http://www.rwjf.org/newsroom/newsreleasesdetail.jsp?id=10396

Study Reveals Prolonged Effectiveness of Early Intervention Program

Mar 6, 2006 - Boston, Mass.

Improvements in cognitive and behavioral development evident into 
adolescence

An 18-year follow-up study of the Infant Health and Development Program 
(IHDP), published in the March 2006 issue of Pediatrics, provides the best 
evidence to date of the sustained, positive effects of early educational 
intervention on children's long-term outcomes. This large, multi-site, 
randomized trial expands on earlier investigations-that were smaller and 
more limited in scope-to support the value of early intervention programs 
and the need to extend educational enrichment activities to a broader range 
of children. The IHDP intervention served lower- and higher-weight preterm 
infants, who tend to be at risk for serious health and developmental 
problems.

"These findings are very encouraging, and provide compelling and useful 
data for health care providers, policy makers, economists and parents with 
regard to the enduring benefits of early childhood interventions," said 
principal investigator Marie C. McCormick, M.D., Sc.D., professor of 
maternal and child health at Harvard School of Public Health. "The 
sustainability of effects reinforces the importance of such programs, and 
the need to make these services available and accessible to at-risk infants 
early on-before problems arise-to maximize their impact."

Adolescents in the intervention group were more likely to have higher 
achievement scores in math and reading and fewer risky behaviors (e.g., 
antisocial behavior, suicidal thoughts/attempts, smoking, alcohol or 
marijuana use) than the follow-up only group. The original 36-month 
intervention consisted of home visits every week for the first year of the 
child's life and every other week in the second and third year, along with 
daily center-based education beginning at 12 months (corrected for duration 
of gestation) and a support group for parents of participating children. 
The follow-up only group received frequent pediatric assessments and 
community services when needed during the intervention period. At age 18, 
636 of the original 985 participants took part (65 percent, or 72 percent 
of those who were eligible having not died or refused at prior 
assessments). Earlier assessments were at 3, 5 and 8 years of age.


"This is the largest study ever to evaluate the effects of early 
development intervention for preterm infants, who we know to be at risk for 
all kinds of academic and behavioral problems," explained Laura Leviton, 
Ph.D., senior program officer at the Robert Wood Johnson Foundation, which 
provided funding for this study. "Results indicate that high-quality early 
education services can greatly improve children's lives, giving them the 
best chance to achieve their full potential and become successful, healthy 
adults." While the present findings are strikingly parallel to those of 
earlier, smaller studies, the IHDP has important methodological strengths, 
which add credibility to the demonstrated long-term value of early 
educational interventions:

The program, which involves the largest number of preterm infants to date, 
was uniformly implemented and closely monitored at eight major birthing 
centers across the country.

This study was rigorously and carefully designed with strict randomization 
and masked assessments at major outcome points-previous studies 
predominantly involved healthy, low-income children often at a single site 
and with fewer participants overall.

The sample is heterogeneous with regard to health (especially 
neurodevelopmental status that might influence school outcomes) and 
socioeconomic status, which suggests that the results can be generalized. 
Positive long-term effects observed for the heavier low birth weight babies 
(2,001-2,499 g) in the intervention group are highly comparable to normal 
birth weight babies. Hence, the study findings should translate to a larger 
infant population.

This is one of the few studies to assess and establish intervention effects 
into adolescence.

A variety of assessment instruments were selected and used to ensure 
continuity with previous measurement periods. Data were adjusted for cohort 
attrition and participant and control groups were comparable. The eight 
study sites were selected based on the institution's capacity to provide 
services and primarily reflect centers with large birthing populations. 
Participating centers were located in Little Rock, Ark., Boston, Mass., 
South Bronx, N.Y., Philadelphia, Pa., Dallas, Texas, Miami, Fla., Seattle, 
Wash., and New Haven, Conn.

"This study is an important contribution to the field of child development, 
and bolsters an impressive body of literature demonstrating the 
effectiveness of early interventions, shown to enhance educational 
achievement and social outcomes," said Jim Heckman, Ph.D., Nobel Laureate 
and professor of economics at the University of Chicago. "Except for the 
lowest birth weight categories, there are lasting effects of the 
intervention on achievement and behavior."

Direction for Future Research The lack of observable benefits in the 
lighter low birth weight group (≤ 2,000 g) is of concern, and 
underscores the need for further research to identify educational, 
environmental or biological factors that may promote or impede sustained 
effects of early educational intervention. It is important to note, this 
group of high-risk babies did demonstrate positive effects at 3 years of 
age. The question of how to best support these high-risk infants, and 
extend the benefits of early education later into their lives, remains.

The age of assessment (18 years) may fall short in terms of being able to 
gauge important economic outcomes, such as higher educational attainment, 
occupational status and eventual income. The Abecedarian Project, which 
IHDP sought to replicate, reported sustained intervention advantages beyond 
21 years of age, including the proportion of participants enrolled in a 
four-year college or university.

The Robert Wood Johnson Foundation focuses on the pressing health and 
health care issues facing our country. As the nation's largest philanthropy 
devoted exclusively to improving the health and health care of all 
Americans, the Foundation works with a diverse group of organizations and 
individuals to identify solutions and achieve comprehensive, meaningful and 
timely change. For more than 30 years the Foundation has brought 
experience, commitment, and a rigorous, balanced approach to the problems 
that affect the health and health care of those it serves. When it comes to 
helping Americans lead healthier lives and get the care they need, the 
Foundation expects to make a difference in your lifetime.

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