A global systematic review and meta-analysis

Abstract

Background

Parents are the primary caregivers of young children. Responsive parent–child relationships and parental support for learning during the earliest years of life are crucial for promoting early child development (ECD). We conducted a global systematic review and meta-analysis to evaluate the effectiveness of parenting interventions on ECD and parenting outcomes.

Methods and findings

We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for peer-reviewed, published articles from database inception until November 15, 2020. We included randomized controlled trials (RCTs) of parenting interventions delivered during the first 3 years of life that evaluated at least 1 ECD outcome. At least 2 reviewers independently screened, extracted data, and assessed study quality from eligible studies. ECD outcomes included cognitive, language, motor, and socioemotional development, behavior problems, and attachment. Parenting outcomes included parenting knowledge, parenting practices, parent–child interactions, and parental depressive symptoms. We calculated intervention effect sizes as the standardized mean difference (SMD) and estimated pooled effect sizes for each outcome separately using robust variance estimation meta-analytic approaches. We used random-effects meta-regression models to assess potential effect modification by country-income level, child age, intervention content, duration, delivery, setting, and study quality. This review was registered with PROSPERO (CRD42018092458 and CRD42018092461). Of the 11,920 articles identified, we included 111 articles representing 102 unique RCTs. Pooled effect sizes indicated positive benefits of parenting interventions on child cognitive development (SMD = 0.32, 95% CI [confidence interval]: 0.23, 0.40, P < 0.001), language development (SMD = 0.28, 95% CI: 0.18 to 0.37, P < 0.001), motor development (SMD = 0.24, 95% CI: 0.15 to 0.32, P < 0.001), socioemotional development (SMD = 0.19, 95% CI: 0.10 to 0.28, P < 0.001), and attachment (SMD = 0.29, 95% CI: 0.18 to 0.40, P < 0.001) and reductions in behavior problems (SMD = −0.13, 95% CI: −0.18 to −0.08, P < 0.001). Positive benefits were also found on parenting knowledge (SMD = 0.56, 95% CI: 0.33 to 0.79, P < 0.001), parenting practices (SMD = 0.33, 95% CI: 0.22 to 0.44, P < 0.001), and parent–child interactions (SMD = 0.39, 95% CI: 0.24 to 0.53, P < 0.001). However, there was no significant reduction in parental depressive symptoms (SMD = −0.07, 95% CI: −0.16 to 0.02, P = 0.08). Subgroup analyses revealed significantly greater effects on child cognitive, language, and motor development, and parenting practices in low- and middle-income countries compared to high-income countries; and significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent–child interactions for programs that focused on responsive caregiving compared to those that did not. On the other hand, there was no clear evidence of effect modification by child age, intervention duration, delivery, setting, or study risk of bias. Study limitations include considerable unexplained heterogeneity, inadequate reporting of intervention content and implementation, and varying quality of evidence in terms of the conduct of trials and robustness of outcome measures used across studies.

Conclusions

Parenting interventions for children during the first 3 years of life are effective for improving ECD outcomes and enhancing parenting outcomes across low-, middle-, and high-income countries. Increasing implementation of effective and high-quality parenting interventions is needed globally and at scale in order to support parents and enable young children to achieve their full developmental potential.

Author summary

Why was this study done?

  • Parenting interventions have been underscored as a key strategy for improving early child development (ECD) outcomes.
  • Although there are several existing reviews regarding the effectiveness of parenting interventions for improving ECD outcomes, prior reviews have focused narrowly on select types of parenting interventions, evaluated impacts on single ECD domain outcomes, included studies in either only high-income countries (HICs) or low- and middle-income countries (LMICs), and have not adequately explored treatment heterogeneity and potential moderators.

What did the researchers do and find?

  • We conducted a systematic review and meta-analysis of 102 randomized controlled trials of parenting interventions for children during the first 3 years of life that were implemented across a total of 33 countries.
  • We found that parenting interventions improved early child cognitive, language, motor, socioemotional development, and attachment and reduced behavior problems. Parenting interventions additionally improved parenting knowledge, parenting practices, and parent–child interactions. However, they did not significantly reduce parental depressive symptoms.
  • We found that parenting interventions had significantly greater effects on child cognitive, language, and motor development and parenting practices in LMICs than HICs (e.g., effect on cognitive development was 3 times greater in LMICs versus HICs). Parenting interventions that included content on responsive caregiving had significantly greater effects on child cognitive development, parenting knowledge, parenting practices, and parent–child interactions than interventions that did not include content on responsive caregiving (e.g., effect on parenting practices was nearly 4 times greater for interventions with responsive caregiving content versus those without responsive caregiving content).
  • We uncovered substantial variation in program content and implementation characteristics across studies and considerable heterogeneity in pooled effect size estimates across nearly all evaluated outcomes.

What do these findings mean?

  • To the best of our knowledge, this is the largest and most comprehensive global systematic review and meta-analysis that demonstrates the effectiveness of parenting interventions during the first 3 years of life on a wide range of ECD and parent-level outcomes.
  • Parenting programs are needed globally to enhance parent–child relationships and promote the healthy development of children during the earliest years of life.
  • Future research should unpack the observed variability in program components and implementation features used across parenting interventions and examine their associations with outcomes to inform improved delivery, effectiveness, and scale of parenting interventions for ECD.

Introduction

Globally, an estimated 250 million children under aged 5 years (43%) are at risk of not achieving their developmental potential in the earliest years of life due to a host of nutritional, health, and psychosocial risks [1–3]. Promotive interventions are particularly important in the first 3 years of life when the developing brain is most sensitive to experiences and the environment [4]. While various types of interventions including nutrition and health can support healthy development, recent evidence has revealed that parenting interventions that include components to directly enhance early child learning or strengthen parent–child relationships are more effective for improving early cognitive, language, motor, and socioemotional development [5–7].

Parenting interventions are social and behavioral programs intended to improve caregivers’ knowledge, attitudes, practices, and skills in order to promote optimal early child development (ECD) [8]. Parenting interventions can encompass a range of interventions targeting various risks, behaviors, or aspects of parent–child relationships, including interventions that focus on stimulation [6], shared book reading [9], attachment and parental sensitivity [10,11], behavior management [12,13], positive discipline and maltreatment prevention [14,15], and parental mental health [16,17]. These different types of parenting interventions have consistently shown benefits across a wide age range of children, and especially during early childhood [5,18].

Despite a significant rise over the past decade in the implementation and quality of parenting interventions globally, there has not been a recent review comprehensively synthesizing the latest state of the literature. One of the most recent and relevant reviews on parenting interventions during early childhood was published by Britto and colleagues [5] as part of The Lancet 2017 series on ECD. This review found significant small-to-medium sized benefits of parenting interventions on child cognitive (standardized mean difference (SMD) = 0.36, n = 19 studies), motor (SMD = 0.13, n = 9), and socioemotional development (SMD = 0.35, n = 13). However, this evidence synthesis was based on a review of 3 selected reviews published in 2014 [19] and 2015 [6,20] that focused only on ECD but not parenting outcomes and was limited to studies in low- and middle-income countries (LMICs). Another relevant review by Jeong, Pitchik, and Yousafzai [21] investigated the effectiveness of stimulation interventions during the first 3 years of life on parent-level outcomes and documented significant medium-to-large benefits on maternal knowledge (SMD = 0.91, n = 6), parenting practices (SMD = 0.57, n = 10), and mother–child interactions (SMD = 0.44, n = 3). No significant effect was observed for reducing maternal depressive symptoms (SMD = −0.10, n = 9). Yet this prior review focused specifically on stimulation interventions, examined effects on parenting but not ECD outcomes, and was also limited to LMICs.

While these and other reviews have underscored positive effects of particular types of parenting interventions on ECD outcomes [22,23], an updated review is overdue and needed to improve our current understanding of the effectiveness of parenting interventions during early childhood and generalizability of the evidence base. Additionally, little attention has been given previously to the role of intervention implementation characteristics as potential moderators of program effects on child or caregiving outcomes. Considering the diversity of contexts and populations in which parenting programs are implemented, there is a need to investigate whether certain implementation factors are associated with differential program effectiveness.

Therefore, the present study aimed to provide a comprehensive global review of the effectiveness of parenting interventions delivered during the first 3 years of life on both ECD and parent-level outcomes. This study updates, synthesizes, and expands on previous reviews by (1) adopting an inclusive definition of parenting interventions as those that aim to improve caregiver interactions, behaviors, knowledge, beliefs, attitudes, or practices with their children in order to improve ECD; (2) focusing on interventions targeting caregivers and children during the first 3 years of life; (3) considering a broad set of both ECD and caregiver outcomes; and (4) including studies across low-, middle-, and high-income countries. The primary aim was to quantify the pooled effectiveness of parenting interventions delivered during the first 3 years of life on ECD and parenting-related outcomes. The secondary aim was to explore whether effects on ECD and parenting outcomes differed by country income level, child age, intervention content, duration, delivery, setting, and study quality.

Methods

Search strategy and selection criteria

This systematic review and meta-analysis was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [24] (S1 PRISMA Checklist). Six electronic bibliographic databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library) were searched for articles published from database inception until May 15, 2019. The search was subsequently updated during the peer-review process to include articles published between May 16, 2019 to November 15, 2020. The search strategy (S1 Text) was informed by search terms and keywords used in prior systematic reviews related to parenting interventions [5,6,25] and through consultations with a research librarian. Reference lists of relevant studies and reviews were also scanned for any additional studies that may have been missed.

Full-text, peer-reviewed articles were included if they met the following criteria: (1) parenting interventions that aimed to improve interactions, behaviors, knowledge, beliefs, attitudes or practices of parents with their children in order to improve ECD; (2) evaluated using a randomized controlled study design; (3) targeted children and their parents during early childhood (pregnancy through the first 3 years of life); and (4) measured at least 1 ECD outcome after the completion of the intervention (or shortly thereafter). In this study, parents are broadly defined as the legal guardian, biological parent, or adult caregiver responsible for the well-being of the child [20]. Studies were excluded if they met any of the following criteria: (1) not a relevant parenting intervention focused on promoting ECD; (2) nonrandomized study design (e.g., quasi-experimental studies); (3) targeted a population of children who were, on average, older than 36 months; (4) targeted a population of children or parents who had a diagnosed illness or disability; and/or (5) did not measure at least 1 ECD outcome.

Titles and abstracts of all identified articles were independently screened by at least 2 reviewers (JJ, EF, and a team of graduate research assistants). If the title and abstract screening was insufficient for determining eligibility, the full-text article was reviewed for eligibility criteria. Any discrepancies between the 2 reviewers regarding the eligibility of a study were resolved through discussions among the reviewers, with input from another author (AKY) as needed until consensus was reached.

For studies meeting the eligibility criteria, full-text articles were reviewed. Data were extracted by JJ, EF, and a team of trained graduate research assistants using a prepiloted extraction form. JJ and EF trained the graduate research assistants over the course of a 3-week training period on how to use the data extraction sheet based on pilot exercises of relevant articles. Throughout the entire data extraction process, each data extraction completed by the research assistants was independently extracted by a second reviewer (JJ or EF), and any issues were discussed and resolved during the weekly in-person team meetings with the research assistants. For additional quality assurance, 35% of assigned articles were randomly selected for independent data extraction by a third reviewer (JJ or EF). Any discrepancies between the master reviewers (JJ and EF) regarding the extracted data were resolved through discussions and consensus together with an additional reviewer (AKY).

Outcomes

The primary outcomes were 6 domains of ECD: cognitive, language, motor, and socioemotional development, behavior problems, and attachment. These ECD outcome domains have been prioritized in previous work, commonly measured across global contexts, and are each unique aspects of child development during the first 3 years of life [26,27]. Moreover, each of these ECD outcome domains has shown predictive validity with later achievement, function, performance, or outcomes [27]. Measures of developmental disabilities (e.g., autism or ADHD) did not qualify as ECD outcomes. The secondary outcomes were 4 measures of parenting: parenting knowledge, parenting practices, parent–child interactions, and parental depressive symptoms.

Data analysis

Effect sizes on ECD and parenting outcomes were calculated as SMD between the intervention and comparison arms (e.g., no intervention, nonparenting intervention, standard of care), with respect to change in mean values from baseline to endline (when baseline values were reported) after standardization by their pooled standard deviation (SD). In multiarm studies, the comparison group was typically the intervention arm without any parenting components and/or the standard of care. For studies that reported outcomes from multiple follow-up waves of assessments, outcome measurements from the time point closest to the completion of the intervention were used for the analyses. The magnitude of effect sizes was interpreted in the context of public health, pediatric, and early education interventions and the practical significance with respect to the outcomes [28].

Each of the primary and secondary outcomes was examined in separate models. We used a robust variance estimation meta-analysis model [29] to account for multiple measurements per trial per outcome domain. This approach allows for the inclusion of any number of dependent effect size estimates from a given study to contribute to the pooled effect size estimate for an outcome, resulting in increased power and more precise estimates. For example, this approach was used to handle the separately reported effect sizes for receptive language and expressive language in a given study for overall language development or both internalizing and externalizing behaviors for overall child behavior problems. Pooled effect size estimates were based on random effects models. P values < 0.05 denoted statistical significance. Heterogeneity of the pooled effect size was assessed using the I2 statistic and the Cochran Q test and its P value.

Moderator analyses were conducted on all outcomes using random effects meta-regression models to explore potential sources of heterogeneity in the average effect by the following prespecified sample, intervention, and study characteristics: country-income level (LMICs or high-income countries (HICs)), average child age at baseline in months, whether the parenting intervention included a component to enhance responsive caregiving (see S1 Table for classification of responsive caregiving interventions) [25,30], intervention duration in months, delivery modality (individual, group, or both), setting (home, community, clinic, or combination), and study quality score. Study quality was assessed using the Cochrane Collaboration Risk of Bias Assessment Tool for randomized controlled trials (RCTs) [31]. Studies were rated as low risk (0 points), unclear risk (1 point), and high risk (2 points) for a total risk of bias score ranging from 0 to 16 [22,32]. For the continuous moderator variables, we generated a binary variable for child age at baseline and intervention duration (< or ≥12 months) and a binary study quality variable based on a mean split of the total risk of bias score (lower or higher risk of bias) and compared effect estimates according to these subgroups. Statistical significance for the moderator variables of country-income level, intervention content, delivery, and setting was determined from the Qbetween test statistic which was evaluated on the χ2 distribution. For the remaining moderator variables that were originally continuous measures (i.e., child age, intervention duration, and study quality score), statistical significance was determined from meta-regressions using the continuous measure (e.g., child age in months).

Publication bias was examined for each outcome analysis using the Egger’s regression test to test the null hypothesis of small-study bias (i.e., the extent to which less precise or smaller sample studies yield greater effects than larger sample studies) [33]. All analyses were conducted using Stata version 16. This review was preregistered with PROSPERO (CRD42018092458 and CRD42018092461). See S1 Protocol for the final review protocol used for the present study and notes regarding any changes made from the initial prospectively registered protocol.

Results

Study selection and inclusion

A total of 11,906 unique records were identified from electronic databases. Fourteen additional records were identified from article references and subject matter expertise. A total of 11,580 records were excluded based on title and abstract screening. The full texts of the remaining 340 articles were reviewed, and 229 articles were excluded for not meeting inclusion criteria. The final set comprised of 111 articles representing 102 unique RCTs (Fig 1).

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Fig 1. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram of search results and included studies.

doi:10.1371/journal.pmed.1003602.g001

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Sample, intervention, and study characteristics

Table 1 presents the characteristics of the 102 RCTs of parenting interventions. Trials were implemented across a total of 33 countries. The majority of trials were conducted in HICs (61 trials in 14 countries), compared to LMICs (41 trials in 19 countries). The most represented countries were the United States of America (40 trials), Bangladesh (8 trials), Jamaica (6 trials), and India (5 trials). Studies were published between 1974 and 2020. Analytic sample sizes ranged from 32 to 3,202 individuals. The average age of children at baseline varied across interventions: 16 trials (16%) enrolled pregnant mothers, 30 (29%) enrolled children with an average age of 3 months and younger, 24 (24%) enrolled children with an average age of 3 to 12 months, and 32 (31%) enrolled children who were on average older than 12 months. Intervention duration ranged from a brief intervention delivered over 1 month to longer interventions delivered across the first 5 years of the child’s life. Nearly all interventions (93%) focused on supporting mothers exclusively, with only 7 interventions (7%) additionally engaging fathers to some degree [34–40].

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Table 1. Characteristics of included parenting interventions.

doi:10.1371/journal.pmed.1003602.t001

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Out of the total 102 interventions, 70 (69%) had some degree of a responsive caregiving component that aimed to improve parent–child interactions. Of these responsive caregiving interventions, 37 interventions (53%) involved facilitators who observed live parent–child interactions and/or utilized video recordings in order to provide feedback for promoting parental sensitivity and responsiveness in the context of play, communication, reading, and/or feeding. The other 33 responsive caregiving interventions (47%) more generally aimed to improve the quality of parent–child interactions through guidance, demonstrations, and encouragement of parents to practice during sessions and on their own.

The remaining 32 interventions (31%) did not include responsive caregiving components. Of these, 22 (69%) provided general parenting support with information and guidance on child development and parenting topics, and 10 (31%) focused on increasing parental stimulation and/or provision of learning materials. Among the total 102 interventions, 45 (44%) also integrated messages beyond parenting for ECD, such as maternal and child nutrition, child health, caregiver mental health, and early education.

Interventions utilized a range of delivery models: 58 interventions (57%) were delivered to individual caregivers and families, 13 (13%) were exclusively group based, and 31 (30%) incorporated both individually delivered and group-based components. Delivery settings also varied. Nearly half or 47 interventions (46%) were delivered exclusively through home visits, 11 in a clinical or hospital context (11%), 11 in a community space (11%), and 32 interventions (31%) used a combination of multiple settings. One intervention was delivered virtually.

Risk of bias assessment

The total risk of bias score across all studies was moderate (mean = 5.1, SD = 1.5) ranging from 2 to 9 on a scale of 0 to 16. In general, risk of bias was low for random sequence generation, blinding of outcome assessors, and incomplete outcome data (S1 Fig). However, risk of bias for allocation concealment and selective reporting were unclear for the majority of studies. Given the nature of psychoeducational and behavioral parenting interventions that involve parents’ active participation, blinding of participants was not possible. Egger’s tests suggested evidence of small-sample bias for 2 out of the 10 outcomes: child language development, z = 2.74, P = 0.01; and parent–child interactions, z = 3.78, P < 0.001.

Effects on early child development outcomes

Fifty-eight studies provided a total of 58 effect sizes for children’s cognitive development. Approximately half of these studies (56%) reported any details regarding reliability or validity of the measure of cognitive development. The Bayley Scales of Infant and Toddler Development (BSID) [41] was the most commonly used measure in more than half the studies (54%). See S2 Table for full list of measures used for each of the outcomes. The pooled result showed a moderate positive impact of parenting interventions on improving cognitive development (SMD = 0.32, 95% CI: 0.23, 0.40, P < 0.001; I2 = 89%, P < 0.001; Fig 2).

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Fig 2. Forest plot for the effect of parenting interventions on cognitive development.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

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Forty-six studies provided a total of 58 effect sizes for children’s language development. Approximately half of these studies (57%) reported any details regarding reliability or validity of the measure of language development. The BSID (25%) and the MacArthur-Bates Communicative Development Inventory (14%) were the most commonly used measures. The pooled result showed a moderate positive impact on improving language development (SMD = 0.28, 95% CI: 0.18, 0.37, P < 0.001; I2 = 91%, P < 0.001; Fig 3).

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Fig 3. Forest plot for the effect of parenting interventions on language development.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g003


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Thirty-five studies provided a total of 45 effect sizes for children’s motor development. Approximately half of these studies (56%) reported any details regarding reliability or validity of the measure of motor development. The BSID was the most commonly used measure in more than half the studies (56%). The pooled result showed a moderate positive impact on improving motor development (SMD = 0.24, 95% CI: 0.15, 0.32, P < 0.001; I2 = 84%, P < 0.001; Fig 4).

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Fig 4. Forest plot for the effect of parenting interventions on motor development.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g004


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Twenty-nine studies provided a total of 31 effect sizes for children’s socioemotional development. Nearly 2 in 5 studies (38%) reported any details regarding reliability or validity of the measure of socioemotional development. All measures were caregiver reported and most commonly included the Ages and Stages Questionnaire [42] (16%), Ages and Stages Questionnaire: Social-Emotional [43] (13%), and the Brief Infant–Toddler Social and Emotional Assessment [44] (13%). The pooled result showed a small positive impact on improving socioemotional development (SMD = 0.19, 95% CI: 0.10, 0.28, P < 0.001; I2 = 81%, P < 0.001; Fig 5).

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Fig 5. Forest plot for the effect of parenting interventions on socioemotional development.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

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Twenty-nine studies provided a total of 35 effect sizes for children’s behavior problems. Nearly half of the studies (47%) reported any details regarding reliability or validity of the measure of behavioral problems. All measures were caregiver reported, and the Child Behavior Checklist [45] was the most commonly used measure in more than half the studies (53%). The pooled result showed a small impact on reducing behavior problems (SMD = −0.13, 95% CI: −0.18, −0.08, P < 0.001; I2 = 53%, P < 0.001; Fig 6).

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Fig 6. Forest plot for the effect of parenting interventions on behavior problems.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

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Eleven studies provided a total of 11 effect sizes for infant–caregiver attachment. The majority of studies (85%) reported any details regarding reliability or validity of the measure of attachment. The Ainsworth Strange Situation Procedure [46] was the most commonly used measure in 2 out of 5 studies (38%). The pooled result showed a moderate positive impact on improving attachment (SMD = 0.29, 95% CI: 0.18, 0.40, P < 0.001; I2 = 0%, P = 0.92; Fig 7).

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Fig 7. Forest plot for the effect of parenting interventions on attachment.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g007


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Effects on parenting outcomes

Sixty-four studies (63%) measured at least 1 parenting outcome, and 35 studies (34%) measured 2 or more parenting outcomes. Sixteen studies provided a total of 16 effect sizes for parenting knowledge. Less than half of studies (44%) reported any details regarding reliability or validity of the measure of parenting knowledge. Nearly all studies (88%) used a knowledge questionnaire that was developed by the authors. The pooled result showed a large positive impact on improving parenting knowledge (SMD = 0.56, 95% CI: 0.33, 0.79, P < 0.001; I2 = 97%, P < 0.001; Fig 8).

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Fig 8. Forest plot for the effect of parenting interventions on parenting knowledge.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g008


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Thirty-five studies provided a total of 40 effect sizes for parenting practices. Two-thirds of studies (66%) reported any details regarding reliability or validity of the measure of parenting practices. The Home Observation of Measurement of the Environment Inventory-Infant and Toddler version [47] was the most commonly used measure in more than half of studies (58%). The pooled result showed a moderate positive impact on improving parenting practices (SMD = 0.33, 95% CI: 0.22, 0.44, P < 0.001; I2 = 93%, P < 0.001; Fig 9).

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Fig 9. Forest plot for the effect of parenting interventions on parenting practices.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g009


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Twenty-seven studies provided a total of 27 effect sizes for parent–child interactions. Three in four studies (77%) reported any details regarding reliability or validity of the measure of parent–child interactions. Nearly all studies directly observed and coded quality of mother–child interactions (91%). The pooled result showed a moderate positive impact on improving parent–child interactions (SMD = 0.39, 95% CI: 0.24, 0.53, P < 0.001; I2 = 93%, P < 0.001; Fig 10).

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Fig 10. Forest plot for the effect of parenting interventions on parent–child interactions.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g010


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Twenty-four studies provided a total of 25 effect sizes for parental depressive symptoms. More than half of studies (59%) reported any details regarding reliability or validity of the measure of depressive symptoms. The Center for Epidemiologic Studies Depression Scale [48] was the most commonly used measure in 2 out of 5 studies (41%). The pooled result did not indicate a significant reduction in caregiver depressive symptoms (SMD = −0.07, 95% CI: −0.16, 0.02, P = 0.08; I2 = 76%, P < 0.001; Fig 11).

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Fig 11. Forest plot for the effect of parenting interventions on parental depressive symptoms.

Blue squares represent the SMD for each study, with the size of the square being proportional to the study weight. The whiskers extending from each side of the square represent the range of the 95% CI. The green diamond shows the overall pooled effect size using a random-effects model, which is centered at the point estimate and the diamond width representing the 95% CI. SMD, standardized mean difference.

doi:10.1371/journal.pmed.1003602.g011


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Moderator analyses

Given the large observed heterogeneity across all but one of the pooled effect size estimates, we conducted several moderator analyses to investigate potential sources of this heterogeneity. Tables 2 and 3 present the effects on ECD and parenting outcomes, respectively, stratified by the 7 characteristics: country-income level, average child age at baseline, intervention content, intervention duration, delivery, setting, and study quality. Parenting interventions had a greater effect on child cognitive, language, and motor development and parenting practices in LMICs compared to HICs, and the subgroup differences for these outcomes were statistically significant (e.g., effects on cognitive development: SMD = 0.41, 95% CI: 0.29, 0.53 in LMICs versus SMD = 0.17, 95% CI: 0.10, 0.22 in HICs; P < 0.001 for difference between subgroups; Table 2). Although effects on child socioemotional development, parenting knowledge, parent−child interactions, and parental depressive symptoms did not significantly differ by country-income level, the magnitudes of the estimates were consistently greater for all outcomes in LMICs versus HICs (Table 3).

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Table 2. Subgroup results for the effect of parenting interventions on early child development outcomes stratified by study characteristics.

doi:10.1371/journal.pmed.1003602.t002

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Table 3. Subgroup results for the effect of parenting interventions on parenting outcomes stratified by study characteristics.

doi:10.1371/journal.pmed.1003602.t003

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Parenting interventions that promoted responsive caregiving had significantly greater effects on child cognitive development, parenting knowledge, practices, and parent–child interactions compared to interventions without responsive caregiving (e.g., effects on parenting practices: SMD = 0.42, 95% CI: 0.29, 0.56 for interventions with responsive caregiving components versus SMD = 0.11, 95% CI: 0.01, 0.22 for those without; P = 0.001 for difference between subgroups; Table 3). With the exceptions of greater subgroup effects on cognitive development for programs targeting children older than 12 months of age and greater effects on parenting practices for programs less than 12 months in duration, there were no other subgroup differences on any outcomes by child age, intervention duration, delivery, setting, or study risk of bias score (Tables 2 and 3).

Discussion

To the best of our knowledge, this is the largest and most comprehensive systematic review and meta-analysis that synthesized 102 parenting interventions delivered during early childhood from across 33 countries and estimated the effectiveness on a wide range of ECD and caregiving outcomes. We found that parenting interventions delivered during the first 3 years of life improved early child cognitive, language, motor, and socioemotional development, and attachment, and reduced behavior problems. Parenting interventions additionally improved parenting knowledge, parenting practices, and parent–child interactions; however, they did not significantly reduce parental depressive symptoms. Our findings extend prior evidence in 4 key ways.

First, previous reviews of parenting interventions delivered during early childhood have focused on the effectiveness of select types of parenting interventions on 1 or 2 developmental outcomes [6,49]. We conducted the most comprehensive synthesis that evaluates intervention effects on 6 distinct child development outcomes that are most relevant to children during the earliest years of life. Overall, pooled effect sizes were relatively greater for cognitive, language, and motor development and attachment, but smaller for socioemotional development and behavior problems. Greater estimated pooled effects on cognitive, language, and motor development are consistent with the strategies used in the majority of reviewed parenting interventions that focused largely on increasing early play and learning opportunities—such as through caregiver engagement in stimulation activities or enhanced verbal responsiveness—which are directly related to these particular outcomes. In contrast, the smaller observed effects on socioemotional development and behavior problems are likely because fewer of the reviewed parenting interventions incorporated program components directly related to the commonly assessed outcome domains such as emotional competence or externalizing problem behaviors.

In order to effectively improve child socioemotional development and reduce behavior problems, interventions require evidence-based curriculum content and strategies that are grounded in social learning theory, such as supporting caregivers’ behavioral management skills, addressing parental mental health, and encouraging nonviolent discipline [23,50]. Yet, most parenting programs for socioemotional and behavioral development to date have been commonly delivered for preschool-aged children rather than young children during the earliest years of life [23]. New intervention models are needed in order to more effectively improve early child socioemotional and behavioral development particularly for young children during infancy and early childhood. Part of this effort will require establishing standardized measurement tools for assessing socioemotional development and behavioral problems that can be used reliably and cross-culturally in the context of interventions with young children [51].

Second, we analyzed the impact of parenting interventions on parents themselves and found improvements in parenting knowledge, parenting practices, and parent–child interactions. However, 40% of studies aimed at improving ECD did not measure a single parenting outcome. Given that the primary focus of parenting interventions is to support parents and improve the caregiving environment, it is critical to measure parenting as a way of understanding how interventions impact ECD [21,52]. More mediation analyses are needed to empirically substantiate program theories of change and identify the key caregiving mechanisms by which parenting programs lead to improved ECD outcomes [36,53–55].

We found little evidence to support that parenting interventions reduced parental depressive symptoms. By covering a broader set of parenting interventions and including studies in HICs, our results extend the findings of a prior meta-analysis that found that stimulation interventions did not significantly reduce maternal depressive symptoms in LMICs [21]. This overall null effect on depressive symptoms is likely due to the fact that few of the parenting interventions had an explicit psychological component to address parental mental health. However, one notable exception was a parenting group intervention in Uganda that integrated sessions on not only stimulation and responsive caregiving but also parental emotion regulation, coping strategies, and principles of cognitive behavioral therapy. This intervention found medium-sized reductions in maternal depression [36]. While bundling multiple components together (e.g., mental health and parenting) to create intervention packages is recommended in the literature [5], additional research is needed to determine the independent and additive benefits of particular components (e.g., those that target mental health versus parenting) in order to optimize intervention effects on outcomes.

In spite of the observational evidence that fathers are critically important for ECD [56], only 7 parenting interventions in this review (7%) engaged fathers to some degree [34–40], and only 1 study measured paternal outcomes from fathers directly (who only comprised 5% of the respondents in this study) [39]. A prior review has drawn attention to the limited number of parenting interventions with fathers and the program implementation barriers that limit fathers’ participation in parenting interventions across global contexts [57]. More research is needed to determine how to optimize the design and delivery of parenting programs so that they are inclusive of fathers and can achieve benefits for maternal and paternal parenting and ECD [58].

Third, moderator analyses showed that parenting interventions had greater effects in LMICs compared to HICs for improving child cognitive, language, and motor development and parenting practices. Parents and children in LMICs are more likely to be exposed to additional risk factors that constrain nurturing care and ECD (e.g., low parental education, malnutrition, fewer early learning opportunities) [3,59], such that support for parenting may be more beneficial in low-resource contexts. More research is needed to understand whether and how variation in risk profiles within populations may influence the degree of benefits from a parenting intervention [60]. It is worth noting that none of the included studies directly compared the same intervention program in a LMIC and HIC. As a result, it is possible that these subgroup results may also, in part, be confounded by other differences in intervention design and implementation between LMICs and HICs.

Regarding intervention content, we found that those with responsive caregiving components had significantly greater impacts on child cognitive development, parenting practices, and parent–child interactions, compared to interventions that did not include responsive caregiving content. These results underscore the importance of not only increasing early play and learning materials (e.g., provision of homemade toys), which have traditionally been the focus of parenting intervention for young children especially in LMICs, but also incorporating program components that directly support parental sensitivity and responsiveness [25,61].

At the same time, we did not find evidence to suggest that child age, intervention duration, delivery modality, or setting moderated intervention effects on more than one outcome. The lack of statistically significant subgroup results by child age are consistent with the few prior meta-analyses that have similarly shown no age effects among parenting interventions focused during early childhood [9,22] or spanning broader age ranges from early to middle childhood [49] or birth to age 18 [62]. Despite strong neuroscience and economic arguments for intervening as early in life as possible [4,63], our review suggests that parental engagement and support programs may indeed have universal benefits on child and parent outcomes irrespective of child age or the timing of introduction.

Furthermore, the lack of statistically significant subgroup results by program duration, delivery modality, and setting are also consistent with the few prior meta-analyses that have conducted similar analyses and shown no associations between these program aspects and intervention effects on ECD and parent-level outcomes [62]. One recently published cluster RCT specifically compared the effectiveness of weekly home visits to weekly mother–child group sessions over a 2-year period in rural India [64]. Trial results revealed that group sessions were as effective as home visits in improving child cognition and language, and both delivery models similarly had null impacts on child motor, socioemotional, behavior development, and parenting knowledge and practices. Of note, cost analysis revealed that the group-based model required a quarter of the costs compared to home visiting. Nevertheless, our findings suggest that there are various effective implementation strategies and program models that can be used to deliver parenting interventions and achieve positive impacts on ECD and parent outcomes. Decisions regarding program duration, delivery modality, and setting should be determined based on the existing resources and systems, community needs, risk profiles of the population, and cultural context.

In summary, our study had several strengths. These include the comprehensive review of RCTs conducted in LMICs and HICs, the investigation of multiple child development and caregiver outcomes, the large number of studies and participants represented, and the various moderator analyses conducted to explore potential features associated with intervention effectiveness. At the same time, there are a number of limitations that should be noted. First, there was considerable unexplained heterogeneity in the pooled effects across outcomes. Future research should further explore heterogeneity in treatment effects by other program factors (e.g., content, theoretical goals, behavior change techniques) and intervention implementation features (e.g., dosage, fidelity, population risk profiles, supervision and training provided to delivery agents). Considering the generally inadequate reporting of intervention details that we identified across the majority of studies, future trials should use standardized guidelines such as CARE [65] and TIDieR [66] for common reporting of intervention content and implementation to facilitate more nuanced comparisons and subgroup analyses. Second, our review focused on parenting interventions for children during the first 3 years of life. As a result, other relevant parenting interventions with preschool-aged children [67,68] or those covering a broader age range of children (e.g., 2- to 6-year-olds) [69,70] were excluded, which limits the generalizability of our results. Third, the reporting of the psychometric properties of measures (e.g., reliability and validity evidence, adaptation procedures) was highly variable across studies, with many studies not reporting any such details. Measures of ECD and parenting ranged widely from validated and adapted assessments to unstandardized measures, which may affect comparability across studies and robustness of findings. Fourth, our meta-analysis involved 6 ECD outcomes and 4 parent-level outcomes and 7 moderator variables, which raises the issue of statistical multiplicity and the increased risk for false positive findings in our estimates of pooled effect sizes and subgroup analyses. Although we used robust variance estimation to address multiplicity and statistical dependencies, this method might raise issues of disproportionate influence from studies that contribute a large number of effect sizes relative to those that contribute fewer, and particularly when the overall number of studies and effect sizes is relatively small [71]. Future reviews should apply additional methods to address issues of multiplicity. Fifth, we found evidence suggesting small-sample bias for 2 outcomes (child language and parent–child interactions) based on the results of Egger’s tests. Future reviews should include searches of grey literature, regional databases, and in multiple languages to improve the global coverage and reduce publication bias in the evidence base.

Finally, our review also highlighted other broader issues with regard to risk of bias in the design, conduct, and reporting of parenting intervention trials. Specifically, the majority of trials had potential concerns of selection bias due to inadequate details about what methods were used to conceal the allocation sequence before assignment to determine whether intervention allocations could have been foreseen before or during enrolment. Additionally, the majority of trials were not preregistered and did not have a study protocol of prespecified outcomes to assess whether selective outcome reporting bias or selective analysis reporting bias was present. Selective reporting bias, especially of null results, may additionally contribute to the publication bias detected for some of the outcomes. In light of our findings, future trials of parenting interventions should preregister primary and secondary outcomes and their scoring methods in study protocols, report all analyzed outcomes regardless of statistical significance levels, and provide adequate descriptions in publications not only regarding random sequence generation but also the allocation concealment process to especially improve the quality of this body of evidence.

Conclusions

Parenting interventions during the first 3 years of childhood are effective for improving ECD and caregiving. In the last decade, there has been considerable policy attention on ECD globally [8]. The United Nation’s Sustainable Development Goal Target 4.2 is to ensure that all girls and boys have access to quality early childhood development, care, and education services [72]. However, the current policy landscape for ECD has not yet resulted in greater investments and implementation of large-scale national parenting programs. More implementation science research regarding how to adapt and deliver parenting programs across diverse local contexts, coordinate within existing systems and services, finance programs so that they are cost-effective and sustainable, and scale parenting programs while maintaining quality and effectiveness is needed to accelerate political will and action. Finally, while the present review supports robust immediate benefits of parenting interventions during early childhood, more follow-up studies of individual trials are needed to determine whether there are sustained, longer-term effects for children and caregivers over the life course [73]. Greater knowledge regarding the sustainability or fadeout of effects can guide the design and packaging of improved parenting programs, such as the integration of subsequent “booster” sessions that can potentially further support children and caregivers’ evolving needs and sustain intervention benefits over the life course.

References

  1. 1.
    Lu C, Black MM, Richter LM. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health. 2016;4(12):e916–e22. Epub 2016/10/09. doi: 10.1016/S2214-109X(16)30266-2 pmid:27717632.
  2. 2.
    Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369(9556):145–57. Epub 2007/01/16. doi: 10.1016/S0140-6736(07)60076-2 pmid:17223478.
  3. 3.
    Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011;378(9799):1325–38. Epub 2011/09/29. doi: 10.1016/S0140-6736(11)60555-2 pmid:21944375.
  4. 4.
    Shonkoff JP, Richter L, van der Gaag J, Bhutta ZA. An integrated scientific framework for child survival and early childhood development. Pediatrics. 2012;129(2):e460–72. Epub 2012/01/06. doi: 10.1542/peds.2011-0366 pmid:22218840.
  5. 5.
    Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, et al. Nurturing care: Promoting early childhood development. Lancet. 2017;389(10064):91–102. doi: 10.1016/S0140-6736(16)31390-3 pmid:27717615.
  6. 6.
    Aboud FE, Yousafzai AK. Global health and development in early childhood. Annu Rev Psychol. 2015;66:433–57. Epub 2014/09/10. doi: 10.1146/annurev-psych-010814-015128 pmid:25196276.
  7. 7.
    Prado EL, Larson LM, Cox K, Bettencourt K, Kubes JN, Shankar AH. Do effects of early life interventions on linear growth correspond to effects on neurobehavioural development? A systematic review and meta-analysis. Lancet Glob Health. 2019;7(10):e1398–e413. Epub 2019/09/21. doi: 10.1016/S2214-109X(19)30361-4 pmid:31537370.
  8. 8.
    Black MM, Walker SP, Fernald LCH, Andersen CT, DiGirolamo AM, Lu C, et al. Early childhood development coming of age: science through the life course. Lancet. 2017;389(10064):77–90. doi: 10.1016/S0140-6736(16)31389-7 pmid:27717614.
  9. 9.
    Dowdall N, Melendez-Torres GJ, Murray L, Gardner F, Hartford L, Cooper PJ. Shared Picture Book Reading Interventions for Child Language Development: A Systematic Review and Meta-Analysis. Child Dev. 2019. Epub 2019/02/10. doi: 10.1111/cdev.13225 pmid:30737957.
  10. 10.
    Wright B, Hackney L, Hughes E, Barry M, Glaser D, Prior V, et al. Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions. PLoS ONE. 2017;12(7):e0180858. Epub 2017/07/15. doi: 10.1371/journal.pone.0180858 pmid:28708838.
  11. 11.
    Bakermans-Kranenburg MJ, Van Ijzendoorn MH, Juffer F. Less is more: meta-analyses of sensitivity and attachment interventions in early childhood. Psychol Bull. 2003;129(2):195–215. doi: 10.1037/0033-2909.129.2.195. pmid:12696839
  12. 12.
    Leijten P, Melendez-Torres GJ, Gardner F, van Aar J, Schulz S, Overbeek G. Are Relationship Enhancement and Behavior Management “The Golden Couple” for Disruptive Child Behavior? Two Meta-analyses. Child Dev. 2018;89(6):1970–82. doi: 10.1111/cdev.13051. pmid:29557553
  13. 13.
    Moon DJ, Damman JL, Romero A. The Effects of Primary Care-Based Parenting Interventions on Parenting and Child Behavioral Outcomes: A Systematic Review. Trauma Violence Abuse. 2020;21(4):706–24. Epub 2018/08/02. doi: 10.1177/1524838018774424 pmid:30064299.
  14. 14.
    Chen M, Chan KL. Effects of Parenting Programs on Child Maltreatment Prevention: A Meta-Analysis. Trauma Violence Abuse. 2016;17(1):88–104. Epub 2015/01/13. doi: 10.1177/1524838014566718 pmid:25573846.
  15. 15.
    McCoy A, Melendez-Torres GJ, Gardner F. Parenting interventions to prevent violence against children in low- and middle-income countries in East and Southeast Asia: A systematic review and multi-level meta-analysis. Child Abuse Negl. 2020;103:104444. Epub 2020/03/15. doi: 10.1016/j.chiabu.2020.104444 pmid:32171126.
  16. 16.
    Letourneau NL, Dennis C-L, Cosic N, Linder J. The effect of perinatal depression treatment for mothers on parenting and child development: A systematic review. Depress Anxiety. 2017;34(10):928–66. doi: 10.1002/da.22687. pmid:28962068
  17. 17.
    Acri MC, Hoagwood KE. Addressing parental mental health within interventions for children: A review. Res Soc Work Pract. 2015;25(5):578–86. doi: 10.1177/1049731514546027. pmid:26527857
  18. 18.
    Engle PL, Fernald LC, Alderman H, Behrman J, O’Gara C, Yousafzai A, et al. Strategies for reducing inequalities and improving developmental outcomes for young children in low-income and middle-income countries. Lancet. 2011;378(9799):1339–53. Epub 2011/09/29. doi: 10.1016/S0140-6736(11)60889-1 pmid:21944378.
  19. 19.
    Rao N, Sun J, Wong J, Weekes B, Ip P, Shaeffer S, et al. Early childhood development and cognitive development in developing countries: A rigorous literature review. Department for International Development. 2014.
  20. 20.
    Britto PR, Ponguta LA, Reyes C, Karnati R. A systematic review of parenting programmes for young children in low-and middle-income countries. New York, NY: United Nations Children’s Fund, 2015.
  21. 21.
    Jeong J, Pitchik HO, Yousafzai AK. Stimulation Interventions and Parenting in Low- and Middle-Income Countries: A Meta-analysis. Pediatrics. 2018;141(4). Epub 2018/03/04. doi: 10.1542/peds.2017-3510 pmid:29500293.
  22. 22.
    Roberts MY, Curtis PR, Sone BJ, Hampton LH. Association of Parent Training With Child Language Development: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(7):671–80. Epub 2019/05/21. doi: 10.1001/jamapediatrics.2019.1197 pmid:31107508.
  23. 23.
    Barlow J, Bergman H, Kornor H, Wei Y, Bennett C. Group-based parent training programmes for improving emotional and behavioural adjustment in young children. Cochrane Database Syst Rev. 2016;(8):CD003680. Epub 2016/08/02. doi: 10.1002/14651858.CD003680.pub3 pmid:27478983.
  24. 24.
    Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535. pmid:19622551
  25. 25.
    Eshel N, Daelmans B, de Mello MC, Martines J. Responsive parenting: interventions and outcomes. Bull World Health Organ. 2006;84(12):991–8. Epub 2007/01/24. doi: 10.2471/blt.06.030163 pmid:17242836.
  26. 26.
    Aboud FE, Yousafzai AK. Very Early Childhood Development. Disease Control Priorities, Third Edition (Volume 2): Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities: The World Bank; 2016. p. 241–61.
  27. 27.
    Fernald LC, Prado E, Kariger P, Raikes A. A Toolkit for Measuring Early Childhood Development in Low- and Middle-Income Countries. Washington, DC: The World Bank, 2017.
  28. 28.
    Durlak JA. How to Select, Calculate, and Interpret Effect Sizes. J Pediatr Psychol. 2009;34(9):917–28. doi: 10.1093/jpepsy/jsp004. pmid:19223279
  29. 29.
    Tanner-Smith EE, Tipton E. Robust variance estimation with dependent effect sizes: practical considerations including a software tutorial in Stata and spss. Res Synth Methods. 2014;5(1):13–30. Epub 2014/03/01. doi: 10.1002/jrsm.1091 pmid:26054023.
  30. 30.
    Black MM, Aboud FE. Responsive Feeding Is Embedded in a Theoretical Framework of Responsive Parenting. J Nutr. 2011;141(3):490–4. doi: 10.3945/jn.110.129973. pmid:21270366
  31. 31.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. Epub 2011/10/20. doi: 10.1136/bmj.d5928 pmid:22008217.
  32. 32.
    Dunning DL, Griffiths K, Kuyken W, Crane C, Foulkes L, Parker J, et al. Research Review: The effects of mindfulness-based interventions on cognition and mental health in children and adolescents—a meta-analysis of randomized controlled trials. J Child Psychol Psychiatry. 2019;60(3):244–58. Epub 2018/10/23. doi: 10.1111/jcpp.12980 pmid:30345511.
  33. 33.
    Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. Epub 1997/10/06. doi: 10.1136/bmj.315.7109.629 pmid:9310563.
  34. 34.
    Walkup JT, Barlow A, Mullany BC, Pan W, Goklish N, Hasting R, et al. Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. J Am Acad Child Adolesc Psychiatry. 2009;48(6):591–601. Epub 2009/05/21. doi: 10.1097/CHI.0b013e3181a0ab86 pmid:19454915.
  35. 35.
    Van Zeijl J, Mesman J, Van IMH, Bakermans-Kranenburg MJ, Juffer F, Stolk MN, et al. Attachment-based intervention for enhancing sensitive discipline in mothers of 1- to 3-year-old children at risk for externalizing behavior problems: a randomized controlled trial. J Consult Clin Psychol. 2006;74(6):994–1005. Epub 2006/12/13. doi: 10.1037/0022-006X.74.6.994 pmid:17154730.
  36. 36.
    Singla DR, Kumbakumba E, Aboud FE. Effects of a parenting intervention to address maternal psychological wellbeing and child development and growth in rural Uganda: A community-based, cluster randomised trial. Lancet Glob Health. 2015;3(8):e458–e69. Epub 2015/07/07. doi: 10.1016/S2214-109X(15)00099-6 pmid:26144389.
  37. 37.
    Kalinauskiene L, Cekuoliene D, Van Ijzendoorn MH, Bakermans-Kranenburg MJ, Juffer F, Kusakovskaja I. Supporting insensitive mothers: the Vilnius randomized control trial of video-feedback intervention to promote maternal sensitivity and infant attachment security. Child Care Health Dev. 2009;35(5):613–23. Epub 2009/03/28. doi: 10.1111/j.1365-2214.2009.00962.x pmid:19323672.
  38. 38.
    Johnson DL, Leler H, Rios L, Brandt L, Kahn AJ, Mazeika E, et al. The Houston Parent-Child Development Center: a parent education program for Mexican-American families. Am J Orthopsychiatry. 1974;44(1):121–8. Epub 1974/01/01. doi: 10.1111/j.1939-0025.1974.tb00876.x pmid:4809577.
  39. 39.
    Abimpaye M, Dusabe C, Nzabonimpa JP, Ashford R, Pisani L. Improving parenting practices and development for young children in Rwanda: Results from a randomized control trial. Int J Behav Dev. 2019;44(3):205–15. doi: 10.1177/0165025419861173.
  40. 40.
    Ara G, Khanam M, Papri N, Nahar B, Kabir I, Sanin KI, et al. Peer Counseling Promotes Appropriate Infant Feeding Practices and Improves Infant Growth and Development in an Urban Slum in Bangladesh: A Community-Based Cluster Randomized Controlled Trial. Curr Dev Nutr. 2019;3(7):nzz072. Epub 2019/07/25. doi: 10.1093/cdn/nzz072 pmid:31334480.
  41. 41.
    Bayley N. Bayley scales of infant and toddler development: PsychCorp, Pearson; 2006.
  42. 42.
    Squires J, Bricker DD. Ages & Stages Questionnaires: A Parent-Completed Child Monitoring System. Baltimore, MD.: Paul H. Brookes; 2009.
  43. 43.
    Squires J, Bricker D, Twombly E. Ages and stages questionnaires: Social-emotional. Baltimore: Brookes. 2002.
  44. 44.
    Briggs-Gowan MJ, Carter AS, Irwin JR, Wachtel K, Cicchetti DV. Brief Infant-Toddler Social and Emotional Assessment (BITSEA) Manual, version 2.0. 2002.
  45. 45.
    Achenbach TM. The Child Behavior Checklist and related instruments. The use of psychological testing for treatment planning and outcomes assessment, 2nd ed. Mahwah, NJ, US: Lawrence Erlbaum Associates Publishers; 1999. p. 429–66.
  46. 46.
    Ainsworth MDS, Blehar MC, Waters E, Wall S. Patterns of Attachment: A Psychological Study of the Strange Situation. Hillsdale, Lawlence Erlbaum Associates. 1978.
  47. 47.
    Caldwell B, Bradley R. Home Observation for Measurement of the Environment: Administration manual. Little Rock, AR: University of Arkansas; 2003.
  48. 48.
    Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Measur. 1977;1(3):385–401.
  49. 49.
    Gardner F, Leijten P, Melendez-Torres GJ, Landau S, Harris V, Mann J, et al. The Earlier the Better? Individual Participant Data and Traditional Meta-analysis of Age Effects of Parenting Interventions. Child Dev. 2019;90(1):7–19. Epub 2018/09/15. doi: 10.1111/cdev.13138 pmid:30216433.
  50. 50.
    Kaminski JW, Valle LA, Filene JH, Boyle CL. A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol. 2008;36(4):567–89. Epub 2008/01/22. doi: 10.1007/s10802-007-9201-9 pmid:18205039.
  51. 51.
    Halle TG, Darling-Churchill KE. Review of measures of social and emotional development. J Appl Dev Psychol. 2016;45:8–18. https://doi.org/10.1016/j.appdev.2016.02.003.
  52. 52.
    Aboud FE, Prado EL. Measuring the implementation of early childhood development programs. Ann N Y Acad Sci. 2018;1419(1):249–63. Epub 2018/05/24. doi: 10.1111/nyas.13642 pmid:29791725.
  53. 53.
    Guttentag CL, Landry SH, Williams JM, Baggett KM, Noria CW, Borkowski JG, et al. “My Baby & Me”: effects of an early, comprehensive parenting intervention on at-risk mothers and their children. Dev Psychol. 2014;50(5):1482–96. Epub 2014/01/23. doi: 10.1037/a0035682 pmid:24447116.
  54. 54.
    Jeong J, Obradović J, Rasheed M, McCoy DC, Fink G, Yousafzai AK. Maternal and paternal stimulation: Mediators of parenting intervention effects on preschoolers’ development. J Appl Dev Psychol. 2019;60:105–18. https://doi.org/10.1016/j.appdev.2018.12.001.
  55. 55.
    Murray L, De Pascalis L, Tomlinson M, Vally Z, Dadomo H, MacLachlan B, et al. Randomized controlled trial of a book-sharing intervention in a deprived South African community: effects on carer-infant interactions, and their relation to infant cognitive and socioemotional outcome. J Child Psychol Psychiatry. 2016;57(12):1370–9. Epub 2016/07/29. doi: 10.1111/jcpp.12605 pmid:27465028.
  56. 56.
    Jeong J, McCoy DC, Yousafzai AK, Salhi C, Fink G. Paternal Stimulation and Early Child Development in Low- and Middle-Income Countries. Pediatrics. 2016;138(4). Epub 2016/09/08. doi: 10.1542/peds.2016-1357 pmid:27600319.
  57. 57.
    Panter-Brick C, Burgess A, Eggerman M, McAllister F, Pruett K, Leckman JF. Practitioner review: Engaging fathers—recommendations for a game change in parenting interventions based on a systematic review of the global evidence. J Child Psychol Psychiatry. 2014;55(11):1187–212. Epub 2014/07/02. doi: 10.1111/jcpp.12280 pmid:24980187.
  58. 58.
    Jeong J. Redesigning and delivering inclusive parenting interventions for fathers. Lancet Glob Health. 2021. doi: 10.1016/S2214-109X(21)00037-1. pmid:33865470
  59. 59.
    McCoy DC, Salhi C, Yoshikawa H, Black M, Britto P, Fink G. Home- and center-based learning opportunities for preschoolers in low- and middle-income countries. Child Youth Serv Rev. 2018;88:44–56. https://doi.org/10.1016/j.childyouth.2018.02.021.
  60. 60.
    Bhopal S, Roy R, Verma D, Kumar D, Avan B, Khan B, et al. Impact of adversity on early childhood growth & development in rural India: Findings from the early life stress sub-study of the SPRING cluster randomised controlled trial (SPRING-ELS). PLoS ONE. 2019;14(1):e0209122. Epub 2019/01/10. doi: 10.1371/journal.pone.0209122 pmid:30625145.
  61. 61.
    Carneiro P, Galasso E, Lopez Garcia I, Bedregal P, Cordero M. Parental Beliefs, Investments, and Child Development: Evidence from a Large-Scale Experiment. Institute of Labor Economics (IZA), 2019.
  62. 62.
    Sanders MR, Kirby JN, Tellegen CL, Day JJ. The Triple P-Positive Parenting Program: a systematic review and meta-analysis of a multi-level system of parenting support. Clin Psychol Rev. 2014;34(4):337–57. Epub 2014/05/21. doi: 10.1016/j.cpr.2014.04.003 pmid:24842549.
  63. 63.
    Heckman JJ. Skill formation and the economics of investing in disadvantaged children. Science. 2006;312(5782):1900–2. Epub 2006/07/01. doi: 10.1126/science.1128898 pmid:16809525.
  64. 64.
    Grantham-McGregor S, Adya A, Attanasio O, Augsburg B, Behrman J, Caeyers B, et al. Group Sessions or Home Visits for Early Childhood Development in India: A Cluster RCT. Pediatrics. 2020. Epub 2020/11/06. doi: 10.1542/peds.2020-002725 pmid:33148771.
  65. 65.
    Yousafzai AK, Aboud FE, Nores M, Kaur R. Reporting guidelines for implementation research on nurturing care interventions designed to promote early childhood development. Ann N Y Acad Sci. 2018;1419(1):26–37. Epub 2018/05/24. doi: 10.1111/nyas.13648 pmid:29791737.
  66. 66.
    Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. Epub 2014/03/13. doi: 10.1136/bmj.g1687 pmid:24609605.
  67. 67.
    Weisleder A, Mazzuchelli DSR, Lopez AS, Neto WD, Cates CB, Goncalves HA, et al. Reading Aloud and Child Development: A Cluster-Randomized Trial in Brazil. Pediatrics. 2018;141(1). Epub 2017/12/30. doi: 10.1542/peds.2017-0723 pmid:29284645 employed by the Instituto Alfa e Beto, and Dr Oliveira is the President of Instituto Alfa e Beto, a nonprofit organization; the other authors have indicated they have no potential conflicts of interest to disclose.
  68. 68.
    Rincon P, Cova F, Saldivia S, Bustos C, Grandon P, Inostroza C, et al. Effectiveness of a Positive Parental Practices Training Program for Chilean Preschoolers’ Families: A Randomized Controlled Trial. Front Psychol. 2018;9:1751. Epub 2018/10/10. doi: 10.3389/fpsyg.2018.01751 pmid:30298035.
  69. 69.
    McGilloway S, Mhaille GN, Bywater T, Furlong M, Leckey Y, Kelly P, et al. A parenting intervention for childhood behavioral problems: a randomized controlled trial in disadvantaged community-based settings. J Consult Clin Psychol. 2012;80(1):116–27. Epub 2011/12/14. doi: 10.1037/a0026304 pmid:22148879.
  70. 70.
    Turner KMT, Sanders MR. Help When It’s Needed First: A Controlled Evaluation of Brief, Preventive Behavioral Family Intervention in a Primary Care Setting. Behav Ther. 2006;37(2):131–42. doi: 10.1016/j.beth.2005.05.004. pmid:16942967
  71. 71.
    Lopez-Lopez JA, Page MJ, Lipsey MW, Higgins JPT. Dealing with effect size multiplicity in systematic reviews and meta-analyses. Res Synth Methods. 2018. Epub 2018/07/05. doi: 10.1002/jrsm.1310 pmid:29971966.
  72. 72.
    United Nations Development Programme. Sustainable Development Goals [cited 2020 November 20]. https://www.undp.org/content/undp/en/home/sustainable-development-goals.html.
  73. 73.
    Jeong J, Pitchik HO, Fink G. Short-term, medium-term and long-term effects of early parenting interventions in low- and middle-income countries: a systematic review. BMJ Glob Health. 2021;6(3). Epub 2021/03/07. doi: 10.1136/bmjgh-2020-004067 pmid:33674266.
  74. 74.
    Abessa TG, Worku BN, Wondafrash M, Girma T, Valy J, Lemmens J, et al. Effect of play-based family-centered psychomotor/psychosocial stimulation on the development of severely acutely malnourished children under six in a low-income setting: a randomized controlled trial. BMC Pediatr. 2019;19(1):336. Epub 2019/09/16. doi: 10.1186/s12887-019-1696-z pmid:31521161.
  75. 75.
    Aboud FE, Akhter S. A cluster-randomized evaluation of a responsive stimulation and feeding intervention in bangladesh. Pediatrics. 2011;127(5):e1191–7. Epub 2011/04/20. doi: 10.1542/peds.2010-2160 pmid:21502222.
  76. 76.
    Aboud FE, Singla DR, Nahil MI, Borisova I. Effectiveness of a parenting program in Bangladesh to address early childhood health, growth and development. Soc Sci Med. 2013;97:250–8. Epub 2013/07/23. doi: 10.1016/j.socscimed.2013.06.020 pmid:23871435.
  77. 77.
    Alvarenga P, Cerezo MÁ, Wiese E, Piccinini CA. Effects of a short video feedback intervention on enhancing maternal sensitivity and infant development in low-income families. Attach Hum Dev. 2019:1–21. doi: 10.1080/14616734.2019.1602660. pmid:30961424
  78. 78.
    Andrew A, Attanasio O, Augsburg B, Day M, Grantham-McGregor S, Meghir C, et al. Effects of a scalable home-visiting intervention on child development in slums of urban India: evidence from a randomised controlled trial. J Child Psychol Psychiatry. 2020;61(6):644–52. Epub 2019/12/05. doi: 10.1111/jcpp.13171 pmid:31797385.
  79. 79.
    Anzman-Frasca S, Paul IM, Moding KJ, Savage JS, Hohman EE, Birch LL. Effects of the INSIGHT Obesity Preventive Intervention on Reported and Observed Infant Temperament. J Dev Behav Pediatr. 2018;39(9):736–43. doi: 10.1097/DBP.0000000000000597 pmid:29927795.
  80. 80.
    Attanasio OP, Fernandez C, Fitzsimons EO, Grantham-McGregor SM, Meghir C, Rubio-Codina M. Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: cluster randomized controlled trial. BMJ. 2014;349:g5785. doi: 10.1136/bmj.g5785 pmid:25266222.
  81. 81.
    Barlow J, Davis H, McIntosh E, Jarrett P, Mockford C, Stewart-Brown S. Role of home visiting in improving parenting and health in families at risk of abuse and neglect: results of a multicentre randomised controlled trial and economic evaluation. Arch Dis Child. 2007;92(3):229–33. Epub 2006/10/28. doi: 10.1136/adc.2006.095117 pmid:17068074.
  82. 82.
    Barrera M, Rosenbaum P, Cunningham C. Early home intervention with low-birth-weight infants and their parents. Child Dev. 1986:20–33. doi: 10.1111/j.1467-8624.1986.tb00003.x. pmid:3948591
  83. 83.
    Brooks-Gunn J, Liaw F-r, Klebanov PK. Effects of early intervention on cognitive function of low birth weight preterm infants. J Pediatr. 1992;120(3):350–9. doi: 10.1016/s0022-3476(05)80896-0. pmid:1538279
  84. 84.
    Health Infant and Program Development. Enhancing the outcomes of low-birth-weight, premature infants. A multisite, randomized trial. JAMA. 1990;263(22):3035–42. Epub 1990/06/13. doi: 10.1001/jama.1990.03440220059030 pmid:2188023.
  85. 85.
    Caughy MOB, Huang K-Y, Miller T, Genevro JL. The effects of the Healthy Steps for Young Children Program: results from observations of parenting and child development. Early Child Res Q. 2004;19(4):611–30.
  86. 86.
    Chang SM, Grantham-McGregor SM, Powell CA, Vera-Hernandez M, Lopez-Boo F, Baker-Henningham H, et al. Integrating a Parenting Intervention With Routine Primary Health Care: A Cluster Randomized Trial. Pediatrics. 2015;136(2):272–80. Epub 2015/07/08. doi: 10.1542/peds.2015-0119 pmid:26148947.
  87. 87.
    Cheng S, Kondo N, Aoki Y, Kitamura Y, Takeda Y, Yamagata Z. The effectiveness of early intervention and the factors related to child behavioural problems at age 2: A randomized controlled trial. Early Hum Dev. 2007;83(10):683–91. doi: 10.1016/j.earlhumdev.2007.01.008. pmid:17317044
  88. 88.
    Constantino JN, Hashemi N, Solis E, Alon T, Haley S, McClure S, et al. Supplementation of urban home visitation with a series of group meetings for parents and infants: results of a “real-world” randomized, controlled trial. Child Abuse Negl. 2001;25(12):1571–81. Epub 2002/01/30. doi: 10.1016/s0145-2134(01)00292-7 pmid:11814156.
  89. 89.
    Cooper PJ, Tomlinson M, Swartz L, Landman M, Molteno C, Stein A, et al. Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: Randomised controlled trial. BMJ. 2009;338(7701):997. doi: 10.1136/bmj.b974. pmid:19366752
  90. 90.
    Murray L, Cooper P, Arteche A, Stein A, Tomlinson M. Randomized controlled trial of a home-visiting intervention on infant cognitive development in peri-urban South Africa. Dev Med Child Neurol. 2016;58(3):270–6. doi: 10.1111/dmcn.12873. pmid:26303135
  91. 91.
    Cronan TA, Cruz SG, Arriaga RI, Sarkin AJ. The effects of a community-based literacy program on young children’s language and conceptual development. Am J Community Psychol. 1996;24(2):251–72. doi: 10.1007/BF02510401. pmid:8795261
  92. 92.
    Dozier M, Lindhiem O, Lewis E, Bick J, Bernard K, Peloso E. Effects of a Foster Parent Training Program on Young Children’s Attachment Behaviors: Preliminary Evidence from a Randomized Clinical Trial. Child Adolesc Social Work J. 2009;26(4):321–32. Epub 2009/08/01. doi: 10.1007/s10560-009-0165-1 pmid:22065891.
  93. 93.
    Drotar D, Robinson J, Jeavons L, Lester Kirchner H. A randomized, controlled evaluation of early intervention: the Born to Learn curriculum. Child Care Health Dev. 2009;35(5):643–9. Epub 2009/08/20. doi: 10.1111/j.1365-2214.2008.00915.x pmid:19689569.
  94. 94.
    Eddy JM, Shortt JW, Martinez CR, Holmes A, Wheeler A, Gau J, et al. Outcomes from a Randomized Controlled Trial of the Relief Nursery Program. Prev Sci. 2019. Epub 2019/02/08. doi: 10.1007/s11121-019-00992-9 pmid:30729363.
  95. 95.
    Feil EG, Baggett K, Davis B, Landry S, Sheeber L, Leve C, et al. Randomized control trial of an internet-based parenting intervention for mothers of infants. Early Child Res Q. 2020;50:36–44. doi: 10.1016/j.ecresq.2018.11.003. pmid:32863565
  96. 96.
    Fergusson DM, Grant H, Horwood LJ, Ridder EM. Randomized trial of the Early Start program of home visitation. Pediatrics. 2005;116(6):e803–9. Epub 2005/12/03. doi: 10.1542/peds.2005-0948 pmid:16322138.
  97. 97.
    Fernald LCH, Kagawa RMC, Knauer HA, Schnaas L, Guerra AG, Neufeld LM. Promoting Child Development through Group-Based Parent Support within a Cash Transfer Program: Experimental Effects on Children’s Outcomes. Dev Psychol. 2017;53(2):222–36. EJ1128988. doi: 10.1037/dev0000185. pmid:27748620
  98. 98.
    Knauer HA, Kagawa RMC, García-Guerra A, Schnaas L, Neufeld LM, Fernald LCH. Pathways to improved development for children living in poverty: A randomized effectiveness trial in rural Mexico. Int J Behav Dev. 2016;40(6):492–9. doi: 10.1177/0165025416652248.
  99. 99.
    Field T, Widmayer S, Greenberg R, Stoller S. Effects of parent training on teenage mother and their infants. Pediatrics. 1982;69(6):703–7. Epub 1982/06/01. pmid:7079035.
  100. 100.
    Frongillo EA, Nguyen PH, Saha KK, Sanghvi T, Afsana K, Haque R, et al. Large-Scale Behavior-Change Initiative for Infant and Young Child Feeding Advanced Language and Motor Development in a Cluster-Randomized Program Evaluation in Bangladesh. J Nutr. 2017;147(2):256–63. Epub 2016/12/30. doi: 10.3945/jn.116.240861 pmid:28031374.
  101. 101.
    Galasso E, Weber AM, Stewart CP, Ratsifandrihamanana L, Fernald LCH. Effects of nutritional supplementation and home visiting on growth and development in young children in Madagascar: a cluster-randomised controlled trial. Lancet Glob Health. 2019;7(9):e1257–e68. Epub 2019/08/14. doi: 10.1016/S2214-109X(19)30317-1 pmid:31402006.
  102. 102.
    Gardner JM, Powell CA, Baker-Henningham H, Walker SP, Cole TJ, Grantham-McGregor SM. Zinc supplementation and psychosocial stimulation: effects on the development of undernourished Jamaican children. Am J Clin Nutr. 2005;82(2):399–405. Epub 2005/08/10. doi: 10.1093/ajcn.82.2.399 pmid:16087985.
  103. 103.
    Goldfeld S, Napiza N, Quach J, Reilly S, Ukoumunne OC, Wake M. Outcomes of a universal shared reading intervention by 2 years of age: the Let’s Read trial. Pediatrics. 2011;127(3):445–53. Epub 2011/02/16. doi: 10.1542/peds.2009-3043 pmid:21321030.
  104. 104.
    Goodson BD, Layzer JI, St. Pierre RG, Bernstein LS, Lopez M. Effectiveness of a Comprehensive, Five-Year Family Support Program for Low-Income Families: Findings from the Comprehensive Child Development Program. Early Child Res Q. 2000;15(1):5–39. EJ633356.
  105. 105.
    Grantham-McGrego SMP, A C, Walker SP, Himes JH. Nutritional supplementation, psychosocial stimulation, and mental development of stunted children: the Jamaican Study. Lancet. 1991;338(8758):1–5. doi: 10.1016/0140-6736(91)90001-6. pmid:1676083
  106. 106.
    Guedeney A, Wendland J, Dugravier R, Saïas T, Tubach F, Welniarz B, et al. Impact of a randomized home-visiting trial on infant social withdrawal in the CAPEDP Prevention Study. Infant Ment Health J. 2013;34(6):594–601.
  107. 107.
    Hamadani JD, Huda SN, Khatun F, Grantham-McGregor SM. Psychosocial stimulation improves the development of undernourished children in rural Bangladesh. J Nutr. 2006;136(10):2645–52. Epub 2006/09/22. doi: 10.1093/jn/136.10.2645 pmid:16988140.
  108. 108.
    Hamadani JD, Mehrin SF, Tofail F, Hasan MI, Huda SN, Baker-Henningham H, et al. Integrating an early childhood development programme into Bangladeshi primary health-care services: an open-label, cluster-randomised controlled trial. Lancet Glob Health. 2019;7(3):e366–e75. Epub 2019/02/21. doi: 10.1016/S2214-109X(18)30535-7 pmid:30784637.
  109. 109.
    Hartinger SM, Lanata CF, Hattendorf J, Wolf J, Gil AI, Obando MO, et al. Impact of a child stimulation intervention on early child development in rural Peru: a cluster randomised trial using a reciprocal convtrol design. J Epidemiol Community Health. 2017;71(3):217–24. Epub 2016/09/11. doi: 10.1136/jech-2015-206536 pmid:27612978.
  110. 110.
    Heinicke CM, Fineman NR, Ruth G, Recchia SL, Guthrie D, Rodning C. Relationship-based intervention with at-risk mothers: Outcome in the first year of life. Infant Ment Health J. 1999;20(4):349–74. doi: 10.1002/(SICI)1097-0355(199924)20:4<349::AID-IMHJ1>3.0.CO;2-X.
  111. 111.
    Helmizar H, Jalal F, Lipoeto NI, Achadi EL. Local food supplementation and psychosocial stimulation improve linear growth and cognitive development among Indonesian infants aged 6 to 9 months. Asia Pac J Clin Nutr. 2017;26(1):97–103. doi: 10.6133/apjcn.102015.10 pmid:28049268.
  112. 112.
    Hepworth AD, Berlin LJ, Martoccio TL, Cannon EN, Berger RH, Harden BJ. Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial. Prev Sci. 2020;21(5):702–13. Epub 2020/05/11. doi: 10.1007/s11121-020-01127-1 pmid:32388694.
  113. 113.
    Huebner CE. Promoting toddlers’ language development through community-based intervention. J Appl Dev Psychol. 2000;21(5):513–35.
  114. 114.
    High PC, LaGasse L, Becker S, Ahlgren I, Gardner A. Literacy promotion in primary care pediatrics: can we make a difference? Pediatrics. 2000;105(4 Pt 2):927–34. Epub 2000/04/01. pmid:10742349.
  115. 115.
    Hutchings J, Griffith N, Bywater T, Williams ME. Evaluating the Incredible Years Toddler Parenting Programme with parents of toddlers in disadvantaged (Flying Start) areas of Wales. Child Care Health Dev. 2017;43(1):104–13. Epub 2016/10/06. doi: 10.1111/cch.12415 pmid:27704590.
  116. 116.
    Jacobs F, Easterbrooks MA, Goldberg J, Mistry J, Bumgarner E, Raskin M, et al. Improving Adolescent Parenting: Results From a Randomized Controlled Trial of a Home Visiting Program for Young Families. Am J Public Health. 2016;106(2):342–9. Epub 2015/11/13. doi: 10.2105/AJPH.2015.302919 pmid:26562107.
  117. 117.
    Jin X, Sun Y, Jiang F, Ma J, Morgan C, Shen X. “Care for Development” intervention in rural China: a prospective follow-up study. J Dev Behav Pediatr. 2007;28(3):213–8. doi: 10.1097/dbp.0b013e31802d410b. pmid:17565288
  118. 118.
    Kaaresen PI, Ronning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB. A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev. 2008;84(3):201–9. Epub 2007/08/19. doi: 10.1016/j.earlhumdev.2007.07.003 pmid:17698301.
  119. 119.
    Kaminski JW, Perou R, Visser SN, Scott KG, Beckwith L, Howard J, et al. Behavioral and socioemotional outcomes through age 5 years of the legacy for children public health approach to improving developmental outcomes among children born into poverty. Am J Public Health. 2013;103(6):1058–66. Epub 2013/04/20. doi: 10.2105/AJPH.2012.300996 pmid:23597356.
  120. 120.
    Khan MA, Owais SS, Maqbool S, Ishaq S, Khan HJ, Minhas FA, et al. Is integrated private-clinic based early child development care effective? A clustered randomised trial in Pakistan. BJGP Open. 2018;2(2):bjgpopen18X101593. doi: 10.3399/bjgpopen18X101593. pmid:30564726
  121. 121.
    Kitzman H, Olds DL, Henderson CR, Hanks C, Cole R, Tatelbaum R, et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA. 1997;278(8):644–52. Epub 1997/08/27. pmid:9272896.
  122. 122.
    Kochanska G, Kim S, Boldt LJ, Nordling JK. Promoting toddlers’ positive social-emotional outcomes in low-income families: a play-based experimental study. J Clin Child Adolesc Psychol. 2013;42(5):700–12. Epub 2013/04/06. doi: 10.1080/15374416.2013.782815 pmid:23557253.
  123. 123.
    Kristensen IH, Juul S, Kronborg H. What are the effects of supporting early parenting by newborn behavioral observations (NBO)? A cluster randomised trial. BMC Psychol. 2020;8(1):107. Epub 2020/10/21. doi: 10.1186/s40359-020-00467-5 pmid:33076981.
  124. 124.
    Kynø NM, Ravn IH, Lindemann R, Fagerland MW, Smeby NA, Torgersen AM. Effect of an early intervention programme on development of moderate and late preterm infants at 36 months: a randomized controlled study. Infant Behav Dev. 2012;35(4):916–26. doi: 10.1016/j.infbeh.2012.09.004. pmid:23063851
  125. 125.
    Leung C, Tsang S, Li B. Efficacy of Fun to Learn for the Young Program: Randomized Controlled Trial. J Child Fam Stud. 2017;26(10):2865–78.
  126. 126.
    Leung C, Tsang S, Lo C. Evaluation of parent and child enhancement (PACE) program: Randomized controlled trial. Res Soc Work Pract 2017;27(1):19–35.
  127. 127.
    Love JM, Kisker EE, Ross C, Raikes H, Constantine J, Boller K, et al. The effectiveness of early head start for 3-year-old children and their parents: lessons for policy and programs. Dev Psychol. 2005;41(6):885–901. Epub 2005/12/15. doi: 10.1037/0012-1649.41.6.88 pmid:16351335.
  128. 128.
    Lozoff B, Smith JB, Clark KM, Perales CG, Rivera F, Castillo M. Home intervention improves cognitive and social-emotional scores in iron-deficient anemic infants. Pediatrics. 2010;126(4):e884–94. doi: 10.1542/peds.2009-3535 pmid:20855384.
  129. 129.
    Luo R, Emmers D, Warrinnier N, Rozelle S, Sylvia S. Using community health workers to deliver a scalable integrated parenting program in rural China: A cluster-randomized controlled trial. Soc Sci Med. 2019;239:112545. Epub 2019/10/01. doi: 10.1016/j.socscimed.2019.112545 pmid:31568997.
  130. 130.
    Madden J, O’Hara J, Levenstein P. Home Again: Effects of the Mother-Child Home Program on Mother and Child. Child Dev. 1984;55(2):636–47. doi: 10.2307/1129975. pmid:6723452
  131. 131.
    McGillion M, Pine JM, Herbert JS, Matthews D. A randomised controlled trial to test the effect of promoting caregiver contingent talk on language development in infants from diverse socioeconomic status backgrounds. J Child Psychol Psychiatry. 2017;58(10):1122–31. Epub 2017/04/22. doi: 10.1111/jcpp.12725 pmid:28429816.
  132. 132.
    Mendelsohn AL, Valdez PT, Flynn V, Foley GM, Berkule SB, Tomopoulos S, et al. Use of videotaped interactions during pediatric well-child care: impact at 33 months on parenting and on child development. J Dev Behav Pediatr. 2007;28(3):206. doi: 10.1097/DBP.0b013e3180324d87. pmid:17565287
  133. 133.
    Mendelsohn AL, Cates CB, Weisleder A, Berkule Johnson S, Seery AM, Canfield CF, et al. Reading Aloud, Play, and Social-Emotional Development. Pediatrics. 2018;141(5). Epub 2018/04/11. doi: 10.1542/peds.2017-3393 pmid:29632254 conflicts of interest to disclose.
  134. 134.
    Muhoozi GKM, Atukunda P, Diep LM, Mwadime R, Kaaya AN, Skaare AB, et al. Nutrition, hygiene, and stimulation education to improve growth, cognitive, language, and motor development among infants in Uganda: A cluster-randomized trial. Matern Child Nutr. 2017. Epub 2017/09/20. doi: 10.1111/mcn.12527 pmid:28925580.
  135. 135.
    Atukunda P, Muhoozi GKM, Westerberg AC, Iversen PO. Nutrition, Hygiene and Stimulation Education for Impoverished Mothers in Rural Uganda: Effect on Maternal Depression Symptoms and Their Associations to Child Development Outcomes. Nutrients. 2019;11(7). Epub 2019/08/03. doi: 10.3390/nu11071561 pmid:31373314.
  136. 136.
    Nahar B, Hossain MI, Hamadani JD, Ahmed T, Huda SN, Grantham-McGregor SM, et al. Effects of a community-based approach of food and psychosocial stimulation on growth and development of severely malnourished children in Bangladesh: a randomised trial. Eur J Clin Nutr. 2012;66(6):701–9. Epub 2012/02/23. doi: 10.1038/ejcn.2012.13 pmid:22353925.
  137. 137.
    Nahar B, Hossain MI, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effects of psychosocial stimulation on improving home environment and child-rearing practices: results from a community-based trial among severely malnourished children in Bangladesh. BMC Public Health. 2012;12:622. Epub 2012/08/09. doi: 10.1186/1471-2458-12-622 pmid:22871096.
  138. 138.
    Nahar B, Hossain I, Hamadani JD, Ahmed T, Grantham-McGregor S, Persson LA. Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh. Child Care Health Dev. 2015;41(3):483–93. Epub 2014/07/22. doi: 10.1111/cch.12176 pmid:25040164.
  139. 139.
    Nair MKC E. P; Jeyaseelan L.; George B.; Mathews S.; Padma K. Effect of Child Development Centre Model Early Stimulation Among At-Risk Babies-A Randomized Controlled Trial. Indian Pediatr. 2009;46:S20–S6. pmid:19279365
  140. 140.
    Norr KF, Crittenden KS, Lehrer EL, Reyes O, Boyd CB, Nacion KW, et al. Maternal and Infant Outcomes at One Year for a Nurse-Health Advocate Home Visiting Program Serving African Americans and Mexican Americans. Public Health Nurs. 2003;20(3):190–203. doi: 10.1046/j.0737-1209.2003.20306.x. pmid:12716399
  141. 141.
    Olds DL, Henderson CR, Tatelbaum R, Chamberlin R. Improving the delivery of prenatal care and outcomes of pregnancy: a randomized trial of nurse home visitation. Pediatrics. 1986;77(1):16–28. Epub 1986/01/01. pmid:3510017.
  142. 142.
    Olds DL, Robinson J, O’Brien R, Luckey DW, Pettitt LM, Henderson CR, et al. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics. 2002;110(3):486–96. Epub 2002/09/03. doi: 10.1542/peds.110.3.486 pmid:12205249.
  143. 143.
    Pontoppidan M, Klest SK, Sandoy TM. The Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial. PLoS ONE. 2016;11(12):e0167592. Epub 2016/12/16. doi: 10.1371/journal.pone.0167592 pmid:27974857.
  144. 144.
    Powell C, Grantham-McGregor S. Home visiting of varying frequency and child development. Pediatrics. 1989;84(1):157–64. Epub 1989/07/01. pmid:2740166.
  145. 145.
    Powell C, Baker-Henningham H, Walker S, Gernay J, Grantham-McGregor S. Feasibility of integrating early stimulation into primary care for undernourished Jamaican children: cluster randomised controlled trial. BMJ. 2004;329(7457):89. Epub 2004/06/26. doi: 10.1136/bmj.38132.503472.7C pmid:15217841.
  146. 146.
    Baker-Henningham H, Powell C, Walker S, Grantham-McGregor S. The effect of early stimulation on maternal depression: a cluster randomised controlled trial. Arch Dis Child. 2005;90(12):1230–4. Epub 2005/09/15. doi: 10.1136/adc.2005.073015 pmid:16159905.
  147. 147.
    Raby KL, Freedman E, Yarger HA, Lind T, Dozier M. Enhancing the language development of toddlers in foster care by promoting foster parents’ sensitivity: Results from a randomized controlled trial. Dev Sci. 2019;22(2):e12753. Epub 2018/09/20. doi: 10.1111/desc.12753 pmid:30230658.
  148. 148.
    Ferjan Ramírez N, Lytle SR, Fish M, Kuhl PK. Parent coaching at 6 and 10 months improves language outcomes at 14 months: A randomized controlled trial. Dev Sci. 2019;22(3):e12762. doi: 10.1111/desc.12762. pmid:30318708
  149. 149.
    Rauh VA, Achenbach TM, Nurcombe B, Howell CT, Teti DM. Minimizing adverse effects of low birthweight: Four-year results of an early intervention program. Child Dev. 1988:544–53. pmid:2454783
  150. 150.
    Robling M, Bekkers MJ, Bell K, Butler CC, Cannings-John R, Channon S, et al. Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial. Lancet. 2016;387(10014):146–55. Epub 2015/10/18. doi: 10.1016/S0140-6736(15)00392-X pmid:26474809.
  151. 151.
    Rockers PC, Fink G, Zanolini A, Banda B, Biemba G, Sullivan C, et al. Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Glob Health. 2016;1(3):e000104. Epub 2017/06/08. doi: 10.1136/bmjgh-2016-000104 pmid:28588962.
  152. 152.
    Roggman LA, Boyce LK, Cook GA. Keeping kids on track: Impacts of a parenting-focused Early Head Start program on attachment security and cognitive development. Early Educ Dev. 2009;20(6):920–41.
  153. 153.
    Santelices M, Guzmán G M, Aracena M, Farkas C, Armijo I, Pérez-Salas C, et al. Promoting secure attachment: evaluation of the effectiveness of an early intervention pilot programme with mother–infant dyads in Santiago, Chile Child Care Health Dev. 2011;37(2):203–10. doi: 10.1111/j.1365-2214.2010.01161.x. pmid:21083685
  154. 154.
    Sawyer MG, Reece CE, Bowering K, Jeffs D, Sawyer ACP, Mittinty M, et al. Nurse-Moderated Internet-Based Support for New Mothers: Non-Inferiority, Randomized Controlled Trial. J Med Internet Res. 2017;19(7):e258. Epub 2017/07/26. doi: 10.2196/jmir.6839 pmid:28739559.
  155. 155.
    Scarr S, McCartney K. Far from home: An experimental evaluation of the Mother-Child Home Program in Bermuda. Child Dev. 1988:531–43.
  156. 156.
    Schaub S, Ramseier E, Neuhauser A, Burkhardt SCA, Lanfranchi A. Effects of home-based early intervention on child outcomes: A randomized controlled trial of Parents as Teachers in Switzerland. Early Child Res Q. 2019;48:173–85. https://doi.org/10.1016/j.ecresq.2019.03.007.
  157. 157.
    Schwarz DF, O’Sullivan AL, Guinn J, Mautone JA, Carlson EC, Zhao H, et al. Promoting early intervention referral through a randomized controlled home-visiting program. J Early Interv. 2012;34(1):20–39.
  158. 158.
    Shi H, Li X, Fang H, Zhang J, Wang X. The Effectiveness and Cost-effectiveness of a Parenting Intervention Integrated with Primary Health Care on Early Childhood Development: a Cluster-Randomized Controlled Trial. Prev Sci. 2020;21(5):661–71. Epub 2020/05/19. doi: 10.1007/s11121-020-01126-2 pmid:32419119.
  159. 159.
    Slade A, Holland ML, Ordway MR, Carlson EA, Jeon S, Close N, et al. Minding the Baby(R): Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program. Dev Psychopathol. 2019:1–15. Epub 2019/01/15. doi: 10.1017/S0954579418001463 pmid:30636649.
  160. 160.
    Spieker SJ, Oxford ML, Kelly JF, Nelson EM, Fleming CB. Promoting first relationships: randomized trial of a relationship-based intervention for toddlers in child welfare. Child Maltreat. 2012;17(4):271–86. Epub 2012/09/06. doi: 10.1177/1077559512458176 pmid:22949743.
  161. 161.
    Tofail F, Hamadani JD, Mehrin F, Ridout DA, Huda SN, Grantham-McGregor SM. Psychosocial stimulation benefits development in nonanemic children but not in anemic, iron-deficient children. J Nutr. 2013;143(6):885–93. doi: 10.3945/jn.112.160473 pmid:23616511.
  162. 162.
    Vally Z, Murray L, Tomlinson M, Cooper PJ. The impact of dialogic book-sharing training on infant language and attention: a randomized controlled trial in a deprived South African community. J Child Psychol Psychiatry. 2015;56(8):865–73. Epub 2014/11/18. doi: 10.1111/jcpp.12352 pmid:25399699.
  163. 163.
    Vazir S, Engle P, Balakrishna N, Griffiths PL, Johnson SL, Creed-Kanashiro H, et al. Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Matern Child Nutr. 2013;9(1):99–117. Epub 2012/05/26. doi: 10.1111/j.1740-8709.2012.00413.x pmid:22625182.
  164. 164.
    Klein Velderman M, Bakermans-Kranenburg MJ, Juffer F, Van Ijzendoorn MH. Effects of attachment-based interventions on maternal sensitivity and infant attachment: differential susceptibility of highly reactive infants. J Fam Psychol. 2006;20(2):266. doi: 10.1037/0893-3200.20.2.266. pmid:16756402
  165. 165.
    Waber DP V-C L, Ortiz N, Clement JR, Christiansen NE, Mora JO, Reed RB, Herrera MG. Nutritional supplementation, maternal education, and cognitive development of infants at risk of malnutrition. Am J Clin Nutr. 1981;34(4):807–13.
  166. 166.
    Wagner M, Spiker D, Linn MI. The effectiveness of the Parents as Teachers program with low-income parents and children. Top Early Child Spec Educ 2002;22(2):67–81.
  167. 167.
    Wake M, Tobin S, Girolametto L, Ukoumunne OC, Gold L, Levickis P, et al. Outcomes of population based language promotion for slow to talk toddlers at ages 2 and 3 years: Let’s Learn Language cluster randomised controlled trial. BMJ. 2011;343(7821):1–10. 2011-20135-001. doi: 10.1136/bmj.d4741. pmid:21852344
  168. 168.
    Walker SP, Chang SM, Powell CA, Grantham-McGregor SM. Psychosocial intervention improves the development of term low-birth-weight infants. J Nutr. 2004;134(6):1417–23. Epub 2004/06/03. doi: 10.1093/jn/134.6.1417 pmid:15173406.
  169. 169.
    Wallander JL, Bann CM, Biasini FJ, Goudar SS, Pasha O, Chomba E, et al. Development of children at risk for adverse outcomes participating in early intervention in developing countries: a randomized controlled trial. J Child Psychol Psychiatry. 2014;55(11):1251–9. Epub 2014/05/09. doi: 10.1111/jcpp.12247 pmid:24811237.
  170. 170.
    Wasik BH, Ramey CT, Bryant DM, Sparling JJ. A longitudinal study of two early intervention strategies: Project CARE. Child Dev. 1990;61(6):1682–96. pmid:2083492
  171. 171.
    Weisleder A, Cates CB, Dreyer BP, Berkule Johnson S, Huberman HS, Seery AM, et al. Promotion of Positive Parenting and Prevention of Socioemotional Disparities. Pediatrics. 2016;137(2):e20153239. Epub 2016/01/29. doi: 10.1542/peds.2015-3239 pmid:26817934.
  172. 172.
    Whitt JK, Casey PH. The mother-infant relationship and infant development: The effect of pediatric intervention. Child Dev. 1982:948–56. pmid:7128259
  173. 173.
    Yousafzai AK, Rasheed MA, Rizvi A, Armstrong R, Bhutta ZA. Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial. Lancet. 2014;384(9950):1282–93. Epub 2014/06/21. doi: 10.1016/S0140-6736(14)60455-4 pmid:24947106.
  174. 174.
    Yousafzai AK, Rasheed MA, Rizvi A, Armstrong R, Bhutta ZA. Parenting Skills and Emotional Availability: An RCT. Pediatrics. 2015;135(5):e1247–57. Epub 2015/04/15. doi: 10.1542/peds.2014-2335 pmid:25869369.

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The JMOR Connection, Inc. is dedicated to providing solutions and companies that may help small businesses grow and hold them up and running. With the JMOR Business Manager plan, take pleasure in all the benefits of the JMOR Business Standard with further give attention to servers and networks. Making the […]