Using the Bayley-III to assess neurodevelopmental delay: which cut-off should be used?

Pediatr Res. 2014 May;75(5):670-4. doi: 10.1038/pr.2014.10. Epub 2014 Feb 3.


Background: As the latest edition of the Bayley Scales (Bayley-III) produces higher scores than its predecessor (BSID-II), there is uncertainty about how to classify moderate-severe neurodevelopmental delay. We have investigated agreement between classifications of delay made using the BSID-II and Bayley-III.

Methods: BSID-II Mental Development Index (MDI) and Bayley-III cognitive and language scales were administered in 185 extremely preterm (<27 wk) children. A combined Bayley-III score (CB-III) was computed. Agreement between delay classified using MDI scores <70 and various Bayley-III cut-offs was assessed.

Results: Bayley-III cognitive and language scores were close to the normative mean and were higher than BSID-II MDI scores. Nineteen (10.2%) children had MDI <70. Bayley-III scores <70 significantly underestimated the proportion with MDI <70. Bayley-III cognitive and language scores <85 had 99% agreement with MDI <70 and underestimated delay by 1.1%. CB-III scores <80 had 98% agreement and produced the same proportion with delay.

Conclusion: Bayley-III cognitive and language scores <85 or CB-III scores <80 provide the best definition of moderate-severe neurodevelopmental delay for equivalence with MDI <70. CB-III scores have the advantage of producing a single continuous outcome measure but require further validation. The relative accuracy of both tests for predicting long-term outcomes requires investigation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child Development
  • Child, Preschool
  • Cognition
  • Cognition Disorders / diagnosis
  • Developmental Disabilities / diagnosis*
  • Female
  • Humans
  • Infant, Premature
  • Language Disorders / diagnosis
  • Male
  • Neuropsychological Tests / standards*
  • Reproducibility of Results
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Treatment Outcome