The usefulness of the Battelle Developmental Inventory Screening Test.

Recent research supporting the effectiveness of early intervention and laws expanding services have increased the demand for accurate developmental screening tests. The Battelle Developmental Inventory Screening Test (BDIST), for children 6 months to 8 years old, has a number of desirable features, including subtests for fine and gross motor, adaptive, personal-social, receptive and expressive language, and cognitive skills; a range cutoff and age-equivalent scores; and national standardization. To assess its accuracy, the BDIST was administered to 104 children 7 to 83 months old, along with several other screening tests and a battery of criterion measures. Tied to 1.5 standard deviations below the mean, BDIST failing scores were moderately sensitive, detecting 75% of the children with developmental problems, such as mental retardation, borderline intelligence, language delays, and learning disabilities. Since 73% of the nonhandicapped children passed the BDIST, the test showed moderate specificity. Children within one month of their birthdays were likely to be over- or underreferred. Although the BDIST needs further research, it is a promising developmental screening instrument. The Receptive Language (RL) subtest, slightly more sensitive than the total BDIST but less specific, takes only a few minutes and thus is useful for prescreening in time-limited settings, such as pediatric practice.

The usefulness of the Developmental Profile-II in developmental screening.

Timely provision of early developmental intervention depends on accurate developmental screening tests. The Developmental Profile-II (DP-II) relies on parent report to assess children from birth to 7 years old. One of its subtests, the Academic scale, is designed for developmental screening. To test its accuracy in detecting children with problems, the scale was administered to parents of 94 children between 6 and 75 months old. Each child was also given a battery of tests, such as the Bayley Scales of Infant Development and the Stanford-Binet Intelligence Scale. The Academic scale detected only 21% of the 19 children thus determined as having developmental problems, while 85% of the nondiagnosed children received normal or advanced scores on DP-II. Analysis revealed that DP-II scoring criteria are far too lenient and that many items are poorly placed in relation to age expectations. Alternative cutoff scores greatly improved sensitivity. DP-II is a potentially accurate measure that needs updating and restandardizing. Alternative tests include the Minnesota Child Development Inventory and the Battelle Developmental Inventory Screening Test.

Accuracy of the Denver-II in developmental screening.

One of the oldest and best known developmental screening tests was recently restandardized and revised as the Denver-II. Because it was published without evidence of its accuracy, the present study was undertaken with 104 children between 3 and 72 months of age attending one of five day-care centers. To determine the presence of developmental problems, children were administered individual measures of intelligence, speech-language, achievement, and adaptive behavior. A second psychological examiner, blind to the outcome of the diagnostic battery, administered the Denver-II. Developmental problems including language impairments, learning disabilities, mild mental retardation, and/or functional developmental delay were found in 17% of the children. The Denver-II identified correctly 83% and thus had high rates of sensitivity. However, more than half the children with normal development also received abnormal, questionable, or untestable Denver-II scores. Thus the test had limited specificity (43%) and a high overreferral rate. The alternative scoring method, categorizing questionable/untestable scores as normal, caused sensitivity to drop to 56% although specificity rose to 80%. Since neither scoring method produced acceptable levels of accuracy, an effort was made to locate the sources of accuracy and inaccuracy within the test. Only items in the language domain were modestly helpful in discriminating children with and without difficulties. The findings suggest that the authors of the Denver-II need to engage in further development of the instrument including revising scoring criteria and item placement in relation to children's ages. In the interim, test users should employ screening tests which are more accurate such as the Minnesota Inventories or the Battelle Developmental Inventory Screening Test.

Carotid artery atheroma: ultrasound appearance in symptomatic and asymptomatic vessels.

The distribution of carotid plaque ultrasound appearance has been evaluated using duplex ultrasound in symptomatic and asymptomatic patients. There were 134 patients with unilateral carotid territory symptoms who subsequently underwent endarterectomy of the symptomatic carotid bifurcation, and 92 asymptomatic patients. Both carotid bifurcations in all patients were examined, thus providing three groups of vessels for study: (i) asymptomatic vessels in asymptomatic patients (n = 184); (ii) asymptomatic vessels in symptomatic patients (n = 134); and (iii) asymptomatic contralateral vessels in symptomatic patients (n = 134). Ultrasound appearances were classified as types 1-4. This classification has previously been compared prospectively with endarterectomy specimen pathology where the more echolucent type 1 and 2 lesions correlated well with the presence of intraplaque haemorrhage or ulceration. In the symptomatic arteries, type 1 and 2 lesions were predominant, whereas in the asymptomatic patients the most common lesions were types 3 and 4. This difference was statistically significant (P less than 0.01). Evaluation of the asymptomatic contralateral vessel in the symptomatic patients showed a pattern of plaque type distribution between the other two groups.