Long-term Predictive Validity Research Articles

Longitudinal stability of detection dog behavioral assessment: A follow-up study of long-term working success

Detection dogs are a critical asset to homeland security, law enforcement, conservation efforts, and more. However, due to the challenges faced in operational working roles and the behavioral requirements to succeed in such roles, many dogs bred and trained for detection tasks are ultimately deemed unsuitable. Therefore, reliable methods for selecting dogs with the highest chances of success are needed. Studies aiming to identify the behavioral traits associated with success and methods for assessment have focused on short-term outcomes related to completion of training or selection for working roles. However, intervening factors may emerge leading to attrition once in service. The goal of the current study was to determine the longitudinal stability of performance on a detection dog behavioral suitability test as well as its predictive validity in determining working success. We followed a cohort of candidate detection dogs (n = 61) to determine changes in number of dogs successfully completing training and still working two years later, as well as determine the long-term predictive validity of the behavioral test. We also repeated the test in a subset of dogs (n = 34) to determine the longitudinal stability of performance on the test from puppy to mature adult. We found that training completion success rates were similar to current working success rates (i.e., minimal attrition). Additionally, performance on aspects of the puppy test such as emotional reactivity conducted at 3 months was predictive of current status (p = .008, OR =.246), and significantly correlated with performance at 3 years (r = .330, p = .028). These findings demonstrate longitudinal stability in behavioral traits considered important for detection dog success, which will be valuable for improving behavioral assessment and selection measures.

Early detection of risk for maltreatment within Dutch preventive child health care: A proxy-based evaluation of the long-term predictive validity of the SPARK method

BackgroundFor effective prevention of child maltreatment, it is crucial that risk factors for child maltreatment are identified as early as possible. In the Dutch preventive child healthcare, the SPARK-method is used for this purpose. ObjectiveThe current study investigated the predictive validity of the SPARK-method for predicting child protection activities, as a proxy for child maltreatment, and whether the estimation can be improved with an actuarial module. Participants and settingParticipants included a community sample of 1582 children of approximately 18-months-old for whom the SPARK was administered during well-child visits at home (51 %) or at the well-baby clinic (49 %). MethodsSPARK measurements were linked to data on child protection orders and residential youth care over a 10-year follow-up period. The predictive validity was evaluated using Area Under the receiver operating characteristic Curve (AUC) values. ResultsResults showed good predictive validity for the SPARK clinical risk assessment (AUC = 0.723; large effect). The actuarial module led to a significant improvement in predictive validity (AUC = 0.802; large effect), z = 2.05, p = .04. ConclusionThese results show that the SPARK is suitable for estimating the risk of child protection activities and that the actuarial module is a valuable addition. The SPARK can be used to support professionals in preventive child healthcare with their decision on appropriate follow-up actions.

Let’s Stop Complaining That Early Childhood Assessments Do Not Predict IQ

This Viewpoint discusses the concern about the long-term predictive validity of early childhood development (ECD) assessments and how this concern reflects a misunderstanding of the constructs of ECD and intelligence, how they are assessed, and the myriad of other influences on the growth and trajectory of intellectual ability in children.

Evaluating validity and bias for hand-calculated and automated written expression curriculum-based measurement scores

ABSTRACT Written expression curriculum-based measurement (WE-CBM) is a formative assessment approach for screening and progress monitoring. To extend evaluation of WE-CBM, we compared hand-calculated and automated scoring approaches in relation to the number of screening samples needed per student for valid scores, the long-term predictive validity and diagnostic accuracy of scores, and predictive and diagnostic bias for underrepresented student groups. Second- to fifth-grade students (n = 609) completed five WE-CBM tasks during one academic year and a standardised writing test in fourth and seventh grade. Averaging WE-CBM scores across multiple samples improved validity. Complex hand-calculated metrics and automated tools outperformed simpler metrics for the long-term prediction of writing performance. No evidence of bias was observed between African American and Hispanic students. The study will illustrate the absence of test bias as necessary condition for fair and equitable screening procedures and the importance of future research to include comparisons with majority groups.

Trans-Contextual Model Predicting Change in Out-of-School Physical Activity: A One-Year Longitudinal Study

The aim of the current study was to test the long-term predictive validity of the trans-contextual model in accounting for variance in adolescents’ out-of-school physical activity measured by self-report and accelerometer based-devices over a one-year period. Secondary school students ( N = 265) aged 11 to 15 years completed a three-wave survey on two occasions in time, spanning a one-year interval, measuring perceived autonomy support in physical education (PE), peer and parent autonomy support in leisure-time, autonomous and controlled motivation in PE and leisure-time, attitude, subjective norms, perceived behavioural control, intention, and out-of-school physical activity both by self-report and accelerometer-based devices. A variance-based structural equation model using residualized change scores revealed that perceived autonomy support from PE teachers predicted autonomous motivation in PE, and autonomous motivation in PE predicted autonomous motivation in leisure-time. In addition, peer and parent autonomy support predicted autonomous motivation in leisure-time. Autonomous motivation in leisure-time indirectly predicted physical activity intention mediated by attitude and perceived behavioural control. Intention predicted self-reported physical activity participation, although the effect was in the opposite direction to our prediction, but not physical activity measured by accelerometer-based devices. Results support some tenets of the trans-contextual model over a one-year time period, particularly the determinants of physical activity intentions. The introduction of COVID-19 restrictions may explain the negative relationship between intention and self-reported physical activity. Further longitudinal studies are needed to verify the results of the current study.

Long-Term Validity and Diagnostic Accuracy of Kindergarten Acadience Reading with English Learners

Acadience Reading (AR) is a screener for early detection of reading problems in elementary students. Limited research exists, however, on its technical adequacy for evaluation of English Learners (ELs). In this study, we tested the long-term predictive validity and diagnostic accuracies of AR and examined the differences between native English-speaking and EL students. A sample of 305 students (94 ELs, 31% of the sample) completed AR at three time points in kindergarten and the statewide reading test in third grade. Hierarchical regression models confirmed good long-term validity for AR with end of the school year scores outperforming the other two time-points and EL status along with ethnic background not playing a significant role. Findings also revealed that AR at the end of the school year provided moderate long-term diagnostic accuracy for students well below benchmark. Implications for research and practice as well as limitations of the study are discussed. Impact Statement Acadience Reading data collected at the end of kindergarten offered the best long-term predictive validity for third grade reading performance compared to other time points. EL status did not play a significant role in the model of kindergarten Acadience Reading predicting performance on a high-stakes reading test in third grade. Diagnostic accuracy and likelihood ratio results indicate the value of Acadience Reading scores at the end of kindergarten for indicating students who are likely to have reading difficulty in the future.

My mission is possible: discussing ethical concerns about genomics and precision medicine.

Although there is considerable evidence that precision anticancer drugs may be more effective than "one size fits all" approach, doubts persist about their cost, availability, and overall benefit for patients. With increasing frequency, patients with metastatic malignancies are undergoing next-generation sequencing (NGS) procedures to determine if there is a viable mutation that could guide their first or next line of treatment. However, this could be prohibitive for many disadvantaged patients. Furthermore, efficacy studies are often structured around surrogate endpoints of dubious long-term predictive validity. Moreover, it is necessary to add that it is often a therapy with significant toxicities, especially in over-treated patients. There is no doubt that precision medicine represents the near future of medical oncology, however, questions need to be asked, out of the spotlight and much closer to our patients.

Development of the Psychological Insight Questionnaire among a sample of people who have consumed psilocybin or LSD.

Background:Several measures have been developed to examine acute psychedelic effects (e.g. mystical-type and challenging experiences), but no measure assesses acute psychologically insightful experiences that may occur during psychedelic experiences.Aim:The purpose of this study was to develop and examine the psychometric properties of the Psychological Insight Questionnaire.Method:A cross-sectional survey study among psilocybin and LSD users. Respondents (n=1661; Mage=22.9, standard deviation=8.5; Caucasian/White=83%; non-Hispanic=91%; men=72%; United States resident=66%) completed an Internet-based survey.Results:The Psychological Insight Questionnaire consists of 23 items with two subscales: (a) Avoidance and Maladaptive Patterns Insights and (b) Goals and Adaptive Patterns Insights. Construct validity of the Psychological Insight Questionnaire was supported by strong correlations of the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores with the insight subscale of the Session Impacts Scale, and weak-to-moderate correlations with the Mystical Experiences and Challenging Experiences Questionnaires. Furthermore, Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores were moderately-to-strongly correlated with retrospectively reported increases in psychological flexibility, and well-being/life satisfaction that were attributed to a memorable psychedelic experience. Lastly, incremental validity was established showing that the Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights subscale) scores predict unique variance in changes in psychological flexibility, and Psychological Insight Questionnaire (and Avoidance and Maladaptive Patterns Insights and Goals and Adaptive Patterns Insights subscales) scores predict changes in well-being and life satisfaction, beyond measures of acute mystical-type and challenging effects.Conclusions:The Psychological Insight Questionnaire has the potential to extend the understanding of the acute and enduring effects of psychedelics. Further longitudinal research is necessary to determine the long-term predictive validity of the Psychological Insight Questionnaire and to examine the role of psychological insight in predicting therapeutic outcomes.

Novel word learning at 21 months predicts receptive vocabulary outcomes in later childhood.

Several aspects of early language skills, including parent-report measures of vocabulary, phoneme discrimination, speech segmentation, and speed of lexical access predict later childhood language outcomes. To date, no studies have examined the long-term predictive validity of novel word learning. We examined whether individual differences in novel word learning at 21 months predict later childhood receptive vocabulary outcomes rather than generalized cognitive abilities. Twenty-eight 21-month-olds were taught novel words using a modified version of the Intermodal Preferential Looking Paradigm. Seventeen children (range 7-10 years) returned to participate in a longitudinal follow-up. Novel word learning in infancy uniquely accounted for 22% of the variance in childhood receptive vocabulary but did not predict later childhood visuospatial ability or non-verbal IQ. These results suggest that the ability to associate novel sound patterns to novel objects, an index of the process of word learning, may be especially important for long-term language mastery.

Long-Term Predictive Validity of the Juvenile Sex Offender Assessment Protocol-II: Research and Practice Implications.

The current study evaluated the predictive validity of the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II) scores in a sample of juveniles who recidivated sexually or nonsexually as adults. Participants included 166 juveniles who had previously sexually offended and were followed into adulthood for an average of 10.75 years. Results of area under the receiver operating characteristic curve (AUC) analyses supported the predictive validity of the J-SOAP-II Total Score, Scale 1, and Static Score in regard to adult sexual recidivism, and predictive validity was found for all J-SOAP-II scores (except Scale 1) in regard to adult nonsexual recidivism. Implications for future research on the assessment of risk factors and treatment needs for adolescents who commit sexual offenses are discussed.

Examining Predictive Validity of Reading Universal Screening Measure After 2 Years of Schooling: An Application of Korean Maze Curriculum Based Measurement

본 연구의 주된 목적은 어절선택 CBM을 사용하여 보편적 선별검사의 예측타당도를 분석하는 것이었다. 특히 본 연구는 기존 연구와 달리 2년이라는 장기간의 예측타당도를 검증하는 연구의 의의를 갖고 있었다. 본 연구에서는 3개교의 초등학교에 입학한 237명의 1학년 학생들을 2학년 말까지 추적하여 검사결과를 수집하였다. 본 연구에서 사용한 주요 분석방법은 상관계수 분석, ROC 곡선 분석, 잠재성장모형 분석이었다. 연구결과에 따르면 어절선택 CBM의 개별 점수와 기울기는 2년 후에도 안정적인 예측타당도를 갖고 있는 것으로 나타났다. 끝으로 연구결과의 시사점과 향후 연구주제에 대한 논의를 제공하였다.This study investigated the predictive validity of universal screening in reading. Especially, this study focused on long-term predictive validity. The participants were 237 students from 3 elementary schools, and data were collected from school entry to the end of Year 2. Correlation coefficients, ROC curve analysis, and latent curve modeling were applied to answer the main research questions suggested in this study. The results showed that maze Korean CBM slope and score are strongly associated with reading achievement test and efficient in predicting students who are at risk for reading after 2 years of schooling. Implication and future directions for research are suggested.

What Is Successful Aging? A Psychometric Validation Study of Different Construct Definitions.

We examined the validity of 5 successful aging (SA) operationalizations that assessed different facets of the SA construct (cognitive and physical health and disability; well-being; social engagement). A total of 2,478 participants (mean age = 82.5 years, standard deviation [SD] = 3.47) were studied. We used confirmatory factor analysis to investigate the relationships between facets and to determine the convergent validity as well as short-term (1.5 years) and long-term (4.5 years) predictive validity of the 5 SA operationalizations for measures of quality of life (QoL) and objective health outcomes. A general SA operationalization that included all SA facets but also allowed differences between them showed the best model fit and construct validity. A biomedical operationalization of SA that excluded either the well-being or the social engagement facet showed lower convergent and predictive validity for subjective measures (e.g., QoL) but higher associations with objective measures (e.g., health). A purely psychosocial SA operationalization that excluded the physiological facet did not allow good prediction of objective health outcomes. Our results suggest that a well-balanced SA operationalization should include measures assessing health, disability, well-being, and social engagement.

School Readiness as a Longitudinal Predictor of Social-Emotional and Reading Performance Across the Elementary Grades

This study is a brief psychometric report examining the Kindergarten Student Entrance Profile (KSEP). Multiple regression models were tested examining associations between kindergarten teachers’ ratings of children’s social-emotional and cognitive readiness during the first month of kindergarten with academic and social-emotional outcomes almost 6 years later. Significant associations ( p < .05) were identified between children’s cognitive readiness at kindergarten entry and reading fluency in Grade 5, as well as between children’s social-emotional readiness and multiple aspects of their social-emotional well-being in Grade 5. This study provides evidence supporting the long-term predictive validity of KSEP screener ratings and highlights the importance of screening for social-emotional, as well as cognitive, indicators of readiness when children enter kindergarten. Practical implications are discussed.

Using Admission Assessments to Predict Final Grades in a College Music Program

Entrance examinations and auditions are common admission procedures for college music programs, yet few researchers have attempted to look at the long-term predictive validity of such selection processes. In this study, archival data from 93 student records of a German music academy were used to predict development of musicianship skills over the course of a 4-year program. Audition grades for the principal instrument, aural skills, and basic knowledge of music theory were correlated with similar data available for the final exams. Final high school grades also were available. Results indicated moderate correlations between entrance and final grades for aural skills ( r = .69) and music theory (.45). Piano majors did better at aural skills and music theory than other candidates. A positive influence of keyboard proficiency also was found for the nonpiano majors. The correlation between initial and final grade on the principal instrument was dependent on the instrument category: piano (.64), followed by voice (.55), winds (.24), and strings (.05). Stronger academic performance prior to college was associated with superior performance in academic subjects in college, whereas no influence was found for academic strength on students’ principal instrument performance.

Predictive validity of the structured assessment of violence risk in youth: A 4‐year follow‐up

Structured violence risk assessment is an essential part of treatment planning for violent young people. The Structured Assessment of Violence Risk in Youth (SAVRY) has been shown to have good reliability and validity in a range of settings but has hardly been studied in adolescent mental health services. This study aimed to evaluate the long-term predictive validity of the SAVRY in adolescent psychiatry settings. In a prospective study, 200 SAVRY assessments of adolescents were acquired from psychiatric, forensic and correctional settings. Re-offending records from the Finnish National Crime Register were collected. Receiver operating curve statistics were applied. High SAVRY total and individual subscale scores and low values on the protective factor subscale were significantly associated with subsequent adverse outcomes, but the predictive value of the total score was weak. At the risk item level, those indicating antisocial lifestyle, absence of social support and pro-social involvement were strong indicators of subsequent criminal convictions, with or without violence. The SAVRY summary risk rating was the best indicator of likelihood of being convicted of a violent crime. After allowing for sex, age, psychiatric diagnosis and treatment setting, for example, conviction for a violent crime was over nine times more likely among those young people given high SAVRY summary risk ratings. The SAVRY is a valid and useful method for assessing both short-term and long-term risks of violent and non-violent crime by young people in psychiatric as well as criminal justice settings, adding to a traditional risk-centred assessment approach by also indicating where future preventive treatment efforts should be targeted. The next steps should be to evaluate its role in everyday clinical practice when using the knowledge generated to inform and monitor management and treatment strategies.

A long-term predictive validity study: Can the CDI Short Form be used to predict language and early literacy skills four years later?

This longitudinal study examined the predictive validity of the MacArthur Communicative Developmental Inventories-Short Form (CDI-SF), a parent report questionnaire about children's language development (Fenson, Pethick, Renda, Cox, Dale & Reznick, 2000). Data were first gathered from parents on the CDI-SF vocabulary scores for seventy-six children (mean age=1 ; 10). Four years later (mean age=6 ; 1), children were assessed on language outcomes (expressive vocabulary, syntax, semantics and pragmatics) and code-related skills, including phonemic awareness, word recognition and decoding skills. Hierarchical regression analyses revealed that early expressive vocabulary accounted for 17% of the variance in picture vocabulary, 11% of the variance in syntax, and 7% of the variance in semantics, while not accounting for any variance in pragmatics in kindergarten. CDI-SF scores did not predict code-related skills in kindergarten. The importance of early vocabulary skills for later language development and CDI-SF as a valuable research tool are discussed.

Could situational judgement tests be used for selection into dental foundation training?

To pilot and evaluate a machine-markable situational judgement test (SJT) designed to select candidates into UK dental foundation training. Single centre pilot study. UK postgraduate deanery in 2010. Seventy-four candidates attending interview for dental foundation training in Oxford and Wessex Deaneries volunteered to complete the situational judgement test. The situational judgement test was developed to assess relevant professional attributes for dentistry (for example, empathy and integrity) in a machine-markable format. Test content was developed by subject matter experts working with experienced psychometricians. Evaluation of psychometric properties of the pilot situational judgement test (for example, reliability, validity and fairness). Scores in the dental foundation training selection process (short-listing and interviews) were used to examine criterion-related validity. Candidates completed an evaluation questionnaire to examine candidate reactions and face validity of the new test. Forty-six candidates were female and 28 male; mean age was 23.5-years-old (range 22-32). Situational judgement test scores were normally distributed and the test showed good internal reliability when corrected for test length (α = 0.74). Situational judgement test scores positively correlated with the management, leadership and professionalism interview (N = 50; r = 0.43, p <0.01) but not with the clinical skills interview, providing initial evidence of criterion-related validity as the situational judgement test is designed to test non-cognitive professional attributes beyond clinical knowledge. Most candidates perceived the situational judgement test as relevant to dentistry, appropriate for their training level, and fair. This initial pilot study suggests that a situational judgement test is an appropriate and innovative method to measure professional attributes (eg empathy and integrity) for selection into foundation training. Further research will explore the long-term predictive validity of the situational judgement test once candidates have entered training.

The long-term predictive validity of early motor development in “apparently normal” ELBW survivors

BackgroundWithin the able majority of ELBW survivors, there is a lack of identified predictors of which children will require extra support despite having escaped significant disability. AimsInvestigate the predictive validity of early motor scores, compared to that of perinatal descriptors or early growth, on long-term motor impairment in non-disabled ELBW (<1000g) children. Study designProspective longitudinal study. Outcome measures48 non-disabled ELBW children (27 male) completed the Neurosensory Motor Developmental Assessment (NSMDA) at 8months, 2years and 4years post term and The Motor Assessment Battery for Children (MABC) at 11–13years of age. Other possible predictors of long-term outcomes (gestational age, birthweight, multiple birth, head circumference measures and gender) were retrieved from the records. ResultsEarly motor assessment (NSMDA score) independently predicted the MABC total score at 11–13years of age with a positive predictive value of 87% by 4years post term. There was increased risk of long-term motor impairment associated with male gender but the degree of prematurity, multiple birth status or early growth measures did not predict motor outcome. Postural control and sensory motor scores at 4years post term, rather than neurological score, were associated with long-term motor outcomes for the ELBW children at 11–13years of age. ConclusionsEarly motor scores are valid markers of long-term motor outcomes for “apparently normal” ELBW children. Early postural competence and sensory motor function are discriminating in regards to long-term motor function in neurologically normal ELBW children.

Can the UK Clinical Aptitude Test (UKCAT) select suitable candidates for interview?

UK medical school traditional selection processes are faltering in their ability to distinguish among highly qualified candidates. New methods of selection, including the UK Clinical Aptitude Test (UKCAT), herald a new era in which candidates are selected on aptitude and also aim to widen participation. However, the predictive validity of UKCAT and its role in the selection process are yet to be defined. This paper examines current selection practices and questions the role that such an aptitude test may take. This study is intended to determine whether UKCAT can select suitable candidates for interview. The study was designed to determine whether selectors rejected fewer candidates with high rather than low UKCAT scores using routine selection techniques. Selector rejection rates for 812 candidates with high UKCAT scores and 200 candidates with low UKCAT scores were compared. Additionally, any relationships among UKCAT and subsequent interview performance scores were explored by examining the correlation coefficients between overall and component UKCAT and interview scores for 637 candidates with high UKCAT scores. The rejection rate before interview of candidates with low UKCAT scores was 2.7 times that of candidates with high UKCAT scores. However, no relationship between overall UKCAT score and overall interview score existed within a pre-selected cohort of applicants with high UKCAT scores (Kendall's correlation coefficient, tau b =- 0.004; p = 0.88). UKCAT can facilitate the independent selection of appropriate candidates for interview when used as described. However, UKCAT is not predictive of success at interview. The long-term predictive validity of UKCAT is currently under investigation. Therefore, we conclude that UKCAT is best viewed as a useful adjunct to current selection processes.

Comparative predictive validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale

SIR–The paper by Harris et al.1 describes the Harris Infant Neuromotor Test (HINT), an assessment of infant motor function developed by the first author. The stated purpose of the HINT is ‘to differentiate atypical from typical motor development in infants aged 2.5 to 12.5 months.’ Hence, this first report of the predictive validity of the HINT deserves careful review. Unfortunately, the article lacks key information, so the reader is unable to evaluate the study procedures, or to determine the clinical validity of the HINT. Demographic and birth characteristics are presented for 144 infants, recruited as a convenience sample of 58-term and 86 at-risk infants. However, the authors report attrition of 21% prior to their primary outcome at 2 years and 50% prior to outcome at 3 years. This implies the predictive validity is actually based on outcome of 114 infants at 2 years and 72 infants at 3 years. But, these participants are not described and the numbers are ambiguous. Tables III and IV indicate that the predictive validity results are based on a sample of 144; the ROC curves in the online supplemental materials indicate 13 missing participants at 2-year outcome. The authors discuss attrition as a limitation but conclude that the ‘considerable’ attrition in their study was not a problem because the statistically significant findings indicate adequate power. However, they do not address attrition as a source of selection bias which can seriously undermine the validity of an epidemiological study. As stated in the resource cited by the authors,2 to address attrition in long-term follow-up studies researchers should, ‘provide clear, unambiguous information on the flow of subjects through the study/cohort at each stage.’ The article by Harris et al. does not clearly describe the evolution of the study sample, nor of the participants at each end-point. The reference cited further advises researchers to ‘provide baseline characteristics for those seen and not seen at follow-up for each intervention group.’2 Harris et al. do not compare the characteristics of participants who were evaluated to those who were lost to follow-up. This information is required because it is likely that accurate prediction of developmental outcome would be more challenging for those infants who were not maintained in the study, due to a higher prevalence of confounding influences. Indeed, in the discussion the authors note a differential rate of attrition between the typical and atypical infants. If this report of predictive validity of the HINT is based only on follow-up of the infants who represented greater developmental stability relative to the source population, this bias should be noted. The authors do not provide explicit information about the outcome status of the participants. Since the key predictive measures (sensitivity, specificity, predictive values) are based on the proportion of participants with normal or abnormal outcomes, it is necessary for readers to know the a priori operational definitions of outcome, as well as the actual developmental outcome of all participants. The authors do not define the outcome criteria in the Method section. The titles for Tables III and IV suggest two levels of outcome measures based on Bayley-II scores; however, the readers are never informed of the outcomes of the individual study participants. The authors note that ‘only two infants showed significant BSID-II motor delays at age 2.’ No report is given of the number of infants who exhibited mild delay at age 2 years, or of the outcome status at 3 years. Finally, the authors claim that their sample is ‘representative of … the US population in terms of ethnic origin’ (and ‘generalizeable’), based on reported 79% Caucasian infants in their sample deemed comparable to 77% white race in the United States. In studies of health outcomes in the US, it is not standard practice to categorize participants simply as ‘white’ or ‘non-white’ because these designations may comprise very different racial/ethnic groups (Hispanic, Asian, African-American, Native American). It is unlikely that a sample of infants in British Columbia is racially comparable to the demographics of the USA. The authors should simply provide the racial/ethnic identity of their participants (not given) and allow the reader to determine the generalizability of the findings. Harris et al. are to be commended for conducting a longitudinal study over a period of 3 years in an effort to demonstrate long-term predictive validity of the HINT. Inclusion of the information missing from this article regarding the study participants and procedures would enable the reader to accurately evaluate the predictive value of this new tool.