Effects of parenting interventions on child development and parent-level outcomes across follow-up studies
| Primary impact paper, country | Post intervention evaluation round | Child age at assessment | Analytical sample size (% of originally enrolled) | Child development outcomes assessed: domains (measure) | Parenting intervention impacts on child development outcomes | Parent outcomes: domains (measure) | Parenting intervention impacts on parent outcomes |
| Grantham-McGregor et al,19 Jamaica | One of five19 | 3–4 years (primary endpoint) | 127 (98%) | Global developmental quotient, which includes hearing and speech, hand and eye, performance, and locomotor subscales (Griffiths Mental Development Scales) | Stimulation intervention improved all the subscales and overall developmental quotient. The stimulation x supplementation interaction term was not significant in any of the regressions. | Stimulation in the home (modified HOME) | The HOME score of the treatment group was 16% greater than that of the control group.20 |
| Two of five27 | 7–8 years | 127 (98%) | School achievement (WRAT) Intelligence quotients (Stanford Binet) Language comprehension (PPVT) Visual reasoning ability (Raven’s Progressive Matrices) Categorical fluency (naming as many items as possible in 1 min) Verbal analogies (11 analogical reasoning problems) and long-term semantic memory (free recall) Paired-associate learning task (French learning test) Auditory working memory (digit span) Visual–spatial working memory (Corsi blocks) Fine motor coordination (Lafayette Grooved Pegboard Test) Factor analysis of the development measures constructed (PCA with varimax rotation) resulted in three factors: general cognitive factor (first factor had most tests loading onto it), perceptual–motor factor and long-term semantic memory | Stimulation arm had significantly higher scores on child development factor 2, no other factors or outcomes. Sign test conducted to examine the direction (not magnitude) of the effects for the child development outcomes, supplemented and combined group had better scores than the control group on more tests than would be expected by chance (14/15, p<0.01), and stimulated group did better than control in 13/15 (p<0.05) | Stimulation (13 questions about stimulation in the home) | There was no difference between the treatment and control groups.20 | |
| Three of five33 34 | 11–12 years | 116 (90%) | General intelligence (WISC-R; verbal and performance subscales) Visual reasoning ability (Ravens Progressive Matrices) Language comprehension (PPVT) Verbal analogies (no specific test mentioned) Vocabulary (modified subset of the Stanford Binet) Auditory working memory (two tests digit span forwards and backwards) Visual–spatial memory (Corsi blocks) Visual information processing and sustained attention (Search Test) Ability to inhibit responses and the speed of processing: modified Stroop Tests School and home behaviours (Rutter Teacher and Parent Scales) School achievement (WRAT) | Children who had received stimulation, with or without supplementation, had significantly higher scores on the WISC-R Full Scale and Verbal scale, Ravens Progressive Matrices, and the Vocabulary Test. | Stimulation in the home (HOME-like questions, including the presence of homework facilities, reading and play materials, and interactions with adults) | There was no difference between the treatment and control groups.20 | |
| Four of five21 51 | 17–18 years | 103 (80%) | Cognitive function (WAIS) Non-verbal reasoning (Raven’s Progressive Matrices) Visual spatial working memory (Corsi blocks test) Auditory working memory (digit span forwards and backwards subsets of the WAIS) Language (Verbal Analogies Test and PPVT) Reading ability (Reading Test 2–Revised) Math ability (WRAT for math) Education (highest grad attained, or current grad) Self-esteem (How I Think About Myself Questionnaire) Anxiety (What I Think and Feel Questionnaire) Depression (Short Mood and Feelings Questionnaire) Antisocial behaviour (Behaviour and Activities Checklist) Attention deficit Cognitive problems or lack of attention Hyperactivity Oppositional behaviour Social behaviour (sexual relationships, pregnancy, contact with the police, exposure to violence) | Children who received psychosocial stimulation had significantly better scores on the WAIS Full Scale and Verbal Subscale, and on the PPVT, Verbal Analogies test, and sentence completion and context comprehension reading tests. After adjustment for covariates, the benefits remained significant and the effects of stimulation approached significance for Raven’s Progressive Matrices and the performance subscale of the WAIS. Multivariate analysis of variance with all behavioural outcomes as the dependent variables and supplementation and stimulation as factors indicated a significant effect of stimulation. Participants who received stimulation reported less anxiety, less depression and higher self-esteem, and parents reported fewer attention problems. These differences are equivalent to effect sizes of 0.40–0.49 SD. No effect on antisocial behaviour, cognitive problems, lack of attention, hyperactivity, oppositional behaviour or social behaviours | None | None | |
| Five of five 20 52 | 22–23 years | 105 (83%) | Cognition/IQ (WAIS) Educational achievement (reading and mathematics from WRAT, Expanded Form; highest grade level attained; secondary level examination passes; expulsion from school; postsecondary school education or skills training) General Knowledge (a test of practical general knowledge useful for daily living in Jamaica) Mental health (Short Mood and Feelings Questionnaire; anxiety was assessed with the State-Trait Anxiety Inventory; Social inhibition subscale from the adapted Inventory on Interpersonal Problems). Antisocial behaviour, arrests, convictions (self-reported involvement in fights, use of weapons, stealing, burglary, rape and gang membership; participant reports of arrests and convictions also were collected). Factor analysis with varimax rotation was used to reduce the number of items related to violent behaviour and to identify underlying constructs (four factors). Other behaviour (relationships with parents and with partners, sexual relationships, number of children and age at birth of first child, alcohol and drug use, church attendance and community involvement) and earnings (log monthly earnings) | Stimulation had significant benefits to IQ and mathematics and reading scores. Stimulation benefitted general knowledge in the residents; among the resident sample, stimulation increased the highest grade level attained and the number of secondary-level examination passes, with similar non-significant trends for the total sample. Stimulation led to significant reductions in symptoms of depression and in social inhibition but was not associated with levels of anxiety. The stimulation groups tended to be less likely to be involved in fights (OR=0.36) and were significantly less likely to be involved in more serious violent behaviour (OR=0.33). There were no significant differences among the groups in alcohol consumption, cigarette smoking, marijuana use, detention by the police, being charged with a crime, being convicted of a crime, the quality of their relationships with their mothers, fathers, or partners, or in the number of sexual partners, condom use, use of birth control, or additional training after secondary school. The estimated impacts on log earnings show that the intervention had a large and statistically significant effect on earnings. Average earnings from full-time jobs are 25% higher for the treatment group than for the control group, and the impact is substantially larger for full-time permanent jobs. | None | None | |
| Walker et al,36 Jamaica | One of two36 | 2 years (primary endpoint) | 130 (93%) | Global developmental quotient, which includes hearing and speech, hand and eye performance, and locomotor subscales (Griffiths Scales) | The intervention did not improve global developmental quotient. For the subscales, improvements were observed in the hand and eye and performance subscales; but not the hearing and speech and locomotor subscales. | Maternal stimulation (HOME) measured at child age 12 months | Intervention did not improve total HOME score. Improvements were observed in avoidance of restriction and punishment, and maternal involvement subscales, but not in the three other subscales (emotional and verbal responsivity, organisation of the environment, and play materials). |
| Two of two32 | 6.8 years | 112 (80%) | IQ (WPPSI), vocabulary (PPVT), Memory (Digit Span Forward Test, Corsi Blocks Test) Attention (Test of Everyday Attention for Children), reading (Early Reading Assessment), behaviour (SDQ) | The intervention group had significantly better scores in performance IQ (d=0.38), visual–spatial memory (d=0.53), and fewer behaviour difficulties (d=0.40) than the control group. No difference between groups for full-scale IQ, digit span memory, attention, PPVT, early reading. | Parenting practices (HOME- middle childhood) | No difference between groups in HOME- middle childhood | |
| Cooper et al, 2009 South Africa28 | One of three28 | 6 months (primary endpoint) | 354 (79%) | None | None | Mother–child interactions (structured play interaction coded for maternal sensitivity and intrusive–coercive control), clinical diagnosis of maternal depression (DSM-IV diagnosis) and maternal depressive symptoms (EPDS) | Mothers in the intervention group were significantly more sensitive (d=0.24) and less intrusive (d=0.26) in their interactions with their infants. No significant reductions in maternal depressive disorder. However, reductions were observed in maternal depressive symptoms |
| Two of three27 37 | 18 months | 342 (76%) | Attachment security (Ainsworth strange situation procedure, coded for secure and insecure attachments), cognitive development (BSID-II) | The intervention was also associated with a higher rate of secure infant attachments (OR=1.70, p<0.05). No significant differences in insecure attachments. Intervention trended towards significant improvement in cognitive development (d=0.20, p=0.09). | None | None | |
| Three of three53 | 13 years | 333 (74%) | Language (KABC-II, specifically the Riddles Subtest), behaviour (CBCL) and self-esteem (Self-Esteem Questionnaire) | Parenting intervention did not improve any child outcomes. | Maternal depressive symptoms (PHQ-9) | Parenting intervention did not reduce maternal depressive symptoms | |
| Yousafzai et al,24 Pakistan | One of two24 35 | 2 years (primary endpoint) | 1411 (95%) | Cognitive, language, motor and socioemotional development (BSID-III) | Responsive stimulation intervention improved child cognitive (d=0.6), language (d=0.7) and motor development (d=0.5). However, no effect was observed for child socioemotional development. | Maternal knowledge of early childhood development (developed by authors), parenting practices (HOME, FCI), mother–child interactions (OMCI), depressive symptoms (SRQ) | Responsive stimulation intervention improved maternal knowledge (d=1.1), practices (HOME, d=0.9) and mother–child interactions (d=0.8). However, no effect was observed for maternal depressive symptoms (d=0.1). |
| Two of two30 | 4 years | 1302 (87%) | Child IQ (WPPSI), executive functioning (fruit Stroop task, knock-tap task, big–little task, go/no go task, forward word span and separated dimensional change card sort), preacademic skills (Bracken School Readiness Assessment, Third Edition), prosocial behaviours (SDQ), motor development (Bruininks-Oseretsky Test for Motor Proficiency-II, Brief Form), preschool enrolment rates | Responsive stimulation intervention improved IQ (d=0.1), executive function (d=0.3), preacademic skills (d=0.35) and prosocial behaviours (d=0.2). No differences were observed for behavioural problems, motor development or preschool enrolment rates. | Mother–child interactions (OMCI), parenting practices (HOME early childhood version and FCI) and maternal depressive symptoms (SRQ) | Responsive stimulation intervention improved mother–child interactions (d=0.25) and parenting practices (HOME, d=0.3). However, no differences were observed for maternal depressive symptoms. | |
| Attanasio et al,22 Colombia | One of two22 | 30–42 months (primary endpoint) | 1263 (88%) | Cognitive, receptive language, expressive language, fine motor and gross motor development (BSID-III) | Parenting intervention improved cognitive scores (d=0.26) and receptive language (d=0.22); no impact on expressive language, and fine and gross motor scores | Maternal stimulation practices and play materials (FCI), depressive symptoms (CES-D) | Parenting intervention improved the amount of stimulation (play activities and play materials) being provided by parents in the home (d=0.34); no effect of parenting intervention on maternal depression. |
| Two of two54 | 4.5–5.5 years | 1256 (88%) | Cognition (Woodcock-Munoz), language (Woodcock-Munoz, PPVT), school readiness (Daberon Screening for School Readiness), executive function (pencil tapping task), child behaviour (SDQ and Children’s Behaviour Questionnaire) | Parenting intervention did not improve any child outcomes. | Maternal stimulation practices and play materials (FCI), depressive symptoms (CES-D) | Parenting intervention did not improve any maternal outcomes. | |
| Chang et al,25 Jamaica, Antigua, St. Lucia | One of two25 | 18 months (primary endpoint) | 426 (85%) | Global developmental quotient, which includes hearing and speech, hand and eye, and performance subscales (Griffiths Scales); vocabulary (MacArthur-Bates Short Form of the CDI) | Intervention improved cognitive development subscale of Griffiths; no impacts on other subscales or global developmental quotient of Griffiths or vocabulary score | Maternal knowledge of care practices (developed by authors), parenting practices (HOME), depressive symptoms (CES-D) | Intervention improved maternal knowledge of care practices (d=0.4); no impacts on parenting practices or maternal depressive symptoms. |
| Two of two31 | 6 years | 262 (66% of the original subsample from Jamaica; however, this follow-up subsample (only Jamaica) represents 52% of original trial, which also included Antigua and St. Lucia) | Cognitive development (WPPSI-IV), behaviour (SDQ) | Intervention did not improve child outcomes. | Maternal involvement (Parent Involvement in Children’s Education Scale, Parental Involvement in Children’s Literacy Development and Family Involvement Questionnaire); self-efficacy (Brief Parental Self Efficacy Scale); depressive symptoms (CES-D) | No impacts on maternal involvement or self-efficacy. Results for depressive symptoms not reported in paper | |
| Muhoozi et al,23 Uganda | One of two23 29 | 12–16 months (primary endpoint) | 467 (91%) | Cognitive, language, motor and socioemotional development (BSID-III, ASQ) | Intervention improved cognitive and motor development. However, no differences were observed for language or personal–social development. | Maternal depressive symptoms (BDI and CES-D) | Intervention reduced maternal depressive symptoms (CES-D, d=−0.70). |
| Two of two26 29 | 3 years | 147 (95%; of 155 randomly selected subsample by design; however subsample revisited represents 29% of original trial) | Cognitive, language, motor and socioemotional development (BSID-III, ASQ and MSEL) | Intervention improved cognitive, language and motor development (eg, BSID-III effect sizes 0.57, 0.56 and 0.50, respectively). However, no difference was observed for personal–social development. | Maternal depressive symptoms (BDI and CES-D) | Intervention reduced maternal depressive symptoms (CES-D, d=−0.51). |
ASQ, Ages and Stages Questionnaire; BDI, Beck Depression Inventory; BSID, Bayley Scales of Infant Development; CBCL, Child Behavior Checklist; CDI, Communicative Development Inventories; CES-D, Center for Epidemiological Studies-Depression; DSM, Diagnostic and Statistical Manual of Mental Disorders; EPDS, Edinburgh Postnatal Depression Scale; FCI, Family Care Indicators; HOME, Home Observation for Measurement of the Environment ; KABC, Kaufman Assessment Battery for Children; MSEL, Mullen Scales of Early Learning; OMCI, Observation of Mother-Child Interactions; PCA, principal component analysis; PHQ-9, Patient Health Questionnaire-9; PPVT, Peabody Picture Vocabulary Test; SDQ, Strengths and Difficulties Questionnaire; SRQ, Self-Reporting Questionnaire; WAIS, Weschler Adult Intelligence Scale ; WISC-R, Wechsler Intelligence Scale for Children-Revised; WPPSI, Wechsler Preschool and Primary Scale of Intelligence; WRAT, Wide Range Achievement Test.