1.4 Measuring neurocognitive development

Assessment of early neurocognitive development in children is challenging for many reasons (Ellingsen 2016). During the first years of life, developmental change occurs rapidly, and the manifestation of different skills and abilities varies considerably across children. Moreover, a child’s performance on a cognitive task is very susceptible to measurement setting, timing and the health of the child that day.

Recently, a toolkit was published that reviews 147 assessment tools developed for children ages 0–8 years in low- and middle-income countries (Fernald et al. 2017). Some of the most widely used tools include the Ages & Stages Questionnaires (ASQ), Achenbach Child Behavior Checklist (CBCL), Bayley Scales of Infant Development (BSID), Denver Developmental Screening Test (DEN), Griffiths Scales of Child Development (GRF), Mullen Scale of Early Learning (MSEL), Strengths and Difficulties Questionnaire (SDQ), Wechsler Intelligence Scale for Children (WISC), and its younger age counterpart Wechsler Preschool and Primary Scale of Intelligence (WPPSI).

Each of these tools has its strengths and limitations. For example, the ASQ and DEN are screeners for general child development. The CBCL and SDQ are screeners for behavioral and mental health, not cognition or general development. DEN is relatively easy and quick to administer, but not very precise. It is out of production, not being sold or re-normed. The BSID, MSEL, and GRF provide a clinical assessment at the individual level and requires a skilled professional to administer. Some instruments collect observations through the caregiver (ASQ), whereas others emphasize traits and behavior over performance (SDQ, CBCL). Also, the age ranges to which the instruments are sensitive vary. Furthermore, they may cover different domains of development.

The ideal child development assessment would be easy to administer and has high reliability, validity, and cross-cultural appropriateness. It should also show appropriate sensitivity in scores at different ages and ability levels. It is no surprise that no test can meet all of these criteria. Many tests are too long, difficult to administer, lack cross-cultural validity, or have low reliability. Also, many instruments are proprietary and costly to use.