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. 2022 May 13;31(2):97-107.
doi: 10.5093/pi2022a6. eCollection 2022 May.

A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies

Randall Waechter  1   2 , Roberta Evans  2 , Michelle Fernandes  3   4 , Becky Bailey  5 , Stephanie Holmes  2 , Toni Murray  2 , Rashida Isaac  2 , Bianca Punch  2 , Nikita Cudjoe  2 , Lauren Orlando  1 , Barbara Landon  1
Affiliations

A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies

Randall Waechter et al. Psychosoc Interv. .

Abstract
in English, Spanish

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.

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.

Keywords: Child neurodevelopment; Corporal punishment; Early child development; Responsive caregiving; Social-emotional connection.

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Conflict of interest statement

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

Figures

Figure 1
Figure 1. CONSORT Diagram of Participant Recruitment, Inclusion, and Analysis.
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