Research Summary & System Design

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Introduction        

 

Developing Childhood is a unique consumer e-health tool developed by a consortium made up of three organisations: Developing Childhood Pty Ltd, The Developing Foundation Inc. and FOBIC Research Pty Ltd (a 100% entity of The Developing Foundation Inc.).  FOBIC Research has been granted the exclusive license to market Developing Childhood within Australasia.  The Developing Foundation Inc. is a government funded organisation which provides financial and emotional support to families caring for children and adults with brain injury or developmental disability.  Developing Childhood has been funded by The Developing Foundation Inc.

Developing Childhood is a software application that monitors and enhances childhood development from ages 0 to 3 years. It is based on a comprehensive milestone chart questionnaire completed by parents, guardians or practitioners.  The data collected from the milestone checking is analysed, individual updates are provided on the child’s progress, and a report is produced providing multi-sensory play-based stimulation activities to facilitate milestone development. A delay detection system picks up when a child’s development is significantly delayed, and parents are referred to appropriate health professionals for further intervention.

 

Initial Research

 

1. Developmental Milestones

Review of academic texts shows consistent reference to milestones as a valid means of measuring child development (Needlman 2004, Chung 2005, Dixon & Stein 2006).

2. Effectiveness of early intervention

Early detection and early intervention have been shown to be effective (Bailey et al 2005, Anderson et al 2003, Berlin et al 1998). There is also evidence of considerable cost saving from early intervention - estimates in 1990 show that two years of intervention prior to kindergarten saves society between $30,000 and $100,000 per child (Meisels & Shonkoff, 1990). Glascoe reports that because developmental and social-emotional delays can be subtle and can occur in children who appear to be developing typically, most children who would benefit from early intervention are not identified until after they start school. Even paediatricians, the child health specialists, fail to detect delays more than 70% of the time when they rely on clinical judgment alone (Glascoe 2000).

3. Validity of parental measurement

Numerous studies have indicated that parent-completed reports are reliable (Glascoe 2007, Bodnarchuk & Eaton 2004, Knobloch et al 1979, Squires et al, 1998).

 

4. Parents lack knowledge of milestones

Canadian research shows that 64% of parents are unable to recognize their children's developmental milestones in the first three months of life, and only half of the parents knew what to look for at six months (Brown 2007). Another study found that the majority of adults questioned were unable to correctly answer questions related to when children under six years of age typically achieve developmental milestones (Rikhy et al, 2010).

5. Incidence of developmental delays

The chief of the Developmental Disabilities Branch of the National Center for Environmental Health Centers for Disease Control and Prevention (USA) estimated in 2000 that about 17% of all children have a developmental disability (Boyle, 2000). The Snapshot of Early Childhood Development in Australia report showed that one in three five-year-olds start school with developmental vulnerability in at least one developmental domain (AEDI National Report, 2009). There is also evidence that the incidence of developmental delays is increasing. In 2008, Pathways Awareness, a US child development organisation, surveyed 409 therapists belonging  to the Neuro-Developmental Treatment Association (NDTA) or the American Physical Therapy Association (APTA), who work regularly with children and who averaged more than 20 years of experience. The results showed that two-thirds of the therapists reported that, in the past several years, they had observed an increase in early motor delays in babies under six months of age (Therapist Survey l, 2008).

 

 

System Features

 

 

Feature

Description

Milestone Chart

Milestones from birth to 36 months in six functional areas:  Vision, Auditory, Tactile, Speech, Movement, Hand Function.  Total of 342 milestones.

Chronological reference

Chronological referencing of milestones focused on the 70th to 90th percentile range.

Dependency System

Streamlines milestone checking to save parental time.

Time allocation

Maximum allocation of stimulation time based on child’s chronological age. If necessary, least important activities eliminated to achieve desired time allocation.

Reporting

Two reports are generated detailing the results of the milestone checking. The Developing Update summarises child’s current developmental state. The Milestone Chart shows complete, not yet complete and upcoming milestones.

Milestone Facilitation

Developing Strategies: stimulation activities for not yet complete and upcoming milestones.

Monthly review

Milestone checking performed monthly, parents sent reminder email.

Delay Detection

Algorithm analyses results of milestone checking and ranks developmental status.

Delay Intervention

Depending on the ranking calculated by the delay detection system, there is either an increase in stimulation activities with further monitoring, or a recommendation is given for further intervention.

Referral System

Referral provided to an appropriate health professional when certain conditions are met.

Terminology

Instructions written in  a style easily understood by parents.

Multimedia

 

In addition to written instructions, extensive use of instructional videos with over 190 videos available.

Free trial

A free assessment is offered, including milestone checking of the six functional areas, Developing Update and Developing Strategies reports.  

Other

Members’ Forum

Subscription System

Links and Resources

Information about child development

 

 

System Development & Design

 

1. Milestone chart  

An extensive review of standardised milestone charts (Black & Matula 1999, Frankenburg et al 1992, Glascoe & Robertshaw 2008, Ireton 1980, Ireton 1995, Squires et al 2002, Squires & Bricker 2009, Glascoe 2010) and milestones charts used by child development experts (Caplan 1981, Caplan 1995, Sheridan 1997, Sears 2003, Einon 2006) was conducted. The criteria for selecting each milestone used in the Developing Childhood Milestone Chart included conforming with existing validated screening tools and milestone charts, instructions easily understood by parents, tests able to be performed in the home environment, and results easily elicited and recorded.

 

2. Chronological reference

In the Developing Childhood milestone chart, the focus has been shifted from time-referencing a milestone by the 50th percentile. According to Sices (2007), a focus on the 50th percentile milestone has the potential to raise parental anxiety, since, by definition, the developmental skills of 50% of children fall below the 50th percentile. Sices (2007) also points out that health professionals are not taught to use mean values in monitoring or screening other aspects of a child’s health, as a more accurate clinical decision is arrived at by looking at the upper and lower bounds of normal (Sices, 2007). In a study conducted by the World Health Organisation (World Health Organisation, 2004), six milestones fundamental to self-sufficient erect locomotion were studied in a group of 816 children from six countries, and percentiles and means were established. All of these six milestones are recorded on the Developing Childhood milestone chart above the 50th and below the 97th percentile.

 

3. Dependency System

Many of the milestones listed in the Developing Childhood milestone chart include different stages of the one milestone. For example, in the Movement section, hands and knees crawling is broken into five stages that occur over a two month period - initial balance on hands and knees, balancing & rocking on hands & knees, initial forward movement on hands and knees, and crawling around house on hands and knees. This enables parents to understand the various components of a milestone, and acknowledges each of the foundation stages. To save time during the milestone checking and to avoid redundant and obvious questions, a dependency system has been created so that the lower stages of a milestone are automatically credited if the higher stages are already achieved. In the example of hands and knees crawling, if a child was able to perform this skill, the lower stages (initial balance on hands and knees, etc.) would automatically be marked as “complete”.

 

4. Time Allocation

To ensure that the stimulation activities suggested conform to realistic temporal requirements, maximum values of allocated time are built in to the system. These values are dependent on the child’s chronological age, and gradually increase as the child gets older. For a child who is not showing any signs of delay, the suggested activities will fall well within the maximum allocated time. In the case of a child showing significant delay, the suggested activities may exceed the maximum allocated time. In this circumstance, a pruning system progressively eliminates the least important activities until the desired time allocation is achieved.

 

5. Reporting

At the completion of the milestone checking, two reports are generated. The Developing Update summarises the results of the milestone checking, listing any milestones marked as Not Yet Complete, and also listing the milestones that are expected to emerge over the next month, referred to as the Upcoming Milestones. The Milestone Chart provides a visual snapshot of the child’s current developmental status, showing the complete, not yet complete, and upcoming milestones.

 

6. Milestone Facilitation

Developing Childhood is not just a milestone monitoring program. It is equally concerned with milestone facilitation. Based on the results of the milestone checking, a Developing Strategies report is produced. This is a list of stimulation activities appropriate for the child’s current developmental stage. This means that the system works from the developmental age established by the milestone checking in each of the functional areas, rather than just looking at the child’s across-the-board chronological age. This caters for the varying levels of development that usually occur in each of the functional areas, and removes dependence on the child’s chronological age. Working from a child’s developmental rather than chronological age helps ensure that the correct foundations for development are established, and that important stages are not missed. This is in accordance with current scientific thinking. Brain circuits that process basic information are wired earlier than those that process more complex information. Higher level circuits build on lower level circuits, and adaptation at higher levels is more difficult if lower level circuits were not wired properly. Parallel to the construction of brain circuits, increasingly complex skills build on the more basic, foundational capabilities that precede them. Stated in simple terms, circuits build on circuits and skill begets skill (National Scientific Council on the Developing Child 2007).

Each milestone measured by the Developing Childhood milestone chart has a specific stimulation activity designed to facilitate the development of that milestone. These are simple, enjoyable, play-based activities easily performed by the parents. Play-based activities enhance perceptual-motor skills, language skills, attention span and emotional development, and allows for repetition. They also allows for the child to experience his or her environment, enabling the child to hear, look at, move toward, touch, and feel all the various stimuli (Liddle & Yorke, 2004).

The rationale behind milestone facilitation is perhaps best described by the National Scientific Council on the Developing Child (2007). Creating the right conditions for early childhood development is likely to be more effective and less costly than addressing problems at a later age. As the maturing brain becomes more specialized to assume more complex functions, it is less capable of reorganizing and adapting to new or unexpected challenges. Once a circuit is “wired,” it stabilizes with age, making it increasingly difficult to alter. Scientists use the term “plasticity” to refer to the capacity of the brain to change. Plasticity is maximal in early childhood and decreases with age. Although “windows of opportunity” for skill development and behavioural adaptation remain open for many years, trying to change behaviour or build new skills on a foundation of brain circuits that were not wired properly when they were first formed requires more work and is more “expensive.” Stated simply, getting things right the first time is more efficient (National Scientific Council on the Developing Child 2007).

Research into the initial stages of post-birth brain development indicates that early experiences are crucial in shaping the cultivation and pruning of neural synapses that underlie the functional capabilities of the developing brain.  At this time dendrites and synaptic connections grow and subcortical myelination takes place (Osawa & Konishi, 2003).  Consequently, opportunity exists for certain conditions to modify the structure or function of the cortical region in the brain – a term described as cortical plasticity.  Maximising the opportunity for stimulating synaptic connections through active parental intervention in this sensitive or critical phase of development is the purpose of the stimulation activities described by Developing Childhood.

Cortical plasticity has been described for the auditory, tactile, olfactory and motor systems and it is now clear that the human brain shows maximum plasticity in infancy and early childhood (Osawa & Konishi, 2003). Eliot (2000) states: “Just like young rats, whose dendrites and synapses flourish when they are reared in an enriched environment, children’s brains benefit directly from variety in their daily experiences” (Eliot, 2000). The more a child practises and reinforces new experiences across different sensory modalities, the chance that the new cell connections within the growing brain will become permanent is increased, and thus, a child’s development has more opportunity for enhancement (Bonnier, 2008).

Research has indicated that parents need to spend time responding to and playing with their young children and to create innovations to make learning fun (Newberger, 1997).  Programs involving the parent and the child have shown greater efficacy (Bonnier, 2008) and hence Developing Childhoodstimulation activities provide for the best possible opportunity for neural stimulation across several sensory developmental areas.

 

7. Monthly review

Milestone checking needs to be an ongoing process, especially since there is evidence to suggest that children with subtle developmental problems are difficult to detect and are at an increased risk of academic failure, behavioural problems and socio-emotional disturbance (Glascoe, 1999). Williams and Holmes (2004) report that although parents may have been aware of these problems for some time, their subtlety has precluded them from detection by health professionals prior to the child entering school  (Williams and Holmes, 2004). Evidence suggests that there is a link between developmental delay, later school learning and behavioural problems. For example, Blumsack et al (1997) found that a ‘sizeable portion’ of students with learning difficulties in the US have a history of undetected neurodevelopmental problems. They argue that learning disabilities are a result of deficits in basic physiological processes that are developmentally related to central nervous system dysfunction (Blumsack at al, 1997). Levine found that many of the factors contributing to school failure occur as a result of subtle deficiencies in neurological development (Levin 1998). Other neurodevelopmental studies suggest a link between neurological development and behavioural idiosyncrasies in children (Nelson and Bloom, 1997; Nelson, 2000).

Longitudinal developmental surveillance minimises the chances of subtle developmental delays going undetected. Developing Childhood offers parents the opportunity to carry out monthly milestone checks from birth until three years.

 

8. Delay Detection

Most of the currently used developmental screening tools have a means of detecting and reporting developmental delay (Robins et al 2001, Glascoe & Robertshaw 2008, Squires & Bricker 2009). The detection system algorithm developed by Developing Childhood calculates the percentage of milestones marked as complete compared to the total number of milestones for the child’s chronological age, and creates a ranking system. This process is calculated by the back-end of the system, and parents are unaware that this has been performed and these ranking terms are not expressed to the parents.

 

9. Delay Intervention

The system responds to the functional developmental ranking produced by the Delay Detection System algorithm in two ways: by increasing the suggested stimulation activities, and if necessary, by recommending further intervention by means of a referral to an appropriate health professional . The type of response depends on the ranking, and will involve a slight increase in the allowed time, and  corresponding increase in stimulation activities. The amount of the increase depends on the ranking value. The stimulation increases are specific to each functional area, and if necessary, some of the stimulation activities in the higher functioning areas will be reduced to allow for extra time to be spent on the problem areas.

 

10. Referral System

As described in the Delay Intervention System in point 9 above, a referral for further intervention with an appropriate health professional is produced when a child has a severe ranking in any of the functional areas.

 

 Empirical Research

Professor Margaret Wu, Research Fellow at the Assessment Research Centre, University of Melbourne will be conducting the following studies using Item Response Theory:

·       Validation of the Developing Childhood milestone chart

·       Correlation and dependency between functional areas (such as the connection between tactile and movement development)

·       Correlation between the lower and higher developmental areas. 

 

Study Design:

·       Based on between 400 and 1000 babies aged from 0-6 months using Developing Childhood for at least 12 months.  

·       At the end of the study it is anticipated the Professor Wu and Ian Hunter will co-author a paper with the results of the study which will be published in the appropriate scientific literature.

 

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