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Examining Early Child Development in Low-Income Countries: A Toolkit for the …

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Fernald LCH, Kariger P, Engle P, Raikes A. Examining Early Child Development in Low-Income Countries: A toolkit for the assessment of children in the first five years of life. In: The World Bank [Internet]. 2009. p. 1–133.

The psychological and biological changes that occur as a child transitions from a dependent infant to an autonomous teenager are collectively referred to as child development. These changes include the development of language, cognitive skills (e.g., symbolic thought, memory, and logic), social-emotional skills (e.g., a sense of self, empathy and how to interact with others) and motor skills (e.g., sitting, running, and more complex movements, etc.). It is now well accepted that development is a process that is not determined independently by nature or nurture alone, but by “nature through nurture” (pp. 41) (Shonkoff & Phillips, 2000). Changes throughout development result from multidirectional interactions between biological factors (genes, brain growth, neuromuscular maturation), and environmental influences (parent-child relationships, community characteristics, cultural norms) over time (Gottlieb, 1991; Pollitt, 2001; Shonkoff & Phillips, 2000). These interactions lead to the re-organization of various internal systems that allow for new developmental capacities (Thelen, 2000). For example, the emergence of locomotive skills results from the co-occurrence and interactions among physiological systems (muscle strength; the ability to balance), social-emotional change (the motivation to move independently), and experience (adequate opportunity to “practice” the emerging skill) (Adolph, 2002; Adolph, Vereijken, & Denny, 1998; Adolph, Vereijken, & Shrout, 2003). The conceptualization of development as a dynamic interplay between biological and environmental factors suggests that development is malleable and can be enhanced by interventions affecting the child, the environment or both.

The primary purpose of this toolkit is to provide a resource for researchers and program personnel from various disciplines interested in planning and evaluating interventions aimed at improving the development of infants and young children. The toolkit provides: an overview of issues affecting early development and its measurement; a discussion of the types of assessments typically used with children five years and under; guidelines for selecting and adapting tests for use in developing countries, and recommendations for planning successful assessment strategies. Our recommendations are primarily based on tests that have already been adapted for use in other countries, in spite of the fact that many studies do not report on the adaptation process. Furthermore, we focused on tests that have been shown to discriminate successfully between groups of children (e.g. those who received a nutrition/health/early childhood intervention).

For the purposes of this review, the toolkit will emphasize the assessment of children aged five and under for several reasons. The primary reason we are focusing on this age group is that during the first five years of life, children’s language, early understanding of mathematics and reading, and self-control emerge. The extent to which children master these skills during this critical period has implications for success in school (Lerner, 1998), and thus we wanted to focus on children in this pre-school period. Given that children in some lower- and middle-income countries enter school at later ages, however, the tests that are reviewed may also be appropriate for children who are slightly older (e.g. 6 or 7 years old).

The majority of the assessments reviewed and presented in this toolkit are for child-based measures that occur through an individual (one-on-one) assessment of a child. While we agree that assessments designed for the population-level are also necessary and important, there are few population-based measures of early childhood development that do not involve an individual assessment of a child. Thus, the majority of the recommendations presented in the toolkit can be adapted for use at the population level by examining the data in aggregate.


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