Early Intervention Demonstrates Long-term Effects on Cognitive Ability at age 18 Years

• In Event: Persisting Effects of Foster Care as an Alternative to Institutional Care for Institutionalized Young Children

Abstract

Background
Despite the promise of early interventions, most often large effects of interventions on relevant cognitive and academic outcomes fade out after a few years. Suggestions to improve the persistence of early intervention effects include targeting a “sustaining environment” (Bailey et al., 2017). Placing children from psychosocially deprived environments into families, as was the design of the Bucharest Early Intervention Project (Zeanah et al., 2003), is a clear example of an intervention that involved sustained changes in the child’s environment: foster families were asked to psychologically commit to children for the long-term and provided regular consultation from mental health providers for caregiving support. In this study we investigated whether a foster care intervention as an alternative to institutional care, with placement at a mean age of 22 months, resulted to persistent effects on cognitive ability at age 18 years.

Method
The participants in this investigation were part of a follow-up of the BEIP study (mean age of assessment=18.73 years; SD=0.65). Of the original 136 children, 42 from the care as usual group (CAUG) and 48 from the foster care group (FCG) were included in this follow-up. In addition, 40 community comparison children were included to represent a never institutionalized group (NIG). Given the expected lower IQ scores in this sample given severe psychosocial deprivation, the Weschler Intelligence Scale for Children (WISC-IV) was used to obtain estimates of cognitive ability at this age. At ages 30 and 42 months, members of the study team masked to condition observed recordings of each child and rated caregiving quality. Non-parametric tests were used given non-normality in IQ distributions. Gaussian generalized additive models were used to test mediation,

Results
Results of a Mann-Whitney test indicated that ever institutionalized participants had significantly lower IQ scores at age 18 years than did NIG participants and that this effect was large (W=537.50, p<.001, rg[95% CI]=-.70[-.83, -.55]). In addition, small but significant effect of randomization to foster care as an alternative to institutional care on cognitive ability. FCG participants had significantly higher IQ scores at age 18 years than did CAUG participants (W=764.50, p=.049, rg[95% CI]=.24[.01, .49]). We explored whether observed caregiving in in toddlerhood mediated the association between intent-to-treat group and later IQ, and found evidence of a significant mediation with observed caregiving explaining 47% of the variance in the association between these variables.

Conclusion
Unlike most long-term assessments of the effectiveness of early intervention on cognitive ability, we provide evidence of persistent effects to age 18 years from an intervention that began at a mean age of 22 months. Children with a history of institutional care were not, on average, obtaining IQ scores at the same level of never institutionalized individuals. However, early placement into family care, and thereby improving exposure to higher quality caregiving in early life, facilitated higher cognitive ability in emerging adulthood.

Authors

• Kathryn Humphreys, Vanderbilt University
  Presenting Author

• Lucy Sobey King, Stanford University
  Non-Presenting Author

• Katherine Leigh Guyon-Harris, University of Pittsburgh
  Non-Presenting Author

• Margaret A. Sheridan, University of North Carolina at Chapel Hill
  Non-Presenting Author

• Katie McLaughlin, Harvard University
  Non-Presenting Author

• Charles A. Nelson, Harvard Medical School
  Non-Presenting Author

• Nathan A Fox, University of Maryland - College Park
  Non-Presenting Author

• Charles H Zeanah, Tulane University
  Non-Presenting Author