Rationale

Brain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes.

Methods

We assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001–2004: at 3.5 years in 2006 and 9–12 years in 2012–2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9–12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9–12 y), for example, the residual of 3.5 y MDS predicting 9–12 y MDS (rMDS).

Results

Three early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: −0.07 [-0.12, −0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: −0.13 [-0.23, −0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome.

Conclusions

Our findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development.

中文翻译：

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母亲抑郁是儿童从幼儿期到青春期前的认知和社会情绪问题的主要持续风险：一项纵向队列研究

基本原理

大脑发育在幼儿时期迅速发生，并在整个童年中期持续发展。存在改变发展轨迹的早期和晚期机会窗口。在低收入和中等收入国家，很少有研究探讨暴露于风险的时间对青春期前认知和社会情感结果不佳的重要性。

方法

我们评估了 359 名儿童，他们参加了 2001-2004 年在印度尼西亚进行的两项补充多种微量营养素干预试验的后续研究：2006 年 3.5 岁，2012-2014 年 9-12 岁。使用结构方程模型，我们检查了儿童早期（3.5 岁）和青春期前（9-12 岁）暴露于风险的指标（儿童年龄别身高 z 评分 [HAZ]、血红蛋白 [Hb]、母亲抑郁症状） [MDS]，家庭环境 [HOME]），具有两个发展结果：认知能力和社会情感问题。我们通过计算较早（3.5 年）测量的指标的残差来表征变化模式，预测稍后测量的相同指标（9-12 年），例如，3.5 年 MDS 的残差预测 9-12 年 MDS (rMDS)。

结果

三个早期风险指标（HOME、Hb 和 MDS）通过早期认知评分与青春期前认知评分间接相关（HOME：0.15，[95% CI 0.09，0.21]；Hb：0.08 [0.04，0.12]，MDS： -0.07 [-0.12, -0.02])。青春期前的认知评分也与童年中期 MDS (rMDS: -0.13 [-0.23, -0.02]) 和 Hb (rHb: 0.10 [0.00, 0.20]) 的变化有关。对于青春期前的社会情绪问题，儿童早期 MDS (0.31 [0.19, 0.44]) 和童年中期 MDS 的变化 (rMDS: 0.48 [0.37, 0.60]) 都与这一结果有很强的直接关联。

结论

我们的研究结果证实了先前研究的结果，即在儿童早期预防风险暴露可能有助于儿童的长期发展。它还为以前稀缺的童年中期文学增添了证据。应评估在童年中期预防母亲抑郁症状和儿童贫血的有效性，以支持儿童发展。