Interventions to Promote Human Competence: Birth to 8

1
Interventions to Promote Human Competence Birth
to 8

• Craig T. Ramey
• Sharon Landesman Ramey
• Georgetown University
• Center on Health and Education
• How Can We Improve Our Brains?
• September 14 17, 2008

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Basic Epidemiological Facts about Human
Competence

• Racial and socioeconomic status consistently
  predict levels of school readiness and academic
  achievement in U.S.
• National Academy of
  Sciences (2002)
• Children born prematurely and low birthweight are
  at elevated risk for intellectual and learning
  disabilities (and they also disproportionately
  come from minority and low SES families)
• National Academy of Sciences
  (2007)

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Well-accepted answers to these epidemiological
facts

• Why some at-risk children fare so poorly
• Children in poverty receive insufficient
  amounts/types of language and cognitive learning
  experiences parenting practices often very harsh
  
• Premature, low birthweight children have
  altered CNS function, so they do not easily
  benefit from standard learning environments
• Environmental interventions and supports can
  alter predictable negative outcomes
• Language and cognitive learning
  opportunities in a positive and predictable
  environment (similar to most middle-to-upper
  class families) yield significant real world
  benefits
• Benefits are greater for children in greater
  need and those who participate at higher levels

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Some challenges to the conventional conclusions
and recommendations

• Many children living in poverty thrive
• H1 Childrens experiences are not the same
  just because they are poor.
• H2 Academically highly capable children
  living in poverty have families and schools that
  provide the needed learning experiences and
  prevent exposure to harm.
• Increasing numbers of middle and upper class
  families have children not thriving
• H1 early caregiving environments are less
  stable and less adequate.
• H2 children are so closely monitored that
  relatively small problems are diagnosed and
  treated (long-term effects not well studied).
• H3 external factors (e.g., media, peer
  pressure) contribute to problems.

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HOW we can improve young childrens brains (based
on prior evidence)

• Ensure equity so all children receive essential
  (universal) language and learning opportunities
  PLUS protection from neglect and abuse (eliminate
  deprivation effects)
• Tailor learning and social opportunities to
  better address needs of individual children and
  families (teach to strengths, targeted therapies
  for identified conditions, adjust environment to
  better match child)
• Attend to subclinical health parameters that
  can impair brains (e.g., lack of exercise,
  improper nutrition, allergies/asthma, sensory
  impairments)

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Examples of findings to helpframe future
science/policy agenda

• Differential benefits for children relate to
  initial risk
• Dosage matters more intensive programs and high
  participation levels are critical to success
• Adult caregivers, parents, and teachers can learn
  new ways of teaching and interacting with
  children (and these are sustainable)
• Academically talented children need supports as
  well as struggling children when children are
  poor, their talents are less likely to be
  correctly detected

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Randomized Controlled Trials (RCTs)to Improve
Child Outcomes

• Abecedarian Project
• Project CARE
• Infant Health and Development Program (8 sites)
• Romanian Orphanage Studies (2 cohorts)
• Intensive Pediatric CI Therapy (crossover RCT)
• National Head Start-Public School Transition
• Demonstration Study (28 of 31 sites)
• Pre-K Curriculum Comparison Study
• RITE Professional Development Study (2 RCTs)
• District of Columbia Excellence-in-Teaching

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Applied Biosocial Contextual Development
(ABCD) A Framework for Understanding Human
Development
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Abecedarian Project Birth to 5 Educational
Program

• Control Group _
• Adequate nutrition provided
• Supportive social services
• Primary health care given

• Treatment Group _
• Adequate nutrition provided
• Supportive social services
• Primary health care given
• Preschool treatment
• Intensive (full day, 5 days/week,
• 50 weeks/year, 5 years)
• Learningames Curriculum
• Cognitive / Fine Motor
• Social / Self
• Motor
• Language literacy
• Individualized pace/activities

Campbell Ramey, 1995 American Educational
Research Journal
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Percent of Abecedarian children in Normal
IQ Range (gt84) by Age (longitudinal analysis)
Martin, Ramey, Ramey, 1990 American Journal of
Public Health
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Abecedarian Project Multiple Influences on IQ in
preschool yrs
Adapted from Martin, Ramey, Ramey, American
Journal of Public Health, 1996
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Abecedarian School Outcomes
Ramey Ramey, 1999 MR/DD Research Review
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Key Findings from Abecedarian Project(Abecedaria
n one who learnsthe basics, such as the
alphabet)

• 18 Months to 21 Years Old

• Intelligence (IQ)
• Reading and math skills
• Academic locus-of-control
• Social Competence
• Years in school,
• including college
• Full-time employment

• Grade Repetition
• Special Education
• placement
• Teen Pregnancies
• Smoking and drug
• use
• Adolescent depression

Plus benefits to mothers of these children
(education, employment)
Ramey et al, 2000
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The Infant Health and Development Program (IHDP)

• Designed to replicate the Abecedarian Project
• for premature, low birthweight children
• (lt 37 wks gestation age, lt 2500 gm)
• Conducted at 8 sites (N985 children families)
• Intervention modified for biological risk factors
• Educational intervention combined with
• parent program lasted only until 3 yrs (CA) old

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Stanford-Binet IQ Scores at 36 Months Heavier LBW
Group (2001-2500gm)
Infant Health and Development, JAMA, 1990
Ramey, AAAS, 1996
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Stanford-Binet IQ Scores at 36 Months Lighter LBW
Group (lt2000gm)
Infant Health and Development, JAMA, 1990
Ramey, AAAS, 1996
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Childrens IQ at 36 months Maternal Education
X Treatment Group
Infant Health and Development Program
Ramey Ramey (1998), Preventive Medicine
(n232)
(n162)
(n166)
(n104)
(n134)
(n63)
(n76)
(n48)
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Differential response to early educational
intervention

• The children who benefited the most had
• mothers with IQs below 70
• mothers with low levels of education
• poor birth outcome indicators
• (PI, Apgar, LBW)
• teen mothers
• greater levels of program participation
• (e.g., Martin, Ramey, and Ramey, American
  Journal of Public Health, 1990 Ramey
  Ramey, 2000 Zeskind Ramey, 1982 Ramey et al,
  2007)

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Why So Many Well-Intentioned PreK Programs Fail
to Close Achievement Gap

• Poorly prepared teachers, weak prof. development
• Educational programs not intensive enough
• Failure to document program quality and measure
• child outcomes adequately
• Not enough teaching of language and academic
  skills
• Inattention to childrens health and health
  promotion
• Limited or no programs in summer and before and
• after school
• No useful information systems or reporting on
  results

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New RCTs on Professional Development Strategies

• RCTs comparing weekly versus monthly coaching to
  improve language and early literacy instruction
  (in school and child care settings) confirm
  DOSAGE principle
• RCTs comparing self-learning, workshops, and
  on-site coaching for 20 full days (inspired by
  the Pediatric Intensive Therapy Study) confirm
  DOSAGE principle with high levels of maintenance
  post-intervention

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LA4 Study Design Population-based, Cohort
Sequential, Case/Control Longitudinal Study

• Pilot year (Jan May 2002) n1358
• Cohort 1 (2002-2003) n3711
• Cohort 2 (2003-2004) n4767
• Cohort 3 (2004-2005) n4665
• Cohort 4 (2005-2006) n7998
• Cohort 5 (2006-2007) ngt10,000

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A Comparison of Childrens Academic Progress in
Pre-K Programs that differ in amount
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HOW we can improve young childrens brains (based
on prior evidence)

• Ensure equity so all children receive essential
  (universal) language and learning opportunities
  PLUS protection from neglect and abuse (eliminate
  deprivation effects)
• Tailor learning and social opportunities to
  better address needs of individual children and
  families (teach to strengths, targeted therapies
  for identified conditions, adjust environment to
  better match child)
• Attend to subclinical health parameters that
  can impair brains (e.g., lack of exercise,
  improper nutrition, allergies/asthma, sensory
  impairments)

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Although all children can learn,when exposed to
good teaching,extremely low levels of academic
readinessamong children from low resource
familieswill not change without vigorous
investmentin their early experiences,their
health, and continued support for later learning
and positive lifestyles.
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For copies of presentation and scientific
references, contact

• Drs. Craig and Sharon Ramey
• Georgetown University Center on Health and
  Education
• ctr5_at_georgetown.edu
• sr222_at_georgetown.edu
• 202-687-8818