An overview of the NIH Infant and Toddler Toolbox: Introduction, validation and plans for norming

• In Event: An Introduction to the NIH Infant and Toddler Toolbox for infants 1-42 months

Abstract

Birth to four years is a critical period of development. Tracking healthy development requires robust, and sensitive measurement tools. Although many standardized, normed early developmental assessments exist, extant measures are time-intensive, costly, and require trained experts to administer, score, and interpret. In response to a Spring 2019 contract solicitation from the National Institutes of Health (NIH) Neuroscience Blueprint, with management by the National Institute of Child Health and Development, we assembled a team of 48 researchers from around the United States to produce a tablet-based set of developmental measures available for use with diverse populations: The NIH Baby Toolbox (NBT). This presentation will give an overview of the NBT and describe the development, validation, and plans for norming.

Designed for infants and toddlers (1-42 months), the NBT will serve as a common currency across six domains of development, as well as a bridge to the existing NIH Toolbox for the Assessment of Neurological and Behavioral Function, which offers standardized, normed measures of cognitive, emotional, sensory, and motor functioning for people from 3-85 years of age. To select measures, we identified brief, easy to use, free, tablet-compatible child-performance and parent-report measures that could be used across the 1-42-month age range. Table 1 shows the measures for each of the six domains included in the NTB. Selection was informed by the results of a scoping literature review and expert survey. The tests use state-of-the-art technological approaches including Computer Adaptive Testing (CAT), tablet-based gaze-tracking, video recording with playback, and automated scoring.

An initial feasibility and pilot validation study tested a diverse sample of 108 children between 4 and 42 months of age in late Fall of 2021. Parents completed the Developmental Profile-4 (DP-4), which is a checklist of dichotomous items in the Cognition, Language, Motor, Adaptive Behavior, and Social-Emotional Functioning domains. As time allowed, children were administered the Mullen Scales of Early Learning (MSEL) following the Baby Toolbox to examine comparability in performance measures. Overall, convergent validity varied but was found to be consistent with expectations for developmental assessments. Two-thirds of measures achieved moderate (.4-.6), high (.6-.8), or very high (.8-1.0) reliability. A random subsample of cases was scored by domain experts, for inter-rater reliability estimates - 86% score high or very high reliability. Based on the results, refinement of NBT procedures and scoring is ongoing.

Beginning in Spring of 2023 instruments will be re-validated and nationally normed with a sample of 2,550 children in both English and Spanish. Participants will be recruited from 12 sites around the country, with demographic characteristics based on the 2020 census. In addition to being validated with a neurotypical sample, the NBT will also be validated with clinical populations. The projected release date is Spring 2024.

The NBT aims to offer a modern approach to developmental assessment across six domains that are critical for healthy development. The creation of the battery reflects a team-based, multidisciplinary approach. Our goal is that the NTB will become an invaluable tool for researchers, clinicians, and educators in the years to come.

Authors

• Richard Gershon, Northwestern University
  Presenting Author

• Aaron J Kaat, Feinberg School of Medicine, Northwestern University

• Karen E Adolph, New York University

• Christina Bethell, Johns Hopkins University

• Douglas H Clements, University of Denver

• Sandra R Waxman, Northwestern University

• Amy Wetherby, Florida State University

• Philip David Zelazo, University of Minnesota - Twin Cities