Harrison Infant Neuromotor Test (HINT)
I. Descriptive Information
A. Harris Infant Neuromotor Test, edition 2.0, November 1993
B. Author (s): SR Harris, PhD, PT, FAPTA, professor
C. Source (publisher or distributor, address): School of Rehabilitation Sciences University of British Columbia, Canada
D. Costs (booklets, forms, kit)*: not found
E. Purpose*: identifying early signs of cognitive and neuromotor delays in infants with known risk factors.
F. Type of Test:evaluative/observation
G. Target Population and Ages*: 3 to 12 months
H. Time Requirements – Administration and Scoring*: 15 to 30 minutes to administer and score
II. Test Administration
A. Administration: 1) recording background information of the child(current age, birth weight, gender, prenatal and neonatal risk factors) and of the caregiver (occupation, education level, race), 2) 5 item parent/caregiver questions, 3) infant assessment of 22 items observed/ assessed
B. Scoring: summing the results of the 21 assessment items; the examiner makes two summary decisions about the infant’s overall neuromotor performance, one for the infant’s developmental level and one for the quality of motor performance
C. Type of information, resulting from testing: Raw scores are converted to index score. Increasing raw score on the HINT indicates increasing risk.
D. Environment for Testing: examination room
E. Equipment and Materials Needed: goniometer, tapemeasure
F. Examiner Qualifications: OT, PT, family physician, pediatrician, community health nurse
G. Psychometric Characteristics*: sensitivity (80%) and specificity (90.9%)
H. Standardization/normative data: not found
I. Evidence of Reliability: interrater = .99, test-retest = .98, and intrarater = .99
J. Evidence of Validity: 94.3%
K. Discriminative: not found
L. Predictive: not found
III. Summary Comments*
A. Strengths: reliability, validity, ease of use
B. Weaknesses: age limit
C. Clinical Applications: early detection of cognitive or motor deficits; especially motor
Article Summary
Harris SR, Daniels LE. Content validity of the harris infant neuromotor test. Phys Ther. 1996;76(7):727-737
The Harris Infant Neuromotor Test (HINT) is a tool to identify cognitive and neuromotor deficits in infants 3-12 months old. This article examines the validity of the HINT by getting the input of 26 various experts, including OT, PT, pediatrics, child neurology, and psychology. Each person was given a validity questionnaire that covers each part of the HINT. Twenty of them filled out the survey and the other 6 gave written comments. The general feedback was that the original HINT was clearly worded and non biased. Also, the written comments suggested modifications which lead to the 2nd edition created in November 1993. The validity is said to be at 94.3%. The HINT is a good reliable and valid tool to assess infants.
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Update on information regarding HINT:
1. Harris SR, Megens AM, Backman CI, Hayes V. (2003) Development and standardization of the Harris Infant Neuromotor Test. Infants Young Children 16: 143-151.
Screen to identify early motor deficits, cognitive delays, or behavioral difficulties in infants ages 3-12 months.
Administer by: reserachers, OT, PT, family physicians, community health nurses
Cost: $60.00
Validity: assessed by comparison with Mental and Motor Scales of BSID-II. Calculated by using Pearson product moment correlation coefficient (r).
Concurrent: Strong relationship between HINT and Bayley Scales of Infant Development (BSID-II)
r= -0.73 (p<.01) BSID-II Mental
r= -0.89 (p<.01) BSID-II Motor
Predictive:
r=-0.11 (p<.01) BSID-II Mental: Poor predictive validity for mental scale
r=-0.49 (p<.01) BSID-II Motor: Modest predictive validity for motor scale
Stronger correlation with motor scale of BSID-II than the mental scale of BSID-II
HINT shown to be stronger predictor than initial BSID-II score for the final BSID-II score.
Valid screen when time constraint
Weakness: age limit, poor predictor for mental score on BSID-II
Overall, the HINT is a reliable screen with strong concurrent and predictive validity. Experts involved in this study rate the HINT as an appropriate screen for early developmental delays based on content validity particularly for motor skills.
2. Harris SR, Backman CL, Mayson TA. Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale. Dev Med Child Neurol. 2010;52(5):462-7.
Predictive Validity of HINT with Bayley-II motor scale for mild delay (1 standard deviation cutoff)
4-6.5 mo HINT: Sensitvity: 21.1%, Specificity: 92%, Positive Predictive Value: 63.2%
Negative Predictive Value: 64%
10-12.5mo HINT: Sensitvity: 19.3%, Specificity: 93.1%, Positive Predictive Value: 64.7%, Negative Predictive Value: 63.8%
Predictive Validity of HINT with Bayley-II motor scale for significant delay
4-6.5 mo HINT: Sensitvity: 100%, Specificity: 88%, Positive Predictive Value: 10.5%, Negative Predictive Value: 100%
10-12.5 mo HINT: Sensitvity: 100%, Specificity: 89.4%, Positive Predictive Value: 11.8%, Negative Predictive Value: 100%
Article Summary: Harris SR, Backman CL, Mayson TA. Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale. Dev Med Child Neurol. 2010;52(5):462-7.
In the 2010 prospective study by Harris et al, researchers compared the predictive ability of the Alberta Infant Motor Scale (AIMS) and Harris Infant Neuromotor Test (HINT) performad during infancy to predict Bayley Scales of Infant Development (BSID) at 2 and 3 years old. Of 144 infants assessed, 86 were rated to be “at risk” based on criteria such as maternal age, low birth weight, less than 38 weeks gestation, along with other factors that can impact an infant’s development. AIMS and HINT were performed for all infants at 4.5-6 months of age and 10-12.5 months and the BSID was performed when the infants were 2 and 3 years old. Based on the results of this study, researchers discovered that the early HINT was better for predicting BSID-motor at 2 years old and BSID-gross motor skills at 3 years old. There was an identical correlation between later HINT and AIMS and the BSID-III gross and fine motor subscales. The HINT was found to have stronger predictive correlations for the infants deemed to be “at risk.” Overall, HINT was determined to have comparable predictive validity to AIMS and should be considered for use as a screen in research and in the clinic.