Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica.
Department of Economics, The University of California at Los Angeles, Los Angeles, CA, USA.
J Child Psychol Psychiatry. 2022 Jun;63(6):626-635. doi: 10.1111/jcpp.13499. Epub 2021 Aug 17.
There is little evidence on adult benefits from early childhood interventions in low and middle-income countries. We assessed adult cognition, psychosocial skills and behaviour from a stimulation trial conducted in Jamaica.
Children with stunted growth (height-for age <-2SD of references) aged 9-24 months were enrolled in a two-year randomised-controlled trial of nutritional supplementation and/or stimulation. At mean age 31.79 (SD 0.40) years, 95 of 127 participants (74.8%; 53.7% male) were assessed. Children without stunted growth were also followed as a comparison group (64 of 84 participants, 76.2%). Measurements included IQ, executive function, mental health, psychosocial skills, personality traits and risk behaviours. A block permutation test, valid for small sample sizes, was used. Analyses accounted for the randomisation protocol, multiple hypothesis testing and attrition.
Treatment group participants (stimulation intervention with or without supplementation, n = 48) had significantly greater IQ (Hedges g effect size 0. 57; 95%CI 0.20, 0.95) and cognitive flexibility (0.61; 0.25, 0.98) compared with no-treatment (no-intervention and supplementation only, n = 47). They also had reduced depressive symptoms (0.61; 0.28, 1.00), increased grit (0.53; 0.16, 0.92) and conscientiousness (0.66; 0.31, 1.07), lower substance use (rank mean score, 0.45; 0.08, 0.81) and risk taking related to health and work (0.64; 0.27, 1.00). There were 18 significant outcomes of 33 assessed. Comparison participants had higher IQ than no-treatment (1.17; 0.81, 1.54) and treatment groups (0.62; 0.18, 1.07); and better executive function, lower social inhibition and risk taking than the no-treatment group.
The wide-ranging benefits at 31 years from the stimulation intervention supports investment in larger scale programmes to promote early childhood development in disadvantaged children. The lower IQ in the treatment group compared with comparison participants, emphasises the need for continued efforts to prevent early childhood growth retardation.
在中低收入国家，关于儿童早期干预对成年人益处的证据很少。我们评估了在牙买加进行的一项刺激试验中成年人的认知、社会心理技能和行为。
9-24 个月大身高发育迟缓（身高-年龄 <-2SD 参考值）的儿童参加了一项为期两年的营养补充和/或刺激随机对照试验。在平均年龄 31.79 岁（SD 0.40）时，对 127 名参与者中的 95 名（74.8%；53.7%为男性）进行了评估。没有发育迟缓的儿童也作为对照组进行了随访（84 名参与者中的 64 名，76.2%）。测量包括智商、执行功能、心理健康、社会心理技能、人格特质和风险行为。使用了一种适合小样本量的块排列检验。分析考虑了随机分组方案、多假设检验和失访。
治疗组参与者（接受刺激干预加或不加补充剂，n=48）的智商（Hedges g 效应量 0.57；95%CI 0.20，0.95）和认知灵活性（0.61；0.25，0.98）显著高于未治疗组（未干预且仅接受补充剂，n=47）。他们还表现出抑郁症状减少（0.61；0.28，1.00）、坚毅增加（0.53；0.16，0.92）和尽责性提高（0.66；0.31，1.07），物质使用减少（排名平均分数，0.45；0.08，0.81）和与健康和工作相关的风险承担减少（0.64；0.27，1.00）。33 项评估中有 18 项有显著结果。对照组参与者的智商高于未治疗组（1.17；0.81，1.54）和治疗组（0.62；0.18，1.07）；并且他们的执行功能更好，社会抑制和风险承担更少，比未治疗组。
31 岁时从刺激干预中获得的广泛益处支持投资更大规模的方案，以促进弱势儿童的儿童早期发展。与对照组参与者相比，治疗组的智商较低，这强调了需要继续努力防止儿童早期生长迟缓。
