Journal of Clinical Epidemiology 66 (2013) 23e29

Development and normative validation of Developmental Assessment

Tool for Anganwadis for 3- to 4-year-old children (DATA-II)
M.K.C. Naira, P.S. Russellb,*
a
Child Development Centre, Medical College, Thiruvananthapuram 695 011, India
b
Facility for Children with Intellectual Disability, Child and Adolescent Psychiatry Unit, Department of Psychiatry, Christian Medical College,
Vellore 632 002, India
Accepted 11 June 2012

Abstract
Objective: To develop, standardize, and validate a developmental scale for children, 3e4 years old, attending Anganwadis (Integrated
Child Development Scheme) in India, as a follow-up assessment, using a normative approach.
Study Design and Setting: After the development of the 12-item Developmental Assessment Tool for Anganwadis (DATA-II), its in-
ternal consistency as well as face, content, and construct validities were studied in 100 children in Anganwadis and were found to be ap-
propriate. A total of 385 children with a mean (standard deviation) age of 43.05 (5.02) months from randomly selected 36 Anganwadis were
recruited for its standardization. Raw scores were converted to standardized T scores. Scoring pattern for domains and aggregate develop-
mental scores were formulated.
Results: Except for four items in the original scale, all the items were endorsed by parents suggesting a good content validity, and
KudereRichardson Formula 20 coefficient of 0.80 suggested a high internal consistency. Factor analysis replicated the six-factor structure
explaining 76.5% of variance. An aggregated developmental score based on the standardized T scores demonstrated that a DATA-II score
between 29 and 33 suggested at risk for developing developmental delays. A score of 28 or less suggested already delayed milestones. A
score of 19e28 suggested a mild delay, 8e18 suggested a moderate delay, and 7 or less suggested a severe delay in development.
Conclusion: The DATA-II is a measure for use in Anganwadis for identifying children at risk or with developmental delays during the
first follow-up assessment, in India, for appropriate referrals and interventions. 2013 Elsevier Inc. All rights reserved.
Keywords: Anganwadi; Child; Developmental scale; India; Normative; Validation

1. Introduction psychological, physical, and social developments of the

children attending the Anganwadis [2]. Therefore, in addi-
Anganwadi is the largest Integrated Child Development
tion to the health and nutrition as well as water and environ-
Scheme (ICDS) in the world with 98 million children
mental sanitation-related services, Anganwadis have also
benefiting from the scheme and 20,000 Anganwadi workers
integrated the component of early stimulation and learning
involved in this child care. The children are eligible for
[3]. This component takes special significance as 2.7% of
enrollment at 2 years old and continue till 6 years old in
the children between 0 and 6 years attending these centers
Anganwadis [1]. Following this, children with developmen- have a developmental disability requiring early identifica-
tal concerns attend either special schools or the Sarva Shik-
tion and intervention [4]. However, virtually there is no
sha Abhiyan program (the inclusive education component
measure for the early identification of these children with
in the mainstream schools). Anganwadis were primarily
global developmental needs in Anganwadi setting although
started by the Government of India in 1975 for promotion
the Anganwadi workers have the proven ability to identify
of maternal and child health and nutrition, but one of the
children with specific developmental and special sensory
stated aims of Anganwadi is to lay foundation of proper
concerns, if participatory training is given [5]. In our previ-
ous article, we have reported the psychometric properties of
Developmental Assessment Tool for Anganwadis (DATA)
* Corresponding author. Tel.: 91-416-2284530; fax: 91-416-
for toddlers in the 2e3-year age group and identified the
2261632. need to have annual follow-up of these children with appro-
E-mail address: russell@cmcvellore.ac.in (P.S. Russell). priate measures [6]. In this article, we present the
0895-4356/$ - see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.jclinepi.2012.06.011
24 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29
What is new?
 A significant proportion of the beneficiaries of the
worlds largest Integrated Child Development
Scheme, Anganwadi, have a developmental need.
 The Anganwadi workers have proven ability to
identify such special needs, but the stumbling
block had been the lack of a standardized scale
to identify these special needs early.
 Developmental Assessment Tool for Anganwadis
(DATA-II) was developed and standardized for this
purpose among 3e4-year-old children.
 This scale when used with DATA will be able to
identify children at risk or with mild, moderate,
and severe disabilities.
 DATA-II is now available as a validated measure
for research and clinical use in India.
development and validation of the DATA-II for children
from 3 to 4 years of age to enable an annual follow-up ap-
praisal of the children earlier identified at admission (at 2
years) with special needs or children enrolling for the first
time at Anganwadis at 3 years of age with a risk for delay
or existing delays. Thus, this measure is proposed to cate-
gorize children as impaired or not and further classify the
severity of the impairment.
2. Materials and methods
In this article, we review only the relevant aspects of our
method, as an extensive description has been presented
elsewhere [6]. This article is the summary of the next two
related studies: The first study describes the development
of the measure and its partial criterion validation. The sec-
ond study documents the norm-referenced validation of the
developed measure to identify children with developmental
delays or for appropriate interventions.
2.1. Study I
2.1.1. Conceptualization and nature of the measure
The measure was intended to screen young children
(3e4 years) at risk for developing developmental delays
and those who already have developed delays as a follow-
up assessment at 1 year or at enrollment. The differential
identification of at risk for delay and with existing delays
is needed for organizing appropriate referrals within the
Anganwadi or later to the special need care section of Sarva
Shiksha Abhiyan, the Indian governments program for the
universalization of elementary education.
2.1.2. Item selection
An inventory of milestones likely to be important to
young children at risk or with developmental delay was
made. Thus, 102 items from the most frequently used de-
velopmental measures (namely, the Denver Developmental
Screening Test, Developmental Assessment Scale for In-
dian Infants, The ReceptiveeExpressive Emergent Lan-
guage Test, and Vineland Adaptive Behavior Scale) were
compiled. Three experts, with a mean (standard deviation
[SD]) experience of 37.73 (9.21) years, in the field of devel-
opmental pediatrics, clinical psychology, and child psychi-
atry ranked the items collected on a three-point scale,
where one was least important and three was most impor-
tant. Only those items that were ranked the most impor-
tant by all the three experts were selected, and thus 26
items were selected, for the next stage of the measure
development.
2.1.3. Item reduction
To take account of all the representative dimensions of
developmental delay, we followed the concepteretention
approach and included the six domains of gross motor
(GM), fine motor (FM), cognitive (C), personal and social
(PS), expressive language (EL), and receptive language
(RL). There were four items in all domains except both
the language domains, which had five items each, and thus
a total of 26 items were present at this stage in the instru-
ment. Second, to maintain the content validity, items in
the domain were based on the endorsement rate of an item
by the parent, and the impact the item had on the parent, as
a problem, was evaluated. As four items were not endorsed
adequately, these items were dropped, and the number of
items in the measure was reduced to 22. In a country with
high disability-related burden and low disability resources,
we planned to develop the most parsimonious measure, to
be used by Anganwadi workers. Therefore, we wanted to
further reduce the number of items, and yet to decrease
the idiosyncratic response to a given item, it was decided
a priori to include two items in each domain. Therefore,
third, the choice of the two items in each domain was based
on the statistical procedures of loading pattern (retained as
an item if it loaded clearly to one component, and those
items that did not load or crossloaded were eliminated) in
the principal component analysis (PCA) and equidiscrimi-
native item-total correlation coefficients (items with the
highest correlation with the overall score evaluated with
polychoric correlations were retained). In the PCA, the
items were removed if they failed to load on any factor
(loading !0.50, this conservative score was to enable max-
imum discordance between the procedures to enable item
reduction) or had unacceptably high secondary loadings
(O0.30). Those items that were discordant for the statisti-
cal procedures were discarded (10 items). If there was
any tie between the two statistical procedures, the loading
scores were given priority over the correlation coefficients
(no ties noted). Thus, we selected the 12 items that
 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29
significantly overlapped in both these statistical procedures
and the previous qualitative methods.
2.1.4. Endorsement category and response category
format
We decided on the dichotomous endorsement category
of emerged and not emerged for endorsing a mile-
stone. These two choices were presented to the respondent
in the form of tick boxes as they could be easily understood
and quickly completed by Anganwadi workers. If the mile-
stone has emerged, the age of emergence of the skill in
months was also noted for further analysis.
2.1.5. Standardization of score and scoring pattern
The development of the milestones recorded in the form
of raw scores (means and SDs in months) was converted to
standardized T scores. The definition of at risk for devel-
opmental delay and definite delay graded as mild delay,
moderate delay, and severe delay was based on the
SDs of 1.5, 2, 3, and 4 on the lower side of the normative
mean and SD.
For the scoring pattern, the emerging age in months for
any milestone was checked at the end of the assessment with
a standardized T score equivalent. The arithmetic average of
the items in a domain formed the domain score, and the arith-
metic average of all the domain scores provided the final ag-
gregate developmental score. These standardization
procedures were done with the sample used for the ensuing
validation study taken from different geographical and socio-
economic strata as detailed in the subsequent sections.
2.2. Sample size and sampling
A list of Anganwadis was collected from three geo-
graphically different districts in Kerala state (Thiruvanan-
thapuram, Kottayam, and Kozhikode); 18 Anganwadis
from urban and 18 Anganwadis from rural areas of these
districts were randomly selected. One hundred children
from these Anganwadis were included if they were 3e4
years old and if they were accompanied by a parent or
the primary caregiver. The study was approved by the local
institutional review board of the Child Development Cen-
tre, Medical College.
2.3. Data analysis
The internal consistency of the selected items in the
DATA-II was manually evaluated with KudereRichardson
Formula 20 (KR-20). The equidiscriminative item-total
correlation coefficients were calculated with polychoric
correlation analyses as the item endorsements were dichot-
omous, and the total DATA-II score was continuous in na-
ture. The construct validity and the Factor structure of
DATA-II were demonstrated by factor analysis. We used
PCA for extraction and promax method for rotation.
DATA-II items were removed if they failed to load on
25
any factor (loading !0.40) or had unacceptably high sec-
ondary loadings (O0.30). Data were analyzed using SPSS
(version 19; SPSS, Inc., Chicago, IL, USA) and R (version
2.3.1; R Foundation for Statistical Computing, Vienna,
Austria) softwares.
3. Study II
3.1. Setting and sample
The study was conducted at randomly selected Angan-
wadis in the three previous districts of Kerala. All young
children (N 5 385) who satisfied the selection criteria were
included in the study. This sample size was considered ad-
equate as a sample size of minimum of 300 participants
was only required when no other subgroup analysis (e.g.,
gender) was planned [7].
3.2. Data collection
The data were collected independently by six develop-
mental therapists with a mean (SD) experience of 5.9 (1.2)
years in assessing children with developmental delays. They
approached the children for data collection after acquiring
informed consent from the parent and verbal assent from
the Anganwadi worker. The study also was approved by the
local institutional review board of child development center.
3.3. Data analysis
The normative data for the study sample were generated
using the mean and SD. From the SD for the norm, the SDs
on the lower side were calculated for those at risk for delay
and those who are already delayed developmentally. Thus,
a SD of 1.5 (at risk), 2 (mild delay), 3 (moderate delay),
and 4 (severe delay) from the normative SD was calculated
and formed the raw scores. The raw scores were converted
to standardized T scores using the formula: T 5 50 (10 
[raw score  mean]/SD), where raw score is the score for
that person on the scale, mean is the mean for that reference
norm, and SD is the standard deviation for that reference
norm. Arithmetic average was calculated wherever appro-
priate. Data were analyzed using SPSS software version 19.
4. Results
In study 1, with the item endorsement for assessing the
content validity and item reduction, four of 26 items,
namely, Can bring or take object from another room upon
request, Wipes nose when reminded, Puts on simple
clothing, Carries out a series of two related commands
were not endorsed by more than 90% of the parents and
was dropped from the measure. Thus, 22 items were avail-
able for statistical reduction of items, and the 12 items
with clear factor loading and highest equidiscriminative
item-total correlations were selected for further analysis
26 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29

(Table 1). In the reliability analysis, the high internal con-
sistency of this 12-item scale was demonstrated by the
KR-20 coefficient of 0.80.
When we investigated the factor structure of the items in
this scale, the PCA reduced the 12 items to six components;
an examination of the scree plot and eigenvalues (of O1)
showed a noticeable drop in both these parameters only af-
ter the sixth factor. For any item, a loading value of 0.4 or
more without any crossloading was considered significant
and classified under the factor later named as a specific de-
velopmental domain. Thus, DATA-II items, Broad jump 5
inches and Hops on one foot loaded on to factor 1
(GM); items, Draws a diagonal line from corner to cor-
ner and Joining the dots loaded on to factor 2 (FM);
items, Name big and little on request and Counts to
3 in imitation loaded on to factor 3 (C); items, Roll rice
balls with fingers and Brushes teeth without help
loaded on to factor 4 (PS); items, Tells the use of common
objects and Does the child ask how questions loaded
on to factor 5 (EL); and items, Comprehend cold/tired/
hungry and Find hidden object loaded on to factor 6
(RL). All items loaded distinctively and without crossload-
ings as expected in the theoretical conceptualization of the
domains (Table 2). This six-factor model explained 76.54%
of the variance. These dozen items in their respective do-
mains formed DATA-II for normative validation in study II.
In the second study, among the 385 young children par-
ticipated, 194 were boys and 191 were girls. Most of the
children were from the low socioeconomic status and be-
tween the chronological ages of 30e54 months (mean
[SD] 5 43.05 [5.02] months). Most of the skills corre-
sponding to the items in the scale emerged between 35
and 40 months. The normative data for referencing
DATA-II were extrapolated from the mean ages and SDs
at which the milestones emerged and are summarized in
Table 3. These raw scores converted to standard T scores
are presented in Table 4. The scoring key based on the stan-
dardized score to identify children at risk for developing
development delay and those who showed developmental
delays is summarized in Table 5.

Table 1. Item reduction for DATA-IIa

Item (N [ 100) Loading pattern of factorsb Equidiscriminative correlationc
I. GM
Stands on one leg for 5 seconds Did not load 0.88
Broad jump 5 inches Loaded 0.65
Hops on one foot Loaded 0.76
Throws ball into basket Did not load 0.34
II. FM
Builds bridge in imitation Loaded 0.63
Draws a diagonal line from corner to corner Loaded 0.86
Can bring or take object from another room upon request Poor endorsement, item deleted
Joining the dots Loaded 0.85
III. C
Complete form board Did not load 0.60
Put together two parts of a shape to make a whole Did not load 0.06
Name big and little on request Loaded 0.92
Counts to 3 in imitation Loaded 0.82
IV. PS
Roll rice balls with fingers Loaded L0.40
Wipes nose when reminded Poor endorsement, item deleted
Brushes teeth without help Loaded 0.55
Puts on simple clothing Poor endorsement, item deleted
V. EL
Tells full name Loaded 0.72
Tells the use of common objects Loaded 0.86
Say I, me, and mine in speech Loaded 0.55
Does the child ask how questions Loaded 0.87
Tells about immediate experiences Did not load 0.87
VI. RL
Carries out a series of two related commands Loaded 0.67
Comprehend cold/tired/hungry Loaded 0.87
Find hidden object Did not load 0.67
Points to first Did not load 0.80
Carries out a series of two related commands Poor endorsement, item deleted
Abbreviations: DATA-II, Developmental Assessment Tool for Anganwadis; GM, gross motor; FM, fine motor; C, cognition; PS, personal and
social; EL, expressive language; RL, receptive language.
a
All the items selected for the final version of the measure are in bold.
b
Principal component analysis.
c
Polychoric correlation coefficients.
 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29 27
a,b
Table 2. The factor structure of the final version of 12-item DATA-II
Items (N [ 100) GM FM C PS EL RL
Broad jump 5 inches 0.62 0.22 0.19 0.18 0.13 0.09
Hops on one foot 0.91 0.25 0.03 0.10 0.03 0.14
Draws a diagonal line from corner to corner 0.24 0.73 0.15 0.11 0.03 0.02
Joining the dots 0.01 0.85 0.01 0.13 0.27 0.17
Name big and little on request 0.27 0.11 0.93 0.05 0.01 0.01
Comprehend cold/tired/hungry 0.06 0.15 0.57 0.25 0.25 0.08
Roll rice balls with fingers 0.03 0.14 0.01 0.99 0.15 0.004
Brushes teeth without help 0.14 0.01 0.01 0.89 0.19 0.02
Tells the use of common objects 0.20 0.02 0.23 0.19 0.66 0.07
Does the child ask how questions 0.06 0.26 0.09 0.02 0.56 0.04
Counts to 3 in imitation 0.25 0.14 0.14 0.10 0.05 0.96
Carries out a series of two related commands 0.06 0.18 0.001 0.24 0.06 0.74
Abbreviations: DATA-II, Developmental Assessment Tool for Anganwadis; GM, gross motor; FM, fine motor; C, cognition; PS, personal and
social; EL, expressive language; RL, receptive language.
a
Extraction: principal component analysis. Rotation method: promax with Kaiser normalization.
b
Loadings O0.40 are in bold.

5. Discussion for measuring the development of children in the 3e4-year

age group, reflecting the endorsement of the content
This developmental measure based on the developmen-
validity.
tal norms of the children attending the Anganwadis in India For item reduction, we used the qualitative and statisti-
proffers Anganwadi workers an efficient way of identifying
cal procedures that effectively selected the most representa-
young children at risk and with developmental disabilities
tive of the items in each domain. Using these techniques,
during the first follow-up assessment at the end of the first
we reduced the 22 items to the most representative 12
year of care at Anganwadis as conceptualized.
items. The factor loading principle looked at items without
The face validity of the measure is high as the items in
crossloading or no loading, and only items with clear load-
the measure were compiled from various internationally
ing on to a specific factor improved the specificity of items
used measures to rate developmental delays. Except four
in identifying symptoms in a specific domain. The equidis-
items in the initial version of the scale (Can bring or take criminative item-total correlations clearly discriminated
object from another room upon request, Wipes nose
those items that contributed to the overall content of
when reminded, Puts on simple clothing, and Carries
the measure. These statistical procedures have been used
out a series of two related commands), none of the items
effectively in addition to the concepteretention approach
was assigned a score of zero by more than 90% of the par-
for item reduction in the psychometric validation of
ents in this study suggesting that the items were appropriate

Table 3. The normative data on the milestones of children between 3 and 4 years old and extrapolated delays based on the standard deviationsa,b
Item (N [ 385) Normal development At risk Mild delay Moderate delay Severe delay
I. GM
Broad jump 5 inches 35.7 (6.6) 46 49 56 62
Hops on one foot 39.3 (5.6) 48 51 56 62
II. FM
Draws a diagonal line from corner to corner 40.0 (5.5) 48 51 57 62
Joining the dots 39.9 (5.5) 48 51 56 62
III. C
Name big and little on request 38.0 (6.0) 47 50 56 62
Counts to 3 in imitation 39.0 (6.1) 48 51 57 63
IV. PS
Roll rice balls with fingers 40.2 (4.9) 48 50 55 60
Brushes teeth without help 35.3 (7.2) 46 50 57 64
V. EL
Tells the use of common objects 40.0 (6.0) 49 52 58 64
Does the child ask how questions 38.0 (6.3) 48 51 57 63
VI. RL
Comprehend cold/tired/hungry 38.0 (7.0) 49 52 59 66
Find hidden object 40.2 (5.3) 48 51 56 61
Abbreviations: GM, gross motor; FM, fine motor; C, cognition; PS, personal and social; EL, expressive language; RL, receptive language.
a
All figures in months adjusted for the decimal.
b
At risk 5 1.5 standard deviation (SD); mild delay 5 2 SD; moderate delay 5 3 SD; severe delay 5 4 SD.
28 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29

Table 4. Conversion of raw score to standardized scores for DATA-II based on T scoresa
Item (N [ 385) At risk Mild delay Moderate delay Severe delay
I. GM
Broad jump 5 inches 32 27 15 5
Hops on one foot 32 26 16 4
II. FM
Draws a diagonal line from corner to corner 34 28 16 6
Joining the dots 32 26 16 4
III. C
Name big and little on request 35 30 20 10
Counts to 3 in imitation 35 30 20 10
IV. PS
Roll rice balls with fingers 30 25 12 0
Brushes teeth without help 34 29 19 9
V. EL
Tells the use of common objects 35 30 20 10
Does the child ask how questions 33 28 18 8
VI. RL
Comprehend cold/tired/hungry 34 30 20 10
Find hidden object 34 28 18 8
Abbreviations: DATA-II, Developmental Assessment Tool for Anganwadis; GM, gross motor; FM, fine motor; C, cognition; PS, personal and so-
cial; EL, expressive language; RL, receptive language.
a
One standard deviation (SD) delay in months in achieving a specific milestone is equivalent to 1 SD in the T score.

instruments [8]. The factor structure demonstrated a six
factor, and there are no previous data to compare our study.
The normative data on the age of emergence of various
skills among the young children at Anganwadis ranged
from 35 to 40 months in this study. There is a slight overall
delay among the Anganwadi population than that is de-
scribed in the literature for all the 12 items when compared
with the original validation data of the measures conducted
in high-income countries. Similar findings were docu-
mented in our previous study too [6]. This could be ex-
plained by the low socioeconomic status of the children
from rural background attending Anganwadis. Over the
past decades, children from low socioeconomic background
have been repeatedly shown to have delay in development
and later low scores in formal intelligence tests because of
malnutrition and poor environmental stimulation [9e11].
The norms for DATA-II items were based on a simple
ratio transformation of the raw data to indicate the level
of delay in development. As Table 3 shows, this yielded
similar but slightly different means and SDs for each
domain. Therefore, if the extrapolated raw scores were
considered equivalent and compared for domain scores
within DATA-II or the aggregate developmental score was
compared with other similar international measures, it
would result in interpretation errors. In our study, especially
where the scores were close to the mean, this error was
minimal and the error was exaggerated as scores moved
away from the mean. Consequently, statistical adjustments
were needed to ensure an informed comparison of scores
between individual DATA-II domains and between various
international development measures. In our study, to over-
come this, we have calculated an exact standard score
equivalent using the T score principles (with a mean of
50 and an SD of 10) to enable comparisons within domains.
Further standardizing the scores using the principle of devi-
ation intelligence quotient will also allow the scores to be
comparable with the internally used measures and will be
done in future studies as noted in the literature [12]. Thus,
Table 4 summarizing the conversion details of SDs to T
scores gives a simple correction to potential interpretation
error based on the traditionally derived SD-based develop-
mental scores.

Table 5. Scoring key for DATA-IIa,b,c

Domains in DATA-II
b
Delay in specific domains GM FM C PS RL EL Total severity of delay as in ICD-10c
At risk 32 33 35 32 34 34 29e33
Mild delay 27 27 30 27 29 29 19e28
Moderate delay 16 16 20 16 19 19 8e18
Severe delay 5 5 10 5 9 9 7
Abbreviations: DATA-II, Developmental Assessment Tool for Anganwadis; GM, gross motor; FM, fine motor; C, cognition; PS, personal and
social; EL, expressive language; RL, receptive language; ICD-10, International Classification of Diseases, Tenth Revision.
a
All scores adjusted for decimals.
b
Specific domain scores are based on the arithmetic average of the scores for the two items in that domain.
c
Total scores are based on the arithmetic average for all the six domains and compared with ICD-10 categorical classification.
 M.K.C. Nair, P.S. Russell / Journal of Clinical Epidemiology 66 (2013) 23e29
This measure has the advantage of differentiating the
young children at risk for developing delays from those
who already have mild to severe delays. This differentiation
is important from a public health perspective as children at
risk can be stimulated at the preschool component of An-
ganwadis itself, whereas children with proved delays need
to be referred for appropriate early interventions [13]. This
study also methodologically has combined the clinimetric
and psychometric approaches in developing and validating
this instrument in a complimentary manner that can add
strength to the development and validation processes
[14e16]. The limitations of the standardization are that
subgroup analysis, like effect of gender, on the emergence
of milestones was not done. The measure was administered
by experienced developmental therapists, as against the in-
tended utility by Anganwadi workers. The prevalence and
pattern of developmental disabilities in Anganwadi may
be different from the general population, and therefore,
the utility of the scale is restricted to the ICDS settings.
It should be remembered that these data are from prefield
trial study, and hence these limitations (lack of diagnostic
accuracy parameters) will be addressed during the field tri-
als of DATA-II with International Classification of Dis-
eases, Tenth Revision as the reference standard for the
disability scores and ranges mentioned in Table 5.
In conclusion, DATA-II is a short norm-referenced de-
velopmental scale with partial criterion referencing to iden-
tify children at Anganwadi who are at risk for developing
developmental delays and differentiate those who already
have developed delays at 2.5 or at 3.5 years for appropriate
interventions. In addition, we recommend that regular de-
velopmental assessments be conducted on the beneficiaries
of Anganwadis, every year, at two more key ages of 4.5 and
5.5 years to institute early intervention when required. In
future, scales appropriate for these two ages should be de-
veloped, standardized, and validated across the country for
the benefit of the Anganwadi children.
Acknowledgments
The study was supported by a grant from the intramural
funds of Child Development Center, Medical College,
Thiruvananthapuram. We gratefully acknowledge child de-
velopment project officers, supervisors, and Anganwadi
29
workers of concerned ICDS blocks for their support during
the study period. We also thank the families and children
for their assistance and observations. There is no conflict
of interest.
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