RESEARCH

ORIGINAL

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Family Medicine and Community Health
ORIGINAL RESEARCH

Seguin Form Board as an intelligence tool for young children in an

Indian urban slum
Beena Koshy1, Hannah Mary Thomas T1, Prasanna Samuel2, Rajiv Sarkar3, Scott Kendall3,a, Gagandeep Kang3

Abstract 1. Developmental Paediatrics,

Objective: The present study evaluates the concurrent and predictive validity of the Seguin Christian Medical College,
Form Board Test (SFBT) as an intelligence tool for children in low- and middle-income countries. ­Vellore, India
Methods: In a cohort of normal children, followed up in South India, two cross-sectional 2. Department of Biostatistics,
analyses were done at 3 and 7 years of age on 95 children. The SFBT and Vineland Social Matu- Christian Medical College,
­Vellore, India
rity Scale (VSMS) were done at 3 years of age and Malin’s Intelligence Scale for Indian Children
3. Department of Gastrointesti-
(MISIC) and the VSMS were done at 7 years of age, and the results were compared for concurrent
nal Sciences, Christian Medical
and predictive validity for the SFBT. College, Vellore, India
Results: Intelligence quotient and social quotient had positive correlations at 3 years of age,
indicating fair concurrent validity. The SFBT done at around 3 years of age had good positive cor- a
University of California, Irvine,
relation with MISIC at 7 years of age, indicating good predictive validity. CA, USA
Conclusion: This study shows the utility of the SFBT as a community-based intelligence tool CORRESPONDING AUTHOR:
with acceptable concurrent and predictive validity. Dr. Beena Koshy
Professor and Head, Devel-
opmental Paediatrics, Chris-
Keywords: Intelligence tests; Seguin Form Board Test; Malin’s Intelligence Scale for Indian tian Medical College, Vellore
Children; Vineland Social Maturity Scale 632004, India
Tel.: +91-416-2283265
Fax: +91-416-2232103
E-mail: beenakurien@cmc
vellore.ac.in
Introduction Several psychological assessment tools
Child-developmental disabilities in the com- and screening measures are available to
Received 11 January 2017;
munity need to be identified early for any assess the level of functioning of the indi- Accepted 5 April 2017
corrective intervention. Identification of devel- vidual child, encompassing intelligence,
opmental delay and other neurodevelopmen- learning profile, personality, and behavior of
tal disabilities in the early formative years in the child. Though widely used, most of the
children is essential to promote prompt and intelligence tests are limited, concrete, and
appropriate intervention at the earliest oppor- specific in their assessments; many circum-
tunity to optimize the developmental potential venting the ‘multiple intelligences’ proposed
of each child [1, 2]. Early screening and identi- by Gardener [4]. The fact that intelligence is
fication of such delays and disabilities are more a complex construct comprising a range of
critical in low- and middle-income countries functions from abstract reasoning to adap-
(LMICs), where more than 200 million chil- tation skills has also restricted our under-
dren younger than 5 years fail to achieve their standing and development of appropriate
full potential [3]. intelligence assessment tools [5].

275  Family Medicine and Community Health 2017;5(4):275–281

www.fmch-journal.org DOI 10.15212/FMCH.2017.0118
© 2017 Family Medicine and Community Health. Creative Commons Attribution-NonCommercial 4.0 International License
 RESEARCH
ORIGINAL
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Seguin Form Board as an intelligence tool for young children

Furthermore, an important challenge in early identifica- what the child would have to do, and the approximate time
tion of developmental disability is having tools that respond required had been explained to them.
to local differences, including cultural perceptions in mean-
ing of childhood ability levels, and that can be used across Assessment tools
countries [2, 6, 7]. Besides the differences in the factor con- Seguin Form Board Test
structs, the performances and interpretations in intelligence In 1856 Seguin developed a simple performance-based intel-
measures differ furthermore between nations and cultural ligence test using form boards to evaluate eye–hand coor-
settings [8, 9]. While many standardized tools developed dination, shape concept, visual perception, and cognitive
in Western countries have been validated in their settings, ability through nonverbal means. It is used to assess the par-
there are many practical limitations in score interpreta- ticipants’ motor dexterity, visuomotor coordination, spatial
tion and implementation in resource-constrained settings in organization, and speed and accuracy of performance, and
LMICs [6]. can be used in children as young as 3 years [15, 16]. The
The conventional intelligence tests predominantly look form board consists of 10 differently shaped wooden blocks,
at mathematical and verbal intelligences, and are difficult to and the participants are required to fit the differently shaped
execute and validate in very young children. Moreover, these blocks into their respective slots on the form board. This
tests require a trained child psychologist, and are arduous in culture-fair test, which can be easily administered in 10 min,
community settings with respect to their duration, administra- is used for preliminary assessment of mental age in a normal
tion guidelines, and strict protocols. Consequently, there is a population.
need for a short, easy-to-use test of ability that can be used as The task administration involved three consecutive tri-
a quick screening tool in the preschool age of 3–5 years, espe- als with an instruction to start placement of blocks at the
cially in community settings in LMICs. The current study was command “Start.” Speed is stressed at the start of the test,
undertaken in this context with the objective to evaluate the with no further between cues or assistance being provided
concurrent validity for the Seguin Form Board Test (SFBT), a to the child. The best time from three trials was used to
culture-fair cognitive test, with the Vineland Social Maturity determine a mental age from the standard chart, which
Scale (VSMS) at 3 years of age and the predictive validity with was subsequently used in determination of the intelligence
Malin’s Intelligence Scale for Indian Children (MISIC) at 7 quotient (IQ) [17].
years of age.
Vineland Social Maturity Scale
Materials and methods The VSMS, originally developed by E.A. Doll in 1935, was
The present study is part of a wider study of a birth cohort of adapted to the Indian scenario by Malin [18]. It is a semistruc-
452 children from a semiurban slum area in Vellore, South tured assessment based on an interview of the caregiver and
India [10], in whom diarrheal episodes were being followed up evaluates the social ability of the child.
for 3 years for studies on rotaviral [11–13] and cryptosporidial In this questionnaire method, adaptive functioning is
[14] diarrhea. The study is designed as a panel study using measured in the context of self-help skills, self-direction,
a modified longitudinal design that performed cross-sectional socialization, and communication. The measure has eight
analyses for intelligence and social maturity at 3 and 7 years of social domains with 89 items, and can be used from birth
age in part of a birth cohort of children to evaluate long-term to 15 years. The VSMS has good concurrent validity of
effects on cognition of early childhood diarrhea. A subsample at least 0.8 with intelligence tests in children with mental
of 116 children enrolled in the birth cohort underwent intel- retardation [19, 20]. The maturity age associated with the
ligence and social maturity assessments at 3 years of age, and level of functioning was calculated along with a social matu-
291 children were assessed at 7 years of age. Written consent rity age that is then converted to an index called the ‘social
was obtained from the parent/s about the assessment tools, quotient’ (SQ).

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Koshy et al.

Malin’s Intelligence Scale for Indian Children data for socioeconomic status and sex. Concurrent validity was
MISIC, the Indian adaptation of the Wechsler Intelligence analyzed by evaluation of the relationship between IQ and SQ
Scale for Children [21], measures verbal and performance at 3 years of age with use of Pearson’s correlation coefficient
abilities, and can be administered by a trained psychologist to (r). Predictive validity was calculated with use of Pearson’s
children to assess intelligence from 6 years onward [22–24]. correlation coefficient between IQ at 3 years of age and IQ at 7
The intelligence scale measured as the full IQ is obtained from years of age. Partial correlation coefficients were calculated to
six verbal subscales and five performance subscales. The verbal adjust the data for the effect of sex, socioeconomic status, and
scale measures verbal information and language development birth weight on the relationship between scores. A P value of
and comprehension, using the following subtests: information, less than 0.05 was considered statistically significant. All anal-
similarities, arithmetic, vocabulary, comprehension, and digit ysis was done with STATA 10.0 (StataCorp, College Station,
span. The performance scale has the following subtests: pic- TX, USA).
ture completion, coding, picture arrangement, block design,
and object assembly. The raw scores obtained from the ver- Results
bal subscales are converted into standardized scores to derive For the 3-year assessment, 116 children were evaluated at an
the verbal IQ. Similarly, the performance subscales yield the average age of 3.46 years (standard deviation 0.37 years). The
performance IQ, and the cumulative score of the verbal and 7-year assessment included 291 children at an average age
performance subscales gives the full-scale IQ. The test has a of 7.23 years (standard deviation 0.38). Ninety-five children
reliability coefficient of about 0.9, and the concurrent and con- underwent both the 3-year assessment and the 7-year assess-
gruent validity scores are both around 0.6 [16, 17]. ment (Fig. 1). Table 1 shows the sociodemographic profile of
the 95 children. The children studied are representative of the
Procedure total study population.
Institutional ethics committee clearance was obtained for
this study, and the institutional review board approved both
assessment protocols. The 3-year assessment was performed
3 years 7 years
between June and December 2005, and the 7-year assessment
was performed between December 2009 and April 2010.
For the purpose of this study, all measures were translated
to the local language, Tamil, and back-translated, and a pilot
study was conducted for appropriateness of measures and 116 recruited 291 recruited
items, before the commencement of individual assessments.
At 3 years a medical research officer trained in testing evalu-
ated the children with the SFBT and the VSMS. At 7 years a
child psychologist assessed the children using MISIC and the 21 did not 291 completed
VSMS. Both assessments were conducted in a distraction-free complete SFBT MISIC
environment in a separate quiet room in the field clinic. The
respective intelligence and social maturity tests were com-
pleted on the same day. The assessment of socioeconomic sta-
95 included for
tus was performed with the modified Kuppuswami scale [25]. 95 included for
analysis who
analysis
took 3 years
assesment
Statistical analysis
All study variables were summarized with use of descriptive Fig. 1. Flowchart depicting numbers of participants in both
statistical methods. Analysis was done after adjustment of the assessments

277  Family Medicine and Community Health 2017;5(4):275–281

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Seguin Form Board as an intelligence tool for young children

Table 1. Comparison of sociodemographic characteristics between the study population and the birth cohort nonparticipants in the study

Variable Nested study (n=95) Others (n=357) P-value

Malea 52 (54.74%) 175 (49.02%) 0.322

Socioeconomic statusa
Low 58 (61.05%) 223 (62.46%) 0.536
Middle 34 (35.79%) 114 (31.93%)
High 3 (3.16%) 20 (5.60%)
Housinga 17 (17.89%) 59 (16.53%) 0.870
‘Pucca’ 52 (54.74%) 191 (53.5%)
Mixed 26 (27.37%) 107 (29.97%)
‘Kutcha’ 17 (17.89%) 59 (16.53%)
Maternal educationa
Nil 38 (40.00%) 101 (28.29%) 0.053
1–5 years 29 (30.53%) 98 (27.45%)
6–8 years 15 (15.79%) 90 (25.21%)
>8 years 13 (13.68%) 68 (19.05%)
Maternal age at birthb 23.89 (4.45) 23.61 (4.09) 0.548
Family size c
5 (4–6) 5 (4–6) 0.061
No. of siblingsc 2 (1–3) 2 (1–3) 0.089
Low birth weighta,d 9 (9.78%) 42 (12.03%) 0.548
Presence of domestic animals 14 (14.74%) 46 (12.89%) 0.636

χ test.
a 2

b
Two-tailed t-test. The mean is given, with the standard deviation in parentheses.
Mann-Whitney U test. The median is given, with the interquartile range in parentheses.
c

d
Data not available for 11 children.

For the SFBT at 3 years of age, 21 children could not complete score (SQ) of 121.1 (t=-3.05, P=0.002). The 7-year analysis
the test within the stipulated time. The internal consistency of the showed a low normal mean intelligence (IQ) of 85.5, significantly
three trials for the SFBT was high at 0.906. The 3-year analysis lower than the corresponding average social maturity quotient
showed an average mean intelligence (IQ) of 110.7 on the SFBT, (SQ) of 101 (t=-8.97, P<0.001). Table 2 summarizes the IQs and
significantly lower than the corresponding mean social maturity SQs for children assessed at both 3 and 7 years of age.

Table 2. Summary of intelligence and social quotients in the children assessed at both 3 and 7 years (n=95)

Test type Test and 3 years Test and coefficient 7 years

coefficient Mean SD Mean SD

Intelligence SFBT (IQ) 110. 7 18.0 MISIC, full scale (IQ) 85.5 11.6
MISIC (VQ) 84.0 11.1
MISIC (PQ) 82.7 15.2
Social maturity VSMS (SQ) 121.3 28.7 VSMS (SQ) 101.0 12.2

IQ, intelligence quotient; MISC, Malin’s Intelligence Scale for Indian Children; PQ, Performance intelligence quotient; SD, standard deviation;
SFBT, Seguin Form Board Test; SQ, social quotient; VQ, Verbal intelligence quotient; VSMS, Vineland Social Maturity Scale.

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Koshy et al.

Concurrent validity for the SFBT Other comparative studies have also reported a simi-
IQ had a moderate positive correlation with SQ at 3 years lar finding of social score being better than the intelligence/
of age (r = 0.39, P= 0.04). After we had controlled for the developmental score. Bhave et al. [27, 28] showed that signifi-
effects of sex, socioeconomic status, and birth weight, the cantly higher mean SQs than mean developmental quotients
adjusted correlation between IQ and SQ at 3 years of age were obtained on the same set of children. Song and Jones
was 0.38 (P= 0.04). For comparative purposes, the adjusted [29] reported an overestimation of social age by 1–2 years with
correlation between IQ and SQ at 7 years of age was 0.40 the VSMS in normal children. However, studies by Raggio
(P<0.001). et al. [30] have shown comparable SQs and developmental
quotients.
Predictive validity for the SFBT This study shows that there is a positive correlation
There was a moderate positive correlation between the IQs between IQ and SQ at 3 and 7 years of age. The strength of the
measured by the SFBT and MISIC. Comparing the analysis relationship was comparable at both 3 and 7 years of age. This
at three and 7 years of age, the adjusted Pearson’s correlation is an important finding showing not just concurrent corrobo-
coefficient for IQ was 0.66 (P<0.001), after we had controlled ration but also stable properties of the intelligence construct
for the effects of sex, socioeconomic status and birth weight. measured by the SFBT to later years, both valuable properties
IQ at 3 years correlated with both Verbal IQ (r=0.57, P=0.001) essential in intelligence assessments in community settings.
and Performance IQ (r=0.54, P=0.003). Indian studies have shown a good correlation of social abil-
ity with intelligence tests in children with intellectual disabil-
Discussion ity or mental retardation [19]. Although social adaptability is
The results of the study suggest that the SFBT has moder- different from intelligence, the VSMS can be used in resource-
ate concurrent validity with the VSMS and moderate predic- poor settings to pick up deviations, enabling the health worker
tive validity with MISIC at a later age. This tool can evolve to refer the child for further evaluations. However, the VSMS,
as an effective community-based intelligence-testing tool in as with other parent-report questionnaires, is a subjective
resource-limited settings. The brevity of the test, its portabil- interpretation of ability. The Vineland Adaptive Behavioral
ity, the ability to arouse attention or sustain interest, and the Scales (VABS) [31], an extensive revision of the VSMS, may
ease of administration are some of reasons that the SFBT lends be ideal to calculate social maturity, but is yet to be adapted to
itself to be used as a screening tool before further referral for the Indian scenario. Further studies are required to standard-
early learning interventions [26]. To the best of our knowledge, ize the VABS for resource-limited settings and its correlations
this is the first study attempting to correlate an early assess- with the VSMS and other intelligence/developmental tools.
ment tool such as the SFBT with intelligence testing at a later Some studies have evaluated the SBFT norm in Indian
age in resource-poor settings. The current study enhances the children. Basavarajappa et al. [32] found that the SFBT con-
already existing literature by presenting good concurrent, and tinues to remain a valid and reliable speed test of intelligence
predictive validity for this measure in the community setting. in younger children. However, they advocate separate SFBT
The children included in the present study are representa- norms to account for differences in age, sex, socioeconomic
tive of the cohort population and consisted of an almost equal level, and residential setting (rural/urban). Thangavel [33]
number of boys and girls. The mean SQs at both 3 and 7 years found that sex tends to influence the performance in children.
of age are higher than the corresponding mean IQs. The dif- In 1968 Ramachandran et al. [34] found that Indian children
ference was statistically significant at both 3 years (P= 0.002) had slower performance speed than their Western counter-
and 7 years (P<0.001) of age. The children examined in our parts. Contrarily, in 1971 Bharatraj [35] reported that a sample
study scored well on the self-help items of the VSMS, giv- of Mysore children studied were on average faster than chil-
ing them a better score than the corresponding intelligence dren in other reports. Goel and Bhargava [36] replicated this
scores. result in their study with a sample of Delhi school children

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Seguin Form Board as an intelligence tool for young children

aged between 3 and 15 years. Verma et al. [37] reported com- Significance statement
paratively better performance in speed of same-aged children The Seguin-Form Board Test (SFBT) is an intelligence testing
from upper-class schools. A study by Venkatesan [38] indi- tool that is brief, portable and easy to administer, highlighting
cated that three trials might not be sufficient to determine its utility as a community screening tool in resource-limited
the mental age equivalence of the child. According to that setting. The present study demonstrates acceptable concurrent
study, the optimum performance is observed at the sixth trial. validity for SFBT as early as three years of age as well as stable
Venkatesan also computed a ‘decrement score and quotient’ properties of the construct with acceptable predictive validity
that showed an inverse relationship between increasing cal- with intelligence assessment at seven years of age, both valuable
endar age of the child and the time taken to complete the test. properties of intelligence assessments in community settings.
Although the SFBT is easy to administer and takes a maxi-
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