Effects of Variations in Caregiving on Cognitive Functioning and Behavior Problems in a U.S. National Sample of Neurodevelopmentally At-risk Children

Neurodevelopmental impairment is a risk factor for later cognitive functioning and behavior problems. However, subsequent caregiving may also affect outcomes for at-risk children. Sara R. Jaffee (2007) tested the hypothesis that sensitive, stimulating caregiving would improve outcomes in a U.S. national sample of 1720 at-risk children. She did this by analyzing predictive associations between initial neurodevelopmental scores and scores for caregivers’ cognitive stimulation and emotional support at ages 3 to 24 months and scores on these same variables, plus scores on a language scale and CBCL Total Problems 18 months later.

All the children had been referred to child protective services for investigation of abuse or neglect. Baseline neurodevelopmental risk and difficult temperament both predicted lower language scores and higher CBCL problem scores 18 months later. Furthermore, improvements in cognitive stimulation and increases in family income significantly predicted improvements on the language measure. Jaffee also compared 18-month outcomes for 49 children who were initially living with their biological parents but were removed from their parents during the 18 months versus 769 children who remained with their biological parents for the 18 months. A significant interaction with removal from the biological parents revealed that the combination of removal and improved cognitive stimulation was followed by higher language scores, whereas removal and decreased stimulation were followed by lower language scores than were found following changes in cognitive stimulation among children who were not removed.

Improvements in emotional support tended to be followed by lower CBCL problem scores. Like the effect of removal on language scores, there was also a tendency for effects of changes in emotional support to be accentuated by removal from biological parents. In light of disagreements about the potential harm versus benefits of removing children from abusive or neglectful parents, the finding that removal appeared to benefit children only when caregiving improved is especially important: “. . . benefits only accrued to children who experienced improvements in the quality of the caregiving they received. When the quality of caregiving they received worsened, they showed poorer (or as poor) functioning compared with children who remained in the care of biological parents” (p. 643).

Reference: Jaffee, S.A. (2007). Sensitive, stimulating caregiving predicts cognitive and behavioral resilience in neurodevelopmentally at-risk infants. Development and Psychopathology, 19, 631-647.