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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