Children's Developmental Potential Research Articles

High doses of a national preschool program are associated with the long-term mitigation of adverse outcomes in cognitive development and life satisfaction among children who experience early stunting: a multi-site longitudinal study in Vietnam.

Stunting (low height-for-age) is a marker of cumulative developmental disadvantage that can also contribute to impaired cognitive development and poor psychological wellbeing. Several interventions designed to preserve stunted children's developmental potential through increasing their cognitive stimulation have proven to be effective. However, their resource-intensive nature limits their sustainability and scalability in the low-and middle-income countries in which 98% of stunted children live. The current study had three aims: to identify the domains of developmental disadvantage associated with stunting at 5 years of age in the Vietnamese context; to examine the relationship between Vietnamese children's stunting status at 5 years of age, the dose of the national preschool program they received, and their cognitive skills and psychological well-being at 4 ages; and to determine whether some doses of the national preschool program were associated with the mitigation of adverse cognitive and wellbeing outcomes among stunted children. The Young Lives Study in Vietnam (n = 2,000; 31 sites) provided archival data that allowed calculation of the approximate dose (in hours) of the preschool program received by children, and longitudinal data on children's growth (1, 5, 8, 12, and 15 years), receptive vocabulary (5, 8, 12 and 15 years), reading skills, mathematics skills and life satisfaction (each at 8, 12, and 15 years). Stunting at 5 years of age was associated with diverse aspects of financial and social disadvantage, greater exposure to health risks, lower preventive health care, and constraints on maternal care. Scores for all cognitive variables at all ages were positively associated with preschool dose and negatively associated with stunted growth at 5 years of age. That is, effects associated with stunting and preschool dose at 5 years of age continued to be found during the subsequent 10 years. High doses of preschool education (3,000 h or more) were associated with the mitigation of adverse outcomes for most cognitive variables at most ages. The current findings raise the possibility that generic preschool programs delivered at high dose may provide a scalable and sustainable intervention to support the life opportunities of children who experience early stunting.

Developing Culturally Appropriate Content for a Child-Rearing App to Support Young Children's Socioemotional and Cognitive Development in Afghanistan: Co-Design Study.

Optimal child-rearing practices can help mitigate the consequences of detrimental social determinants of health in early childhood. Given the ubiquity of personal digital technologies worldwide, the direct delivery of evidence-based information about early childhood development holds great promise. However, to make the content of these novel systems effective, it is crucial to incorporate place-based cultural beliefs, traditions, circumstances, and value systems of end users. This paper describes the iterative approach used to develop the Thrive by Five child-rearing app in collaboration with Afghan parents, caregivers (eg, grandparents, aunts, and nannies), and subject matter experts (SMEs). We outline how co-design methodologies informed the development and cultural contextualization of content to meet the specific needs of Afghan parents and the content was tested and refined in collaboration with key Afghan stakeholders. The preliminary content was developed based on a comprehensive literature review of the historical and sociocultural contexts in Afghanistan, including factors that influence child-rearing practices and early childhood development. After an initial review and refinement based on feedback from SMEs, this content was populated into a beta app for testing. Overall, 8 co-design workshops were conducted in July and August 2021 and February 2022 with 39 Afghan parents and caregivers and 6 SMEs to collect their feedback on the app and its content. The workshops were audio recorded and transcribed; detailed field notes were taken by 2 scribes. A theoretical thematic analysis using semantic codes was conducted to inform the refinement of existing content and development of new content to fulfill the needs identified by participants. The following 4 primary themes were identified: child-rearing in the Afghan sociocultural context, safety concerns, emotion and behavior management, and physical health and nutrition. Overall, participants agreed that the app had the potential to deliver valuable information to Afghan parents; however, owing to the volatility in the country, participants recommended including more activities that could be safely done indoors, as mothers and children are required to spend most of their time at home. Additionally, restrictions on public engagement in music required the removal of activities referencing singing that might be performed outside the home. Further, activities to help parents reduce their children's screen time, promote empathy, manage emotions, regulate behavior, and improve physical health and nutrition were requested. Direct engagement with Afghan parents, caregivers, and SMEs through co-design workshops enabled the development and refinement of evidence-based, localized, and contextually relevant child-rearing activities promoting healthy social, emotional, and cognitive development during the first 5 years of children's lives. Importantly, the content was adapted for the ongoing conflict in Afghanistan with the aim of empowering Afghan parents and caregivers to support their children's developmental potential despite the security concerns and situational stressors.

Shared reading: Parental attitudes, practices and barriers in Turkey.

Understanding the nature of parent-child shared reading (SR) practices is important to reach children's developmental potential and subsequent achievement. We evaluated the parental attitudes and practices, associated variables and barriers related to SR. This prospective study enrolled 624 parents of children aged 1-72 months who presented to a tertiary hospital for well-child care or acute minor illness. Face-to-face interviews were conducted using a questionnaire. The median age for starting SR was 12 (0-72) months. Daily SR activities were provided by 29.5% of the parents. Owning >10 children's books, higher socioeconomic status, attending pre-school/kindergarten and being a single child were associated with daily reading (P< 0.001). In total, 36.5% of the parents reported that they had not yet started SR and planned to start SR when their children reached a median age of 20.5 (2-72) months. The most commonly reported barriers were time constraints and the perception that their child was too young. Almost 10% of the parents had received an SR recommendation. Parents who had received a recommendation and those who had a habit of self-reading multiple times a week were more likely to begin SR at younger child age and to read daily (P< 0.001). This study demonstrated low rates of parent-child SR activities in early childhood, particularly in the first years of life, in Turkey. Our findings emphasise the need for a national strategy integrated into the healthcare system to promote SR.

Qualitative evaluation of a scalable early childhood parenting programme in rural Colombia.

Integrating early childhood parenting programmes into existing government services is a key strategy for reducing the loss of children's developmental potential in low- and middle-income countries. There is limited evidence of participants' perceptions of these programmes, especially when implemented at scale. We integrated an intervention into an existing government programme targeting pregnant women and mothers of children up to 2 years of age and their families in rural Colombia. As part of a cluster randomized trial, 171 government workers (facilitators) implemented the intervention. The intervention included four components: (1) structured curricula, (2) play materials, (3) nutrition and (4) training and supervision. In this qualitative evaluation of the programme, we conducted semi-structured interviews with beneficiary mothers (n = 62), facilitators (n = 40) and supervisors (n = 8). Topic guides were developed to collect information on participants' perspectives of the acceptability, feasibility and effectiveness of the intervention and the enablers and barriers to implementation. All interviews were audiotaped and transcribed, and data were analysed using the framework approach. Participants' responses indicated that the intervention was acceptable, feasible and effective. Key enablers to implementation were (1) the use of evidence-based behaviour change techniques leading to interactive, fun and participatory sessions; (2) structured curricula with easy to use, simple activities and materials; (3) the focus on positive, supportive relationships; and (4) the perceived benefits of the programme to the beneficiary mothers, children and families, facilitators and programme supervisors. The main barriers were (1) facilitators took time to become comfortable and competent in using the new participatory methodology and (2) the logistics related to making and distributing the play materials. Providing structured curricula and play materials with training and ongoing supervision to enhance an existing programme targeting mothers, families and children was reported as acceptable, feasible and effective by beneficiary mothers and programme staff.

Measuring "Language Access Profiles" in Deaf and Hard-of-Hearing Children With the DHH Language Exposure Assessment Tool.

Purpose The purposes of this study were (a) to introduce "language access profiles" as a viable alternative construct to "communication mode" for describing experience with language input during early childhood for deaf and hard-of-hearing (DHH) children; (b) to describe the development of a new tool for measuring DHH children's language access profiles during infancy and toddlerhood; and (c) to evaluate the novelty, reliability, and validity of this tool. Method We adapted an existing retrospective parent report measure of early language experience (the Language Exposure Assessment Tool) to make it suitable for use with DHH populations. We administered the adapted instrument (DHH Language Exposure Assessment Tool [D-LEAT]) to the caregivers of 105 DHH children aged 12 years and younger. To measure convergent validity, we also administered another novel instrument: the Language Access Profile Tool. To measure test-retest reliability, half of the participants were interviewed again after 1 month. We identified groups of children with similar language access profiles by using hierarchical cluster analysis. Results The D-LEAT revealed DHH children's diverse experiences with access to language during infancy and toddlerhood. Cluster analysis groupings were markedly different from those derived from more traditional grouping rules (e.g., communication modes). Test-retest reliability was good, especially for the same-interviewer condition. Content, convergent, and face validity were strong. Conclusions To optimize DHH children's developmental potential, stakeholders who work at the individual and population levels would benefit from replacing communication mode with language access profiles. The D-LEAT is the first tool that aims to measure this novel construct. Despite limitations that future work aims to address, the present results demonstrate that the D-LEAT represents progress over the status quo.

Optimising Children's Readiness to Learn through Mediating Social Disadvantage: Exploring Models of Best Practice

THIS ARTICLE DISCUSSES THE importance of early support for families in increasing their children's readiness to learn and optimising their developmental outcomes. It reports the findings of the evaluation of the It Takes a Village: Multicultural Early Learning Program, a research project undertaken in 2009–2011 by a research team from Edith Cowan University, Western Australia. The unique model and characteristics of the program are discussed in the context of its role in facilitating children's developmental potential, through the mediation of social disadvantage of the new migrant and humanitarian entrant families in the south-east corridor of Perth's metropolitan area.

Integrated play groups: promoting symbolic play and social engagement with typical peers in children with ASD across settings.

Children with autism spectrum disorders (ASD) face pervasive challenges in symbolic and social play development. The Integrated Play Groups (IPG) model provides intensive guidance for children with ASD to participate with typical peers in mutually engaging experiences in natural settings. This study examined the effects of a 12-week IPG intervention on the symbolic and social play of 48 children with ASD using a repeated measures design. The findings revealed significant gains in symbolic and social play that generalized to unsupported play with unfamiliar peers. Consistent with prior studies, the outcomes provide robust and compelling evidence that further validate the efficacy of the IPG model. Theoretical and practical implications for maximizing children's developmental potential and social inclusion in play are discussed.

Looking into Early Childhood Education and Development Spaces: Visual Ethnography's Contribution to Thinking about Quality

Discussions about what constitutes a quality early childhood (EC) environment rarely focus on visual or spatial aspects, except to provide background information for talking about EC practice and children's development in the preschool years. There is a need to look beyond the usual quality indicators, which tend to focus on poverty and children's developmental potential so that context and cultural dimensions are often omitted in the discussion. This article thus explores the contribution of visual ethnography for thinking more about, or rethinking, some of the prevailing notions of quality in early childhood education (ECE). To do so, culture is seen as central to the discussion. This includes the organisation of space and the use of materials in EC settings. The idea in this article is to present images that stand in contrast to some of the current globalising discourse about what is good for the world's children. In so doing, the authors thread together seemingly disparate ideas stemming from the centrality of culture and space theory, to the organisation of space, to the use of materials and to transitions in ECE.

Developmental Impacts of Heavy Metals and Undernutrition

A recent Lancet series highlighted enormous loss to young children's developmental potential in developing countries, from exposure to sociocultural and health risks. The possibility that nutritional deficiencies might exacerbate the adverse impact of environmental exposures to developmental toxicants such as heavy metals and pesticides has not been explored. While both arsenic and manganese exposures have known neurotoxicity in adults, systematic investigation in young children has only recently begun. Five hundred and ninety 6- and 10-year-old Bangladeshi children participated in three overlapping studies. Well-water arsenic and manganese were measured from home wells; urine and blood samples were provided; and sociodemographic and household characteristics obtained. For new analyses, 'stunting' was defined as 2 or more standard deviations below the Centers for Disease Control and Prevention gender-specific height-for-age norms. Developmental assessments employed culturally adapted variants of the WISC-III (age 10) or WPPSI-III (age 6). In prior analyses, after adjusting for social factors, well-water arsenic and manganese were both significantly associated with poorer developmental scores at age 10; associations for water arsenic at 6 years were significant, but attenuated. Negative associations with metal exposures held up in newer analyses, and stunting was significantly associated with lower intellectual functioning in analyses considering either metal. There were no significant stunting-by-metal interactions. Developmental risks often co-occur. Millions in South Asia are exposed to naturally occurring arsenic and manganese through household wells. Stunting affects more than 25% of young children in developing countries. The combined neurocognitive loss from both risks, although rarely jointly studied, represents a substantial loss of global potential.

2003 C. Anderson Aldrich award lecture: enhancing developmental services in child health supervision--an idea whose time has truly arrived.

In 1938, in his famous Babies Are Human Beings , C. Anderson Aldrich was cautious in describing the feasibility of enhancing children's developmental potential: “Every human being, as he grows into childhood, must inevitably be hampered and opposed by the restrictions of his environment, and the best we can hope for is to modify somewhat the urgency of this conflict. The degree to which we are considerate of our baby's early needs, however, may be the measure of his later ability to feel secure in a world of change and to adapt himself to the necessities of circumstance.”1(p xi) Aldrich's contributions occurred at a crucial transitional period for child health. In the early 20th century, child health services were almost exclusively focused on the treatment of the sick child, with the modest exception of cursory examinations to detect signs of contagion, milk stations for feeding and weighing, and urban child health conferences for examining and later immunizing children. Subsequent control of infection through improved sanitation, public health measures, the introduction of antibiotic agents, and effective immunization profoundly influenced the scope of child health care, with the founding of the American Academy of Pediatrics in 1930 heralding a shift of emphasis to include health promotion and disease prevention.2 In 1944, Aldrich helped to pioneer this shift through the founding of the Rochester (Minnesota) Child Health Institute, devoted to research on the development of normal infants and children and to a program of delivering child health care to an entire community. Contemporary efforts to enhance the effectiveness of developmental services similarly occur within the context of a profound transition in children's health services. In the mid-1970s, the recognition of developmental, behavioral, and psychosocial problems as the “new morbidity” of pediatric practice by Haggerty et al3 reinforced an emphasis … Reprint requests to (P.H.D.) Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106. E-mail: pdworki{at}ccmckids.org

Perceptions and attitudes toward prenatal cocaine exposure in young children.

This paper investigated perceptions and attitudes toward young children believed to be prenatally exposed to cocaine. 37 college students watched a videotape of eight children doing the same task and rated each child's performance after being told if the child had, might have been, or had not been prenatally exposed to cocaine. Multiple analysis of variance confirmed that when a child was labeled prenatally exposed to cocaine, the participants generally scored the child lower and less positively than it the child was thought to be possibly exposed or not exposed at all. Ethnicity and gender differences were also found. Participants rated males higher than females and African-American children higher than Caucasian children. Individuals who believe a child is exposed prenatally to cocaine hold more negative perceptions regarding that child's developmental abilities. These negative perceptions of a child labeled prenatally exposed to cocaine may diminish expectations for that child's developmental potential.

Advanced Care Planning for Children With Special Health Care Needs: A Survey of Parental Attitudes

Objectives. This study explored parental attitudes about their interactions with their children's providers when decision making involved critical life situations. We evaluated parents' attitudes regarding the following questions: What was the parents' understanding of their children's health care issues, and what was the parental perception of the professionals' understanding of their children and of themselves? Who should be the principal decision makers for the children? What was the parents' knowledge about advance directives? Did parents want to participate in a process of advance planning to assist with critical life decision making for their children? Methods. We surveyed all parents attending a conference sponsored by the Massachusetts Department of Public Health for parents of children with special needs. The questionnaire was provided to all parents attending the conference. An announcement was made at the conference requesting parental participation. The 76 respondents constitute a convenience sample of parents of children with special needs sufficient for this preliminary stage of investigation. Results. Of 177 parents attending the conference, 76 (43%) completed the questionnaire. Eighty-eight percent of the participants strongly agreed that they understood their children's conditions. Twenty-one percent stated that they had sufficient understanding of their children's future medical needs, and 21% thought that they had a sufficient understanding of their children's developmental potential. Ninety-nine percent of parents strongly agreed that physicians should share information with parents no matter how serious or potentially upsetting. Ninety-four percent of those parents who thought that their children's physicians understood their own needs also thought that the physicians understood their children's needs. In contrast, only half (55%) of those parents who thought the physicians did not understand their needs thought the physicians understood their children's needs. Ninety-two percent of parents who thought that the physicians understood their needs agreed that the physicians would make the best decisions in crises versus 60% of those who did not think the physicians understood their needs. Seventy-four percent stated that they would consider written guidelines for their children that dealt with critical life situations. All parents who thought their children's conditions were not understood wanted written guidelines. Of those parents who had thought their children would not survive (15 parents), 94% wanted written guidelines. All seven parents who had been told their children would not survive wanted written guidelines. Conclusions. Parents in this study were generally satisfied with care being provided to their children. Nevertheless, the results clearly suggest goals that could lead to improved capacity for parents and providers to make critical life decisions for and with children. First, physicians must understand the needs of parents to be able to make decisions that would be in the children's best interests. Second, parents should participate fully in critical life decisions for their children and should use written guidelines to assist with the process of these critical life decisions. Our findings strongly support the development of a longitudinal process, initiated early after the onset or discovery of illness and maintained longitudinally throughout the course of a child's illness, to help parents and providers work together in this vital area of health care to children.