (diabetic breast milk, DBM) may increase the risk of being overweight and delay speech development in offspring of diabetic mothers (ODM). Late neonatal DBM ingestion (2nd-4th week), however, not independently influenced the risk of overweight. We investigated whether late neonatal DBM ingestion might independently influence neuro-development.

METHODS

Achievement of developmental milestones according to late neonatal DBM intake was analyzed in 242 ODM.

RESULTS

No impact of DBM ingestion on psychomotor parameters was observed. In contrast, it negatively influenced onset of speaking (no DBM: median 44.0 weeks, range 31.0-72.0; some DBM: 48.0, 24.0-100.0; DBM only: 52.0, 28.0-84.0; P=0.037) and halved the probability of reaching this milestone at any time point (hazard ratio: 0.53, 95% confidence interval: 0.31-0.91). However, adjustment for DBM volume ingested during the early neonatal period weakened the hazard ratio towards non-significance. In the fully adjusted model, the hazard ratio was halved, but insignificant.

CONCLUSIONS

Our results underscore that neonatal DBM ingestion, particularly during the first week of life, may delay speech development, an important indicator of cognitive development. Further studies are urgently recommended on consequences of breast-feeding for neurodevelopment in ODM.

Validity of the Clinical Adaptive Test (CAT)/Clinical Linguistic and Auditory Milestone Scale (CLAMS) as a screening instrument for very low birth weight infants in Taiwan

The authors investigated the validity of the Clinical Adaptive Test (CAT)/Clinical Linguistic and Auditory Milestone Scale (CLAMS) for developmental screening and early prediction in very low birth weight (VLBW) infants, using the Bayley Scales of Infant Development II (BSID-II) as a reference standard. A total of 808 VLBW infants discharged from neonatal intensive care units in Taiwan from January 1995 to December 1997 were enrolled and followed up at the corrected ages of 6, 12, 18, and 24 months. The CAT/CLAMS and BSID-II were performed separately during each visit. The CAT/CLAMS showed strong concurrent correlations (r = 0.51-0.86, p < .0001) with BSID-II mental developmental index (MDI), and had high conegativity scores (96.7%-100%) but low copositivity scores (30.0%-45.3%) for detecting developmental delay. At 24 months of age, the CAT/CLAMS had better predictive validity for significant (MDI <70) rather than borderline (MDI = 70-84) developmental delay. The authors conclude that the CAT/CLAMS is not an appropriate developmental instrument for screening and early prediction in VLBW infants in Taiwan.

A population-based study to determine the performance of the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale to Predict the Mental Developmental Index at 18 Months on the Bayley Scales of Infant Development-II in very preterm infants

OBJECTIVES

To determine optimal ages to perform the Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) and optimal "cutoff" score of the CAT/CLAMS to screen very preterm infants (<31 weeks) for severe cognitive-adaptive delay and to ascertain the sensitivity, specificity and likelihood ratios using optimal cutoff scores compared with the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development II.

METHODS

A population-based cohort of very preterm infants who were born to mothers who resided in Nova Scotia or Prince Edward Island were evaluated at 4, 8, 12, and 18 months' corrected gestational age, which included a CAT/CLAMS by a physician. At 18 months' corrected gestational age, each child was assessed using the Bayley Scales of Infant Development II, the "gold standard" for developmental delay in young infants. The results of each CAT/CLAMS was compared with the 18-month MDI to identify significant developmental delay (MDI <70).

RESULTS

Optimal scores on the CAT/CLAMS to identify correctly MDI <70 were determined by using the kappa statistic for chance independent agreement. Sensitivities and specificities for optimal cutoff scores were as follows: 4-month score <109 (88% and 37%), 8-month score <98 (75% and 82%), 12-month score <81 (63% and 99%), and 18-month score <83 (88% and 98%).

CONCLUSION

Sensitivity and specificity of the CAT/CLAMS are high in very preterm infants at identifying major developmental delay at 12 and 18 months. For follow-up programs without psychology services, the CAT/CLAMS at 12 and 18 months is a reasonable screening tool to determine which children need expedited psychology referral for cognitive delay.

Screening for developmental and behavioral problems

Early detection of developmental and behavioral/mental health problems is greatly facilitated when quality instruments are deployed. This article describes how to identify accurate measures and presents standards for screening tests. Included is a table delineating accurate tools for primary care: typically those relying on information from parents (e.g., PEDS, ASQ, PSC, etc.) as well as measures useful in settings where providers have more time and skill at eliciting behaviors from children (e.g., Brigance screens). Screening measures should be used in the context of developmental surveillance; the longitudinal process of incorporating professional observations into decision-making about children's developmental needs.

Developmental screening

An estimated 5 to 10% of the pediatric population has a developmental disability. The current strategy to identify these children is through developmental surveillance, a continuous procedure in which the health professional observes the infant, takes a developmental history, and elicits any concerns that the caregiver might have. However, identification of delayed children is ineffective when based solely on routine surveillance. A necessary adjunct is developmental screening: the process of systematically identifying children with suspected delay who need further assessment. Screening tests greatly improve the rate of identification. With the advent of intervention programs and the support of organizations such as the American Academy of Pediatrics, the topic of developmental screening is a timely and essential one. This review aims to describe the properties of screening tests, to evaluate the available tools for developmental screening while providing a representative sample of the currently available developmental tests, and, finally, to evaluate the efficacy of intervention programs, a needed prerequisite to justify screening.

Standardization of the Capute Scales: methods and results

The Capute Scales is a 100-item developmental assessment tool to quantitatively measure expressive and receptive language and nonverbal problem-solving skills in infants from birth to 3 years of age. The present multisite study standardized the instrument on a population of 1055 typically developing children balanced for age, sex, and race and generated normative tables to document the instrument's utility. There were no significant performance differences by race or sex. The achieved age levels for individual test items and for total scores were accurately predicted by the age levels assigned to the test items. The conversion of age levels to standard scores was found to be unnecessary because the developmental quotients derived from age ratios did not differ significantly from the derived scores.

Concurrent and predictive validity of the cognitive adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) and the Mental Developmental Index of the Bayley Scales of Infant Development

The Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) was designed for use by primary pediatric health care providers to identify children with developmental delays. This study assesses the concurrent and predictive validity of CAT/CLAMS developmental quotient (DQ) scores and the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development in healthy children without risk factors for developmental delay. Overall CAT/CLAMS DQ scores correlated significantly with Bayley MDI scores at both 12 (r = 0.393; p = 0.008) and 30 months (r = 0.742; p = 0.0001) of age. Overall CAT/CLAMS DQ scores at 12 months of age also correlated modestly with Bayley MDI scores at 30 months of age (r = 0.181; p = 0.036). Despite its modest predictive validity at 12 months, its satisfactory concurrent validity plus its ease and speed of administration make the CAT/CLAMS a reasonable choice for assessment of early development by primary pediatric health care providers.

The Brigance Infant and Toddler Screen: standardization and validation

The goal of this study is to present research behind the downward extension of the Brigance Screens into the 0- to 2-year-old age range. Items were selected from the Brigance Inventory of Early Development (standardized on 1156 children) to produce fine motor, receptive language, expressive language, gross motor, self-help, and social-emotional subtests. Sites included 29 pediatric offices, day-care centers, and developmental evaluation centers in 22 states. Subjects were 408 children, 0 to 24 months of age. Internal consistency, test-retest, and interrater reliability ranged from 0.98 to 0.99 for both the Infant and Toddler Screens. Parent report and direct elicitation versions/observation varied by an average of only one point. Correlations with diagnostic measures were high (0.46 to 0.91). Specificity ranged from 85% to 86% and sensitivity ranged from 76% to 77%. Accordingly, the Brigance Infant and Toddler Screens are shown to be accurate, valid, and reliable tools that can be administered by a range of professionals using either parent interview or direct elicitation/observation or both.

Developmental milestones of vertically HIV infected and seroreverters children: follow up of 83 children

The aim of the study was to detect neurological abnormalities in human immunodeficiency virus (HIV) infected children. This was achieved by a prospective evaluation, from November/1995 to April/2000, of 43 HIV infected children (group I) and 40 HIV seroreverters children (group II) through neurological exam and neurodevelopmental tests: Denver Developmental Screening Test (DDST) and Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS). A control group (III), of 67 children, were evaluated by CAT/CLAMS. Hyperactivity, irritability and hypotonia were the findings on neurological examination, without statistical differences between group I and II. On CAT/CLAMS, the group I developmental quotient (DQ) was significantly lower than the other groups. The same occurred in DDST, with group I presenting significantly more failures than group II. Nineteen HIV children of group I had brain computed tomographic scan, with abnormalities in three of them (basal ganglia calcification, white matter hypodensity and asymmetry of lateral ventricles). We conclude that in HIV infected children a neurodevelopment delay occur early in the disease, and it can be detected by screening tests.