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

1
Early Social-Emotional and Cognitive Basis for
Human Development Potential, and Improved
Quality of Life

• 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)

2
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)

3
Traditional Domains of Child Development

• Language
• Cognitive (IQ)
• Social-Emotional
• Fine Motor
• Gross Motor

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

4
Brain DevelopmentSocial-Emotional Domain starts
early

• Newborns show visual preference for faces and
  rapid face recognition

Social Cognition
Emotion Recognition
Face Perception
Eye Gaze
Adapted from G. Dawson, 2006
5
Influence of Social Motivation on Brain
Development
Brain Development
Social Motivation
Cortical Specialization and Integration
Attention to Social Stimuli
Development of Expertise
Efficiency (neural speed)
Dawson et al., 2005, Developmental Neuropsychology
6
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,
  251.

7
Functional , Integrated Social-Emotional ,
Language Cognitive Domains
Classical Domains

• 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

8
Shared Attention and Regulation
Critical link between nutrition and
social-emotional development
9
Engagement and Relating
10
Purposeful Emotional Interactions
11
Shared Problem Solving
12
Emotional Ideas
13
Greenspan Social-Emotional Growth Chart,
PsychCorp 2004
Quicker Progress
Slower Progress
14
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

15
Measuring Child Development Outcomes through
Household SurveysA pilot effort to explore
feasibility and methodological challengesInter-Am
erican Development Bank, 2005-2006
16
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)

17
Comparable Domains Survey Items Age Band
36-47 months
18
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)

19
Logistic Regression Analysis Correlation
between Poverty and Children with Emerging Delays
Risk of emerging delays increases in children
living in households with lower incomes, 53
difference between highest (V) and lowest (I)
quintile.
20
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.

21

• Redefining each childs potential

S. Greenspan, M.D. C. Breinbauer, M.D., M.P.H,
Infant Mental Health Initiative Interdisciplinary
Council on Developmental and Learning Disorders,
ICDL