Establishing the norm of cognitive adaptive test/clinical linguistic and auditory milestone scale (CAT/CLAMS) in Chinese infants

The Cognitive Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS) has been recommended as a useful diagnostic tool for cognitive delay. To provide wider application of this instrument as a general screening tool for pediatricians, a normative percentile graph from a large convenience sample of Chinese infants has been established. The effects of environmental factors on early language and adaptive development were also analyzed. A total of 402 normal infants aged 4 to 36 months attending well- child clinics were recruited. These infants were from all socioeconomic strata, and half were bilingual with Mandarin and Taiwanese. Grandmothers were the chief caretakers or co-caretakers in 28% of this population. The milestones were attained in a sequential and orderly fashion. In contrast to the adaptive ability, there was a wide variation in language acquisition between age 12 and 24 months. Multiple stepwise regression of demographic and environmental factors revealed that age was the main variance in CAT score (P=0.0001). In CLAMS score, however, age and caretakers were the significant predictors (P=0.0001). Infants cared for by both mothers and grandmothers had higher CLAMS score by two months over those cared by mothers only (P=0.001). Those cared for by grandmothers only had lower language score than those by mothers only, though without statistical significance (P=0.05). Bilingualism, birth order, numbers of siblings, familial structures, and parental socioeconomic status had no effect on early development.