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Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:472
  1. Susan P Walker, professor (susan.walker{at},
  2. Susan M Chang, lecturer1,
  3. Christine A Powell, senior lecturer1,
  4. Emily Simonoff, professor2,
  5. Sally M Grantham-McGregor, professor3
  1. 1 Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston 7, Jamaica
  2. 2 Institute of Psychiatry, London SE5 8AF
  3. 3 Institute of Child Health, London WC1N 1EH
  1. Correspondence to: S Walker
  • Accepted 7 June 2006


Objective To determine whether dietary supplementation or psychosocial stimulation given to growth retarded (stunted) children age 9-24 months has long term benefits for their psychosocial functioning in late adolescence.

Design Sixteen year follow-up study of a randomised controlled trial.

Setting Poor neighbourhoods in Kingston, Jamaica.

Participants Of 129 stunted children identified at age 9-24 months, 103 adolescents aged 17-18 were followed up.

Intervention Supplementation with 1 kg milk based formula each week or psychosocial stimulation (weekly play sessions with mother and child), or both, for two years.

Main outcome measures Anxiety, depression, self esteem, and antisocial behaviour assessed by questionnaires administered by interviewers; attention deficit, hyperactivity, and oppositional behaviour assessed by interviews with parents.

Results Primary analysis indicated that participants who received stimulation had significantly different overall scores from those who did not (F = 2.047, P = 0.049). Supplementation had no significant effect (F = 1.505, P = 0.17). Participants who received stimulation reported less anxiety (mean difference - 2.81, 95% confidence interval - 5.02 to - 0.61), less depression (- 0.43, - 0.78 to - 0.07), and higher self esteem (1.55, 0.08 to 3.02) and parents reported fewer attention problems (- 3.34, - 6.48 to - 0.19). These differences are equivalent to effect sizes of 0.40-0.49 standard deviations.

Conclusions Stimulation in early childhood has sustained benefits to stunted children's emotional outcomes and attention.


  • Contributors All authors conceived and designed the study. SC and SW conducted the study. SW and SGM analysed the data and SW drafted the manuscript. All authors critically reviewed the paper and approved the final draft for publication. SW is guarantor.

  • Funding Supported by a grant from the Wellcome Trust (066088). The funders approved the study design but had no involvement in data collection, analysis, interpretation, or writing the report.

  • Competing interests None declared.

  • Ethical approval Ethics committees of the University of the West Indies and the Institute of Child Health, University College, London.

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