Emily Hanno, Jorge Cuartas, Luke Miratrix, Stephanie Jones, and Nonie Lesaux. 10/3/2021. “Changes in Children's Behavioral Health and Family Well-Being During the COVID-19 Pandemic.” Journal of Developmental & Behavioral Pediatrics . Publisher's VersionAbstract

Objective: The coronavirus disease 2019 pandemic and associated public health measures have influenced all aspects of life for children and families. In this study, we examine changes in children's behavioral health and families' well-being at the start of the pandemic.

Method: We used longitudinal data on 2880 children from 1 US state collected over 3 waves to compare family and child well-being before and after a state-wide stay-at-home advisory set in March 2020. We descriptively examined levels and changes in 4 child behavioral health outcomes (externalizing, internalizing, adaptive, and dysregulated behaviors) and 4 family well-being outcomes (parental mental health, parental stress, parent-child relationship conflict, and household chaos) across the preshutdown and postshutdown periods. Fixed effects regression models were used to predict within-child and within-family differences in preshutdown and postshutdown outcomes.

Results: Fixed effects analyses showed children's externalizing (0.09 points; 95% confidence interval [CI] 0.05-0.13), internalizing (0.04 points; 95% CI, 0.01-0.08), and dysregulated (0.11 points; 95% CI, 0.06-0.16) behaviors increased after the shutdown, whereas children's adaptive behaviors declined (-0.10 points; 95% CI, -0.15 to -0.05). Parental mental health issues (0.22 points; 95% CI, 0.17-0.27), parental stress (0.08 points; 95% CI, 0.03-0.12), parent-child relationship conflict (0.10 points; 95% CI, 0.04-0.16), and household chaos (0.10 points; 95% CI, 0.05-0.14) all increased relative to preshutdown levels.

Conclusion: Many children experienced declines in behavioral health and many families experienced declines in well-being in the early months of the public health crisis, suggesting the need for family-focused and child-focused policies to mitigate these changes.

Dana McCoy, Jorge Cuartas, Jere Behrman, Claudia Cappa, Jody Heymann, Florencia López Boo, Chunling Lu, Abbie Raikes, Linda Richter, Alan Stein, and Günther Fink. 8/25/2021. “Global estimates of the implications of COVID-19-related preprimary school closures for children’s instructional access, development, learning, and economic wellbeing.” Child Development. Publisher's VersionAbstract
Observational data collected prior to the pandemic (between 2004 and 2019) were used to simulate the potential consequences of early childhood care and education (ECCE) service closures on the estimated 167 million preprimary-age children in 196 countries who lost ECCE access between March 2020 and February 2021. COVID-19-related ECCE disruptions were estimated to result in 19.01 billion person-days of ECCE instruction lost, 10.75 million additional children falling “off track” in their early development, 14.18 million grades of learning lost by adolescence, and a present discounted value of USD 308.02 billion of earnings lost in adulthood. Further burdens associated with ongoing closures were also forecasted. Projected developmental and learning losses were concentrated in low- and lower middle-income countries, likely exacerbating long-standing global inequities.
Jorge Cuartas. 8/21/2021. “The effect of spanking on early social-emotional skills.” Child Development. Publisher's VersionAbstract
Whether spanking is detrimental for social-emotional (SE) development remains controversial, mostly due to disputes around the internal and external validity of existing evidence. This study examined the effect of spanking on the SE development of Bhutanese children, using a national, longitudinal sample (N = 1377; Mage = 50.5 months old; 50% girls). Following best-practice recommendations for mitigating issues of selection bias in observational developmental research, the study employed conservative methods (i.e., child fixed-effects and lagged-dependent variables) and robustness checks to assess the internal validity of estimates. Across approaches, spanking predicted reductions in SE skills of .09–.17 SD, even after controlling for all time-invariant confounders and baseline levels of SE skills. These findings strengthen the argument that spanking might be harmful to young children's SE development.
Kaitlin Paxton Ward, Andrew Grogan-Kaylor, Garret T Pace, Jorge Cuartas, and Shawna Lee. 8/2021. “Multilevel ecological analysis of the predictors of spanking across 65 countries.” BMJ Open, 11. Publisher's VersionAbstract

Objective Ending violence against children is critical to promote the health and socioemotional development of children across the globe. To this end, the UNICEF and the WHO have called for the abolishment of spanking, which is the most pervasive form of physical violence against children worldwide. This study used an ecological perspective to examine micro-level and macro-level predictors of parental spanking across 65 countries.

Participants Data came from the fourth and fifth rounds of the UNICEF Multiple Indicator Cluster Surveys, which were administered between 2009 and 2017 (N=613 861 households). We examined the predictors of spanking using multilevel logistic regression analysis.

Results Micro-level factors (ie, those observed at the familial level) were stronger predictors of spanking in comparison to macro-level factors (ie, those observed at the community and country level). Caregiver belief that children need physical punishment in order to be raised properly was the largest risk factor for spanking (OR=2.55, p<0.001). Older child age, the child being female, the head of the household having a secondary education or higher, and higher household wealth were protective factors against spanking, while a higher number of people living in the household was a risk factor for spanking. Living in an urban community was the only macro-level factor associated with spanking.

Conclusions Intervention at the micro-level and macro-level are important to reduce violence against children across the globe.

Jorge Cuartas. 7/21/2021. “Corporal punishment and early childhood development in 49 low- and middle-income countries.” Child Abuse & Neglect, 120. Publisher's VersionAbstract


To systematically assess the association between corporal punishment and young children's development in low- and middle-income countries (LMICs).


Data for 69 population-based surveys from the Multiple Indicators Cluster Survey (MICS) were combined. The sample included 131,164 children aged 36–59 months living in 49 LMICs. The surveys included information about children's developmental status and exposure to corporal punishment in the prior month. Logistic models, random-effects meta-analysis, and moderation analysis were used to obtain pooled estimates and assess the extent to which the association between corporal punishment and child developmental outcomes varied across countries.


On average, children exposed to corporal punishment were about 24% (β = 0.76, 95% CI 0.72–0.80) less likely to be developmentally on track than children who were not exposed to corporal punishment. Challenges in social-emotional development may drive the association between child development and corporal punishment. Corporal punishment was not associated with any positive developmental outcome in any country. There was minor heterogeneity in the estimated associations, which was not explained by the extent to which corporal punishment was normative within countries.


All forms of corporal punishment – including spanking – are likely to be harmful to young children's development and wellbeing. Public education, legal prohibition of corporal punishment, and other efforts are needed to protect children from corporal punishment and promote their wellbeing, health, and development.

Jorge Cuartas. 6/28/2021. “The effect of maternal education on parenting and early childhood development: An instrumental variables approach.” Journal of Family Psychology. Publisher's VersionAbstract
Maternal education is often considered an important determinant of children's early development. However, there is little empirical evidence on whether it is maternal education that contributes to better developmental outcomes or other ecological factors that relate to both education and children's development. This study used data on 4,874 mother-child (M age = 47.7 months) dyads from Uganda of the 2016 Demographic and Health Survey to assess the effects of maternal education on parenting and children's development. Taking advantage of a natural experiment with an instrumental variables approach, the study identified positive causal impacts of maternal schooling on children's development. Additional years of schooling also increased maternal engagement in stimulating activities, children's attendance to early childhood education programs, and reduced harsh corporal punishment. A mediation analysis suggested that increases in maternal stimulation and children's attendance to early childhood education programs and reductions in harsh corporal punishment partially explain the effects of maternal education on children's development. The positive impacts of education on parenting and child development indicate the need for more efforts to expand access to education in Uganda and other low- and- middle-income countries, including the abolishment of school fees for primary education. 
Jorge Cuartas, David Weissman, Margaret Sheridan, Liliana Lengua, and Katie McLaughlin. 4/9/2021. “Corporal punishment and elevated neural response to threat in children.” Child Development. Publisher's VersionAbstract
Spanking remains common around the world, despite evidence linking corporal punishment to detrimental child outcomes. This study tested whether children (Mage = 11.60) who were spanked (N = 40) exhibited altered neural function in response to stimuli that suggest the presence of an environmental threat compared to children who were not spanked (N = 107). Children who were spanked exhibited greater activation in multiple regions of the medial and lateral prefrontal cortex (PFC), including dorsal anterior cingulate cortex, dorsomedial PFC, bilateral frontal pole, and left middle frontal gyrus in response to fearful relative to neutral faces compared to children who were not spanked. These findings suggest that spanking may alter neural responses to environmental threats in a manner similar to more severe forms of maltreatment.
Marcus Waldman, Dana McCoy, Jonathan Seiden, Jorge Cuartas, and Günther Fink. 4/6/2021. “Validation of motor, cognitive, language, and socio-emotional subscales using the Caregiver Reported Early Development Instruments: An application of multidimensional item factor analysis.” International Journal of Behavioral Development. Publisher's VersionAbstract
The Caregiver Reported Early Development Instruments (CREDI) are assessments tools for measuring the development of children under age three in global contexts. The present study describes the construction and psychometric properties of the motor, cognitive, language, and socio-emotional subscales from the CREDI’s long form. Multidimensional item factor analysis was employed, allowing indicators of child development to simultaneously load onto multiple factors representing distinct developmental domains. A total of 14,113 caregiver reports representing 17 low-, middle-, and high-income countries were analyzed. Criterion-related validity of the constructed subscales was tested in a subset of participants using data from previously established instruments, anthropometric data, and a measure of child stimulation. We also report internal-consistency reliability and test–retest reliability statistics. Results from our analysis suggest that the CREDI subscales display adequate reliability for population-level measurement, as well as evidence of validity.
Jorge Cuartas and Dana McCoy. 1/6/2021. “Causal mediation in developmental science: a primer.” International Journal of Behavioral Development. Publisher's VersionAbstract
Mediation has played a critical role in developmental theory and research. Yet, developmentalists rarely discuss the methodological challenges of establishing causality in mediation analysis or potential strategies to improve the identification of causal mediation effects. In this article, we discuss the potential outcomes framework from statistics as a means for highlighting several fundamental challenges of establishing causality in mediation analysis, including the difficulty of meeting the key assumption of sequential ignorability, even in experimental studies. We argue that this framework—which, although commonplace in other fields, has not yet been taken up in developmental science—can inform solutions to these challenges. Based on the framework, we offer a series of recommendations for improving causal inference in mediation analysis, including an overview of best practices in both study design and analysis, as well as resources for conducting analysis. In doing so, our overall objective in this article is to support the use of rigorous methods for understanding questions of mechanism in developmental science.
Linda Richter, Jere Behrman, Pia Britto, Claudia Cappa, Caroline Cohrssen, Jorge Cuartas, Bernadette Daelmans, Amanda Dervecelli, Günther Fink, Sandra Fredman, Jody Heymann, Florencia Lopez Boo, Chunling Lu, Elizabeth Lule, Dana McCoy, Sara Naicker, Nirmala Rao, Abbie Raikes, Alan Sten, Claudia Vazquez, and Hirokazu Yoshikawa. 2021. “Measuring and forecasting progress in education: what about early childhood?” npj Science of Learning. Publisher's VersionAbstract
A recent Nature article modelled within-country inequalities in primary, secondary, and tertiary education and forecast progress towards Sustainable Development Goal (SDG) targets related to education (SDG 4). However, their paper entirely overlooks inequalities in achieving Target 4.2, which aims to achieve universal access to quality early childhood development, care and preschool education by 2030. This is an important omission because of the substantial brain, cognitive and socioemotional developments that occur in early life and because of increasing evidence of early-life learning’s large impacts on subsequent education and lifetime wellbeing. We provide an overview of this evidence and use new analyses to illustrate medium- and long-term implications of early learning, first by presenting associations between pre-primary programme participation and adolescent mathematics and science test scores in 73 countries and secondly, by estimating the costs of inaction (not making pre-primary programmes universal) in terms of forgone lifetime earnings in 134 countries. We find considerable losses, comparable to or greater than current governmental expenditures on all education (as percentages of GDP), particularly in low- and lower-middle-income countries. In addition to improving primary, secondary and tertiary schooling, we conclude that to attain SDG 4 and reduce inequalities in a post-COVID era, it is essential to prioritize quality early childhood care and education, including adopting policies that support families to promote early learning and their children’s education.
Jorge Cuartas, Dana McCoy, Andrew Grogan-Kaylor, and Elizabeth Gershoff. 9/8/2020. “Physical punishment as a predictor of early cognitive development: Evidence from econometric approaches.” Developmental Psychology. Publisher's VersionAbstract
This study estimates the effect of physical punishment on the cognitive development of 1,167 low-income Colombian children (Mage = 17.8 months old) using 3 analytic strategies: lagged-dependent variables, a difference-in-differences-like approach (DD), and a novel strategy combining matching with a DD-like approach. Across approaches, physical punishment at ages 9–26 months predicted reductions in children’s cognitive development of 0.08–0.21 SD at ages 27–46 months. These results, plus null results of falsification tests, strengthen the argument that physical punishment leads to slower cognitive growth and illustrate the utility of alternative statistical methods to reduce problems of selection bias in developmental research. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
Jorge Cuartas, Joshua Jeong, Catalina Rey-Guerra, Dana McCoy, and Hirokazu Yoshikawa. 7/10/2020. “Maternal, paternal, and other caregivers’ stimulation in low- and- middle-income countries.” Plos One, 16, 7, Pp. e0236107. Publisher's VersionAbstract

Background and objectives

Globally, studies have shown associations between maternal stimulation and early child development. Yet, little is known about the prevalence of paternal and other caregivers’ stimulation practices, particularly in low- and- middle-income countries (LMICs).


Data from the Multiple Indicators Cluster Survey (MICS) and the Demographic and Health Survey (DHS) were combined across 62 LMICs (2010–2018). The sample included 205,150 mothers of children aged 3 and 4 years. High levels of stimulation were defined as caregiver engagement in at least 4 out of 6 possible activities with the child. The proportion of mothers, fathers, and other caregivers providing high levels of stimulation was calculated by country, region, and for the whole sample. Socioeconomic disparities within and between countries were estimated.


On average, 39.8% (95% CI 37.4 to 42.2) of mothers, 11.9% (95% CI 10.1 to 13.8) of fathers, and 20.7% (95% CI 18.4 to 23.0) of other adult caregivers provided high levels of stimulation. Stimulation varied by region, country income group, and Human Development Index (HDI), with higher levels of maternal and paternal–but not other caregivers’–stimulation in high-income and high-HDI countries. Within countries, stimulation levels were, on average, lower in the poorest relative to the richest households, and some but not all countries exhibited differences by child sex (i.e., boys vs. girls) or area (i.e., urban vs. rural).


Results suggest a need for intervention efforts that focus on increasing caregiver stimulation in LMICs, particularly for fathers and in low-income contexts.

Jorge Cuartas. 5/29/2020. “Heightened risk of child maltreatment amid the COVID-19 pandemic can exacerbate mental health problems for the next generation.” Psychological Trauma: Theory, Research, Practice, and Policy. Publisher's VersionAbstract
The spread of the COVID-19 disrupted ecological systems in which children develop, exacerbating threats to their safety and increasing their vulnerability to future psychopathology. Supports to reduce sources of stress for caregivers and protect children from threats to their safety are warranted
Sandra García and Jorge Cuartas. 5/19/2020. “Can poverty alleviation programs crowd-in private support? Short- and Middle-Run Effects of a Conditional Cash Transfer Program on Inter-Household Transfers.” Journal of Social Policy. Publisher's Version
Jorge Cuartas, Catalina Rey-Guerra, Dana McCoy, and Emily Hanno. 4/27/2020. “Maternal knowledge, stimulation, and early childhood development in low‐income families in Colombia.” Infancy. Publisher's Version
Jorge Cuartas, Kaitlin P. Ward, Julie Ma, and Andrew Grogan-Kaylor. 4/22/2020. “Physical punishment and Colombian children and adolescents' cognitive and behavioral outcomes.” Journal of Applied Developmental Psychology, 68, Pp. 101140. Publisher's VersionAbstract
Research from U.S. samples has shown consistent associations between physical punishment and adverse child outcomes. Nonetheless, little is known about the effects of physical punishment in countries where its use is more accepted. The purpose of this study was to examine the association between physical punishment and children and adolescents' outcomes in Colombia using longitudinal data from a national sample (N = 5801). Matching techniques were used to improve balance in covariates between children and adolescents exposed and not exposed to physical punishment. Findings suggest that children and adolescents' exposure to physical punishment was linked to higher internalizing and externalizing problems, as well as lower prosocial behaviors and receptive vocabulary. These results highlight the importance of implementing legislation and interventions aimed at eliminating physical punishment in Colombia.
Jorge Cuartas. 3/12/2020. “Improving the Measurement of Children’s Mental Health Problems in Colombia with Item Response Theory.” Revista Colombiana de Psicología, 29, 1, Pp. 87-103. Publisher's Version cuartas_2020_-_revista_colombiana_de_psicologia.pdf
Chunling Lu, Jorge Cuartas, Günther Fink, Dana McCoy, Kai Liu, Zhihui Li, Bernadette Daelmans, and Linda Richter. 2/4/2020. “Inequalities in early childhood care and development in low/middle-income countries: 2010–2018.” BMJ Global Health, 5. Publisher's VersionAbstract

Background Inequalities in early childhood development (ECD) tend to persist into adulthood and amplify across the life course. To date, little research on inequalities in early childhood care and development in low/middle-income countries has been available to guide governments, donors and civil society in identifying which young children and families should be targeted by policies and programmes to improve nurturing care that could prevent them from being left behind.

Methods Using data from 135 Demographic and Health Surveys and Multiple Indicator Cluster Surveys between 2010 and 2018, we assessed levels and trends of inequalities in exposure to risks of stunting or extreme poverty (under age 5; levels in 85 and trends in 40 countries), early attendance of early care and education programmes (36–59 months; 65 and 17 countries), home stimulation (36–59 months; 62 and 14 countries) and child development according to the Early Childhood Development Index (36–59 months; 60 and 13 countries). Inequalities within countries were measured as the absolute gap in three domains—child gender, household wealth and residential area—and compared across regions and country income groups.

Results 63% of children were not exposed to stunting or extreme poverty; 39% of 3–4-year olds attended early care and education; and 69% received a level of reported home stimulation defined as adequate. Sub-Saharan Africa had the lowest proportion of children not exposed to stunting or extreme poverty (45%), attending early care and education (24%) and receiving adequate home stimulation (47%). Substantial gaps in all indicators were found across country income groups, residential areas and household wealth categories. There were no significant reductions in gaps over time for a subset of countries with available data in two survey rounds.

Conclusions Available data indicate large inequalities in early experiences and outcomes. Efforts of reducing these inequalities must focus on the poorest families and those living in rural areas in the poorest countries. Improving and applying population-level measurements on ECD in more countries over time are important for ensuring equal opportunities for young children globally.

Jorge Cuartas and Tama Leventhal. 1/8/2020. “Exposure to community violence and children's mental health: a quasi-experimental examination.” Social Science & Medicine. Publisher's VersionAbstract


Community violence and mental health problems are global health concerns. Yet, assessing the causal links between community violent crime and mental health is challenging due to problems of selection bias.


This study examines the link between community violent crime and children’s mental health problems, as well as the moderating role of parents’ mental health.


The study employs a representative sample of 404 children (Mage=8.99, range=7–11) from Bogotá, Colombia, as well as longitudinal geocoded data on violent crimes from the national police. To account for problems of selection bias, the empirical strategy exploits naturalistic exogenous variation in the timing and location of an incident of violent crime relative to assessment of children’s mental health problems, combined with matching techniques.


Findings suggest an incident of violent crime in close proximity to children’s homes is associated, on average, with increases in children’s mental health problems by 0.28-0.38 SD; having parents with worse mental health exacerbates children’s problems. Results from sensitivity checks and falsification tests further support the internal validity of the findings.


Collectively, the results from the present study and those of previous research suggest that community violent crime has the potential to affect local residents negatively beyond direct victims, placing a heavy burden on individuals and society.

Dana C. McCoy, Jorge Cuartas, Marcus Waldman, and Günther Fink. 11/18/2019. “Contextual variation in young children's acquisition of social-emotional skills.” PLOS One, 14, 11, Pp. e0223056. Publisher's VersionAbstract
This study examined variation in the timing of 5,447 infants’ and toddlers’ reported acquisition of 12 basic social-emotional skills across and within 11 developing and developed country sites. Although children differed significantly across sites in when they attained social-emotional skills on average (e.g., M age Brazil = 20.50 months vs. M age India = 26.92 months), there was also substantial heterogeneity across skills. For example, children in Pakistan were reported to demonstrate sympathy on average seven months earlier than their peers in Ghana, whereas the opposite was true for sharing. Overall, country-level health and education were strongly associated (r > .60) with earlier site-level skill attainment. In addition to heterogeneity across sites, we also observed notable within-site variability in skill development (ICCs = .03 to .38). Future research is needed to identify sources of variability and how to promote skills that matter within a given context.