Lifecycle: maturing CRAN status

The D-score is a numerical score that measures generic development in children. Use the D-score to analyze and predict early development of children similar to measures like height and weight.

The dscore package contains tools to

The required input consists of item level responses on milestones from widely used instruments for measuring child development.


You can install the development version from GitHub with:



You may estimate the D-score and the Development-for-Age Z-score (DAZ) from child data on developmental milestones. Four steps are needed:

  1. Identify whether the dscore package covers your measurement instrument;
  2. Map your variable names to the GSED 9-position schema;
  3. Calculate D-score and DAZ;
  4. Summarise your results.

The dscore package provides various function that support these steps. See Getting started for more details.


Books and reports

  1. D-score: Turning milestones into measurement
  2. Inventory of 147 instruments for measuring early child development: Fernald et al. (2017)


  1. Project with dutch key, 0-2 years: van Buuren (2014)
  2. Project with gcdg key: Weber et al. (2019)
  3. Project with gsed keys: World Health Organization (WHO) (2023)


  1. Interval scale: Jacobusse, van Buuren, and Verkerk (2006)
  2. Adaptive testing: Jacobusse and van Buuren (2007)

Shiny app

If you want to calculate the D-score on your own data, and you’re not an R user, you might wish to check out our interactive Shiny dcalculator app.


The authors wish to recognize the principal investigators and their study team members for their generous contribution of the data that made this tool possible and the members of the Ki team who directly or indirectly contributed to the study: Amina Abubakar, Claudia R. Lindgren Alves, Orazio Attanasio, Maureen M. Black, Maria Caridad Araujo, Susan M. Chang-Lopez, Gary L. Darmstadt, Bernice M. Doove, Wafaie Fawzi, Lia C.H. Fernald, Günther Fink, Emanuela Galasso, Melissa Gladstone, Sally M. Grantham-McGregor, Cristina Gutierrez de Pineres, Pamela Jervis, Jena Derakhshani Hamadani, Charlotte Hanlon, Simone M. Karam, Gillian Lancaster, Betzy Lozoff, Gareth McCray, Jeffrey R Measelle, Girmay Medhin, Ana M. B. Menezes, Lauren Pisani, Helen Pitchik, Muneera Rasheed, Lisy Ratsifandrihamanana, Sarah Reynolds, Linda Richter, Marta Rubio-Codina, Norbert Schady, Limbika Sengani, Chris Sudfeld, Marcus Waldman, Susan P. Walker, Ann M. Weber and Aisha K. Yousafzai.

This study was supported by the Bill & Melinda Gates Foundation. The contents are the sole responsibility of the authors and may not necessarily represent the official views of the Bill & Melinda Gates Foundation or other agencies that may have supported the primary data studies used in the present study.


Fernald, L. C. H., E. Prado, P. Kariger, and A. Raikes. 2017. “A Toolkit for Measuring Early Childhood Development in Low and Middle-Income Countries.” https://documents.worldbank.org/en/publication/documents-reports/documentdetail/384681513101293811/a-toolkit-for-measuring-early-childhood-development-in-low-and-middle-income-countries.
Jacobusse, G., and S. van Buuren. 2007. “Computerized Adaptive Testing for Measuring Development of Young Children.” Statistics in Medicine 26 (13): 2629–38. https://stefvanbuuren.name/publication/jacobusse-2007/.
Jacobusse, G., S. van Buuren, and P. H. Verkerk. 2006. “An Interval Scale for Development of Children Aged 0-2 Years.” Statistics in Medicine 25 (13): 2272–83. https://stefvanbuuren.name/publication/jacobusse-2006/.
van Buuren, S. 2014. “Growth Charts of Human Development.” Statistical Methods in Medical Research 23 (4): 346–68. https://stefvanbuuren.name/publication/van-buuren-2014-gc/.
Weber, A. M., M. Rubio-Codina, S. P. Walker, S. van Buuren, I. Eekhout, S. Grantham-McGregor, M. C. Araujo, et al. 2019. “The D-Score: A Metric for Interpreting the Early Development of Infants and Toddlers Across Global Settings.” BMJ Global Health 4: e001724. https://gh.bmj.com/content/bmjgh/4/6/e001724.full.pdf.
World Health Organization (WHO). 2023. “Global Scales for Early Development (GSED) V1.0: Technical Report.” Geneva: World Health Organization.