using the total growth chart scaled score of 6 or less as the cut- off, the Bayley-III Social-Emotional Scale yields a specificity of 90.2 percent and a sensitivity of 86.6 percent in correctly identifying children with ASDs when used as a screening tool.
Table 5.3 shows the newly recommended categories that emerge when using a scaled score 6 as a cut-off score to differentiate different levels of functioning and risk for ASD.
The 7-year-old, Steven, was diagnosed with ASD at age 2 years. After the diagnosis the parents consulted a psychiatrist specializing in child development, who became the case manager for the family, helping them develop a home program based on the DIR/Floortime Model (ICDL, 2000) and coordi- nate the different therapies needed according to the child’s individual processing profile. After a year of intervention Steven was showing good progress, including better self- regulation when visiting crowded places like supermarkets and malls, increased joint attention, engagement and two-way communication when playing with parents, and emerging language abilities to express his own intentions. At this time, the mother became pregnant, and both parents started showing increased anxiety and fear that the new baby would share the same diagnosis as his brother. The clinician observed this increased anxiety when the parents brought Steven for the next follow-up session. He immediately developed a plan with the parents to monitor the new baby’s development from birth. He also gave recommendations to both parents on how to use self- regulatory techniques to reduce their anxiety during the preg- nancy (e.g., enjoying activities together that were calming and soothing). Both parents are musicians. They started spending time together composing music and sharing new melodies with their son and unborn baby.
The family came for follow-up when the new baby, Peter, was 3 months old. The baby was irritable most of the time during the session. The clinician reviewed with the parents the eight items of the ‘‘sensory processing’’ component of the scale and the three items for Stage 1 (Items 9–11). Peter scored 21 points on the Sensory Processing section and 22 points on Stage 1. For example, parents reported that only some of the time would the baby show attention to sounds or visual objects, enjoy different sensations, or be able to calm down with their help. The scores placed Peter on the category of possible moderate challenges for Stage 1. The clinician recommended they play the ‘‘Look and Listen Game’’ described in the Care- giver Report of the Greenspan Social-Emotional Growth Chart, and suggested doing several floortime sessions per day with both children using ideas from the Engaging Autism book (Greenspan & Wieder, 2008) for Steven, and theBuilding Healthy
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Mindsbook (Greenspan, 1999) for Peter. He also recommended follow-up with him when Peter was 6, 9, 12, 15, 18, and 24 months old, bringing a completed questionnaire from the Greenspan Social-Emotional Growth Chart to each visit. At
3 months score: 22
9 months score: 55
18 months: 78 24 months: 94
30 months: 122 Peter's scores
FIGURE 5.4 Greenspan’s Social Emotional Growth Chart: Peter’s scores.
CASE STUDY: STEVEN 173
every follow-up visit the clinician gave the parents guidelines of how to strengthen each stage through an intensive home-based program built on the DIR/Floortime Model (ICDL, 2000).
Figure 5.4shows Peter’s progress as plotted on the growth chart. As shown in the figure, Peter’s scores gradually improved throughout the follow-up period from possible
‘‘moderate challenges’’ at 3 months of age, to ‘‘mild challenges’’
at 9 months, to ‘‘emerging mastery’’ at 18 months, and, finally,
‘‘typical functioning’’ at 24 months of age.
Monitoring Peter’s development through the Social- Emotional Growth Chart and future visits with the clinician proved to be very effective, as indicated by the child’s increased mastery of social-emotional milestones and re-confirmed by increased scores on the Social-Emotional Growth Chart. The clinician was able to use this tool as a quick and easy assessment of the child’s developmental mastery, as well as a surveillance instrument that helped this at-risk child keep on track and derail any further challenges from deepening.
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C H A P T E R
6
The Bayley-III Adaptive Behavior Scale
Jennifer L. Harman
1and Tina M. Smith-Bonahue
21Yale University Child Study Center, New Haven, CT
2University of Florida, Gainesville, FL
INTRODUCTION
The 1986 amendment to Public Law 99-457, the Education of Handicapped Children Act, and its subsequent iterations require assessments of infants and young children at risk for disabilities to be comprehensive, multidisciplinary, and focus on functional abilities. Therefore, understanding the adaptive skills present in early childhood is essential in any assessment of young children. Adaptive behavior encompasses the key functional developmental tasks accomplished during the first years of life. In many ways these tasks are critical to a child’s survival, and include activities such as communicating basic needs, learning to feed oneself, crawling, walking, and toileting.
This chapter provides an overview of adaptive behavior in young children, and briefly discusses theory related to adaptive skills in infants, toddlers, and preschoolers. The content, administration, scoring, and interpretation of the Adaptive Behavior Scale of the Bayley-III are discussed, including its strengths and concerns regarding the use of this scale. Next, the use of the Adaptive Behavior Scale with clinical populations is discussed. A case study illustrates an evaluation of a 21-month- old child with the use of the Bayley-III.
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BAYLEY-III Clinical Use and Interpretation Ó2010 Elsevier Inc.