Developmental scientists and medical social science experts at Northwestern University have spearheaded the creation of the most recent NIH Toolbox, providing the newest nationally standardized assessment of cognitive, language, motor and social-emotional skill development in infants aged 16 days to 42 months.
The original NIH Toolbox, although widely implemented in clinical and research settings, was designed to measure children from 3 years of age through adulthood. This left a serious gap: There was no research-based, nationally validated measurement battery to assess infants and toddlers. This was troubling because infants' earliest years have a broad and significant impact on later developmental outcomes. Early delays or deficits often cascade into persisting developmental challenges, making timely intervention critical.
A special eight-article issue of the journal Infant Behavior and Development dedicated to the development and validation of the NIH Baby Toolbox can be accessed online at https://www.sciencedirect.com/special-issue/108S3JV73J2 and will appear in print this September.
Supporting positive developmental outcomes 'in a way that was not possible before'
There were considerable challenges in creating the new NIH Baby Toolbox. First, it needed to include comprehensive measures that did not require separate licenses and platforms, costly equipment and specialized training to administer. Second, the new Toolbox needed to implement measures that reliably engage and measure skills in infants and children too young to answer questions or complete paper and pencil tasks.
The NIH Baby Toolbox overcomes these obstacles by incorporating video to present content and documents infants engaged in assessment tasks. The state-of-the-art technology takes advantage of gaze-based learning paradigms that have effectively and efficiently measured infants' burgeoning capacities in research laboratories but have not been available for broad assessments.
Developmental scientist Sandra Waxman, the Louis W. Menk Professor of Psychology at Northwestern, has conducted gaze-based learning experiments for more than 30 years in her Infant and Child Development Center lab.
"Now, armed with the first-ever standardized, validated and widely available assessment tool, clinicians will be able to identify infant development and detect when development is going awry," Waxman said. "This early assessment, and the intervention that may follow, will support positive developmental outcomes in a way that was not possible before."
Precise measurement in a fraction of the time
Northwestern University Feinberg School of Medicine's Richard Gershon, who led the development of the original NIH Toolbox, is the principal investigator of the NIH Baby Toolbox.
"The NIH Baby Toolbox dovetails with the first NIH Toolbox for children and adults to make longitudinal assessments seamless," said Gershon, professor of medical social sciences and preventative medicine, and division chief for outcomes and measurement science at Feinberg. "Researchers, clinicians and even school personnel now have access to tools to enable precise developmental measurement in a fraction of the administration time, with no per patient costs, fully automated or guided scoring, and with a fraction of the training time required by similar tests."
Development and proof of concept
In developing the suite of assessments for the app, the team first conducted a survey of more than 400 domain experts and undertook a systematic literature review to identify measures that met the project criteria. Tools were required to have established validity evidence, suitable for tablet-based implementation; relevant for age 16 days to 42 months; and easy to administer and score within a brief timeframe.
"We were contracted to identify existing measures that could be administered on the iPad, but we found that many widely used measures required extensive training or were too expensive for regular research and clinical use," said NIH Baby Toolbox scientific director Aaron Kaat, professor of medical social sciences at Feinberg. "For many of the measures in the Baby Toolbox we worked with top research teams across the country to create new measures that met our requirements."
Before releasing the Baby Toolbox, the researchers conducted a comprehensive norming study on more than 2,500 infants and toddlers from English- and Spanish-speaking households. The study showed high test-retest correlations and demonstrated the app as a reliable, scalable tool for assessing development milestones in diverse populations.
