The INTERGROWTH-21st Project Neurodevelopment Package: A Novel Method for the Multi-Dimensional Assessment of Neurodevelopment in Pre-School Age Children

Abstract

BackgroundThe International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) Project is a population-based, longitudinal study describing early growth and development in an optimally healthy cohort of 4607 mothers and newborns. At 24 months, children are assessed for neurodevelopmental outcomes with the INTERGROWTH-21st Neurodevelopment Package. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package.MethodsAn advisory panel shortlisted project-specific criteria (such as multi-dimensional assessments and suitability for international populations) to be fulfilled by a neurodevelopment instrument. A literature review of well-established tools for preschoolers revealed 47 candidates, none of which fulfilled all the project's criteria. A multi-dimensional assessment was, therefore, compiled using a package-based approach by: (i) categorizing desired outcomes into domains, (ii) devising domain-specific criteria for tool selection, and (iii) selecting the most appropriate measure for each domain.ResultsThe Package measures vision (Cardiff tests); cortical auditory processing (auditory evoked potentials to a novelty oddball paradigm); and cognition, language skills, behavior, motor skills and attention (the INTERGROWTH-21st Neurodevelopment Assessment) in 35–45 minutes. Sleep-wake patterns (actigraphy) are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. The Package is in use in Brazil, India, Italy, Kenya and the United Kingdom.ConclusionsThe INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early child development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts.

Concurrent Validity and Feasibility of Short Tests Currently Used to Measure Early Childhood Development in Large Scale Studies: Methodology and Results

“…Overall, the low-to-moderate concurrent validity of all tests except the gross motor scales in the youngest children concurs with reported difficulties in assessing young children's development, particularly at large scale (Frongillo et al 2014;Fernald et al 2009;Fernandes et al 2014). As a result, with the exception of the gross motor domain, all tests seem to have limited validity under 18 months.…”

“…There is general agreement that multi-dimensional tests are most desirable (Fernandes et al 2014). But, where resources are limited, it may be possible to use selected scales of a test or single-domain tests, depending on the children's age and purpose of the assessment.…”

“…Multi-dimensional diagnostic tests such as the Bayley Scales of Infant Development (Bayley 1969;Bayley 2006) are considered to be the 'gold standard' to measure the developmental levels of infants and toddlers (Frongillo et al 2014;Fernald et al 2009;Fernandes et al 2014). Importantly, this test has shown sensitivity to differences in ECD outcomes due to interventions in diverse contexts (Hamadani et al 2006;Nahar et al 2009;Attanasio et al 2014).…”

“…Neurodevelopmental Package (Fernandes et al 2014) for the assessment of developmental outcomes at 24 months, or the Engle Scale, developed by the Inter-American Development Bank as part of the Regional Project on Child Development Indicators (PRIDI) (Verdisco et al 2009) for children 24-59 months. Save the Children has developed the International Development and Early Learning Assessment (IDELA) to measure development and early learning, including early literacy and numeracy, for children 3.5-6 years (Wolf et al 2015).…”

Neurodevelopment: The Impact of Nutrition and Inflammation During Infancy in Low-Resource Settings

“…In all settings, the prevalence of mild impairments is higher than severe disability. 1,2 Among several factors identified as contributors to developmental disabilities in LMIC, infections and malnutrition, including micronutrient deficiencies, are particularly important and potentially modifiable. 3 Infancy and early childhood (ie, birth through age 24 months) represent a period of life with both exquisite opportunity and vulnerability for neurodevelopment.…”