Developmental Neurorehabilitation, August 2010; 13(4): 234–238

Developmental profiles from the Battelle developmental inventory:

A comparison of toddlers diagnosed with Down Syndrome, global
developmental delay and premature birth

JOHNNY L. MATSON, JULIE A. HESS, MEGAN SIPES, & MAX HOROVITZ

Louisiana State University, Baton Rouge, USA

(Received 23 February 2010; accepted 28 February 2010)

Dev Neurorehabil Downloaded from informahealthcare.com by Universitat de Girona on 11/20/14

Abstract
Objective: Developmental profiles and milestone attainment have been examined for children suffering from various
developmental disabilities. However, research comparing the same across numerous developmental disabilities is scant.
Method: Therefore, the purpose of the current study was to examine the developmental profiles of toddlers (i.e. aged 17–34
months) who were premature, diagnosed with Down Syndrome, or diagnosed with Global Developmental Delay. A total of
28 toddlers met inclusion criteria for the study.
Results: Those diagnosed with Global Developmental Delay or Down Syndrome scored significantly lower on the Battelle
Developmental Inventory, Second Edition (BDI-2), compared to those who were born premature. More specifically,
differences emerged on the BDI-2 domains of personal-social and motor.
Conclusion: Implications of these findings and directions for future research are discussed.

Keywords: BDI-2, atypically developing, toddlers, developmental milestones, Down Syndrome, premature
For personal use only.

Resumen
Objetivo: Se han examinado los perfiles de desarrollo y de adquisición de hitos para niños que sufren de múltiples
discapacidades del desarrollo. Sin embargo, las investigaciones comparando lo mismo a través de múltiples discapacidades
del desarrollo son escasas.
Método: Por lo tanto, el propósito del presente estudio fue examinar los perfiles de desarrollo de niños (esto es, 17 a 34
meses de edad) prematuros, diagnosticados con sı́ndrome de Down, o diagnosticados del retraso global del desarrollo. Un
total de 28 niños cumplieron con los criterios de inclusión para el estudio.
Resultados: Aquellos niños diagnosticados con retraso global de desarrollo o con sı́ndrome de Down arrojaron calificaciones
más bajas en el Battelle Developmental Inventory, Second Edition (BDI-2), comparados con aquellos que nacieron
prematuramente. Especı́ficamente, las diferencias emergieron en los dominios motor y personal-social del BDI-2.
Conclusión: Se discuten las implicaciones de estos hallazgos y direcciones para futuras investigaciones.

Palabras clave: BDI-2, desarrollo atı́pico, niños, hitos del desarrollo, sı́ndrome de Down, prematurez

Introduction Developmental assessment should play a useful role

Developmental disabilities are life-long and affect all
aspects of the person’s life [1–3]. The identification
and prioritizing of skill deficits in very young
children remains one of the greatest challenges [4,
5]. As a result, detecting the signs of neurological
delay as early as possible has become a priority
among researchers and clinicians [6]. Some
researchers have demonstrated that some beha-
vioural deficits can be identified at birth to 20
weeks of age [7]. However, behaviour does not
develop in a uniform fashion. Thus, a continuous
and finer grained analysis should be ongoing [8–10].
in identifying children who are at risk and for
identifying specific skills that may require early
intervention [11–13].
Considerable literature has emerged looking at
developmental milestones across a host of develop-
mental disabilities. These disorders include genetic
forms of intellectual disability, seizures, Down syn-
drome, and general global delays. However, typically
only one disability is examined in a particular study
vs comparing multiple disabilities, and most of the
research tends to focus on newborns or school-aged
children [14–16]. In addition, researchers
have examined development across different

Correspondence: Johnny L. Matson, Ph.D., 324 Audubon Hall, Louisiana State University, Baton Rouge, LA 70803, USA. E-mail: johnmatson@aol.com
ISSN 1751–8423 print/ISSN 1751–8431 online/10/040234–5 ß 2010 Informa UK Ltd.
DOI: 10.3109/17518421003736032

developmental disability groups; however, this
research has tended to focus on only one or a few
areas of development (e.g. language, social skills
and/or communication) [17].
The present study is an extension of the existing
literature by comparing the developmental strengths
and deficits across a number of developmental
disabilities in toddlers, 17–34 months of age.
Comparisons among toddlers with Down syndrome,
global developmental delay and premature birth
were made using a well established scale, the BDI-2
[18]. Thus, the aim of this study was exploratory and
conducted to determine how the above-mentioned
group of toddlers develop in relation to each
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other across multiple domains of development
(i.e. personal/social, adaptive, motor, communica-
tion and cognitive).
Method
Participants
Twenty-eight participants met inclusion criteria for
this study. The participants in this study (i.e. infants
For personal use only.
and toddlers) ranged in age from 17–34 months
(M ¼ 24.93 months, SD ¼ 5.20). Within the sample,
57.1% was male. The ethnicity of the participants
was 42.9% African American and 57.1% Caucasian.
Based on their diagnosis, participants were
sectioned into three groups: Group 1, Down
syndrome (n ¼ 8); Group 2, Global Developmental
Delay (n ¼ 10); and Group 3, Premature (n ¼ 10).
No participant had more than one of the above
conditions (e.g. Down Syndrome and premature).
Diagnoses were reported by informants (i.e. parents
or guardians) during the assessment process. Table I
includes demographic information for each of the
three groups utilized in this study.
All participants for this study were obtained
through their enrolment in a state-funded early
intervention programme for children at-risk for a
Table I. Demographic information.
Group 1 Group 2 Group 3
Age
M (SD) 25.12 (6.03) 26.10 (5.51) 23.60 (4.35)
Range 17–33 19–34 18–33
Gender
Male 50.0% 80.0% 40.0%
Female 50.0% 20.0% 60.0%
Ethnicity
Caucasian 87.5% 30.0% 60.0%
African-American 12.5% 70.0% 40.0%
Group membership is as follows: Group 1, Downs Syndrome;
Group 2, global developmental delay; Group 3, premature.
Developmental profiles 235
developmental disability. EarlySteps is Louisiana’s
Early Intervention System under the Individuals
with Disabilities Education Act, Part C, which
provides services to infants and toddlers and their
families from birth to 36 months. Children qualify
for these services if they have a developmental delay
or a medical condition likely to result in a develop-
mental delay as identified by their family paediatri-
cian. Exclusion criteria for the current study
eliminated any toddlers who had a diagnosis of an
Autism Spectrum Disorder.
Measures
Battelle Developmental Inventory, 2nd Edition (BDI-2)
[18]. The BDI-2 is used to assess developmental
skills in children from birth to 7 years 11 months.
Using observation and informant report, the 450
items assess five domains of development: personal/
social, adaptive, motor, communication and cogni-
tive. Items are answered on a three-point scale:
0 ¼ ‘no ability in this skill’, 1 ¼ ‘emerging ability’ or
2 ¼ ‘ability at this skill’. Each domain in the BDI-2
yields a developmental quotient (DQ) for that area.
The five domain areas are summed to yield a total
DQ. The total DQ has a mean of 100 and a standard
deviation of 15. For this study, the DQ’s for each
domain and the total DQ were of interest. The
BDI-2 has shown acceptable test–re-test reliability
and excellent internal consistency. In addition, the
BDI-2 has content validity and criterion validity at
acceptable levels [18].
Procedure
For each participant, parents or caretakers were
interviewed by qualified personnel who provide
services for the State of Louisiana’s Early Steps
Program. The assessors, occupational therapists,
physical therapists, social workers, speech-language
pathologists, educators or psychologists were certi-
fied or licensed in their respective disciplines. The
BDI-2 and other measures were administered to
the caregivers in a quiet area with the child present.
For the current study, non-identifying demographic
information, as well as BDI-2 scores were used. This
study was approved by the state of Louisiana’s Office
for citizens with Developmental Disabilities
(OCDD) and by the Louisiana State University
Institutional Review Board.
Research design
In order to ensure groups did not differ significantly
on demographic variables, Chi square analyses were
employed. The three groups did not differ signifi-
cantly in regard to gender, 2(2) ¼ 3.50, p ¼ 0.17;
but differed significantly in regards to ethnicity,
 236 J. L. Matson et al.

2(2) ¼ 6.05, p ¼ 0.049. To ensure age did not
significantly differ between groups, an analysis of
variance (ANOVA) was conducted. Groups did not
significantly differ on age, F(2, 25) ¼ 0.567, p ¼ 0.57.
Next, three separate one sample t-tests were per-
formed to determine if each groups mean total DQ
significantly differed from the mean total DQ of the
BDI-2 (i.e. 100). For these three t-tests, alpha was
set to 0.017 to control for multiple tests. Third, an
Analysis of Covariance (ANCOVA) was employed
to examine if there was a difference between groups
on the total DQ. Group membership was utilized as
the independent variable, BDI-2 total DQ as the
dependent variable and ethnicity as the covariate.
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All three groups had total DQs significantly
less than the mean total DQ of the BDI-2.
Therefore, analyses were conducted to determine if
the three group’s total DQs differed significantly
from each other. An ANCOVA was conducted to
examine group differences on the BDI-2 Total
Developmental Quotient. A significant difference
between groups was found, F(2, 24) ¼ 8.15,
p 5 0.05. Post-hoc analyses revealed that the
Premature group (M ¼ 90.90, SD ¼ 7.14) differed
significantly from both the Down Syndrome group
(M ¼ 72.50, SD ¼ 10.53) and the Global
Developmental Delay group (M ¼ 71.20, SD ¼
15.85). That is, participants with Down Syndrome

Post-hoc analyses were utilized to determine which
groups differed significantly.
Lastly, to determine if groups varied significantly
on the specific domains of the BDI-2 (personal/
social, adaptive, motor, communication and cogni-
tive), a multivariate analysis of covariance
(MANCOVA) was conducted using the DQ from
the five BDI-2 domains as dependent variables,
group membership as the independent variable and
ethnicity as the covariate. By ensuring the no group
was 1.5-times larger than the smallest group;
For personal use only.
and Global Developmental Delays had significantly
lower total DQs when compared to those who
were Premature. Those diagnosed with Global
Developmental Delay and Down syndrome did not
significantly differ from each other on their total
DQ score.
Next, a MANCOVA was conducted to determine
if the five groups differed in regards to scores on the
five domains of the BDI-2. There was a significant
difference between groups in regards to the sub-scale

scores, F(10, 40) ¼ 2.23, p 5 0.05. Table II displays

assumptions of the MANCOVA were controlled the mean score for each group on each sub-scale of
for [19]. An a priori power analysis using GPOWER the BDI-2. This significant result was followed up
was conducted to determine the required sample size with an ANCOVA for each of the five domain areas.
[20]. Based on this analysis, using a medium effect Bonferroni correctional procedures were used to
size with the level of significance set at  ¼ 0.05 and control for the inflation of Type I errors. First,
power at 0.80 a sample size of 24 was required. To groups differed on the Personal-Social Domain
follow up significant results of the MANCOVA, Developmental Quotient, F(2, 24) ¼ 5.88, p 5 0.01.
individual ANCOVAs were used to assess group The Premature group (M ¼ 99.60, SD ¼ 10.95) had
differences on each domain of the BDI-2. In order to a significantly higher Developmental Quotient than
control for inflated alpha error due to running the Global Developmental Delay group (M ¼ 82.80,
multiple ANCOVAs, a Bonferroni correction was SD ¼ 8.79). The Down Syndrome group was not
used. Thus, the alpha level was set at 0.01 for each of significantly different from either the premature or
the five ANOVAs conducted. Global Developmental Delay group. Secondly, sig-
nificant differences were found between groups on
the Motor Domain Developmental Quotient,
Results F(2, 24) ¼ 9.56, p 5 0.01. The Premature group
First, three separate one sample t-tests were per- (M ¼ 103.70, SD ¼ 6.60) had a significantly higher
formed and compared against a test value of 100 (i.e. Developmental Quotient than both the Down
BDI-2 DQ, M ¼ 100). These analyses were per- Syndrome group (M ¼ 76.63, SD ¼ 15.31) and the
formed to determine if each of the three groups total
mean DQ differed significantly from mean DQ for
Table II. Mean (SD) DQ per group.
the BDI-2 (i.e. 100). The total mean DQ of all three
groups differed significantly from the mean of the Group 1 Group 2 Group 3
BDI-2. That is, all groups had a significantly lower
Total DQ score 72.50 (10.53) 71.20 (15.85) 90.90 (7.14)
total DQ when compared to the mean DQ of the Sub-scales
BDI-2 (Groups Means are displayed in Table II). Adaptive 72.50 (12.94) 72.30 (17.90) 88.70 (16.03)
Results of the one sample t-tests are as follows: Personal–Social 87.38 (12.63) 82.80 (8.79) 99.60 (10.95)
Communication 67.63 (7.17) 74.60 (15.44) 79.50 (15.32)
Group 1 (Down Syndrome), t(7) ¼ 7.387, Motor 76.63 (15.31) 81.50 (18.06) 103.70 (6.60)
p 5 0.017; Group 2 (Global Developmental Cognitive 80.88 (12.08) 72.00 (13.41) 86.20 (6.53)
Delay), t(9) ¼ 5.745, p 5 0.017; and Group 3 Group membership is as follows: Group 1, Downs Syndrome;
(Premature), t(9) ¼ 4.030, p 5 0.017. Group 2, global developmental delay; Group 3, premature.

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For personal use only.
Figure 1. Mean developmental quotient for each group across each of the five domains of the BDI. Domains are as follows: (1) Adaptive,
(2) Personal-Social, (3) Communication, (4) Motor, and (5) Cognitive.
Global Developmental Delay group (M ¼ 81.50,
SD ¼ 18.06). However, the Down syndrome and
Global developmental delay groups were not signif-
icantly different from each other. Figure 1 displays
the developmental quotient of each sub-scale for
each group.
Discussion
The current study confirmed that toddlers with
various forms of developmental disabilities experi-
ence delays in the attainment of developmental
milestones. However, the toddlers most affected in
terms of development were those diagnosed with a
Global Developmental Delay or Down syndrome.
Although toddlers who were born premature had
significant deficits in development (i.e. when com-
pared to the mean BDI-2 score), they were not as
developmentally delayed when compared to toddlers
with concomitant problems (i.e. diagnosis of Down
syndrome and experiencing developmental delays)
or those with a diagnosis of Global Developmental
Delay. Furthermore, no significant differences were
found when examining the domains of adaptive,
communication and cognitive skills; thus, differences
within these developmental domains may not be as
pronounced at this age and simply emerge later in
Developmental profiles 237
childhood. However, differences between the three
groups surfaced when examining the developmental
quotient in the Motor Domain and the Personal-
Social Domain.
As evinced by these results, those diagnosed with
Global Developmental Delay or Down syndrome
had significantly more problems in motor develop-
ment compared to those who were premature. Also,
those with Global Developmental Delay had the
greatest deficits in the personal-social domain com-
pared to the other two groups. Thus, on both of
these domains, those who were premature had
significantly higher DQs, indicating fewer problems
with attaining milestones in these areas. This is
consistent with other research, which has shown that
2-year-olds who were born premature were compa-
rable in their development to children who were full
term [21]. However, the same authors indicated that
at 1-year of age; the above-mentioned does not
hold true.
Therefore, future studies would benefit from
examining developmental profiles of those diagnosed
with Down syndrome or Global Developmental
Delay at specific ages. Conducting such an investi-
gation would allow for researchers to determine
whether differences in development (i.e. across
personal/social, adaptive, motor, communication
and cognitive domains) emerge at sensitive time
 238 J. L. Matson et al.
periods. For example, specific language impairments
in those diagnosed with Down syndrome primarily
emerge from the pre-school to school-age years [22].
Knowing this information would help establish
intervention services prior to these susceptible ages.
Lastly, weeks or months premature were not
accounted for in the current study for Group 3
(premature group). An earlier birth (e.g. months
premature vs weeks premature) could possibly
account for within-group differences regarding
achieving developmental milestones. Thus, effects
on development from those born ‘more’ premature
could be negated when combining all toddlers born
premature into one group. Future research of this
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sort may benefit from partitioning out those born
‘more’ or ‘less’ prematurely than others and includ-
ing them in the analyses as separate groups.
Declaration of Interest: The authors report no
conflicts of interest. The authors alone are respon-
sible for the content and writing of the paper.
For personal use only.
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