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Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial
Elizabeth B Miller1, Erin Roby2, Yudong Zhang3
1Department of Population Health, NYU Grossman School of Medicine, New York, NY.
Insights
The Smart Beginnings intervention effectively enhanced parental support of cognitive stimulation in infants and toddlers. This integrated model shows promise for supporting early relational health through pediatric primary care.
Area of Science:
- Child Development
- Public Health Interventions
- Early Childhood Education
Background:
- Parental support of cognitive stimulation is crucial for early child development.
- Preventive interventions delivered in pediatric settings can impact child outcomes.
- The Smart Beginnings model integrates universal and targeted prevention strategies.
Purpose of the Study:
- To evaluate the impact of the integrated Smart Beginnings model on parental support of cognitive stimulation.
- To assess cognitive stimulation from 6 to 24 months of age in infants and toddlers.
- To determine the effectiveness of a combined Video Interaction Project and Family Check-Up program.
Main Methods:
- A single-blind, 2-site randomized clinical trial involving 403 mother-infant dyads.
- The Smart Beginnings intervention combined the Video Interaction Project and Family Check-Up programs.
- Parental support of cognitive stimulation was measured via surveys and parent-child interaction observations.
Main Results:
- Smart Beginnings significantly improved cognitive stimulation outcomes across infancy and toddlerhood.
- Survey results showed positive effects on StimQ common total, READ Quantity, and Quality.
- Observational data indicated significant impacts at 6 and 24 months, but not 18 months.
Conclusions:
- The integrated Smart Beginnings model effectively promotes cognitive stimulation from infancy through toddlerhood.
- This study supports the role of preventive interventions in pediatric primary care and home visiting for early relational health.
- Findings highlight the potential of combined intervention approaches to enhance parental support for cognitive development.
Objective:
To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6 to 24 months across infancy and toddlerhood.
Study Design:
This was a single-blind, 2-site randomized clinical trial of the Smart Beginnings intervention. Enrollment took place at birth in postpartum units of hospitals in New York City and Pittsburgh, Pennsylvania, with a consecutive sample of 403 mother-infant dyads. Smart Beginnings combines a Video Interaction Project-14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months-with potential for Family Check-Up-3-4 sessions targeted secondary prevention home-visiting program. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted.
Results:
Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). Smart Beginnings significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (effect size [ES] = 0.25, P = .01) and READ Quantity (ES = .19, P = .04) and Quality (ES = .30, P = .001). For the observations, the impact of Smart Beginnings varied by time, with significant impacts at 6 (ES = 0.37-.40, P < .001) and 24 (ES = 0.27-.30, P < .001) months, but not 18 months.
Conclusions:
Smart Beginnings positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation.
Trial Registration:
NCT02459327.
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