Programs that help parents read and play more effectively with their young children may prevent behavior problems such as hyperactivity and increase social and academic engagement for children growing up in poverty, according to a new study led by pediatricians and psychologists at NYU Langone Medical Center and NYC Health + Hospitals/Bellevue.
The study, published online January 27th in the journal Pediatrics, examines two specific programs employed to supplement low-income families' standard pediatric care: the Video Interaction Project and Building Blocks.
"In the last decade, scientists have begun to understand the mechanisms by which poverty can actually cause changes in brain development that can lead to higher rates of behavior problems and lower educational achievement for disadvantaged children," said Alan Mendelsohn, MD, associate professor in the departments of Pediatrics and Population Health at NYU Langone, pediatrician at Bellevue, and the study's principal investigator. "The intervention programs that we have developed and refined provide a practical solution to this problem."
The Video Interaction Project takes place at regular pediatric check-ups starting at the first well-child visit. A trained parenting coach meets with the family at each visit and records video of learning and play time between parent and child. The coach then reviews the video with the parent to identify and reinforce positive interactions and encourage strong parent-child relationships during this important period for brain development in children from birth to three years of age. The second intervention program, Building Blocks, is a lower-intensity option in which families receive parenting pamphlets and learning materials monthly by mail to facilitate reaching specific developmental goals.
"Programs like the Video Interaction Project and Building Blocks are vital for improving academic, health, and mental health outcomes among our most vulnerable children," said Mendelsohn. "Previous efforts to improve young children's behavior have addressed problems after they have emerged. These programs fill a critical gap by working with families to prevent problems before they arise."
What the Study Showed
The results of the three-year study showed notable benefits for children's social and emotional development. For example, children of families who participated in the Video Interaction Project had better attention and play skills as toddlers and reduced hyperactivity and aggression at three years, compared to children in a control group. For the highest risk families, hyperactivity was reduced by more than half -- a significant result as the ability to behave has been shown to be one of the most important factors in children's learning and educational achievement.
Building Blocks also showed benefits for toddlers, and both programs demonstrate that low-cost pediatric parenting interventions starting from infancy can meaningfully impact disadvantaged families' lives, providing a lasting effect through adulthood in the areas of education, employment, criminal activity, substance use, and mental health.
"One clear advantage of providing parents with a program like the Video Interaction Project is that it can be delivered at about one-tenth of the cost of other programs with comparable impacts," says lead study author Adriana Weisleder, PhD, research scientist in the Department of Pediatrics at NYU Langone. "The magnitude of these effects is surprisingly large. Policymakers should consider the low cost and potential for large-scale growth of this program when discussing future school readiness initiatives."
Researchers conducted the single-blind (i.e. staff conducting the assessments did not know families' assigned group) randomized controlled trial at NYC Health + Hospitals/Bellevue, where care is provided by physicians with academic appointments at NYU Langone. The study enrolled 675 pairs of mothers and children, who were then randomly assigned to one of three groups: the Video Interaction Project; Building Blocks; and a control group, which received standard pediatric care. The groups were examined at regular intervals over the course of 36 months. Mothers were primarily Hispanic or Latino and born outside the U.S.
Besides Dr. Mendelsohn and Dr. Weisleder, other researchers involved in the study were Benard Dreyer, MD, the President of the American Academy of Pediatrics, director of NYU's Division of Developmental-Behavioral Pediatrics and Director of Pediatrics at Bellevue; Carolyn Cates, PhD, Samantha Berkule Johnson, PhD, Anne Seery, PhD, and Caitlin Canfield, PhD, all of the Department of Pediatrics at NYU Langone Medical Center; and Harris Huberman, MD, MPH, of SUNY Downstate.
The program is currently being expanded to a number of hospitals and clinics in New York City as part of a New York City Council initiative called City's First Readers, and in collaboration with the Reach Out and Read program, Children of Bellevue, Inc, and NYC Health + Hospitals/Woodhull.
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