PRIDI Urgency and Possibility

URGENCY
AND
POSSIBILITY
FIRST INITIATIVE OF COMPARATIVE DATA
ON CHILD DEVELOPMENT
IN LATIN AMERICA
Aimee Verdisco Santiago Cueto Jennelle Thompson Oliver Neuschmidt

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URGENCY AND POSSIBILITY . FIRST
INITIATIVE OF COMPARATIVE DATA
ON CHILD DEVELOPMENT
IN LATIN AMERICA
01
Presentation &
Executive Summary
For many children, the circumstances of their birth and earliest years have
lifelong consequences. Where and to whom a child is born can predict
her economic and social outcomes later in life. Children born to parents
who invest emotional and economic resources in their development tend
to become healthy and productive adults, passing on the advantages
that such investments bring to their own children. Children born in
adverse circumstances, where poverty and stress limit possibilities and
aspirations, fare less well. The odds are stacked against them from the
beginning. Chances are that neither school nor any life experience will
level the playing field.
Meaningful change requires meaningful action, Desarrollo Infantil), or PRIDI, emerged in this context
early-on. Gaps in what a child knows and is capable and with the intent of narrowing this void. It was
of doing will grow over time absent targeted and launched in December of 2009 as the first initiative
high quality interventions incorporating stimulation, of its kind. Three pillars oriented its activities: (i)
early education, health and nutrition. The potential children develop in an integral manner and the data
of these interventions, referred to as early childhood used to assess their development should capture
development (ECD), has caught the attention of this; (ii) children should be able to achieve basic
policy makers across the globe. Indeed, ECD occupies developmental milestones and competencies before
an increasingly central place on policy agendas entering school, independent of their race, gender,
in Latin America and internationally. Research socioeconomic background, origin, language, or
confirms the economic and social returns of ECD any other circumstance; and (iii) internationally
and its potential to help level the playing field for all comparable, nationally representative data on child
children. Although more and more of this research development to inform and guide policies, particularly
concentrates on places other than North America towards the most disadvantaged children, are largely
or Europe, comparable data and validated tools that absent in the region.
allow for the monitoring and benchmarking of young
PRIDI took its inspiration from regional and
children remain scarce in other regions.
international tests, such as the Latin American
The Regional Project on Child Development Laboratory on Education Quality (LLECE and its
Indicators (Programa Regional de Indicadores de subsequent iterations, SERCE and TERCE), PIRLS
URGENCY AND POSSIBILITY . FIRST INITIATIVE OF COMPARATIVE DATA ON CHILD DEVELOPMENT IN LATIN AMERICA 5
(Progress in International Reading Literacy Study) and 7. Technical annexes detailing the processes
PISA (Program for International Student Assessment), undertaken to create, validate and apply the
among others. By providing comparable data across Engle Scale and Survey, as well as the quality
countries that served to empirically define oft-used controls implemented during each phase to
yet vaguely defined concepts such as “quality” and ensure validity of items and data.
benchmark progress against solid indicators, these
8. The present report which highlights the
initiatives opened new avenues for policy dialogue
main policy messages emerging from PRIDI.
and collaborative efforts between governments on
how best to improve education. PRIDI hopes to do
the same, providing a platform for informed dialogue After five years in execution, PRIDI has lived up to
and cooperation on how best to address the needs of its promise. Working together with four countries
young children and their families. – Costa Rica, Nicaragua, Paraguay and Peru – it
created, validated and applied a series of new
PRIDI is a package of tools, data and analyses, each of
instruments in nationally representative samples.
which is available to policy makers, researchers and
The Engle Scale and accompanying Survey measure
practitioners in Latin America and internationally. It
cognitive, language and communication, motor and
includes:
socio-emotional development in children from 24 to
1. A Conceptual Framework detailing the objectives 59 months and capture key factors associated with
and scope of PRIDI. child development. Notably, in contrast to other
studies that have looked at learning in pre-school
2. The Engle Scale for evaluating cognitive, language
aged children in organized settings (e.g., ECD centers
and communication, and motor development
or schools), all PRIDI instrumentation was applied in
through direct observation of the child. It is named
nationally representative samples in homes. In this
in honor and recognition of Patrice Engle who
way, PRIDI captured the universe of children 24 to 59
made enormous contributions to PRIDI and ECD
months in the four countries.
internationally until her untimely death in 2012.
With few items, the Engle Scale allows for a holistic
3. A Survey of the child and home, which captures
measurement of child development through
factors associated with child development. It is
direct observation and maternal report. The data it
designed to be applied to the mother or principal
generates are regionally comparable and identify
caregiver, and includes a section of the Engle
gaps between different groups of children. PRIDI
Scale for evaluating the child’s socio-emotional
includes indigenous populations, thus differentiating
development.
it – again - from other studies (e.g., standardized tests
4. Application and training manuals and materials of learning) that exclude, ex-ante, such populations,
for the Engle Scale and Survey. given the logistical difficulties, including language
and cost, of reaching them.
5. Sampling guide.
PRIDI finds a sense of urgency and of possibility. Child
6. A database with nationally representative data development in Latin America is unequal. Inequality in
collected from the Engle Scale and Survey for the results appears as early as 24 months, PRIDI’s youngest
four countries that participated in PRIDI. participants, and increases with age. There is variation
in inequality. For example, correlations of the results of would rise and would start to approach levels found
the Engle Scale with the socio-economic characteristics in children in richer but less nurtured households.
of the home and maternal education are stronger for The nurturing environment thus appears to mitigate
cognition, and language and communication than the negative association lower levels of wealth have
for motor development. The environment within with the domains of development measured by the
which children develop – the nurturing environment Engle Scale.
- is important for all domains of child development
This is the profile of children entering formal
measured by the Engle Scale, although stronger
education in the four participating countries. Insofar
associations appear for cognition, language and
as the data speak to the readiness of these children
communication, and socio-emotional development.
to learn, they also speak to the readiness of schools
Gaps between the development of children in the to receive and provide them with a quality education.
top and low extremes in these factors matter. By The challenges schools will face run the gamut,
59 months, the development of a poor and under- from appropriately trained teachers, to adequate
nurtured child will lag by as much as 18 months infrastructure and mechanisms for interacting in
behind her richer and more nurtured peers. This meaningful ways with families.
child will not be able to recognize basic shapes like
All PRIDI products are regional public goods, freely
triangles or squares, count to 20, or understand
available on our website. We invite other countries
temporal sequences. She will also have gaps in her
to apply these instruments and to add to the data
basic executive functioning and socio-emotional
and knowledge initiated by PRIDI. We hope that
skills, including empathy and autonomy. She will not
the information and data it provides will serve
likely be ready for school and may not have success
governments and practitioners in better identifying
once there. Notably, however, if this same child, in
and dimensioning high quality ECD programs that
the same poor household, were to benefit from a
will help all kids get off to a good start in life.
nurturing environment, her level of development
Emiliana Vegas, Chief

EDUCATION DIVISION
Inter-American Development Bank
December 11, 2014
02
The Nuts Bolts
of PRIDI
The PRIDI Conceptual Framework, created in close collaboration with the
four participating countries (Costa Rica, Nicaragua, Paraguay and Peru)
recognizes child development as a holistic and integrated process that
encompasses a number of inter-related domains, including: cognitive,
language, emotional, health, social, motor, executive functioning,
etc. Of these, PRIDI measures four (Table I): cognition, language
and communication, socio-emotional, and motor. Each domain finds
theoretical and empirical justification in the literature (see PRIDI
Conceptual Framework and Selected Bibliography, below).
Table I. Domains of Child Development Included in PRIDI
Domain Definition Justification
Cognition Ability to solve problems, including Basic abilities for learning in school.
abilities to categorize, sequence, pay Associated with learning, test scores and
attention, recognize relationships between later successes in life.
numbers and relationships between parts
and whole, and of executive functioning.
Language Development of expressive and receptive Predictive of learning in school.

and language. Expressive language relates Interest in books is associated with the
Communication to the child´s ability of articulate words development of early learning skills.
and concepts. Receptive language relates
to a child´s comprehension of language.
Relates to knowledge and interest in
books and drawings.
Socio- Recognizing and learning to deal with Association with a child´s ability to adapt
Emotional emotions, along with the development of to new situations. Has predictive validity.
self-esteem, autonomy, and social skills.
Motor Fine and gross motor skills, including Through their motor skills, children
coordination. experience new situations and things. Motor
skills are related to learning and to cognition.
PRIDI also captures factors associated with ECD. Child development emerges from and is affected by the
interaction of a number of contextual variables from the home, community, and parents. A broad literature
speaks to the impact these and other factors have on child development (see Selected Bibliography, below).
The associated factors included in PRIDI are summarized in Table II:
Table II. Associated Factors Included in PRIDI
Factor Definition Justification
Child Birth date, sex, maternal language, Immutable characteristics of the child.
Characteristics wwbirth-order
Household Socio-economic status of the home, Environment in which a child develops

Characteristics presence of both parents in home, and grows. Socio-economic status
maternal language and education level strongly correlates with ECD. Poverty
of parents, access to basic services in poses a serious risk to ECD and tends to
the home, number of siblings, parental occur concomitantly with other factors
interaction with child, language-rich that detrimentally affect it, including
activities and materials in the home, inadequate nutrition, poor sanitation and
child rearing strategies, basic health hygiene, poor maternal education, and
information inadequate stimulation in the home.
Community Urban or rural, distance from health post Services available to the family and
Characteristics or hospital, availability of basic services child that may have an impact on child
development
ECD or early Participation and duration of child in such Participation in these programs, if they
education programs. Included here are ECD, early are of quality, is likely to have a positive
programs education, nutrition, and conditional cash influence on child development.
transfers
PRIDI´s Children
PRIDI evaluates children aged 2 to almost 5 years (4 years, 11 months and 30 days) in their homes. In this way,
PRIDI includes the universe of children in this age range, not just those in ECD centers or other organized care.
PRIDI also includes indigenous children in all countries but Costa Rica (given the small size of its indigenous
population) and adapted its instruments to the peculiarities of each in an effort to give all children as equal a
chance as possible to show what they know and are capable of doing. Children displaying a clear disability or
illness at the time of evaluation were excluded.
Creation of PRIDI Instruments

Instruments bear a close relationship to what is measured and how it is measured. A potential avenue
for PRIDI would have been to choose a test currently in use in the region or elsewhere, adapt it and apply
it. After carefully inventorying and reviewing instruments for child development in use in the Region and
internationally, this course of action was rejected. The majority of these evaluations tended to either replicate,
to a larger or lesser extent, tests used elsewhere in the world or were outdated, not informed by currently
advances in ECD and brain research. Anecdotal evidence on others warned of biases against indigenous and
rural children and an underestimation of their abilities. For example, a widely applied test based on black and
white drawings includes a hot air balloon and an ornamental lamp in its opening sequences – objects that are
not likely to be recognized by young children living outside of urban areas.
PRIDI chose to create new instruments for evaluating child development. The new instruments it created
were built around commonalities in the scales and evaluations applied in the region (e.g., Escala Abreviada
de Nelson Ortiz, Escala de Desarrollo Integral del Niño) and complemented with items found in more recent,
international tests (see PRIDI Technical Annex). PRIDI instruments were not to be screening instruments, but
rather tools for understanding various dimensions of child development at a population level. They were to be
applied within the home, thus allowing for the universe of children aged 24 to 59 months to be captured and
differentiating PRIDI from other studies that confine their analyses to children in ECD centers or preschools.
A three-phase plan was laid out for elaborating, validating and applying the instruments; the countries
participated actively in all phases:
1. A formative phase (Phase I), in which the newly created instruments and respective materials, manuals
and forms were piloted in small samples of children in two countries and adapted to different populations,
particularly indigenous populations. Two countries participated: Paraguay and Peru. Implemented over
the course of 2010.
2. A validation phase (Phase II), in which the instruments, adapted through the formative experiences of
Phase I, were applied in limited samples (200 children) in all four participating countries, and validated
against two internationally normed tests: the Peabody Picture Test (in its Spanish version, Test de
Vocabulario en Imágenes Peabody, TVIP) , a normed reference test for measuring receptive vocabulary
in children that has been applied in various countries in the Region; and height-for-age, an internationally
used anthropometric test to measure physiological growth. Implemented over the course of 2011-2012.
3. A phase of national application (Phase III), in which PRIDI instruments together with the TVIP (children
42 to 59 months, only) and height-for-age were applied in nationally representative populations with a
target of 2,000 children in each participating country. Implemented over the course of 2013-2014.
The set of instruments included a development scale (Escala Engle de Desarrollo Infantil, or Engle Scale),
a survey administered to the mother or principal caregiver, application and training manuals, and a number
of complementary forms (e.g., informed consent, household registry, etc.). All were designed to be easily
administered by people with some knowledge of ECD and short, hands-on training. The Scale and Survey
were adapted to the national contexts. Indigenous language versions of the Scale and Survey were generated
for the Región Autónoma del Atlántico Norte (RAAN) in Nicaragua (Miskito), for rural areas in Paraguay
(Guaraní), and the Cusco area in Peru (Quechua). In each case, the instruments were translated from Spanish
and then translated back from the respective indigenous language to Spanish. Where differences existed, the
translators met to determine the final wording to be used in the indigenous version.
The Engle Scale applies two main approaches for evaluating child development. Cognition, language and
communication, and motor development are assessed via direct observation of the child; socio-emotional
development is assessed via maternal (or principal caregiver) report. Given the large range of development
which occurs in children from 24 to 59 months, the Scale for direct observation consists of two evaluations,
one for children from the age of 24 to 41 months (referred to as Form A), and the other, more appropriate
for children 42 to 59 months (referred to as Form B). The socio-emotional scale is contained in the Survey;
mothers/principal caregivers of all participating children respond to the same scale.
The materials necessary for the application of the Scale are of common-usage in the countries and within
their various populations, of minimal cost, durable and easily transported in a backpack, and can be used
for various items and in both scales: e.g., small wooden blocks, a puppet, pencils, and a ball. An application
manual includes figures and instructions on the correct use and positioning of the materials and the correct
application of each item.
The Survey enquires into basic characteristics of the household and environment within which the child
develops. It also enquires into factors associated with the child, including her socio-emotional development,
attendance in preschool or organized care, overall health, and disciplinary methods applied in the home. A
manual was created to orient its application and scoring in the field.
Training for PRIDI
A basic tenet of PRIDI was that its application would not require highly sophisticated human resources. A
firm was hired through internationally competitive bidding processes to carry out all aspects of the field work
in each country:
• Costa Rica: Leyden Consulting Group
• Nicaragua: Centro de Investigación y Acción Educativa y Social (CIASES) and Gesaworld
• Paraguay: Universidad Iberoamericana
• Peru: SASE Consultores
The responsibilities of these firms included the recruitment and training of enumerators, the application of
instruments and scoring of results, and the digitalization of data.
PRIDI created a detailed training curriculum and support materials (e.g., DVDs) to facilitate the recruitment
and training of enumerators and to ensure that they were sufficiently competent in the application of the
Scale and Survey, the TVIP, and height-for-age prior to going to the field. This training was designed to be
implemented over an 11 day period. It included structured activities on how to gain the trust of mothers/
caregivers and children, apply and score each instrument, evaluate performance of individual enumerators,
and ensure the standardization of all procedures.
Validation of Items
Results obtained from Phases II and III were rigorously analyzed to ensure validation of items, the reliability of
the four domains, and ease and efficiency in application (see the PRIDI Technical Annex). The International
Association for the Evaluation of Educational Achievement (IEA) provided technical support and oversight
along these lines, running Rasch/item response and factor analyses on both Forms and all items, including
those comprising the socio-emotional scale. Items that functioned poorly across countries (e.g., no variation,
too easy/hard) or that were difficult to apply were removed from the Engle Scale and Survey, and improvements
in formatting were introduced to allow for a more efficient registry and scoring of results. Both Forms of the
Engle Scale were streamlined: Form A to 21 items and Form B to 22 items (from more than 40 on each in
Phase I; and 35 and 41, respectively, in Phase II). This reduced application time from a high of two hours to
30-40 minutes. Similar changes were made in the Survey.
Issues of Sampling
These firms listed above, in consultation with the respective national statistical institute and with technical
support from the IEA, created each of the nationally representative samples (see the PRIDI Technical Annex).
A manual created for this purpose called for a three-staged strategy. In the first stage, a sample of primary
sampling units (PSUs, discrete geographic or administrative divisions covering the entire country) was drawn
and stratified by following criteria; in all cases, urban/rural was defined by each country:
• Costa Rica (two stratification variables): Valle Central/rest of country, urban/rural
• Nicaragua (three stratification variables): Departments and regions, urban/rural
• Paraguay (one stratification variable): Urban/rural
• Peru (four stratification variables): Cusco/rest of country, region (Sierra, Costa, Selva, Lima), proportion
of Spanish speakers (high/low), rural/urban.
From here, a sample of secondary sampling units (SSUs, in the case of PRIDI, households) was selected within
each of the sampled PSUs. In an effort to prevent clustering, a single child per household could participate
in PRIDI (third stage). In homes where more than one child fell within the 24 to 59-month age cohort, the
participating child was selected randomly using a Kish Grid (table of selection numbers).
An intended sample size of at least 2000 children was targeted in each country (in Peru, the target sample
size was 2300, given oversampling in Cusco). This sample size met international standards. Its precision
required that the appropriate number of children were selected from a sufficient number of different PSUs.
Where there was interest in a particular segment of the population, sample size was increased (oversampled)
in areas where such segments were found. In the case of PRIDI, indigenous children were oversampled in the
RAAN (Nicaragua, Miskito-speaking children) and in Cusco (Peru, Quechua-speaking children). In the case
of Paraguay, initial results from the field indicated that the sample was smaller than expected. As a result, a
second sample of PSUs was selected to compensate for the shortfall.
The intended and achieved sample sizes for PSUs and for children in each of the participating countries follow (Table III).
Table III. Intended versus Achieved Samples, PRIDI
PSUs Children
Country
PSUs Children PSUs Children
Costa Rica 150 150 2000 1804
Nicaragua 57 57 2000 1835
Paraguay 310 297 2000 1504
Peru 416 416 2300 2567
The results reported in this present document were calculated with sampling weights and corrected sampling
variance. The PRIDI Technical Annex provides additional details of these processes. The PRIDI child weight is
a product of base weights and non-response adjustments. Base weights reflect the selection probabilities of
PSUs and SSUs and, at each level of sample selection, are the inverse of the selection probability of a sampled
unit. Non-response adjustments compensate for potential bias due to non-participation of sampled units.
PRIDI’s sample of children results from a stratified multi-stage cluster sample. PSUs are geographical areas,
not individuals. This introduces a potential bias of children likely being more similar to one another within
PSUs than across PSUs. The PRIDI stratification limits the possibility for atypical samples and decreases
sampling variance, and the use of systematic sampling from lists sorted by PSU size further reduces the
overall standard errors. The Jackknife Repeated Replication (JRR) was applied to mitigate the potential biases
of these effects and provide correct estimators for standard errors of the population parameter estimates. All
results reported here are presented with the appropriate sampling weights.
Scaling and Standardization of Scores

Twelve anchor items were included in both Forms A and B to allow for their vertical equating and the reporting
of all results as a single scale (as is done in this present document). The socio-emotional scale, applied via
maternal report, was applied to all PRIDI children, with no differences between children receiving Form A or B.
In Phase III, PRIDI used IRT scaling to combine responses and provide accurate estimates of proficiency for
each domain (see PRIDI Technical Annex for details). Items were calibrated onto a single scale using a one
parameter IRT model where the probability of a response was modeled as a function of the difficulty of the
item and the ability of the person. The discrimination parameters for all items were fixed to 1 and scores
were calculated using a weighted maximum likelihood estimation procedure. For the purpose of estimating
the item difficulties, sampling weights were applied in such a way that each country contributed equally
to the difficulty of the items and, within each country, children from each Form A and Form B contributed
equally as well. The internal consistency, as measured by Cronbach’s Alpha, was calculated and deemed to
be acceptable (> .6) in all domains on both Forms (Table IV).
Table IV. Internal Consistency of the Engle Scale
Dimensions Internal Consistency (Cronbach´s Alpha)
Form A Form B
Cognition 0.68 0.76
Motor 0.68 0.64
Language and Communication 0.76 0.70
Socio-Emotional 0.85
Based on these analyses and results, all scores were standardized and placed on a more useful metric with a
mean 50 and standard deviation of 5. This metric is used from this point forward in this report. Standardiza-
tion was done separately for each domain.
03
What PRIDI Tells Us
about Children and Child
Development in Four
Countries
Table V presents a basic profile of PRIDI children. Their average age is
about 3.5 years. Most speak Spanish. Their mothers have completed
primary education, and a significant percent have completed some
secondary education. Given the small size of its indigenous population,
no indigenous children were included in Costa Rica.
Costa Nicaragua Paraguay Peru Four
Rica Country
Average
Age 2 years 33.45 32.71 31.36 32.53 32.51
Range (1.38) (1.51) (1.37) (1.01)
3 years 32.35 32.44 35.73 33.56 33.52

(1.51) (1.48) (1.45) (1.27)
4 years 34.21 34.84 32.91 33.91 33.97

(1.46) (1.68) (1.45) (1.18)
Sex Male 49.73 51.41 51.97 51.97 51.27

(1.41) (1.37) (1.27) (1.30)
Female 50.27 48.59 48.03 48.03 48.73

(1.41) (1.37) (1.27) (1.30)
Maternal Spanish 99.83 96.50 57.75 98.70 88.20

Language (0.12) (0.86) (2.01) (0.28)
Indigenous --- 3.50 41.62 1.30 11.60

--- (0.86) (1.96) (0.28)
Maternal Incomplete primary 19.92 32.37 35.91 14.21 25.60

or less (1.55) (2.08) (1.90) (1.14)
Education
Primary but 59.52 39.94 44.23 28.02 42.93
incomplete (1.51) (3.34) (1.93) (1.34)
secondary
Secondary or more 20.56 27.69 19.86 57.78 31.47

(1.53) (4.67) (1.36) (1.67)
Standard errors in parentheses.
Mothers report that their children are generally healthy (Table VI).
Table VI. Reported Health of PRIDI Children

Rica Country
Average
Health Good 94.71 86.44 97.27 91.75 92.54

Status Health (0.64) (1.01) (0.60) (0.72)
Poor 5.29 13.56 2.73 8.25 7.46

Health (0.64) (1.01) (0.60) (0.72)
Good health indicator takes the value of one if the mother/caregiver reported that her child is in excellent, very good or good health.
Poor health takes the value of one if she reported that her child has somewhat good or bad health. Standard errors in parentheses.
When measured by PRIDI, the prevalence of stunting remains high (Table VII).
Table VII. Incidence of Stunting in PRIDI Children

Rica Country
Average
Stunted Non 91.44 84.46 88.01 80.52 86.11

Stunted (1.09) (1.74) (1.06) (1.10)
Stunted 8.56 15.54 11.99 19.48 13.89

(1.09) (1.74) (1.06) (1.10)
Child is stunted if height for age, z-score (HAZ) is less than -2 SD. HAZ was calculated based on WHO 2006 tables for child
nutritional status. Standard errors in parentheses.
Stunting, as the literature suggests, is caused by poor nutrition rather than genetic differences and can lead
to cognitive damage (see Grantham-McGregor, et al, 2007). Stunted children are chronically malnourished.
What limited energy their bodies have is devoted to essential organ function and growth, with what remains
going to learning and social interaction. The figures reported above are consistent with data from other
sources (e.g., the World Health Organization), and are alarming.
This finding suggests that neither stunting nor its consequences are well understood within households
across the four countries. Stunting is less visible than fevers, diarrhea, respiratory or other more general health
problems. Parents are likely unaware of the specific needs of young children and have little referent against
which to demand higher quality services. PRIDI data indicate that the majority of its children live in homes
with access to basic services and assets and most parents report that their children are healthy. Yet the high
prevalence of stunting clearly suggests these endowments are insufficient for ensuring a good start in life.
04
Results of the Engle Scale:
Scores and Associated
Factors
Child development emerges from the interaction of any number of factors.
Based on the leading literature (see Selected Bibliography, below), results
of the Engle Scale should discriminate along various dimensions, including
the socio-economic endowment of the home, maternal education, and
indigenous-non, among others.
PRIDI conforms to these expectations and takes the analyses further. Insofar as the Engle Scale offers
a multidimensional view of child development, it allows for deeper insight on how different factors affect
child development. The PRIDI data clearly show that the magnitude of correlation of a given factor varies by
domain. This variation is visible both between countries and within countries, thus offering fertile ground for
structuring and targeting ECD interventions.
The following section discriminates overall results of the Engle Scale by key associated factors. The next
section breaks these findings down by country. Annex A provides additional data on each country, domain
and associated factor.
It merits reiterating that the Engle Scale is not a screening tool. No threshold exists for determining “good” or
“bad” levels of development. Rather, the data allow for a deeper understanding of child development by the
four domains measured by the Engle Scale and the associated factors captured by the Survey.
Age
Scores on each sub-scale of the Engle Scale, in each country, discriminate by age. Insofar as child development
is a process of ordered emergence of skills, older children know more and are able to do more than younger
children. This is reflected in Graph I: older children have higher levels of development. In each case, “r” denotes
the correlation between the score on the given domain and the age; asterisks indicate that this correlation is
statistically significant.
Graph I. Score by Domain and Age
Score
Maternal Education
Overall, the Engle Scale discriminates by maternal education. Gradients are steepest for cognition and
language and communication. Gaps tend to widen as children age (Graph II). As will be discussed below,
these results look different at a country level. Maternal education does not discriminate motor development
in a statistically significant way in three of the four PRIDI countries and its association with socio-emotional
development is statistically significant in only two countries. No statistically significant association with
maternal education appears for any domain in Costa Rica.
Graph II. Scores by Domain, Maternal Education and Age
Incomplete primary or less
Complete secondary or more
The Environment within which Children Develop

Poverty negatively affects child development and tends to be inseparable from a range of other risk factors,
including inadequate nutrition, inadequate sanitation and hygiene, low levels of maternal education and
inadequate stimulation in the home. The literature finds that the deficits generated by the interaction of these
factors increase with age and remain present throughout adulthood. As children age, they are increasingly
more vulnerable to composition of their environment. By the age of two to three, children begin to learn
more complex processes, such as language, and meaningful differences begin to appear in their levels of
development. From this point onwards, the interaction of the child with her environment matters more and
more for her development. The poorer the household both in terms of wealth and stimulation, the more likely
it is that the child will have lower levels of development (Fernald et al., 2012). In short, wealth and stimulation
gradients are present across most domains of child development, and tend to increase over time.
To see if PRIDI results conform to the wealth and stimulation gradients mentioned above, exploratory factor
analysis was used to create two indices. Following Schady et al (2014) a wealth index was created using
characteristics of the infrastructure found in the home, assets found in the home, access to basic services,
and the ratio of household members to bedrooms. A second index was created to describe the nurturing
environment. Drawing from Hamadani et al (2010) and the Family Care Indicators, it includes the number
of books for children in the home, the number of adults who interact (play, sing, draw, tell stories) with the
child, the frequency of adult-child interaction, routines implemented in the home, and basic hygiene routines
practiced by the child. Table VIII provides the correlations for these indices and the Engle Scale domains based
on the weighted averages for each of the four PRIDI countries.
Table VIII. Correlations of Indices and Domains
Socio- Cognitive Motor Language and Wealth

Emotional Communication Index
Cognition 0.21*
Motor 0.17* 0.69*
Language and 0.19* 0.75* 0.69*

Communication
Wealth Index 0.14* 0.18* 0.10* 0.21*
Nurturing 0.25* 0.24* 0.17* 0.27* 0.35*

Environment
* Correlations statistically significant at 5%
These results indicate that the developmental domains measured by the Engle Scale are related, albeit different,
and vary in their relation to different subdomains. The positive correlations observed are to be expected. Each
domain contributes to healthy child development. This is consistent with the literature. Fernald et al. (2009)
argue that while tasks can be divided into domains for categorical purposes, they often are overlapping and
mutually influencing in children. Take, for example, the task of creating a bridge with 3 or 5 blocks, depending
on the age of the child. In the Engle Scale, this task falls into the motor domain. But doing the task correctly
requires cognitive skills, such as problem-solving and basic numeracy (e.g., fine motor and cognitive skills).
Wealth of the Household

Consistent with results obtained by Schady et al (2014) and others (Rubio-Codina et al., 2014; Paxson and
Schady, 2011; Schady, 2006, among others), wealthier PRIDI children perform better than their poorer peers
(Graph III).
Graph III. Scores by Domain, Wealth Index and Age
Lowest quintile (less wealthy)
Higuest quintile (most wealthy)

The association between the wealth index and scores on the Engle Scale vary by domain, as will be discussed
in more detail below. The stronger associations appear with cognition, language and socio-emotional; the
weakest is with motor skills. In all cases, gaps are wider at 59 months than at 24 months.
Nurturing Environment
PRIDI data find that the nurturing environment is more strongly associated with child development than the
socioeconomic situation of the household, depending on the domain evaluated (Graph IV). For example, as
will be discussed below, whereas the wealth index is not statistically significant for a child´s socio-emotional
development in Costa Rica or Nicaragua, the nurturing environment is. In fact, the association with the
nurturing environment is statistically significant for all domains, in all countries. What parents or caregivers
do or do not do with their children has lifelong consequences for children. Mother-child interactions serve as
crucial mediators of child outcomes in the United States (Gelfand and Teti, 1990; Goodman, 1992; Murray,
1997; Murray and Cooper, 1997; Webster-Stratton and Hammond, 1988). The PRIDI data confirm similar
patterns in four countries in Latin America.
Graph IV. Scores by Domain and Nurturing Environment
Lowest quintile (less nurturing)
Highest quintile (more nurturing)
Highest quintile (more nurturing)

05
Differences between
Countries
Variation in levels of child development exists between PRIDI countries
(Table IX). Means with different superscripts (a, b, c, read horizontally
across countries) differ in a statistically significant way from each other
(p < 5%, T-test for independent samples): a > b > c. Take, for example, the
socio-emotional domain. Scores for children in Costa Rica are significantly
higher than scores for children in the other three countries (a > b, and
a > c). Differences between scores in Nicaragua and Paraguay are not
statistically significant (b = b). Scores in Peru are significantly lower than
in the other three countries (c < b, and c < a).
Table IX. PRIDI Scores between Participating Countries
Costa Rica Nicaragua Paraguay Peru
Socio-Emotional 53.09 a 49.28 b 49.17 b 48.52 c

(0.17) (0.19) (0.17) (0.15)
Cognitive 49.42 c 48.91 c 50.38 b 51.55 a

(0.19) (0.21) (0.17) (0.18)
Motor 49.40 c 49.16 c 50.32 b 51.40 a

(0.18) (0.19) (0.15) (0.14)
Language and 49.90 b 48.97 c 49.76 b 51.61 a

Communication (0.20) (0.19) (0.17) (0.15)
Mean of 50. Standard deviation of 5. Standard errors in parentheses
Following this logic, Peruvian children perform best in all other domains. Differences between Peru and
the other three countries are statistically significant. Nicaraguan children on average perform below all
the countries in the cognitive, motor, and language and communication domains, although no statistically
significant difference exists between children in Nicaragua and Costa Rica in cognition and motor skills.
06
Differences within
Countries
The analyses that follow find that the variation in child development, as
measured by the Engle Scale, within countries is greater than the variation
between countries. Child development is unequal, and inequality in
results appears as early as 24 months. Correlations of any given factor
vary by domain. For example, and as will be seen below, correlations with
the wealth index and maternal education are stronger for cognition and
language and communication than for motor development. The nurturing
environment appears to be particularly important for all domains of child
development, although the strength of this association varies. Concrete
examples from the Engle Scale are provided to illustrate what different
children can and cannot do when categorized by associated factor. Again,
in addition to the data presented below, Annex A provides additional,
descriptive data for each domain.
Socio-Emotional
Recent literature has suggested that non-cognitive skills, including those in the socio-emotional domain, can
be stronger predictor of future success than either the physical or the cognitive skills (Heckman, 2005). Non-
cognitive skills also appear to be more malleable than cognitive skills.
A child’s socio-emotional development is the only domain in the Engle Scale assessed through maternal or
principal caregiver report. The literature finds maternal report to be a valid means for assessing development
in this domain (Fernald, et al, 2009).
The Engle Scale asks mothers or caregivers a series of 15 questions associated with the child’s autonomy and
socialization. Mothers respond to these questions with one of four options: almost never, sometimes, often,
and almost always. For example, if the child can play for 15 minutes or more without needing attention from
an adult; if, after a conflict, the child can control himself with the help of an adult; if the child helps with some
things in the home when asked; if the child worries if someone is crying (is interested in the wellbeing of this
person); and if the child is bothered by something, she can calm herself quickly by herself. The same scale
was applied to all PRIDI children.
Of all the subscales measured by the Engle Scale, the socio-emotional subscale displays the weakest
association with the age of the child (Graph V). Consistent with results reported above, “r” denotes that
correlation between the score on the given domain and the age; asterisks indicate that this correlation is
statistically significant.
Graph V. Socio-Emotional Scores by Age and Country
Score
Score
Results from the Engle Scale suggest socio-emotional development bears a direct and statistically significant
relationship with the social and economic context within which children are raised and reflect caregiver
practices and limitations. The maternal education (Graph VI), wealth index (Graph VII) and nurturing
environment (Graph VIII) wield interesting and varying associations.
In the cases of Nicaragua and Costa Rica, differences in a child’s socio-emotional development by levels of
maternal education are not statistically significant. In Paraguay and Peru, where the correlation with maternal
education is statistically significant, results from the Engle Scale indicate that children with mothers with
secondary education or more are “almost always” interested in the well-being of others: for example they
“almost always” worry when another person is crying, sick or wounded.
Graph VI. Socio-Emotional Scores by Maternal Education, Age and Country
Complete secundary or more
The wealth index correlates in a similar manner. In neither Costa Rica nor Nicaragua does a significant
association appear. In those countries where statistically significant associations do appear (Paraguay and
Peru), results from the Engle Scale find that children from wealthier homes “almost always” play alone for 15
minutes or more without needed attention from an adult and like to paint or draw.
Graph VII. Socio-Emotional Scores by Wealth Index, Age and Country
The nurturing environment appears to be a stronger discriminator than maternal education or the wealth
index, in that its correlation with a child´s socio-emotional development appears statistically significant in
all countries. This is consistent with literature from outside the Region. Mother sensitivity, a key component
of the nurturing environment, tends to be the greatest predictor of non-cognitive development (Bakermans-
Kranenburg, et al., 2004). Results from the Engle Scale indicate that children in nurturing environments
“almost always” have preferences for some things and activities, like to paint or draw, and care about the
well-being of others (i.e., they worry if someone else is sick or wounded, or crying).
Graph VIII. Socio-Emotional Scores by Nurturing Environment, Age and Country
Higuest quintile (most nurturing)

The association between stunting and children´s socio-emotional development is less understood than the
association with cognitive development. PRIDI results presented in Annex A suggest that, in contrast to
results in the other domains, stunting may not necessarily wield a fully negative association with a child’s
socio-emotional development. Stunted children in the four countries studied, on average, have the same level
of socio-emotional development as non-stunted children; the same holds true for children reported to be in
good and poor health. No statistically significant difference exists between boys and girls.
A clear message emerging from these results is that the nurturing environment appears to matter. How parents
interact with their children and the quality of the adult-child interaction has important consequences for the
socio-emotional development of children and their future successes in school, the labor market and beyond:
do parents play with the child, sing with the child, is the child included in conversations. These are activities
that can be performed independently of the resources available to the family, although poverty generates
increased stress levels in households and often diminishes the ability of the parents to provide and engage
in the necessary stimulation. Children in wealthier and more nurtured environments, and with mothers with
higher levels of education, display by the age of 59 months key socio-emotional skills – including autonomy
and empathy – that children from poorer and less nurtured environments do not. These skills are necessary
for success in school and beyond.
Cognitive
Cognitive abilities in young children include problem-solving and analytical skills, memory, executive
functioning (higher order skills that regulate goal-directed behavior, including abilities to concentrate, stay
focused and think, and not act on impulse), and basic notions of math. The Engle Scale evaluates these
abilities by prompting children to solve problems with simple objects (e.g., identify concepts of more or less
by using a puppet of a dog and asking which bowl has more food in it), match and sort colors (pairing toy
animals; grouping colored cubes by size and color), do puzzles, and repeat series of unrelated words (head,
pot; shoe, bread, moon; girl, sugar, hand, door). A direct relationship exists between age and scores on this
subscale (Graph IX), as in the others. The “r´s” indicate the correlation between the score on the given domain
and the age; asterisks indicate that this correlation is statistically significant.
Graph IX. Cognitive Scores by Age and Country
Score
Cognition, like language and communication development (discussed in the next section), bears a strong
relationship with the level of parental, particularly maternal education, and the interaction of this factor with
genetics (Shonkoff and Phillips, 2000; Fernald, et al., 2009). Results from the Engle Scale generally confirm
this trend, although maternal education is not statistically significant in Costa Rica (Graph X). Results from the
Engle Scale indicate that children with mothers who have secondary education or more understand temporal
sequences (i.e., they can order cards showing the hatching of a chick: of an egg, an egg cracking open, and a
chick coming out) and can order objects by shape or color.
Graph X. Cognitive Scores by Maternal Education, Age and Country
The wealth of the household bears a strong relationship with the level of cognitive development in PRIDI
children (Graph XI). Statistically significant differences between richer and poorer children exist by the age
of two and expand over time. This is consistent with trends for the Region documented by Schady et al.
2014, Rubio-Codina et al., 2014, Paxon and Schady, 2011; and Schady, 2006. Poverty places considerable
constraints on the abilities of families to invest in resources (e.g., books) necessary for development along
these domains (Grantham-McGregor et al., 2007; Engle et al., 2007; Almond and Currie, 2010). Results from
the Engle Scale indicate that children from richer homes can respond coherently to when asked what they do
if they fall and get hurt, are tired, or are hungry; and can count to 20.
Graph XI. Cognitive Scores by Wealth Index, Age and Country
Highest quintile (most wealthy)

The nurturing environment also holds an important relationship to a child’s cognitive development. Differences
between children on the high and low-end of the nurturing environment index are statistically significant and
increase as the child ages (Graph XII). Gaps at 59 months are greater than those observed at 24 months.
Results from the Engle Scale find that children from nurtured environments have better executive functioning
skills (measured by showing a child a series of card with images of a dog, chicken and cow, and asking a child
to put her hand over only those cards showing a cow).
Graph XII. Cognitive Scores by Nurturing Environment, Age and Country

Non-stunted children outperform stunted children in all countries but Paraguay. In contrast to the socio-
emotional domain where no statistically significant difference exists in gender, a gap favoring girls emerges in
Costa Rica and Peru (see Annex A).
The message emerging from these results echoes the need to target high quality interventions towards the
poorest children. There is an important gap in cognitive development between poorer and richer PRIDI children,
in both the material (wealth index) and emotional sense (nurturing environment). Meaningful differences are
apparent throughout the PRIDI age cohort and tend to widen as children age. The skills that children have by
59 months on the higher ends of the maternal education, wealth, and nurturing environment indices are basic.
The fact that children on the lower ends of these indices have not mastered such skills is alarming.
Language and Communication

Language skills run the gamut of vocabulary and the communication of thoughts, ideas and feelings, to the
understanding of instructions and the ability to read. The Engle Scale assesses expressive language skills by
asking the child to name different body parts (finger, eyebrow, knee, stomach, elbow), differentiate concepts
such as in front of and behind, give her name and the name of mother, and correctly use the present, past and
future tenses of a verb. In the Engle Scale, and consistent with the literature, this subscale is positively related
to the age of the child (Graph XIII). Again, “r” denotes that correlation between the score on the given domain
and the age; asterisks indicate that this correlation is statistically significant.
Graph XIII. Language and Communication Scores by Age and Country
Score
Score
The literature establishes a close link between language, vocabulary and reading comprehension. It also finds
that a child’s language development bears a close association with the socioeconomic level of the home, the
level of parental (particularly maternal) education, and the quality of the adult-child relationship. Families
with fewer of these assets and resources have fewer books in their homes and thus are less likely than more
advantaged families to read to their children, a critical means for exposing children to words and building their
vocabularies. Fernald et al. (2013), Fernald et al, (2009) and Hart and Risley (2005), among others, find
that children in disadvantaged households receive less directed speech and shared communication from their
parents or caregivers. The speech these children hear is less complex in sentence structure and vocabulary and
less responsive to their signals. As a result, they enter formal schooling with deficits, speaking and recognizing
fewer words than children from more advantaged homes. Such deficits tend to accumulate over time.
Results from the Engle Scale are consistent with these findings. In all countries but Costa Rica, statistically
significant differences appear: the more educated the mother, the higher the language and communication
development of her children; this is particularly the case for older children (Graph XIV). Results from the Engle
Scale find that children of mothers who have secondary education or more know their colors (i.e., red, yellow,
blue) and can name geometric figures (i.e., triangle, square, circle, star, rectangle, oval).
Graph XIV. Language and Communication Scores by Maternal Education, Age and Country
Children at the top end of the wealth and nurturing environment indices display higher language and
communication scores. Differences between children at the tails of both indices are statistically significant
and widen over time (Graphs XV and XVI). Results from the Engle Scale find that children at the high ends
of wealth and nurturing environment indices – in addition to knowing their colors and being able to name
geometric shapes – know the difference between front and back; can correctly use the past, present and
future tenses; and can name common activities (i.e., petting a dog, cleaning, milking a cow, brushing hair,
washing clothes, building a wall, swinging). These are all skills that will make these children considerably
more ready to learn when they enter school than their peers in poorer and less nurtured environments.
Graph XV. Language and Communication Scores by Wealth Index, Age and Country

Graph XVI. Language and Communication Scores by Nurturing Environment, Age and Country
Highest quintile (most nurturing)
Annex A provides additional data. Similar to the cognitive domain, girls outperform boys, and stunted children
fall behind non-stunted children. Language and communication development in children reported to be in
good health does not differ in a statistically important way from children reported to be in poor health in any
of the four countries.
The message emerging from these analyses suggest that interventions working directly with mothers or
caregivers in how to be more responsive to their children’s needs and signals could generate improvements
along this domain. Included here would be teaching mothers or caregivers how to listen, understand and
communicate more effectively with their children. This includes reading. Results of the Engle Scale in this
domain parallel those found in the other domains and sound the alarm for children in less educated, less
nurtured and less wealthy households.
Motor
At its most basic, this domain speaks to the ability of children to move. Nearly all healthy children reach key
milestones – e.g., walking, running – in this domain, although the timing often varies. For this reason, motor
skills, particularly gross motor skills at the ages under study, tend to be less predictive of future skills and
abilities, although failure to reach a milestone can indicate the possibility of a developmental delay. Results
from the Engle Scale confirm this relationship between age and motor development (Graph XVII). The “r”
denotes that correlation between the score on the given domain and the age; asterisks indicate that this
correlation is statistically significant.
Graph XVII. Motor Scores by Age and Country
Score
Recent research suggests that a child’s development along this domain reflects more than brain and
neuromuscular maturation. Motor development requires perception and adaptation to the surrounding
environment, factors that are affected by physical growth and caregiver practices, among other variables
(Fernald, el at., 2009). For example, walking is a developmental milestone but, by walking, a child can explore,
communicate, and learn more.
The Engle Scale assesses both gross and fine motor skills, which the literature suggests function together. For
example, it asks the child to copy figures (a straight line, circle, rectangle, triangle), to create a bridge out of 5
blocks, jump with two feet (younger children only), walk in a straight line, and catch a ball.
Results on this domain differ from those on others in significant ways. Of the four countries studies, only in
Nicaragua does maternal education wield a statistically significant impact on a child´s motor development
(Graph XVIII). There, results from the Engle Scale find that children of mothers with secondary education or
more can jump with both feet together and walk in a straight line.
Graph XVIII. Motor Scores by Maternal Education, Age and Country

The wealth index (Graph XIX) displays statistically significant differences in all countries, but the respective
trends are curious. In Paraguay, richer children start off behind their poorer counterparts, then catch up and
surpass them. In Costa Rica and Peru, motor development appears quite equal in younger children, with a gap
appearing around 3.5 years, the same point at which trends in Paraguay between richer and poorer children
start to reverse. In Nicaragua, a gap favoring richer children remains across the PRIDI cohort. Results from
the Engle Scale indicate that children from wealthier homes can build a bridge from 3 blocks, in addition to
walking in a straight line and jumping with both feet together.
Graph XIX. Motor Scores by Wealth Index, Age and Country

The nurturing environment maintains a more linear and statistically significant association with a child’s
motor development as measured by the Engle Scale (Graph XX). In addition to those skills mentioned above,
children from nurtured environment can catch a ball.
Graph XX. Motor Scores by Nurturing Environment, Age and Country
As seen in Annex A, no statistically significant difference overall exits between boys and girls, between
stunted and non-stunted children, or between children reported to be in good and poor health.
The clear message emerging from this domain is the lack of association between motor skills and the three
key associated factors included in this report (maternal education, wealth index, nurturing index). The motor
domain thus functions differently than the socio-emotional, cognitive, language and communication domains.
Interesting next steps would be to look at the interaction between motor skills and the other domains measured
by the Engle Scale. An increasingly larger body of literature links physical activity with better cognitive control
(inhibition and working memory, in particular, both of which are associated with achievement in math and
reading) and executive functioning from the age of 3-4 onwards (Diamond and Lee, 2011; Chaddock et al.,
2011a, 2011b).
07
PRIDI’s Indigenous
Children
PRIDI includes indigenous children and is able to report results for
indigenous-language speakers in Nicaragua and Paraguay. Despite best
efforts to include Quechua-speaking children in Peru, the final sample is
not sufficient to draw reliable results.
Several interesting results emerge from the results of the Engle Scale in indigenous children. Guarani-speaking
children tend to underperform when compared to their Spanish speaking peers. However, the reverse is true
for Miskito children in Nicaragua. These children outperform Spanish-speaking children in the cognitive
and motor domains, with no statistically significant difference between the two groups in the language and
communication domain (Table X). The use of superscripts (a, b) follow the same logic as above. Means with
different superscripts (a, b, read horizontally between populations in the same country) differ in a statistically
significant way from each other (p < 5%, T-test for independent samples): a > b.
Table X. Results of Indigenous-Speaking versus Spanish-Speaking Children in Nicaragua and Paraguay
Nacaragua Paraguay
Miskito Spanish Guarani Spanish
Socio- 43.12 b 49.50 a 48.25 b 49.82 a

Emotional (0.40) (0.19) (0.22) (0.21)
Cognitive 50.00 a 48.87 b 49.19 b 51.23 a

(0.33) (0.22) (0.21) (0.23)
Motor 50.31 a 49.12 b 49.73 b 50.75 a

(0.46) (0.19) (0.22) (0.20)
Language and 48.90 a 48.97 a 47.98 b 51.03 a

Communication (0.34) (0.20) (0.20) (0.22)
Standard errors in parentheses.
Results for Miskito children invite reflection. An issue regarding the Scale and its translation in indigenous
languages arises. At the end of Phase II, the country team in Nicaragua reviewed the instruments and the
translated versions, adjusted some of the translations in Miskito and re-tested the newly translated items
prior to advancing to Phase III. This was not the case in Paraguay. The Guarani version of the Engle Scale was
not applied during phase II, but first used in Phase III. This calls attention to the difficulties of ensuring the
cross-cultural and cross-linguistic comparability of items (e.g., ensuring items the same level of difficulty of
items included in the language and communication scale). Another factor could be the composition of the
sample, which was largely urban in the RAAN, whereas the overall sample in Nicaragua was more rural.
These factors aside, it merits noting that in the 2009 application of the Early Grade Reading Assessment
(EGRA) test in Nicaragua, Miskito children display better performance in oral comprehension (Castro, et
al., 2010). Miskito largely remains an oral language, widely spoken in the RAAN but with few inhabitants
who write and read it. In addition, Serpell and Nsamenang (2014), in stressing the importance of culturally
relevant instruments, suggest that bilingualism may be associated with better cognitive capacities. Although
PRIDI data do not indicate whether its children in the RAAN are mono- or bilingual, a high probability exists
that they have been exposed to Spanish. Morales, et al. (2013) find that bilingual 5 to 7 year olds have better
working memory and executive functioning skills, abilities which bear a close relation to cognition.
08
Gaps in Child
Development
Wealth Matters. Gaps in development in PRIDI children vary by
domain, as illustrated above. Consistent with the literature, the stronger
associations with the wealth index appear with cognition, language
and communication, and socio-emotional; the weakest is with motor
skills. By the time a PRIDI child in the poorest wealth quintile turns 5,
her development lags behind that of her peers in the highest quintile by
2 months for cognition, 9 months for motor skills, and 16 months for
language and communication.
But the environment in which a child develops may matter more. Scores from the Engle Scale suggest that the
nurturing environment is a powerful factor affecting child development. Trends from this factor track those of
the wealth index but, depending on domain, are stronger. By the time a PRIDI child in a home with minimal
stimulation (lowest quintile in the nurturing environment index) turns 5, her development lags behind that
of her peers in homes characterized by high quality adult-child interactions by 8 months for cognition, 19
months for motor skills, and 13 months for language.
Results from the Engle Scale also suggest that the nurturing environment can give kids in poorer households
an edge-up. Performance of nurtured but poor children approaches that of the richest but less nurtured
children on all domains with the exception of language and communication. In this domain, their performance
continues to lag behind richer and less nurtured children, but is higher than their less nurtured peers (e.g.,
poor and un-nurtured children). Notably, on the socio-emotional domain, performance of poor children in a
nurtured environment is essentially on par with that of nurtured children in richer homes. In this case, the
nurturing environment closes the gap between rich and poor children.
09
Benchmarking Child
Development
Economic and emotional investments in children are the best bet for
ensuring a good start in life. In an effort to benchmark results from the
Engle Scale, two groups of children were created (see Annex A). The first,
privileged, has all the benefits of wealth and a nurturing environment
(highest quintile in both indices). The second, not privileged, falls on
the other end of the scale (lowest quintiles of wealth and the nurturing
environment). The results are clear. The gaps between the two groups
are large across all domains with the exception of socio-emotional.
These differences are equivalent to 18 months for cognition, 17 months
for motor skills, and 18 months for language and communication.
These results clearly highlight the advantages of children born to parents who invest emotional and economic
resources in their development. These children will likely thrive in school, become healthy and productive
adults, and pass on the advantages that such advantage brings to their own children. Children born in homes
that lack such economic and emotional resources are at a disadvantage prior to entering school. The odds are
stacked against them from the beginning. Chances are that neither school nor any life experience will level
the playing field.
10
Conclusions and Moving
Forward
The processes applied throughout the three phases of PRIDI have produced
a valid and reliable instrument – the Engle Scale - for measuring the
cognitive, language, socio-emotional and motor development of children
24 to 59 months in 4 countries. Results from the Engle Scale clearly show
that child development is unequal. Inequalities exist between countries,
by populations within countries and developmental domains. Particularly
in the cases of cognition, and language and communication, gaps are
evident early-on, with the youngest of the PRIDI cohort, and increase
as children age. These gaps signal that not all children will have success
in school. This calls attention to the urgency to intervene early on. The
analyses presented also suggest that interventions targeting both children
and parents may be effective in closing gaps in child development, such
as working with parents to be more responsive in talking, listening and
communicating with their children.
Gaps also exist by associated factors. Of all factors considered in this report, three are consistent in the
relation they hold with child development: wealth, maternal education, and the nurturing environment. When
young children have the benefits of all three, they likely will thrive, although the results presented here suggest
that a nurturing environment can help mitigate the negative association lower levels of wealth have with the
domains of development measured by the Engle Scale.
A long line of literature speaks to the correlations between child development, maternal education and the
socio-economic status of the home. PRIDI confirms this for all domains, although the relation with these
factors is weaker with motor skills. Far less evidence exists for the relationship with the nurturing environment.
In this respect, PRIDI contributes to the existing body of knowledge by demonstrating the association child
development has with the nurturing environment. Results from the Engle Scale clearly indicate that the
quality of adult-child interactions matters. The nurturing environment matters for child development in the
four domains included here, for all countries, and populations within countries. This opens the door to a
plethora of interventions targeted towards families and parenting, including programs to improve the quality
of the adult-child interactions in the home (e.g., reading, singing, responsive communication).
PRIDI calls attention to the need to look deeper into what different communities are doing to promote the
development of children, like the Miskito in Nicaragua. The development of these children is mostly on par
with their Spanish-speaking peers, despite the fact that levels of household wealth and maternal education
tend to be lower in the RAAN than in the rest of Nicaragua.
In addition, PRIDI sends a message to schools and administrators. The PRIDI children are entering formal
schooling. Schools need to be ready to receive them and provide them with a quality education, all of which
holds implications for the structuring of curricula, the training of teachers, and outreach with families and
communities.
Moving Forward
The analyses presented here raise a number of questions for future research. Foremost among these is the
issue of predictability. Skills that children need for success in school are quite similar across countries and
populations. These skills run the gamut of cognitive, social and emotional skills, some of which the Engle
Scale measures in young children. To confirm the hypothesis, a panel of PRIDI children would need to be
constructed and their performance in primary education measured. PRIDI samples were constructed in such
a way as to allow for this type of analysis in the future.
Finally, PRIDI is a public good. Its instruments, manuals, database and reports are available to researchers
and practitioners interested in child development in Latin America. The PRIDI database is a goldmine for
research, with information on a number of factors not included in this report. The Engle Scale is solid and
provides holistic look at ECD with relatively few items. This invites replication in other countries and, by doing
so, opens the frontier for installing new capacities for evaluating early childhood development beyond the four
original PRIDI countries.
Annex A
Data Tables by Domain
Socio-Emotional Development Costa Nicaragua Paraguay Peru Four
Rica Country
Average
Sex Male 52.84 a 49.28 a 49.00 a 48.58 a 49.92 a
(0.21) (0.25) (0.19) (0.19)
Female 53.34 a 49.28 a 49.35 a 48.46 a 50.11 a

(0.23) (0.20) (0.23) (0.16)
Maternal Incomplete 53.31 a 49.12 a 48.34 c 46.13 c 49.22 c
primary or less (0.41) (0.31) (0.25) (0.56)
Education
Primary but 52.87 a 49.43 a 49.22 b 47.98 b 49.88 b
incomplete (0.21) (0.35) (0.25) (0.30)
secondary
Secondary or 53.09 a 49.37 a 50.44 a 49.28 a 50.55 a

more (0.36) (0.17) (0.23) (0.15)
Wealth First Quintile 53.33 a 49.53 a 47.93 c 46.05 c 49.21 d
Index (0.35) (0.47) (0.32) (0.53)
Second Quintile 52.93 a 48.61 a 48.81 b 48.00 b 49.59 d
(0.38) (0.48) (0.32) (0.43)
Third Quintile 52.94 a 49.30 a 49.17 b 48.66 b 50.02 c
(0.24) (0.30) (0.27) (0.30)
Fourth Quintile 52.76 a 49.57 a 49.93 a 49.71 a 50.49 b
(0.31) (0.39) (0.26) (0.25)
Fifth Quintile 53.59 a 49.43 a 50.39 a 50.19 a 50.90 a
(0.39) (0.20) (0.34) (0.26)
Nurturing First Quintile 51.92 c 47.71 c 47.36 d 46.46 e 48.36 e

Environment (0.40) (0.39) (0.31) (0.53)
Second Quintile 52.58 a,c 48.70 b 48.45 c 47.41 d 49.29 d
(0.32) (0.20) (0.29) (0.27)
Third Quintile 53.00 b 49.67 a 49.36 b 48.38 c 50.10 c
(0.31) (0.29) (0.24) (0.21)
Fourth Quintile 53.58 b,a 49.77 a 50.06 b 49.30 b 50.68 b
(0.38) (0.39) (0.26) (0.29)
(0.32) (0.32) (0.34) (0.24)
Height-for- Non Stuntend 53.10 a 49.28 a 49.28 a 48.53 a 50.05 a

Age (0.18) (0.20) (0.18) (0.19)
Stunted 53.00 a 49.28 a 48.34 b 48.50 a 49.78 a
(0.52) (0.43) (0.37) (0.31)
Health Poor health 53.41 a 47.93 b 48.61 a 47.68 a 49.41 b

(0.59) (0.38) (0.61) (0.57)
Good health 53.08 a 49.49 a 49.17 a 48.61 a 50.09 a
(0.17) (0.18) (0.16) (0.15)
Extreme Privileged 53.93 a 49.82 a 51.06 a 51.82 a 51.66 a

Groups (0.36) (0.32) (0.43) (0.39)
Non-Privileged 52.59 a 47.82 b 46.82 b 44.72 b 48.03 b
(0.72) (0.72) (052) (0.84)
Standard errors in parentheses. Means with different superscripts, read vertically within the same country and associated factor,
differ in a statistically significant way from each other (p < 5%, T-test for independent samples): a > b > c > d > e.
Cognitive Development Costa Nicaragua Paraguay Peru Four
Rica Country
Average
Sex Male 49.06 b 48.75 a 50.12 b 51.46 a 49.85 b
(0.21) (0.23) (0.21) (0.22)
49.78 a 49.08 a 50.66 a 51.65 a 50.29 a
Female (0.27) (0.27) (0.21) (0.24)
Maternal Incomplete 49.37 a 48.39 b 49.25 c 50.13 c 49.29 c

primary or less (0.38) (0.30) (0.19) (0.39)
Education
Primary but 49.27 a 48.83 a,b 50.63 b 51.29 b 50.00 b
incomplete (0.21) (0.26) (0.28) (0.29)
secondary

more (0.59) (0.35) (0.39) (0.19)
Wealth First Quintile 48.07 c 48.48 b 49.26 c 50.18 c 49.00 d
Index (0.34) (0.48) (0.32) (0.39)
Second Quintile 48.97 b 48.28 b 49.80 b,c 50.82 c 49.46 c
(0.40) (0.39) (0.30) (0.35)
Third Quintile 49.10 b 48.77 b 50.42 b 51.05 c 49.84 c
(0.31) (0.33) (0.29) (0.24)
Fourth Quintile 50.31 a 49.35 a,b 50.61 b 52.22 b 50.62 b
(0.46) (0.43) (0.32) (0.24)
(0.36) (0.20) (0.47) (0.26)
Nurturing First Quintile 47.51 c 47.59 d 48.53 d 49.85 c 48.37 d

Environment (0.36) (0.35) (0.25) (0.49)
Second Quintile 48.88 b 48.18 c,d 49.85 c 51.12 b 49.51 c
(0.37) (0.40) (0.34) (0.25)
Third Quintile 48.97 b 48.93 b,c 49.81 c 51.28 b 49.75 c
(0.32) (0.23) (0.30) (0.30)
Fourth Quintile 50.37 a 49.36 b 51.42 b 51.64 b 50.69 b
(0.32) (0.29) (0.35) (0.35)
(0.38) (0.40) (0.35) (0.27)

Age (0.20) (0.25) (0.17) (0.18)
Stunted 48.50 a 48.24 a 50.01 a 50.96 b 49.43 b
(0.60) (0.46) (0.46) (0.34)
Health Poor health 48.45 a 48.93 a 49.50 a 51.06 a 49.48 a

(0.68) (0.36) (0.99) (0.53)
(0.19) (0.21) (0.17) (0.18)

Groups (0.44) (0.61) (0.58) (0.36)
Non-Privileged 46.67 b 47.83 b 48.10 b 50.17 b 48.19 b
(0.61) (0.54) (0.41) (0.48)
differ in a statistically significant way from each other (p < 5%, T-test for independent samples): a > b > c > d.
Language and Communication Costa Nicaragua Paraguay Peru Four
Development Rica Country
Average
Sex Male 49.74 a 48.73 a 49.31 b 51.55 a 49.83 b
(0.26) (0.23) (0.22) (0.18)
50.06 a 49.22 a 50.25 a 51.66 a 50.30 a
Female (0.24) (0.24) (0.21) (0.21)
Maternal Incomplete 49.99 a 47.99 c 48.4 c 50.11 c 49.12 c

primary or less (0.40) (0.20) (0.22) (0.40)
Education
Primary but 49.82 a 48.89 b 49.89 b 51.38 b 49.99 b
incomplete (0.25) (0.19) (0.26) (0.24)
secondary

more (0.59) (0.29) (0.39) (0.17)
Wealth First Quintile 48.28 c 48.04 c 48.24 c 50.87 c 48.86 d
Index (0.43) (0.33) (0.28) (0.35)
Second Quintile 49.08 b,c 48.44 b,c 48.49 c 50.70 c 49.18 d
(0.39) (0.33) (0.30) (0.27)
Third Quintile 49.77 b 48.66 b,c 49.79 b 50.89 c 49.78 c
(0.34) (0.26) (0.28) (0.27)
Fourth Quintile 51.02 a 49.19 b 50.44 b 52.12 b 50.69 b
(0.40) (0.35) (0.36) (0.23)
(0.40) (0.15) (0.38) (0.26)
Nurturing First Quintile 48.20 d 47.78 c 47.72 d 49.69 c 48.35 d

Environment (0.38) (0.33) (0.25) (0.37)
Second Quintile 49.05 c,d 48.12 c 49.04 c 51.23 b 49.36 c
(0.39) (0.35) (0.29) (0.32)
Third Quintile 49.33 c 48.65 b,c 49.33 c 51.11 b 49.61 c
(0.38) (0.25) (0.32) (0.32)
Fourth Quintile 50.72 b 49.41 b 50.76 b 51.90 b 50.70 b
(0.37) (0.27) (0.34) (0.32)
(0.45) (0.42) (0.32) (0.23)

Age (0.21) (0.22) (0.17) (0.16)
Stunted 48.89 a 47.92 b 49.22 a 50.76 b 49.20 b
(0.55) (0.40) (0.45) (0.26)
Health Poor health 49.02 a 48.91 a 48.59 a 51.07 a 49.40 b

(0,70) (0,35) (0,83) (0,52)
(0,20) (0,21) (0,17) (0,15)

Groups (0.72) (0.39) (0.48) (0.31)
(0.63) (0.52) (0.40) (0.53)
Motor Development Costa Nicaragua Paraguay Peru Four
Rica Country
Average
Sex Male 49.07 b 49.35 a 50.06 b 51.40 a 49.97 a
(0.21) (0.21) (0.20) (0.14)
49.73 a 48.97 a 50.61 a 51.40 a 50.18 a
Female (0.24) (0.28) (0.21) (0.25)
Maternal Incomplete 49.30 a 48.51 b 49.87 a 50.92 a 49.65 b

primary or less (0.33) (0.31) (0.25) (0.37)
Education
Primary but 49.31 a 49.23 a 50.52 a 51.72 a 50.19 a
incomplete (0.23) (0.22) (0.25) (0.26)
secondary

more (0.45) (0.25) (0.36) (0.16) (0.16)
Wealth First Quintile 48.76 c 48.51 b 49.87 b 51.04 b,c 49.54 c
Index (0.44) (0.41) (0.35) (0.43)
Second Quintile 48.95 b,c 48.88 a,b 49.96 b 51.02 c 49.70 c
(0.31) (0.47) (0.32) (0.30)
Third Quintile 49.15 a,c 49.33 a,b 50.98 a 50.70 c 50.04 b,c
(0.39) (0.30) (0.33) (0.24)
Fourth Quintile 50.16 a 49.25 a,b 50.18 a,b 51.86 a,b 50.37 a,b
(0.36) (0.27) (0.33) (0.22)
Fifth Quintile 49.77 a,b 49.75 a 50.85 a,b 52.28 a 50.66 a
(0.35) (0.19) (0.44) (0.22)
Nurturing First Quintile 48.44 b 48.07 c 49.18 c 50.04 c 48.93 d

Environment (0.34) (0.27) (0.29) (0.46)
Second Quintile 48.83 b 48.42 c 50.39 a,b 50.96 b 49.65 c
(0.33) (0.32) (0.31) (0.21)
Third Quintile 48.91 b 49.28 b 49.73 b,c 50.73 b,c 49.66 c
(0.33) (0.28) (0.31) (0.28)
Fourth Quintile 50.02 a 49.50 b 50.98 a 51.53 b 50.51 b
(0.37) (0.36) (0.32) (0.39)
(0.37) (0.28) (0.31) (0.24)

Age (0.19) (0.22) (0.16) (0.14)
Stunted 48.82 a 48.08 v 49.84 a 50.81 b 49.39 b
(0.50) (0.34) (0.35) (0.34)
Health Poor health 48.54 a 48.78 a 49.24 a 51.58 a 49.53 a

(0.59) (0.41) (1,11) (0,63)
(0.18) (0.21) (0,16) (0,13)

Groups (0.47) (0.43) (0.53) (0.38)
(0.50) (0.52) (0.47) (0.31)
Standard errors in parentheses. . Means with different superscripts, read vertically within the same country and associated factor,
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PRIDI
Team
Patrice Engle Santiago Cueto Aimee Verdisco
Lead Investigator Lead Investigator Education Specialist
Cal Poly, USA GRADE, Peru IDB
Jennelle Thompson Oliver Neuschmidt Sebastian Meyer

Education Specialist Senior Research Analyst Research Analyst
IDB IEA IEA
A number of other people made significant contributions to PRIDI and without whom PRIDI would not have
been possible. Beatriz Ore (Universidad Ruiz de Montoya, Peru) led the formative work during Phase I in
Peru, assisted by Fabiola Lazarte and Claudia Melo Vega. Beatriz played a large role in creating the items
and ensuring their correct application and adjustment through Phase III. Maria Estela Ortiz helped with the
Conceptual Framework and the launching of the project. Olaf Zuehlke, Dirk Hastedt, Phamen Mirazchiyski,
and Andres Sandoval from IEA provided technical assistance of issues related to sampling, and Eugenio
Gonzalez provided key support for item validation, IRT, RASCH and factor analyses. The contribution of
incredible and tireless research assistants is greatly appreciated: Katelyn Hepworth, Alejandra Miranda, Mayli
Zapata, Ismael Muñoz, Andrew Ostroff, and Caila Driscoll. Special thanks also go to Hugo Ñopo for critically
reviewing the content, as well as to Joan Lombardi, Ann Weber and Lia Fernald for their detailed comments

PRIDI Urgency and Possibility

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URGENCY

Aimee Verdisco Santiago Cueto Jennelle Thompson Oliver Neuschmidt

Emiliana Vegas, Chief

Table I. Domains of Child Development Included in PRIDI

Domain Definition Justification

Language Development of expressive and receptive Predictive of learning in school.

Table II. Associated Factors Included in PRIDI

Factor Definition Justification

Household Socio-economic status of the home, Environment in which a child develops

Creation of PRIDI Instruments

• Costa Rica: Leyden Consulting Group

• Nicaragua: Centro de Investigación y Acción Educativa y Social (CIASES) and Gesaworld

• Paraguay: Universidad Iberoamericana

• Peru: SASE Consultores

• Costa Rica (two stratification variables): Valle Central/rest of country, urban/rural

• Nicaragua (three stratification variables): Departments and regions, urban/rural

• Paraguay (one stratification variable): Urban/rural

Table III. Intended versus Achieved Samples, PRIDI

Costa Rica 150 150 2000 1804

Nicaragua 57 57 2000 1835

Paraguay 310 297 2000 1504

Peru 416 416 2300 2567

Scaling and Standardization of Scores

Table IV. Internal Consistency of the Engle Scale

Dimensions Internal Consistency (Cronbach´s Alpha)

Cognition 0.68 0.76

Motor 0.68 0.64

Language and Communication 0.76 0.70

3 years 32.35 32.44 35.73 33.56 33.52

4 years 34.21 34.84 32.91 33.91 33.97

Sex Male 49.73 51.41 51.97 51.97 51.27

Female 50.27 48.59 48.03 48.03 48.73

Maternal Spanish 99.83 96.50 57.75 98.70 88.20

Indigenous --- 3.50 41.62 1.30 11.60

Maternal Incomplete primary 19.92 32.37 35.91 14.21 25.60

Secondary or more 20.56 27.69 19.86 57.78 31.47

Standard errors in parentheses.

Table VI. Reported Health of PRIDI Children

Costa Nicaragua Paraguay Peru Four

Health Good 94.71 86.44 97.27 91.75 92.54

Poor 5.29 13.56 2.73 8.25 7.46

Table VII. Incidence of Stunting in PRIDI Children

Costa Nicaragua Paraguay Peru Four

Stunted Non 91.44 84.46 88.01 80.52 86.11

Stunted 8.56 15.54 11.99 19.48 13.89

Graph II. Scores by Domain, Maternal Education and Age

Incomplete primary or less

Complete secondary or more

Complete secondary or more

The Environment within which Children Develop

Socio- Cognitive Motor Language and Wealth

Motor 0.17* 0.69*

Language and 0.19* 0.75* 0.69*

Wealth Index 0.14* 0.18* 0.10* 0.21*

Nurturing 0.25* 0.24* 0.17* 0.27* 0.35*

* Correlations statistically significant at 5%

Wealth of the Household

Lowest quintile (less wealthy)

Higuest quintile (most wealthy)