Do Children with Pre-Existing Developmental Delay Benefit from Standard Early Parenting Intervention?

Background/Purpose: Children growing up in developing countries are at increased risk of developmental delay. Developmental delay is broadly defined as a child not reaching developmental milestones within the expected timeframe and measured as a child performing significantly below an age-referenced norm. Developmental delays are more common among children affected by perinatal complications such as preterm birth and low birthweight, children who are malnourished, children exposed to infections disease, and children growing up in severe poverty. Due to significant progress ensuring infant and young child survival worldwide, more children survive conditions that may delayed development. Despite the large number of children at risk of developmental delay, little is currently known about the prevalence of developmental delay in most developing countries. Screening for developmental delay can help governments get a better understanding of the magnitude of the problem and identify children who may benefit from extra support to promote child development. Rwanda is a low-income county with high rates of poverty, child malnutrition, and a rapidly growing population. The government recognizes the acute need for knowledge about how to support children with developmental delay. A number of interventions have been developed to support early child development among children in poverty, yet previous effectiveness studies often view pre-existing developmental delay as a confounding factor and exclude children at increased risk of developmental delay such as children born preterm or with mental or physical disability. Therefore, little is known about how developmental delay and disability affects children’s ability to gain from early child development services.

Methods: We use data collected for a cluster randomized trial (n=1049 households) testing the impact of the Sugira Muryango parenting intervention in Rwanda. The trial is linked to the Rwandan national social protection program, thus reaching the poorest households with children aged 6-36 months. Sugira Muryango is delivered by trained lay workers and integrates promotion of early childhood development with violence prevention. The curriculum is delivered via active coaching in the families’ home and covers responsive parenting, problem solving to promote family functioning and reduce violence in the home, increase father engagement, and improve family health and hygiene.

Results: Using the Ten Questions questionnaire 30% of the children enrolled in the study screened positive for developmental delay or disability. The ASQ-3 also revealed high rates of children screening positive for possible developmental delay across all domains, namely 27% for communication, 29% for personal social, 36% for problem solving, 50% for fine motor and 29% for gross motor. Participation in Sugira Muryango was associated with improvements in child developmental outcomes on the ASQ-3 and MDAT. We examine whether intervention effect differed among children with pre-existing developmental delay versus not delayed children.

Conclusions and Implications: Understanding whether children with preexisting developmental delay benefit equally from parenting interventions to support child development is important for policy and intervention work to support early child development among children growing up in developing countries who are at increased risk of experiencing developmental delay.