Rapid standardized neurodevelopmental assessment for 2-year-olds

The INTERGROWTH-21st Project Neurodevelopment Assessment (INTER-NDA) is a rapid, standardized neurodevelopmental assessment for children aged 18 to 30 months. It measures performance scores and rates of delay for cognitive, language, fine motor, gross motor, positive behaviour and negative behaviour domains. It categorises domain-specific delay based on two thresholds of severity: mild to moderate and severe delay. Its norms are the first and only international standards (rather than descriptive, population-specific references) of early child development, constructed according to the WHO’s prescriptive guidelines.

The INTER-NDA’s 37 items are administered in an assessment time of 15 minutes using techniques of direct assessment, observer ratings and caregiver reports. It shows good agreement with the Bayley Scales of Infant Development-III edition, and has excellent psychometric properties including test-retest and inter-rater reliability.

The INTER-NDA has been applied across international and UK-based clinical and research settings for the assessment of high-risk term and preterm children, as well as for population-level screening of low-risk groups, health programme evaluations and in randomized controlled trials. It does not require specialists professionals or infrastructure for its implementation.

The INTER-NDA toolkit is freely available and can be accessed at www.inter-nda.com. It features:

The INTER-NDA test
An open source, automated, web-based ‘App’ for assessors to input INTER-NDA scores (this takes <60 seconds) and for the automatic calculation and interpretation of developmental delay risk (takes about 0-1 second). The results generated can be saved as a pdf or printed to be added to a child’s healthcare record.
The first international early child development standards constructed according to WHO guidelines, presented as centiles on a chart.
A free e-training programme for training and standardising assessors, run twice a year.
A resources checklist to guide the INTER-NDA's implementation in clinical practice, research and health programmes.

So far, the INTER-NDA has been applied to assess over 40,000 children from 21 countries. In June 2024, the INTER-NDA toolkit was highly commenced at the MRC’s Impact Awards Ceremony. The INTER-NDA team would be happy to answer your questions and support your training and implementation needs. Please contact [email protected] for further information.

References
_{Fernandes M, Villar J, Stein A, et al. INTERGROWTH-21st Project international INTER-NDA standards for child development at 2 years of age: an international prospective population-based study. BMJ open. 2020 Jun 1;10(6):e035258.
Murray E, Fernandes M, Newton CR, et al. Evaluation of the INTERGROWTH-21st Neurodevelopment Assessment (INTER-NDA) in 2 year-old children. PLoS One. 2018 Feb 28;13(2):e0193406.
Fernandes M, Stein A, Newton CR, et al. The INTERGROWTH-21st Project Neurodevelopment Package: a novel method for the multi-dimensional assessment of neurodevelopment in pre-school age children. PloS one. 2014 Nov 25;9(11):e113360.
Villar J, Fernandes M, Purwar M, et al. Neurodevelopmental milestones and associated behaviours are similar among healthy children across diverse geographical locations. Nature communications. 2019 Jan 30;10(1):511.}