The Relationship between Behavior Ratings and Concurrent and Subsequent Mental and Motor Performance in Toddlers Born at Extremely Low Birth Weight.
An 18-month behavior rating gives extra early warning of later cognitive and motor delays in extremely low-birth-weight toddlers.
01Research in Context
What this study did
Doctors tracked the toddlers who weighed under two pounds at birth.
At 18 months they filled out a 30-item Behavior Rating Scale (BRS).
The same kids took Bayley mental and motor tests at 18 and 30 months.
The team asked: do early BRS scores tell us more than the first Bayley scores alone?
What they found
BRS scores at 18 months predicted 30-month mental and motor scores even after the 18-month Bayley results were counted.
Kids with worse behavior ratings made smaller gains over the next year.
The added predictive power was medium-sized and statistically significant.
How this fits with other research
YMitchell et al. (2025) pushed the timeline earlier.
They found that brain-scan patterns at term-equivalent age forecast 24-month delays better than the toddler BRS used here.
Together the papers show a ladder: MRI flags highest risk in the NICU, BRS refines the forecast in the toddler room.
Chen et al. (2013) used the same pre-post design in school-age CP.
They showed knee strength, not behavior ratings, predicted 12-week motor gains.
The two studies do not clash; they simply test different age bands and predictors.
Why it matters
You now have a cheap, 10-minute tool that adds value beyond costly Bayley testing.
If an ELBW toddler scores low on BRS items like persistence and emotion regulation, tighten your monitoring schedule and consider starting motor and language enrichment earlier.
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02At a glance
03Original abstract
When predicting child developmental outcomes, reliance on children's scores on measures of developmental functioning alone might mask more subtle behavioral difficulties especially in children with developmental risk factors. The current study examined predictors and stability of examiner behavior ratings and their association with concurrent and subsequent mental and motor performance in toddlers born at extremely low birth weight. Toddlers were evaluated using the Behavior Rating scale (BRS) and the mental and psychomotor indexes of the Bayley-II at 18 and 30 months corrected age. BRS total and factor scores showed moderate stability between 18 and 30 months. These scores also predicted 30-month Mental Scale and Psychomotor Scale scores above and beyond prior mental and motor performance. Our findings suggest that early behavior ratings are associated with child mental and motor performance; therefore, behavior ratings might be useful in identifying toddlers at developmental risk and who might benefit from early intervention.
Journal of early intervention, 2010 · doi:10.1177/1053815110380917