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      A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies Translated title: Un programa comunitario de parentalidad responsiva mejora el desarrollo neurológico en niños de dos años en un país de renta media, Granada, Indias Occidentales

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          ABSTRACT

          Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group ( n = 151) on measures of cognition ( p = .022), fine motor ( p < .0001), gross motor ( p = .015), and language development ( p = .013). No difference in secondary outcomes, including CP, was detected.

          RESUMEN

          Muchos niños en países de renta media y baja corren el riesgo de sufrir retrasos en el desarrollo. Las intervenciones en periodos tempranos del desarrollo infantil pueden mejorar sus resultados, pero pocas de ellas abordan la violencia culturalmente normativa, como el castigo corporal. En asociación con una organización comunitaria que trabajaba en el ámbito del desarrollo infantil temprano en Granada se llevó a cabo una intervención paralela de parentalidad responsiva mediante un ensayo controlado de simple-ciego con el fin de educar a los padres sobre el cerebro en desarrollo y alternativas al castigo corporal, a la vez que les enseñaban destrezas de autorregulación y se fortalecían los vínculos socioemocionales entre padres e hijos. Para ello se eligieron padres y cuidadores primarios de niños menores de dos años. La asignación a los grupos de intervención y lista de espera de control no fue ciega, estando determinada por el reclutamiento al programa. El desarrollo neurológico fue evaluado a ciegas cuando el niño cumplía dos años. La comparación primaria constaba de puntuaciones en neurodesarrollo entre los grupos intervención y lista de espera de control (Clinicaltrials.gov registration # NCT04697134). La comparación secundaria constaba de cambios en la salud mental materna, entorno del hogar y actitudes hacia el castigo corporal. Los niños en el grupo de intervención ( n = 153) tenían puntuaciones significativamente superiores a las de los niños del grupo control ( n = 151) en las medidas de cognición ( p = .022), motricidad fina ( p < .0001), motricidad gruesa ( p = .015) y desarrollo del lenguaje ( p = .013). No se encontraron diferencias en los resultados secundarios, entre los que se incluía el castigo corporal.

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          Most cited references52

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          Developmental potential in the first 5 years for children in developing countries

          Summary Many children younger than 5 years in developing countries are exposed to multiple risks, including poverty, malnutrition, poor health, and unstimulating home environments, which detrimentally affect their cognitive, motor, and social-emotional development. There are few national statistics on the development of young children in developing countries. We therefore identified two factors with available worldwide data—the prevalence of early childhood stunting and the number of people living in absolute poverty—to use as indicators of poor development. We show that both indicators are closely associated with poor cognitive and educational performance in children and use them to estimate that over 200 million children under 5 years are not fulfilling their developmental potential. Most of these children live in south Asia and sub-Saharan Africa. These disadvantaged children are likely to do poorly in school and subsequently have low incomes, high fertility, and provide poor care for their children, thus contributing to the intergenerational transmission of poverty.
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            Nurturing care: promoting early childhood development.

            The UN Sustainable Development Goals provide a historic opportunity to implement interventions, at scale, to promote early childhood development. Although the evidence base for the importance of early childhood development has grown, the research is distributed across sectors, populations, and settings, with diversity noted in both scope and focus. We provide a comprehensive updated analysis of early childhood development interventions across the five sectors of health, nutrition, education, child protection, and social protection. Our review concludes that to make interventions successful, smart, and sustainable, they need to be implemented as multi-sectoral intervention packages anchored in nurturing care. The recommendations emphasise that intervention packages should be applied at developmentally appropriate times during the life course, target multiple risks, and build on existing delivery platforms for feasibility of scale-up. While interventions will continue to improve with the growth of developmental science, the evidence now strongly suggests that parents, caregivers, and families need to be supported in providing nurturing care and protection in order for young children to achieve their developmental potential.
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              Inequality in early childhood: risk and protective factors for early child development.

              Inequality between and within populations has origins in adverse early experiences. Developmental neuroscience shows how early biological and psychosocial experiences affect brain development. We previously identified inadequate cognitive stimulation, stunting, iodine deficiency, and iron-deficiency anaemia as key risks that prevent millions of young children from attaining their developmental potential. Recent research emphasises the importance of these risks, strengthens the evidence for other risk factors including intrauterine growth restriction, malaria, lead exposure, HIV infection, maternal depression, institutionalisation, and exposure to societal violence, and identifies protective factors such as breastfeeding and maternal education. Evidence on risks resulting from prenatal maternal nutrition, maternal stress, and families affected with HIV is emerging. Interventions are urgently needed to reduce children's risk exposure and to promote development in affected children. Our goal is to provide information to help the setting of priorities for early child development programmes and policies to benefit the world's poorest children and reduce persistent inequalities. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Interv Psicosoc
                Interv Psicosoc
                inter
                Psychosocial Intervention
                Colegio Oficial de la Psicología de Madrid
                1132-0559
                2173-4712
                13 May 2022
                May 2022
                : 31
                : 2
                : 97-107
                Affiliations
                [a ] orgnameGeorge’s University Grenada West Indies originalSt. George’s University, Grenada, West Indies
                [b ] orgnameCaribbean Center for Child Neurodevelopment orgdiv1Windward Islands Research and Education Foundation Grenada West Indies originalCaribbean Center for Child Neurodevelopment, Windward Islands Research and Education Foundation, Grenada, West Indies;
                [c ] orgnameUniversity Hospitals Southampton Southampton UK originalUniversity Hospitals Southampton, Southampton, UK;
                [d ] orgnameUniversity of Oxford Oxford UK originalUniversity of Oxford, Oxford, UK;
                [e ] orgnameConscious Discipline Florida USA originalConscious Discipline, Florida, USA
                Author notes
                Correspondence: rwaechte@ 123456sgu.edu (R. Waechter).

                Conflict of Interest: The authors of this article declare no conflict of interest.

                Article
                00003
                10.5093/pi2022a6
                10268546
                37360060
                36bc6b2e-1a78-4b20-8b72-731867713cf2
                Copyright © 2022, Colegio Oficial de la Psicología de Madrid

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial No Derivative License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided the original work is properly cited and the work is not changed in any way.

                History
                : 09 July 2021
                : 08 February 2022
                : 11 March 2022
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 47
                Categories
                Research-Article

                child neurodevelopment,early child development,responsive caregiving,social-emotional connection,corporal punishment,desarrollo neurológico infantil,desarrollo temprano infantil,parentalidad responsiva,vínculos socioemocionales,castigo corporal

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