A Multi-Component Early Intervention Program and Trajectories of Behavior, Cognition, and Health

• In Event: 1-104 - Disentangling the Impact of Home Visiting Programs on Children’s Behaviour, Cognition, and Health

Integrative Statement

Introduction. Early intervention programs supporting low socioeconomic status families are recognized as a viable strategy for preventing long-term social and health problems. In this study, we aimed to investigate the developmental impact of a prenatal to age five multi-component early intervention program targeting families living in low socioeconomic conditions. Efficacy of such programs is usually evaluated for the entire population (mean impact of the intervention on all participants) considered to and homogeneous group of individuals. However, by studying the differential impact of the intervention for children with different developmental profiles (i.e., population heterogeneity over time), it is possible to identify who benefits most from early interventions.
Hypothesis. We tested 3 competing hypotheses: 1) compensatory hypothesis, stating that children at the lower end of the skills distribution should gain the most from early intervention because they have the greatest potential for improvement; 2) skills-beget-skills hypothesis, stating that children at the higher end of the skills distribution should gain the most because skills are cumulative, and higher initial levels facilitate subsequent gains; 3) average treatment effect hypothesis, implying that all children benefit from the intervention regardless of their initial skills.
Study population. We used data from the Preparing for life (PFL) randomized trial, a multi-component early intervention program (from pregnancy to age 4/5) targeting families living in low socioeconomic communities of Dublin (Ireland) and aiming to promote children’s development. Pregnant women were randomized into a treatment (n=115, receiving home visiting, baby massage, and parenting program) or a control (n=118) group.
Methods. Children’s behavioral problems (externalizing and internalizing behaviors), cognitive skills (general skills and vocabulary), and health service use (number of health clinic visits), were regularly (3-6 times) assessed between six months and four years. Children’s developmental trajectories were modeled using latent class growth analyses to test whether certain subgroups (i.e., trajectories) of children benefited more than others from the treatment.
Results. Two developmental trajectories (high and low) were identified for each outcome (Figure 1). Treated children were more likely to follow the high-level trajectory for cognition (OR=2.89; 95%CI=1.55-5.50) and vocabulary skills (OR=2.02; 95%CI=1.08-3.82). There were no differences by treatment condition in the risk of belonging to a high externalizing or high health clinic visit trajectory (Figure 1). However, within the high externalizing trajectory, treated children had lower scores than controls (Hedges’ g=0.45, 0.58 and 0.52, p<0.05, at 2, 3, and 4 years respectively) and, within the high health clinic visit trajectory, only control children experienced an increasing number of visits (Table 1). Results suggest that the PFL program showed moderate positive impacts on trajectories of cognitive development (supporting the average treatment effect hypothesis), while positive impacts on externalizing behavior problems and number of health clinic visits were restricted to those with the most severe problems (supporting the compensatory hypothesis). These findings may help refine and enhance the efficacy of future iterations of the PFL program.

Authors

• Sylvana Côté, University of Montreal
  Presenting Author

• Massimiliano Orri, McGill University
  Non-Presenting Author

• Richard Ernest Tremblay, University of Montreal
  Non-Presenting Author

• Orla Doyle, University College Dublin
  Non-Presenting Author