Early developmental intervention in lower resource countries may improve cognitive development

1. Children from low-resource families whose parents were taught cognitively stimulating activities had better cognitive function at 36 months compared to those whose parents were not.

2. No difference in cognitive function was observed in children of higher resource households whose parents received training compared to controls.

Evidence Rating Level: 2 (Good)

Study Rundown: Socioeconomic status is one of many factors that influence child development and cognitive function. Babies born into lower resource households have been shown to perform worse on cognitive function assessments (e.g., intelligence and language ability) compared to their more well-off peers. Such trends have been observed in low-, middle-, and high-resource countries; however, encouragingly, data suggest that early developmental interventions (EDIs) may be helpful for disadvantaged children. Prior to this study, it was not known whether such improvement was on par with that of more advantaged children or, if despite intervention, a cognitive performance gap remained. To answer this question, a longitudinal analysis of children from lower resource countries was performed and cognitive assessment was conducted at 12, 24, and 36 months of age. Children from lower resource families whose parents received interactive learning instruction showed greater cognitive improvement than those whose parents simply received advice on managing their child’s health. Furthermore, although starting from a lower baseline assessment at 12 months, the EDI group performed similarly to both control and EDI-receiving children from higher resource households at 36 months of age. No added benefit of EDI was observed for the more advantaged children. Despite the questionable generalizability of these findings to countries with broader inequality gaps, these results suggest that an educationally stimulating environment is critical for child development. Therefore, any educational materials or encouragement that clinicians are able to provide to pregnant women and new mothers would likely be beneficial.

Click to read the study, published today in Pediatrics

Relevant Reading: Socioeconomic status and the developing brain

Study Author, Carla M. Bann, PhD, talks to 2 Minute Medicine: Statistics and Psychometrics Fellow, RTI International, Research Triangle Park, North Carolina.

“Our research demonstrates that providing parents of low-resource families with training on activities for interacting with and engaging their children can help these children catch up with their higher resource peers. Clinicians can play an important role in reducing disparities by providing parents in need with referrals to home-based programs and tools and information to help them foster their child’s development.”

In-Depth [randomized controlled trial]: Participants included 293 of 407 infants (72%) from India, Pakistan, or Zambia whose families consented to enrollment in the Brain Research to Ameliorate Impaired Neurodevelopment Home-based Intervention Trial (BRAIN-HIT). Socioeconomic status was assessed using a Family Resources Index (score range 0 to 20), and participants were classified as having relatively low or high resources based on their score (median = 8; low: <8, high: ≥8). Beginning before age 1 month and continuing to 36 months of age, a trainer came to each child’s home biweekly and provided the parents with health education, including nutritional information and proper hygiene instruction. For the EDI group, the trainers also taught the parents cognitively stimulating activities to integrate into their daily lives. The impact of the EDI was assessed at 12, 24, and 36 months of corrected age using the Bayley Scales of Infant Development—Second Edition (BSID-II) Mental Development Index (MDI) score. Controlling for factors including study site, birth weight, and maternal education, infants from the relatively high-resource families had significantly greater MDI scores over time regardless of intervention (EDI: p < 0.001, control: p = 0.002). Additionally, MDI scores at 36 months were not significantly different (adjusted means: EDI = 102.5, control = 101.5; p = 0.602). In contrast, the EDI group of the lower resource children significantly outperformed the lower resource control group at 36 months (adjusted means: EDI = 101.2, control = 94.1; p < 0.001). The mean MDI score at 36 months of the lower resource infants receiving the EDI was not significantly different from those of the higher resource infant groups.

Image: PD

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