Cutoffs, norms, and patterns of comorbid difficulties in children with developmental disabilities on the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT-Part 2).
BISCUIT-Part 2 cut-offs flag the four most common comorbid problems in toddlers with developmental delays—eating, sleep, inattention, and tantrums—so you can treat them before they snowball.
01Research in Context
What this study did
The team gave the BISCUIT-Part 2 to the toddlers who already had a developmental-delay diagnosis.
They wanted to know how many kids scored in the “moderate” or “severe” range on each problem area.
No treatment was given—this was a head-count study to build cut-off scores clinicians could use later.
What they found
Eating and sleep troubles topped the list—about 15 % of toddlers hit the moderate/severe band.
Next came bad tantrums and heavy inattention/impulsivity, each seen in roughly 10 % of the group.
These four flags give you a quick short-list to watch for after any positive developmental-delay screen.
How this fits with other research
Hatzell et al. (2026) followed kids longer and showed sleep issues double the odds of later self-injury and aggression—Matson et al. (2009) gives the toddler baseline that warns you early.
Woods et al. (2019) proved feeding refusal can be treated; Matson et al. (2009) tells you which toddlers are most likely to need that help.
van der Miesen et al. (2024) meta-analysis says caregiver-run SIB treatments work as well as clinic ones; spotting sleep and tantrum risks with BISCUIT cut-offs lets parents start those programs sooner.
Why it matters
You now have hard numbers to show families why sleep, meals, and tantrums deserve space on the IFSP.
Use the BISCUIT-Part 2 cut-offs at intake; when a toddler lands above the line, write a referral or add a behavior goal the same day.
Early targets are clear—eating, sleeping, inattention, tantrums—so you waste no time guessing which problem to tackle first.
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02At a glance
03Original abstract
Behavioral symptoms of comorbid psychopathology of 651 children 17-37 months of age who were at risk for developmental disabilities were studied using the BISCUIT-Part 2. In Study 1, norms and cutoff scores were established for this new scale on this sample. In Study 2, frequency of response on the 52 items measured was reported. Problems in eating and sleep were the most common with just over 15% of the sample experiencing these difficulties of either a moderate or severe nature. For severe problems, the most commonly reported difficulties were inattention/impulsivity, and tantrums/conduct behavior problems. Implications of this scale and these data for early identification of behavior disorders in atypically developing children are discussed.
Research in developmental disabilities, 2009 · doi:10.1016/j.ridd.2009.04.004