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Macrae E, Milosavljevic B, Katus L, Mason L, Amadó MP, Rozhko M, de Haan M, Elwell CE, Moore SE, Lloyd-Fox S. Cognitive control in infancy: Attentional predictors using a tablet-based measure. INFANCY 2024; 29:631-655. [PMID: 38768285 DOI: 10.1111/infa.12599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 11/28/2023] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
Cognitive control is a predictor of later-life outcomes and may underpin higher order executive processes. The present study examines the development of early cognitive control during the first 24-month. We evaluated a tablet-based assessment of cognitive control among infants aged 18- and 24-month. We also examined concurrent and longitudinal associations between attentional disengagement, general cognitive skills and cognitive control. Participants (N = 60, 30 female) completed the tablet-task at 18- and 24-month of age. Attentional disengagement and general cognitive development were assessed at 5-, 8-, 12-, 18- and 24-month using an eye-tracking measure and the Mullen Scales of Early Learning (MSEL), respectively. The cognitive control task demonstrated good internal consistency, sensitivity to age-related change in performance and stable individual differences. No associations were found between infant cognitive control and MSEL scores longitudinally or concurrently. The eye-tracking task revealed that slower attentional disengagement at 8-month, but faster disengagement at 18-month, predicted higher cognitive control scores at 24-month. This task may represent a useful tool for measuring emergent cognitive control. The multifaceted relationship between attention and infant cognitive control suggests that the rapid development of the attentional system in infancy results in distinct attentional skills, at different ages, being relevant for cognitive control development.
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Affiliation(s)
- Emma Macrae
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Bosiljka Milosavljevic
- Department of Psychology, University of Cambridge, Cambridge, UK
- Department of Biological and Experimental Psychology, Queen Mary University of London, London, UK
| | - Laura Katus
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Luke Mason
- Department of Forensic and Neurodevelopmental Sciences, King's College London, London, UK
| | | | - Maria Rozhko
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Michelle de Haan
- Great Ormond Street Institute of Child Health, University College London, London, UK
- Great Ormond Street Hospital for Children NHS Foundation Trust London, London, UK
| | - Clare E Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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Williams EH, Thompson NM, McCray G, Crespo-Llado MM, Bhavnani S, Gajria D, Mukherjee D, Del Bianco T, Lockwood-Estrin G, Mason L, Ngoma V, Namathanga C, Nkhata R, Bennie A, Ranjan A, Kawelama U, Midha N, Singh A, Mpakiza I, Gautam A, Gulati S, Johnson MH, Lancaster G, Belmonte MK, Jones E, Patel V, Chandran S, Mbale E, Divan G, Gladstone M, Chakrabarti B. Scalable Transdiagnostic Early Assessment of Mental Health (STREAM): a study protocol. BMJ Open 2024; 14:e088263. [PMID: 38871663 DOI: 10.1136/bmjopen-2024-088263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Early childhood development forms the foundations for functioning later in life. Thus, accurate monitoring of developmental trajectories is critical. However, such monitoring often relies on time-intensive assessments which necessitate administration by skilled professionals. This difficulty is exacerbated in low-resource settings where such professionals are predominantly concentrated in urban and often private clinics, making them inaccessible to many. This geographic and economic inaccessibility contributes to a significant 'detection gap' where many children who might benefit from support remain undetected. The Scalable Transdiagnostic Early Assessment of Mental Health (STREAM) project aims to bridge this gap by developing an open-source, scalable, tablet-based platform administered by non-specialist workers to assess motor, social and cognitive developmental status. The goal is to deploy STREAM through public health initiatives, maximising opportunities for effective early interventions. METHODS AND ANALYSIS The STREAM project will enrol and assess 4000 children aged 0-6 years from Malawi (n=2000) and India (n=2000). It integrates three established developmental assessment tools measuring motor, social and cognitive functioning using gamified tasks, observation checklists, parent-report and audio-video recordings. Domain scores for motor, social and cognitive functioning will be developed and assessed for their validity and reliability. These domain scores will then be used to construct age-adjusted developmental reference curves. ETHICS AND DISSEMINATION Ethical approval has been obtained from local review boards at each site (India: Sangath Institutional Review Board; All India Institute of Medical Science (AIIMS) Ethics Committee; Indian Council of Medical Research-Health Ministry Screening Committee; Malawi: College of Medicine Research and Ethics Committee; Malawi Ministry of Health-Blantyre District Health Office). The study adheres to Good Clinical Practice standards and the ethical guidelines of the 6th (2008) Declaration of Helsinki. Findings from STREAM will be disseminated to participating families, healthcare professionals, policymakers, educators and researchers, at local, national and international levels through meetings, academic journals and conferences.
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Affiliation(s)
- Elin H Williams
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Nicholas M Thompson
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Faculty of Health, Education and Society, University of Northampton, Northampton, UK
| | | | - Maria M Crespo-Llado
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | | | | | - Debarati Mukherjee
- Indian Institute of Public Health, Bengaluru, Public Health Foundation of India, Kamataka, India
| | - Teresa Del Bianco
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, UK
- School of Social Sciences and Professions, London Metropolitan University, London, UK
| | | | - Luke Mason
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Vukiwe Ngoma
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | - Allan Bennie
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | | | | | | | | | - Akshat Gautam
- Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Sheffali Gulati
- Center of Excellence & Advanced Research for Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Mark H Johnson
- Department of Psychology, University of Cambridge, Cambridge, UK
| | | | - Matthew K Belmonte
- The Com DEALL Trust, Bengaluru, Karnataka, India
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck University of London, London, UK
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Sharat Chandran
- Indian Institute of Technology Bombay, Mumbai, Maharashtra, India
| | - Emmie Mbale
- Department of Paediatrics, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Bhismadev Chakrabarti
- Centre for Autism, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychology, Ashoka University, Sonipat, India
- India Autism Center, Kolkata, India
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Stasolla F, Akbar K, Passaro A, Dragone M, Di Gioia M, Zullo A. Integrating reinforcement learning and serious games to support people with rare genetic diseases and neurodevelopmental disorders: outcomes on parents and caregivers. Front Psychol 2024; 15:1372769. [PMID: 38646123 PMCID: PMC11026657 DOI: 10.3389/fpsyg.2024.1372769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/05/2024] [Indexed: 04/23/2024] Open
Affiliation(s)
| | - Khalida Akbar
- Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
- MANCOSA, Research Doctorate, Durban, South Africa
| | - Anna Passaro
- University “Giustino Fortunato”, Benevento, Italy
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Milosavljevic B, Cook CJ, Fadera T, Ghillia G, Howard SJ, Makaula H, Mbye E, McCann S, Merkley R, Mshudulu M, Saidykhan M, Touray E, Tshetu N, Elwell C, Moore SE, Scerif G, Draper CE, Lloyd-Fox S. Executive functioning skills and their environmental predictors among pre-school aged children in South Africa and The Gambia. Dev Sci 2023:e13407. [PMID: 37128134 DOI: 10.1111/desc.13407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
Executive functions (EFs) in early childhood are predictors of later developmental outcomes and school readiness. Much of the research on EFs and their psychosocial correlates has been conducted in high-income, minority world countries, which represent a small and biased portion of children globally. The aim of this study is to examine EFs among children aged 3-5 years in two African countries, South Africa (SA) and The Gambia (GM), and to explore shared and distinct predictors of EFs in these settings. The SA sample (N = 243, 51.9% female) was recruited from low-income communities within the Cape Town Metropolitan area. In GM, participants (N = 171, 49.7% female) were recruited from the rural West Kiang region. EFs, working memory (WM), inhibitory control (IC) and cognitive flexibility (CF), were measured using tablet-based tasks. Associations between EF task performance and indicators of socioeconomic status (household assets, caregiver education) and family enrichment factors (enrichment activities, diversity of caregivers) were assessed. Participants in SA scored higher on all EF tasks, but children in both sites predominantly scored within the expected range for their age. There were no associations between EFs and household or familial variables in SA, except for a trend-level association between caregiver education and CF. Patterns were similar in GM, where there was a trend-level association between WM and enrichment activities but no other relationships. We challenge the postulation that children in low-income settings have poorer EFs, simply due to lower socioeconomic status, but highlight the need to identify predictors of EFs in diverse, global settings. RESEARCH HIGHLIGHTS: Assessed Executive Functioning (EF) skills and their psychosocial predictors among pre-school aged children (aged 3-5 years) in two African settings (The Gambia and South Africa). On average, children within each setting performed within the expected range for their age, although children in South Africa had higher scores across tasks. There was little evidence of any association between socioeconomic variables and EFs in either site. Enrichment activities were marginally associated with better working memory in The Gambia, and caregiver education with cognitive flexibility in South Africa, both associations were trend-level significance.
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Affiliation(s)
- Bosiljka Milosavljevic
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
| | - Caylee J Cook
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tijan Fadera
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Giulia Ghillia
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
- Department of Women and Children's Health, King's College London, London, UK
| | - Steven J Howard
- Early Start and School of Education, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hleliwe Makaula
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ebrima Mbye
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Samantha McCann
- Department of Women and Children's Health, King's College London, London, UK
| | - Rebecca Merkley
- Department of Cognitive Science, Carleton University, Ottawa, Canada
| | - Mbulelo Mshudulu
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mariama Saidykhan
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Ebou Touray
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Keneba, The Gambia
| | - Nosibusiso Tshetu
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clare Elwell
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Sophie E Moore
- Department of Women and Children's Health, King's College London, London, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Catherine E Draper
- SAMRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah Lloyd-Fox
- Department of Psychology, University of Cambridge, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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McHenry MS, Mukherjee D, Bhavnani S, Kirolos A, Piper JD, Crespo-Llado MM, Gladstone MJ. The current landscape and future of tablet-based cognitive assessments for children in low-resourced settings. PLOS DIGITAL HEALTH 2023; 2:e0000196. [PMID: 36821551 PMCID: PMC9949664 DOI: 10.1371/journal.pdig.0000196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Interest in measuring cognition in children in low-resourced settings has increased in recent years, but options for cognitive assessments are limited. Researchers are faced with challenges when using existing assessments in these settings, such as trained workforce shortages, less relevant testing stimuli, limitations of proprietary assessments, and inadequate parental knowledge of cognitive milestones. Tablet-based direct child assessments are emerging as a practical solution to these challenges, but evidence of their validity and utility in cross-cultural settings is limited. In this overview, we introduce key concepts of this field while exploring the current landscape of tablet-based assessments for low-resourced settings. We also make recommendations for future directions of this relatively novel field. We conclude that tablet-based assessments are an emerging and promising method of assessing cognition in young children. Further awareness and dissemination of validated tablet-based assessments may increase capacity for child development research and clinical practice in low-resourced settings.
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Affiliation(s)
- Megan S. McHenry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, United States of America
- * E-mail:
| | - Debarati Mukherjee
- Indian Institute of Public Health—Bengaluru, Life Course Epidemiology, Bengaluru, Karnataka, India
| | | | - Amir Kirolos
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Joe D. Piper
- Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Maria M. Crespo-Llado
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Melissa J. Gladstone
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
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Yuan H, Ocansey M, Adu-Afarwuah S, Sheridan M, Hamoudi A, Okronipa H, Kumordzie SM, Oaks BM, Prado E. Evaluation of a tablet-based assessment tool for measuring cognition among children 4-6 years of age in Ghana. Brain Behav 2022; 12:e2749. [PMID: 36086855 PMCID: PMC9575601 DOI: 10.1002/brb3.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2022] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To investigate several basic psychometric properties, including construct, convergent and discriminant validity, of the tablet-based Rapid Assessment of Cognitive and Emotional Regulation (RACER) among children aged 4-6 years in Ghana. METHODS We investigated whether RACER tasks administered to children in Ghana could successfully reproduce expected patterns of performance previously found in high-income countries on similar tasks assessing inhibitory control (e.g., slower responses on inhibition trials), declarative memory (e.g., higher accuracy on previously seen items), and procedural memory (e.g., faster responses on sequence blocks). Next, we assessed the validity of declarative memory and inhibitory control scores by examining associations of these scores with corresponding paper-based test scores and increasing child age. Lastly, we examined whether RACER was more sensitive than paper-based tests to environmental risk factors common in low- and middle-income countries (LMICs). RESULTS Of the 966 children enrolled, more than 96% completed the declarative memory and inhibitory control tasks; however, around 30% of children were excluded from data analysis on the procedural memory task due to missing more than half of trials. The performance of children in Ghana replicated previously documented patterns of performance. RACER inhibitory control accuracy score was significantly correlated with child age (r (929) = .09, p = .007). However, our findings did not support other hypotheses. CONCLUSIONS The high task completion rates and replication of expected patterns support that certain RACER sub-tasks are feasible for measuring child cognitive development in LMIC settings. However, this study did not provide evidence to support that RACER is a valid tool to capture meaningful individual differences among children aged 4-6 years in Ghana.
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Affiliation(s)
- Haiying Yuan
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California
| | - Maku Ocansey
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Margaret Sheridan
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, North Carolina
| | - Amar Hamoudi
- Sanford School of Public Policy, Duke University, Durham, North Carolina
| | - Harriet Okronipa
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California
| | - Sika M Kumordzie
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California
| | - Brietta M Oaks
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingstown, Rhode Island
| | - Elizabeth Prado
- Institute for Global Nutrition, Department of Nutrition, University of California, Davis, California
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Ernst JR, Grenell A, Carlson SM. Associations between executive function and early math and literacy skills in preschool children. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH OPEN 2022; 3:100201. [PMID: 36578863 PMCID: PMC9794199 DOI: 10.1016/j.ijedro.2022.100201] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current study directly compared the magnitude of associations between executive function (EF) and math versus literacy and investigated whether they differed by age within the preschool years. Participants were 92 typically developing, preschool children in the United States (M age=58.53 months; 47.8% Female; 58.7% White; 29.3% Non-White). Children completed a developmentally sensitive battery of direct EF assessments, math and literacy achievement tests, and IQ tests. Results showed an EF Composite was associated with math, but not literacy, after controlling for age, verbal and nonverbal IQ, and socioeconomic status. Extending prior work to a younger age, we examined whether the association between EF and academic achievement was moderated by age but found no significant interactions. These findings support the link between EF and math before kindergarten and indicate a similar magnitude of associations in younger and older preschoolers.
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Affiliation(s)
- Jasmine R. Ernst
- Institute of Child Development, University of Minnesota – Twin Cities, 51 E River Road, Minneapolis, MN 55455, United States
| | - Amanda Grenell
- Department of Psychological and Brain Sciences, Indiana University, 1101 E 10th St, Bloomington, IN 47405, United States
| | - Stephanie M. Carlson
- Institute of Child Development, University of Minnesota – Twin Cities, 51 E River Road, Minneapolis, MN 55455, United States
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Mukherjee D, Bhopal S, Bhavnani S, Sharma KK, Roy R, Divan G, Mandal S, Soremekun S, Kirkwood B, Patel V. The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India. Wellcome Open Res 2022; 7:74. [PMID: 35592545 PMCID: PMC9096148 DOI: 10.12688/wellcomeopenres.17712.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/09/2023] Open
Abstract
Background: Early adversities negatively impact children's growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.
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Affiliation(s)
- Debarati Mukherjee
- Life course Epidemiology, Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bengaluru, Karnataka, 560023, India
| | - Sunil Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Supriya Bhavnani
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Kamal Kant Sharma
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Reetabrata Roy
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Gauri Divan
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Siddhartha Mandal
- Center for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, New Delhi, 110016, India
| | - Seyi Soremekun
- Department of Infection Biology, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Betty Kirkwood
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vikram Patel
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
- Department of Global Health & Social Medicine, Harvard Medical School, 41 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
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9
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Mukherjee D, Bhopal S, Bhavnani S, Sharma KK, Roy R, Divan G, Mandal S, Soremekun S, Kirkwood B, Patel V. The effect of cumulative early life adversities, and their differential mediation through hair cortisol levels, on childhood growth and cognition: Three-year follow-up of a birth cohort in rural India. Wellcome Open Res 2022; 7:74. [PMID: 35592545 PMCID: PMC9096148 DOI: 10.12688/wellcomeopenres.17712.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Early adversities negatively impact children’s growth and development, putatively mediated by chronic physiological stress resulting from these adverse experiences. We aimed to estimate the associations between prospectively measured cumulative early adversities with growth and cognition outcomes in rural Indian preschool children and to explore if hair cortisol concentration (HCC), a measure of chronic physiological stress, mediated the above association. Methods: Participants were recruited from the SPRING cRCT in rural Haryana, India. Adversities experienced through pregnancy and the first year of life were measured in 1304 children at 12-months. HCC was measured at 12-months in 845 of them. Outcome measures were height-for-age-z-score (HAZ), weight-for-age-z-score (WAZ) and cognition, measured in 1124 children followed up at 3-years. Cognition was measured using a validated tablet-based gamified tool named DEEP. Results: Cumulative adversities at 12-months were inversely associated with all outcomes measures at 3-years. Each unit increase in adversity score led to a decrease of 0·08 units [95% confidence interval (CI):-0·11,-0·06] in DEEP-z-score; 0·12 units [-0·14,-0·09] in HAZ and 0·11 units [-0·13,-0·09] in WAZ. 12-month HCC was inversely associated with DEEP-z-score (-0·09 [-0·16,-0·01]) and HAZ (-0·12 [-0·20,-0·04]), but the association with WAZ was not significant (p = 0·142). HCC marginally mediated the association between cumulative adversities and HAZ (proportion mediated = 0·06, p = 0·014). No evidence of mediation was found for the cognition outcome. Conclusions: Cumulative early adversities and HCC measured at 12-months have persistent negative effects on child growth and cognition at 3-years. The association between adversities and these two child outcomes were differentially mediated by HCC, with no evidence of mediation observed for the cognitive outcome. Future studies should focus on other stress biomarkers, and alternate pathways such as the immune, inflammation and cellular ageing pathways, to unpack key mechanisms underlying the established relationship between early adversities and poor child outcomes.
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Affiliation(s)
- Debarati Mukherjee
- Life course Epidemiology, Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bengaluru, Karnataka, 560023, India
| | - Sunil Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Supriya Bhavnani
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Kamal Kant Sharma
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Reetabrata Roy
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Gauri Divan
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
| | - Siddhartha Mandal
- Center for Chronic Disease Control, C-1/52, 2ND FL, Safdarjung Development Area, New Delhi, 110016, India
| | - Seyi Soremekun
- Department of Infection Biology, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Betty Kirkwood
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Vikram Patel
- Child Development Group, Sangath, 451 Bhatkar Waddo, Succor, Bardez, Goa, 403501, India
- Department of Global Health & Social Medicine, Harvard Medical School, 41 Huntington Ave, Boston, MA, 02115, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Ave, Boston, MA, 02115, USA
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10
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Bhavnani S, Parameshwaran D, Sharma KK, Mukherjee D, Divan G, Patel V, Thiagarajan TC. The Acceptability, Feasibility, and Utility of Portable Electroencephalography to Study Resting-State Neurophysiology in Rural Communities. Front Hum Neurosci 2022; 16:802764. [PMID: 35386581 PMCID: PMC8978891 DOI: 10.3389/fnhum.2022.802764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Electroencephalography (EEG) provides a non-invasive means to advancing our understanding of the development and function of the brain. However, the majority of the world’s population residing in low and middle income countries has historically been limited from contributing to, and thereby benefiting from, such neurophysiological research, due to lack of scalable validated methods of EEG data collection. In this study, we establish a standard operating protocol to collect approximately 3 min each of eyes-open and eyes-closed resting-state EEG data using a low-cost portable EEG device in rural households through formative work in the community. We then evaluate the acceptability of these EEG assessments to young children and feasibility of administering them through non-specialist workers. Finally, we describe properties of the EEG recordings obtained using this novel approach to EEG data collection. The formative phase was conducted with 9 families which informed protocols for consenting, child engagement strategies and data collection. The protocol was then implemented on 1265 families. 977 children (Mean age = 38.8 months, SD = 0.9) and 1199 adults (Mean age = 27.0 years, SD = 4) provided resting-state data for this study. 259 children refused to wear the EEG cap or removed it, and 58 children refused the eyes-closed recording session. Hardware or software issues were experienced during 30 and 25 recordings in eyes-open and eyes-closed conditions respectively. Disturbances during the recording sessions were rare and included participants moving their heads, touching the EEG headset with their hands, opening their eyes within the eyes-closed recording session, and presence of loud sounds in the testing environment. Similar to findings in laboratory-based studies from high-income settings, the percentage of recordings which showed an alpha peak was higher in eyes-closed than eyes-open condition, with the peak occurring most frequently in electrodes at O1 and O2 positions, and the mean frequency of the alpha peak was found to be lower in children (8.43 Hz, SD = 1.73) as compared to adults (10.71 Hz, SD = 3.96). We observed a deterioration in the EEG signal with prolonged device usage. This study demonstrates the acceptability, feasibility and utility of conducting EEG research at scale in a rural low-resource community, while highlighting its potential limitations, and offers the impetus needed to further refine the methods and devices and validate such scalable methods to overcome existing research inequity.
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Affiliation(s)
- Supriya Bhavnani
- Child Development Group, Sangath, Goa, India.,Public Health Foundation of India, New Delhi, India
| | | | | | - Debarati Mukherjee
- Indian Institute of Public Health-Bengaluru, Public Health Foundation of India, Bengaluru, India
| | - Gauri Divan
- Child Development Group, Sangath, Goa, India
| | - Vikram Patel
- Child Development Group, Sangath, Goa, India.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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11
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Lord C, Charman T, Havdahl A, Carbone P, Anagnostou E, Boyd B, Carr T, de Vries PJ, Dissanayake C, Divan G, Freitag CM, Gotelli MM, Kasari C, Knapp M, Mundy P, Plank A, Scahill L, Servili C, Shattuck P, Simonoff E, Singer AT, Slonims V, Wang PP, Ysrraelit MC, Jellett R, Pickles A, Cusack J, Howlin P, Szatmari P, Holbrook A, Toolan C, McCauley JB. The Lancet Commission on the future of care and clinical research in autism. Lancet 2022; 399:271-334. [PMID: 34883054 DOI: 10.1016/s0140-6736(21)01541-5] [Citation(s) in RCA: 258] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022]
Affiliation(s)
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Alexandra Havdahl
- Nic Waals Institute, Lovisenberg Diaconal Hospital, Oslo, Norway; Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Paul Carbone
- Department of Pediatrics at University of Utah, Salt Lake City, UT, USA
| | - Evdokia Anagnostou
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | | | - Themba Carr
- Rady Children's Hospital San Diego, Encinitas, CA, USA
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | | | | | | | | | | | - Peter Mundy
- University of California, Davis, Davis, CA, USA
| | | | | | - Chiara Servili
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | | | - Emily Simonoff
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Vicky Slonims
- Evelina Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul P Wang
- Simons Foundation Autism Research Initiative, Simons Foundation, New York, NY, USA; Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | | | - Rachel Jellett
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Andrew Pickles
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Patricia Howlin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Szatmari
- Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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12
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Bignardi G, Dalmaijer ES, Anwyl-Irvine A, Astle DE. Collecting big data with small screens: Group tests of children's cognition with touchscreen tablets are reliable and valid. Behav Res Methods 2021; 53:1515-1529. [PMID: 33269446 PMCID: PMC7710155 DOI: 10.3758/s13428-020-01503-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/25/2023]
Abstract
Collecting experimental cognitive data with young children usually requires undertaking one-on-one assessments, which can be both expensive and time-consuming. In addition, there is increasing acknowledgement of the importance of collecting larger samples for improving statistical power Button et al. (Nature Reviews Neuroscience 14(5), 365-376, 2013), and reproducing exploratory findings Open Science Collaboration (Science, 349(6251), aac4716-aac4716 2015). One way both of these goals can be achieved more easily, even with a small team of researchers, is to utilize group testing. In this paper, we evaluate the results from a novel tablet application developed for the Resilience in Education and Development (RED) Study. The RED-app includes 12 cognitive tasks designed for groups of children aged 7 to 13 to independently complete during a 1-h school lesson. The quality of the data collected was high despite the lack of one-on-one engagement with participants. Most outcomes from the tablet showed moderate or high reliability, estimated using internal consistency metrics. Tablet-measured cognitive abilities also explained more than 50% of variance in teacher-rated academic achievement. Overall, the results suggest that tablet-based, group cognitive assessments of children are an efficient, reliable, and valid method of collecting the large datasets that modern psychology requires. We have open-sourced the scripts and materials used to make the application, so that they can be adapted and used by others.
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Affiliation(s)
- Giacomo Bignardi
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Rd, Cambridge, CB2 7EF, UK.
| | - Edwin S Dalmaijer
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Rd, Cambridge, CB2 7EF, UK
| | - Alexander Anwyl-Irvine
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Rd, Cambridge, CB2 7EF, UK
| | - Duncan E Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Rd, Cambridge, CB2 7EF, UK
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13
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Abstract
The Research Domain Criteria (RDoC) project constitutes a translational framework for
psychopathology research, initiated by the National Institute of Mental Health in an
attempt to provide new avenues for research to circumvent problems emerging from the
use of symptom-based diagnostic categories in diagnosing disorders. The RDoC
alternative is a focus on psychopathology based on dimensions simultaneously defined
by observable behavior (including quantitative measures of cognitive or affective
behavior) and neurobiological measures. Key features of the RDoC framework include an
emphasis on functional dimensions that range from normal to abnormal, integration of
multiple measures in study designs (which can foster computational approaches), and
high priority on studies of neurodevelopment and environmental influences (and their
interaction) that can contribute to advances in understanding the etiology of
disorders throughout the lifespan. The paper highlights key implications for ways in
which RDoC can contribute to future ideas about classification, as well as some of
the considerations involved in translating basic behavioral and neuroscience data to
psychopathology.
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14
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Bhavnani S, Mukherjee D, Bhopal S, Sharma KK, Dasgupta J, Divan G, Soremekun S, Roy R, Kirkwood B, Patel V. The association of a novel digital tool for assessment of early childhood cognitive development, 'DEvelopmental assessment on an E-Platform (DEEP)', with growth in rural India: A proof of concept study. EClinicalMedicine 2021; 37:100964. [PMID: 34195580 PMCID: PMC8225699 DOI: 10.1016/j.eclinm.2021.100964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/21/2021] [Accepted: 05/28/2021] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is an urgent need to fill the gap of scalable cognitive assessment tools for preschool children to enable identification of children at-risk of sub-optimal development and to support their timely referral into interventions. We present the associations between growth in early childhood, a well-established marker of cognitive development, and scores on a novel digital cognitive assessment tool called DEvelopmental Assessment on an E-Platform (DEEP) on a sample of 3-year old pre-schoolers from a rural region in north India. METHODS Between February 2018 and March 2019, 1359 children from the Sustainable Programme Incorporating Nutrition and Games (SPRING) programme were followed up at 3-years age and data on DEEP, anthropometry and a clinical developmental assessment, the Bayley's Scale of Infant and Toddler Development, 3rd edition (BSID-III) was collected. DEEP data from 200 children was used to train a machine learning algorithm to predict their score on the cognitive domain of BSID-III. The DEEP score of the remaining 1159 children was then predicted using this algorithm to examine the cross-sectional and prospective association of growth with the DEEP score. FINDINGS The magnitude of the concurrent positive association between height-for-age and cognitive z-scores in 3-year olds was similar when cognition was measured by BSID-III (0.20 standard deviations increase for every unit change in specifically age-adjusted height (HAZ), 95% CI = 0.06-0.35) and DEEP (0.26 CI, 0.11-0.41). A similar positive prospective relationship was found between growth at 18 (0.21 CI, 0.17-0.26) and 12-months (0.18 CI, 0.13-0.23) and DEEP score measured at 3-years. Additionally, the relationship between growth and cognitive development was found to be dependant on socioeconomic status (SES). INTERPRETATION In this study, we suggest the utility of DEEP, a scalable, digital cognitive assessment tool, to measure cognition in preschool children. Further validation in different and larger datasets is necessary to confirm our findings. FUNDING The SPRING Programme was funded through a Wellcome Trust programme grant and the follow-up study by the Corporate Social Responsibility initiative grant from Madura Microfinance Ltd.
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Affiliation(s)
- Supriya Bhavnani
- Child Development Group, Sangath, Goa, India
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, India
| | - Debarati Mukherjee
- Indian Institute of Public Health-Hyderabad, Bengaluru Campus, Bengaluru, Karnataka, India
| | - Sunil Bhopal
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Population Health Sciences Institute, Newcastle University, United Kingdom
| | | | | | - Gauri Divan
- Child Development Group, Sangath, Goa, India
| | - Seyi Soremekun
- Department of Clinical Research, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London United Kingdom
- Observational and Pragmatic Research Institute, Singapore
| | - Reetabrata Roy
- Child Development Group, Sangath, Goa, India
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Betty Kirkwood
- Maternal & Child Health Intervention Research Group, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Vikram Patel
- Child Development Group, Sangath, Goa, India
- Department of Global Health & Social Medicine, Harvard Medical School, United States
- Department of Global Health and Population, Harvard T H Chan School of Public Health, United States
- Corresponding author at: Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA
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15
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Bhavnani S, Divan G, Patel V. Converging disciplines for assessing child development. iScience 2021; 24:102462. [PMID: 34027320 PMCID: PMC8121958 DOI: 10.1016/j.isci.2021.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Supriya Bhavnani
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, India 403501
| | - Gauri Divan
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, India 403501
| | - Vikram Patel
- Child Development Group, Sangath, House 451 Bhatkar Waddo, Succor, Bardez, Goa, India 403501
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
- Department of Global Health and Population, Harvard T H Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA
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16
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Schiariti V, Simeonsson RJ, Hall K. Promoting Developmental Potential in Early Childhood: A Global Framework for Health and Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042007. [PMID: 33669588 PMCID: PMC7923196 DOI: 10.3390/ijerph18042007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/29/2021] [Accepted: 02/16/2021] [Indexed: 02/06/2023]
Abstract
In the early years of life, children’s interactions with the physical and social environment- including families, schools and communities—play a defining role in developmental trajectories with long-term implications for their health, well-being and earning potential as they become adults. Importantly, failing to reach their developmental potential contributes to global cycles of poverty, inequality, and social exclusion. Guided by a rights-based approach, this narrative review synthesizes selected studies and global initiatives promoting early child development and proposes a universal intervention framework of child-environment interactions to optimize children’s developmental functioning and trajectories.
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Affiliation(s)
- Verónica Schiariti
- Division of Medical Sciences, University of Victoria, Victoria, BC V8W 2Y2, Canada
| | - Rune J Simeonsson
- School Psychology Program, School of Education, University of North Carolina, Chapel Hill, NC 27599, USA
- School of Education and Communication, Jönköping University, SE-551 11 Jönköping, Sweden
| | - Karen Hall
- School Psychology Program, School of Education, University of North Carolina, Chapel Hill, NC 27599, USA
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17
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Akoodie Y. Gamification in psychological assessment in South Africa: A narrative review. AFRICAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.4102/ajopa.v2i0.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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18
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Mukherjee D, Bhavnani S, Swaminathan A, Verma D, Parameshwaran D, Divan G, Dasgupta J, Sharma K, Thiagarajan TC, Patel V. Proof of Concept of a Gamified DEvelopmental Assessment on an E-Platform (DEEP) Tool to Measure Cognitive Development in Rural Indian Preschool Children. Front Psychol 2020; 11:1202. [PMID: 32587551 PMCID: PMC7299081 DOI: 10.3389/fpsyg.2020.01202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/08/2020] [Indexed: 11/17/2022] Open
Abstract
Over 250 million children in developing countries are at risk of not achieving their developmental potential, and unlikely to receive timely interventions because existing developmental assessments that help identify children who are faltering are prohibitive for use in low resource contexts. To bridge this “detection gap,” we developed a tablet-based, gamified cognitive assessment tool named DEvelopmental assessment on an E-Platform (DEEP), which is feasible for delivery by non-specialists in rural Indian households and acceptable to all end-users. Here we provide proof-of-concept of using a supervised machine learning (ML) approach benchmarked to the Bayley’s Scale of Infant and Toddler Development, 3rd Edition (BSID-III) cognitive scale, to predict a child’s cognitive development using metrics derived from gameplay on DEEP. Two-hundred children aged 34–40 months recruited from rural Haryana, India were concurrently assessed using DEEP and BSID-III. Seventy percent of the sample was used for training the ML algorithms using a 10-fold cross validation approach and ensemble modeling, while 30% was assigned to the “test” dataset to evaluate the algorithm’s accuracy on novel data. Of the 522 features that computationally described children’s performance on DEEP, 31 features which together represented all nine games of DEEP were selected in the final model. The predicted DEEP scores were in good agreement (ICC [2,1] > 0.6) and positively correlated (Pearson’s r = 0.67) with BSID-cognitive scores, and model performance metrics were highly comparable between the training and test datasets. Importantly, the mean absolute prediction error was less than three points (<10% error) on a possible range of 31 points on the BSID-cognitive scale in both the training and test datasets. Leveraging the power of ML which allows iterative improvements as more diverse data become available for training, DEEP, pending further validation, holds promise to serve as an acceptable and feasible cognitive assessment tool to bridge the detection gap and support optimum child development.
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Affiliation(s)
- Debarati Mukherjee
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
| | - Supriya Bhavnani
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India.,Child Development Group, Sangath, Goa, India
| | - Akshay Swaminathan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | | | - Gauri Divan
- Child Development Group, Sangath, Goa, India
| | | | | | | | - Vikram Patel
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India.,Child Development Group, Sangath, Goa, India.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
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19
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Song H, Yi DJ, Park HJ. Validation of a mobile game-based assessment of cognitive control among children and adolescents. PLoS One 2020; 15:e0230498. [PMID: 32196531 PMCID: PMC7083303 DOI: 10.1371/journal.pone.0230498] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
Cognitive control is the most fundamental psychological function that underlies the execution of many other psychological functions. A mobile game application could be a useful strategy to evaluate cognitive control in the groups of children and adolescents. Although a serious game that is based on gamification would be an optimal platform for the administration of behavioral and clinical assessments of children and adolescents, most studies on gamification have been conducted among adults and older adults than among children and adolescents. This study aimed to assess cognitive control using a mobile game that used gamification and compared the results to those from traditional neuropsychological tests for children and adolescents. In order to address this objective, this study used a serious game, namely, “CoCon,” which was developed to assess cognitive control in children and adolescents. This study included 100 participants from a community sample (mean age = 11.75 years, ranged from 9 to 16 years, SD = 1.40 years; Male = 59(59%), Female = 41(41%)). The analyses interrogated the relationships among various game behaviors scores of CoCon, the standardized neuropsychological tests (K-WISC-IV, CTT, and Stroop), and self-reporting executive function difficulty questionnaire. As results, a mobile game application-based assessment proved to be a reliable and valid measure of the cognitive control in children and adolescents. The index scores from the CoCon were significantly related to various cognitive control functions and differentiated between the high and low cognitive control groups. Specifically, even though the participants completed the mobile game ‘CoCon’ in their natural habitats, the CoCon scores were comparable to the measures from standard neuropsychological tests. In conclusion, the present findings suggest that mobile games that use advanced technology and sophisticated psychological strategies can serve as a new and expanded platform for the administration of psychological assessments.
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Affiliation(s)
- Hyunjoo Song
- Department of psychotherapy, the Graduate School of Professional Therapeutic Technology, Seoul Women's University, Seoul, Republic of Korea
| | - Do-Joon Yi
- Department of Psychology, Yonsei University, Seoul, Republic of Korea.,Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea
| | - Hae-Jeong Park
- Graduate Program in Cognitive Science, Yonsei University, Seoul, Republic of Korea.,Department of Nuclear Medicine, Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.,BK21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
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20
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Obradović J, Willoughby MT. Studying Executive Function Skills in Young Children in Low‐ and Middle‐Income Countries: Progress and Directions. CHILD DEVELOPMENT PERSPECTIVES 2019. [DOI: 10.1111/cdep.12349] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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