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Zeitschrift für Psychologie / JournalT.

of Macha & F.
Psychology
© 2008 Petermann:
Hogrefe
2008; Vol. The
& Huber ET 6–6
216(3):154–160
Publishers

The ET 6–6
A Method for Developmental Assessment
for German-Speaking Countries
Thorsten Macha and Franz Petermann
Center for Clinical Psychology and Rehabilitation, University of Bremen, Germany

Abstract. The ET 6–6 presents a procedure for the assessment of a developmental status in children from 6 months to 6 years of age
that uses experimentally based test tasks for a great variety of developmental skills. The results are shown in a multidimensional and
age-specific profile. The instrument has been standardized by testing 950 children.

Keywords: developmental test, developmental assessment, child development

Preventive medical check-ups for children that rely on med- 2004) argues that a large amount of interindividual and intra-
ical examination, short conversation with parents, and some individual variability is characteristic even for normal child
behavior monitoring may not be sufficient to detect or ex- development. Low-contact pathways, then, describe basic
clude the presence of a developmental disorder. The ET 6–6 abilities that may expedite or inhibit the development of
(Developmental Test 6 Months to 6 Years; Petermann, Stein, skills. A large number of such developmental pathways are
& Macha, 2006a) provides a standardized test procedure suit- supposed to interact in a complex manner such that they can-
able for a large age range that allows for norm-oriented as- not be observed by standard psychometric testing. Conse-
sessment based on a new model of development. quently, it is the interaction that forms an observable skill pattern
and that needs to be monitored by a developmental test.
The individual developmental process is modeled by a
circumscribed developmental cone (see Figure 1). The status
Theoretical Considerations at a particular time (e.g., T) can be obtained by considering
the appropriate section of the cone. At time 0, individual de-
The development of the ET 6–6 was based on suggestions velopment begins. At the time of birth (B), the individual
by pediatricians as well as results from research in devel- developmental process has already differentiated progres-
opmental neurology and neuropsychology. This resulted in sively, which is illustrated by the increased expansion of the
a multiperspective view: conic section. For example, at times t1 and t2, the differentia-
– Age: Is a skill profile of a child typical for a particular tion of the developmental paths are illustrated by P1 and P2.
developmental period? They attain stability after a certain time interval. By interac-
– Disorder: Do signs and symptoms relate to specific cat- tion of different developmental paths in the individual’s bio-
egories of developmental deviations? psychosocial context, specific skills are developed at time t3.
– Course: Can valid predictions of future development be Such skills are accessible to assessment and can be measured
derived from the instrument’s scoring pattern? by items of the ET 6–6. With the continuous influence of
developmental paths, these skills are further differentiated
The ET 6–6 is based on theories of maturation (Plomin et al., and lead to complex skills (C). The complex skills are known
1993; Scarr, 1992) as well as on learning theory, Piaget’s as context bound behavioral dispositions and frequently give
theory of cognitive development, and Bronfenbrenner’s eco- the impression of an abnormal development.
logical theory (2006). Other concepts considered include sen-
sitive phases, risk and protective factors, developmental
tasks, or milestones. A core characteristic of the ET 6–6 is the
concept of development as complex interaction instead of
linear progression. Sroufe (1997), for example, suggests a Methodic Implementation and
tree-like structure of developmental pathways (patterns), fea- Structure of the Test
turing increased differentiation with increasing age, and dif-
ferent normal and abnormal trajectories in different develop- For normal development and specific types of disorders,
mental areas. Touwen (1984; see Michaelis & Niemann, Petermann, Stein, and Macha (2006b) analyze configura-

Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160 © 2008 Hogrefe & Huber Publishers
DOI 10.1027/0044-3409.216.3.154
T. Macha & F. Petermann: The ET 6–6 155

tions of age-specific and age-typical developmental paths,


basic skills, and complex skills. Quantifiable developmen-
tal deviations can however arise from minute causes like
disturbances in the development of one of the developmen-
tal paths. The ET 6–6 shows these typical configurations
using the empirically based constellation of items. In addi-
tion descriptive dimensions based on historically devel-
oped, evident classification categories are used. A multi-
plicity of age-relevant and different qualitative develop-
mental aspects will be considered within each dimension.
This heterogeneity of the dimensions ensures an inventory
of complex developmental processes. The areas of mea-
surement are then represented by 10 empirical develop-
mental dimensions (see Table 1). Starting from the middle
of the 4th year, an additional descriptive category is intro-
duced: the subtest drawing. The content of the develop-
mental dimension is different for each age-group. While
some dimensions are tested globally during early infancy,
the precise developmental status can be indicated through
differentiated assessment of motor skills. For older chil-
dren, age-appropriate differentiated tasks for the cognitive
and emotional development, as well as language and social
development, are necessary. The grouping of items within
each age-group (see below) of the ET 6–6 was not used to
develop subtests with scales over a wide age range. There-
Figure 1. A systematic diagram for developmental process- fore, quantitative progress in specific ranges can be record-
es (see Petermann, Stein, & Macha, 2006b) 0 = beginning ed exactly. However, such procedures frequently lead to the
of development; b = Birth; t1, t2, t3, t4, T = periods in the neglect of qualitative aspects. Very reliable methods whose
developmental process; P1, P2 = developmental paths; S = validity appears questionable are often used. The ET 6–6
skills; C = complex skills. concentrates on the collection of multiple, age-specific,

Table 1. Dimensions of the ET 6–6


Descriptive Empirical developmental Represented complex abilities
dimensions dimensions
Gross motor skills – Gross motor skills (GMS) Head and body control, development of locomotion, progressive differentiation and inte-
gration of basal elements of body control by acquiring typical daily and game skills e.g.,
climbing stairs, jumping, balancing, catching, using a tricycle or bicycle.
Fine motor skills – Fine motor skills (FMS) Targeted grasping and releasing, manipulation and use of objects, improvement in han-
dling a pen, implied aspects of visuomotor activities (frequent evaluation in relation to
Subtest Drawing is meaningful).
Cognitive – Memory (M) Different aspects of the memory (visual as well as phonetic recognition, visual and phonet-
development – Action strategies (Strat) ic reproduction); perception control, object permanence, understanding of causation, spa-
– Categorization (Cat) tial perspective consideration, action planning, formation of categories, differentiation and
– Body awareness (BA) specification within and between categories, consideration of many categories, class inclu-
sion, aspect of conception about knowledge of and orientation to one’s body and the body
of others.
Language – receptive language (RL) Different aspects of sound, word and sentence production; understanding of words and
development – expressive language (EL) sentences.
Social development – Social development (Soc) Start and organization of relationships with important related people and peers as well as
within groups according to age; signs of temporary and accompanying symptoms of be-
havior disorder.
Emotional – Emotional development Emotion regulation, exploration behaviors, behavior in specific daily life situations (meet-
development (Emo) ing, separation, annoyance); qualities of children’s games.
Additionally from 3;6 mon.: Apart from hand motor talents, aspects of visual perception, spatial-constructive abilities
Subtest Drawing (SD) as well as additional aspects of perception organization (“integrated comprehension,” “as-
pect of form”) are collected and particularly indicate specific neurological/fine neurologi-
cal impairments.

© 2008 Hogrefe & Huber Publishers Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
156 T. Macha & F. Petermann: The ET 6–6

scoring questionnaires, each of which are based on gen-


eral knowledge from research on toddlers, infants and
preschoolers. Information about social and emotional de-
velopment is obtained with the help of a parent question-
naire that can be completed during testing. Following the
test, a structured sampling of possible conditions influ-
encing the testing process is conducted.
The scoring and interpretation of individual test pro-
files is very economical since a greater part of the respec-
tive age-group-specific standardization data is contained
Figure 2. Duration of administration (average values) of in the protocol and scoring questionnaires. Hence, refer-
the ET 6–6 in the age groups. ring to the specific tables of the manual is only necessary
Note: The values on the category axis mark the respective in a few cases. For the scoring of the subtest drawing,
upper limits of an age group (“9” describes the age range scoring stencils are available. First, a developmental pro-
from 6 to 9 months). The age group “at least 6 months” (6) file of all dimensions collected in the respective age
is not a part of the age range of the ET 6–6, but supplies an group is produced. This permits an initial orientation con-
additional reference for the age group “at least 9 months.” cerning the strengths and weaknesses of the individual
profile. The dimension-specific test values can be con-
and relevant qualitative characteristics within the individ- verted into the assessment classes “unremarkable,” “risk
ual developmental status (Macha & Petermann, 2006). range,” and “serious deficit.”
The ET 6–6 provides a development assessment for a
wide age spectrum. From the extensive item pool (113 test
items, 67 items for parent questionnaires), an age-specific
item selection for carrying out the test is conducted. For
this, the entire age span is classified into 12 groups; the An Example of a Developmental
respective age ranges are presented in Figure 2. Prelimi- Profile
nary studies on ET 6–6 were performed with a constructive
sample of 260 children from Bremen, Germany. The stan- Figure 3 shows the development profile of a 5.8-year-old
dardization was conducted with 950 children from three girl with global developmental deficits in the motor as well
regions (Bremen, Dortmund, Rostock; all in Germany). as cognitive domains.
The construction of the ET 6–6 allows practitioners to The motor performances (gross motor skills, GMS; fine
conduct a time-effective assessment. As shown in Figure motor skills, FMS) lie far within the serious deficits range,
2, the average administration time for the individual age the cognitive performances (memory, M; strategies, Strat;
groups ranges from about 12 minutes (babies) to about 50 categorization, Cat; body Awareness, BA; expressive lan-
minutes for ages 3 years and above. guage, EL) also lie in the range of serious deficits but partly
less clearly. The result of an additional intelligence test
showed mental retardation (IQ = 69). The subtest drawing
Administration and Scoring (SD) gave similar results, because the girl could not obtain
a score. Additionally, unremarkable test scores were ob-
The ET 6–6 is administered while playing with the child. tained from the parents’ information concerning social de-
Thus, a parent can be present during the test. The results velopment (Soc), while emotional development (Emo) was
are documented using age-group-specific protocol and slightly above the risk range.

Figure 3. The ET 6–6 profile of a girl


(68 months old) with the Kabuki-syn-
drome. Remarks: See Table 1 for an
explanation of the abbreviations on
the category axis; for each develop-
mental dimension, the average of the
test values of age groups (60–72
months) as well as their respective up-
ward and downward standard devia-
tions are shown as a corridor.

Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160 © 2008 Hogrefe & Huber Publishers
T. Macha & F. Petermann: The ET 6–6 157

Validation pared to matched controls). They were able to attribute spe-


cific deficits to the location of etiologic brain lesion.
In order to evaluate the validity of a developmental test, the
following topics need to be addressed empirically:
– Can children with developmental disorders or delays be Behavioral Disorders
reliably identified?
– Can a developmental status in normal children be mod- Deficits in cognition, social development, and emotional
eled by means of a differentiated profile? development in children with behavior disorders (ADHS,
– Do quantitative scale characteristic derived from data oppositional disorder; N = 54) were investigated by Gadow
conform to theoretical assumptions? (2003). Compared to controls matched for ethnicity, age
– Will scores or scoring patterns allow for predictions? and gender, motor skills did not differ significantly from
normal level, but achievement in all cognitive areas as well
The ET 6–6 consists of 12 age-specific subtests that, by as the social and emotional domain did.
scale structure and item compilation, display a certain de-
gree of incommensurability. Therefore, validation must ac-
count for this heterogeneity: Do empirical results conform
to theoretical assumptions pertaining to the respective age Criterion Validity
groups? During the past years, numerous studies have es-
tablished evidence that the ET 6–6 meets the requirements Various studies of criterion validity demonstrate that re-
quoted above (see Table 2). sults of the ET 6–6 correspond to scores from other tests.
A pilot study by Petermann et al. (2006b) resulted in
moderate correlations between scores of the Kaufman
Assessment Battery for Children (K-ABC, German ver-
Extreme Group Comparisons sion; Melchers & Preuß, 2001) and the ET 6–6. These
findings are considered highly plausible because K-ABC
Premature born infants are not a homogeneous clinical subtests are constructed as homogeneous scales and as-
group, but, on average, have developmental deficits when sess isolated partial abilities, whereas the ET 6–6 pur-
compared to full term children (Schneider, Wolke, Schlag- posely compiles heterogeneous items into its dimensions.
müller, & Meyer, 2004). A study by Macha, Proske, and Since the ET 6–6 model assumes high variability even in
Petermann (2005) showed that underachievement as ex- normal children, statistical association cannot be expect-
pected in premature infants can be identified using the ET ed. For children with cognitive deficits, however, the fol-
6–6. In a sample of N = 69 prematures, significant reduc- lowing can be stated:
tion in motor skill as well as cognitive abilities were found – Children with reduced global cognitive ability in K-
even in 1-year-olds. Rapp, Thyen, Müller-Steinhardt, and ABC (2 SD below average in summative scores) display
Kohl (2005) achieved similar results using a sample of N = pronounced cognitive retardation with the ET 6–6.
63 very-preterm children tested in preschool age. Here, – Specific cognitive deficits are detected by both tests, al-
68.3% of subjects displayed deviations of more than 1 beit in a different manner. Inspection of patients profile
standard deviation (SD) unit from the age-corrected mean from the Psychological Ambulance of the Center for
score (profile center), and 38.1% of subjects scored even Clinical Psychology and Rehabilitation (University of
more than 2 SD units below average. Hampel et al. (2007) Bremen, Germany) indicate that children with deviation
were able to show cognitive and socioemotional deficits in of 2 SD below average in at least one K-ABC subtest
prematures when testing 5- and 6-year-old children with have regularly significant deviating patterns in ET 6–6
the ET 6–6 (N = 29). profile. Thus, the ET 6–6 can be considered as a screen-
ing instrument suitable for initial diagnosis.

A recent study by Goertz, Kolling, Frahsek, and Knopf


Physical Disorder and Handicap (2008; Goertz, Kolling, Frahsek, Stanisch, & Knopf, 2007;
Goertz, Knopf, Kolling, Frahsek, & Kressley, 2006; Kol-
Hülser, Dubowny, Knobl, Meyer, and Schölmerich (2007) ling, Goertz, Frahsek, & Knopf, 2007) demonstrated an as-
tested motor function and cognitive abilities in children sociation of cognitive achievement as assessed by the ET
with congenital heart disease (N = 44) as compared to 6–6 and nonverbal declarative memory in 2 year-old chil-
matched controls. Supposedly due to reduced performance dren (N = 174). They found highly significant correlations
capacity and power of concentration, diseased children of achievement in the Frankfurter Imitationstests (FIT
scored significantly lower. Daseking, Lemcke, Macha, & 12/FIT 18/FIT 24) and indicators of cognitive abilities in
Petermann (2007) studied stroke children (N = 32), which the ET 6–6, especially action strategies. Thus, the ET 6–6
had significantly lower levels of achievement (again com- may be used to evaluate prospects for untroubled language

© 2008 Hogrefe & Huber Publishers Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
158 T. Macha & F. Petermann: The ET 6–6

acquisition even in preverbal children. The German Lan- Table 2. Overview of validation studies of the ET 6–6
guage Development Test for 2 years olds (SETK-2; Grimm,
Studies Authors (year)
2000) as well as the German Language Development Test
for 3- to 5-year-olds (SETK 3–5; Grimm, 2001) also vali- Extreme group comparisons
date ET 6–6 indications of language disorders (Lissmann, – Premature infants Manual
Domsch, & Lohaus, 2006). Predictive validity of the ET – Premature infants Macha, Proske, & Petermann
6–6 has been demonstrated in a pilot study by Lissmann et (2005)
al. (2006) using the Bayley Scales (Bayley II; Bayley, – Premature infants Hampel, Kropf, Petermann, Kö-
1993) as a reference. nig, Gloger-Tippelt, & Dikici
(2007)
– Very premature infants Rapp, Thyen, Müller-Steinhardt,
& Kohl (2005)
Physical disorders
Longitudinal Studies
– Heart disease Hülser, Dubowny, Knobl,
Meyer, & Schölmerich (2007)
Petermann et al. (2006b) used a sample of N = 41 normal
– Perinatal stroke Daseking, Lemcke, Macha, & Pe-
children to demonstrate a high but regular fluctuation of ET termann (2007)
6–6 scores even within the normal range (1 SD unit
Behavioral disorders
above/below the average) in children from their 3rd to their
4th year. Lissmann et al. (2006) found similar variability in – Externalizing behavior disor- Gadow (2003)
ders
children assessed at 6, 12, and 24 months of age. Here,
significant test-retest correlations were obtained between Criterion validity
the ages 6 months and 12 months in the cognitive and emo- – Intelligence assessment (K- Manual
tional domain, whereas there was far less stability from 6 ABC)
to 24 months and 12 to 24 months of age (Lissmann, Korn- – Language (SETK-2; SETK Lissmann, Domsch, & Lohaus
theuer, & Lohaus, 2007). 3–5) (2006)
– Specific cognitive abilities Goertz, Knopf, Kolling, Frahsek,
& Kressley (2006)
Goertz, Kolling, Frahsek, &
Knopf (2008)
Practicability – Developmental assessment Lissmann, Domsch, & Lohaus
(BSID II) (2006)
Aspects of practicability and predictive validity of the ET Longitudinal studies
6–6 were investigated in a single-case study of a child with – Normal children (ages 2–3) Manual
severe developmental disorders (Heubrock, Spranger, Lex, – Normal infants (6–24 months) Lissmann, Domsch, & Lohaus
Lepach, & Petermann, 2003). Profound retardation is ex- (2006)
pected to produce substantial, and noticeable, deviation Lissmann, Korntheuer, & Lo-
from the normal range in a developmental profile from the haus (2007)
ET 6–6, on the premise that the child is challenged with the Practicability
tasks suitable for his or her actual age. Deliberately choos- – Practicability of verbal testing Macha, Daseking, Vogel, & Pe-
ing a test level for earlier ages, on the other hand, will pro- termann (2008)
vide differentiated information on actual competence in- – Practicability of motor testing Macha, Mayer, Petermann, Peter-
stead of deficits: information most valuable for indication mann, & Waldeck (2007)
of special training or therapy. – Extreme retardation Heubrock, Spranger, Lex, Le-
Results by Macha, Daseking, Vogel, and Petermann pach, & Petermann (2003)
(2008) suggest that language-oriented testing with the ET
6–6 might introduce bias in a developmental profile for
language-impaired children. Diagnosed children (ICD-10 Conclusion
F80.1 or F80.2, N = 26) of preschool age attained lower
profile scores (0.5 to 0.9 SD units) when tested with the ET Since 2000, the ET 6–6 has received widespread recogni-
6–6 than when tested with the completely nonverbal SON- tion and is increasingly used in German-speaking coun-
R (Janke & Petermann, 2006). Using a sample of children tries, in both practical health care settings and academic
with cerebral palsy (N = 23) Macha, Mayer, Petermann, research.
Petermann, and Waldeck (2007) point out the influence of In consideration of recent advances of child neuropsy-
motor skills on testing cognitive functions and argue that chology (Petermann & Lepach, 2007), the test will undergo
the ET 6–6 is suitable also for children with motor impair- extensive revision in near future, and will then, of course,
ment. be based on updated norms.

Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160 © 2008 Hogrefe & Huber Publishers
T. Macha & F. Petermann: The ET 6–6 159

ing infancy. Journal of Reproductive and Infant Psychology,


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