Development tests are tools that are used to help measure a child's developmental progress from infancy through adolescence .
Every child develops at an individual pace. However, development tests may help to discriminate between normal variations in development among children and early signs of a developmental problem. About 16 percent of children have some form of developmental difficulty or delay, and more than 500,000 American children are assessed for early-intervention programs every year.
Development tests have different purposes depending on the age of the child and may be administered under a variety of circumstances. They are designed according to the expected skills of children at a specific age. The tests range from the passive evaluation of an infant to the complex testing of adolescents.
Development testing begins at birth in order to identify any problems as early as possible and try to correct them. The testing of a newborn can be used to detect neurological problems such as cerebral palsy . Testing continues with well-baby visits to the pediatrician. Although there are various schedules for routine well-child visits, the American Academy of Pediatrics recommends visits at the following ages:
- two to four days after birth or discharge from the hospital
- one month
- two months
- four months
- six months
- nine months
- 12 months
- 15 months
- 18 months
- yearly between the ages of two and six
- eight years
- ten years
- yearly until age 21
Many daycare centers and preschools use development tests. Most schools administer school readiness tests before admission. Many states and metropolitan school districts have devised or adapted their own development tests to be administered by schools. Development tests are also used to identify specific social or academic problems.
Developmental assessments usually combine standardized tests and observations to cover all aspects of a child's development, including the following:
- motor skills
- language development
- mental development
- social/emotional development
- self-help skills, including dressing and toileting
The types of developmental assessment include:
- developmental screening to identify children with special needs or who may be at risk for developmental delays or school difficulty
- diagnostic evaluation, if indicated by the screening, to confirm the presence and extent of a disability
- readiness tests to assess a child's specific skills and information
- observational and performance assessments to provide ongoing information about a child's development
Developmental screening tests usually are brief, general, play-based tests of skills. Screenings include tests administered to the child by an educator or healthcare professional and questionnaires for parents or childcare providers that inquire about developmental milestones. Screening tests only try to identify children who may have one or more problems. A screening test is not a diagnosis. Rather it may indicate that a child should be referred for developmental assessment or evaluation.
Developmental evaluations are lengthy, in-depth assessments of a child's skills. They are administered by trained professionals. They provide a profile of a child's strengths and weaknesses in all developmental areas and may be used to determine if the child is in need of an early-intervention and/or treatment program.
Readiness tests measure the extent to which a child has acquired certain skills for successfully undertaking some new learning activity. Although school-readiness tests may concentrate on academic skills, most of them also evaluate other aspects of development.
A multitude of different development tests address every aspect of development at every age. They vary greatly in their reliability or validity (how consistently the test measures what it purports to measure). Many widely used tests have been administered, analyzed, and revised by professionals over a period of years. These, as well as new development tests, undergo frequent examination and review for reliability and validity. Other tests are devised by individuals and sold to parents over the Internet. Parents administer these tests to their child and return them for evaluation.
Some tests use developmental ages to describe a child's physical, perceptual, social, and emotional maturity. Development tests do not necessarily correlate in any way with intelligence tests. A standardized development has the following features or functions:
- attempts to obtain a systematic sample of a child's performance under prescribed conditions
- is scored by defined rules
- enables professionals to compare a child's performance to the performance of every other child who takes the same test
- has defined norms (averages, means, or patterns) that are regarded as typical for the specific population being tested
Some development specialists use a standard battery of tests. Others customize tests for the individual child, choosing the most appropriate. A written evaluation of the child is based on the child's test results. Standardized tests for infants and toddlers may be used to assess social, emotional, and intellectual development. Such tests usually consist of presenting a variety of tasks to the child, from very simple to challenging, in order to assess the child's full range of skills.
Types of development tests include the following:
- infant development scales
- sensory-motor tests
- speech and hearing tests
- neuropsychological tests that measure neurological functioning
- preschool psychoeducational batteries
- early screeners
- developmental surveys or profiles
- early learning profiles
- kindergarten or school readiness tests
- tests of play behavior
- social skills and social acceptance tests
Sensory-motor tests include general or specific measures of each of the five senses and gross motor skills (large muscle movement and control), fine motor skills (hand and finger skills), and hand-eye coordination . The development of motor skills generally progresses from head to toe. Thus babies usually gain control of their body parts in the following order:
- head and neck at about two months of age
- arms and hands, with grasping at about three months
- trunk, with sitting well by about eight months
- legs and feet, with most children walking by 14 or 15 months
Sensory-motor tests may include:
- visual acuity
- visual perception and organization
- color discrimination or color blindness
- visual-motor skills
- sensory integration
- perceptual skills
- perceptual-motor skills
- motor development
- movement and posture
- manual dexterity
An audiologist may test an infant or young child for signs of hearing impairment or loss, usually by transmitting sounds through earphones. Speech and hearing tests measure the mechanics of speaking and hearing the spoken word. These include tests for the following:
- auditory discrimination and comprehension
- speech perception and discrimination
- voice fluency
- hearing loss or impairment
There are countless development tests designed for children from birth to about seven years of age, as well as tests for assessing development in disabled school-age children. The tests measure various skills, including the following:
- gross motor skills
- fine motor skills
- number concepts
- letter recognition
- social competence
Development tests are performed at each well-baby visit to the healthcare provider. Children are weighed and measured for height and head circumference. The results may be plotted on a growth chart that is specific for the child's age and gender (EpicCare Growth Chart) and compares a child's growth to other children of the same age and gender. The pediatrician may check the child's eyesight and hearing and ask various questions about the child's development, including the following areas:
- eating and sleeping patterns
- head control
- response to voices
- voice recognition
- eye focusing
- strength and coordination
THE BRAZELTON TEST In 1973 Harvard University pediatrician T. Berry Brazelton and his colleagues developed the Neonatal Behavioral Assessment Scale (NBAS), commonly known as "the Brazelton." It is based on the assumption that babies are highly capable at birth and communicate through their behavior. Test examiners are trained to support the infant in achieving the best possible scores. The test assumes that infants are born with four major developmental tasks:
- regulation of their autonomic nervous systems, including breathing and temperature regulation
- controlling their motor systems
- controlling their states or levels of consciousness
- social interaction
The NBAS examines a wide range of behaviors in newborns up to two months of age, creating a portrait of the infant's strengths, adaptive responses, possible vulnerabilities, and individuality. It tests 28 behavioral and 18 reflex items, including the following:
- signals that may overtax the infant, such as looking at the mother's face, noise, startles, or color changes
- muscle tone, reflexes, and activity levels
- ability to follow a red ball, a face, or a voice
- ability to control his or her state of consciousness and transitions between states
The examiner tests the infant's response to light, sound, or touch during sleep and the infant's ability to block out stimulation during sleep. The states examined are as follows:
- quiet sleep
- active sleep
- drowsy waking
- quiet alert
- active crying
CLINICAL NEWBORN BEHAVIORAL ASSESSMENT SCALE (CLNBAS) The Clinical Newborn Behavioral Assessment Scale (CLNBAS), based on the NBAS, was developed in 2004 for use by clinicians. It is conducted in the presence of the parents. It focuses on the baby's individuality and unique adaptive or temperamental style and is designed to develop parent-infant and clinician-family relationships.
Ages and stages questionnaires are used to identify infants and young children who may need further evaluation. These questionnaires are completed by the parent or primary caregiver and are administered at the following ages:
- two-month intervals between the ages of four and 24 months
- three month intervals between the ages of 24 and 36 months
- six-month intervals between the ages of 36 and 60 months
Development tests for infants and toddlers usually include testing for the typical sequence of development that most children go through; for example, most children crawl before they walk and eat with their fingers before using utensils. These tests often are administered by a development assessment specialist, a developmental pediatrician, or an early-childhood special educator. The tests may measure developmental domains that include the following:
- gross motor development
- fine motor development
- language/communication and speech
- relationships to toys and other objects, to people, and to the larger world
- coping behavior
- self-help skills
ARNOLD L. GESELL TESTS One of the earliest development tests was designed by Arnold L. Gesell, who founded the Clinic of Child Development at Yale University in 1911. By observing and filming infants and young children, and analyzing their functioning by studying the films frame by frame, Gesell delineated 10 normal stages of early childhood development. Gesell's tests include:
- Gesell Developmental Schedules
- Gesell Child Developmental Age Scale (GCDAS)
- Gesell Preschool Test to measure relative maturity in four basic fields of behavior
- Gesell Developmental Observation to assess a child's developmental age for grade placement and the development of instructional programs
NANCY BAYLEY SCALES OF INFANT DEVELOPMENT Developmental psychologist Nancy Bayley authored the Bayley Scales of Infant Development in the mid-twentieth century. Her mental scale evaluates various abilities, yielding a normalized standard score called the Mental Development Index. The Bayley Scales of Mental and Motor Development are used worldwide as standardized measures of infant development at eight months of age. The motor scale assesses:
- the degree of body control
- large-muscle coordination
- fine-motor manipulatory skills
- postural imitation
- motor quality
The behavior rating scale consists of 30 items, which measure the following:
- emotional regulation
- test-taking behaviors
OTHER TESTS Other infant/toddler development tests include:
- Peabody Developmental Gross Motor Scale for infants
- Bury Infant Check to help identify children with special needs
- Infant Monitoring System for children aged four months to 36 months
- Early Coping Inventory of 48 items on sensory-motor organization, reactive behavior, and self-initiated behavior that are used to assess everyday coping strategies in children between the ages of four and 36 months
Developmental milestones are widely used tests for development in infants and children of all ages. Milestones in preschoolers evaluate the development of the following skills:
- gross motor skills
- fine motor skills
- language and communication
- emotional and social competency
- thinking, reasoning, and problem solving
- reading and writing
The milestone test uses collection forms that are completed by a parent, caregiver, or educator on a monthly basis. The forms cover family , friends, and milestones corresponding to a specific area of development. They include a photo or anecdote that illustrates the activity corresponding to the milestone. The forms request that the activities be categorized according to the following descriptors:
- a new task
- a familiar task
- performed independently
- performed with adult guidance
- performed with peers
- one to five minutes in duration
- five to 15 minutes in duration
- more than 15 minutes in duration
Children who are slow to reach developmental milestones in one area may be ahead of their age in other areas. Sometimes developmental milestones are used as part of an assessment method known as minimum adequate surveillance that combines simple testing with the collection of relevant data.
TYPES OF PRESCHOOL TESTS The Assessment, Evaluation, and Programming System (AEPS) for infants and children often is used to test three to six-year-olds. Using activity stations in a school setting, the test measures skills such as balance, mobility, standing, and walking as well as play skills. The AEPS consists of the following:
- a 98-item family report on functional and social skills used in the child's everyday environment
- 87 cognitive items
- 49 social/communicative items
- 33 social items
- 39 adaptive items
- eight gross motor items
- four fine motor items
Other development tests that frequently are administered to preschoolers include the following:
- Griffith's mental development scales, which measure gross motor skills, personal-social development, hand and eye coordination, and performance, providing a general developmental quotient (GDQ) and separate subquotients (DQs) for each area of development
- Mullen Scales of Early Learning (MSEL), a comprehensive assessment of language, motor, and perceptual abilities in children from birth to five years, eight months of age
- Vineland Social-Emotional Early Childhood Scales
The Denver Developmental Screening Test (DDST) is a widely-used test of motor, language, speech, and interpersonal skills for children from birth to six years of age. It is used by physicians in well-baby visits and may include parental questionnaires.
Other screening tests include the following:
- Infant Developmental Screening Scale
- ages and stages questionnaires
- Battelle Developmental Inventory (BDI) screening test for screening, preliminary assessment, and/or initial identification of possible developmental strengths and weaknesses
- Brigance Early Preschool Screen for two-year-old and two-and-a-half-year-old children
- Brigance K and 1 Screen for kindergarten and first-grade children
- Miller FirstSTEP Screening Test for evaluating preschoolers
- Preschool Development Inventory, a brief screening inventory to help identify children with developmental, behavioral, or health problems
- Children at Risk Screener: preschool and kindergarten
- Early Screening Inventory for children aged three to six
- Howell Prekindergarten Screening Test
- Humanics National Child Assessment Form
- Kindergarten Screening Inventory
- Milani-Comparetti Motor Development Screening Test
Readiness tests include the following:
- ABC Inventory to Determine Kindergarten and School Readiness
- Developmental Tasks for Kindergarten Readiness
- Kindergarten Readiness Test
- Phelps Kindergarten Readiness Scale
- Pediatric Examination of Educational Readiness at Middle Childhood
Communication development tests include the following:
- Sequenced Inventory of Communication Development for testing various early communication skills and assigning a communication age
- Assessing Semantic Skills Through Everyday Themes for preschool and early-elementary-aged children
- Expressive One-Word Picture Vocabulary Test to measure a child's ability to verbally label objects and people; a standardized test that yields age equivalents, standard scores, scaled scores, and percentile ranks
- Receptive One-Word Picture Vocabulary Test to provide information about a child's ability to understand language; a standardized test that yields age equivalents, standard scores, scaled scores, and percentile ranks
- Early Language Milestone (ELM) Scale to measure language development in children from birth to three years of age
- Peabody Picture Vocabulary Test, called "the Peabody," a short test that measures vocabulary in two-and-a-half to four-year-olds; sometimes used for screening
Speech and hearing tests include the following:
- Early Speech Perception Test
- Joliet 3-Minute Preschool Speech and Language Screen
- Fluharty Preschool Speech and Language Screening Test to identify preschool children who may warrant a comprehensive communication evaluation
- Assessing Linguistic Behaviors, Assessing Prelinguistic and Early Linguistic Behaviors in Developmentally Young Children
- Assessment of Fluency in School-Age Children
- Children's Articulation Test
- Clinical Evaluation of Language Fundamentals
- Phonological Assessment of Child Speech
Intelligence tests attempt to measure a child's ability to learn. Many such tests generally measure what a child has already learned. Results of these tests may be represented on a scale, as a mental age, or as an intelligence quotient (IQ). Some research indicates that IQ tests for children aged 18 to 20 months are not good indicators of future or even current abilities and that they usually measure motor rather than mental skills. However, other research has indicated that IQ tests in children as young as six months are good predictors of school IQ test results years later.
Frequently used intelligence tests include the following:
- Wechsler Preschool and Primary Scale of Intelligence for children aged three to seven years with norms for 17 age groups at three-month intervals
- Wechsler Intelligence Scale for Children
- Differential Ability Scales (DAS), for measuring overall cognitive ability and specific abilities in children aged two years and six months to seventeen years and eleven months
- Stanford-Binet Intelligence Scale for ages two years to adult, for scoring verbal reasoning, abstract and visual reasoning, quantitative reasoning, and short-term memory and yielding a composite score with a mean of 100
The Columbia Mental Maturity Scale (CMMS) does not depend on reading skills. The child makes perceptual discriminations involving color, shape, size, use, number, missing parts, and symbolic material. It appears to measure general reasoning ability, although there is some evidence that it is more a test of the ability to form and use concepts than a test of general intelligence. It provides standard age deviation scores for chronological ages between three years and six months and nine years and eleven months. The Maturity Index indicates the age group of the child in terms of test performance.
The Test of Nonverbal Intelligence is a quick, language-free measure of cognitive ability in children aged five years and older. It contains 55 problem-solving tasks of progressively increasing difficulty. It often is used for assessing children with speech, language, or hearing impairments, academic handicaps, or brain impairments, and for children who do not speak English. The Merrill-Palmer Scale of Mental Tests (MPSMT) is widely used as a nonverbal test for assessing visual-spatial skills in children aged one year and six months to six years.
Designing child development tests presents numerous difficulties that may affect the results, including the following:
- motivating the child
- keeping the child's attention
- not discriminating among children
Some healthcare and education professionals are concerned that children are being over-tested, overscreened, and overanalyzed. Some experts question the use of conventional early childhood development tests for the following reasons:
- Young children are inexperienced at test-taking.
- High-stakes tests, such as those that influence major educational decisions, can have long-term negative consequences for children.
- Tests may be too narrow or one-dimensional.
- Teaching and learning may be negatively affected because of a focus on test results.
- There are major differences in the learning opportunities available to children.
- Sometimes tests are used for purposes other than those for which they were designed.
The parent, the person who knows the child best, should participate in development tests as much as possible. Tests should be explained to parents who can then explain them to their children in terms that they will understand. The parents' feelings and personal observations should be considered when evaluating a child's development.
The major risk of development tests is that some children may be labeled in inappropriate ways because of their test results. Development tests are not infallible. Developmental screenings may over- or under-identify children with developmental delays. For example, some children who under-perform on a school readiness test go on to perform very well in school. Development tests may become outdated because of new, improved methods. Other tests may be found to be unreliable. Development tests must keep pace with demographic changes in the United States, in order to meet the needs, for example, of large numbers of young children who speak languages other than English.
The range of normal development is very large. No two children develop at exactly the same rate. Children reach developmental milestones on their individual schedules and at their own pace. Some children completely skip developmental milestones such as rolling over or crawling . Although some children begin walking at eight months, others do not walk until 18 months; both are within the normal range. Children also may regress periodically. For example, children who sleep through the night may begin waking up often as they learn to talk.
Although development tests often are used to reassure parents that their child is normal, many parents may feel anxious or defensive when told that their child should be tested. Parents should try to become active participants in their child's testing and understand the testing process and terminology. Increasingly parents and other family members are joining healthcare professionals and educators in administering development tests.
ZERO TO THREE: National Center for Infants, Toddlers, and Families recommends the following:
- Young children should not be separated from their parent or caregiver during testing since separation can cause anxiety.
- Children should not be assessed by a person they have just met for the first time.
- Tests should not be limited to easily measured factors such as motor or cognitive skills.
- Normative tests or milestone scales should not be the major basis for the developmental assessment of infants and young children.
Development tests can provide parents with a better understanding of their child's development and any possible need for intervention. Parents should feel free to disagree with test results and participate in further discussions concerning their child's development.
When to call the doctor
A pediatrician should be consulted if any of the following occurs:
- an infant's growth or development seems abnormal
- an infant or child seems to be losing developmental milestones
Developmental assessment —The ongoing process of testing, observing, and analyzing a child's skills.
Developmental domains —Areas of a child's development.
Diagnostic testing —Testing performed to determine if a person has a particular disease.
Intelligence test —A questionnaire or series of exercises designed to attempt to measure intelligence.
Readiness test —A test that measures the extent of a child's acquired skills for successfully undertaking a new learning activity such as kindergarten.
Screening —A process through which carriers of a trait may be identified within a population.
Standardized test —A test that follows a regimented structure, and each individual's scores may be compared with those of groups of people. In the case of the Cognistat, test taker's scores can be compared to groups of young adults, middle-aged adults, the geriatric, and people who have undergone neurosurgery.
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American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site: http://www.aap.org.
The Brazelton Institute. Children's Hospital Boston, 1295 Boylston Street, Suite 320, Boston, MA 02215. Web site: http://www.brazelton-institute.com.
Buros Center for Testing. University of Nebraska-Lincoln, Lincoln, NE 68588. Web site: http://www.unl.edu/buros/index.html.
Child Development Institute. 3528 E. Ridgeway Road, Orange, CA 92867. Web site: http://ww.cdipage.com/index.htm.
Children's Institute. 27 N. Goodman St., Suite D103, Rochester, NY 14607. Web site: http://www.childrensinstitute.net.
ZERO TO THREE: National Center for Infants, Toddlers and Families. 2000 M Street NW, Suite 200, Washington, DC 20036. Web site: http://www.zerotothree.org.
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Margaret Alic, Ph.D.