D-score: worldwide insight into the development of children

20 March 2019 • 3 min reading time

Many children around the world are still lagging behind in their first five years of life, due to poor nutrition, insufficient care, and too few learning opportunities. This is estimated to affect more than four out of every ten children. To get a clear picture of this problem, TNO has developed a special screening method for measuring the Development Score (D-score) of young children.

Care to know more?

Would you like to know more about the D-score that TNO has developed? If so, please contact Stef van Buuren.


It may seem a little odd to use the term ‘return on investment’ in this connection. However, research has shown that boosting remedial efforts during the period from conception up to a child’s second year of life can, on average, be seven to ten percent more effective than subsequent interventions.

Getting off to a bad start causes lifelong problems

Stef van Buuren, coordinator of the D-score programme on behalf of TNO, asserts that “The first thousand days of your life are hugely important”. “But things often go wrong during that time. Newborn babies are more or less the same size and weight, all over the world. Yet, two years later, you see that children in many developing countries are well below the World Health Organization’s (WHO) standard. And if you are lagging so far behind, you can never catch up. So a poor start will affect you for the rest of your life. Together with the Bill & Melinda Gates Foundation, we want to do something about that.”

“If the brain does not develop properly in the first few years, this will impact that individual's educational opportunities, well-being, and productivity later on in life”

The causes

Developmental delays in young children can have a variety of causes, such as a lack of proper nutrition, of educational care or of learning opportunities. In developing countries, you often see that young children suffer deprivation in all these areas. “In addition, if the brain does not develop properly in those first few years, this will impact that individual’s educational opportunities, well-being, and productivity later on in life.”

United Nations programme

So this is a problem that really has a major impact. The United Nations, too, is very aware of this. Its ‘2030 Sustainable Development Goals’ specifically target children in this at-risk group, so that they, too, can have a chance of a healthy and productive life. The main challenge here is to provide young children around the world with their basic needs. In addition to proper nutrition and a caring and safe environment, children must also have an opportunity to fully adapt to their surroundings.

“TNO has created a screening method to identify young children’s physical, emotional, and communication abilities”

Identifying any developmental delays

The sooner you become aware that a child is lagging behind in terms of its development, the sooner you can intervene. “This prompted TNO to create a screening method for identifying young children’s physical, emotional, and communication abilities. This method enables you to quickly determine whether or not there is any developmental delay. TNO uses the results of these measurements to compile a Development Score. This is also known as the ‘D-score’.

Simple, robust measuring instruments

Can a child stack one block on top of another? Can he or she walk? The D-score is based on the standard questions used by Dutch child healthcare practitioners during physical examinations. TNO is now putting this expertise to work, in the context of a large-scale, international joint project to measure the development of young children around the world, using the same standardized approach. That project will last for five years. The ultimate goal is to develop simple, robust measuring instruments that can be easily used by carers around the world. Thus, the D-score developed by TNO will play an important part in this.

“A smart algorithm is used to quickly identify any children who need extra attention”

Help from a smart algorithm

If all goes well, there will soon be a worldwide database containing information on the development of young children. It should then be possible to use a smart algorithm to quickly identify any children who need extra attention” This D-score – coupled with the use of artificial intelligence – will, therefore, enable us to get young children around the world off to a good start.


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