|Year : 2018 | Volume
| Issue : 4 | Page : 246-249
Baroda development screening test for infants in a perinatal psychiatry setting: A preliminary report from India
M Thomas Kishore1, Geetha Desai2, Poornima Mahindru1, G Ragesh3, Harish Thippeswamy2, Sundarnag Ganjekar2, Prabha S Chandra2
1 Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
|Date of Web Publication||15-Oct-2018|
Dr. Geetha Desai
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
BACKGROUND: There is a need for early and reliable screening methods to identify the developmental delays in infants born to mothers with perinatal psychiatric disorders. Developmental assessment scales for Indian infants (DASII) is the only standardized tool from India for use in infants but is time-consuming and expensive, which may not be useful in busy outpatient settings or when the mother has a psychiatric illness.
AIM: To examine the correlation between the Baroda development screening test (BDST), developmental screening test (DST), and DASII full scale (i.e., both motor and mental scales).
METHODS: The study included thirty consecutive infants in the age range of 1–6 months from inpatient and outpatient perinatal psychiatric services. The infants were screened with DST and BDST and later assessed with DASII full scale.
RESULTS: Both BDST and DST showed significant correlation with mental subscale and motor subscale of DASII, but only BDST predicted the DASII scores on mental scale (standard error [SE] = 0.14; t = 0.73; P < 0.01) and the motor scale (SE = 0.12; t = 0.73; P < 0.01).
CONCLUSIONS AND IMPLICATIONS: Both DST and BDST show good correlation with DASII, but only BDST predicts the DASII scores. The findings need to be replicated with larger sample size and different settings to establish BDST as an effective screening tool in identifying developmental delays in infants born to mothers with perinatal psychiatric disorders.
Keywords: Developmental delay, early identification, India, screening
|How to cite this article:|
Kishore M T, Desai G, Mahindru P, Ragesh G, Thippeswamy H, Ganjekar S, Chandra PS. Baroda development screening test for infants in a perinatal psychiatry setting: A preliminary report from India. Int J Health Allied Sci 2018;7:246-9
|How to cite this URL:|
Kishore M T, Desai G, Mahindru P, Ragesh G, Thippeswamy H, Ganjekar S, Chandra PS. Baroda development screening test for infants in a perinatal psychiatry setting: A preliminary report from India. Int J Health Allied Sci [serial online] 2018 [cited 2019 Apr 20];7:246-9. Available from: http://www.ijhas.in/text.asp?2018/7/4/246/243271
| Introduction|| |
Infants born to mothers with psychiatric disorders may be at high risk for developmental delays. Inadequate stimulation and delay in early interventions during the infancy poses a higher risk for long-term cognitive, social, and emotional problems.,, One of the ways to ensure early stimulation for these at-risk infants is early detection of developmental delays. However, the availability of tools that are clinically valid and brief is limited. Developmental assessment scales for Indian infants (DASII) is the only standardized tool available for assessing infants in the Indian context. However, it is relatively expensive, time-consuming, and requires trained professionals for its administration., In this scenario, brief and cost-effective developmental screening tools are needed, which can be used at a larger scale, especially in busy outpatient settings. Existing scales used in India, such as the developmental screening test (DST), Vineland Social Maturity Scale (VSMS), Gesell Developmental Schedules (GDS), and Trivandrum Developmental Screening Chart, have specific limitations. DST is loaded more with language items and does not cover all areas of development adequately. VSMS focuses on the gross development of adaptive behavioral skills. GDS is comprehensive, but it is neither revised since 1967 nor standardized for the Indian population. Further, GDS is more useful for program planning than diagnosing developmental problems. Although the Trivandrum Developmental Screening Chart was reported to have high diagnostic efficiency in identifying children at risk for developmental delay in 0–6 years,, it is a derivate of Bayley scales of infant development (BSID) (Baroda norms) and does not have optimum representation of items for the lower end of 0–6 years' age group for which it was developed. There are few more tools that have been reported from India, but are not in wide use for lack of standardization and acceptance across various clinical settings.,,
The Baroda development screening test (BDST), like DASII, is based on BSID. The tool reported to have a sensitivity and specificity of 65% and 95%, respectively. There are little published data on its corroboration with the gold standard DASII full scale and other standardized DSTs. To establish its validity, BDST should show correlation with at least one standardized DST and the DASII full scale. In addition, there should be evidence that the association does not vary with age. Given that rapid developmental changes happen during the first one year, it is important to rule out the effect of age on the association between two developmental measures.
Nonavailability of trained developmental psychologists to do a full assessment in low- and middle-income (LAMI) countries is a major challenge. The need to routinely assess all infants of mothers with mental health problems necessitates the use of brief tools. In this backdrop, the purpose of the current study was to examine the correlation of BDST and DST with the DASII full scale in a perinatal psychiatry setting. We chose DST for comparison as it is widely used in Indian setting for assessing general development and it shows a strong correlation with other standardized measures of adaptive behavior and general intelligence.
| Methods|| |
This cross-sectional study included thirty consecutive infants aged 1 to 6 months, whose mothers were receiving perinatal psychiatric services at the National Institute of Mental Health and Neurosciences, Bengaluru. The sample size was based on the minimum estimates required to detect the power of the test. Both male and female infants from any socioeconomic status and maternal age of 18–40 years from intact families were included in the study.
Baroda development screening test for infants
Baroda development screening test for infants was developed in 1983 as part of a UNICEF-aided program for the prevention, early detection, and intervention of childhood disability in urban slums in Baroda, India. BDST contains 54 items extracted from the BSID and has been standardized on Baroda infants (Baroda norms). The items selected are simple, easy to administer, and do not require any special training, experience, or equipment. The tool is applicable for 0–30 months of age. A child who fails items in his/her chronological age group is screened out for detailed evaluation by skilled professionals.
Developmental screening test
Developmental Screening test is an age scale, which measures general development in children between 0–15 years. The number of items varies across the age intervals. The first one year has been divided into four equal intervals to capture minute aspects of development. The test yields developmental age, which could be converted to developmental quotient.
Developmental assessment scales for Indian infants
Developmental assessment for Indian infants is an Indian adaptation of the BSID originally devised by Nancy Bayley. Pathak adapted BSID and published Indian norms in 1970 as an outcome of longitudinal growth studies of children between 1 and 30 months. The DASII scale in its present form is a revision of the Baroda norms with a major modification, where indigenous test materials are used for standardization and published in 1996. This scale consists of 67 items for the assessment of motor development and 163 items for the assessment of mental development. The motor scale assesses control of gross and fine motor muscle groups. The mental scale assesses cognitive, personal, and social skill development. Both mental development index and psychomotor development index can be calculated by DASII. For each item, 50% placement age is considered as equivalent motor and mental age. The age placement of the item at the total score rank of the scale is noted as the child's developmental age. Specific to the domain, total scores yield the motor age and the mental age, which are used to calculate the motor and mental development quotients, respectively. The composite DQ is derived as an average of motor and mental development quotients. The scale also yields deviation quotient and cluster profile which are standardized methods of comparing infants' development in various areas of functioning.,
The study was approved by the institutional ethics committee. Infants meeting the study criteria were identified, and written informed consent was obtained from the mothers for the administration of developmental scales. The developmental screening with BDST and DST was done by the two authors (PM and RG) and an independent, detailed assessment with DASII was done by the first author (TK). Both the screening and the detailed developmental assessment were done during the single session with adequate breaks to suit the attention span and activity levels of the mother–infant dyads. Based on the test findings, all families were offered appropriate early intervention services and referrals for the infants. Minimum personal details such as the age of the mother, socioeconomic status, domiciliary, and status of the family were taken from the case records of the mothers.
Data were analyzed with Statistical Package for the Social Sciences for Windows, Version 16.0. Descriptive statistics, Pearson's correlation, partial correlation, and linear regression analysis were applied based on their assumptions. The correlation and linear regression was performed on the developmental quotients of the individual scales. Developmental quotients yielded on BDST, DASII motor scale, mental scale, full scale, and of the DST were considered for analysis.
| Results|| |
The mean age of the infants in months was 3.48 (range: 1–6; standard deviation [SD] 1.78). There were 19 boys and 11 girls among the infants. None of them had any significant medical problems. The mean age of the mothers in years was 26.9 (range: 19–39; SD 4.51). Majority of them studied up to 10th grade and above (n = 27), two mothers had primary education, and one mother was illiterate. Twenty-two mothers were from lower socioeconomic status (n = 22) and the rest were from middle (n = 5) and higher (n = 3) socioeconomic status. Majority were homemakers (n = 26), and among the remainder, there was an equal representation of salaried employees and unskilled laborers. Except for six mothers, all were from rural background. Details of the maternal mental illnesses were as follows: unspecified psychosis (n = 8), bipolar affective disorder (n = 9), acute and transient psychotic disorder (n = 5), paranoid schizophrenia (n = 3), severe depression with psychotic symptoms (n = 2), dissociative disorder (n = 2), and obsessive–compulsive disorder (n = 1). One mother in the bipolar affective disorder group had comorbid mild intellectual disability.
[Table 1] indicates that the three developmental measures shared a significant positive correlation (P < 0.01). [Table 2] indicates that the positive correlation remained statistically significant among the three developmental measures when controlled for age of the infants (P < 0.01). [Table 3] shows that BDST quotients significantly predicted the quotients of both DASII motor scale (B = 0.86, t(29) = 6.98, P < 0.01) and DASII mental scale (B = 0.82, t(29) = 5.79, P < 0.01). DST scores did not predict the scores of DASII.
|Table 2: Correlation between the three developmental measures when controlled for age|
Click here to view
| Discussion|| |
The findings of this study suggest that BDST has a good correlation with both the motor and mental subscales of DASII. DST also showed significant correlation with DASII. In both cases, the correlation remained significant even when controlled for age. This indicates that both DST and BDST continue to show good correlation with DASII at all age groups. However, it is only BDST that predicted the scores of DASII. As there was no collinearity between BDST and DASII, it could be assumed that the predictability of BDST developmental scores is robust. Therefore, BDST appears to be a promising tool in the context of screening infants at risk for developmental problems at least in a perinatal psychiatric setting. However, these findings need to be examined with a larger sample covering different age points of infancy. The study findings have limited generalizability due to small sample size and the setting from which the sample was derived.
Infants of mothers with mental illnesses form a high-risk group for various developmental and mental health challenges., Therefore, it would be a good idea to target this population as there is a scope to intervene throughout the perinatal period and beyond, depending on the need. Identifying the developmental problems and intervening before the critical period is vital to intervention. Ideally, all infants and children should be screened for developmental delay. However, such a policy may not be practical in low-resource settings and LAMI countries where trained human resources are limited and the need is immense. Further, it will be time-consuming. Hence, it is neither feasible nor cost-effective in low-resource settings such as those in LAMI countries. Hence, screening may be considered in selected high-risk infants.,
One of the essential components of intervention is early and valid assessment. While a skillful clinician can identify developmental deviations and other concerns in an infant, they may have to invest considerable time in the form of conducting interview of the caregivers to elicit the developmental history of the infants. Sometimes, there is a possibility that they might miss out asking for information on specific developmental tasks. Where mothers have had mental health problems, the information they provide about their infants may not be comprehensive. Hence, a screening tool like BDST, which is easy and takes less time for administration, is useful for identifying infants at risk for developmental problems.
| Conclusions|| |
The study findings indicate that BDST may be used as a screening tool for developmental delays in low-resource settings. While the developmental scores yielded on both BDST and DST show good correlation with the scores obtained on DASII full scale, it was only the scores on BDST that predicted DASII full-scale scores. Studies with larger sample size need to be conducted to establish BDST as an effective screening tool.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kingston D, Tough S, Whitfield H. Prenatal and postpartum maternal psychological distress and infant development: A systematic review. Child Psychiatry Hum Dev 2012;43:683-714.
Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al.
Interventions for common perinatal mental disorders in women in low- and middle-income countries: A systematic review and meta-analysis. Bull World Health Organ 2013;91:593-601I.
Satyanarayana VA, Lukose A, Srinivasan K. Maternal mental health in pregnancy and child behavior. Indian J Psychiatry 2011;53:351-61.
] [Full text]
Pathak P. Developmental assessment scales for Indian infants (DASII). Pune: Anand Agencies; 1998.
Kadam A. Developmental screening in high risk newborns through infancy. J Neonatol 2005;19:100-6.
Choudhury J. Common causes of developmental delay. Indian J Growth Dev Behav Pediatr 2007;3:8-10.
Bharatraj J. Developmental screening test. Mysore: Swayamsidha Prakashanam; 1977.
Bharatraj J. Vineland Social Maturity Scale-Indian adaptation: Enlarged Version. Mysore: Swayamsiddha Prakashanam; 1992.
Gessell A, Amatruda CS. Developmental Diagnosis: Normal and Abnormal Child Development – Clinical Methods an Pediatric Application. 2nd
ed. New York: Harper and Row; 1967.
Nair MK, George B, Philip E, Lekshmi MA, Haran JC, Sathy N, et al.
Trivandrum developmental screening chart. Indian Pediatr 1991;28:869-72.
Nair MK, Nair GS, George B, Suma N, Neethu C, Leena ML, et al.
Development and validation of Trivandrum development screening chart for children aged 0-6 years [TDSC (0-6)]. Indian J Pediatr 2013;80 Suppl 2:S248-55.
Juneja M, Mohanty M, Jain R, Ramji S. Ages and stages questionnaire as a screening tool for developmental delay in Indian children. Indian Pediatr 2012;49:457-61.
Nair MK, Bhaskaran D, George B. Developmental assessment – When and how? Indian J Pract Pediatr 2012;14:401-8.
Phatak AT, Khurana B. Baroda development screening test for infants. Indian Pediatr 1991;28:31-7.
Robertson J, Hatton C, Emerson E, Yasamy MT. The identification of children with, or at significant risk of, intellectual disabilities in low- and middle-income countries: A review. J Appl Res Intellect Disabil 2012;25:99-118.
Jayashankarappa BS. Intellectual tests and social-adaptive behavioural scales used for the assessment of the mentally handicapped in India. J Pers Clin Stud 1986;2:89-98.
Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G. The establishment of a mother-baby inpatient psychiatry unit in India: Adaptation of a western model to meet local cultural and resource needs. Indian J Psychiatry 2015;57:290-4.
] [Full text]
Pathak P, Misra N. Developmental assessment scales for Indian infants (DASII) 1-30 months – Revision of Baroda Norma with indigenous material. Psychol Stud 1996;41:55-6.
Patni B. Developmental assessment scales for Indian infants (DASII). Ind J Pract Pediatr 2012;14:409-12.
Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, et al.
Maternal mental health in primary care in five low – And middle-income countries: A situational analysis. BMC Health Serv Res 2016;16:53.
Chandra PS, Venkatasubramanian G, Thomas T. Infanticidal ideas and infanticidal behavior in Indian women with severe postpartum psychiatric disorders. J Nerv Ment Dis 2002;190:457-61.
Phatak P, Dhapre M, Pandit AN, Kulkarni S. A study of Baroda development screening test for infants. Indian Pediatr 1991;28:843-9.
[Table 1], [Table 2], [Table 3]