Frequently Asked Questions

Q:    Can the CREDI be used to diagnose or screen children for early signs of disability or developmental delay? 

A:     No.  The CREDI is not designed to provide information on individual children and therefore should not be used in this way.  

Q:    Do you have recommendations for a cut-off score that could tell users which children are developmentally “on track” versus “off track” ?  

A:     No.  Although we may provide such recommendations in the future, we do not currently have enough evidence to support the development of a cut-off score.  Users who want to categorize children (e.g., as on versus off track) should create their own cut-off scores to reflect their specific project/contextual needs.  

Q:    I am planning to monitor the proportion of children meeting a benchmark on the Z-scores from the CREDI Short Form. Is this appropriate?   

A:     We currently do not recommend this.  The CREDI team recently discovered that the CREDI Short Form scores are underdispersed. This is not generally a problem for estimating the average level of development in a population and does not cause issues for users interested in hypothesis testing (e.g., examining differences in Short Form scores between groups). However, this underdispersion problem poses important challenges when looking at Z-scores generated from Short Form data, particularly when attempting to calculate the proportion of children above or below a benchmark. Because of the underdispersion problem, it is difficult or impossible to observe very extreme Z-scores (e.g., below -2 or above +2). This is a major problem for those wanting to examine the number or proportion of children falling below a given benchmark (e.g. the proportion of children with scores below -2 SD) because the estimate of children below this benchmark is very much undercounted in the current Z-scores. As such, we are currently recommending not to use existing Short Form Z-scores for monitoring purposes until we update the methodology we use to calculate scores using a revised reference population. We estimate that this process should take several months and will notify users when updates have been made. In the meantime, users who are interested in learning more about this issue and our planned methodological solutions are welcome to contact us. While less interpretable, it would be appropriate to monitor the average Short Form scores by age group until we have developed a more acceptable solution that allows users to calculate proportions based on Z-scores. 

Q:    I am planning a study to evaluate the effects of an intervention program.  Can I use the CREDI in my evaluation?  

A:     Yes, with some caveats.  The CREDI Long Form has been successfully used as an outcome measure in several evaluation studies (see Research page for details). At the same time, we recommend that, whenever possible, the CREDI should be paired with a more detailed and domain-focused measure that captures finer differences in the specific skill(s) that your intervention is designed to improve.  If, for example, your intervention is targeting children’s language outcomes, we recommend that you pair the CREDI Long Form with a direct assessment of children’s language skills in at least a subsample of your participants.  Doing so will help to reduce the possibility that you may fail to detect small but potentially meaningful effects of your program in at least one domain.  Furthermore, triangulation of measurement (i.e., using multiple approaches to measure the same thing) is useful for addressing potential weaknesses in one approach versus another.  Given that the CREDI is a caregiver-reported scale, using a direct assessment to address issues of social desirability (for example) may be useful.  

Q:    I am hoping to adapt some of the CREDI items so that they are more targeted to my specific population.  Is that ok?  

A:     No.  The CREDI Short Form and the CREDI Long Form have been validated as scales that are designed to be use exactly as they are written.  You should not adapt the items or change them in any way unless absolutely necessary (see Adaptation & Translation section of the CREDI User Guide).  If you want to add more items that are specifically relevant to your population, you may create your own items or borrow them from another tool.  If you choose to do this, you should still score the CREDI using only the items in the original Short or Long Form based on the instructions provided in the CREDI Data Management and Scoring Manual.  If you want to integrate your additional items into your scores, you will need to validate your new scale on your own and be clear in publishing about the changes you have made.  

Q:    I want to use the CREDI, but I am only interested in using a subset of the questions.  Can I pick and choose which items I use?  

A:     No.  Once again, the CREDI Short Form and the CREDI Long Form are designed to be used as-is.  You should not get rid of any items or you will compromise the properties of the scores.  

Q:    I am confused about how to administer the CREDI Long Form.  How do I decide where to start and stop the assessment for each child?  

A:     Details on how to administer the CREDI Long Form are available in the CREDI Assessor Manual.  Briefly, the Long Form includes a total of 108 items that are ordered from least to most difficult. Individual children receive answers for a different subset of these items depending on their age and ability level. To start the Long Form, data collectors should find the item that corresponds to the child’s age band (marked on the Long Form itself by à to the left of the items). The data collectors should then stop the Long Form after the caregiver responds “no” or “don’t know” to 5 items in a row. Items before the start point and after the stop point (i.e., items not answered by the caregiver) should be left blank/missing.   

Q:    I want to use the CREDI Long Form, but I am only interested in one specific domain (for example, social-emotional development). Can I only use items that correspond to that domain?  

A:   We do not recommend this. Under normal circumstances, the scoring procedure for the CREDI Long Form takes into account information from all domains when producing its individual scores for the motor, language, cognitive, and social-emotional domains.  As such, even though the scores produced when items from some domains are missing are highly correlated and show strong agreement with the scores using the full Long Form, our analyses suggest that they are not exactly the same. More details are available in Appendix E of the Data Management & Scoring Guide.

Q:    Is it possible to produce domain-specific scores using the CREDI Short Form, or do I have to use the CREDI Long Form? 

A:     Our CREDI Scoring App only produces domain-specific scores (i.e., motor, language, cognitive, and social-emotional scores) for the Long Form. Users who score the Short Form will only receive overall development scores. Domain-specific scores calculated based on the Short Form items would be unreliable because they would be based on just a few responses. More advanced users who would like to recover domain-specific scores even with this caveat should reach out to the CREDI team for further guidance. 

Q:    I noticed that the CREDI Scoring App doesn't produce a mental health score.  How do I score children's mental health?

A:  The CREDI Long Form includes several items at the end that are intended to measure children's mental health symptoms. Our team has not yet identified a reliable and valid method for scoring these items. As such, we do not currently recommend any standardized approach for their scoring.  Recommendations for scoring the mental health items are available in Appendix D of the Data Management & Scoring Guide. 

Q:    How is the CREDI similar and different from the Global Scales of Early Development (GSED) being developed by the WHO?

A:  The CREDI team has been directly involved with the development of the GSED, and the CREDI's conceptual framework, item set, and data were used to directly inform the GSED.  As such, the tools share a number of common features.  In particular, both tools are intended to measure the development of children under age three years in global settings.  

There are, however, several key differences between the tools. First, the GSED Long Form includes items administered directly to the child by a trained assessor (i.e., direct assessment) and is therefore not directly comparable to either the CREDI Short Form or the CREDI Long Form (which are both caregiver-reported).  

The GSED Short Form is exclusively caregiver-reported and therefore more comparable to the CREDI.  The main difference between the CREDI and the GSED Short Form is that the CREDI Long Form produces domain-specific scores in motor, language, cognitive, and social-emotional development, as well as an overall development score.  The GSED Short Form, however, produces only an overall development score.   

There are also several other differences in terms of the tools' format.  The GSED Short Form is approximately the same length as the CREDI Long Form, and both tools use start/stop rules.  The CREDI Short Form is somewhat shorter than the GSED Short Form, and uses a fixed set of 20 items per child.  The CREDI also uses line drawings to support the implementation of some of the items, whereas the GSED Short Form includes line drawings, as well as video and audio files.