Pediatrics. Joseph F. Fagan III, Lynn T. Singer, Jeanne E. Montie and Patricia A. Shepherd. Development in Infants at Risk for Later Mental Retardation.
Selective Screening Device for the Early Detection of Normal or Delayed Cognitive Development in Infants at Risk for Later Mental Retardation Joseph F. Fagan III, Lynn T. Singer, Jeanne E. Montie and Patricia A. Shepherd Pediatrics 1986;78;1021
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PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 1986 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
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Selective Screening Device for the Early Detection of Normal or Delayed Cognitive Development in Infants at Risk for Later Mental Retardation Joseph and
F. Fagan
Patricia
III, PhD,
From the Department
ABSTRACT.
The present
study
tested
the
predictive
va-
device The
for the screening
early de-
vice, administered between 3 and 7 months of age, is based on the infant’s differential fixation “to novel” over previously shown pictures. The sample was composed of
(IQ
70) at 3
scores layed
correctly children.
normal
for later mental retarcognitive development years of age was 13%. Novelty preference identified six of eight (75%) of the deThe test identified 49 of 54 (91%) of the
children.
was 55%. 96%. The
specific,
Validity
Validity screening
and
to be at risk of delayed
for predicting
cognitive
delay
for the prediction of normality was device proved to be equally sensitive,
valid
when
the
sample
was
divided
into
infants born at term or born preterm. The results of the present study and of a previous study indicate that detection of cognitive delay based on early novelty preferences is as easily accomplished for infants who will later be mildly delayed (IQ scores 60 to 70) as it is for those who will later be severely delayed (IQ scores 50). Moreover, such results are in contrast to those obtained with con-
ventional atrics
tion,
tests
tapping
sensorimotor retardation,
1986;78:1021-1026;
memory,
development. screening,
Pedicogni-
novelty.
T. Singer,
Case Western
fixation
to
among
the
predictive device delay. between infant’s
validity
presents
at 3 years
initial of age
data
on the
of a screening
for the early identification of later cognitive The screening device, which is administered 3 and 7 months of age, is based on the ability to recognize visual stimuli. Visual
recognition novel” over
is measured previously
by differential shown pictures.1
fixation Differential
“to
infant’s
pictures
developing
information.
MA,
Cleveland
previously
the
infant
being
shown
memory formance able
ability
To
the
processes on later
to
shown can
pictures
discriminate
and
can
remember
that
memory
to individual fact, individual during
infancy
individual
during
have
of
risk
would
prenatal
on
be
due
to
prefer-
device
suspected Suspicion
presence
(eg,
is to
potentially
of infants
the
linked
novelty
retardation.
factors
of
research for later
from
groups mental
or peninatal
are
screening
normal
within later
In
of our device
early
the
potentially
nec-
related
to be predictive
preferences
based
infants
be
later intelligence. in novelty preferences
shown
of
in
would
a major goal a screening
purpose
for
and
differences
in
been
deficit The
to retain
perceptual
infancy
functioning.2 early novelty
to later intelligence, has been to develop intellectual
and
that
differences differences
later intelligent Given that
ences.3
to perceive
extent
tests of on the
are necessary for successful perinteligence tests, it seems reason-
suppose
ognition
of
various
extreme
prema-
turity).
The the
rationale
metric
for
for choosing infant
of, normative
bility
screening
of the
previously.3 problem
to one
two
standard
basic
consists following
of the
approach assessment
on, have
of a pairing a standard
details
and been
the
melia-
discussed of
problem.”
the Each
of two period
as on the
component
is a “novelty
immediately
Our
data
the
preferences
and
device
Briefly, procedure
novelty
novelty
intelligence
construction
screening Received for publication June 27, 1985; accepted Feb 26, 1986. Reprint requests to (J.F.F.) Department of Psychology, Case Western Reserve University, Cleveland, OH 44106 PEDIATRICS (ISSN 0031 4005). Copyright © 1986 by the American Academy of Pediatrics.
University,
over
that
differentiate
study
E. Montie,
the picture previously seen. In other words, visual novelty preference yield information
deficient
present
Jeanne
Reserve
novel
demonstrates
to be at risk
The
PhD,
PhD
of Psychology,
lidity at 3 years of age of a screening identification of later cognitive delay.
62 infants suspected dation. The prevalence
Lynn
A. Shepherd,
stimuli of study
stimuli.
to the
development of
individual
of a practical differences
PEDIATRICS Vol. 78 No. 6 December 1986 Downloaded from pediatrics.aappublications.org at Cleveland Health Sciences on February 8, 2012
in
1021
early recognition particular length less
than
memory of study
necessary
for
was time,
to allow a length
asymptotic
infants somewhat
novelty
a
or familiar,
which
necessitated
prefer-
initial
sessions.
The
result
of all this
effort
with
was
a
sample
years years
The
sample
for
the
12-
item test by conducting a longitudinal study using a sample of 92 infants with recognition tests administered at 52, 56, 62, and 69 weeks of conceptional age. Infants in the normative sample showed significant
visual
preferences
for novelty
on each
of
the 12 novelty problems. Finally, the screening device, known as the Fagan Test of Infant Intelligence, proved to have concurrent validity because groups of infants at risk for later intellectual deficit in the study by Fagan and Singer3 performed less well on the test at 3 to 7 months of age than did the 92 normal controls. The present study followed the same high-risk infants originally tested by Fagan and Singer3 to 3 years of age in order to estimate the predictive validity of the screening device. Specifically, we wanted to know if children who did poorly on the Fagan test as infants would also exhibit delayed cognitive development at 3 years of age. Delayed cognitive development at 3 years of age was operationally defined as an IQ score of 70 or less on a standard test of intelligence. Although the predictions from the infant tests have only been followed to 3 years of age, thus far, it is highly likely that
1022
and
delayed
at 3 years for example,
more
than
cog-
will still be has shown
400
childen
that
tests at ages of .65 to .73).
6 to 9
METHODS
was composed for later
mental
ofpmematunity (birth growth retardation,
weight treated
suspected
retardation
as a result
.90.
screening
device
administered
to
each three
infant was composed of 12 novelty problems, of which were administered at 52, two at 56,
four
at
62,
and
three
at
69 weeks
of conceptional
age. Specifically, the 12-problem novelty test included three pairs of abstract, black and white patterns that differed from one another along a variety of dimensions constituting three novelty problems at 12 weeks. Study times of 60 seconds were allowed for each problem given at 12 weeks, ie,
the
infant
looked
before it was paired two pairs of abstract used
as novelty
problems.
variety of dimensions 16 seconds to study prior to its pairing of the
pair.
for
The
60
seconds
with a new picture. black and white One
pair
at
a target
At 16 weeks, patterns were varied
along
a
and infants were only allowed one of the pictures in that pair with the other (novel) member
second
problem
at
16 weeks
con-
tamed two targets differing solely in arrangement of internal pattern elements. Infants were allowed 60 seconds of study for the second problem at 16 weeks. At 22 weeks, two sets of achromatic face photos (man v woman, woman v baby) with study times
of 40 seconds
and
two
pairs
COGNITIVE DEVELOPMENT Downloaded from pediatrics.aappublications.org at Cleveland Health Sciences on February 8, 2012
of abstract
pat-
temns
varying
study
times
in
arrangement
of
of 30 seconds
decreased
to
20
were
seconds
per
elements
used.
problem
delay
with
Study
times
at
weeks
29
when three pairs of face photos were used, including two pairs with achromatic photos of women and one pair of chromatic prints of babies’ faces. Every
attempt
was
made
to
test
each of the four ages (12, 16, corrected age), but more infants
weeks
29
than
were
seen
22,
at 12 or 16 weeks
referrals. In the final analysis, included in the sample if they seven of the novelty problems.
tion with
ensured at least
The
scone
an test
infant given
assigned
infant
scores
due
infant
to
twice
on the
Fagan
preference score. shown a new and
For exa pmevi-
ously seen pattern and devoted 10 seconds ing time to the new pattern and six seconds
of lookto the
with
old pattern,
>70
to the
his
new
problem. divided a mean
on her
pattern
percentage
of total
fixation
be
or 63%
for
would
10/16
Intellectual
outcome
by
the and
Peabody giving
tests.
If
the
were
was
by
estimated
were
formed
as an
RESULTS The
Bayley
unaware
age
sample
the
L)7 two
55%,
the
who ad3-year-old
child
had
per-
novelty
Sensitivity
The and
of Cognitive
Delay
incidence
Specificity
at 3 Years
preference IQ at 3 years 135). Delayed defined as an
for
Specificity Predictive Predictive
prediction to delay
to normality validity for delay validity for normality
pmef-
IQ of 25 had
were whose
also
mepme-
IQ scores
were
at risk
were
predicted
indeed
at 7 months
delayed
at 3 years
>36
weeks)
and
those
born
preterm.
to thrive.
The
Visual
Novelty
Preference
incidence
at 3 years
of delayed
cog-
of age was 40%
(eight
< 70). Novelty Given
preference
at 3 to 7 Months
scores
of Age
for
the
of Age
Delayed Normal Sensitivity
the
children
54 children
nitive development of 20 had IQ scores
All Children (n=62)
prediction
with
six of 11 infants
to be
Intellectual
Risk
child
delayed the
because
as failure
of cognitive of Tests
Novelty
In an earlier study,9 a preliminary version of the Fagan Test of Infant Intelligence consisting of four novelty problems was administered between 5 and 7 months of age to a group of 20 infants diagnosed
DISCUSSION a mean
68. The
eight
among
(gestation
yielded
13%.
of age. Validity for the prediction of normality was 96%, ie, 49 of 51 predicted to be normal were later found to be normal. As one can see from the data presented in Table 1, the screening device proved to be equally sensitive, specific, and valid when the sample was divided into those infants born at term
IQ score on
the
of age
Mental
an
technicians tests to the
of how
of 70 or less. 1.
(Form for the
attained
score of 59.5% (SD 8.1) and a mean of age of 96.3 (SD 23.1, mange 25 to cognitive development at 3 years was
TABLE Prediction
asand
of
and
the The
was
infant.
AND
IQ score
age
Scales
administered dividing
chronologic age. the intelligence
children
of
was
at 3 years of age. High sensitivity in predicting delayed cognitive development was not accomplished at great cost to specificity for normality, because the test also correctly identified 49 of 54 or 91% of the normal children. In the present sample, the validity of the screening device for predicting cognitive delay was
that
Stanfomd-Binet6
Vocabulary Test a mean IQ score the
Development8
3 years the
Picture child
necessary,
test by ministered
at
administering
at 3 years
of 25 and
sented
The sum of these percentages to novelty by the number of problems received yielded novelty preference score for each infant.
sessed
70)
a median novelty preference score of