Gains From Early Intervention Shown In Study of Low-Birth-Weight
By Debra Viadero
A groundbreaking study to be published this week may provide conclusive proof that early education can help markedly improve the cognitive and behavioral propects of one of the largest groups of infants considered at risk for developmental problems: premature, low-birth-weight babies.
The $33-million study, whose results are to appear in the June 13 issue of the Journal of the American Medical Association, is the largest ever done on low-birth-weight infants. It tracked 985 infants in eight cities who were born weighing 5.5 pounds or less.
Some of the infants were given only traditional pediatric follow-up care. The rest received such care as well as intensive educational services at home and, later on, in special day-care programs.
By age 3, the researchers report, the children receiving special-educational services had significantly higher iq scores and fewer behavior problems than did the toddlers receiving only health care.
"The implications of this finding for public policy are considerable at a time when day-care and early-intervention programs are expanding," Julius Richmond, former U.S. Surgeon General and national director of Head Start, writes in an accompanying editorial.
"Any efforts to enhance the cognitive and behavioral development of these children ... are potentially important for their functioning in school," adds Dr. Richmond, who is now on the staff of Harvard University's division of health-policy research and education.
"Thus," he suggests, "there might be an additional, longer-term benefit in the reduction of later expenditures for developmental disabilities."
The new findings come as states are gearing up to take part in a new federal special-education program serving handicapped infants and toddlers.
The program, established by the Education of the Handicapped Amendments Act of 1987, or pl 99-457, requires states to extend special-education services to children as4young as age 3 and encourages them to serve children even younger. It also gives states the option of including in the population of children they plan to serve infants deemed at risk for developmental delays.
"Perhaps this study will help states decide whether to include low-birth-weight infants in their new service system," said Joseph Sparling, who, as associate director of the Frank Porter Graham Child Development Center at the University of North Carolina at Chapel Hill, helped develop the education portion of the research project.
"It gives clear evidence," he said, "that interventions with this group would be well worth the effort."
Odds Against Them
According to medical experts, an estimated 250,000 premature, low-birth-weight infants are born each year in the United States. They represent nearly 7 percent of all live births.
Concern about the health and developmental outcomes of these children has grown in recent years, as advances in medical technology have enabled more of these tiny babies to survive.
"Once you save the lives of these children, the question then becomes what else can you do to improve their outcomes," said Ruby P. Hearn, vice president of the Robert Wood Johnson Foundation, the major underwriter of the four-year study.
The project was also supported with grants from the Pew Charitable Trusts, the U.S. Bureau of Maternal and Child Health, the National Institute of Child Health and Human Development, and the Stanford University Center for the Study of Families, Children, and Youth.
More than their normal-weight counterparts, studies have shown, low-birth-weight infants are at risk for developmental delays and a variety of medical complications in infancy. In later years, they tend to score lower on cognitive measurements and are more prone to behavior problems. They also come disproportionately from poor and disadvantaged families.
Only about half of the states so far have included this population in8plans for their new early-intervention programs, according to James Gallagher, director of the Carolina Policy Studies Program at the Frank Porter Graham Center.
"It's also a matter of how low is low," noted Dr. Gallagher, who has tracked states' progress in implementing the program. Some states, he noted, only consider infants low-birth-weight if they weigh less than about four pounds.
For the new study, the researchers divided infants into two groups: ''lighter" babies, who weighed 4.4 pounds or less at birth, and "heavier" infants weighing between 4.4 pounds and 5.5 pounds.
All were randomly assigned to either the intervention group or the comparison group.
During their first year of life, the infants in the intervention group were visited weekly by trained educators. The educators provided mothers with health and developmental information about their children and taught them play activities designed to enhance their children's development.
"We wrote down ideas for them," explained Mr. Sparling of the Frank Porter Graham Center, "showed them pictures of other parents playing with their kids to demonstrate a particular play activity, and encouraged them to believe their children were capable."
In the infants' second year, the home visits were reduced to every other week.
Between their first and third birthdays, the toddlers in the intervention group began attending a day-care-center program designed especially for them. The centers had lower-than-average ratios of caregivers to children. They also featured a special curriculum that emphasized individual attention.
In addition, the parents of the children in the experimental group attended bimonthly group meetings that provided information on child rearing, health and safety, and other parenting concerns.
At age 3, the researchers found, the iq scores for the "heavier" low-birth-weight infants in the experimental group were an average ofel10l13.2 points higher than they were for toddlers of similar weights in the comparison group. The "lighter" infants in the intervention group scored an average of 6.6 points higher than their counterparts receiving no educational services.
The children who received no special services beyond pediatric care were also 2.7 times more likely than the experimental group to have iq scores in the range of mental retardation.
"If the follow-up of these children continues to be as positive as the present findings," said Ruth T. Gross, the study director and a professor of pediatrics at Stanford University, "the implications for schools could be great."
"We know from other studies that iq tests at 3 have predictive value for later cognitive performance," Dr. Gross said.
"We also know," she added, "that, even if the iq differences wash out in later years, there can still be real differences in school achievement and reduced retention rates for these children."
The mothers of the toddlers getting special help also reported fewer serious behavior problems for their children than did the mothers of those in the control group, according to the study.
On a somewhat less positive note, the infants in the special program tended to suffer from slightly more minor ailments, such as colds and diarrhea, than their peers did, according to their mothers. The incidences of serious illnesses, however, were similar in both groups.
"It shows group day care can be safe and even beneficial for even biologically vulnerable infants," Mr. Sparling said.
The researchers are currently assessing the same group of children at 4 and 5 years old, according to Ms. Hearn of the Johnson Foundation. She said the study team was also working to get funding to continue tracking the children through age 8 and, possibly, into early adolescence.
In addition, some of the investigators are preparing an analysis of the costs involved in these kinds of interventions on a per-child, state, and national basis. They acknowledged the interventions are probably more expensive than most day-care programs.
"But," said Dr. Gross, "if these children's outcomes are improved so that they don't drop out of school or they don't need remedial help, then the cost of the program is really minimal."