Barbara A. Schaefer

Prenatal Micronutrient Supplementation and Intellectual and Motor Function in Early School-aged Children in Nepal

CONTEXT Iron and zinc are important for the development of both intellectual and motor skills. Few studies have examined whether iron and zinc supplementation during gestation, a critical period of central nervous system development, affects childrens later functioning. OBJECTIVE To examine intellectual and motor functioning of children whose mothers received micronutrient supplementation during pregnancy. DESIGN, SETTING, AND PARTICIPANTS Cohort follow-up of 676 children aged 7 to 9 years in June 2007-April 2009 who had been born to women in 4 of 5 groups of a community-based, double-blind, randomized controlled trial of prenatal micronutrient supplementation between 1999 and 2001 in rural Nepal. Study children were also in the placebo group of a subsequent preschool iron and zinc supplementation trial. INTERVENTIONS Women whose children were followed up had been randomly assigned to receive daily iron/folic acid, iron/folic acid/zinc, or multiple micronutrients containing these plus 11 other micronutrients, all with vitamin A, vs a control group of vitamin A alone from early pregnancy through 3 months postpartum. These children did not receive additional micronutrient supplementation other than biannual vitamin A supplementation. MAIN OUTCOME MEASURES Childrens intellectual functioning, assessed using the Universal Nonverbal Intelligence Test (UNIT); tests of executive function, including go/no-go, the Stroop test, and backward digit span; and motor function, assessed using the Movement Assessment Battery for Children (MABC) and finger-tapping test. RESULTS The difference across outcomes was significant (Bonferroni-adjusted P < .001) for iron/folic acid vs control but not for other supplement groups. The mean UNIT T score in the iron/folic acid group was 51.7 (SD, 8.5) and in the control group was 48.2 (SD, 10.2), with an adjusted mean difference of 2.38 (95% confidence interval [CI], 0.06-4.70; P = .04). Differences were not significant between the control group and either the iron/folic acid/zinc (0.73; 95% CI, -0.95 to 2.42) or multiple micronutrient (1.00; 95% CI, -0.55 to 2.56) groups. In tests of executive function, scores were better in the iron/folic acid group relative to the control group for the Stroop test (adjusted mean difference in proportion who failed, -0.14; 95% CI, -0.23 to -0.04) and backward digit span (adjusted mean difference, 0.36; 95% CI, 0.01-0.71) but not for the go/no-go test. The MABC score was lower (better) in the iron/folic acid group compared with the control group but not after adjustment for confounders (mean difference, -1.47; 95% CI, -3.06 to 0.12; P = .07). Finger-tapping test scores were higher (mean difference, 2.05; 95% CI, 0.87-3.24; P = .001) in the iron/folic acid group. CONCLUSION Aspects of intellectual functioning including working memory, inhibitory control, and fine motor functioning among offspring were positively associated with prenatal iron/folic acid supplementation in an area where iron deficiency is prevalent. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00115271.

Learning Behavior and Intelligence as Explanations for Children's Scholastic Achievement.

This study assesses the unique and complementary ability of childhood intelligence and learning-related behavior to explain variation in achievement outcomes. Teacher-observed classroom learning behaviors and individually administered intelligence and achievement test performances were collected for a representative national sample (N = 1,100) of students ages 6–17 years. The sample was blocked for age, grade level, and gender, and stratified according to the U.S. Census by race/ethnicity, parent education level, national region, community size, family structure, and educational placement. Teacher-assigned grades were collected for a secondary national sample (N = 420). Hierarchical regression models revealed substantial proportions of assigned grade variance explained primarily by learning behavior and achievement test score variance explained by intelligence. Explanatory patterns remained consistent after control for demographics and alternative intellectual or behavioral variation, and the variance explained jointly by learning behavior, intelligence, and their interactions exceeded appreciably the contributions of any one source. Implications are discussed for educational assessment and intervention.

Generalizing Nigrescence Profiles Cluster Analyses of Cross Racial Identity Scale (CRIS) Scores in Three Independent Samples

The two studies in this article examine the interpretability and generalizability of nigrescence profiles based on Cross Racial Identity Scale scores across different educational contexts. Study 1 participants (N = 333) came from a predominantly White institution (PWI) and were grouped into six clusters labeled Afrocentric, multiculturalist, assimilated, immersion, low race salience, and miseducated variant. The two samples in Study 2 consisted of students from PWIs (N = 314) and from historically Black colleges and universities (HBCUs;N = 306), respectively. Both PWI and HBCU participants were grouped into five clusters. Four of the six original clusters (assimilated, immersion, low race salience, and miseducated variant) replicated in both samples, and one (multiculturalists) replicated only in the PWI sample. The results indicate that there are generalizable racial identity profiles in the Black population. The authors discuss the implications of the findings.

Preschool Micronutrient Supplementation Effects on Intellectual and Motor Function in School-aged Nepalese Children

OBJECTIVE To examine intellectual and motor functioning of children who received micronutrient supplementation from 12 to 35 months of age. DESIGN Cohort follow-up of children 7 to 9 years of age who participated in a 2 × 2 factorial, placebo-controlled, randomized trial from October 2001 through January 2006. SETTING Rural Nepal. PARTICIPANTS A total of 734 children 12 to 35 months of age at supplementation and 7 to 9 years of age at testing. INTERVENTIONS Children received iron plus folic acid (12.5 mg of iron and 50 μg of folic acid); zinc (10 mg); iron plus folic acid and zinc; or placebo. MAIN OUTCOME MEASURES Intellectual, motor, and executive function. RESULTS In both the unadjusted and adjusted analyses, iron plus folic acid supplementation had no effect overall or on any individual outcome measures being tested. In the unadjusted analysis, zinc supplementation had an overall effect, although none of the individual test score differences were significant. In the adjusted analysis, the overall difference was not significant. CONCLUSION In rural Nepal, we found that iron plus folic acid or zinc supplementation during the preschool years had no effect on aspects of intellectual, executive, and motor function at 7 to 9 years of age, suggesting no long-term developmental benefit of iron or zinc supplementation during 12 to 35 months of age.

Preschool Iron-Folic Acid and Zinc Supplementation in Children Exposed to Iron-Folic Acid in Utero Confers No Added Cognitive Benefit in Early School-Age

In Nepal, antenatal iron-folic acid supplementation improved aspects of intellectual, executive, and fine motor function among school-age children. We examined the impact of added zinc to the maternal antenatal supplement (M-IFAZn) and preschool supplementation from 12 to 36 mo with iron-folic acid (C-IFA) ± zinc (C-IFAZn) on cognitive outcomes compared to maternal iron-folic acid (M-IFA) alone. Children 7-9 y old (n = 780) who participated in early childhood micronutrient supplementation trial during 2001-2004 and whose mothers participated in an antenatal micronutrient supplementation between 1999 and 2001 were followed for cognitive assessments in 2007-2009. Using multivariate analysis of variance and adjusting for confounders, M-IFA with child supplementation (either C-IFA or C-IFAZn) did not impact scores on the tests of general intelligence (Universal Nonverbal Intelligence Test), and executive function (Stroop and go/no go tests) relative to the M-IFA alone. However, children in the C-IFAZn group had slightly lower scores on the backward digit span (-0.29, 95% CI: -0.55, -0.04) and Movement Assessment Battery for Children (1.33, 95% CI: 0.26, 2.40) relative to the referent group, whereas both C-IFA (-1.92, 95% CI: -3.12, -0.71) and C-IFAZn (-1.78, 95% CI: -2.63, -0.92) produced somewhat lower finger tapping test scores (fine motor skills). The combination of M-IFAZn and C-IFA or C-IFAZn did not lead to any outcome differences relative to M-IFA alone. Preschool iron-folic acid ± zinc to children exposed to iron-folic acid in utero or addition of zinc to maternal iron-folic acid conferred no additional benefit to cognitive outcomes assessed in early school age. The late timing of supplementation during preschool may explain the lack of impact of iron and/or zinc.

Agreement among classroom observers of children's stylistic learning behaviors

Standardized and reliable rating scales have an important role in educational assessment and behavioral classroom intervention. The Learning Behaviors Scale (LBS) is a standardized behavior rating scale designed to report how individual students respond to classroom learning situations. This study investigated the interobserver agreement of the LBS with the use of linear and intraclass correlation methods. The methods jointly assessed the three salient aspects of observer judgments—severity level, rank order, and directionality. Participants were 72 students enrolled in special education programs as observed by 16 educators in eight self-contained classrooms. Both linear and intraclass coefficients were substantial (averages = .83 and .84, respectively). No significant observer effect was found. Moreover, the LBS produced comparable levels of differential learning styles for assessments of individual children.

The MAL-ED Cohort Study: Methods and Lessons Learned When Assessing Early Child Development and Caregiving Mediators in Infants and Young Children in 8 Low- and Middle-Income Countries

More epidemiological data are needed on risk and protective factors for child development. In The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study, we assessed child development in a harmonious manner across 8 sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa, and Tanzania. From birth to 24 months, development and language acquisition were assessed via the Bayley Scales of Infant and Toddler Development and a modified MacArthur Communicative Development Inventory. Other measures were infant temperament, the childs environment, maternal psychological adjustment, and maternal reasoning abilities. We developed standard operating procedures and used multiple techniques to ensure appropriate adaptation and quality assurance across the sites. Test adaptation required significant time and human resources but is essential for data quality; funders should support this step in future studies. At the end of this study, we will have a portfolio of culturally adapted instruments for child development studies with examination of psychometric properties of each tool used.

Learning Behaviours, Attention and Anxiety in Caribbean Children Beyond the 'Usual Suspects' in Explaining Academic Performance

Research suggests learning-related behaviours, anxiety and attention may influence academic performance. This research, however, has been limited to children from industrialized countries. Studies of children in developing countries have usually concentrated on childrens cognitive abilities and home background. Contributions of learning behaviours, anxiety, attention problems, cognitive ability and home background to the academic performance of village children (N = 61; ages 6-12) on St Vincent, the West Indies, were investigated. Teachers provided academic scores and rated children using the Learning Behaviours Scale and using a modified version of the Revised Behaviour Problem Checklist. Childrens cognitive ability was assessed using the Raven Colored Progressive Matrices and their academic skills were assessed using a locally standardized achievement test. Stimulating home experiences, caregiver involvement, affluence and caregiver education were assessed using the MC-HOME Inventory and by interviews. Hierarchical regression indicated that anxiety, attention and learning-related behaviours explain 32-35 percent of the variance in academic scores. In contrast, home background and cognitive ability

The Factor Structure of Preschool Learning Behaviors Scale Scores in Peruvian Children

The factor structure of the Escala de Conductas de Aprendizaje Preescolar (ECAP), a Spanish translation of the Preschool Learning Behaviors Scale (PLBS), was examined in this study. Children aged 2 to 6 years (N = 328) enrolled in public and private preschools in the Republic of Peru were rated by classroom teachers on the frequency of observable, learning-related behaviors using the ECAP. Exploratory factor analyses identified three underlying dimensions of the scale: competence motivation, effortful strategy/flexibility, and attention. The three factor scores exhibited internal reliability coefficients above .70, and the alpha was .92 for the total score. La structure des facteurs de l’Escala de Conductas de Aprendizaje Preescolar (ECAP), une traduction en espagnol de la Preschool Learning Behaviors Scale (PLBS), a été examinée dans cette étude. Des enfants de l’âge de 2 à 6 ans (N = 328) inscrits dans des écoles maternelles publiques et privées au République du Pérou ont été évalués par des enseignants selon la fréquence de comportements observables relatifs à l’apprentissage, en utilisant l’ECAP. Des analyses factorielles exploratoires ont identifié trois dimensions qui sous-tendent cette échelle: la Motivation à la compétence, la Stratégie appliquée à l’effort/Flexibilité, Attention. Les scores des trois facteurs ont exhibé des coefficients de consistance interne au dessus de 0,70 et l’alpha était de 0,92 pour le score total.

Learning-related behaviours versus cognitive ability in the academic performance of Vincentian children

BACKGROUND The few studies of childrens academic performance in developing countries have largely focused on effects of early risks and cognitive ability and usually neglected other factors such as attention and anxiety. Previously, we reported that scores on the Learning Behaviour Scale (LBS) and the Revised Behaviour Problem Checklist (RBPC) were correlated with academic scores and achievement test scores for village children in St Vincent, the West Indies. AIMS We examined the stability of LBS and RBPC scores and their ability to predict academic and achievement scores in the same population. SAMPLE Vincentian village children, ages 6-12, participated in the study: 65 participated in the one-year sample and 68 participated in the two-year sample. METHOD Children completed a curriculum-based achievement test and the Raven Coloured Progressive Matrices. Teachers completed the LBS and an adjusted RBPC and reported childrens academic scores in 1998 and 1999. RESULTS LBS scores were stable over one year and RBPC scores were stable over two years. LBS, RBPC, and Raven scores predicted achievement and academic scores. For both academic scores and achievement test scores, the greatest improvement in prediction came when the RBPCs attention and anxiety subscales were added to regression models. CONCLUSIONS Results provide additional support for the finding that Caribbean village childrens academic performance is greatly influenced by attention and anxiety problems, not just their cognitive ability. Despite cultural differences, LBS and RBPC scores were as predictive of academic performance in this population as in American populations. The best way to improve academic performance for these children may be to reduce attention problems.