Improve Long-Term Development of Children

Readers of this CLAHRC WM News Blog will know that we have an enduring interest in early childhood interventions to improve long-term psychosocial development. First, we have carried out an individually randomised trial of perinatal lay support for over 1,400 women at high social risk.[1] Second, we summarised two recent RCTs of infant support (published almost simultaneously in the BMJ [2] and the Lancet [3]) in a previous post. In that post we suggested that a systematic review of experimental evidence is urgently needed. Now we report a third fascinating study from Science to add to studies for review.[4] This was an RCT of 129 participants conducted back in 1986, of whom 105 were available for interview 20 years later. The participants were growth-stunted children aged 9 to 24 months. As in the trials reported in a previous post, they were randomized to four groups:

  1. Psychosocial intervention given weekly by community health workers to encourage mothers in active play.
  2. A nutritional intervention.
  3. Both.
  4. Neither.

There was no selective attrition and the samples were balanced with respect to prognostic factors at baseline. Although multiple outcomes were tested, the authors used a previously published step-down algorithm. The results show that those given the psychosocial intervention did better than controls in terms of completing school and subsequent earnings. In terms of earning capacity, they had caught up with the general population of non-stunted children.

— Richard Lilford, CLAHRC WM Director


  1. Kenyon S, Jolly K, Hemming K, et al. Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial. BMC Preg Child. 2012; 12: 11.
  2. Attanasio OP, Fernandez C, Fitzsimons EO, Grantham-McGregor SM, Meghir C, Rubio-Codina M. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trialBMJ. 2014; 349: g5785.
  3. Yousafzai AK, Rasheed MA, Rizvi A, Armstrong R, Bhutta ZA.Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trialLancet. 2014; 384: 1282-93.
  4. Gertler P, Heckman J, Pinto R, et al. Labor market returns to an early childhood stimulation intervention in Jamaica. Science. 2014; 344: 998-1001.

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