Exploring the Potential of a Gamified DEvelopmental Assessment on an E-Platform (DEEP) Tool to Measure Cognitive Development in Rural Indian Preschool Children

Abstract

Background: 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. Methods: 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. 70% of the sample was used for training the ML algorithms using a 10-fold cross validation approach and ensemble modelling, while 30% was assigned to the ‘test’ dataset to evaluate the algorithm’s accuracy on novel data. Findings: 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. Interpretation: Leveraging the power of ML which allows iterative improvements as more diverse data become available for training, DEEP holds promise to serve as an acceptable, feasible and validated cognitive assessment tool to bridge the detection gap and support optimum child development. Funding Statement: This work was funded by the Corporate Social Responsibility (CSR) initiative of Madura Microfinance Ltd. Declaration of Interests: Dr Tara Thiagarajan, a collaborator from Sapien Labs in her scientific capacity, also holds the position of Chairperson of Madura Microfinance Ltd. The other authors declare no competing interests. Ethics Approval Statement: This study was conducted in accordance with the Declaration of Helsinki and approved by the institutional ethics committees of the Public Health Foundation of India and Sangath. Prior to data collection, the objectives and methods of our study were explained to the parent and written informed consent was obtained from those who agreed to participate in this study.