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. 2014 Mar;18(2):223-30.
doi: 10.1016/j.ejpn.2013.11.011. Epub 2013 Dec 31.

Validity of US norms for the Bayley Scales of Infant Development-III in Malawian children

Elizabeth A Cromwell  1 , Queen Dube  2 , Stephen R Cole  3 , Chawanangwa Chirambo  4 , Anna E Dow  5 , Robert S Heyderman  6 , Annelies Van Rie  7
Affiliations

Validity of US norms for the Bayley Scales of Infant Development-III in Malawian children

Elizabeth A Cromwell et al. Eur J Paediatr Neurol. 2014 Mar.

Abstract

Objective: Most psychometric tests originate from Europe and North America and have not been validated in other populations. We assessed the validity of United States (US)-based norms for the Bayley Scales of Infant and Toddler Development-III (BSID-III), a neurodevelopmental tool developed for and commonly used in the US, in Malawian children.

Methods: We constructed BSID-III norms for cognitive, fine motor (FM), gross motor (GM), expressive communication (EC) and receptive communication (RC) subtests using 5173 tests scores in 167 healthy Malawian children. Norms were generated using Generalized Additive Models for location, scale and shape, with age modeled continuously. Standard z-scores were used to classify neurodevelopmental delay. Weighted kappa statistics were used to compare the classification of neurological development using US-based and Malawian norms.

Results: For all subtests, the mean raw scores in Malawian children were higher than the US normative scores at younger ages (approximately <6 months) after which the mean curves crossed and the US normative mean exceeded that of the Malawian sample and the age at which the curves crossed differed by subtest. Weighted kappa statistics for agreement between US and Malawian norms were 0.45 for cognitive, 0.48 for FM, 0.57 for GM, 0.50 for EC, and 0.44 for RC.

Conclusion: We demonstrate that population reference curves for the BSID-III differ depending on the origin of the population. Reliance on US norm-based standardized scores resulted in misclassification of the neurological development of Malawian children, with the greatest potential for bias in the measurement of cognitive and language skills.

Keywords: Child development; Cross-cultural testing bias; Testing norms.

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Conflict of interest statement

Conflict of Interest: All authors have no conflict of interest to disclose.

Figures

Figure 1
Figure 1. Charts for standard reference curves of raw scores for five BSID-III subtests from Malawian sample
Standard reference curves for (A) expressive and receptive communication, (B) fine and gross motor and (C) cognitive are presented with the mean (solid line), first and second standard deviations (dotted lines).
Figure 2
Figure 2. Comparison of mean raw score using the US and Malawian norms for five BSID-III subtests
The mean for the Malawian normative curve (solid line) is compared to an estimate of the mean US normative curve (dotted line) for (A) expressive and receptive communication, (B) fine and gross motor and (C) cognitive subtests.
See this image and copyright information in PMC

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