Abstract
Introduction: It is unclear if the assessment of early child development can be carried out using a group approach, as opposed to individually.
 Objective: To compare scores obtained from children aged 22 to 26 months assessed either in small groups or individually using the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA), which measures cognition, language, motor skills, behavior, attention and socio-emotional reactivity.
 Methods: A small group based strategy for administering and scoring the INTER-NDA was developed. Thirty-six preschool children attending four Centros de Cuidado y Atención Infantil of the Sistema Nacional para el Desarrollo Integral de la Familia (DIF) of Mexico were assessed in small groups of three children by a teacher specifically trained in the INTER-NDA. A second teacher, unaware of the group results, assessed the children individually on a different day. The sex, age, weight, length and head circumference of the children at the time of assessment were recorded.
 Results: INTER-NDA domain scores for group and individual assessments were statistically significantly correlated (range r=0.35 to r=1.00) for all domains except receptive language (r=0.25, p=0.14). Bland-Altman analysis showed agreement between group and individual scores for the language, behavior, attention and socio-emotional reactivity domains, and consistency (but not agreement) between group and individual scores for the cognitive and motor domains. None of the differences between group and individual scores examined were statistically significant, even after adjusting for the children’s age, sex, nutritional status and location of the preschool.
 
 Conclusion: INTER-NDA domain specific scores obtained following group and individual assessment of children aged 22 to 26 months are consistent. It is feasible for trained preschool teachers to administer INTER-NDA at both group and individual level.
Highlights
It has been estimated that 250 million preschool children in low-and middle-income countries are at risk of not achieving their developmental potential [1]
Through several complementary statistical strategies, we have demonstrated consistent similarities and lack of differences between group and individual INTER-NDA domain scores
Scores for group and individual assessments were significantly correlated for all domains, except receptive language
Summary
It has been estimated that 250 million preschool children in low-and middle-income countries are at risk of not achieving their developmental potential [1]. There is limited information on ‘small groupbased’ approaches to ECD measurement as a strategy to increase coverage and it is not known whether assessing children in small groups is feasible and comparable to individual assessment. Concerns about the reliability of developmental scores obtained through group-based ECD assessments arise because of inter-child interference, disruption and mimicry. Scoring multiple children simultaneously in an unbiased format can be challenging. It may be possible, to implement ECD assessments in small groups in settings such as preschools where the children are already familiar with the assessor, the environment and other participants
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