Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI)

Altafim, Elisa Rachel Pisani; McCoy, Dana Charles; Brentani, Alexandra; Escobar, Ana Maria de Ulhôa; Grisi, Sandra J.F.E.; Fink, Günther

doi:10.1016/j.jped.2018.07.008

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Original articles • J. Pediatr. (Rio J.) 96 (1) • Jan-Feb 2020 • https://doi.org/10.1016/j.jped.2018.07.008 copy

Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI)^☆ ☆ Please cite this article as: Altafim ER, McCoy DC, Brentani A, Escobar AM, Grisi SJ, Fink G. Measuring early childhood development in Brazil: validation of the Caregiver Reported Early Development Instruments (CREDI). J Pediatr (Rio J). 2020;96:66-75.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to analyze the psychometric properties and general validity of the Caregiver Reported Early Development Instruments (CREDI) short form for the population-level assessment of early childhood development for Brazilian children under age 3.

Method

The study analyzed the acceptability, test-retest reliability, internal consistency and discriminant validity of the CREDI short-form tool. The study also analyzed the concurrent validity of the CREDI with a direct observational measure (Inter-American Development Bank's Regional Project on Child Development Indicators; PRIDI). The full sample includes 1,265 Brazilian caregivers of children from 0 to 35 months (678 of which comprising an in-person sample and 587 an online sample).

Results

Results from qualitative interviews suggest overall high rates of acceptability. Most of the items showed adequate test-retest reliability, with an average agreement of 84%. Cronbach's alpha suggested adequate internal consistency/inter-item reliability (α > 0.80) for the CREDI within each of the six age groups (0-5, 6-11, 12-17, 18-23, 24-29 and 30-35 months of age). Multivariate analyses of construct validity showed that a significant proportion of the variance in CREDI scores could be explained by child gender and family characteristics, most importantly caregiver-reported cognitive stimulation in the home (p < 0.0001). Regarding concurrent validity, scores on the CREDI were significantly correlated with overall PRIDI scores within the in-person sample at r = 0.46 (p < 0.001).

Conclusions

The results suggested that the CREDI short form is a valid, reliable, and acceptable measure of early childhood development for children under the age of 3 years in Brazil.

Keywords
Child development; Measurement; Validation studies; Population assessment; Brazil

	n	Mean (%)	SD	Min	Max
In-person sample	678
Child - female	353	52.1%
Child age (months)	678	31.92	1.87	27.73	37.08
Children experiencing stunting (HAZ <-2)	35	5.4%
Caregiver education	659
Lower than secondary schooling	249	37.8%
Secondary schooling	366	55.5%
Higher education	44	6.7%
Asset quintile (1-5)	600	2.97	1.42	1	5
Home stimulation score (0-6)	672	4.94	1.42	0	6
Online sample	587
Child - female	263	44.8%
Child age (months)	587	21.0	8.62	0	35
Caregiver education	579
Lower than secondary schooling	14	2.42%
Secondary schooling	175	30.22%
Higher education	390	67.4%
Socioeconomic (0-100)	551	62.83	19.69	0	100
Home stimulation score (0-6)	587	4.86	1.19	1	6

Item Number - Question	Kappa	Agreement	n
A1 - Does the child smile when others smile at him/her?	0.27	0.89	36
A2 - Does the child grasp onto a small object (e.g. your finger, a spoon) when put in his/her hand?	0.27	0.89	35
A3 - Does the child recognize you or other family members (e.g. smile when they enter a room or move toward them)?	0.80	0.94	36
A4 - Does the child show interest in new objects by trying to put them in his/her mouth?	0.56	0.84	37
A5 - When lying on his/her stomach, can the child hold his/her head and chest off the ground using only his/her hands and arms for support?	0.79	0.91	35
A6/B1 - Can the child pick up a small object (e.g. a small toy or small stone) using just one hand?	0.42	0.78	36
A7 - When lying on his/her back, does the child grab his/her feet?	0.47	0.82	33
A8/B6 - Does the child look at an object when someone says "look!" and points to it?	0.62	0.86	35
A9/B4 - Does the child look for an object of interest when it is removed from sight or hidden from him/her (e.g. put under a cover, behind another object)?	0.71	0.89	37
A10/B3 - Does the child intentionally move or change his/her position to get objects that are out of reach?	0.63	0.84	37
A11/B2 - Does the child play by tapping an object on the ground or a table?	0.69	0.85	34
A12/B5 - Can the child hold him/herself in a sitting position without help or support for longer than a few seconds?	0.77	0.89	36
A13/B7 - Can the child pick up and eat small pieces of food with his/her fingers?	0.63	0.87	69
A14/B9 - Can the child transfer a small object (e.g. a small toy or small stone) from one hand to the other?	0.78	0.94	65
A15/B10 - Can the child use gestures to indicate what he/she wants (e.g. put arms up to indicate that he/she wants to be held, or point to water)?	0.61	0.87	68
A16/B8 - Can the child crawl, roll, or scoot forward on his/her own?	0.85	0.94	67
A17/B12 - Can the child throw a small ball or small stone in a forward direction using his/her hand?	0.67	0.88	68
A18/B11 - Can the child pick up and drop a small object (e.g. a small toy or small stone) into a bucket or bowl while sitting?	0.74	0.89	64
A19/B13 - Can the child say one or more words (e.g. names like "Mama" or "ba" for "ball")?	0.86	0.95	110
A20/B15 - Can the child walk several steps while holding on to a person or object (e.g. wall or furniture)?	0.78	0.90	69
C12 - Can the child drink from a cup (without a lid) on his/her own without spilling?	0.66	0.84	67
B14 - Does the child ask you for help using signs or words when he/she cannot do something on his/her own (e.g. to reach an object up high)?	0.47	0.74	69
B16/C2 - Can the child follow simple directions (e.g. "Stand up" or "Come here")?	0.83	0.92	66
B17/C1 - Can the child maintain a standing position on his/her own, without holding on or receiving support?	0.72	0.87	68
B18/C7 - Can the child point to a person or object when asked (e.g. "Where is mama?" or "Where is the ball?")?	0.81	0.91	68
B19/C4 - Can the child climb onto an object such as a chair or bench?	0.75	0.88	65
B20/C8 - Can the child kick a ball or other round object forward using his/her foot?	0.85	0.92	66
C3 - Does the child imitate others' behaviors (e.g. washing hands or dishes)?	0.53	0.92	74
C5 - Is the child kind to younger children (e.g. speaks to them nicely and touches them gently)?	0.28	0.85	74
C6 - Does the child show curiosity to learn new things (e.g. by asking questions or exploring a new area)?	0.54	0.91	74
C9 - Does the child involve others in play (i.e. play interactive games with other children)?	0.41	0.91	74
C10 - Does the child show sympathy or look concerned when others are hurt or sad?	0.22	0.86	72
C11 - Can the child run more than a few steps without falling or bumping into objects?	0.77	0.89	109
C13 - Can the child stack three or more small objects (e.g. blocks, cups, bottle caps) on top of each other?	0.75	0.88	108
C14 - Can the child answer simple questions (e.g. "Do you want water?") by saying "yes" or "no", rather than nodding?	0.73	0.87	67
C15 - Does the child play by pretending objects are something else (e.g. imagining a bottle is a doll, a stone is a car, or a spoon is an airplane)?	0.38	0.74	66
C16/D3 - Can the child correctly name at least one family member other than mom and dad (e.g. name of brother, sister, aunt, uncle)?	0.67	0.93	73
C17/D2 - Can the child ask for something (e.g. food, water) by name when he/she wants it?	0.77	0.95	75
C18/D1 - Can the child walk backwards?	0.43	0.76	70
C19/D4/E1 - If you show the child an object he/she knows well (e.g. a cup or animal), can he/she consistently name it?	0.65	0.85	73
C20/D6/E2/F1 - Can the child say ten or more separate words (e.g. names like "Mama" or objects like "ball")?	0.65	0.84	75
D5 - Can the child remove an item of clothing (e.g. take off his/her shirt)?	0.62	0.85	74
D7 - Can the child tell you when he/she is tired or hungry?	0.70	0.92	75
D8/E3/F4 - Can the child sing a short song or repeat parts of a rhyme from memory by him/herself?	0.70	0.89	75
D9/E4/F2 - Can the child jump with both feet leaving the ground?	0.66	0.85	75
D10/E7/F7 - Can the child correctly use any of these words: "I", "you", "she", or "he" (e.g. "I go to store", or "He eats rice")?	0.66	0.84	74
D11/E6/F5 - Can the child correctly ask questions using any of these words: "what", "which", "where", or "who"?	0.56	0.78	72
D12/E9/F8 - Can the child count up to five objects (e.g. fingers, people)?	0.63	0.82	71
D13/E5/F3 - Can the child speak using sentences with three or more words that go together (e.g. "I want water" or "The house is big")?	0.62	0.82	74
D14/F10/E12 - If you show the child two objects or people of different size, can he/she tell you which one is the big one and which is the small one?	0.49	0.75	72
D15/E10/F9 - Can the child identify at least one color (e.g. red, blue, yellow)?	0.63	0.82	71
D16/ E17/ F12 - Can the child explain in words what common objects like a cup or chair are used for?	0.40	0.70	76
D17/E16/F15 - If you ask the child to give you three objects (e.g. stones, beans), does the child give you the correct amount?	0.48	0.74	70
D18/E14/F11 - If you point to an object, can the child correctly use the words "on", "in", or "under" to describe where it is (e.g. "The cup is on the table" instead of "The cup is in the table")?	0.30	0.69	36
D19/E8/F6 - Does the child ask about familiar people other than parents when they are not there (e.g. "Where is the neighbor?")?	0.00	0.73	41
D20/E15/F14 - Does the child ask "why" questions (e.g. "Why are you tall")?	0.52	0.77	39
E11/F16 - Does the child often kick, bite, or hit other children or adults?	0.23	0.69	42
E13/F17 - Does the child become extremely withdrawn or shy in new situations?	0.17	0.60	42
E18/F13 - Can the child dress him/herself (e.g. put on his/her pants and shirt without help)?	0.62	0.81	69
E19/F19 - Can the child say what others like or dislike (e.g. "Mama doesn't like fruit" "Papa likes football")?	0.46	0.74	42
E20/ F20 - Can the child talk about things that have happened in the past using correct language (e.g. "Yesterday I played with my friend" or "Last week she went to the market")?	0.53	0.80	69
F18 - Does the child frequently act impulsively or without thinking (e.g. running into the street without looking)?	0.28	0.65	40
Average	0.58	0.84	62
Average by age group 0-5	0.65	0.88
Average by age group 6-11	0.60	0.84
Average by age group 12-17	0.62	0.87
Average by age group 18-23	0.56	0.82
Average by age group 24-29	0.50	0.78
Average by age group 30-35	0.48	0.77

Outcome	CREDI SF z-score
In-person sample	(1)	(2)	(3)	(4)	(5)	(6)
Child is female	0.164^a a p < 0.05.					0.138^b b p < 0.10.
	(0.077)					(0.0778)
Lower than secondary schooling	Ref. group					Ref. group
Secondary schooling		-0.005				-0.0823
		(0.081)				(0.0837)
Higher education		0.487^c c p < 0.001.				0.333^a a p < 0.05.
		(0.152)				(0.152)
Asset quintile (1-5)			0.098^c c p < 0.001.			0.0396
			(0.029)			(0.0297)
Home stimulation score (0-6)				0.214^c c p < 0.001.		0.203^c c p < 0.001.
				(0.027)		(0.0310)
Children experiencing stunting (HAZ <-2)					0.093	0.175
					(0.201)	(0.169)
Observations	678	659	600	672	643	553
R-squared	0.007	0.015	0.020	0.094	0.000	0.121
Online sample	(1)	(2)	(3)	(4)		(5)
Child is female	0.461^c c p < 0.001.					0.421^c c p < 0.001.
	(0.079)					(0.082)
Lower than secondary schooling		Ref. group				Ref. group
Secondary schooling		0.361				0.328
		(0.297)				(0.271)
Higher education		0.370				0.285
		(0.291)				(0.265)
Self-reported relative income (1-100)			-0.002			-0.00290
			(0.002)			(0.002)
Home stimulation score (0-6)				0.156^c c p < 0.001.		0.145^c c p < 0.001.
				(0.035)		(0.036)
Observations	587	579	551	587		545
R-squared	0.054	0.003	0.001	0.035		0.089

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[1] * Corresponding author. altafim.elisa@gmail.com