Indigenous children: opportunities for early childhood development through book-sharing

Indigenous people comprise approximately 6% of the world’s population (486 million people) and represent “distinct social and cultural groups that share collective ancestral ties to the lands and natural resources where they live, occupy, or from which they have been displaced.”¹ Many children in Indigenous families are raised speaking Indigenous languages, often with limited exposure to dominant languages. Although children benefit from being brought up learning their ancestral culture and languages, Indigenous children experience inequities related to poverty, opportunities, and discrimination that might hinder their early development.² In this issue of The Lancet Global Health, Ann C Miller and colleagues³ have shown that Indigenous children aged 3–4 years who are from households that speak a minority or Indigenous language are less likely to be on-track developmentally, compared with children from dominant language-speaking households. These differences, based on results on the Early Child Developmental Index (ECDI), were pronounced in the literacy–numeracy and socioemotional domains.

The ECDI is a population-based measure of development among children aged 3–4 years that has been used in the UNICEF Multiple Index Cluster Surveys. Although the ECDI has made major contributions to the understanding of early childhood development globally, concerns have been raised regarding potential mismeasurement, and it has recently been replaced by the ECDI2030. Specifically, on the original ECDI, the three-item literacy–numeracy domain might overestimate developmental risk by targeting specific pre-literacy and pre-numeracy skills (ie, identify or name at least ten letters, read at least four words, and name and recognise all numbers from 1 to 10). These items are more advanced than items in other assessments for children aged 3–4 years. Based on a large sample of children, Miller and colleagues estimated on track development in the literacy–numeracy domain in 31·6% (95% CI 30·6–32·7) children from dominant language-speaking households, and 18·8% (17·4–20·2) for those from minority or Indigenous language-speaking households.³ In the learning domain, proportions on track were greater than 91% for both groups, illustrating that the Indigenous children were learning, although literacy-numeracy skills were low. A large study in Australia found that preschool participation compared with home care led to benefits on school readiness among Indigenous children at age 5 years.⁴ At preschool entry, 36% of the Indigenous children were developmentally vulnerable on the Australian Early Development Census compared with 20% of the non-Indigenous children. Benefits of preschool participation were greater for non-Indigenous than Indigenous children, highlighting the importance of very early learning opportunities for Indigenous children.

Children’s acquisition of language and other developmental skills occurs rapidly in the first 3 years of life, consistent with rapid brain development. The human brain is highly sensitive during this period, making it an ideal time to ensure that children have early learning opportunities. Childhood development is driven by exposure to language and learning in the context of nurturant social interactions.⁵ Early skills are expanded into more sophisticated skills as children have increasingly complex interactions and opportunities. Being off track developmentally during the preschool years can hinder the learning process, such that children are not well prepared for primary school, and at risk of falling behind and entering adulthood with limited confidence and preparation for productivity.

The recognition that early childhood development programmes during the first few years of life can overcome the negative consequences of poverty and other adversities on children’s development has led to a global emphasis on early childhood development and equity. These efforts have reached Indigenous children and others who are often left behind.⁶ Recent evidence from low-income and middle-income countries has shown that not only do early childhood development programmes advance children’s development, but they can be integrated with existing programmes in clinics and community sites and delivered through home visits, remote contacts, and group sessions.⁷ Evidence-based programmes, such as Reach Up,⁸ have been effective in crisis and conflict settings, particularly when they focus on cultural adaptation, flexible delivery methods, and training and support for frontline workers.

Interactive book sharing, in which caregivers use picture books to engage children in conversations, has been shown to effectively promote language development globally.⁹ Interactive book sharing is based on the Vygotskian principal of scaffolding, whereby the caregiver follows the child’s cues and interests by increasing the complexity of the conversation.⁹ Caregivers are coached to ask open-ended questions, to praise children for their comments, and to extend the conversation beyond the pictures by linking to concepts in the child’s environment, including novel and abstract concepts. The conversational turn-taking in interactive book sharing has an effect on children’s neural pathways, influencing language and learning.¹⁰ Books can be locally produced by laminating familiar pictures, or by taking photos of familiar activities and turning into a book. Picture books without printed words facilitate conversations that link the child with the pictures.

Another approach is precision child development interventions that consider Indigenous families’ unique needs and traditions. One such intervention is Precision Family Spirit, which has shown promising findings related to feasibility and acceptance with Native American families. Adapting evidence-based interventions to be consistent with Indigenous families’ needs and traditions is a crucial step in supporting Indigenous children’s early development.

Early childhood development programmes that incorporate interactive book sharing and other innovative activities that focus on language and learning for Indigenous children could transform children’s lives. Children who have a strong start in life have an increased likelihood of succeeding academically and contributing to society. In keeping with the UN Declaration on the Rights of Indigenous Peoples in 2007, and supported by global mechanisms, such as the UN Permanent Forum on Indigenous Issues,¹ local and national programmes are needed to ensure that Indigenous children receive Indigenous-sensitive opportunities throughout childhood to develop to their full potential.