Features
The INTERGROWTH-21st Neurodevelopment Package was developed by the INTERGROWTH-21st Project at the University of Oxford in 2012. The Package is a holistic assessment of early child development at 22 - 26 months designed to:
- Measure multiple dimensions of ECD - vision, auditory processing, cognition, language, fine & gross motor skills, behaviour, attention, social-emotional reactivity, sleep, circadian rhythm and daytime physical activity
- Incorporate neurophysiological tests (electroencephalography & actigraphy) with psychological and clinical assessments
- Be free from cultural biases and therefore suitable for use in international settings
- Be easy and reliable to administer by non-specialists, and quick to administer with minimal infrastructure in under 45 minutes
- Be sensitive enough to detect differences in healthy populations of children
- Characterise outcomes across a spectrum in order to screen for neuro-disability in population-based settings
- Measure entire visual and auditory pathways (rather than components of the visual or auditory apparatus)
- Yield objective, rather than subjective, information about the child's performance.
The Package takes 35-45 mins to administer as follows: vision (5 mins), auditory processing (12 mins), the INTER-NDA (15 mins), sleep, circadian rhythm & daytime physical activity (5 mins).
The INTER-NDA has been validated against the Bayley Scales of Infant Development III ed. and has an inter-rater and test-retest reliability of k = 0.70 (95% CI: 0.47–0.88) and k = 0.79 (95%CI: 0.48–0.96) respectively.
The INTER-NDA's norms were constructed according to the prescriptive WHO approach and excluded children born preterm and those with significant postnatal/neurological morbidity. For all domains, except negative behaviour, higher scores reflect better outcomes and the threshold for normality was defined as ≥10th centile. For the INTER- NDA’s cognitive, fine motor, gross motor, language and positive behaviour domains these are ≥38.5, ≥25.7, ≥51.7, ≥17.8 and ≥51.4, respectively. The threshold for normality for the INTER-NDA’s negative behaviour domain is ≤50.0, that is, ≤90th centile.
At 22–30 months of age, the cohort overlapped with the WHO motor milestone centiles, showed low postnatal morbidity (<10%), and vision outcomes, attentional problems and emotional reactivity scores within the respective normative ranges.
To facilitate the easy and rapid implementation of these standards in clinical, community and research settings for the identification of children at risk who would benefit from routine and urgent further assessment and specialist referral, respectively, we have developed the INTER-NDA neurodevelopmental chart that can be printed or downloaded.
Read more about the INTER-NDA's standards and its use by non-specialist assessors across international settings here.
HALLMARKS OF THE IMPLEMENTATION PROCESS
I. Automation of Data Collection
(a) The NeuroApp: An iPad application for data collection, with integrated help cues, examples and quality checks
(b) Gel-free, wireless EEG: A customisation of the Enobio system, with a 'strap-and-click' design whereby following the entry of participant information and fastening the EEG cap on the child's head, the auditory novelty oddball ERP paradigm runs in an automated, sequential manner including presentation of sounds, recording of EEG signals, experiment termination and upload of EEG data to the server.
II. Integrated Quality Checks
(a) The NeuroApp: Multiple entries per item and missed entries are highlighted before processing from one test to another. Mis-matches (for example in the alphabet code and vision strength of the Cardiff Cards) are also flagged for correction prior to data upload.
III. Integrated Manuals
Operation manuals are integrated into the NeuroApp as full text documents and as 'post-it help cues'. A number of pictures and examples are accessible as help options for each item.
IV. Real Time Data Upload
Data from the NeuroApp and Enobio upload immediately to our servers upon termination of the tests.
V. Cloud-based Data Storage and Management
All data are encrypted and stored securely in an on-line database developed and maintained by MedSciNet. Study users may access their study data only, while consortium users may access anonymised data belonging to the whole consortium.
V. Automated Signal Processing Pipelines
We have developed an automated signal processing pipeline to clean and process the EEG data to extract the amplitudes and latencies of P1, N2 and P3a waves to frequent, infrequent and novel stimuli. Our methodology been QC'd against those of the Institute of Child Health, London (Dr. Michelle de Haan) and the Kilifi KEMRI Wellcome Trust Research Institute (Dr. Michael Kihara). The pipeline reduces the EEG interpretation time from hours to under 60 seconds affording an almost real-time result to patients, participants and researchers.
VI. Standardisation in Administration and Scoring
We have developed a standardisation and QC protocol to ensure all assessors are performing tests at a high level of protocol adherence and reliability.
(a) The NeuroApp: An iPad application for data collection, with integrated help cues, examples and quality checks
(b) Gel-free, wireless EEG: A customisation of the Enobio system, with a 'strap-and-click' design whereby following the entry of participant information and fastening the EEG cap on the child's head, the auditory novelty oddball ERP paradigm runs in an automated, sequential manner including presentation of sounds, recording of EEG signals, experiment termination and upload of EEG data to the server.
II. Integrated Quality Checks
(a) The NeuroApp: Multiple entries per item and missed entries are highlighted before processing from one test to another. Mis-matches (for example in the alphabet code and vision strength of the Cardiff Cards) are also flagged for correction prior to data upload.
III. Integrated Manuals
Operation manuals are integrated into the NeuroApp as full text documents and as 'post-it help cues'. A number of pictures and examples are accessible as help options for each item.
IV. Real Time Data Upload
Data from the NeuroApp and Enobio upload immediately to our servers upon termination of the tests.
V. Cloud-based Data Storage and Management
All data are encrypted and stored securely in an on-line database developed and maintained by MedSciNet. Study users may access their study data only, while consortium users may access anonymised data belonging to the whole consortium.
V. Automated Signal Processing Pipelines
We have developed an automated signal processing pipeline to clean and process the EEG data to extract the amplitudes and latencies of P1, N2 and P3a waves to frequent, infrequent and novel stimuli. Our methodology been QC'd against those of the Institute of Child Health, London (Dr. Michelle de Haan) and the Kilifi KEMRI Wellcome Trust Research Institute (Dr. Michael Kihara). The pipeline reduces the EEG interpretation time from hours to under 60 seconds affording an almost real-time result to patients, participants and researchers.
VI. Standardisation in Administration and Scoring
We have developed a standardisation and QC protocol to ensure all assessors are performing tests at a high level of protocol adherence and reliability.
Languages
The INTER-NDA is currently available in English, Spanish, Italian, French and other languages. Please click here for copies of the French, Italian and Spanish translations. For other translations, please contact us.
TERMS OF USE
The University of Oxford allows the INTERGROWTH-21st Neurodevelopment Package to be used by academics and NGOs free of licensing charges following completion of the necessary MOUs and licensing agreements between academic/clinical institutions. However, these institutions must arrange to meet equipment and personnel costs themselves. Please contact us to discuss an MOU and a licensing agreement.
For commercial, clinical and non-academic use, please contact us.
For commercial, clinical and non-academic use, please contact us.
