Early environmental factors that affect child cognitive test performance appear modifiable
Most inequities in the pre- and post-natal environment that contribute to racial disparities in child performance on cognitive tests are modifiable, according to study results published in JAMA Pediatrics.
“While we often have a very complex, multilevel view of the factors that shape child development, we tend to look at each of these factors independently,” Kaja LeWinn, ScD, MS, of the department of psychiatry and behavioral sciences at the University of California, San Francisco, told Healio Psychiatry. “This hypothesis-driven approach is at the core of scientific discovery, but it doesn’t always help us with the big picture of what matters. Prediction methods can help us take a broader view, and the approach we took in this study allowed us to examine many factors within a single study and identify those most strongly associated with cognitive test scores in early childhood.
“We included multiple domains and types of exposures (e.g., family and neighborhood resources, maternal well-being, early childhood exposures such as breastfeeding, parenting, etc.) to identify modifiable predictors of cognitive test scores that might be targets for future intervention or prevention efforts,” LeWinn added.
LeWinn and colleagues used the full dataset from the Conditions Affecting Neurodevelopment and Learning in Early Life (CANDLE) longitudinal cohort study, in which researchers collected data from 2006 to 2011, for a prospective analysis and used 155 adjusted independent multivariable regression models. The CANDLE study gathered longitudinal data from mothers twice during pregnancy and annually during early childhood, then measured children’s cognitive ability with the Stanford-Binet Intelligence Scales during follow-up visits at ages 4 to 6 years. The final analysis of 1,055 mothers, of whom most were Black, evaluated 155 pre- and post-natal target exposures.
Results showed that of the seven exposures correlated with cognitive test scores in the final analysis, all except birth order “could be considered modifiable.” Factors associated with higher child cognitive test scores included parents completing graduate school, mother’s literacy level, behaviors that foster cognitive growth and breastfeeding. Factors associated with lower child cognitive test scores included parental stress. According to the researchers, Black children were less likely to experience 22 of 24 exposures that benefit cognitive performance.
LeWinn noted that the researchers created a model that improved each of the exposures by a modest amount. They observed a 7-point increase in cognitive test scores.
“It is important to note that racial inequities in the exposures identified, while measured at the individual level, are closely tied to upstream, structural inequalities,” LeWinn told Healio Psychiatry. “As one example, education quality and access varies dramatically across the United States. Black children are more likely to attend low-resourced schools that offer inadequate preparation for secondary education.
“In the South, where this study took place, some have called this legacy of disparate educational opportunities the ‘education debt,’ ” LeWinn added. “In our study, Black children were much more likely to live in neighborhoods with low educational opportunity than white children. It is necessary to address these inequities in early educational environments to minimize the impact on the next generation.”
Reference:
- The CANDLE Study. CANDLE Investigators. Available at: https://candlestudy.uthsc.edu/research/candle-investigators. Accessed Oct. 5, 2020.