PediaTrac V.3.0 protocol: a prospective, longitudinal study of the development and validation of a web-based tool to measure and track infant and toddler development from birth through 18 months

Longitudinal caregiver-reported motor development in infants born at term and preterm

AIM

To examine the extent to which estimates of a latent trait or underlying construct of motor ability differ in infants born at term and preterm, based on caregiver ratings of the motor domain of PediaTrac v3.0.

METHOD

The sample consisted of 571 caregiver-infant dyads (331 born at term, 240 born preterm), 48% female, with 51.7% of caregivers identifying as an ethnic minority. Latent trait of motor ability was estimated based on item response theory modeling. Gestational group differences (term and preterm birth) were examined at the newborn/term-equivalent, 2-, 4-, 6-, 9-, and 12-month time points.

RESULTS

Caregiver ratings of latent trait of motor ability were reliably modeled across the range of abilities at each time point. While the group born preterm exhibited significantly more advanced motor abilities at the term-equivalent time point, by 6 months the group born at term was more advanced. Biological sex difference main and interaction effects were not significant.

INTERPRETATION

Caregivers provided reliable, longitudinal estimates of motor ability in infancy, reflecting important differences in the motor development of infants born at term and preterm. The findings suggest that significant motor development occurs in infants born preterm from birth to the term-equivalent time point and provide a foundation to examine motor growth trajectories as potential predictors in the early identification of neurodevelopmental conditions and needs.

WHAT THIS PAPER ADDS

Longitudinal caregiver ratings of motor function in early infancy yielded reliable estimates of the latent trait of motor ability. Motor ability at the term-equivalent time point was higher in infants born preterm than infants born at term.

Measuring Early Relational Health Using PediaTrac TM in a Diverse Sample of Infant-Caregiver Dyads

OBJECTIVE

Early relational health (ERH) is a key developmental predictor and outcome in infancy and early childhood that reflects social-emotional well-being and promotes resilience throughout childhood. Currently, there is no gold-standard developmental screening tool for ERH in pediatric care settings. This study examined the psychometric properties of items assessing ERH that are part of a web-based, caregiver-report screening tool called PediaTrac TM . It was hypothesized that ERH could be reliably estimated and that second-order factors would be revealed within the latent construct ERH.

METHOD

Participants included 571 caregivers of term (n = 331; ≥37 weeks) and preterm (n = 240; <37 weeks) infants recruited shortly after birth from several academic medical centers and a community health clinic. Caregivers completed PediaTrac modules at birth and 2, 4, 6, 9, 12, 15, and 18 months; data for this study are from the newborn through 12-month periods.

RESULTS

Results from Item Response Theory Graded Response Modeling revealed excellent reliability for the PediaTrac ERH domain at all time points, ranging from 0.96 to 0.98. Exploratory factor analyses revealed 4 to 5 second-order factors, representing Parent-Child Relationship, Parent Distress, Parenting Stress, Parenting Efficacy, Sensitivity, and Perceptions of Child, depending on period.

CONCLUSION

The caregiver-report developmental screening tool, PediaTrac, reliably measures ERH during the first year of life. The measure has promising clinical utility in pediatric clinic settings for tracking ERH over time to ensure early social-emotional well-being and to identify concerns as early as possible.

Convergent Validity Between the Motor Domain of PediaTracTM and Ages and Stages in Term and Preterm Infants at 2, 4, 6, and 9 Months of Age

The primary aim of this study was to evaluate the convergent validity of the Motor domain (MOT) of PediaTracTM v3.0, an online developmental tracking instrument based on caregiver reports, with fine and gross motor domains (ASQ-FM and ASQ-GM) of the Ages and Stages Questionnaire (ASQ-3) in infants between 2- and 9 months of age. Participants were caregivers of 571 infants born term or preterm (gestational age <37 weeks) enrolled in a multi-site psychometric study of PediaTracTM. Findings revealed significant correlations between MOT and ASQ-3 scores at 2, 4, 6, and 9 months across time periods, term-preterm status, and biological sex. A significantly higher percentage of infants born preterm, compared with those born at term, was identified as a moderate or high risk on both the ASQ-3 and PediaTrac. Future investigations are warranted to further examine the psychometric properties of the MOT domain, including sensitivity, specificity, and positive and negative predictive value.

Caregiver-reported infant motor and imitation skills predict M-CHAT-R/F

Altered motor and social-communicative abilities in infancy have been linked to later ASD diagnosis. Most diagnostic instruments for ASD cannot be utilized until 12 months, and the average child is diagnosed substantially later. Imitation combines motor and social-communicative skills and is commonly atypical in infants at risk for ASD. However, few measures have been developed to assess infant imitation clinically. One barrier to the diagnostic age gap of ASD is accessibility of screening and diagnostic services. Utilization of caregiver report to reliably screen for ASD mitigates such barriers and could aid in earlier detection. The present study developed and validated a caregiver-report measure of infant imitation at 4, 6, and 9 months and explored the relationship between caregiver-reported imitation and motor abilities with later ASD risk. Participants (N = 571) were caregivers of term and preterm infants recruited as part of a large multi-site study of PediaTrac™, a web-based tool for monitoring and tracking infant development. Caregivers completed online surveys and established questionnaires on a schedule corresponding to well-child visits from birth to 18 months, including the M-CHAT-R/F at 18 months. Distinct imitation factors were derived from PediaTrac at 4, 6, and 9 months via factor analysis. The results supported validity of the imitation factors via associations with measures of infant communication (CSBS; ASQ). Imitation and motor skills at 9 months predicted 18-month ASD risk over and above gestational age. Implications for assessment of infant imitation, detecting ASD risk in the first year, and contributing to access to care are discussed.

Caregiver-reported development in term and preterm infants from birth to nine months of age: Psychometrics of the PediaTracTM social/communication/cognition domain

Term and preterm neonates were assessed at the newborn (NB) period (term, term equivalent) and at 2, 4, 6, and 9 months in a study of the psychometric properties of the Social/Communication/Cognition (SCG) domain of PediaTrac™ v3.0, a novel caregiver-based developmental monitoring instrument. Item response theory (IRT) was used to model item parameters and estimate theta, an index of the latent trait, social/communication/cognition. Exploratory factor analysis (EFA) was conducted to further clarify the dimensionality of the domain. In a cohort of 571 caregiver-infant dyads (331 term, 240 preterm), mean theta values could be reliably estimated at all time periods, with term infants demonstrating significantly more advanced social/communication/cognition abilities at 9 months of age. Item discrimination and item difficulty of the 15, 15, 35, 47, and 57 items at the NB, 2-, 4-, 6-, and 9-month periods, respectively, could be reliably modeled across the range of ability. Total Information for the SCG domain was high and the reliability ranged from 0.97 to 0.99 (NB = .98, 2 month = .97, 4 month = .98, 6 month = .99 and 9 month = .99). EFA revealed second-order factors at each time period, with two factors at the NB period (affect/emotional expression, social responsiveness) accounting for 43% of variance; three factors at 2, 4, and 6 months (affect/emotional expression, social responsiveness imitation/emerging communication), accounting for 43%, 34%, and 34% of the variance, respectively; and four factors at 9 months (imitation/communication, nonverbal/gestural communication, affect expression, and social responsiveness), accounting for 34% of the variance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Caregiver-reported newborn term and preterm motor abilities: psychometrics of the PediaTracTM Motor domain

BACKGROUND

Approximately 5-10% of children exhibit developmental deviations in motor skills or other domains; however, physicians detect less than one-third of these abnormalities. Systematic tracking and early identification of motor deviations are fundamental for timely intervention.

METHODS

Term and preterm neonates were prospectively assessed at the newborn (NB) period in a study of the psychometric properties of the Motor (MOT) domain of PediaTrac^TM v3.0, a novel caregiver-based development tracking instrument. Item response theory graded response modeling was used to model item parameters and estimate theta, an index of the latent trait, motor ability. Exploratory factor analysis (EFA) was conducted to examine the dimensionality and factor structure.

RESULTS

In a cohort of 571 caregiver/infant dyads (331 term, 240 preterm), NB MOT domain reliability was high (rho = 0.94). Item discrimination and item difficulty of each of the 15 items could be reliably modeled across the range of motor ability. EFA confirmed that the items constituted a single dimension with second-order factors, accounting for 43.20% of variance.

CONCLUSIONS

The latent trait, motor ability, could be reliably estimated at the NB period.

IMPACT

The caregiver-reported Motor domain of PediaTrac provides a reliable estimate of the latent trait of motor ability during the newborn period. This is the first known caregiver-reported instrument that can assess motor ability in the newborn period with high reliability in term and preterm infants. Item response theory methods were employed that will allow for future characterization of developmental subgroups and motor trajectories. The PediaTrac Motor domain can support early identification of at-risk infants. Including caregivers in digital reporting and child-centered monitoring of motor functioning may improve access to care.

Cumulative risk, infant sleep, and infant social-emotional development

The effect of cumulative biological, psychosocial, and demographic risk and infant sleep on infant social-emotional functioning in 12-month-old infants (46% female) was examined in data from racially (30% Black, 60% White, 10% multiracial/other) and socioeconomically (41% below median income) diverse caregivers (N = 468, M = 30.42 years old, SD = 5.65) recruited from two midwestern states in 2019-2020. Due to the major changes in sleep patterns during infancy and the reported association between sleep and social-emotional functioning, this study also examined whether sleep moderates the association between risk and infant social-emotional functioning and potentially promotes healthy social-emotional functioning despite risk. Greater cumulative risk was associated with poorer sleep efficiency and more social-emotional problems, but was not associated with the general acquisition of social-emotional milestones. Results also suggested that poorer sleep efficiency was associated with more social-emotional problems and poorer social-emotional milestone acquisition. No significant interaction effects were found between cumulative risk and infant sleep. Risk and sleep appear to have unique associations with infant social-emotional problems and development; thus both could be targeted in early intervention to promote social-emotional functioning during infancy and early childhood.

The influence of sociodemographic factors and response style on caregiver report of infant developmental status

Caregiver report is the most feasible way to assess early childhood development but is susceptible to the influences of response style and sociodemographic factors. In a sample of 571 caregiver-infant dyads (47.8% female; 48% White), we compared caregiver reports on the Ages and Stages Questionnaire-Third Edition (ASQ-3) with reports on a novel, web-based assessment, PediaTrac™. Ratings on PediaTrac correlated with ratings on the ASQ-3 at all time points (2, 4, 6, and 9 months). Caregiver age, response style, and sociodemographic factors accounted for significant variance on both measures. Developmental reporting of early childhood skills is influenced by caregiver response style and sociodemographic factors. These influences must be considered in order to ensure the accurate identification of infant developmental status.