Screen infants at risk for developmental delay or neurological impairment. Abstract. Objective: To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) as a screening technique for premature, low birth weight. Objective To determine predictive validity of the Bayley Infant Neurodevelopmental. Screener (BINS) during the first 2 years of life with a group of children at risk.

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Physician inter-rater agreement with training tapes was Infants were classified into being at low, moderate, or high risk for developmental delay or neurological impairment based on their total BINS score. Female infants performed higher than male at 16 to 20 months and 21 to 24 months; male infant scores were more variable at 5 to 6 months. Scores on only two items were significantly different between Spanish and Portuguese speaking participants.

South American neurodevelo;mental were typically significantly higher than the US sample, and a lower proportion of infants were classified as being at high risk in the South American sample than in the US standardization sample. Overall, the results of this study indicate that the BINS is feasible and appropriate for neurodevelopmental screening in South America.

Bayley Infant Neurodevelopmental Screener™ (BINS™)

Developmental disabilities are common disorders neurodevelopmenntal impose significant physical, mental and learning limitations on affected children. In the US, children under three years of age with developmental disabilities are eligible to receive early intervention services through programs such as the Neurodecelopmental with Disabilities Education Act IDEA Individuals with Disabilities Education Improvement Act, Identifying infants at risk for developmental disabilities is the first step in providing them with services to maximize their screrner and cognitive neuroddevelopmental and to minimize complications.

The American Academy of Pediatrics recommends that pediatricians screen all infants and children during routine office visits for developmental problems Council on Children with Disabilities, In the US, the emphasis has shifted to screening for disabilities at a younger age, birth to 2 years, with the passage of the IDEA amendments Individuals with Disabilities Education Act, Certain health conditions such as low birth weight, preterm birth, perinatal infection and birth defects increase the risk for developmental difficulties.

Robust estimates of the prevalence of development disabilities in less developed countries are rare. Rates are expected to be at least similar to if not higher than those in developed countries given the overall higher prevalence of most diseases of early childhood in less developed countries compared to developed countries.

The availability of adequate screening for developmental disabilities is limited in less developed countries where expenses on health are unfant lower than developed countries.

Therefore, developmental disabilities may have larger adverse effects on future health and socioeconomic outcomes in less developed countries due to the higher poverty rates.

One inrant that limits screening in less developed countries is that, unlike the US where several standardized instruments are available to screen and assess infant development, few instruments have been standardized or evaluated for use in less developed countries. Instruments that are translated for use with ethnic minority groups in the US sometimes are used in other countries without proper evaluation.

This limits the ability of health care practitioners in less developed counties to carry out systematic screening procedures and to refer children infat available infznt programs even when the costs of such screening are minimal. An important question is whether instruments standardized in the US are useful and applicable in less developed countries.

Assessing the utility of these instruments for use in less developed settings is essential to enhance the capacity of health professionals to screen for developmental disabilities.

Primary care providers play a crucial role in the identification of children with developmental difficulties through frequent monitoring jnfant development, identifying at-risk children who are outside the normal range of development, and referring them for further developmental assessment and treatment as needed.

In South America, there is a real need for standardized developmental screening instruments that can be used by primary care providers. Identifying the utility of existing instruments that are used in the US to screen infants for risk for developmental problems is needed to expand the capacities of pediatricians and primary care physicians to screen for neurodevelopmental problems in South America.

The Bayley Infant Neurodevelopmental Screener BINS is a developmental screening measure that offers an alternative to detailed assessment for infants 3 to 24 months of age. It can be administered by a wide range of health professionals with limited training and in an acceptable time frame for screening. The specific objectives of this study were to:.


The physicians voluntarily report to ECLAMC the occurrence of birth defects among infants born in affiliated hospitals. These physicians also routinely care for infants and children who are healthy as well as infants with a range of health conditions in their general pediatric practices.

Children in this study were recruited in and from the practices of the participating ECLAMC-affiliated physicians. Inclusion criteria were being a healthy child between 3 and 24 months of age and being seen by the physician for routine well-child care.

Bayley Infant Neurodevelopmental Screen

The mother or a primary caregiver of the child had to be with the child at the pediatric visit. The participating countries and number of participants per country are found in Table 1. The number of participants per the six BINS age groups 3 to 4 months, 5 to 6 months, 7 to 10 months, 11 to 15 months, 16 to 20 months, 21 to 24 months which are described below ranged from to The study sample was stratified by language, sex and age group and was projected based neirodevelopmental an anticipated enrollment capacity of about 60 children bayldy pediatrician over the course of the study 10 children, 5 males and 5 females, in each of the six BINS infannt groups.

For comparison, the US sample used in standardizing the BINS included infants across all six age groups between 3 and 24 months of age and clinical cases Aylward, The study sites were located in geographically and socioeconomically diverse communities.

The self-reported ethnic ancestry of the child was African for The average age of the mother was More than one-third of the mothers For maternal education, More than a third This diversity provides inference that the sample is representative of large percentages of children in the study countries.

Unfortunately, national-level data are not readily available scrfener these characteristics lnfant all study countries to compare to the sample characteristics. Nonetheless, the study employs a unique existing network of providers for selecting a large multi-country and geographically, socioeconomically, and demographically diverse sample of children.

The BINS Aylward, was designed to identify infants, 3 to 24 months of age, at risk for developmental delays or neurological impairments by assessing four conceptual areas of ability: The BINS consists of six item sets grouped by screenwr 3 to 4 months, 5 to 6 months, 7 to 10 months, 11 to 15 months, 16 to 20 months, 21 to 24 months scteener, each containing 11 to 13 items.

The BINS takes approximately 10 minutes to administer. The BINS is reported to have good internal incant 0. A Screening Form that included questions on the exclusion criteria listed above was developed to screen for the appropriateness of a child to participate in this study.

A subgroup of participating physicians reviewed and approved the cultural appropriateness of these forms. The translations were then reviewed for validity and accuracy. Neuroeevelopmental, all the physicians enrolling children in this study were trained in the administration of the BINS at a group meeting in Brazil by one of the study investigators AMM.

Participating physicians were provided BINS testing kits, translated study procedures and scoring forms.

Letters explaining the project, along with a verbal explanation from a staff member, were given to the parent or primary caregiver of the eligible children.

After screening for eligibility based on the criteria described above, the study staff administered the informed consent document, in the appropriate language. A total of infants were retested at a mean number of A program for random selection of enrolled children for test-retest reliability was also added to the PDAs. The PDA data collection system had built-in quality control checks including range and skip patterns.

Data were evaluated for errors and inconsistencies, which were corrected through communication between the Data Center and the study pediatricians. The BINS data were collected on paper forms, which were double keyed and compared to identify and resolve data entry errors.

The youngest age inclusion criterion for our study was 3 completed months. An adjusted BINS score distribution for the 3 month group was estimated for the South American sample using trend analysis and linear interpolation. Using the ogives for groups defined by half months, it was possible to estimate the score distribution for the missing half month and adjust the distribution appropriately.

There was no need for adjustment when comparing the other five benchmark ages to the US sample since the age criteria were similar between the two groups. The BINS item scores were summed to obtain the total score for each infant and infants were classified into risk categories Low, Moderate, and High based on the US norms.

Bayley Infant Neurodevelopmental Screener™

Next, differences at the item and test level by selected characteristics and similarity of the South American distributions to the US norms were evaluated Descriptive statistics for the total BINS score were calculated for the overall sample as well as by sex and language. Group differences were evaluated using t-tests. At the item level, differences in performance by language and sex were tested using logistic regression.


Differences in the distributions of scores in the South American sample and the US norming sample were conducted at six benchmark ages 3, 6, 9, 12, 18, and 24 months corresponding to the six ages where data were collected for the US standardization 1.

Differences were tested using the Kolmogorov-Smirnov test. In addition, chi-square tests were used to compare the distributions of the risk categories low, moderate, and high between the two samples. Descriptive statistics by age group and specific age in months for the BINS scores in the South American sample are presented in Table 2. As expected for a sample neueodevelopmental infants without major health conditions, the BINS scores were high.

For example, in the month age group, the mean BINS score was 9. Table 3 reports BINS scores by sex and language. Differences were compared for each age sceener between male and female infants and by language. At most age levels, female infants performed higher than male, however the difference was only significant for the older age groups 16 to 20 wcreener and 21 to 24 months.

In addition, scores of male infants were more variable than those of females, however, the variability difference was only significant at 5 to 6 months. Spanishnone of the comparisons yielded significant difference. Sex and language differences were also examined at the item level using logistic regression. For each item, performance differences based on language, sex, and the interaction of sex and language were tested. Because of the large number of tests being conducted, an alpha of.

The BINS scores were significantly different only for 2 nekrodevelopmental. Language had a significant main effect on item 1 an item that measures conjugate gaze while looking at a small object of the 5 to 6 month BINS form. A closer look at the data showed that in Spanish speaking countries, Both sex and the interaction between sex and language had significant effects on item 4 an item that measures object permanence of the month BINS form.

A lower percentage of female infants from Brazil demonstrated this skill than males from Brazil or infants of either sex from neruodevelopmental Spanish-speaking countries.

Given the large number of tests conducted for this analysis more thanthe observed result of 3 significant tests is in line with the chosen alpha. Detailed results for the item-level logistic regression are available from the authors upon request.

At six benchmark ages, the six observed ages in the US standardization sample 3, 6, 9, 12, 18, 24 monthsthe distribution of the neurodevelopmehtal BINS scores in the South American sample 2 was compared to the distribution in the US standardization sample Table 4. Examining the differences showed that at three months, infants in the South American sample outscored infants in the US sample, whereas at six months the relationship was reversed.

The Appendix provides the distribution of the total BINS scores in the South American sample compared to the distribution in the US standardization sample for the non-benchmark months.

Table 5 reports the percent of infants in each risk category along with the p-value for the chi-square test for risk category differences between the two populations.

Cell chi-square statistics indicate that there were fewer high-risk infants in the South American sample than would be expected had the two distributions been identical. There was no neurodeevelopmental explanation for the differences at these ages — at 6 months there were more infants in the moderate risk category in South America whereas 12 months was similar to 3 months in that there were fewer high-risk infants in the South American sample.

This study evaluated the utility of the BINS in South America by recruiting and screening a large sample sceener healthy infants in several South American countries. The study results innfant that the instrument appears to be both feasible neurodevwlopmental appropriate for neurodevelopmental screening in South America.

Specific findings include differences in Neurodevekopmental scores by sex for certain age groups and overall lower rates of high-risk infants and higher BINS scores in the South American sample compared to the US standardization sample.