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Many autistic children access some form of early intervention, but little is known about the value for money of different programs. We completed a scoping review of full economic evaluations of early interventions for autistic children and/or their families. We identified nine studies and reviewed their methods and quality. Most studies involved behavioral interventions. Two were trial-based, and the others used various modelling methods. Clinical measures were often used to infer dependency levels and quality-adjusted life-years. No family-based or negative outcomes were included. Authors acknowledged uncertain treatment effects. We conclude that economic evaluations in this field are sparse, methods vary, and quality is sometimes poor. Economic research is needed alongside longer-term clinical trials, and outcome measurement in this population requires further exploration., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study measured resource utilization and costs for pre-school autism spectrum disorder (ASD)-related services in community-based sectors from multiple payer perspectives in two Canadian provinces, Nova Scotia (NS) and New Brunswick (NB), during the 12 months prior to and following the start of early intensive behavioural intervention (EIBI). The results indicate significant differences between NB and NS in utilization of services and costs to families, public sector and society. Differences can be attributed to variation in EIBI delivery models and may also be influenced by differences in diagnostic assessment practices. The study results provide resource utilization rates and costs which could be used in future economic evaluations and to inform policy making to improve outcomes for children with ASD.

Infants from low-income households typically spend less time exploring objects and use less mature strategies when they do explore compared to their higher-income peers (e.g., Clearfield et al., 2014). The current study tested a novel intervention designed to boost early object exploration in infants from low-income households. The intervention, called Play for Success, was administered through the Early Head Start home visiting program, and asked all infants to explore a toy with a caregiver for 10 min a day every day for two weeks. Forty-two 6- to 10-month-old infants were randomly assigned to one of three intervention groups: Social (unstructured direction), Teach Two (simple structured direction), or Teach Many (complex structured direction). Infants' exploratory behaviors were tested three times: before the intervention, immediately following, and again four weeks later. The results demonstrated that only infants in Teach 2 maintained their level of exploration at both the post-test and 4 weeks later while infants in the other groups showed significant decreases in exploration over time. These results suggest that Play for Success is a promising new intervention, but only in the condition that included repeated simple structured direction., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Serious mental illness (SMI) is a disabling condition that develops early in life and imposes substantial economic burden. There is a growing belief that early intervention for SMI has lifelong benefits for patients. However, assessing the cost-effectiveness of early intervention efforts is hampered by a lack of evidence on the long-term benefits. We addressed this by using a dynamic microsimulation model to estimate the lifetime burden of SMI for those diagnosed by age twenty-five. We estimated that the per patient lifetime burden of SMI is $1.85 million. We also found that a policy intervention focused on improving the educational attainment of people with SMI reduces the average per person burden of SMI by $73,600 (4.0 percent)-a change driven primarily by higher lifetime earnings-or over $8.9 billion in reduced burden per cohort of SMI patients. These findings provide a benchmark for the potential value of improving educational attainment for people with SMI.

Publicly funded center-based preschool programs were designed to enhance low-income children's early cognitive and social-emotional skills in preparation for kindergarten. In the U.S., the federal Head Start program and state-funded public school-based pre-kindergarten (pre-k) programs are the two primary center-based settings in which low-income children experience publicly funded preschool. Although evidence suggests that these programs generally promote cognitive and social-emotional skills for low-income children overall, whether the benefits of program participation vary for low-income children with difficult temperaments is unexplored. Difficult temperament status is a source of vulnerability that connotes increased risk for poor early school outcomes-risks that may be ameliorated by public preschool programs known to promote kindergarten readiness among other vulnerable populations. Using a nationally representative sample of low-income children ( N ≈ 3,000) drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), this study tests whether associations between public preschool participation and children's cognitive and social-emotional skills in kindergarten are moderated by difficult temperament status. We focus on Head Start and public school-based pre-k, comparing both with parental care and with each other. Results provide weak evidence that public preschool's benefits on children's cognitive and social-emotional skills in kindergarten are moderated by child temperament. School-based pre-k is significantly associated with better reading skills relative to parental care only for children with difficult temperaments. Additionally, for children with difficult temperaments, Head Start is significantly associated with better approaches to learning relative to parental care, and with reduced externalizing behavior problems relative to school-based pre-k. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Purpose: To determine the feasibility of completing a randomized clinical trial of motor affordance program at home for infants living in poverty., Methods: Fourteen infants living in poverty were randomized assigned to groups: intervention at 1st month (G-1), and at 2nd month (G-2). They were assessed into 3 visits: Visit 1 (baseline), Visit 2 (after 4 weeks), and Visit 3 (after 8 weeks). The motor affordance program was provided at home by parents/caregivers. To determine feasibility of the program, descriptive data was used. Effect sizes and non-parametric analysis were performed for motor and affordances at home., Results: The motor affordance program was considered feasible and showed improvement on affordances at home and motor performance only for G-2., Conclusion: Amplifying motor affordance at home may be considered appropriate for future clinical trials. It may be an efficient/low-cost early intervention strategy for infants at environmental risk., (Copyright © 2018. Published by Elsevier Inc.)

In this paper we analyze the need for consistent and accurate cost data on early childhood development (ECD) interventions as a basis for increasing and improving the effectiveness of current spending on ECD. We establish the key components necessary in a costing model and present a new standardized costing tool intended for use across a broad range of stakeholders and contexts. Learnings from piloting the tool in Bangladesh, Malawi, Mali, Mexico, and Mozambique are shared. Providing a standardized methodology for costing ECD is an important contribution to the field and has the potential to improve both the volume and effectiveness of ECD financing., (© 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.)

Political action and investment are critical to meet the development needs of vulnerable young children today. Early childhood development (ECD) has become a global priority: an ECD target and other ECD-related targets are included in the sustainable development goals, over 75 countries have officially adopted multisectoral ECD policy instruments, and ECD is a programmatic focus in major global institutions (including UNICEF, UNESCO, the WHO, and the World Bank). However, lack of clear and strong ownership of and champions for ECD, operational and communication siloes of constituent sectors that constitute ECD, political pressures for investment in other arenas, and low international investment in ECD inhibit making a compelling and cohesive investment case for ECD. This commentary explores how a global ECD network can facilitate systematic alignment and action across sectors to support country systems, strengthen political will, and increase investment to deliver results for young children's development. The ECD Action Network is in formation and offers an opportunity for the field to share knowledge among countries and sectors, identify pathways for sectoral coordination and collaboration, and undertake advocacy to generate the scale of political and financial support necessary to ensure that every child receives the nurturing care he/she needs., (© 2018 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.)

Background: An estimated 43% of children younger than 5 years of age are at elevated risk of failing to achieve their human potential. In response, the World Health Organization and UNICEF developed Care for Child Development (CCD), based on the science of child development, to improve sensitive and responsive caregiving and promote the psychosocial development of young children., Methods: In 2015, the World Health Organization and UNICEF identified sites where CCD has been implemented and sustained. The sites were surveyed, and responses were followed up by phone interviews. Project reports provided information on additional sites, and a review of published studies was undertaken to document the effectiveness of CCD for improving child and family outcomes, as well as its feasibility for implementation in resource-constrained communities., Results: The inventory found that CCD had been integrated into existing services in diverse sectors in 19 countries and 23 sites, including child survival, health, nutrition, infant day care, early education, family and child protection and services for children with disabilities. Published and unpublished evaluations have found that CCD interventions can improve child development, growth and health, as well as responsive caregiving. It has also been reported to reduce maternal depression, a known risk factor for poor pregnancy outcomes and poor child health, growth and development. Although CCD has expanded beyond initial implementation sites, only three countries reported having national policy support for integrating CCD into health or other services., Conclusions: Strong interest exists in many countries to move beyond child survival to protect and support optimal child development. The United Nations Sustainable Development Goals depend on children realizing their potential to build healthy and emotionally, cognitively and socially competent future generations. More studies are needed to guide the integration of the CCD approach under different conditions. Nevertheless, the time is right to provide for the scale-up of CCD as part of services for families and children., (© 2017 The Authors. Child: Care, Health and Development Published by John Wiley & Sons Ltd.)

Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Early intervention is considered the optimal response to developmental disorders in children. We evaluate a nationwide developmental screening program for preschoolers in Austria and the resulting interventions. Identification of treatment effects is determined by a birthday cutoff-based discontinuity in the eligibility for a financial incentive to participate in the screening. Assigned preschoolers are 14.5 percentage points more likely to participate in the program. For participants with high socio-economic status (SES), we find little evidence for interventions and consistently no effect on healthcare costs in the long run. For low SES preschoolers, we find evidence for substantial interventions, but only weak evidence for cost savings in the long run., (Copyright © 2016 Elsevier B.V. All rights reserved.)

This study examined the long-term cost-savings of the Better Beginnings, Better Futures (BBBF) initiative, a community-based early intervention project for young children living in socioeconomically disadvantaged neighborhoods during their transition to primary school. A quasi-experimental, longitudinal two-group design was used to compare costs and outcomes for children and families in three BBBF project neighborhoods (n = 401) and two comparison neighborhoods (n = 225). A cost-savings analysis was conducted using all project costs for providing up to 4 years of BBBF programs when children were in junior kindergarten (JK) (4 years old) to grade 2 (8 years old). Data on 19 government service cost measures were collected from the longitudinal research sample from the time the youth were in JK through to grade 12 (18 years old), 10 years after ending project participation. The average family incremental net savings to government of providing the BBBF project was $6331 in 2014 Canadian dollars. When the BBBF monetary return to government as a ratio of savings to costs was calculated, for every dollar invested by the government, a return of $2.50 per family was saved. Findings from this study have important implications for government investments in early interventions focused on a successful transition to primary school as well as parenting programs and community development initiatives in support of children's development.

Novel management strategies for autism spectrum disorder (ASD) propose providing interventions before diagnosis. We performed a cost-effectiveness analysis comparing the costs and dependency-free life years (DFLYs) generated by pre-diagnosis intensive Early Start Denver Model (ESDM-I); pre-diagnosis parent-delivered ESDM (ESDM-PD); and the Ontario Status Quo (SQ). The analyses took government and societal perspectives to age 65. We assigned probabilities of Independent, Semi-dependent or Dependent living based on projected IQ. Costs per person (in Canadian dollars) were ascribed to each living setting. From a government perspective, the ESDM-PD produced an additional 0.17 DFLYs for $8600 less than SQ. From a societal perspective, the ESDM-I produced an additional 0.53 DFLYs for $45,000 less than SQ. Pre-diagnosis interventions targeting ASD symptoms warrant further investigation.

Head Start (HS) is the largest federally funded preschool program for disadvantaged children. Research has shown relatively small impacts on cognitive and social skills; therefore, some have questioned its effectiveness. Using data from the Head Start Impact Study (3-year-old cohort; N = 2,449), latent class analysis was used to (a) identify subgroups of children defined by baseline characteristics of their home environment and caregiver and (b) test whether the effects of HS on cognitive, and behavioral and relationship skills over 2 years differed across subgroups. The results suggest that the effectiveness of HS varies quite substantially. For some children there appears to be a significant, and in some cases, long-term, positive impact. For others there is little to no effect., (© 2014 The Authors. Child Development © 2014 Society for Research in Child Development, Inc.)

Since modern welfare reform began in the 1980s, we have seen low-income parents leave the welfare rolls and join the workforce in large numbers. At the same time, the Earned Income Tax Credit has offered a monetary incentive for low-income parents to work. Thus, unlike some of the other two-generation mechanisms discussed in this issue of Future of Children, policies that encourage low-income parents to work are both widespread and well-entrenched in the United States. But parents' (and especially mothers') work, writes Carolyn Heinrich, is not unambiguously beneficial for their children. On the one hand, working parents can be positive role models for their children, and, of course, the income they earn can improve their children's lives in many ways. On the other hand, work can impair the developing bond between parents and young children, especially when the parents work long hours or evening and night shifts. The stress that parents bring home from their jobs can detract from their parenting skills, undermine the atmosphere in the home, and thereby introduce stress into children's lives. Unfortunately, it is low-income parents who are most likely to work in stressful, low-quality jobs that feature low pay, little autonomy, inflexible hours, and few or no benefits. And low-income children whose parents are working are more likely to be placed in inadequate child care or to go unsupervised. Two-generation approaches, Heinrich writes, could maximize the benefits and minimize the detriments of parents' work by expanding workplace flexibility, and especially by mandating enough paid leave so that mothers can breastfeed and form close bonds with their infants; by helping parents place their children in high-quality child care; and by helping low-income parents train for, find, and keep a well-paying job with benefits.

Early childhood programs are heralded as a way to improve children's health and educational outcomes. However, few studies in developing countries calculate the effectiveness of quality early childhood interventions. Even fewer estimate the associated costs of such interventions. The study here looks at the costs and effectiveness of a cluster-randomized effectiveness trial on children from birth to 24 months in rural Sindh, Pakistan. Responsive stimulation and/or enhanced nutrition interventions were integrated in the Lady Health Worker program in Pakistan. Outcomes suggest that children who receive responsive stimulation had significantly better development outcomes at 24 months than those who only received enhanced nutrition intervention. A cost-effectiveness analysis of the results verifies that early childhood interventions that include responsive stimulation are more cost effective than a nutrition intervention alone in promoting children's early development. Costs of a responsive stimulation intervention integrated in an existing community-based service providing basic health and nutrition care is approximately US$4 per month per child. We discuss these findings and make recommendations about scaling up and costs for future early child development programs., (© 2014 New York Academy of Sciences.)

This paper estimates the cost-benefit ratio for an integrated early childhood development program in Nicaragua (PAININ). Using longitudinal data, we estimate the average treatment effects of PAININ including micronutrient sprinkles on the prevalence of anemia and hemoglobin levels among disadvantaged children aged 6-36 months. We also estimate the effects of PAININ excluding sprinkles on cognitive outcomes among children aged 2.5-5 years. In the younger age group the program reduced anemia by 4 percentage points after 8 months and nearly 6 percentage points after 1 year; the latter is a 26% decrease in anemia. In the older age group, the program improved verbal and numeric memory after a year and a half, but the effects were modest (0.13 SD). When analyzing its potential impact on earnings, we conclude that the discounted annual costs of the program per child are less than the discounted annual increase in beneficiary earnings. Specifically, we estimate a cost-benefit ratio of 1.50 from the PAININ plus sprinkles package. Our sensitivity analysis suggests a range for this ratio between 1.30 and 2.30., (© 2014 New York Academy of Sciences.)

There is a strongly held view that a narrow window exists for effective nutritional interventions and a widely known stylized depiction of age-dependent economic rates of returns to investments in cognitive and socioemotional development. Both indicate critical periods in early life. Moreover, the fact that both the physical and cognitive development of a child in these early years are highly dependent on childcare practices and on the characteristics of the caregivers motivates an interest in finding effective means to enhance stimulation in the context of nutritional programs, or vice versa. Nevertheless, there is relatively little evidence to date on how to align integrated interventions to these age-specific patterns and how to undertake benefit-cost analyses for integrated interventions. Thus, many core questions need further consideration in order to design integrated nutritional and stimulation programs. This paper looks at some of these questions and provides some guidelines as to how the economic returns from joint nutrition and stimulation programs might be estimated., (© 2014 New York Academy of Sciences.)

The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

Recently, early investment in the human capital of children from socially disadvantaged environments has attracted a great deal of attention. Programs of such early intervention, aimed at children's health and well-being, are spreading considerably in the US and are currently being tested in several European countries. In a discrete version of the Mirrlees model with a parents' and a children's generation, we model the intra-generational and the inter-generational redistributional consequences of such intervention programs. It turns out that the parents' generation loses whenever such intervention programs are implemented. Furthermore, the rich part of the children's generation always benefits. Despite the expectation that early intervention puts the poor descendants in a better position, our analysis reveals that the poor among the children's generation may even be worse off, if the effect of early intervention on their productivity is not large enough.

Globalization has transformed the workplace at the same time that increasing numbers of children live in families in which all adults work for pay outside the home. Extensive research evidence demonstrates the importance of parental involvement in the early years of a child's life. Yet, parents caring for young children may face challenges in fulfilling both work and family responsibilities under current labor force conditions. In this article, we review the evidence on the importance of parental care for meeting young children's routine care needs, preventive health care needs, and curative medical treatment requirements. We examine the evidence regarding the impact of four policies in particular on young children's health and development: parental leave, breastfeeding breaks, early childhood care and education, and leave for children's health needs. Last, we examine the availability of these policies worldwide and discuss the potential economic implications.

Early intensive behavioral intervention (EIBI) may result in improved cognitive, adaptive and social functioning and reductions in autism severity and behavioral problems in children with Autism Spectrum Disorder (ASD). For a subset of children, normal functioning may be the result. However, due to the intensity (20-40 h per week for 3 years with a low child staff ratio) implementation costs are high and can be controversial. Estimated costs for education, (supported) work and (sheltered) living for individuals with ASD in The Netherlands are applied in a cost-offset model. A compelling argument for the provision of EIBI is long term savings which are approximately € 1,103,067 from age 3 to 65 years per individual with ASD. Extending these costs to the whole Dutch ASD population, cost savings of € 109.2-€ 182 billion have been estimated, excluding costs associated with inflation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Externalising and internalising problems affect one in seven school-aged children and are the single strongest predictor of mental health problems into early adolescence. As the burden of mental health problems persists globally, childhood prevention of mental health problems is paramount. Prevention can be offered to all children (universal) or to children at risk of developing mental health problems (targeted). The relative effectiveness and costs of a targeted only versus combined universal and targeted approach are unknown. This study aims to determine the effectiveness, costs and uptake of two approaches to early childhood prevention of mental health problems ie: a Combined universal-targeted approach, versus a Targeted only approach, in comparison to current primary care services (Usual care)., Methods/design: Three armed, population-level cluster randomised trial (2010-2014) within the universal, well child Maternal Child Health system, attended by more than 80% of families in Victoria, Australia at infant age eight months.Participants were families of eight month old children from nine participating local government areas. Randomised to one of three groups: Combined, Targeted or Usual care.The interventions comprises (a) the Combined universal and targeted program where all families are offered the universal Toddlers Without Tears group parenting program followed by the targeted Family Check-Up one-on-one program or (b) the Targeted Family Check-Up program. The Family Check-Up program is only offered to children at risk of behavioural problems.Participants will be analysed according to the trial arm to which they were randomised, using logistic and linear regression models to compare primary and secondary outcomes. An economic evaluation (cost consequences analysis) will compare incremental costs to all incremental outcomes from a societal perspective., Discussion: This trial will inform public health policy by making recommendations about the effectiveness and cost-effectiveness of these early prevention programs. If effective prevention programs can be implemented at the population level, the growing burden of mental health problems could be curbed., Trial Registration: ISRCTN61137690.

Early childhood education and childcare have traditionally been dominated by nonprofit and other grant-funded agencies. However, public education agencies are increasingly involved with early childhood education through state funded pre-K program initiatives. As public pre-school programming has steadily expanded, programs such as Head Start have to compete for enrollment. As funds for these programs are tied directly to enrollment, the sustainability of these programs is uncertain. Not all such agencies view state funded pre-K as a threat however. Some have seized this as an opportunity to improve service delivery through interagency collaboration. This case study examines the partnership between an urban school district and its local Head Start program. Responding, in part, to the potential threat from state-funded Pre-K, Head Start partnered with the school district to provide enhanced services to Head Start eligible children in the district's early childhood education programs. Through an examination of secondary data and staff surveys, the collaboration is first evaluated in terms of the use of best practices. The success of the collaboration is measured through teacher and administrator perceptions. From these results, specific recommendations for early education and childcare providers are offered.

Education is important for all children, but even more so for children with disabilities, whose social and economic opportunities may be limited. In this article, Laudan Aron and Pamela Loprest assess how well the nation's education system is serving students with disabilities. Aron and Loprest trace the evolution of the special education system in the United States from its origins in the civil rights movement of the mid-twentieth century. They note the dual character of federal legislation, which both guarantees eligible children with disabilities the right to a "free, appropriate public education in the least restrictive setting" and establishes a federal funding program to help meet this goal. They then review the types of services and accommodations these children receive from infancy through young adulthood. The special education system has given children with disabilities much greater access to public education, established an infrastructure for educating them, helped with the earlier identification of disabilities, and promoted greater inclusion of these children alongside their nondisabled peers. Despite these advances, many problems remain, including the over- and underidentification of certain subgroups of students, delays in identifying and serving students, and bureaucratic, regulatory, and financial barriers that complicate the program for everyone involved. More important, the authors show that special education students still lag behind their nondisabled peers in educational achievements, are often held to lower expectations, are less likely to take the full academic curriculum in high school, and are more likely to drop out of school. Only limited evidence is available on the effectiveness of specific special education services or on how to improve student achievement for this important subgroup of students. Improving the system will require better ways of understanding and measuring both ends of the special education continuum, namely, what services special education children need and receive, and what academic outcomes these students achieve. Without stronger evidence linking these two aspects of the system, Aron and Loprest argue, researchers will be unable to gauge the efficacy of the services now being delivered or to formulate effective reforms to the system as a whole.

In the 1950s, the term "deprivation" entered American psychiatric discourse. This article examines how the concept of deprivation permeated the field of mental retardation, and became an accepted theory of etiology. It focuses on sensory deprivation and cultural deprivation, and analyzes the interventions developed, based on these theories. It argues that the controversial theory of cultural deprivation derived its scientific legitimization from the theory of sensory deprivation, and was a highly politicized concept that took part in the nature-nurture debate.

Using data collected up to age 26 in the Chicago Longitudinal Study, this cost-benefit analysis of the Child-Parent Centers (CPC) is the first for a sustained publicly funded early intervention. The program provides services for low-income families beginning at age 3 in 20 school sites. Kindergarten and school-age services are provided up to age 9 (third grade). Findings from a complete cohort of over 1,400 program and comparison group participants indicated that the CPCs had economic benefits in 2007 dollars that exceeded costs. The preschool program provided a total return to society of $10.83 per dollar invested (18% annual return). The primary sources of benefits were increased earnings and tax revenues and averted criminal justice system costs. The school-age program had a societal return of $3.97 per dollar invested (10% annual return). The extended intervention program (4-6 years) had a societal return of $8.24 (18% annual return). Estimates were robust across a wide range of analyses including Monte Carlo simulations. Males, 1-year preschool participants, and children from higher risk families derived greater benefits. Findings provide strong evidence that sustained programs can contribute to well-being for individuals and society., (© 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.)

Chronic pain is a costly and debilitating condition that has proven difficult to treat, solely with medical interventions, due to the complex interplay of biological, psychological, and social factors in its onset and persistence. Many studies have demonstrated the effectiveness of interdisciplinary treatment that includes psychosocial interventions for low back pain. Nevertheless, these interventions continue to be under-utilized due to concerns of cost and applicability. The present study utilized a cost utility analysis to evaluate effectiveness and associated costs of interdisciplinary early intervention for individuals with acute low back pain that was identified as high-risk for becoming chronic. Treatment effectiveness was evaluated using a standard pain measure and quality-adjusted life years, and associated medical and employment costs were gathered for 1 year. Results indicated that subjects improved significantly from pretreatment to 1-year follow-up, and that the early intervention group reported fewer health-care visits and missed workdays than the treatment as usual group. The majority of 1,000 bootstrapped samples demonstrated the dominance of the early intervention program as being both more effective and less costly from a societal perspective. The early intervention treatment was the preferred option in over 85% of samples within an established range of acceptable costs. These results are encouraging evidence for the cost-effectiveness of interdisciplinary intervention and the benefits of targeted early treatment., (© 2009 World Institute of Pain.)

Advancements in videoconferencing equipment and Internet-based tools for sharing information have resulted in widespread use of telemedicine for providing health care to people who live in remote areas. Given the limited supply of people trained to provide early-intervention services to infants and young children who are deaf or hard-of-hearing, and the fact that many families who need such services live significant distances from each other and from metropolitan areas, such "teleintervention" strategies hold promise for providing early-intervention services to children who are deaf or hard-of-hearing. Unfortunately, little is known about the cost-effectiveness of such teleintervention services. In this article we outline the rationale for using teleintervention services for children who are deaf or hard-of-hearing, describe a teleintervention program that has been serving relatively large numbers of children in Australia since 2002, and summarize what we know about the cost-effectiveness of such an approach. We conclude by summarizing the type of research needed to decide whether teleintervention should be used more frequently with children who are deaf or hard-of-hearing and the potential relevance of the teleintervention approach for the development of intervention systems in the United States.

It is increasingly recognized that early sensitive care-giving predicts a secure attachment in infancy and early childhood.This preliminary report details the development, implementation and evaluation of a clinical programme that used a targeted prevention approach following a universally-offered screening of parent-infant interactions. The CARE-Index was used to assign dyads to low, medium and high risk groups, and interventions - featuring reflective videotape-based feedback - were tailored to each risk group in order to increase maternal sensitivity and improve infant attachment status. Results showed improved maternal sensitivity in the intervention conditions compared to comparisons. In addition, infants in the intervention conditions were significantly more likely to be classified as secure, and significantly less likely to be classified as having DMM complex attachment strategies. Methodological shortcomings, however, mean that these findings should be regarded as tentative.

The authors reviewed papers published between 1999 and 2009 in journals indexed in PsycInfo, PubMED, EBSCO and ProQuest concerning the characteristics, effectiveness and challenges of home visit programmes orientated towards early childhood intervention, clarifying the research's scope and limitations and its applications. Home visiting has been shown to be effective for a variety of relevant areas, especially for developing parent skills and child-caregiver relationships. The most effective programmes have started at pregnancy, lasted more than a year, had specially trained staff and have focused on building a trustworthy relationship and on modelling the infant-caregiver interaction. The importance of considering target population characteristics, the visiting model used and the visitor agent was identified in designing these programmes. In spite of the evidence accumulated in Anglo-Saxon studies, the costs associated with these programmes can be very high, thereby implying barriers which can make their dissemination difficult in Latin-American countries. The authors discuss the need for developing and evaluating other variants (i.e. including community agents), considering their cost/effectiveness ratio for treating early childhood problems, needs and characteristics in Latin-America.

As is maintained in the Seville Statement on Violence, the role of education in shaping human relations is fundamental. In order to develop effective educational interventions aiming to foster empathic relations, some important prerequisites need to be satisfied. One of these prerequisites, which is based on a constructivist model, is constituted by the identification and analysis of the pre-existing concepts and attitudes of those to whom interventions are directed, regarding the specific issues involved in the specific educational process. More effective positive changes can be obtained this way as they are generated from within the individuals themselves. Using this perspective, a study was conducted in Italian schools on the attitudes of young people between 9–18 years of age towards multiculturalism in contemporary society. The participants (N=350, 176 girls and 174 boys) were invited to write down anonymously their thoughts about multiculturalism. Their essays were quantitatively and qualitatively analysed. The aim was to obtain a deep understanding not only of the explicit but also of the implicit meaning of the texts and consequently also of the motivations underlying the participants' attitudes. Some of the results of this study are discussed and suggestions are made for the development of educational interventions aiming to foster young people's empathic attitudes.

Variations in the dosage of social interventions and the effects of dosage on program outcomes remain understudied. This study examines the dosage effects of the Chicago School Readiness Project, a randomized, multifaceted classroom-based intervention conducted in Head Start settings. Using a principal score matching method to address the issue of selection bias, the study finds that high-dosage levels of teacher training and mental health consultant class visits have larger effects on children's school readiness than the effects estimated through intention-to-treat (ITT) analyses. Low-dosage levels of treatment are found to have effects that are smaller than those estimated in ITT analyses or to have no statistically significant program effects. Moreover, individual mental health consultation services provided to high-risk children are found to have statistically significant effects on their school readiness. The study discusses the implications of these findings for research and policy.

A full accounting of the excess burden of poor health in childhood must include any continuing loss of productivity over the life course. Including these costs results in a much higher estimate of the burden than focusing only on medical costs and other shorter-run costs to parents (such as lost work time). Policies designed to reduce this burden must go beyond increasing eligibility for health insurance, because disparities exist not only in access to health insurance but also in take-up of insurance, access to care, and the incidence of health conditions. We need to create a comprehensive safety net for young children that includes automatic eligibility for basic health coverage under Medicaid unless parents opt out by enrolling children in a private program; health and nutrition services for pregnant women and infants; quality preschool; and home visiting for infants and children at risk. Such a program is feasible and would be relatively inexpensive.

Objective: Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments., Study Design: PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling., Result: Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions., Conclusion: Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.

Policy discussions to ameliorate socioeconomic (SES) inequalities are increasingly focused on investments in early childhood. Yet such interventions are costly to implement, and clear evidence on the optimal time to intervene to yield a high economic and social return in the future is meagre. The majority of successful early childhood interventions start in the preschool years. However socioeconomic gradients in cognitive skills, socio-emotional functioning and health can be observed by age three, suggesting that preventative programmes starting earlier in childhood may be even more effective. We discuss the optimal timing of early childhood intervention with reference to recent research in developmental neuroscience. We motivate the need for early intervention by providing an overview of the impact of adverse risk factors during the antenatal and early childhood periods on outcomes later in life. We provide a brief review of the economic rationale for investing early in life and propose the "antenatal investment hypothesis". We conclude by discussing a suite of new European interventions that will inform this optimal timing debate.

Objective: The aim of this randomised controlled trial was to evaluate the effectiveness of a short, highly structured parent based language intervention group programme for 2-year-old children with specific expressive language delay (SELD, without deficits in receptive language)., Methods: 61 children with SELD (mean age 24.7 months, SD 0.9) were selected between October 2003 and February 2006 during routine developmental check-ups in general paediatric practices, using a German parent-report screening questionnaire (adapted from the MacArthur Communicative Development Inventories). Standardised instruments were used to assess the language and non-verbal cognitive abilities of these children and of 36 other children with normal language development (reference group; mean age 24.6 months, SD 0.8). 58 children with SELD were sequentially randomly assigned to an intervention group (n = 29) or a 12-month waiting group (n = 29). In the intervention group, mothers participated in the 3-month Heidelberg Parent-based Language Intervention (HPLI). All children were reassessed 6 and 12 months after pretest. Assessors were blind to allocation and previous results., Results: 47 children were included in the analysis. At the age of 3 years, 75% of the children in the intervention group showed normal expressive language abilities in contrast to 44% in the waiting group. Only 8% of the children in the intervention group versus 26% in the waiting group met the criteria for specific language impairment (t score < or =35)., Conclusions: By applying the short, highly structured HPLI in children with SELD, the rate of treatment for language impairment at the age of 3 years can be significantly reduced.

Schools request consultation from neuropsychologists employed outside the school setting to enhance assessment and intervention for children with neurological, medical, and psychological conditions. The legislative and administrative parameters governing special education services for exceptional children most pertinent to the consulting neuropsychologist are examined. The role of the school-based multidisciplinary team in determining eligibility for special education is discussed. Potential roles for the clinical neuropsychologist on the school-based team and approaches to interprofessional collaboration between clinical neuropsychologists and school psychologists are presented. Reimbursement for services and ethical considerations are also discussed.

Objective: In this article, we compared the costs of testing meconium for alcohol exposure in newborns with the lifetime benefits of early detection and intervention., Method: A decision analytic model was developed to assess the cost-effectiveness of testing meconium for two scenarios: (1) all infants in the Canadian province of Ontario and (2) infants who have an older sibling diagnosed with fetal alcohol spectrum disorder (FASD). The model incorporated the costs of early screening, early intervention, and the lifetime societal benefits of early intervention., Results: The cost of the meconium test is Can. $150. The lifetime societal cost of the disease is Can. $1.3 million per incident case. The benefit of early intervention is an improvement in literacy, which improves the quality of life parameter by 0.17 and increases adult lifetime earnings by $26,400 per year. The ratio of the incremental cost to the incremental benefits results in an incremental cost-effectiveness ratio for mandating a universal screen of all newborns in Ontario of $65,874 per quality-adjusted life years. When considering targeted screening, there is a cost savings for society and improvements in quality of life., Conclusions: Depending on society's willingness-to-pay threshold for improving infants' lives in a setting of considerable equity concerns, universal screening and targeted screening of infants who have an older sibling diagnosed with FASD both represent policies that are good value for the money.

Background: The UK Government introduced a large-scale early childhood intervention programme, Sure Start, in 1999. Sure Start is to be further expanded, to achieve national coverage. US experience is highly relevant for anticipating challenges that this expansion will raise., Methods: This is a focused, narrative review. We examine the impact, funding, quality-improvement and programme objectives of Head Start and Early Head Start programmes., Results: (1) Early childhood interventions can make a significant difference to children's life chances; (2) expansion without adequate funding threatens quality; (3) narrower objectives, which are easier to measure, can crowd out broader objectives, which are difficult to measure; (4) programmes must balance fidelity to the model and flexibility to local conditions; (5) multiple objectives may conflict; and (6) programmes may have differential impacts. We consider the implications of these findings for Sure Start, focusing on funding, quality control and parental involvement. We also consider that the potential Sure Start should offer for tackling health inequalities in early childhood and suggest ways in which this aspect of the Programme could be enhanced., Conclusion: Head Start has been dogged by concerns about quality and effectiveness. Many of these problems stemmed from an over-hasty expansion, which locked the Programme into inadequate funding and uneven project- and staff-quality. These issues have been addressed through large funding increases and more rigorous performance measures. Nevertheless, concerns about the aims of the Programme and the extent of parental involvement in management remain. Current funding for Sure Start appears to be adequate, while systematic evaluation procedures have been built in from its inception. Concerns have been raised about the implications of expansion for funding, quality and for parental involvement in management of local programmes. US experience shows that these are centrally important issues and that, if they are not addressed early on, they can take many years to rectify.