Abstract
RationaleBrain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes. MethodsWe assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001–2004: at 3.5 years in 2006 and 9–12 years in 2012–2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9–12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9–12 y), for example, the residual of 3.5 y MDS predicting 9–12 y MDS (rMDS). ResultsThree early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: −0.07 [-0.12, −0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: −0.13 [-0.23, −0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome. ConclusionsOur findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development.
Highlights
Poverty contributes to an estimated 250 million children under five years of age worldwide not fulfilling their developmental potential (Black et al, 2017)
In a sample of 2305 children age 9–12 years in Indonesia, we found that concurrent measures of the home environment and maternal depressive symptoms were the strongest predictors of pre-adolescent cognitive and social-emotional outcomes
In this study, we focus on four measures for which con current associations were previously found with pre-adolescent out comes and for which early childhood measures were available: child height-for-age z-scores (HAZ) and haemoglobin concentration (Hb), maternal depressive symptoms (MDS), and the Home Observation for the Measurement of the Environment (HOME) Inventory, a measure of responsive care and learning opportunities in the home environment
Summary
Poverty contributes to an estimated 250 million children under five years of age worldwide not fulfilling their developmental potential (Black et al, 2017). Effects of many early interventions fade out over time (Bailey et al, 2017) and intervention during later childhood may be needed to maintain early gains and reverse early deficits (Bundy et al, 2018). An essential package of interventions for children age 5–14 has been proposed, which focuses on prevention of biomedical risk factors. Timing refers to when during development children are exposed to risks, while chronicity refers to whether the exposure is transient or long in duration. Such understanding is important for planning and targeting in terventions, including understanding both biomedical and socio-environmental risk factors
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