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The ET 6–6: A Method for Developmental Assessment for German-Speaking
Countries
Article in Zeitschrift für Psychologie / Journal of Psychology · January 2008
DOI: 10.1027/0044-3409.16.3.154
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Zeitschrift für Psychologie / JournalT.
of Macha
Psychology
© 2008
& F.
Hogrefe
2008;
Petermann:
Vol.
& Huber
216(3):154–160
The
Publishers
ET 6–6
The ET 6–6
A Method for Developmental Assessment
for German-Speaking Countries
Thorsten Macha and Franz Petermann
Center for Clinical Psychology and Rehabilitation, University of Bremen, Germany
Abstract. The ET 6–6 presents a procedure for the assessment of a developmental status in children from 6 months to 6 years of age
that uses experimentally based test tasks for a great variety of developmental skills. The results are shown in a multidimensional and
age-specific profile. The instrument has been standardized by testing 950 children.
Keywords: developmental test, developmental assessment, child development
Preventive medical check-ups for children that rely on medical examination, short conversation with parents, and some
behavior monitoring may not be sufficient to detect or exclude the presence of a developmental disorder. The ET 6–6
(Developmental Test 6 Months to 6 Years; Petermann, Stein,
& Macha, 2006a) provides a standardized test procedure suitable for a large age range that allows for norm-oriented assessment based on a new model of development.
Theoretical Considerations
The development of the ET 6–6 was based on suggestions
by pediatricians as well as results from research in developmental neurology and neuropsychology. This resulted in
a multiperspective view:
– Age: Is a skill profile of a child typical for a particular
developmental period?
– Disorder: Do signs and symptoms relate to specific categories of developmental deviations?
– Course: Can valid predictions of future development be
derived from the instrument’s scoring pattern?
The ET 6–6 is based on theories of maturation (Plomin et al.,
1993; Scarr, 1992) as well as on learning theory, Piaget’s
theory of cognitive development, and Bronfenbrenner’s ecological theory (2006). Other concepts considered include sensitive phases, risk and protective factors, developmental
tasks, or milestones. A core characteristic of the ET 6–6 is the
concept of development as complex interaction instead of
linear progression. Sroufe (1997), for example, suggests a
tree-like structure of developmental pathways (patterns), featuring increased differentiation with increasing age, and different normal and abnormal trajectories in different developmental areas. Touwen (1984; see Michaelis & Niemann,
2004) argues that a large amount of interindividual and intraindividual variability is characteristic even for normal child
development. Low-contact pathways, then, describe basic
abilities that may expedite or inhibit the development of
skills. A large number of such developmental pathways are
supposed to interact in a complex manner such that they cannot be observed by standard psychometric testing. Consequently, it is the interaction that forms an observable skill pattern
and that needs to be monitored by a developmental test.
The individual developmental process is modeled by a
circumscribed developmental cone (see Figure 1). The status
at a particular time (e.g., T) can be obtained by considering
the appropriate section of the cone. At time 0, individual development begins. At the time of birth (B), the individual
developmental process has already differentiated progressively, which is illustrated by the increased expansion of the
conic section. For example, at times t1 and t2, the differentiation of the developmental paths are illustrated by P1 and P2.
They attain stability after a certain time interval. By interaction of different developmental paths in the individual’s biopsychosocial context, specific skills are developed at time t3.
Such skills are accessible to assessment and can be measured
by items of the ET 6–6. With the continuous influence of
developmental paths, these skills are further differentiated
and lead to complex skills (C). The complex skills are known
as context bound behavioral dispositions and frequently give
the impression of an abnormal development.
Methodic Implementation and
Structure of the Test
For normal development and specific types of disorders,
Petermann, Stein, and Macha (2006b) analyze configura-
Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
DOI 10.1027/0044-3409.216.3.154
© 2008 Hogrefe & Huber Publishers
T. Macha & F. Petermann: The ET 6–6
Figure 1. A systematic diagram for developmental processes (see Petermann, Stein, & Macha, 2006b) 0 = beginning
of development; b = Birth; t1, t2, t3, t4, T = periods in the
developmental process; P1, P2 = developmental paths; S =
skills; C = complex skills.
155
tions of age-specific and age-typical developmental paths,
basic skills, and complex skills. Quantifiable developmental deviations can however arise from minute causes like
disturbances in the development of one of the developmental paths. The ET 6–6 shows these typical configurations
using the empirically based constellation of items. In addition descriptive dimensions based on historically developed, evident classification categories are used. A multiplicity of age-relevant and different qualitative developmental aspects will be considered within each dimension.
This heterogeneity of the dimensions ensures an inventory
of complex developmental processes. The areas of measurement are then represented by 10 empirical developmental dimensions (see Table 1). Starting from the middle
of the 4th year, an additional descriptive category is introduced: the subtest drawing. The content of the developmental dimension is different for each age-group. While
some dimensions are tested globally during early infancy,
the precise developmental status can be indicated through
differentiated assessment of motor skills. For older children, age-appropriate differentiated tasks for the cognitive
and emotional development, as well as language and social
development, are necessary. The grouping of items within
each age-group (see below) of the ET 6–6 was not used to
develop subtests with scales over a wide age range. Therefore, quantitative progress in specific ranges can be recorded exactly. However, such procedures frequently lead to the
neglect of qualitative aspects. Very reliable methods whose
validity appears questionable are often used. The ET 6–6
concentrates on the collection of multiple, age-specific,
Table 1. Dimensions of the ET 6–6
Descriptive
dimensions
Empirical developmental
dimensions
Represented complex abilities
Gross motor skills
– Gross motor skills (GMS) Head and body control, development of locomotion, progressive differentiation and integration of basal elements of body control by acquiring typical daily and game skills e.g.,
climbing stairs, jumping, balancing, catching, using a tricycle or bicycle.
Fine motor skills
– Fine motor skills (FMS)
Targeted grasping and releasing, manipulation and use of objects, improvement in handling a pen, implied aspects of visuomotor activities (frequent evaluation in relation to
Subtest Drawing is meaningful).
Cognitive
development
– Memory (M)
– Action strategies (Strat)
– Categorization (Cat)
– Body awareness (BA)
Different aspects of the memory (visual as well as phonetic recognition, visual and phonetic reproduction); perception control, object permanence, understanding of causation, spatial perspective consideration, action planning, formation of categories, differentiation and
specification within and between categories, consideration of many categories, class inclusion, aspect of conception about knowledge of and orientation to one’s body and the body
of others.
Language
development
– receptive language (RL)
– expressive language (EL)
Different aspects of sound, word and sentence production; understanding of words and
sentences.
Social development – Social development (Soc) Start and organization of relationships with important related people and peers as well as
within groups according to age; signs of temporary and accompanying symptoms of behavior disorder.
Emotional
development
– Emotional development
(Emo)
Emotion regulation, exploration behaviors, behavior in specific daily life situations (meeting, separation, annoyance); qualities of children’s games.
Additionally from 3;6 mon.: Apart from hand motor talents, aspects of visual perception, spatial-constructive abilities
Subtest Drawing (SD)
as well as additional aspects of perception organization (“integrated comprehension,” “aspect of form”) are collected and particularly indicate specific neurological/fine neurological impairments.
© 2008 Hogrefe & Huber Publishers
Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
156
T. Macha & F. Petermann: The ET 6–6
Figure 2. Duration of administration (average values) of
the ET 6–6 in the age groups.
Note: The values on the category axis mark the respective
upper limits of an age group (“9” describes the age range
from 6 to 9 months). The age group “at least 6 months” (6)
is not a part of the age range of the ET 6–6, but supplies an
additional reference for the age group “at least 9 months.”
and relevant qualitative characteristics within the individual developmental status (Macha & Petermann, 2006).
The ET 6–6 provides a development assessment for a
wide age spectrum. From the extensive item pool (113 test
items, 67 items for parent questionnaires), an age-specific
item selection for carrying out the test is conducted. For
this, the entire age span is classified into 12 groups; the
respective age ranges are presented in Figure 2. Preliminary studies on ET 6–6 were performed with a constructive
sample of 260 children from Bremen, Germany. The standardization was conducted with 950 children from three
regions (Bremen, Dortmund, Rostock; all in Germany).
The construction of the ET 6–6 allows practitioners to
conduct a time-effective assessment. As shown in Figure
2, the average administration time for the individual age
groups ranges from about 12 minutes (babies) to about 50
minutes for ages 3 years and above.
Administration and Scoring
The ET 6–6 is administered while playing with the child.
Thus, a parent can be present during the test. The results
are documented using age-group-specific protocol and
scoring questionnaires, each of which are based on general knowledge from research on toddlers, infants and
preschoolers. Information about social and emotional development is obtained with the help of a parent questionnaire that can be completed during testing. Following the
test, a structured sampling of possible conditions influencing the testing process is conducted.
The scoring and interpretation of individual test profiles is very economical since a greater part of the respective age-group-specific standardization data is contained
in the protocol and scoring questionnaires. Hence, referring to the specific tables of the manual is only necessary
in a few cases. For the scoring of the subtest drawing,
scoring stencils are available. First, a developmental profile of all dimensions collected in the respective age
group is produced. This permits an initial orientation concerning the strengths and weaknesses of the individual
profile. The dimension-specific test values can be converted into the assessment classes “unremarkable,” “risk
range,” and “serious deficit.”
An Example of a Developmental
Profile
Figure 3 shows the development profile of a 5.8-year-old
girl with global developmental deficits in the motor as well
as cognitive domains.
The motor performances (gross motor skills, GMS; fine
motor skills, FMS) lie far within the serious deficits range,
the cognitive performances (memory, M; strategies, Strat;
categorization, Cat; body Awareness, BA; expressive language, EL) also lie in the range of serious deficits but partly
less clearly. The result of an additional intelligence test
showed mental retardation (IQ = 69). The subtest drawing
(SD) gave similar results, because the girl could not obtain
a score. Additionally, unremarkable test scores were obtained from the parents’ information concerning social development (Soc), while emotional development (Emo) was
slightly above the risk range.
Figure 3. The ET 6–6 profile of a girl
(68 months old) with the Kabuki-syndrome. Remarks: See Table 1 for an
explanation of the abbreviations on
the category axis; for each developmental dimension, the average of the
test values of age groups (60–72
months) as well as their respective upward and downward standard deviations are shown as a corridor.
Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
© 2008 Hogrefe & Huber Publishers
T. Macha & F. Petermann: The ET 6–6
pared to matched controls). They were able to attribute specific deficits to the location of etiologic brain lesion.
Validation
In order to evaluate the validity of a developmental test, the
following topics need to be addressed empirically:
– Can children with developmental disorders or delays be
reliably identified?
– Can a developmental status in normal children be modeled by means of a differentiated profile?
– Do quantitative scale characteristic derived from data
conform to theoretical assumptions?
– Will scores or scoring patterns allow for predictions?
The ET 6–6 consists of 12 age-specific subtests that, by
scale structure and item compilation, display a certain degree of incommensurability. Therefore, validation must account for this heterogeneity: Do empirical results conform
to theoretical assumptions pertaining to the respective age
groups? During the past years, numerous studies have established evidence that the ET 6–6 meets the requirements
quoted above (see Table 2).
Extreme Group Comparisons
Premature born infants are not a homogeneous clinical
group, but, on average, have developmental deficits when
compared to full term children (Schneider, Wolke, Schlagmüller, & Meyer, 2004). A study by Macha, Proske, and
Petermann (2005) showed that underachievement as expected in premature infants can be identified using the ET
6–6. In a sample of N = 69 prematures, significant reduction in motor skill as well as cognitive abilities were found
even in 1-year-olds. Rapp, Thyen, Müller-Steinhardt, and
Kohl (2005) achieved similar results using a sample of N =
63 very-preterm children tested in preschool age. Here,
68.3% of subjects displayed deviations of more than 1
standard deviation (SD) unit from the age-corrected mean
score (profile center), and 38.1% of subjects scored even
more than 2 SD units below average. Hampel et al. (2007)
were able to show cognitive and socioemotional deficits in
prematures when testing 5- and 6-year-old children with
the ET 6–6 (N = 29).
Physical Disorder and Handicap
Hülser, Dubowny, Knobl, Meyer, and Schölmerich (2007)
tested motor function and cognitive abilities in children
with congenital heart disease (N = 44) as compared to
matched controls. Supposedly due to reduced performance
capacity and power of concentration, diseased children
scored significantly lower. Daseking, Lemcke, Macha, &
Petermann (2007) studied stroke children (N = 32), which
had significantly lower levels of achievement (again com© 2008 Hogrefe & Huber Publishers
157
Behavioral Disorders
Deficits in cognition, social development, and emotional
development in children with behavior disorders (ADHS,
oppositional disorder; N = 54) were investigated by Gadow
(2003). Compared to controls matched for ethnicity, age
and gender, motor skills did not differ significantly from
normal level, but achievement in all cognitive areas as well
as the social and emotional domain did.
Criterion Validity
Various studies of criterion validity demonstrate that results of the ET 6–6 correspond to scores from other tests.
A pilot study by Petermann et al. (2006b) resulted in
moderate correlations between scores of the Kaufman
Assessment Battery for Children (K-ABC, German version; Melchers & Preuß, 2001) and the ET 6–6. These
findings are considered highly plausible because K-ABC
subtests are constructed as homogeneous scales and assess isolated partial abilities, whereas the ET 6–6 purposely compiles heterogeneous items into its dimensions.
Since the ET 6–6 model assumes high variability even in
normal children, statistical association cannot be expected. For children with cognitive deficits, however, the following can be stated:
– Children with reduced global cognitive ability in KABC (2 SD below average in summative scores) display
pronounced cognitive retardation with the ET 6–6.
– Specific cognitive deficits are detected by both tests, albeit in a different manner. Inspection of patients profile
from the Psychological Ambulance of the Center for
Clinical Psychology and Rehabilitation (University of
Bremen, Germany) indicate that children with deviation
of 2 SD below average in at least one K-ABC subtest
have regularly significant deviating patterns in ET 6–6
profile. Thus, the ET 6–6 can be considered as a screening instrument suitable for initial diagnosis.
A recent study by Goertz, Kolling, Frahsek, and Knopf
(2008; Goertz, Kolling, Frahsek, Stanisch, & Knopf, 2007;
Goertz, Knopf, Kolling, Frahsek, & Kressley, 2006; Kolling, Goertz, Frahsek, & Knopf, 2007) demonstrated an association of cognitive achievement as assessed by the ET
6–6 and nonverbal declarative memory in 2 year-old children (N = 174). They found highly significant correlations
of achievement in the Frankfurter Imitationstests (FIT
12/FIT 18/FIT 24) and indicators of cognitive abilities in
the ET 6–6, especially action strategies. Thus, the ET 6–6
may be used to evaluate prospects for untroubled language
Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
158
T. Macha & F. Petermann: The ET 6–6
acquisition even in preverbal children. The German Language Development Test for 2 years olds (SETK-2; Grimm,
2000) as well as the German Language Development Test
for 3- to 5-year-olds (SETK 3–5; Grimm, 2001) also validate ET 6–6 indications of language disorders (Lissmann,
Domsch, & Lohaus, 2006). Predictive validity of the ET
6–6 has been demonstrated in a pilot study by Lissmann et
al. (2006) using the Bayley Scales (Bayley II; Bayley,
1993) as a reference.
Longitudinal Studies
Petermann et al. (2006b) used a sample of N = 41 normal
children to demonstrate a high but regular fluctuation of ET
6–6 scores even within the normal range (1 SD unit
above/below the average) in children from their 3rd to their
4th year. Lissmann et al. (2006) found similar variability in
children assessed at 6, 12, and 24 months of age. Here,
significant test-retest correlations were obtained between
the ages 6 months and 12 months in the cognitive and emotional domain, whereas there was far less stability from 6
to 24 months and 12 to 24 months of age (Lissmann, Korntheuer, & Lohaus, 2007).
Practicability
Aspects of practicability and predictive validity of the ET
6–6 were investigated in a single-case study of a child with
severe developmental disorders (Heubrock, Spranger, Lex,
Lepach, & Petermann, 2003). Profound retardation is expected to produce substantial, and noticeable, deviation
from the normal range in a developmental profile from the
ET 6–6, on the premise that the child is challenged with the
tasks suitable for his or her actual age. Deliberately choosing a test level for earlier ages, on the other hand, will provide differentiated information on actual competence instead of deficits: information most valuable for indication
of special training or therapy.
Results by Macha, Daseking, Vogel, and Petermann
(2008) suggest that language-oriented testing with the ET
6–6 might introduce bias in a developmental profile for
language-impaired children. Diagnosed children (ICD-10
F80.1 or F80.2, N = 26) of preschool age attained lower
profile scores (0.5 to 0.9 SD units) when tested with the ET
6–6 than when tested with the completely nonverbal SONR (Janke & Petermann, 2006). Using a sample of children
with cerebral palsy (N = 23) Macha, Mayer, Petermann,
Petermann, and Waldeck (2007) point out the influence of
motor skills on testing cognitive functions and argue that
the ET 6–6 is suitable also for children with motor impairment.
Table 2. Overview of validation studies of the ET 6–6
Studies
Authors (year)
Extreme group comparisons
– Premature infants
Manual
– Premature infants
Macha, Proske, & Petermann
(2005)
– Premature infants
Hampel, Kropf, Petermann, König, Gloger-Tippelt, & Dikici
(2007)
– Very premature infants
Rapp, Thyen, Müller-Steinhardt,
& Kohl (2005)
Physical disorders
– Heart disease
Hülser, Dubowny, Knobl,
Meyer, & Schölmerich (2007)
– Perinatal stroke
Daseking, Lemcke, Macha, & Petermann (2007)
Behavioral disorders
– Externalizing behavior disor- Gadow (2003)
ders
Criterion validity
– Intelligence assessment (KABC)
Manual
– Language (SETK-2; SETK
3–5)
Lissmann, Domsch, & Lohaus
(2006)
– Specific cognitive abilities
Goertz, Knopf, Kolling, Frahsek,
& Kressley (2006)
Goertz, Kolling, Frahsek, &
Knopf (2008)
– Developmental assessment
(BSID II)
Lissmann, Domsch, & Lohaus
(2006)
Longitudinal studies
– Normal children (ages 2–3)
Manual
– Normal infants (6–24 months) Lissmann, Domsch, & Lohaus
(2006)
Lissmann, Korntheuer, & Lohaus (2007)
Practicability
– Practicability of verbal testing Macha, Daseking, Vogel, & Petermann (2008)
– Practicability of motor testing Macha, Mayer, Petermann, Petermann, & Waldeck (2007)
– Extreme retardation
Heubrock, Spranger, Lex, Lepach, & Petermann (2003)
Conclusion
Since 2000, the ET 6–6 has received widespread recognition and is increasingly used in German-speaking countries, in both practical health care settings and academic
research.
In consideration of recent advances of child neuropsychology (Petermann & Lepach, 2007), the test will undergo
extensive revision in near future, and will then, of course,
be based on updated norms.
Zeitschrift für Psychologie / Journal of Psychology 2008; Vol. 216(3):154–160
© 2008 Hogrefe & Huber Publishers
T. Macha & F. Petermann: The ET 6–6
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Dipl.-Psych. Thorsten Macha / Prof. Dr. Franz Petermann
Center of Clinical Psychology and Rehabilitation
Grazer Straße 2–6
D-28359 Bremen
Germany
Tel. +49 421 218-4618
Fax +49 421 218-4617
E-mail fpeterm@uni-bremen.de
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