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Baroda development screening test for infants in a perinatal psychiatry setting:

A preliminary report from India

Article · December 2018

DOI: 10.4103/ijhas.IJHAS_82_17

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Baroda development screening test
for infants in a perinatal psychiatry
setting: A preliminary report from India
M Thomas Kishore, Geetha Desai1, Poornima Mahindru, G Ragesh2,
Website: Harish Thippeswamy1, Sundarnag Ganjekar1, Prabha S Chandra1
www.ijhas.in

DOI:
10.4103/ijhas.IJHAS_82_17 Abstract:
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

Introduction is limited. Developmental assessment

scales for Indian infants (DASII) is the only

I nfants born to mothers with psychiatric

disorders may be at high risk for
developmental delays. Inadequate
standardized tool available for assessing
infants in the Indian context.[4] However,
it is relatively expensive, time‑consuming,
stimulation and delay in early interventions and requires trained professionals for its
during the infancy poses a higher risk for administration.[5,6] In this scenario, brief
Departments of Clinical
Psychology, 1Psychiatry long‑term cognitive, social, and emotional and cost‑effective developmental screening
and 2Psychiatric Social problems.[1‑3] One of the ways to ensure tools are needed, which can be used at a
Work, National Institute early stimulation for these at‑risk infants larger scale, especially in busy outpatient
of Mental Health and is early detection of developmental settings. Existing scales used in India, such
Neurosciences, Bengaluru,
Karnataka, India delays. However, the availability of as the developmental screening test (DST),[7]
tools that are clinically valid and brief Vineland Social Maturity Scale (VSMS),[8]
Address for Gesell Developmental Schedules (GDS),[9]
correspondence: and Trivandrum Developmental Screening
Dr. Geetha Desai, This is an open access journal, and articles are
Department of Psychiatry, distributed under the terms of the Creative Commons
National Institute of Attribution‑NonCommercial‑ShareAlike 4.0 License, which How to cite this article: Kishore MT, Desai G,
Mental Health and allows others to remix, tweak, and build upon the work Mahindru P, Ragesh G, Thippeswamy H, Ganjekar S,
Neurosciences, Bengaluru, non‑commercially, as long as appropriate credit is given and et al. Baroda development screening test for infants in
Karnataka, India. the new creations are licensed under the identical terms. a perinatal psychiatry setting: A preliminary report from
E‑mail: desaigeetha@ India. Int J Health Allied Sci 2018;7:246-9.
nimhans.ac.in For reprints contact: reprints@medknow.com

246 © 2018 International Journal of Health & Allied Sciences | Published by Wolters Kluwer ‑ Medknow
[Downloaded free from http://www.ijhas.in on Wednesday, December 5, 2018, IP: 59.90.101.67]
Kishore, et al.: Development screening test for infants in a perinatal psychiatry
Chart,[10] 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,[10,11] 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.[5,12,13]
The Baroda development screening test (BDST), [14]
like DASII, is based on BSID. The tool reported to
have a sensitivity and specificity of 65% and 95%,
respectively.[15] 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.[16]
Methods
Sample
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.[17]
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
International Journal of Health & Allied Sciences - Volume 7, Issue 4, October‑December 2018
maternal age of 18–40 years from intact families were
included in the study.
Tools
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.[18,19]
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Kishore, et al.: Development screening test for infants in a perinatal psychiatry

Procedure Table 1: Correlation between the three developmental

The study was approved by the institutional ethics scales
committee. Infants meeting the study criteria were Mean SD DST BDST DASII
identified, and written informed consent was obtained Motor Mental
scale scale
from the mothers for the administration of developmental
DST 87.78 25.935 1.00 0.84** 0.79** 0.84**
scales. The developmental screening with BDST and
BDST 79.01 21.849 1.00 0.93** 0.93**
DST was done by the two authors (PM and RG) and
DASII motor scale 79.67 20.739 1.00 0.89**
an independent, detailed assessment with DASII was
DASII mental scale 76.53 24.590 1.00
done by the first author (TK). Both the screening and the **P<0.01. DST = Developmental screening test, BDST = Baroda development
detailed developmental assessment were done during screening test, DASII = Developmental assessment scales for Indian infants,
SD = Standard deviation
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 Table 2: Correlation between the three developmental
offered appropriate early intervention services and measures when controlled for age
Control variables DST BDST DASII
referrals for the infants. Minimum personal details
such as the age of the mother, socioeconomic status, Motor scale Mental scale
Age
domiciliary, and status of the family were taken from
DST 1.00 0.79** 0.75** 0.81**
the case records of the mothers.
BDST 1.00 0.92** 0.91**
DASII motor scale 1.00 0.87**
Statistical analysis DASII mental scale 1.00
Data were analyzed with Statistical Package for the **P<0.01. DST = Developmental screening test, BDST = Baroda development
Social Sciences for Windows, Version 16.0. Descriptive screening test, DASII = Developmental assessment scales for Indian infants
statistics, Pearson’s correlation, partial correlation, and
linear regression analysis were applied based on their Table 3: Predictability of the scores of DASII by
assumptions. The correlation and linear regression BDST and DST scores
was performed on the developmental quotients of the DASII motor scale DASII mental scale
individual scales. Developmental quotients yielded on B SE β t B SE β t
BDST, DASII motor scale, mental scale, full scale, and of Constant 9.66 5.56 ‑ 1.74 −7.73 6.45 ‑ −1.20
the DST were considered for analysis. BDST 0.86 0.12 0.90 6.98** 0.82 0.14 0.73 5.79**
DST 0.03 0.10 0.03 0.26 0.22 0.12 0.23 1.83
Results **P<0.01. DST = Developmental screening test, BDST = Baroda development
screening test, DASII = Developmental assessment scales for Indian infants,
SE = Standard error
The mean age of the infants in months was 3.48 (range:
1–6; standard deviation [SD] 1.78). There were 19 boys Table 2 indicates that the positive correlation remained
and 11 girls among the infants. None of them had any statistically significant among the three developmental
significant medical problems. The mean age of the mothers measures when controlled for age of the infants (P < 0.01).
in years was 26.9 (range: 19–39; SD 4.51). Majority of them Table 3 shows that BDST quotients significantly predicted
studied up to 10th grade and above (n = 27), two mothers the quotients of both DASII motor scale (B = 0.86, t(29)
had primary education, and one mother was illiterate. = 6.98, P < 0.01) and DASII mental scale (B = 0.82, t(29)
Twenty‑two mothers were from lower socioeconomic
= 5.79, P < 0.01). DST scores did not predict the scores
status (n = 22) and the rest were from middle (n = 5)
of DASII.
and higher (n = 3) socioeconomic status. Majority were
homemakers (n = 26), and among the remainder, there
was an equal representation of salaried employees and Discussion
unskilled laborers. Except for six mothers, all were
The findings of this study suggest that BDST has a good
from rural background. Details of the maternal mental
correlation with both the motor and mental subscales
illnesses were as follows: unspecified psychosis (n = 8),
bipolar affective disorder (n = 9), acute and transient of DASII. DST also showed significant correlation with
psychotic disorder (n = 5), paranoid schizophrenia (n = 3), DASII. In both cases, the correlation remained significant
severe depression with psychotic symptoms (n = 2), even when controlled for age. This indicates that both
dissociative disorder (n = 2), and obsessive–compulsive DST and BDST continue to show good correlation with
disorder (n = 1). One mother in the bipolar affective DASII at all age groups. However, it is only BDST that
disorder group had comorbid mild intellectual disability. predicted the scores of DASII. As there was no collinearity
between BDST and DASII, it could be assumed that the
Table 1 indicates that the three developmental measures predictability of BDST developmental scores is robust.
shared a significant positive correlation (P < 0.01). Therefore, BDST appears to be a promising tool in the
248 International Journal of Health & Allied Sciences - Volume 7, Issue 4, October‑December 2018
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Kishore, et al.: Development screening test for infants in a perinatal psychiatry
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.[20,21] 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.[5,6]
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.[22]
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
Nil.
Conflicts of interest
There are no conflicts of interest.
International Journal of Health & Allied Sciences - Volume 7, Issue 4, October‑December 2018
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