Child Enrichment Program Still Pays Off After 15 Years

In one of the largest and most rigorous studies of a comprehensive early childhood enrichment program, researchers have detected continuing benefits 15 years after the program ended. The findings affirm and extend a body of research suggesting that well-designed experiences in a child’s earliest years can overcome certain environmental and biological disadvantages.

Photo by Graham Ramsay

Fifteen years after an intensive childhood education program ended, Marie McCormick and her colleagues found lasting effects in achievement and behavior. The study is one of the largest and most rigorous to document the importance of the first few years of life in setting the stage for successful adulthood.

“Early educational intervention works,” said Marie McCormick, the Sumner and Esther Feldberg professor of maternal and child health at HSPH and HMS professor of pediatrics at Children’s Hospital Boston. McCormick is lead author of the latest analysis, published in the March Pediatrics.

The original three-year study, which began in 1984, involved nearly 1,000 premature infants. Researchers wanted to know if an intensive educational curriculum proven to help dozens of healthy children overcome the hardships of extreme poverty could also help the growing number of low–birth weight infants at higher risk of developmental disabilities.

The randomized trial provided services for children weighing less than 5.5 pounds at birth at eight different U.S. sites with an economically and ethnically mixed population, including Boston. This intervention was called the Infant Health and Development Program.

The intervention group had home visits the first year and the equivalent of the country’s best educational childcare for their next two years in the study. Trained childhood development professionals worked with the infants and their mothers on activities that probably seemed like fun and games to the kids, but steadily advanced their capabilities on several fronts—language, cognition, fine motor skills, social skills, and emotional growth. Activities ranged from scribbling with crayons to putting the square peg in its proper hole to jumping and skipping.

“To the best of my knowledge, this is the first demonstration that one can do a longitudinal child development study in multiple sites, analogous to a multisite clinical trial,” said Julius Richmond, HMS professor emeritus of health policy and first director of the Head Start program. “It clearly answers the policy question, Does it make a difference if you provide children with a comprehensive care program in their preschool years?”

ABCs of Success
As part of the national “war on poverty” 41 years ago, Head Start first drew attention to the benefits of preschool intervention for poor children. Most of the research in the field focuses on Head Start and generally shows that the improved performance of kids entering school tends to drop off by third grade.

In contrast, the most recent follow-up studies of two well-known more intensive experimental programs for poor children have found sustained effects lasting well into adulthood. Each study included just over 50 kids in both the intervention and control groups. By age 40, African Americans from urban Ypsilanti, Michigan, who participated in the Perry Preschool Study at ages 3 and 4 had higher earnings, were more likely to hold a job, committed fewer crimes, and were more likely to have graduated from high school. By age 21, rural black infants exposed to the intensive childcare of the Carolina Abecedarian Project still had higher math and reading scores, were more likely to have attended or graduated from a four-year college, and were an average of two years older than members of the control group when their first child was born.

“Basically, all of us who have been arguing that early childhood education is a good investment and has long-term payoffs for the children have been making those statements based on two small-scale studies, because that is the best we had,” said Jeanne Brooks-Gunn, a child psychology professor at Columbia medical school in New York and the second author of the Pediatrics paper. “This study provides additional compelling evidence for the importance of early childhood education. It also demonstrates that these effects are going to occur in programs of high quality that are fairly intensive.”

Aging Well
The original program had been modeled in part on the Abecedarian Project, but McCormick and her colleagues approached their latest update with some trepidation. In earlier analyses, only babies born heavier than 4 pounds seemed to benefit. And the big difference in intelligence scores at age 3 between the intervention group and the control group had started to fade at ages 5 and 8. Other differences in achievement tests and behavior had simply vanished by age 8. The children were now 18.

“We were not sure we would see a difference, and that would be a powerful argument against early childhood education,” McCormick said.

The institutional review board at Children’s had other concerns. Among the assessments was the Youth Risk Behavior Surveillance System. Its questions about smoking, alcohol use, marijuana use, premature sexual behavior, and suicidal tendencies are typically asked anonymously. Answers could not only be self-incriminating, they could also signal a problem in need of immediate attention. McCormick and her colleagues addressed the objections by obtaining a certificate of confidentiality from the National Institutes of Health to protect the teens’ privacy and putting in place a plan to deal with any serious situations revealed in the follow-up. Fortunately, nothing serious arose.

In the end, the researchers were able to track down just over 600 youths from the original Infant Health and Development Program. Adolescents from the intervention group were more likely to have higher achievement scores in math and reading. They also had fewer risky behaviors, although the confidence interval for the results stretched to zero, which means the lower risky behavior scores could be due
to chance.

“This is an extremely careful, well-designed, and well-analyzed experimental study that both adds to and reinforces the evidence base,” said Greg Duncan, an economist specializing in childhood development at Northwestern University, who is not one of the study’s co-authors. “Accumulating evidence suggests that child-focused interventions tend to be more successful than targeting the family level or the neighborhood, and that earlier is probably better than later.”

The overall differences in scores between the intervention and control groups are deceptively small in part because the study design was biased against showing any differences between the two groups, McCormick said. For example, the control group had frequent checkups by the study’s full interdisciplinary team, who referred the families to specific services needed for any detected developmental issues.

Curiously, the Boston site, now an unrelated childcare facility at Emmanuel College, was an anomaly from the beginning, showing no difference between the intervention and control groups. An earlier subgroup analysis of the results at age 8 showed that premature infants were most likely to benefit only if their mothers had a high school education or less.

The study authors and their colleagues speculate that in Boston, the combination of highly educated parents living in a state with some of the earliest community intervention programs meant that the kids in the control group may have received many of the developmental enrichment activities that those in the intervention group did.

As with earlier analyses, sustained effects were confined to the heavier low–birth weight babies, between 4 and 5.5 pounds. The lack of sustained benefits for youths who had weighed less than 4 pounds at birth suggests that different or more individually tailored interventions are needed for the smallest premature babies, said David Olds, a developmental psychologist at the University of Colorado in Denver, who wrote an accompanying commentary.

“These are not even the tiniest infants that are surviving now,” said McCormick, who co-directs the Infant Follow-up Program at Children’s. Half of the babies born at just under 2 pounds now survive, she said, thanks to advances in neonatal intensive care.

The heavier low–birth weight infants who thrived on the intervention may be more similar to the larger infant population, McCormick said. “Prematurity is not a syndrome with fixed characteristics. It simply increases the risk. I would argue that this pertains to a broader group. In my heart of hearts, I believe it pertains to every child, but first it should go to children at a relative economic disadvantage,” she said.

The public policy implications are clear, said James Heckman, a Nobel laureate in economics at the University of Chicago. Heckman developed a model that bridges basic neuroscience and intervention studies. “Early advantages accumulate, just as early disadvantages do,” he said. “Current policies such as the No Child Left Behind Act are premised on using schools to remedy the consequences of disadvantaged families. Schools can only work with what families give them. School comes too late in the life cycle of child development to be the main locus of remediation for the disadvantaged, and public schools focus only on tested academic knowledge and not the non-cognitive behavioral components that are needed for success in life.”

—Carol Cruzan Morton

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