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Infant Tests as Predictors of Cognitive and Language Development at Two Years Author(s): Linda S. Siegel Source: Child Development, Vol. 52, No. 2 (Jun., 1981), pp. 545-557Published by: on behalf of the Wiley Society for Research in Child DevelopmentStable URL: http://www.jstor.org/stable/1129173Accessed: 10-03-2015 02:44 UTC

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Infant Tests as Predictors of Cognitive and Language Development at Two Years

Linda S. Siegel McMaster University

SIEGEL, LINDA S. Infant Tests as Predictors of Cognitive and Language Development at Two Years. CmILD DEVELOPMENT, 1981, 52, 545-557. The ability of infant tests to predict subsequent language and cognitive abilities and to detect infants at risk for developmental problems was assessed for 148 infants, 80 preterm (birth weight less than 1,501 grams) and 68 full-term infants. The Bayley and Uzgiris-Hunt scales-administered at 4, 8, 12, and 18 months-were significantly correlated with cognitive and language development at 2 years. Object relations items, the understanding of means-end relationships, and the Bayley PDI (Psychomotor De- velopment Index) were predictive of language development. The infant tests, particularly the Bayley MDI (Mental Development Index) scores, were capable of detecting many of the infants at risk for developmental delay. Infants who were classified as being at risk in infancy but who were developing normally at 2 years came from families with significantly higher scores on the HOME (Caldwell Inventory of Home Stimulation) scale. Infants not detected as being at risk in infancy but who showed delayed development at 2 years came from families with lower HOME scores. Thus, more adequate environments may provide the infant with sufficient stimulation to attenuate developmental delay. Infant tests, in conjunction with assessments of the child's environment, appear to be useful in predicting developmental functioning and delay at 2 years.

The usefulness of infant tests as predictors of subsequent development has been a subject of debate, ranging from assertions of the tests' uselessness to cautious optimism concerning their value (Crano 1977; Honzik 1976; Horo- witz & Dunn 1978; Lewis & McGurk 1972, 1973; McCall, Hogarty, & Hurlburt 1972; Matheny 1973; Scott 1978; Wilson 1973, 1978a, 1978b).

The expectation that infant tests would be predictive of subsequent behavior stems from the hypothesis that there are continuities in mental development. The assumption of cognitive theorists such as Bruner (1966) and Piaget (1960) is that there is a common sub- strate to the diverse behaviors that underlie cognitive development. Abilities such as cate- gorization, problem solving, understanding of causal relationships, exploration of novelty, and

symbolization are assumed to be fundamental processes of cognitive development and independent of any particular behavioral manifes- tation. The actual behaviors that are used as indices of cognitive functioning change as the child grows older. Obviously, the infant grasp- ing a dangling ring and putting it in his or her mouth is engaging in a different kind of behavior than a 5-year-old pointing out the simi- larities between an apple and a banana. How- ever, as McCall, Eichorn, and Hogarty (1977) have suggested, development may only appear to be discontinuous, but may still be controlled by the same fundamental processes such that "individual differences in the 'deep structure' of behavior remain stable while its surface grammar changes from age to age" (p. 19).

If development is assumed to be a con- tinuous process with regularities among parts

This research was supported by grants 558 and 732/77-79 from the Ontario Mental Health Foundation. The author wishes to thank Charles Cunningham and Lorraine Rocissano for helpful comments on earlier drafts of the manuscript; Saroj Saigal, Peter Rosenbaum, and Barbara Stoskopf for providing access to the preterm infants through their clinic; Lois Barry, Sophie Berenbaum, Richard Faulkner, Bernice Laufer, Dana McClaren, Helen McDonald, Nicki Peli- owski, and Alix Young who assisted in various phases of data collection and analysis; Gerard Kimmons, Maria Wong, and Richard Morton for computer programming: Jennifer Birrell for secretarial assistance; and the Special Enquiries and Grievance Committee without whom this research would not have been possible. Requests for reprints should be sent to: Linda S. Siegel, Department of Psychiatry, McMaster University Health Sciences Centre, Hamilton, Ontario, Canada, L8N 3Z5.

[Child Development, 1981, 52, 545-557. @ 1981 by the Society for Research in Child Development, Inc. 0009-3920/81/5202-0004$01.001


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546 Child Development

of the life cycle, it would seem that cognitive functions measured at one point in time should have some relation to similar functions measured at a different point in time, and that scores on infant tests should be predictive of later behavior.

In addition to the expectation that there are relations among cognitive abilities in different developmental periods, it has been pos- tulated that certain aspects of early cognitive development are related to the acquisition of language. According to Moore and Meltzoff (1978), the understanding of object permanence and identity are critical aspects of language development. When children become aware that objects can retain their identity in the face of transformation, they have acquired the basis by which they can attach labels to objects. Therefore, mastery of the object concept should be related to language development. Another aspect of language is its function as a communicative activity. If, as Bates, Cama- ioni, and Voltera (1976) have suggested, the child must understand the role of language in influencing others and the significance of in- tentionality in communication, then the understanding of how to manipulate and control the environment should be important to language development. Therefore, problem solving and the understanding of causality should be related to language development. Gestural imitation has also been assumed to be relevant to language acquisition (Morehead & Morehead 1974). The infant tests used in the present study were designed to assess these and other aspects of early cognitive development and to relate them to subsequent language development.

The question of the relationship between infant behavior and later functioning is of prac- tical significance for the identification of infants at risk for developmental problems. To exam- ine the validity of infant tests for predicting later development and for detecting infants at risk for later problems, two tests of infant development were used-the Bayley scale and a modified version of the Uzgiris-Hunt scale (1975). It has been suggested that the testing of infant abilities may be of greater value if more specific abilities rather than global functioning are measured (e.g., Honzik 1976). Therefore, the Bayley scores were divided into subscales, such as items measuring eye-hand coordination and vocalization, according to a system proposed by Kohen-Raz (1967). The Uzgiris-Hunt instrument measures the develop-

ment of various Piagetian concepts such as object permanence and the understanding of means-end relationships. The Kohen-Raz system and the Uzgiris-Hunt scale were used to provide a more detailed assessment of infant abilities.

It is possible that infant tests, by them- selves, may not be the most useful predictors of subsequent development because environmental influences may enhance or retard the infant's functioning. Stimulating environments may help compensate for delayed development, while inadequate environments may increase the delay (see Cornell & Gottfried [1976] for a review of some relevant studies). To assess this possibility, the Caldwell Inventory of Home Stimulation (HOME) was used (Elardo, Bradley, & Caldwell 1975) and was administered when the children were 12 months old. The measurement of the infant's environment, in addition to his or her developmental functioning, may be helpful in determining infants at risk.

The specific hypotheses tested by this study were that (a) infant test scores are predictive of subsequent cognitive and language development; (b) subsequent language development is related to the understanding of the object permanence concept, the manipulation and control of the environment, and the ability to engage in gestural and vocal imitation; (c) infant tests can be used to detect infants at risk for subsequent developmental problems; and (d) assessments of the quality of the environment in which the infant is developing may enhance the predictability of infant tests.

Method

Subjects The subjects were 148 infants from Hamil-

ton, Ontario, and the surrounding area (100-km radius) enrolled in a prospective longitudinal study of preterm (birth weights under 1,501 grams) and full-term infants. The preterm infants and the full-term infants were matched on socioeconomic status (Hollingshead), parity, sex, and maternal age at the birth of the child. The infants were primarily from the lower social class (Hollingshead 3-5) and were 56% male. The characteristics of these groups are described in detail elsewhere (Siegel, Saigal, Rosenbaum, Young, Berenbaum, & Stoskopf, Note 1). Ten of the preterm and one of the full-term infants were discovered to have seri-



Linda S. Siegel 547

ous disabilities (e.g., blindness, cerebral palsy, severe developmental delay), so these infants were not included in the testing. Scores of a number of infants were unavailable at each age due to illness; inability to come for testing due to inclement weather; and failure to com- plete the testing session due to crying, falling asleep, etc. The number missing never ex- ceeded 10% at any age level.

Procedure The children were administered the Bayley

scales of infant development at 4, 8, 12, 18, and 24 months; an adaptation of the Uzgiris- Hunt1 scale at 4, 8, 12, and 18 months; and the Reynell developmental language scales at 24 months. The Reynell is a standardized test measuring language expression and comprehension. The assessments were done by two trained psychometrists who were not informed of the child's perinatal history or the results of previ- ous assessments. The reliability of scoring was examined by having a second person score the tests from behind a one-way mirror approximately 5% of the time. Percentage agreement ranged from 85%-100%.

Reynell Developmental Language Scales The Reynell scales measure language com-

prehension and expression and are designed for children in the age range 1-7 years. The reliability of the Reynell scales is .78-.92. The standardization is described in Reynell (1972) and Randall, Reynell, and Curwen (1974). The Reynell has been found to discriminate between normal-hearing and hearing-impaired children (Reynell 1972), and between children with age-appropriate language and those with specific language delay (Siegel, Cunningham, & van der Spuy, Note 2). It has also been found to detect changes in language development in both normal and language-delayed children (Donachy 1976; van der Spuy, Siegel, & Cun- ningham, Note 3) and improvements in the language behavior of several groups of children: deaf children as a function of a parent education program (House & Neville-Smith, Note 4); preschool children whose parents received training in the stimulation of their child's development (Donachy 1976; Wilkinson & Murphy 1976); and children with language problems who receive special education (Coo- per, Moodley, & Reynell 1974).

Kohen-Raz Scoring of the Bayley Scales The Kohen-Raz scoring of the Bayley was

used. This system separates the Bayley MDI (Mental Development Index) score into a set of five subscales. These are: (a) eye-hand coordination ("reaches for dangling ring," "puts three or more cubes in cup"); (b) manipulation ("simple play with rattle," "fingers holes in pegboard"); (c) conceptual ability, originally called "object relations" by Kohen-Raz ("un- covers toy," "exploitive paper play"); (d) imitation-comprehension ("responds to verbal re- quest," "imitates crayon strokes"); (e) and vocalization-social ("repeats performance laughed at," "says 'da-da' or equivalent").

Uzgiris-Hunt Scale These are tests of cognitive capacities of

infants based on Piagetian theory. The following scales were used: (a) schemes-a test of the type and variety of activities that a child exhibits with objects (e.g., car, doll); (b) visual pursuit and object relations-test of the child's ability to visually and/or manually search for objects that are hidden; (c) means- the extent that a child tries to influence and solve problems in the environment by, for example, using tools such as a stick to obtain an object beyond his immediate reach; (d) concepts of space--the capacity of the child to understand and use containers and recognize obstacles; (e) gestural imitation-the ability of the child to imitate familiar (e.g., stirring a spoon in a cup) and unfamiliar (e.g., scratch- ing a surface) gestures; (f) vocal imitation- the ability of the child to imitate familiar and unfamiliar sounds and words; and (g) causality-the ability of the child to understand and try to activate some environmental event (e.g., pulling a string to make a music box work).

Caldwell Inventory of Home Stimulation (HOME)

The HOME scale measures several dimen- sions of the child's environment in a structured interview of 45 questions that takes place in the home. This scale was administered in a home visit at 12 months to those children living in the Hamilton area. It is composed of six subscales: (a) emotional and verbal respon- sivity of mother (e.g., "Mother responds to child's vocalizations with a verbal response");

1 The scale used was an adaptation of an earlier version of the one described in Uzgiris and Hunt (1975). In some cases there were substantial deviation from the procedures and scoring outlined by Uzgiris and Hunt, so the scores are not directly comparable with other admin- istrations of the test. Details of the procedures and scoring system are available from the author.




(b) avoidance of restriction and punishment (e.g., "Mother does not shout at child during visit"); (c) organization of physical and temporal environment (e.g., "Child's play environment seems safe and free of hazards"); (d) provision of appropriate play materials (e.g., "Provides eye-hand coordination toys.... stack- ing or nesting toys, blocks or building toys"); (e) maternal involvement with child (e.g., "Mother tends to keep the child within visual range and look at him often"); and (f) oppor- tunities for variety in daily stimulation (e.g., "Mother reads stories at least three times weekly").

The reliability of the HOME is .90. The HOME has been found to correlate with subse-

quent cognitive and language development (e.g., Bradley & Caldwell 1976a, 1976b; Brad-

ley, Caldwell, & Elardo 1977, 1979; Elardo et al. 1975, 1977). The HOME scale has been found to have a significant correlation with con- current, independent assessments of infant de-

velopment (Wachs 1971). It has been found to discriminate between "high risk" and general populations (Ramey, Mills, Campbell, & O'Brien 1975). The HOME scale is capable of

detecting infants who will subsequently show

significant increases or decreases in mental test scores (Bradley & Caldwell 1976a).

Correction for prematurity.-The Reynell and the Bayley scores were analyzed in two ways: uncorrected and corrected. For the uncorrected score the child's chronological age is used for the calculation of age. For the corrected score the child's degree of prematurity is taken into account, by subtracting the infant's gestational age in weeks from 40, the normal gestation period, and subtracting this difference from his chronological age. Thus, an infant born at 32 weeks gestational age would be considered, at 4 months chronological age, to have a corrected age of 2 months.

For brevity, we have included only the uncorrected scores. Most of the results were similar for the corrected scores, although some of the correlations among the corrected scores were lower.

Results

Predicting cognitive and language development.-In order to facilitate comparison of these data to others, the range of variation of scores on the Bayley, Uzgiris-Hunt, and the

Reynell scales is shown in table 1. The inter-

TABLE 1

MEANS AND RANGES OF SCORES ON THE SCALES

BAYLEY REYNELLa UZGIRIS-

MDIb PDIb HUNT HOME Comprehension Expression

4 Months

Range ....... 50-131 54-144 0-37 X............ 87.3 93.4 14.4 ......

8 Months

Range....... 50-143 50-124 3-63 . . . ... ... X ........... 94.8 85.4 31.5 ........

12 Months

Range ....... 52-128 50-122 0-41 13-45 ...... X ........... 90.5 82.1 25.2 34.0

18 Months

Range........ 52-140 50-133 20-75 ... X ........... 89.0 88.4 51.9 .. . ... ... 24 Months

Range....... 57-137 50-122 ...... -2.5 to +3.0 -3.0 to +2.0 X ........... 92.3 90.7 ... ... -.1 -.4

a The Reynell scores are standard scores. b In the normative sample on which this scale was developed, 9 was approximately 100 and the SD was 15.



Linda S. Siegel 549

TABLE 2

INTERCORRELATIONS AMONG BAYLEY SCORES

AT DIFFERENT AGES*

MONTHS

MONTHS 8 12 18 24

MDIa

4 ........... .71 .68 .57 .43 8 ........... .67 .50 .37 12 .......... .65 .59 18 .......... .73

PDIa

4 .......... .84 .74 .53 .63 8 ........... .76 .54 .66 12 .......... .55 .60 18 ......... .52

- In the normative sample in which this scale was developed, X was approximately 100 and the standard deviation was approximately 15.

"* All correlations are significant at p < .001.

correlations among the Bayley scores at different ages are shown in table 2. For these and all the correlations reported here, N's ranged between 90 and 115. There is a substantial degree of positive correlation among the Bayley scores. All the correlations are significant (p < .001). Even scores early in development---4 and 8 months-predict Bayley scores at 2 years to a moderately significant degree.

The relationship between the Bayley scores and language development as measured by the Reynell scales is shown in table 3. The Bayley is significantly correlated with language development at 2 years. At 4, 8, and 12 months the PDI (Psychomotor Development Index) scores are more highly correlated with language development than the MDI scores; the MDI scores are more highly correlated at 18 months.

The correlations of the HOME scale with the Bayley and Reynell scores are shown in table 4. While the correlations of the organization of the physical and temporal environment and avoidance of restriction and punishment subscales of the HOME were not significantly correlated with the 2-year scores, most of the remaining scores were significantly but moderately correlated. The correlations of the HOME scale with subsequent scores are typically lower than the correlations of the Bayley or the Uz- giris-Hunt scores with subsequent scores.

Kohen-Raz scoring of the Bayley MDI.-- To test the hypothesis that certain items on the Bayley might be more predictive of later development than others, the Kohen-Raz scoring

system was used. The correlations between these subscales and the Bayley and the Reynell are shown in tables 5 and 6. In several cases shown in the tables, the small range of scores precluded any computation of correlations.

The eye-hand items are significant at all ages. The manipulation items are predictive at

TABLE 3

CORRELATIONS BETWEEN BAYLEY SCORES

AT 4, 8, 12, AND 18 MONTHS AND 2- YEAR REYNELL LANGUAGE SCORES

REYNELL LANGUAGE DEVELOPMENT SCALES

BAYLEY Compre- SCALES hension Expression

4 Months

MDI ....... .34*** .35*** PDI ........ . .44*** .47***

8 Months

MDI....... .30** .26** PDI........ .37*** .39***

12 Months

MDI ....... .45*** .47*** PDI......... .52*** .55***

18 Months

MDI ....... .59*** .60*** PDI........ .53*** .45***

"**p < .01. *** p

TABLE 5

CORRELATIONS OF KOHEN-RAz SUBSCALES OF THE BAYLEY WITH TOTAL BAYLEY SCORE AT 2 YEARS

KOHEN-RAZ SCORING OF THE BAYLEY

24-MONTH Eye-Hand Conceptual Vocalization Imitation and BAYLEY Coordination Manipulation Ability and Social Comprehension

4 Months

MDI........ .47*** .52*** .27** ...a a PDI......... .58*** .64*** .28** ...

8 Months

MDI........ .35*** .23* .43*** .30** .16 PDI......... .49*** .44*** .59*** .44*** .27**

12 Months

MDI......... .54*** .46*** .44*** .42*** .61*** PDI......... .58*** .38*** .45*** .42*** .58***

18 Months

MDI........ .41*** ...a a .51*** .62*** PDI......... .42*** ...... .46*** .47***

a The range is insufficient to calculate these correlations. "*p

Linda S. Siegel 551

4, 8, and 12 months. Conceptual ability is significant at 8 and 12 months; vocalization-social at 8, 12, and 18 months; and imitation-comprehension at 8 (PDI only), 12, and 18 months. A similar predictive pattern emerges in the correlations of the subscales of the Bayley with the Reynell language comprehension and expression scales.

Uzgiris-Hunt.-The correlations among the Uzgiris-Hunt scales and the 24-month Bayley scores are shown in table 7. As can be seen in table 7, many subscales of the Uzgiris-Hunt correlate highly with the Bayley, particularly the means, schemes, conceptual ability, and space subtests. At 18 months the correlations are lower, probably because many of the infants are performing at ceiling level on the tests. For example, for the means subtest, the maximum score was 12 and the mean was 10.4 and, for the gestural imitation subtest, the maximum score was 10 and the mean was 7.96.

Table 8 shows the correlations among the Uzgiris-Hunt scales and the Reynell language scores at 24 months. Certain subscales (e.g., means, space, schemes) are significantly correlated with language development. As with the correlations among the Uzgiris-Hunt and the Bayley, the lack of correlations of 18-month scores are probably a reflection of ceiling effects.

Predicting Developmental Delay A Bayley score of less than 85 has been

used as an indicator of risk (e.g., Field, Hal- lock, Ting, Dempsey, Dabiri, & Shuman 1978). The degree to which infant test scores could predict delayed Bayley scores at 2 years was examined. The following classification scheme was used (Scott 1978): (a) True negatives were children who received scores of > 85 at 2 years and also at the early period, 4, 8, 12, or 18 months-that is, they did not show developmental delay. (b) True positives received scores of < 85 at 2 years and also at 4, 8, 12, or 18 months-that is, they did show developmental delay. (c) False negatives received scores of < 85 at 2 years, but scores of > 85 at 4, 8, 12, or 18 months-that is, they did not score in the risk range at infancy but were delayed at 2 years. (d) False positives received scores of > 85 at 2 years but scores of < 85 at 4, 8, 12, or 18 months, and, thus, they scored in the risk range in infancy but were not delayed at 2 years. The ability of the Bayley to detect these children at risk-that is, children with MDI scores of less than 85 at 2 years-was calculated by combining the percentages of true negatives and true positives. These percentages were as follows: 4-month uncorrected MDI, 71; 4-month corrected MDI, 84; 8-month uncorrected MDI, 77; 8-month corrected MDI, 82; 12-month uncorrected

TABLE 7 CORRELATIONS BETWEEN UZGIRIS-HUNT SCALE IN INFANCY AND BAYLEY SCORES AT 2 YEARS

UZGIRIS-HUNT

BAYLEY AT Object Gestural Vocal 2 YEARS Schemes Relations Means Space Imitation Imitation Total

4 Months

MDI............ .42*** .34*** .49*** .46*** .20 .32*** .49*** PDI............. .56*** .42*** .59*** .55*** .24* .31"** .58***

8 Months

MDI............ .33*** .25** .42*** .38*** .29** .23* .40*** PDI............. .32*** .43*** .58*** .54*** .35*** .30** .57***

12 Months

MDI............ .27** .37*** .30** .43*** .40*** .11 .51** PDI............. .30** .29** .33** .38*** .44*** .07 .46***

18 Months

MDI............ .20 .37*** .15 .23* .09 .14 .41** PDI............. .08 .24* .11 .28* .18 .18 .33*** "* p


MDI, 74; 12-month corrected MDI, 74; 18- month uncorrected MDI, 81; 18-month corrected MDI, 77. The corrected scores were more accurate in the early months, while the uncorrected scores produced more correct clas- sifications at 18 months.

Certain characteristics of the false nega- tive and false positive groups were assessed to determine other factors that contribute to outcome and improve the predictability of infant tests. The HOME scores of the true positives and false positives were analyzed. Scores of less than 85 on the Bayley MDI and more than 1 SD (standard deviation) below the mean on the Reynell were considered as positive for developmental delay. In some cases, the scores of the false positives were significantly higher than the scores of the true positives. These data are shown in table 9. All comparisons are based on t tests. The false positives at 4 months had more responsive mothers; the false positives at 12 months had higher scores in the provision of toys and play materials subscale and in two out of three cases on the total score. Similar comparisons were made for the false and true negatives. There were very few false negatives (4-6 depending on the age and test), so that many of the comparisons were not statistically significant. In some cases the false negatives had significantly lower HOME scores than the

true negatives: for example, 12-month HOME total using the Bayley MDI as outcome, t(53) = 1.93, p

Linda S. Siegel 553

TABLE 9

MEAN HOME SCORES OF THE TRUE AND FALSE POSITIVES

REYNELL REYNELL BAYLEY MDI COMPREHENSION EXPRESSION

True False True False True False SUBSCALES OF THE HOME Positive Positive Positive Positive Positive Positive

4 Months

Maternal responsiveness......... 7.8 9.6*** 7.8 9.6*** 7.1 9.8*** Avoid restriction/punishment ... 5.1 6.4 5.5 6.0 5.0 6.5* Organization of environment.... 5.3 5.6 5.0 5.6 5.1 5.6 Provision of play materials ..... 7.0 7.6 7.3 7.3 7.0 7.6 Maternal involvement ......... 3.1 4.0 2.5 3.9 2.6 4.2* Variety of stimulation.......... 2.4 3.2 2.0 3.2 2.1 3.3

Total HOME score .......... 30.6 33.4 29.6 32.4 29.0 34.0

12 Months

Maternal responsiveness........ 8.9 9.5 9.0 9.2 9.1 9.2 Avoid restriction/punishment... 6.4 7.5* 6.7 7.0 6.5 7.3 Organization of environment.... 4.9 5.7 4.5 5.6 4.9 5.7 Provision of play materials ..... 5.9 8.3** 5.2 7.8 6.0 8.2 Maternal involvement ......... 2.7 4.3 1.7 4.2** 2.8 4.1 Variety of stimulation.......... 2.5 4.0 2.3 3.7 2.8 3.7

Total HOME score .......... 25.6 39.3** 29.5 33.0 26.6 38.2**

*p < .05. "**p < .01. *** p < .001.

TABLE 10

MEAN BAYLEY SCORES OF DELAYED AND

NONDELAYED INFANTS AT 2 YEARS

Non- delayed Delayed*

4 Months

MDI......... 92.96 72.71 PDI.......... 101.05 78.71

8 Months

MDI......... 101.56 77.84 PDI........... 92.23 69.77

12 Months

MDI......... 97.69 73.52 PDI.......... 87.97 68.22

18 Months

MDI......... 97.96 71.15 PDI.......... 93.33 81.63

"* All I tests of the comparisons between the delayed and the nondelayed infants were significant at p < .001.

Hunt total scores differentiated between the delayed and the nondelayed at each age. The following subscales differentiated between the groups: 4 months, schemes, object relations, means, space, vocal and gestural imitation; 8 and 12 months, schemes, object relations, means, space, gestural imitation; 18 months, object concept, means, and causality.

A number of the scales distinguished the infants who were subsequently to show delays in language at 2 years from those whose language scores at 2 years were in the normal range. The Bayley (MDI and PDI) and Uzgiris- Hunt total scores at all ages differentiated these two groups, as did the Uzgiris-Hunt subscales and object relations scores at 4, 8, 12, and 18 months; means at 4 and 8 months; space at 4, 8, 12, and 18 months; vocal imitation at 4, 8, 12, and 18 months; and gestural imitation at 8, 12, and 18 months.

The following Kohen-Raz subscales differentiated between the language- and nonlan- guage-delayed children at 2 years; eye-hand coordination at 4, 8, 12, and 18 months; manipulation at 4, 8, and 12 months; object relations at 8 and 12 months; imitation-comprehension at 12 and 18 months; vocalization- social at 8, 12, and 18 months.




The ability of infant tests to predict children with specific language delay was defined as cognitive functioning in the normal range (Bayley MDI_> 85 at 2 years), but with Rey- nell comprehension and/or expression scores more than 1 SD below the mean for chronological age. When the children with delayed language were compared with children who had age-appropriate language, the specifically language-delayed children had lower Bayley PDI scores at 4 months and lower Bayley MDI and PDI scores at 12 and 18 months. The following Kohen-Raz subscales differentiated between the delayed and nondelayed language groups: at 4 months, eye-hand and manipulation; and, at 18 months, imitation-comprehension and vocalization-social. The following Uz- giris-Hunt scales differentiated between the specific language-delayed and nondelayed language groups: at 4 months, schemes; at 8 months, schemes and space; and at 18 months, schemes and gestural imitation.

Discussion The findings of this study indicate that

the Bayley and Uzgiris-Hunt test scores are significantly correlated with cognitive and language scores at 2 years and are also reasonably accurate at detecting infants who are at risk for developmental delay. While these relationships have been assessed only up to 2 years, there is evidence that 2-year Bayley scores are highly correlated with IQ test scores at later ages (e.g., Gannon 1968; Geoffeney, Hender- son, & Butler 1971; Hunt 1976; Ramey, Camp- bell, & Nicholson 1973; Wilson 1973, 1974, 1978a, 1978b). The relationships cannot easily be attributed to the effects of repeated testing.

Haskins, Ramey, Stedman, Blacher-Dixon, and Pierce (1978) have found that repeated testing on the Bayley every 3 months between 4 and 28 months did not affect Stanford-Binet scores at 31 months.

A number of the Uzgiris-Hunt subscales predicted cognitive development at 2 years as measured by the Bayley. For example, the means and space concepts subscales were predictive at 4, 8, and 12 months, and the object relations subscale at 4, 8, 12, and 18 months. Similar to the findings by King and Seegmiller (1973), the Uzgiris-Hunt test is most predictive below 18 months. The restricted range of scores of many of the subscales probably contribute to this lack of predictability. These tests can be viewed as tests of problem-solving ability, and the significant correlations at different

ages indicate certain continuities in mental development.

The infant tests also predicted language development. The object relations items are predictive of language development, indicating that the rudimentary symbolic functions involved in searching for a vanished object may be precursors of language development, as predicted by Moore and Meltzoff (1978). The means subtest was also correlated with language development; this subtest measures aspects of the child's understanding of the man- ner in which he or she can manipulate and control the environment. This ability may be a precursor of the skills involved in understanding the communicative functions of language (e.g., Bates et al. 1976). The gestural and vocal imitation scores were, in some cases, significantly correlated with language development, but these correlations were of a lower magnitude than those involving the means and object relations subtests.

The motor scale (PDI) of the Bayley was more predictive of language development than the mental scale (MDI) until 18 months. In 1897, Baldwin reported a relationship between motor development and language development based on observations of his own children (Baldwin 1897). Ramey et al. (1973) reported data suggesting a relationship between motor development and language development. They found that the Bayley PDI was more correlated than the MDI with a subsequent measure of language development, the Illinois Test of Psy- cholinguistic Abilities. This relationship sup- ports the contention of Lenneberg (1967) that language and motor development are closely related because of a possible large maturational component in language development.

With a division of the Bayley into subscales, a clear pattern emerged in the prediction of cognitive and language development. This pattern is such that the perceptual-motor items tend to be predictive early, the object relations and similar items become predictive later on, and, finally, the language-related items (imitation-comprehension and vocalization-social) become predictive at 12 and 18 months. The items that differentiated children who subsequently showed developmental delay from those who did not were initially perceptual- motor (Kohen-Raz manipulation and eye-hand coordination), then conceptual (object relations, schemes, and mean), and, finally, imitation-vocalization. In terms of differentiating specific language delay as compared to a more



Linda S. Siegel 555

global cognitive delay, some perceptual-motor items at 4 months (Bayley PDI, Kohen-Raz eye-hand coordination and manipulation) differentiated among infants who were subsequently to develop a specific language delay at two years; conceptual items differentiated at 8 and 12 months (schemes and space); and language-related functions differentiated at 18 months (Kohen-Raz imitation-comprehension and vocalization-social, and Uzgiris-Hunt gestural imitation).

The pattern of results can support a maturational lag hypothesis proposed by Satz and his associates (e.g., Satz & Friel 1973). This theory postulates that developmental disorders may represent a maturational lag, not a deficit, and this lag may be reflected in younger children showing delays in skills which develop earlier (e.g., visual-perceptual functioning), while older children manifest delays in skills which develop later (e.g., language). The results of the present study support this type of theoretical analysis. Children who showed general cognitive delay or specific language delay were initially delayed in perceptual-motor functions; then in simple cognitive skills; and, finally, in language comprehension, vocal imitation, and vocalization. As early as 4 months, delay in perceptual-motor functions which appear to be quite different from language or complex cognitive functioning were related to Bayley and Reynell language scores at 2 years. A maturational delay manifests itself in whatever behavior is predominant at that developmental stage, and these delays are significant in terms of forecasting later delays in more complex behavior. This theoretical analysis is similar to that proposed by McCall et al. (1977) in their description of infant development. According to their analysis, perceptual-motor exploration is important in the first 7 months, the understanding of means-end relationships and inten- tion is important at 8-13 months, the use of representation instead of action develops at 14-18 months, and true symbolic functioning and understanding of relationships develops at 18 months. The predictive factors of infant tests fit into this model.

While the correlations between infant test scores and later development are statistically significant, the infant tests accounted for, at best, 50% of the variance. Other factors are obviously needed to predict developmental out- comes. Some of the results suggest the possible importance of environmental factors. Infants who were performing in the risk range early

in development but whose subsequent development at 2 years was normal, the false positives, came from more stimulating environments as measured by the HOME scale. The environment may have been one factor in overcoming their poor performance. In addition, infants who were not detected as being at risk early in development but showed developmental delay at 2 years, the false negatives, came from homes which provided less stimulation. This pattern of results suggests the possible significant effects of early environment. When the infant tests incorrectly detected developmental lag at 4 months, maternal responsiveness as measured by the HOME was a significant factor. When developmental delay was incorrectly detected at 12 months, toys and play materials were significant factors. This pattern of findings, particularly if it is corroborated by subsequent research, suggests that the most effec- tive environmental intervention differs as a con- sequence of the child's developmental level. Responsive and stimulating caregiving may be important in the early months, while play with stimulating toys may be more important later on in the first year. This pattern was particularly strong in the case of language expression, such that responsive caregiving may be important for the early stimulation and reward of the production of sounds, while the cognitive abilities (e.g., problem solving, object permanence), which are stimulated by toys, become particularly important for later language development. In any case, the HOME scale ap- pears to be assessing some dimension not com- pletely tapped by infant tests. These results also support the transactional model proposed by Sameroff and Chandler (1975) in which there are mutual influences between the child and his environment. Infant tests of the child's development and analyses of the child's environment appear to be useful tools in the detection of infants at risk for delays in cognitive and language development.

Combined with measures of the environment, infant tests are predictive of subsequent cognitive and language development.

Reference Notes

1. Siegel, L. S.; Saigal, S.; Rosenbaum, P.; Young, A.; Berenbaum, S.; & Stoskopf, B. Corre- lates and predictors of cognitive and language development of very low birthweight infants. Paper presented at the meeting of the Society for Research in Child Development, San Fran- cisco, March 1979.




2. Siegel, L. S.; Cunningham, C. E.; & van der Spuy, H. I. J. Interaction of language delayed and normal preschool children with their mothers. Paper presented at the meeting of the Society for Research in Child Development, San Francisco, March 1979.

3. van der Spuy, H. I. J.; Siegel, L. S.; & Cun- ningham, C. E. The effects of a classroom program on the language development of children with delayed language. Unpublished manuscript, McMaster University, 1979.

4. House, A. M., & Neville-Smith, C. Home cen- tered videotaped counselling for parents with hearing impaired children (0-5 years of age) in rural Newfoundland and Labrador. Unpub- lished manuscript. (Available from Dr. L. Chambers, Department of Epidemiology and Biostatistics, McMaster University Health Sci- ences Centre.)

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Article Contentsp. [545]p. 546p. 547p. 548p. 549p. [550]p. 551p. 552p. 553p. 554p. 555p. 556p. 557

Issue Table of ContentsChild Development, Vol. 52, No. 2, Jun., 1981Front MatterAn Editorial NoteReviewsThe Analysis of Dominance and Bidirectionality in Social Development [pp. 393 - 412]Origins of Human Competence: A Cultural-Ecological Perspective [pp. 413 - 429]

An Investigation of Factors Contributing to the Apparent Overselective Responding of Mentally Retarded Children [pp. 430 - 442]Lateral Preference Behaviors in Preschool Children and Young Adults [pp. 443 - 450]Children's Left-Right Concepts: Generalization across Figure and Location [pp. 451 - 456]The Role of Symmetry in Infant Form Discrimination [pp. 457 - 462]A Longitudinal Study of Prism Adaptation in Infants from Six to Nine Months of Age [pp. 463 - 469]Language Effects in Assessment of Class-Inclusion Ability [pp. 470 - 478]Processing and Memory Factors in Children's Reading Comprehension Skill [pp. 479 - 488]The Origins of Concept Formation: Object Sorting and Object Preference in Early Infancy [pp. 489 - 497]Children Talk about the Time and Aspect of Actions [pp. 498 - 506]Learning to Communicate from Models: Children Confuse Length with Information [pp. 507 - 513]Causal Reasoning as a Function of Behavioral Consequences [pp. 514 - 522]The Development of the Conception of Economic Inequality. I. Descriptions and Comparisons of Rich and Poor People [pp. 523 - 532]Stability of Behaviorally Induced Heart-Rate Changes in Children after One Week [pp. 533 - 537]How Adolescents Approach Decisions: Changes over Grades Seven to Twelve and Policy Implications [pp. 538 - 544]Infant Tests as Predictors of Cognitive and Language Development at Two Years [pp. 545 - 557]Discrimination of Strangers by the Three-Month-Old [pp. 558 - 563]The Developmental Course of Behavioral States in Preterm Infants: A Descriptive Study [pp. 564 - 568]Measurement of Temperament in Infancy [pp. 569 - 578]Behavioral Contrasts in Twinships: Stability and Patterns of Differences in Childhood [pp. 579 - 588]Birth-Order Differences in Peer Sociability at Thirty-Three Months [pp. 589 - 595]Neglected Children: Mothers' Report of Child Behavior Problems and Observed Verbal Behavior [pp. 596 - 602]Full- versus Half-Day Preschool Attendance: Effects in Young Children as Assessed by Teacher Ratings and Behavioral Observations [pp. 603 - 610]Pretend Play and Patterns of Cognition in Down's Syndrome Children [pp. 611 - 617]The Role of Inanimate Objects in Early Peer Interaction [pp. 618 - 626]Social Interaction in Hearing and Deaf Preschoolers: Successes and Failures in Initiations [pp. 627 - 635]Effects of Friendship on Prosocial Intentions and Behavior [pp. 636 - 643]Social Participation of Preschool Children in Same- versus Mixed-Age Groups [pp. 644 - 650]Indeterminate and Sequential Goal Structures in Relation to Task Performance in Children's Small Groups [pp. 651 - 659]Adult Reactions to Children's Cross-Gender Verbal Behavior [pp. 660 - 666]Gender Constancy and the Effects of Sex-Typed Televised Toy Commercials [pp. 667 - 673]Self-Control and Altruism: Delay of Gratification for Another [pp. 674 - 682]Developmental Changes in the Formation and Organization of Personality Attributions [pp. 683 - 691]Social Factors Influencing Absenteeism due to Illness in Nursery School Children [pp. 692 - 700]Brief ReportsThe Effects of Family Constellation and Child Gender on Parental Use of Evaluative Feedback [pp. 701 - 704]Two's Company, Three Makes a Difference: An Examination of Mothers' and Fathers' Speech to Their Young Children [pp. 705 - 707]The HOME Inventory: A Validation of the Preschool Scale for Black Children [pp. 708 - 710]Correlations between Sociability and Cognitive Performance among Eight-Month-Olds [pp. 711 - 713]Recognition of Mother's Photographed Face by the Three-Month-Old Infant [pp. 714 - 716]Selective Imitation of Same-Age, Older, and Younger Peer Models [pp. 717 - 720]Effects of Interpersonal Distance on Children's Vocal Intensity [pp. 721 - 723]The Pursuit of Mastery by Preschool Boys and Girls: An Observational Study [pp. 724 - 727]"Metaphorical" Mapping in Human Infants [pp. 728 - 731]Semantic Integration and the Development of Memory for Logical Inferences [pp. 732 - 735]Social Class Differences in Preschool Children's Comprehension of "Wh"-Questions [pp. 736 - 740]Children's Use of the Discounting Principle in Their Perceptions of Exertion [pp. 741 - 744]The Affective Response of Down's Syndrome Infants to a Repeated Event [pp. 745 - 748]The Averaged Evoked Potential in the Study of Infant Auditory Discrimination [pp. 749 - 751]The Theoretical Distribution of Evoked Brainstem Activity in Preterm, High-Risk, and Healthy Infants [pp. 752 - 754]Generalization of a Modified Food Preference [pp. 755 - 758]

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