On Health, Human Development Potential and the Quality of Life:

Towards Biological-based Indexes of Human Development Potential for Assessing the Quality of Life

IDB-PAHO, May 25, 2007

S. Greenspan, M.D. & C. Breinbauer, M.D., M.P.H.

Interdisciplinary Council on Developmental and Learning Disorders (ICDL)

Early Social-Emotional and Cognitive Basis for Human Development Potential,

and Improved Quality of Life

Brain Development Index??“Social-Emotional & Cognitive Development”

The evidence is clear: good nutrition and social, emotional, language and cognitive development are critical for human development and quality of life

We know how to measure early childhood stunting

The next challenge is to develop “internationally comparable and feasible measures of child development” (Grantham-McGreggor et al., 2007)

Traditional Domains of Child Development

• Language

• Cognitive (IQ)

• Social-Emotional

• Fine Motor

• Gross MotorLimitations for internationally comparable & feasible measures:• Separate and/or long instruments for each domain• Complex application, expensive• Fragmented approach

Brain Development:Social-Emotional Domain starts early

• Newborns show visual preference for faces and rapid face recognition

SocialCognition

EyeGaz

e

Emot

ion

Recog

nitio

n FacePerception

Adapted from G. Dawson, 2006

Influence of Social Motivation on Brain Development

Brain Development

Social Motivation

Attention to Social Stimuli

Development of Expertise

Efficiency (neural speed)

CorticalSpecialization and

Integration

Dawson et al., 2005, Developmental Neuropsychology

The role of Emotions on Child Development

• Traditionally, language and cognition were thought to be autonomous faculties that develop independent of emotion.

• Greenspan & Shanker have demonstrated that language and cognition emerge from, and are inextricably tied to, increasingly complex affect gesturing between a child and his or her caregiver.– Shanker & Greenspan (2007). The Developmental Pathways to pattern

Recognition, Joint Attention, Language and Cognition. New Ideas in Psychology, 25:1.

• Language• Cognitive• Socio-emotional• Gross motor• Fine motor

• Attention & Regulation• Engagement• Purposeful Communication• Problem Solving• Symbolic Ideas• Logical, Critical Thinking• Multi-Causal, Comparative,

and Triangular Thinking• Gray-Area Thinking• Reflective Thinking

Classical Domains

Functional , IntegratedSocial-Emotional , Language & Cognitive Domains

Shared Attention and Regulation

Critical link between nutrition and social-emotional development

Engagement and Relating

Purposeful Emotional Interactions

Shared Problem Solving

Emotional Ideas

Greenspan Social-Emotional Growth Chart, PsychCorp 2004

Slower Progress

Quicker Progress

Functional Social-Emotional Domains

• 1994-1995 National Health Interview Survey on Disability (NHIS-D), NCHS– Simpson, Colpe & Greenspan (2003). Measuring functional

developmental delay in infants and young children: prevalence rates from the NHIS-D. Paediatric and Perinatal Epidemiology, 17, 68-80

• Social-Emotional Scale of Bayley Scales of Infant and Toddler Development, third edition– Nancy Bayley (2006) PsychCorp

Measuring Child Development Outcomes through Household Surveys

A pilot effort to explore feasibility and methodological challengesInter-American Development Bank, 2005-2006

Chile Nicaragua Honduras

Type of Survey

Quality of Life and Health

Survey

Demographic Health Survey

(DHS)

Demographic Health Survey

(DHS)

Sample 6,300 households

14,000 households

21,000 households

Date March-April 2006

August 2006 -June 2007

November 2005-April 2006

Measuring Child Development Outcomes

• % of children not developing to their fullest potential

Purpose?• Gather evidence to inform policy makers of the need for specific

country ECD policies & programs, “Evidence for Action”

• Add ECD data to infant mortality and nutritional data

“No data, no problem, no action” (A. Solari, 2006)

Comparable Domains & Survey Items Age Band: 36-47 months

36-47 months Chile NicaraguaE. Language &

Purposeful

Communication

Does (NAME) say sentences with 4 or more words to request something he/she wants to do (E.g. Can we go to the swings)?

(NAME) Briefly describes an event or significant moment? E.g. “I went to the park with my mom and played with the ball”?

Receptive

Language &

Problem solving (planning)

Does (NAME) obey instructions that involve 2 or more actions? (For example, if you ask him/her to take the milk out of the shelf and place it on the table, does he /she do it)?

(NAME) follows instructions that contain two or more actions? E.g.: “Take the plate and the cup to the table and bring me the spoon”?

Cognitive Dev.

&

Symbolic

Ideas

Does (NAME) play "make believe" at home, taking on different roles like pretending to be a mother, father, brother, uncle, grandmother, etc.?

(NAME) plays with others representing different characters: mother, father, doctor, driver, teacher, others?

Preliminary Results from Chile

• % of children under 5 years with emerging delays: 29.9%

• % of children under 6 years with moderate delays: 11.3%

• Delays increase with age, and are more prevalent among boys– 45.5% of boys between 4-5 years old have emerging

delays (21.3% of girls between 4-5 years old have emerging delays)

Logistic Regression Analysis: Correlation between

Poverty and Children with Emerging Delays

Income Level (“Quintile”)

OR 95% CI

I (lowest income) 1,000

II 0.762 0.751 – 0,772

III 0.834 0.822 – 0,846

IV 0.504 0.497 – 0,512

V (highest income) 0.465 0.458 – 0,473

Risk of emerging delays increases in children living inhouseholds with lower incomes, 53% difference between highest (V) and lowest (I) quintile.

Conclusions

• Optimal nutrition and social-emotional development are the basic building blocks for higher level thinking abilities, human development and quality of life.

• It is feasible to measure early child development outcomes through household surveys by interviewing their main caretaker, usually the mother.

• More work is needed to develop feasible valid, reliable, and internationally comparable measures of early child development.

“Redefining each child’s potential”

S. Greenspan, M.D. & C. Breinbauer, M.D., M.P.H, Infant Mental Health Initiative

Interdisciplinary Council on Developmental and Learning Disorders, ICDL