Converging disciplines for assessing child development

Abstract

The failure of hundreds of millions of children to achieve their full developmental potential or having their development disrupted due to neurodevelopmental disorders is a formidable barrier to a healthier, more equal, and inclusive future for humanity (Lu et al., 2016). One major reason for the limited global response to this challenge, despite the accumulation of evidence on effective interventions (Aboud and Yousafzai, 2015), is the absence of a pragmatic and valid tool for assessing early life neurodevelopment (Boggs et al., 2019).The current dependence on observation of a child in a clinical setting by highly trained child development experts, an extremely scarce and inequitably distributed human resource, and the reliance on proprietary tools that are prohibitively costly effectively means that there is no routine assessment of child development, such as what is done for growth, in any low-and middle-income country. If developmental surveillance is implemented at all, it is done using parent-report questionnaires, which depend on the caregiver's own knowledge of healthy development in childhood, or observations by trained non-specialists, which differ based on the level of skill of the observer and which need continuing fidelity monitoring to ensure sustained quality through repeated intensive training. Indeed, in most settings, the health system simply waits for a child's development to become so awry that the consequences become visible to the parent, teacher, or health worker. As a result, the precious developmental window for early intervention is squandered and millions of children struggle with their learning, which, in turn, leads to poorer employment prospects and, ultimately, fuels the vicious cycle of disadvantage and poverty.The authors, Vikram Patel (a global mental health expert), Gauri Divan (a developmental pediatrician), and Supriya Bhavnani (a neuroscientist), along with a clinical psychologist and two neurobiologists, formed a small team that explored how their respective fields could collaborate to solve this challenge. In this backstory, they feature the tools that they have developed to easily assess early-life neurodevelopment that required the convergence of diverse disciplines. CONVERGING DISCIPLINES TO INNOVATEWith the increasing accessibility of digital technologies, we challenged ourselves to consider whether we could innovate to close this monitoring and detection gap by designing scalable assessment tools. This approach was inspired by three strands of science: implementation science demonstrating the success of task-sharing, a strategy in which paraprofessionals are trained to deliver specific health care interventions, for other global health challenges, including parenting interventions for promoting early child development and managing neurodevelopmental disorders (Britto et al., 2017); neuroscience, which showed how diverse technologies such as eye-tracking and electroencephalography (EEG) could be used to assess the developing brain; developmental science, which showed th...