Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trialBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38897.555208.2F (Published 31 August 2006) Cite this as: BMJ 2006;333:472
All rapid responses
Another ‘real world’ study about the benefits of psychosocial
stimulation in early childhood may lead readers to the inevitable
conclusion that group based parenting programmes could mitigate the impact
of socioeconomic adversity and environmental risk factors upon the
psychosocial outcome of children when they reach adolescence and
Results of the study by Walker et al (1) would struggle to be
generalisable to much of the Western child population. A selective sample
of stunted children (unresponsive to dietary supplementation) from
Kingston, Jamaica and identified by house to house survey of poor
neighbourhoods introduces a strong selection bias. Randomisation with
small numbers adds little comfort and majority of the effects on outcomes
are only modest.
Prevalence of emotional and behavioural disorders in children in the
UK ranges between 10 and 20 % of the childhood population and is probably
the most common reason for referral to some Community Child Health
Services and most Child and Adolescent Mental Health Services. Offering
parenting programmes to families with insurmountable socioeconomic
difficulties is certainly therapeutic to many healthcare professionals,
but often misses the point completely.
The complex interplay of genetic, neurobiological and environmental
risk factors in producing emotional and behavioural disorders in children
and contributing towards criminality in adulthood is often predictable. It
would, of course, be ideal if socioeconomic and biological adversities in
families could be eliminated and all children offered an equal chance in
life. Barring that, our options vary from using the Webster-Stratton (and
similar parenting programmes) for prevention, the Supernanny approach when
crisis point has been reached, or let the State intervene to ‘identify
tomorrow’s potential troublemakers even before they are born’(2).
We have had some success with the first two approaches; now let us give
the third a fair chance.
1. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM.
Effects of psychosocial stimulation and dietary supplementation in early
psychosocial functioning in late adolescence: follow-up of randomised
controlled trial. BMJ 2006; 333: 472-4
2. Blair to tackle ‘menace’ children. BBC News online: 31 August
Competing interests: No competing interests