Early Childhood Assessment: A Comparison of the Bayley

Scales of Infant Development and Play-Based Assessment

in Two-Year Old At-Risk Children

Lisa Kelly-Vance, University of Nebraska-Omaha;

Howard Needelman, Children's Hospital and Munroe Meyer
Institute, University of Nebraska Medical Center, Omaha;
Kim Troia, Children's Hospital, Omaha; and
Brigette Oliver Ryalls, University of Nebraska-Omaha, USA

Practitioners are using a variety of assessment tools to measure

cognitive functioning in young children. These measures are used for
similar purposes yet the relationship among them is largely unknown.
The purpose of this study was to analyze the relationship between two
assessment approaches used to determine the cognitive functioning
level in young children, the Bayley Scales of Infant Development-II
and Play-Based Assessment. A sample of two-year olds participating
in a Neonatal Intensive Care Unit Follow-Up Clinic were evaluated on
both measures. Results indicated a high correlation between the two
techniques. A comparison of the two techniques is provided as well as
recommendations as to when each might be used most effectively in
early childhood assessment.

Early childhood assessment has received increased attention over the

last decade, primarily because of the expansion of programs that serve
young children with special needs. The primary purposes of these
assessments is threefold and includes: 1) determining eligibility for early
childhood special education; 2) identifying specific strengths and
weaknesses so that appropriate interventions can be developed; and 3)
developing a method of monitoring a child's progress. In the United
States, public policy has had a major impact on the services provided to
children with disabilities. Public Law 99-457, originally passed into law
in 1986, guaranteed that exceptional children aged three to five will
receive special service through public education programs. In
subsequent years, revisions of the Individuals with Disabilities
Education Act, 1997 (IDEA 97) ensured that services were also available
for infants and toddlers (from ages birth through two). These services
are now encompassed under Part C of IDEA 97. The purpose of the law
is to ensure that free and appropriate educational programs are made
available to meet the unique needs of eligible preschoolers and their
2 Lisa Kelly-Vance et al

families. The intent is to raise a child's level of functioning and prevent

new problems from developing or existing problems from worsening
(Hardman, Drew, & Egan, 1999).

One developmental domain that must be measured, as required by

Public Law 99-457 and its subsequent revisions, is cognitive functioning.
Because of the increase in need for measures of cognitive functioning,
new tests and innovative assessment techniques have been developed in
recent years. The law does not require any specific test but, instead, that
some reliable and valid method of assessing cognitive level is utilized
when evaluating the cognitive functioning level of children (McLean,
1996).

Because of the need for sound psychometric properties, standardized

tests are frequently chosen to measure cognitive functioning in referred
children. The Bayley Scales of Infant Development-Second Edition
(BSID-II; Bayley, 1993) is a standardized assessment technique
commonly used to determine the cognitive level of young children.

The primary purpose of standardized tests, such as BSID-II, is to meet

the first goal of assessment, which is to determine eligibility for special
education programs. They also provide several benefits such as
providing normative data and possessing high reliability and adequate
validity. Standardized tests, however, have received considerable
criticism (e.g., Greenspan & Meisels, 1996; Linder, 1993; McCormick,
1996; Neisworth & Bagnato, 1992). Specifically, these tests require the
use of standardized procedures that are foreign to most children,
including: use of an unfamiliar and unappealing environment, an
unfamiliar examiner, instructions regarding how to play with specific
toys, and a question and answer format with which the child may have
minimal experience or ability. For purposes of maintaining
standardization, examiners cannot deviate from the administration
procedures dictated in the test manual. Thus, they cannot accommodate
the potentially different needs of children with disabilities.
Furthermore, the tests may be biased against children with disabilities,
as they require use of language and motor skills that these children may
not possess at the time of the evaluation. Children with communication
or physical impairments may not be adequately assessed for other
strengths they possess; thus, potentially unrepresentative or even
inappropriate samples of behaviour may be obtained from the child
 Early Childhood Assessment: A Comparison 3

being tested (Linder, 1993; McCormick, 1996). An additional concern is

that, although standardized tests are generally used in determining
eligibility, they were not developed to define intervention needs or
monitor progress and, therefore, should not be used for these purposes.

Because of the proposed limitations of standardized tests, the context of

play has been suggested as a viable setting for collecting assessment
data. Many researchers have conducted studies that support ecological
validity of play assessment and they state that assessment in the context
of play can lead to specific interventions and a mechanism to monitor
progress (e.g., Bailey & Bricker, 1986; Barnett, Macmann, & Carey, 1992;
Bricker, Bailey, & Slentz, 1990; Fewell & Kaminski, 1988; Fewell & Rich,
1987; Lidz, 1986; Lidz, 1992; Linder, 1993; Lowenthal. 1997; and Wolery
& Dyk, 1984). Specifically, the use of free play in a natural environment
as an appropriate means of assessing cognitive functioning has been
purported by numerous researchers (e.g., Fewell & Kaminski, 1988;
Linder, 1993; Lowenthal, 1997; and Wolery & Dyk, 1984). For instance,
Barnett, Macmann, and Carey (1992) emphasized the importance of
preschool assessments conducted in natural settings. They define this
type of assessment as ecobehavioural analysis and specifically suggest
that examiners observe play behaviours. Similarly, Lidz (1986) proposed
that early childhood assessments should lead directly to interventions
and be based in natural environments such as play settings.

One innovative method of play assessment that has received

considerable attention and use by practitioners is Transdisciplinary Play-
Based Assessment (Linder, 1993). The focus of this technique is on the
child's strengths and areas of need for intervention. Unlike standardized
tests, flexibility is allowed in the assessment process and, therefore,
children with disabilities may be more fairly evaluated to determine
strengths and areas of need. Linder did not develop Transdisciplinary
Play-Based Assessment (TPBA) with the purpose of determining
eligibility. Her primary focus was to find an ecologically valid method
for determining a child's specific needs as they related to interventions.
The methodology can be used to assess skills in several areas of
development including: cognitive, fine motor, gross motor,
communication, and social skills (Linder, 1993).

Little published research exists that analyzes the use of TPBA in

determining cognitive development (Malone, Stoneman, & Langone,

Developmental Disabilities Bulletin, Vol. 27 (1), 1999

4 Lisa Kelly-Vance et al

1994). This is a major concern given that many practitioners are

routinely using TPBA in their evaluation of the functioning level of
young children. One exception is a study that examined the social
validity of TPBA (Myers, McBride, & Peterson, 1996). Social validity
was defined as "the validation of our work by consumers" (p. 103). The
researchers found that professionals and parents had positive
perceptions of the assessment of their child, team meetings, feedback
from professionals, and written reports that resulted from the TPBA
evaluation. They also reported that, overall, play-based evaluations
were completed in a significantly shorter time than traditional
assessments. Furthermore, the reports generated from data obtained
during the play sessions were said to include more useful information
that could be directly translated into interventions than did traditional
reports.

Although published research is yet to be available, professional interest

in TPBA is increasing (Eisert & Lamorey, 1996). Preliminary work has
been conducted and has been receiving attention at conferences. For
example, Karr (1998) conducted a study using children who were
developing normally and compared their results from BSID-II and
TPBA. Data from each measure were converted to standard scores for
ease of comparison. Results indicated a significant correlation between
the two measurement techniques. In a related study, Cornett and
Farmer-Dougan (1998) analyzed the use of open-ended versus objective
scoring procedures in TPBA. They found that objective scoring
procedure produced more consistent results across raters than the open-
ended procedure.

While empirical interest is on the rise, studies to date have not compared
the results obtained from BSID-II and TPBA with at-risk populations.
Despite criticisms, BSID-II continues to hold a prominent position in
early childhood assessment. TPBA is gaining in popularity even though
the technique has not been studied empirically. Some practitioners are
attempting to use standardized tests and alternative assessments for
more than what they were designed to do, others are choosing to
abandon standardized measures entirely, and some are using a
combination of standardized and alternative assessment techniques.
Furthermore, some practitioners are using the two instruments
interchangeably without first considering the purpose of the techniques.
 Early Childhood Assessment: A Comparison 5

Therefore, studies comparing BSID-II and TPBA are highly relevant and
important.

The purpose of the present study was to examine the relationship

between the Mental Developmental Index (MDI) score from BSID-II and
the results of play-based assessment in an at-risk population. Since no
studies of this relationship between the two techniques have been
attempted with children who are at-risk, this project was exploratory in
nature. Understanding the relationship between techniques intended to
measure cognitive functioning is an important first step to providing
relevant information to practitioners. The cognitive domain is of pivotal
interest in determining eligibility for early intervention services.
Therefore, the transdisciplinary component was omitted and hereafter
the process will be referred to as Play-Based Assessment (PBA). In sum,
the main question was whether or not the two different assessment
approaches provide similar results and identify the same children as
eligible for special education services.

Method

Participants

Thirty-eight two-year olds were recruited from the Neonatal Intensive

Care Unit (NICU) follow-up clinic at a large midwestern children's
hospital in the United States. The average age, adjusted for prematurity,
was 24 months 15 days (range 23 months 10 days to 27 months 26 days).
These infants were all below 1500 grams at birth and required significant
medical intervention during their first months of life. The sample
included 20 males and 18 females who were predominantly Caucasian
and from middle- to upper middle-class families. The purpose of the
clinic was to monitor the developmental progress of the infants deemed
most at-risk for physical or cognitive problems to occur. The follow-up
clinic routinely evaluated children at approximately 6, 12, and 24 months
of corrected age to determine cognitive, motor, and language
development, as well as medical needs. If deemed necessary, children
were referred to their local school district for consideration for early
intervention services.

Procedure

Developmental Disabilities Bulletin, Vol. 27 (1), 1999

6 Lisa Kelly-Vance et al

Data were collected at the Neonatal Intensive Care Unit follow-up clinic.
Specific information about the two assessment techniques is described
followed by a thorough explanation of the PBA scoring procedures.

Assessment Techniques

Bayley Scales of Infant Development-Second Edition - BSID-II consists of

three scales (mental, motor, and behaviour) that are used to assess
development in young children aged 15 days to 42 months. The test was
standardized in the United States with a representative sample of the
target population. Standard scores are derived from the results with a
mean of 100 and a standard deviation of 15. The psychometric
properties of the instrument are reportedly high for all scales. Reliability
coefficients for MDI range from .78 to .93 and PDI ranges from .81 to .91.
Adequate short-term test/retest stability and interrater reliability are
also reported (Bayley, 1993).

As a routine component of the clinic, BSID-II is administered to every

child by advanced graduate students in school or clinical psychology
under the supervision of a licensed psychologist. In the present study,
the Mental Developmental Index (MDI) was used as the measure of
cognitive functioning that could be compared to the results from the
PBA. The Physical Developmental Index (PDI) was included to provide
a discriminant validity check to determine if the measurement technique
or the construct being measured had a larger impact on the relationship
between scores.

Play-Based Assessment - The second phase of data collection, PBA, also

took place in the clinic setting and was conducted by a School
Psychologist trained in the procedures. The technique is stated to be
appropriate for young children from 6 months to 6 years of age. The
model for PBA used in this study was a modification of the procedures
proposed by Linder (1993). A variety of toys (see Appendix),
appropriate for children ages 6 months to 3 years, were arranged in a
small room and were selected to encompass varying developmental
levels that participants may display. The toys were arranged in the
room the same way for every child according to function (e.g., all kitchen
items together).
 Early Childhood Assessment: A Comparison 7

The child entered the playroom and was instructed to play with any of
the toys. The investigator built rapport with the child but was not
involved in the initial play. After the child played freely for
approximately 10 to 15 minutes, she or he was prompted to participate
in specific play activities that encouraged skills not yet observed. The
play facilitator suggested that the child play with additional toys that
might promote additional behaviours that could be coded at a higher
level on the observational guidelines. The facilitator attempted to
encourage the child to play with all the toys during the session, but not
all children played with every toy. At the end of each play session, the
child was given paper and crayons and asked to draw. The play
facilitator drew lines and circles with the intent of the child imitating
them. Children were observed as they played and data were recorded
utilizing Linder's observational guidelines (Linder, 1993). The play
sessions lasted 20 to 30 minutes.

The sessions varied from Linder's TPBA model in two ways. First, only
cognitive functioning was evaluated and, thus, the transdisciplinary
component was eliminated. Second, Linder suggests that the session
end with a snack in order to analyze fine motor skills. Because the
information was not pertinent to the current study, no snack was
provided.

Play-Based Assessment Scoring - PBA provides information about

children's play in several subdomains or specific categories of cognitive
functioning including: Early Object Use; Symbolic and Representational
Skills; Imitation Skills; Problem-Solving Skills; Discrimination/
Classification Skills; One-to-One Correspondence; Sequencing Abilities;
and Drawing Skills. The PBA observational guidelines are based on the
developmental sequences demonstrated by typically developing
children. Children's play skills are observed and age scores determined
for each of the subdomains. Within each subdomain play behaviours are
listed in a developmental sequence. Several behaviours are listed for
each age range. For example, six different play behaviours may be listed
in the 18 to 24 month age range for the Symbolic/Representational Skills
subdomain.

General age scores from the PBA are described in terms of age ranges
and these age ranges can be derived for each of the subdomains. Age
scores can then be averaged to obtain an overall age-equivalent score.

Developmental Disabilities Bulletin, Vol. 27 (1), 1999

8 Lisa Kelly-Vance et al

Age-equivalent scores were determined by the first author according to

the method described below. The Age Equivalents (AEs) from the play
data were based on the age range guidelines for the cognitive domain
(Linder, 1993). No specific method for calculating AEs is available in the
guidelines but this technique may prove to be an innovative method of
analyzing the results of PBA.

AEs were utilized for the purpose of analyzing the data in this study so
it could be compared to standardized techniques. Each subdomain was
analyzed separately and then averaged to determine the overall PBA AE.
Specifically, if a child displayed all the behaviours listed in a specific age
range for a subdomain and none in the next, he or she received a
designation of the highest age level specified by that subdomain. For
example, if a child demonstrated all the skills in the 18 to 24 month
range for the subdomain of Problem-Solving Skills, but none of the skills
in the 24 to 28 month range, his or her AE for Problem-Solving Skills
would be 24 months. If, however, the child displayed four of the six
skills in the 18 to 24 month range in Problem-Solving Skills, the AE
would be prorated to 22 months. An overall AE score for cognitive
functioning was calculated by averaging the subdomains. Total AEs
were rounded to the nearest whole number. The overall age-equivalent
score from the PBA was standardized by converting it to a ratio score
using the basic formula of mental age, represented by the AE score,
divided by chronological age and then multiplied by 100 (Karr, 1998).
The PBA standard scores were then used in the analysis with the mental
(MDI) and motor (PDI) scores from BSID-II. The comparison of the PBA
and BSID-II scores is appropriate because they were both utilizing the
same scaling method.

It should be noted that one of the PBA subdomains, One-to-One

Correspondence, was removed from the data analysis because these
skills are not rated until the 24-month level. Many of the children in the
current study did not display the skills in this domain. Thus, including
the scale would have inflated the PBA score. In addition, the Sequencing
Abilities subdomain was not used in the present study because this skill
begins at approximately the 36 to 42-month level.

Results and Discussion

 Early Childhood Assessment: A Comparison 9

Three separate analyses were conducted to investigate the relationship

between PBA MDI and to determine whether the two measures of
cognitive functioning can be used interchangeably. First, means and
standard deviations for each of the three measures were calculated. The
average of the PBA scores was 94.56 (SD = 21.35). The MDI average
score was 85.66 (SD = 17.40) and the average of the PDI scores was 85.55
(SD = 16.65). Of primary interest was comparing the PBA and MDI
standard scores to determine if the children received similar scores on
the two measures. A t-test was then conducted that revealed a
significant difference, t(37) = 4.00, p < .001, between the PBA and MDI
standard scores with the PBA resulting in higher scores.

Overall, these results suggest that children may demonstrate their

optimum skills during the play assessment and be more restricted by the
standardized format. A possible explanation for the results is that the
nature of the two assessment techniques may have affected how children
performed. PBA allows for more flexibility and follows the child's lead.
In contrast, BSID-II is adult-directed. Since two-year olds often have
difficulty complying with directions, they may perform better when they
are able to select their own activities. Behavioural difficulties and
noncompliance are more likely to negatively affect the BSID-II score than
PBA.

Alternative explanations of these results are related to the nature of the

data collection and analyses. The PBA data are less standardized, more
subjective, and may be more influenced by the rater than BSID-II. PBA
procedures also include an enabling aspect that is not present in the
BSID-II administration. An adult can encourage or coach a child to play
with toys in a specific manner that might lead the child to play at a
higher developmental level. No coaching can occur with BSID-II. Thus,
the higher PBA scores might be attributed to adult facilitation. The
enabling may make even more of an impact for special populations who
receive considerable direction from adults (Beckman, Lieber, & Strong,
1993; Roach, Barratt, Miller, & Leavitt, 1998). Furthermore, the ratings
are based on subjective judgments of adults and may be biased. The fact
that two different persons administered BSID-II and PBA may also have
influenced the results. Finally, because of the possibility of chance
occurrences of the play behaviours, the PBA scores may be inflated. The
scoring procedures utilized in this study are preliminary and need
further research to confirm this methodology.

Developmental Disabilities Bulletin, Vol. 27 (1), 1999

10 Lisa Kelly-Vance et al

Because of the differences in scores from the two measures, a second

analysis was performed to determine if the same children would have
been found eligible for early intervention services through special
education using the two different measurement techniques. A cut-off
score of 70 on the PBA and MDI standard scores was utilized for the
purposes of this investigation. This is the most frequently used cut-off
for determining eligibility as a child with a cognitive delay.

This analysis of the data revealed that 31 (82%) of the children would not
have been identified for early intervention services, because of delays in
cognitive development, based on results from both PBA and MDI. Four
of the children (10%) would have qualified for services according to
results from both techniques. Three of the children (8%) had discrepant
findings from PBA and MDI. All three of these children would have
qualified based on their results from BSID-II but not PBA. With the
philosophy of early intervention services being preventative in nature,
this may not necessarily be a positive result for PBA. The risk of not
finding children who may need services is of concern. As previously
stated, some practitioners are using PBA for identification purposes and
they should be aware of the potential for under-identification.

Of additional interest was investigating the relationship among the PBA,

MDI, and PDI. Therefore, the third analysis conducted was a simple
correlation used to explore these relationships. The results indicated
that the PBA was significantly correlated (p < .001) with the MDI (r =
.747) and PDI (r = .746). The highest correlation of the three standard
scores was between the MDI and PDI (r = .874; p < .001). As previously
stated, the correlations between the PDI and MDI and between the PDI
and PBA were explored to provide discriminant validity information.
More specifically, the purpose was to find if the two measures of
cognitive functioning (MDI and PBA) were more closely related than the
two scores that were based on similar, standardized assessment
techniques (MDI and PDI). The results indicate that the method of
assessment (i.e., standardized vs observational) may influence the
outcome of the assessment. In the present study, the two tests that
measured different constructs but that used a standardized testing
approach (i.e., MDI and PDI) were more closely related than dissimilar
testing approaches that measured the same construct (i.e., MDI and
PBA). Clearly, practitioners need to be aware that the assessment
 Early Childhood Assessment: A Comparison 11

procedures may influence the results and that they may not be
measuring identical constructs if procedures are different.

Our results have several implications for professionals working with

young children. When early childhood personnel are selecting
assessment instruments, it is important to know how the techniques
compare in terms of the type of information provided and whether the
same children are identified for eligibility. Because the relationship
between the two measures was strong but not perfect, practitioners must
realize that the measures may define different strengths and weaknesses
in children and that more children may be identified for services when
using BSID-II than when using PBA. The two measures should not be
used interchangeably without careful consideration of the impact of the
results.

Although the present study did not utilize a transdisciplinary format,

the results are not thought to be greatly influenced by this alteration of
the original method. In both the original and the modified version of the
play assessment, one trained professional rates the child's cognitive
functioning. The presence of additional professionals rating other
developmental domains would have minimal, if any, impact.

In sum, these results indicate that a positive relationship exists between

the two measures but that enough differences exist to suggest that they
cannot be used interchangeably. Fewer children may potentially be
found eligible for special services when using PBA than the MDI from
BSID-II. Given the tremendous implication for early prevention, much
more research is necessary. Replication studies are needed that include
a larger age group, more varied sample, and examine other
developmental domains such as communication, social behaviour, and
motor development in a transdisciplinary format. The restricted sample
used in the present study limits the generalizability of the results. The
scoring procedures used in the present study deserve additional
investigation and the results should be replicated before further
conclusions can be drawn. Finally, and most importantly, reliability
data must be collected on the PBA techniques to determine if the
procedures possess adequate psychometric properties. Specifically,
studies of test/retest and interrater reliability are essential. Without
these data, PBA cannot be considered as a psychometrically sound
approach for measuring cognitive functioning.

Developmental Disabilities Bulletin, Vol. 27 (1), 1999

12 Lisa Kelly-Vance et al

In conclusion, the purpose for using a measure of cognitive development

in the assessment of a young child should guide the selection process in
determining which measure to use in assessing cognitive functioning.
BSID-II provides the standard score that is often needed for placement in
special programs. PBA does not provide a standard score but gives
more detailed information in planning interventions and may also be the
preferred method to monitor the progress of an individual child.

The present study should caution those who may currently be using
PBA as a measure of cognitive functioning. We are not dissuading its
use because we believe PBA holds potential for being a valuable tool in
an assessment process. Because of the paucity of existing research, our
ultimate goal is to motivate others to conduct additional studies so that
PBA can be used with confidence in early childhood.

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Author Note

Please address all correspondence regarding this manuscript to:

Lisa Kelly-Vance, PhD
Psychology Department
Arts and Science Hall 347
University of Nebraska-Omaha,
Omaha, NE 68182-0274, USA
Telephone: (402) 554-3563
Fax: (402) 554-2556
e-mail: Lisa_Kelly-Vance@unomaha.edu
 Early Childhood Assessment: A Comparison 15

Appendix

Toy List
Blocks
Shaper sorter
Play telephones
Pop-up toy
Baby dolls, stroller, bottle
Nesting cups
Pop beads
Play dishes, kitchenware and food
Gumball machine
Toy cars
Ring stacker
Puzzles
Music box
Crayons

Developmental Disabilities Bulletin, Vol. 27 (1), 1999