Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi; Department of Pediatrics & Child Health, Queen Elizabeth Central Hospital, Blantyre, Malawi.
Eur J Paediatr Neurol. 2014 Mar;18(2):223-30. doi: 10.1016/j.ejpn.2013.11.011. Epub 2013 Dec 31.
Most psychometric tests originate from Europe and North America and have not been validated in other populations. We assessed the validity of United States (US)-based norms for the Bayley Scales of Infant and Toddler Development-III (BSID-III), a neurodevelopmental tool developed for and commonly used in the US, in Malawian children.
We constructed BSID-III norms for cognitive, fine motor (FM), gross motor (GM), expressive communication (EC) and receptive communication (RC) subtests using 5173 tests scores in 167 healthy Malawian children. Norms were generated using Generalized Additive Models for location, scale and shape, with age modeled continuously. Standard z-scores were used to classify neurodevelopmental delay. Weighted kappa statistics were used to compare the classification of neurological development using US-based and Malawian norms.
For all subtests, the mean raw scores in Malawian children were higher than the US normative scores at younger ages (approximately <6 months) after which the mean curves crossed and the US normative mean exceeded that of the Malawian sample and the age at which the curves crossed differed by subtest. Weighted kappa statistics for agreement between US and Malawian norms were 0.45 for cognitive, 0.48 for FM, 0.57 for GM, 0.50 for EC, and 0.44 for RC.
We demonstrate that population reference curves for the BSID-III differ depending on the origin of the population. Reliance on US norm-based standardized scores resulted in misclassification of the neurological development of Malawian children, with the greatest potential for bias in the measurement of cognitive and language skills.
大多数心理测试源于欧洲和北美，尚未在其他人群中进行验证。我们评估了基于美国的贝利婴幼儿发展量表第三版（BSID-III）的常模在美国的有效性，BSID-III 是一种为美国开发并广泛使用的神经发育工具，适用于马拉维儿童。
我们使用 167 名健康马拉维儿童的 5173 项测试分数构建了认知、精细运动（FM）、粗大运动（GM）、表达性沟通（EC）和接受性沟通（RC）子测试的 BSID-III 常模。使用广义加性模型对位置、比例和形状进行建模，年龄连续建模。标准 z 分数用于分类神经发育迟缓。使用加权 kappa 统计量比较使用美国和马拉维常模对神经发育的分类。
对于所有子测试，在较年轻的年龄（约<6 个月），马拉维儿童的原始分数均值高于美国参考分数，之后均值曲线交叉，美国参考均值超过马拉维样本的均值，且曲线交叉的年龄因子测试而异。美国和马拉维常模之间的加权 kappa 统计量在认知方面为 0.45，在 FM 方面为 0.48，在 GM 方面为 0.57，在 EC 方面为 0.50，在 RC 方面为 0.44。
我们证明，BSID-III 的人群参考曲线因人群来源而异。依赖美国基于标准分数的标准化分数会导致马拉维儿童神经发育的错误分类，对认知和语言技能的测量存在最大的偏差风险。
