Video-based assessment of motor development (1-42 months) for the NIH Infant and Toddler Toolbox

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

Abstract

Existing assessment instruments of motor development in infants and young children rely on parent report, expert evaluation, or specialized technology. Parent report measures are quick and easy to administer but may be unreliable and offer no way for researchers to verify the target behaviors through direct observation. Expert evaluators can give nuanced, holistic judgments based on observed behaviors, but require extensive training and deep expertise. And specialized recording technology is expensive and requires additional processing after the session. Here, we report a new approach developed for the NIH “Baby Toolbox”: We leveraged the video capabilities of the iPad to enable researchers and clinicians without motor expertise to directly evaluate the details of infant and child motor behavior in a 10-minute assessment.

We designed three tasks to measure key aspects of motor development from 1 to 42 months of age. Get Up & Go measures postural transitions and locomotion; children lie on their back and are encouraged to get up, locomote a small platform, and climb up and back down. Reach To Eat focuses on manual actions and tool use; children reach for a block or small snack with their hand or a spoon. Sit & Stand measures stationary postural control; children hold independent sitting and standing postures. Crucially, all tasks focus on functional, everyday behaviors that typically-developing children must master in daily life. And every task requires a suite of motor abilities critical for adaptive behavior, such as head and trunk control, action planning, and affordance perception. Each task has various difficulty levels, selected based on the child’s current skill level.
Administrators video record children performing each task, then are guided through a series of questions to score aspects of children’s actions based on reviewing the video. For each question, the app includes drawings and written descriptions of possible behaviors (Figure 1). The target behaviors were selected based on prior work and expert opinion, then refined based on pilot testing of 70 infants (ages 3-43 months).

In usability testing of 108 infants (ages 4-42 months), administrators with minimal expertise in motor development successfully administered and scored the tasks. Reliability with expert ratings was high: 0.97 for Get Up & Go, 0.93 for Reach to Eat, and 0.95 for Sit & Stand (Krippendorff’s alpha for ordinal data). Likewise, the measures correctly detected known changes in motor skill, such as increased locomotor speed with age (r=.45, p<.001) and increased sophistication in strategies for getting off the floor (r=.57, p<.001).

In summary, with commonplace technology (an iPad) and everyday objects (blocks, snacks, spoon), it is possible for non-experts to obtain detailed assessments of infant and child motor skills based on directly observed behavior in a short amount of time. These assessments are the foundation of the motor domain of the upcoming NIH Baby Toolbox, but our video-based approach could be applied to other domains of development.

Authors

• Whitney G Cole, New York University
  Presenting Author

• Miriam A Novack, Northwestern University

• Jaya Rachwani, City University of New York Hunter College

• Orit Herzberg, New York University

• Stacey C. Dusing, University of Southern California

• Jill Heathcock, Ohio State University

• Laura Prosser, Children's Hospital of Philadelphia

• Jane Clark, University of Maryland

• Jeffrey J Lockman, Tulane University

• Richard Gershon, Northwestern University

• Karen E Adolph, New York University