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Comparative Effectiveness of Early Childhood Interventions (public)

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September 12, 2025

What are the comparative effect sizes of early childhood educational interventions across different age groups and learning domains?

Early childhood educational interventions demonstrate varying effectiveness across domains, producing effect sizes of 0.10-1.45 standard deviations for cognitive outcomes, 0.18-1.22 for mathematics, 0.10-0.44 for language (up to 1.10 for literacy), and 0.19-0.56 for socioemotional and motor development, with comparable benefits observed across preschool and infant age groups.

Abstract

Early childhood educational interventions yield effect sizes that vary by learning domain, intervention modality, and age group. Studies targeting cognitive outcomes report gains ranging from 0.10 to 1.45 standard deviations—with intensive, multi-year programs (e.g., Ramey and Ramey, 2023) achieving the largest benefits—while language-focused programs generally produce improvements of 0.10 to 0.44 standard deviations, with some literacy interventions reaching 1.10. Mathematics interventions typically exhibit effects from 0.18 to 1.22 standard deviations, especially when curriculum-based and structured (as in Yıldız et al., 2025 and Clements et al., 2011). Socioemotional and motor development interventions tend to yield modest gains (approximately 0.19–0.56), a range further supported by evaluations of responsive caregiving and physical activity programs. Most studies concentrate on preschool-aged children, though interventions for infants show comparable benefits. Greater intervention intensity, duration, and multi-component design are associated with larger effects, according to the reported findings.

Methods

We analyzed 40 sources from an initial pool of 997, using 8 screening criteria. Each paper was reviewed for 6 key aspects that mattered most to the research question. More on methods

Papers identified with Elicit search

n = 997

Papers screened using: Population Age Range, Quantitative Data Availability, Study Design Rigor, Educational Setting, Learning Domain Focus, Typical Development Population, Intervention Component, Educational vs. Medical Focus

n = 997

Papers screened out

n = 957

Papers included for extraction

n = 40

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Paper search

Using your research question “What are the comparative effect sizes of early childhood educational interventions across different age groups and learning domains?”, we searched across over 126 million academic papers from the Semantic Scholar corpus. We retrieved the 997 papers most relevant to the query.

Screening

We screened in sources based on their abstracts that met these criteria:

• Population Age Range: Does the study focus on children aged 0-8 years (early childhood period)?
• Quantitative Data Availability: Does the study report quantitative effect sizes or provide sufficient quantitative data to calculate effect sizes?
• Study Design Rigor: Is the study a randomized controlled trial, quasi-experimental study, or controlled study with comparison groups?
• Educational Setting: Is the intervention implemented in early childhood educational settings (e.g., preschools, kindergartens, childcare centers, or home-based educational programs)?
• Learning Domain Focus: Does the intervention target specific learning domains (cognitive, language, literacy, numeracy, social-emotional, or motor skill development)?
• Typical Development Population: Does the study include typically developing children (rather than focusing solely on children with diagnosed developmental disabilities or special needs)?
• Intervention Component: Does the study include an intervention component (rather than being purely observational)?
• Educational vs. Medical Focus: Is the intervention primarily educational in nature (rather than primarily focused on medical or therapeutic treatments)?

We considered all screening questions together and made a holistic judgement about whether to screen in each paper.

Data extraction

We asked a large language model to extract each data column below from each paper. We gave the model the extraction instructions shown below for each column.

• Study Design Type:

Identify the specific type of study design used. Look in the methods section for precise description. Categorize as:

• Randomized Controlled Trial (RCT)
• Quasi-experimental study
• Comparative study
• Longitudinal study

If multiple design elements are present, list all that apply. If uncertain, note “unclear” and provide a brief explanation of why.

• Intervention Type and Components:

Comprehensively list all components of the educational intervention:

• Primary pedagogical approach (e.g., direct instruction, inquiry-based)
• Specific learning domains targeted
• Additional support services (if any)
• Delivery method (group size, individual/group)

Be as detailed as possible. If multiple intervention components exist, list each separately. Include frequency, duration, and specific content of interventions where mentioned.

• Participant Demographics:

Extract the following participant details:

• Age range of children
• Socioeconomic status (if reported)
• Risk factors or special circumstances
• Total sample size
• Gender distribution (if reported)

Use exact numbers or percentages from the study. If a range is given, record the full range. If any demographic information is not reported, clearly mark as “NR” (not reported).

• Outcome Domains and Measurement:

List all primary outcome domains measured:

• Cognitive development
• Language development
• Motor development
• Socioemotional development
• Academic achievement
• Other specific domains

For each domain:

• Note specific measurement tools/instruments used
• Record effect sizes if provided
• Indicate statistical significance
• Note follow-up time points for measurements

If multiple measurements exist for a domain, list all with their respective details.

• Long-term Outcomes:

Identify and extract any long-term outcomes measured beyond immediate child development:

• Educational attainment
• Employment
• Social relationships
• Health indicators
• Economic outcomes

Record:

• Specific outcome measured

• Age/time point of measurement

• Effect size or key findings

• Statistical significance (if reported)

• Geographical and Contextual Factors:

Extract:

• Country or region of study
• Income level classification (low, middle, high-income)
• Urban/rural setting
• Specific contextual challenges or environmental factors

If multiple contexts are represented, list each separately. Use the study’s own classification or standard international definitions for income levels.

Results

Characteristics of Included Studies

Study

Intervention Type

Age Group

Learning Domain

Study Design

Full text retrieved

Love et al., 2013

Direct coaching, video modeling, self-reflection, resource/referral services

Prenatal to 5 years

Cognitive, language, attention, behavior, health, parenting, mental health, employment

Randomized controlled trial (RCT), Longitudinal, Comparative

Yes

Meghir et al., 2023

Early stimulation (home-based), enhanced preschool (center-based)

7-16 months to ~4 years

Cognition, language, executive function, school readiness

Randomized controlled trial (RCT), Longitudinal

No

Olive et al., 2023

Physical activity intervention (AEL)

3-5 years

Executive function, expressive vocabulary, motor skills

Randomized controlled trial (RCT)

Yes

Camilli et al., 2010

Direct instruction, inquiry-based, teacher/small-group

Pre-Kindergarten

Cognitive, social, school progress

Comparative, Quasi-experimental, Randomized controlled trial (RCT)

No

Campbell et al., 2001

Full-time, high-quality educational child care

Infancy to 21 years

Cognitive, academic (reading, math)

Randomized controlled trial (RCT), Longitudinal

No

Campbell and Ramey, 1994

Infant/preschool/primary school educational treatment

Infancy to 12 years

Cognitive, academic achievement

Randomized controlled trial (RCT), Longitudinal

Yes

Reynolds et al., 2001

Comprehensive education, family, health services

3-9 years, followed to 20

Academic, social, educational attainment, crime

Longitudinal, Quasi-experimental, Comparative

Yes

Blewitt et al., 2018

Universal curriculum-based social-emotional learning (SEL)

2-6 years

Social, emotional, behavioral, early learning

Randomized controlled trial (RCT), Quasi-experimental

Yes

Jeong et al., 2021

Parenting interventions (responsive caregiving, stimulation, etc.)

Prenatal to 3 years

Cognitive, language, motor, socioemotional, behavior, attachment

Randomized controlled trial (RCT)

Yes

Cahoon et al., 2023

Home-based literacy/math interventions

3.07–5.32 years

Literacy, mathematics

Randomized controlled trial (RCT), Quasi-experimental

Yes

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Intervention Types:

• Curriculum-based interventions:13 studies (including literacy, math, social-emotional learning, spatial skills, etc.).
• Center-based early childhood education/preschool programs:10 studies.
• Home-based or parenting interventions:7 studies.
• Multi-component interventions (education plus health, nutrition, or social services):6 studies.
• Physical or motor skill interventions:3 studies.
• Technology-based interventions (educational apps, computer-supported learning):3 studies.
• Policy or large-scale program evaluations:3 studies.

Age Groups:

• 25 studies targeted preschool-aged children (3-5/6 years).
• 15 studies included prenatal or infancy (0-2 years).
• 5 studies included early primary ages (6-8 years).
• 7 studies followed participants into adolescence or adulthood.
• We didn’t find mention of the age group in 7 studies.

Learning Domains:

• Language and literacy outcomes: 22 studies.
• Cognitive or academic outcomes: 20 studies.
• Math outcomes: 14 studies.
• Social-emotional or behavioral outcomes: 15 studies.
• Motor or physical development outcomes: 5 studies.
• Health outcomes: 4 studies.
• Economic or employment outcomes: 5 studies.

Study Designs:

• 26 studies used randomized controlled trial (RCT) designs.
• 14 studies used quasi-experimental designs.
• 10 studies used comparative designs.
• 17 studies included longitudinal follow-up.
• 6 studies were systematic reviews or meta-analyses.

Effects

Effect Sizes by Age Group

Study

Age Group

Learning Domain

Effect Size Range

Number of Studies

Love et al., 2013

1-5 years

Cognitive, language, socioemotional

0.10–0.20 (cognitive/language), 0.31–0.38 (engagement)

1

Meghir et al., 2023

7-48 months

IQ, school readiness

0.13–0.24 standard deviations

1

Olive et al., 2023

3-5 years

Executive function, vocabulary

Cohen’s d=0.24–0.29

1

Camilli et al., 2010

Pre-Kindergarten

Cognitive, social

Largest for cognitive, no mention found

1

Campbell et al., 2001

3-21 years

Cognitive, academic

Moderate-large, no mention found

1

Campbell and Ramey, 1994

Infancy-12 years

Cognitive, academic

Maintained advantage, no mention found

1

Reynolds et al., 2001

3-20 years

Educational, social

11.2% increase in high school completion, 8.2% decrease in arrest

1

Blewitt et al., 2018

2-6 years

Socioemotional, cognitive

Cohen’s d=0.18–0.54

1

Jeong et al., 2021

0-3 years

Cognitive, language, motor, socioemotional

Standardized mean difference (SMD)=0.19–0.56

1

Cahoon et al., 2023

3-5 years

Literacy, math

Cohen’s d=0.10 (literacy), 0.18 (math)

1

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Learning Domains Targeted:

• Mathematics: 13 studies.
• Cognitive outcomes: 12 studies.
• Language outcomes: 11 studies.
• Socioemotional or emotional outcomes: 6 studies.
• Academic or educational outcomes: 5 studies.
• Literacy and reading outcomes: 5 studies (3 literacy, 5 reading; some overlap).
• Other domains: executive function (2 studies), motor/physical/fine motor skills (4 studies), health (2 studies), social (3 studies), behavior (2 studies), school readiness (1 study), problem-solving/STEM (1 study), spatial skills (1 study), phonological/alphabet (4 studies), pre-literacy (1 study).

Effect Size Reporting:

• Numeric effect size estimates (e.g., standard deviation, Cohen’s d, Hedges’ g, standardized mean difference, correlation coefficient, or percentage) were found in 26 studies.
• 13 studies reported only qualitative descriptors of effect (e.g., “significant”, “modest”, “moderate-large”).
• Of the 26 studies with numeric effect sizes, 2 reported only percentage or non-standard deviation outcomes (e.g., percentage increase in school completion).
• All included studies reported at least a qualitative or numeric effect size.

Age Groups:

• 16 studies targeted preschool or pre-Kindergarten children (3-5/6 years).
• 6 studies targeted infants (0-2 years).
• 3 studies targeted early childhood (0-6/8 years).
• 8 studies included school-age children (6+ years), with some spanning into adolescence or adulthood.
• We didn’t find mention of the age group in 7 studies.

Effect Sizes by Learning Domain

Cognitive Development:

• Effect sizes reported in the included studies range from 0.10–1.45 standard deviations, with larger effects observed in intensive, multi-year interventions (e.g., as reported by Ramey and Ramey, 2023).
• Meta-analyses included in this review (Jeong et al., 2021; Blewitt et al., 2018) reported pooled standardized mean differences of 0.18–0.32 for cognitive and early learning outcomes.

Language Development:

• Effect sizes typically ranged from 0.10–0.44 standard deviations, with some studies reporting larger effects for emergent literacy (Barnett et al., 2018: 1.10).
• Computer-supported and storybook-based interventions yielded small to moderate effects (Verhoeven et al., 2020: 0.28; Carolin and Fardzadeh, 2018: 0.21–0.27).

Mathematics:

• Effect sizes ranged from 0.18–1.22 standard deviations, with the largest effects in structured, curriculum-based interventions (Yıldız et al., 2025; Clements et al., 2011).
• Meta-analyses (Wang et al., 2016; Malofeeva, 2005) reported moderate effects (0.43–0.68; 0.47).

Socioemotional Development:

• Effect sizes were generally small to moderate (Blewitt et al., 2018: Cohen’s d=0.19–0.54; Jeong et al., 2021: standardized mean difference=0.19).
• Classroom-wide and universal social-emotional learning interventions showed consistent, though modest, benefits.

Motor Development:

• Physical activity and fine motor interventions yielded moderate effects (Grady et al., 2024: standardized mean difference=0.19–0.54; Strooband et al., 2020: moderate).

Academic Achievement:

• Reading and math achievement effect sizes ranged from 0.10–0.60 standard deviations, with larger effects in high-intensity or multi-year programs.
• Long-term follow-up studies (Reynolds et al., 2001; Campbell and Ramey, 1995) reported sustained academic benefits.

Other Domains:

• Executive function, school readiness, spatial skills, and problem-solving showed moderate to large effects in targeted interventions (Meghir et al., 2023; Yang et al., 2020; Burns et al., 2025).

Methodological Factors Influencing Effect Sizes

• Study Design:In the included studies, randomized controlled trials and large-scale longitudinal studies tended to report more robust and reliable effect sizes, while quasi-experimental and comparative studies appeared more susceptible to bias.
• Sample Size:Larger studies and meta-analyses provided more precise estimates, though heterogeneity remained a concern.
• Intervention Intensity and Duration:More intensive, longer-duration, and multi-component interventions were associated with larger and more sustained effects.
• Measurement Tools:Use of standardized, validated instruments enhanced comparability; studies using researcher-developed measures often reported larger effects.
• Fidelity and Implementation:Higher fidelity and professional development for educators were associated with greater effects (as reported by Carolin and Fardzadeh, 2018).
• Contextual Moderators:Socioeconomic status, country income level, and risk status of participants moderated effect sizes, with disadvantaged and low- and middle-income country populations often showing larger gains.

Generalizability and Study Context

• Geographical Diversity:The included studies spanned high-, middle-, and low-income countries, with interventions adapted to local contexts.
• Population Diversity:Most studies focused on low-income or high-risk populations, which may limit generalizability to more advantaged groups.
• Setting:Interventions were delivered in a variety of settings, including center-based, home-based, community, and digital environments. The context of delivery influenced both feasibility and effectiveness, as reported in several studies.
• Long-term Outcomes:Sustained benefits were more likely in intensive, multi-year interventions, but evidence was limited by the small number of long-term follow-up studies.
• Adverse Effects:Few studies reported adverse effects. One study (Love et al., 2013) noted increased parent-reported aggression with formal program participation. We didn’t find mention of other adverse effects in the available full texts or abstracts.

Limitations:

• Heterogeneity in intervention types, outcome measures, and reporting limited direct comparison across studies.
• Some studies lacked detailed reporting of effect sizes, statistical significance, or confidence intervals.
• Risk of bias was present in studies with small samples, non-randomized designs, or low fidelity.
• Generalizability was limited by the focus on high-risk and low-income populations in many studies.

References

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F. Campbell, E. Pungello, S. Miller-Johnson, M. Burchinal, C. Ramey\ (2001).The development of cognitive and academic abilities: growth curves from an early childhood educational experiment. Developmental Psychology

F. Campbell, C. Ramey\ (1994).Effects of early intervention on intellectual and academic achievement: a follow-up study of children from low-income families. Child Development

A. Reynolds, Judy A Temple, Dylan L. Robertson, Emily A. Mann\ (2001).Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. Journal of the American Medical Association (JAMA)

C. Blewitt, M. Fuller‐Tyszkiewicz, A. Nolan, Heidi J Bergmeier, D. Vicary, and 4 more\ (2018).Social and Emotional Learning Associated With Universal Curriculum-Based Interventions in Early Childhood Education and Care Centers. JAMA Network Open

Joshua Jeong, E. Franchett, C. V. Ramos de Oliveira, K. Rehmani, A. Yousafzai\ (2021).Parenting interventions to promote early child development in the first three years of life: A global systematic review and meta-analysis. PLoS Medicine

Abigail Cahoon, Carolina Jiménez Lira, Nancy Estévez Pérez, Elia Verónica Benavides Pando, Yanet Campver García, and 2 more\ (2023).Meta-Analyses and Narrative Review of Home-Based Interventions to Improve Literacy and Mathematics Outcomes for Children Between the Ages of 3 and 5 Years Old. Review of Educational Research

S. Ramey, Craig T. Ramey\ (2023).Early Childhood Education that Promotes Lifelong Learning, Health, and Social Well-being: The Abecedarian Project and its Replications. Medical Research Archives

F. Campbell, C. Ramey\ (1995).Cognitive and School Outcomes for High-Risk African-American Students at Middle Adolescence: Positive Effects of Early Intervention

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A. Grady, Rebecca Lorch, Luke Giles, Hannah Lamont, Amy Anderson, and 6 more\ (2024).The impact of early childhood education and care‐based interventions on child physical activity, anthropometrics, fundamental movement skills, cognitive functioning, and social–emotional wellbeing: A systematic review and meta‐analysis. Obesity Reviews

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Marit Carolin, Ebad Fardzadeh\ (2018).University of Southern Denmark The Effectiveness of a Large-Scale Language and Preliteracy Intervention The SPELL Randomized Controlled Trial in Denmark

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Early Childhood Education that Promotes Lifelong Learning, Health, and Social Well-being: The Abecedarian Project and its Replications

S. Ramey, Craig T. Ramey

Medical Research Archives·

2023·

4 citations

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Study Design Type

Randomized Controlled Trial (RCT), Longitudinal study

Intervention Type and Components

- Primary pedagogical approach: Combination of direct instruction and interactive learning - Specific learning domains targeted: Language development, cognitive skills, social-emotional development - Additional support services: Pediatric health care, early nutritional enhancement, family social services - Delivery method: Group setting with trained teachers, full-day, 5 days a week, 50 weeks a year for 5 years

Participant Demographics

- Age range of children: NR - Socioeconomic status: High-risk environments (socioeconomically disadvantaged) - Risk factors or special circumstances: High-risk environments, non-optimal development risk - Total sample size: 1160 - Gender distribution: NR

Outcome Domains and Measurement

- Cognitive development: Standardized assessments; effect sizes 1.22 to 1.45; significant benefits; measured at 18 months to 4 years. - Academic achievement: School-age academic performance; significant benefits; measured during school years. - Brain development: MRI; increased brain size and volume; significant differences; measured at age 40. - Social decision-making: Interactive economic games; better social norm enforcement and planning; significant differences; measured at age 40.

Long-term Outcomes

- Educational attainment: Higher rates of holding skilled jobs and being enrolled in higher education at ages 21 and 30. - Employment: Higher rates of full-time employment at ages 21, 30, and 40. - Social relationships: Stronger positive relationships with parents at age 40. - Health indicators: Lower reliance on welfare and better self-rated health at ages 21 and 30; fewer risk factors for cardiovascular and metabolic disease at age 35. - Economic outcomes: Lower reliance on public assistance and higher rates of having bank accounts and savings at age 40.

Geographical and Contextual Factors

- Country or region of study: United States - Income level classification: Low-income - Urban/rural setting: Urban - Specific contextual challenges or environmental factors: Rarity of center-based care in the 1970s, concerns about the mother-child bond, differences in maternal employment patterns and family structure, shift towards more affluent urban settings over time

Introduction: The Abecedarian Project was a randomized controlled trial (RCT) that tested the effects of 5 years of early education combined with social and health supports on learning and cognitive development in infants from high-risk environments. This article provides a reflective review of its key findings from 50 years along with results from variations also tested in RCTs. Methods: The Abecedarian Project and its replications all used a comparative efficacy RCT design. The Early Education treatment group received systematic early education with pediatric health care, early nutritional enhancement, and family social services while the Health/Social Services comparison group received health and family supports but not the formal early education program. In childhood, key outcomes were cognition and school-age academic achievement; in adulthood, assessments included post-high school educational attainment, employment, income/assets, adult family relationships, brain development, and social decision-making. Results: At all tested ages after 12 months of age, the Abecedarian Early Education was associated with significant benefits in children’s cognitive development, school and educational achievements, and multiple indicators of positive health and indicators of adult social adjustment. Collectively, the major replication studies provide affirmation of the positive impact of high-quality early education, although the breadth and magnitude of benefits vary with the child’s environmental risks and dosage of the early education intervention. Some unexpected long-term associations include enhanced caring and future planning in social decision-making, positive relationships with parents, altered brain structure, and improved cardiovascular health. Conclusions: This series of RCTs improved developmental trajectories of infants born into multi-risk social, economic, and biological life circumstances, thus strongly resolving that human malleability is achievable. The challenge ahead concerns how to effectively disseminate and practically use these findings to realize widespread benefits. We nominate both a guiding conceptual framework to help plan and measure strategic interventions as well as a set of hallmarks associated with successful community implementation of effective child and family programs.

Introduction to The Abecedarian Approach to Early Childhood Enhanced Care and Education

Some questions about human development can only be answered by conducting randomized controlled trials (RCTs) that permit careful control over the experiences of children and their families. The compelling question is "Can the course of human development be significantly and practically altered by intentional and directed acts beginning early in development?" If so, then which systematic interventions produce meaningful and enduring benefits for children from low resource circumstances?

The question of human malleability has a long and controversial history. Opinions have deep philosophical, religious, and societal origins. Unsupported and influential racial and social class assumptions continue to shape policies in education, housing, health care, employment, and all aspects of family life. One dominant and tragic assumption held that certain groups are pre-determined to lead lives of "lesser" versus "better" value to society. Importantly, this societal view of fixed differences always had strong, vocal, and sometimes effective challengers. Not surprisingly, the arena of scientific inquiry about human development often mirrored the philosophical and public policy debates, civil conflict, and social justice initiatives in the U.S. and throughout the world.

Scientists contributed to this well-known 19 th and 20 th century nature-nurture paradigm. Proponents of the unalterable genetic views, including Galton, 1 Jensen, 2 and Herrnstein and Murray 3 often relied on inadequate, distorted, or even sometimes falsified data. In contrast, among those favoring an environmental and experience-dependent viewpoint -prominently pursued in the 1960swere Hunt 4 and Bijou and Baer. 5 They and many others provided examples of how the environment could influence how well children performed on standardized cognitive tests and real-world indicators of academic achievement and income. What was clear in the 1960s was the need to conduct ethical experiments to resolve this longstanding, vigorous controversy. Stated differently, no amount of sophisticated and detailed statistical analyses of naturalistic, longitudinal studies of children could answer the question of what causes differential life courses. Rather, experiments could uniquely answer this question of whether receiving a package of essential resources, starting at birth, could lead to improved cognitive, social-emotional, and health outcomes. The essential resources included individualized high-quality pediatric health care, infant nutrition, and family social services; further, early childhood education in the form of stable, warm, responsive care and fun learning and language interactions comprised a promising "additional essential" for young children to thrive. Accordingly, we chose these essentials to manipulate via RCT studies, thus permitting a rigorous test of their impact on human health and development.

Children who meet criteria for being "at risk" for non-optimal development often come from families and communities that have endured deprivation due to societal policies and practices that marginalize, devalue, and directly harm entire groups of individuals. Even in the early 1970s when the Abecedarian Project began, there was abundant evidence that intergenerational economic poverty, regardless of race or ethnicity, was powerfully linked to poor outcomes in school readiness, school achievement, and adult health and well-being. 6 ore recent findings show that growing up in poverty is associated with measurable differences in adult brain structure, 7 findings consistent with experimental animal studies of early enrichment versus deprivation 8 and worldwide crises of early childhood maltreatment, such as occurred in the Romanian orphanages under oppressive national policies. 9,10 e Biosocial Contextual Systems Framework: An overview of the ideas that shaped the Abecedarian Project

We have organized the key ideas about influences on early human development into a conceptual framework [11][12][13] that builds on formal biological systems theory, measures nearby and distal ecological influences, incorporates the paradigmchallenging findings in the 1960s and 1970s from our labs and others' about infant learning. e.g., [14][15] Figure 1 , The Biosocial Contextual Systems Framework, illustrates the key ideas or constructs in this framework. This emphasizes the importance of multiple types and levels of influences co-occurring. An individual's course of development is directly influenced by conditions that begin before conception and birth, as shown in the top row of the figure. The figure's central box labelled "Transactions with Others & Environment" identifies the most important driving force for an individual's development. Adjacent boxes are the "Supports and Stressors" that occur "Within Family" and in "Extra-Familial" contexts. In turn, the transactions produce complex changes in both the biology and behavior of the individual, as well as in the child's family members. Figure 1 This conceptual framework points to the necessity of identifying which aspects of "Transactions with Others & Environments" and which environmental stressors and supports should be manipulated (i.e., improved) and measured. Specifically, the Abecedarian Project provided a multi-component treatment package designed to improve the child's daily transactions via the Abecedarian Early Education intervention and delivered to both groups an increased package of external supports and stress reducing strategies for children for both treatment groups.

This intergenerational and practical framework emphasizes changes in both children and their families. 12 This framework has helped guide the selection of intervention strategies, outcome measures, and data analytic approaches. Within this framework, the "Current biological and behavior status" of children and adults corresponds to data we collect at each timepoint on study participants. These repeated assessments help capture the cumulative effects of the treatments being tested. Because an RCT is a study design in which treatment groups are created by an equitable process -that is, random assignment with parent permission and engagement -the influences of genetics, the prenatal environment, sociocultural norms and practices, and special characteristics and resources of local communities are assumed to be similar, on average, across the treatment groups.

Within this general conceptual framework, for the Abecedarian Project and its replication RCTs known as Project CARE and the Infant Health and Development Program, we developed a systematic, written early childhood education curriculum or program that was delivered by trained "teachers" (a mix of adults with relevant content expertise, coming from the children's immediate neighborhoods and the larger community). These three RCTs have been archived by the Eunice Kennedy Shriver National Institute of Child Health and Human Development for public availability, and described in the companion book "Abecedarian: The Ideas, the Approach, and the Findings" by Ramey, Sparling, and Ramey. 16 More recently, Sparling, Ramey, Meunier, and Ramey 17 wrote "The Abecedarian Approach to Healthy Development" to provide a shorter, practical overview of the early education intervention. The Abecedarian Approach refers to the training and specific educational materials used within an organized educational childcare setting that we designed and operated. The key areas emphasized in the educational transactions involved activities grouped under four pillars: 1) language priority, 2) conversational reading, 3) specific "learning games" appropriate for the child's developmental readiness, and 4) enriched caregiving throughout the day. .19 In 1999, we wrote "Right from Birth: Building Your Child's Foundation for Life" 20 and "Going to School: How to Help Your Child Succeed" 21 that provided a synthesis of "Transactions with Others & the Environment" for young children. Consistent with more than 1000 peer-reviewed scientific papers about early learning and brain development, we identified a set of 7 distinctive social interaction activities, displayed in Table 1 . These learning essentials can assist adult care providers and teachers focus on activities known to promote cognitive and social-emotional maturation. These books were the companion guides for two Public Broadcast System (PBS) television series; together, the books and televised episodes provided core materials for implementing several large-scale, community-based programs that successfully enhanced both parenting as well as early childcare and education services in multiple states.

The Three "Abecedarian Approach" Randomized Controlled Trials (RCTs)

The Abecedarian Approach was tested in three longitudinal projects -two single-site and one multisite randomized controlled trial (RCT) involving 1160 children and their families. The Abecedarian Approach assumes children are learning all the time. Thus, the Abecedarian enhanced childcare and early education program was designed to be highly engaging, fun, and active -for both children and the adults -with learning activities occurring naturally throughout the day during caregiving, physical play, exploration, and structured interactive learning games. 1. ENCOURAGE Encourage exploration with all the senses, in familiar and new places, with others and alone, safely and with joy.

2. MENTOR Mentor in basic skills, showing the whats and whens, the ins and outs of how things and people work.

3.CELEBRATE

Celebrate developmental advances, for learning new skills, little and big, and for becoming a unique individual.

4. REHEARSE Rehearse and extend new skills, showing your baby how to practice again and again, in the same and different ways, with new people and new things.

5.PROTECT

Protect from inappropriate disapproval, teasing, neglect, or punishment.

6.COMMUNICATE

Communicate richly and responsively with sounds, songs, gestures, and words; bring your baby into the wonderful world of language and its many uses.

7.GUIDE

Guide and limit behavior to keep your child safe and to teach what's acceptable, and what's not -the rules of being a cooperative, responsive, and caring person.

The educational curriculum was based on known types of learning processes in infants, toddlers, and young children, such as described by Ramey, Breitmayer, Goldman, and Wakeley. 22 Learning activities were paced to be appropriate for each child's development so each child had a mix of new challenges along with practice of skills recently acquired to advance their levels of mastery. 4][25] Accordingly, planned activities included many ways to use pictures, signs, symbols, sounds, words, sentences, stories, toys, everyday objects, and interactive conversations -starting early in the first year of life. Even conversational reading and play began in the first 6 months of life with specially written picture/word books. Teachers were skilled in using varied, complex, and informative language throughout the day.

A brief description of three independent RCTs and their study participants follows: Major Findings from The Abecedarian Project: From Birth to Kindergarten Entry (age 5)

The Abecedarian Project was conducted by a large multidisciplinary team of investigators. In this overview, we highlight two major types of findings -first, those that addressed the compelling question about the malleability of children's cognitive and academic outcomes; and second, those that provide insights into how early experiences might "get under the skin" and influence other aspects of the human life course. We emphasize that all of the standardized assessments were administered by trained assessors who had nothing to do with the treatment of the child or family.

Figure 2 summarizes findings about developmental and cognitive outcomes in the first 54 months of life.

During the first 12 months of life, children in both groups performed similarly with mean scores close to the national average of 100. Starting at 18 months, however, scores of children in the Health/Social Services group declined sharply and differed significantly from the Abecedarian Early Education group. By this age, those who received the educational intervention earned average scores of 108, 18 points higher than those in the Health/Social Services group (mean = 90). Significant group IQ differences of at least 10 points continued until the children were 4 ½ years old, the last age assessed prior to entering kindergarten. 26 arly Childhood Education that Promotes Lifelong Learning, Health, and Social Wellbeing In the fields of education and pediatrics, effect sizes of 0.25 and higher are widely accepted as sufficient for guiding policy and practice. In the Abecedarian Project, the effect sizes from 18 through 36 months were exceptionally high -from 1.22 to 1.45 (shown on the bottom line of Figure 2 ). Interestingly, the effect sizes remained high -but somewhat less so -when children were 48 and 54 months of age. Figure 1 indicates that between 3 and 5, children in the Health/Social Services group had modest increases in IQ scores. We were able to link these increases to the fact that about half of these children participated in community preschool programs. Even more specifically, whether or not the child attended a child development center for at least one or two years in the community significantly increased their IQ scores. 27 We noted that the community child development centers in Chapel Hill, NC were mostly rated as high quality and well-staffed. Within the conceptual framework presented above, this finding of a bimodal divergence within one of the treatment groups provides another source of evidence (observational rather than experimental) that receiving highquality childcare and early education confers measurable benefits for children's cognitive development and school readiness.

A clinical perspective on these test scores offers other insights. Figure 3 shows the percentage of children in each group who scored in the normal range of intelligence (i.e., earning IQ scores of 85 or higher on tests that have a national average of 100 and a standard deviation of 15 or 16) from 6 months to 4 years. The findings are as follows 28 : for the Health/Social Services group, 93% were in the normal range at age 6 months, but this dropped precipitously and continuously through age 4 when less than half of these children (45%) had IQ scores of 85 points or higher. This finding is consistent with a cumulative environmental toll hypothesis that insufficient cognitive, language, and social learning

. 7

Maternal Outcomes and Mother-Child Interactions

We examined mothers' educational advancement, employment, and transactions with their children at multiple timepoints. Key findings 29 include the following: significantly more mothers in the Abecedarian Educational treatment obtained posthigh school formal education than those in the Health/Social Services group; teen mothers showed the largest benefits with 80% eventually completing post-high school education compared to only 28% whose children did not receive the Abecedarian Early Education treatment; and maternal employment for adult mothers was 84% in the Abecedarian Educational group compared to 74% in the Health/Scoial Services group. Once again, these maternal benefits were even greater for teen mothers: 92% vs 66% employed when their child was age 15.

Important to remember was the national and local context for the Abecedarian Project. In the 1970s, center-based infant and toddler care in the community was rare, mothers often stayed home full-time, relatives frequently helped informally with infant and child care, and many pediatricians cautioned that the mother-child bond might be harmed by strangers caring for very young infants. So, we carefully measured the mother-child relationship. We documented that the quality of the mother-child attachment (assessed via a standardized lab protocol) did not differ between the treatment groups, affirming that early group care did not harm or disrupt a positive mother-child bond. Further, within each treatment group, the mother-child dyads that had more frequent, warm, and positive scores predicted better cognitive outcomes for the children. Finally, for children in the Abecedarian Early Education group, they showed increased skills compared to those in the Health/Social Services group in being able to elicit positive and prompt responses from their mothers. 1][32] These findings about improving mother-child interactions relate to the conceptual framework for the Abecedarian Project by demonstrating that the child's "Transactions with Others and Environments" (Figure 1 ) leads to She told us she had been a very young, inexperienced mother, often angry and allowing her anger to spill over into how she treated her young child. Her child was in the Abecedarian Early Education group. One day after she was very upset with her child, the child asked "Why don't you treat me nice like the teachers do every day?" She took that to heart, and began to change how she treated her child, noticing that their relationship improved a lot. Then, many years later she served as a mentor to her daughters-in-law, telling them her own story of being overly harsh as a mother, but learning firsthand that being patient and kinder to her child made both of them much happier. This mother told us we had helped everyone in her family.

We also frequently measured the quality of the child's home environment, through direct observations and scoring via a standardized home assessment tool. The home environments -which the treatments did directly try to change -were highly similar in the two groups; and, as shown by others, the measured quality of the home environment significantly related to children's cognitive performance. 28 Once again, this finding supports the guiding conceptual framework about multiple, co-occurring influences. Even when a planned early intervention RCT, such as the Abecedarian Approach, proves to be associated with large and enduring benefits, the treatment does not change the fact that there are other strong and significant influences that co-exist in the child's life -both positive and negative. 28

Replication RCTs: Findings from Project CARE and The Infant Health and Development Program in The Early Years

A hallmark in science is replicability of findings. The Abecedarian Project was replicated with variations, as described above. Here we summarize similarities and differences in the measured effects of the Abecedarian Early Education treatment compared to the other tested treatments.

Project CARE. Project CARE 33,34 was the closest study ever conducted as a true replication of the Abecedarian Project. We did add a third treatment group -the Home Visiting Education Group -to find out if parents could learn to provide the early education in their own homes. Home Visitors went once a week until children were 3 years old to establish close relationships with the mothers and guidance in how to provide the pillars of the Abecedarian Approach. Then from age 3 to kindergarten, home visits continued with a schedule adjusted to meet parental preference. Mothers were given supplies, games, books, and toys to support the home-based curriculum. Findings from Project CARE showed that at 6 months of age and at all subsequent assessment ages, children in the Abecedarian Early Education group performed significantly higher than those in the Health/Social Services group. Further, the magnitude of these group differences closely replicated those in the Abecedarian Project. Quite unexpected, however, was that the Home Visiting Education treatment did not show any advantage above the Health/Social Services group. This was particularly disappointing because the families were highly participatory in the home visiting program, the mothers reported they liked and benefited from the home visits, and the home visitors also had positive appraisal of this treatment approach. We originally predicted that the Home Visiting group would show significant benefits, perhaps falling in-between the performance of children in the child development center where they received the curriculum from qualified, actively supervised teachers and assistants and those in the Health/Social Services group. To find no benefits from home visiting led us to think more carefully about the "dosage" of the "Transactions with Others & Environments" hypothesized in the guiding conceptual framework (see Figure 1 above ). Thus, we speculated that even when mothers reported learning much from the home visiting program, they still may have been less adept and consistent (for a myriad of reasons) or may have had less time and energy to provide the equivalent of a full 8 hours/day, 5 days/week, 50 weeks/year of professional educational caregiving. As we report below, however some of the international RCTs using the Abecedarian Approach and parent education -in quite different contexts and conducted many decades later -did result in measured benefits for both children and parents. 17 e Infant Health and Development Program (IHDP). IHDP 35,36 focused on the malleability of infants born prematurely and low birthweight, who generally are at elevated risk for developmental delays and lower cognitive and academic achievement. This study thus tested the generalizability of findings about the Abecedarian Approach to a clinical group of at-risk infants. The treatments provided were shortened to just the first 3 years of life, with the rationale that this Early Childhood Education that Promotes Lifelong Learning, Health, and Social Wellbeing encompassed a sensitive developmental period for these biologically vulnerable children. We tested the treatments in 8 cities, providing a wide range of community contexts, population demographics, and extra-familial supports and stressors. Because the study enrolled a large number of infants and families, we were able to treat each site as an independent test of the Abecedarian Early Education treatment to produce significant benefits.

IHDP results replicated many of the Abecedarian Project conclusions about the first 3 years of life. First, we succeeded in building child development centers in the community and providing staff with the training and active supervision in how to deliver the Abecedarian Approach at high levels of fidelity to the original program in all 8 sites. We did find, however, that some sites required more intensive supervision and additional supports as they launched the program than did other sites. Second, in all 8 cities, the children in the early education treatment group had significantly higher mean IQ scores at both 24 and 36 months of age than did those in the Health/Social Services treatment group. Overall, the early education treatment conferred a combined site benefit of 10-plus points on average -highly similar to findings from the Abecedarian Project and Project CARE more than a decade earlier. Third, because IHDP had a much larger number of children from a wider range of both biological and environmental risk conditions than those in the Abecedarian Project and Project CARE, we were able to test for differential effects associated with infant risk (specifically, their birthweight category) and family risk (specifically, maternal education). Further, for the first time ever within an RCT, we were able to test for a significant relationship between child cognitive outcomes and the actual "dosage" each child and family received of the Abecedarian Early Education intervention. We expand on these differential effects below.

Differential effects in IHDP of the Abecedarian

Early Education treatment as a function of child and family risks and participation levels. Concerning the role of infant biological risk at birth, we found that children in the lighter low-birthweight group (<2000 gm) showed smaller magnitude benefitsalthough the benefits were still significant -than did those from the heavier low-birthweight group (2001-2500 gm). 35,37 Demographically, those in the heavier low-birthweight group had an overrepresentation of families with very low income and low levels of maternal education, similar to the multi-risk children born into poverty in the earlier North Carolina studies. For these heavier lowbirthweight children, at age 3 they showed a mean benefit of scoring 13.2 IQ points higher when they received the Early Education treatment, while those in the lighter low-birthweight group had an additional 6.6 points. We think this finding suggests there may be a greater need for specialized treatment and supports for the most biologically vulnerable premature infants, and that there also may have been other influential neurobiological factors (not directly measured) associated with their suboptimal prenatal growth and development.

Looking at maternal education as a potential factor in differential effects, Figure 4 displays the IHDP finding that the magnitude of benefits is greater for mothers whose highest educational attainment was less than a 4-year college degree. When looking at the age 3 IQ scores for children in the Health/Social Services group, the well-established stepwise association between maternal education and child test scores appears. This pattern is dramatically disrupted, however, for those in the Early Education group. The early educational program essentially "leveled the playing field" for these low birth weight, premature children and enabled them to perform at levels slightly higher (mean IQs of 104 -107) than the national average at 3 years of age. 12 The greatest benefit was for children of mothers with less than a high school education. These children came from low-resource families that were similar to those in the Abecedarian Project and Project CARE. As Figure 4 shows, these children had almost a 20-point IQ advantage compared to those in the comparison group. In other words, the early educational treatment produced outcomes that allowed these biologically at-risk children to overcome the cognitive "disadvantage" associated with low maternal education and low birthweight.

Interestingly, for children whose mothers were college graduates, the early education program neither increased nor decreased their average tested intelligence at age 3 -which was considerably above the national average. We speculate that the highly educated parents of these low birth weight, premature infants were able to provide opportunities for learning (at home and elsewhere) that were comparable in quality, quantity, and content to what the IHDP home visiting and child development centers offered. These results support our conclusion that there are many ways that young children can receive the active "Transactions with Others & Environment" as well as the 7 daily learning essentials shown in Finally, the IHDP analyses offer more direct affirmation of the "dosage hypothesis" as a significant influence in children's individual differences. Within the education treatment group, we have shown that at both 24 and 36 months of age, there is a significant relationship between children's IQ and the level of participation in the education program. Specifically, we detected this by creating a Participation Index Score for each child and family -a composite of the days attended at the child development center, the number of home visits completed, and parents' attendance at planned group meetings. The analyses also took into account other variables, such as maternal education, family income, child birth risk, and the child's previous cognitive score. These results demonstrate that the yearly participation index predicted a child's cognitive gains at each assessed age, strongly supporting a cumulative toll hypothesis (i.e., for children who had lower levels of participation) and its corollary hypothesis -that enriched learning experiences produce immediate benefits for children's cognitive performance (i.e., for children who had higher levels of participation in the second and third years of life). 36,38 e Abecedarian Project: Findings during the School Years and Adulthood

The Abecedarian Project followed the children into their middle age years. The long-term outcomes from the Abecedarian Project are highly informative, and once again, include some that were unexpected. The children in the early educational treatment group continued to display benefits associated with their participation in the early childhood program -lasting throughout their school years and well into adulthood.

During the school years, the children in the educational treatment had: The markedly reduced rates of grade repetition and special education are particularly important outcomes, with both fiscal implications for governments and personal consequences for children and families. The cost of special education programs is approximately 2.5 times the cost of regular education. Children in special education are entitled to free public education until age 22 (approximately 4 additional years compared to students in regular education). The U.S. average for placement into special education programs is approximately 11 percent of the school-age population. For many children, the psychological and social stigma associated with being labeled a special education student can be considerable, often with subsequent reduction in their post-high school education and employment opportunities.

At ages 21 and then 30, the individuals in the early education treatment group continued to show multiple signs of significantly more favorable outcomes compared to those who did not. 39,40 xamples include higher rates of holding a skilled job, being employed full-time and/ or enrolled in higher education; much lower rates of becoming a teen parent; few reports of depression and illegal substance use. The higher academic and cognitive achievement scores continued in adulthood as well.

Other benefits were much lower reliance on welfare or public assistance programs and better self-rating of their overall health. At age 35, Campbell et al (2014) 41 reported biomedical data indicating the early education group had significantly fewer risk factors for cardiovascular and metabolic disease, especially for males. For example, 25% of the males in the comparison group were affected by Metabolic Syndrome, while there were none in the early education treatment group. These findings are intriguing, and raise many questions about the link between early and lifelong education to health -a well-established relationship in population-based correlational studies. Did increased cognitive and academic abilities earlier in their lives and their higher levels of educational attainment contribute to these adults making more informed healthy lifestyle choices? Did the early childhood education perhaps encourage the individuals to be more physically active? Did their higher status jobs or increased incomes allow them to have better health care coverage and thus they may have received more medical advice and preventive medical interventions?

At age 40, we conducted a major follow-up with novel measures and an unprecedented opportunity for the Abecedarian Project participants to share their own perceptions about being in a study since birth. We assessed brain structure and function, behavior during structured social decision-making games, and reflections on the quality of their adult relationships with their parents, their civic engagement, and an update on their current assets (e.g., financial, employment, home ownership). Here we selectively highlight some of these findings that expand our understanding of the potential relationship of early experiences to their overall life course.

Concerning brain development, Farah 7 previously had reported that childhood poverty was associated with differences in adult brain structure detected via magnetic resonance imaging (MRI). These differences had many hypothesized causes, but prior to the Abecedarian Project 40-year Follow-up Study, there had been no experimental test of early childhood education contributions to adult brain structure. The MRI findings 42 focused on the volumes of five specific brain Regions of Interest (ROIs), a primary summary brain measure, and the overall volume of cortex. Four of the specific ROIs were selected because they appeared particularly relevant to the early educational intervention that strongly emphasized language for communication and building strategies for successful learning and problem-solving. The early educational treatment was associated with an increased size of the whole brain, the cortex, and 4 of the 5 ROIs (the left inferior frontal gyrus did not differ between groups). Further, the group treatment effects for males were substantially greater than for females. We concluded that the Abecedarian Project provides "the first evidence that normal variation in early life experience impacts human brain structure. Specifically, we show that the cognitive and linguistic environment of young humans affects macroscopic brain structure. Unlike previous observational research, which cannot address causality, the present data show that early life experience shapes brain structure, through its immediate causal effects and continuing chains of casual consequences. 42 "

Concerning social decision-making strategies, we 43 used well-validated interactive economic games that were constructed to probe social norm enforcement and planning. These games reflect a growing consensus that many of life's decisionmaking strategies are socially embedded and this skill relies on a combination of cognitive and socialemotional competencies -that is, practical strategies that could benefit (or harm) an individual, including their own financial, educational, social, and health outcomes. The games involve the study participant making "investments" in back-and-forth activities, in which each of their choices is followed by a move or reaction by their hypothetical partner.

Early Childhood Education that Promotes Lifelong Learning, Health, and Social Wellbeing

These games involve dynamics associated with being fair to one's partner, while also seeking to win or at least not allow someone else to take advantage of them. These games are enacted so that the study participants can actually earn money if they play the games well (but they never are faced with truly losing money). This is achieved by having sufficient variation in how the hypothetical partners treat the study participants, so that assessment of the sequential behavior of the player reflects how to initiate, cope with, and seek to counteract the different types of behaviors on the part of their partners. What we discovered was:

• Adults who received the Abecedarian Early Education treatment, compared to those who did not, were significantly more likely to enforce equality between the partners during exchanges and to reject overly advantageous offers (that is, when the partners made a decision that was disadvantageous or harmful to themselves). These findings suggest that the Abecedarian early education promoted a stronger belief in reciprocity than simply winning or reaping short-term benefits; • Participating in the Abecedarian Early Education treatment was associated, in another multi-round "trust" game, with paying significantly more attention to future and longterm outcomes, compared to the decisionmaking of those who received the Health/Social Services treatment. This longer "planning horizon" often is considered a signature feature among individuals from more resourceful (higher education, higher income) backgrounds than those from poverty backgrounds -based on research with other study samples. 19 re is how we summarized this set of complex findings: "By investing in the early education of highly vulnerable children -with a program that underscores positive adult-child interactions, explicitly teaches about cause-and-effect, permits active learning and early decision-making opportunities, and promotes increasingly complex social cooperation -children realize a brighter future, becoming healthier, more productive, and as our results show, stronger promoters of the norms on which our society is built (p.8). 43 " Self-appraisal and self-report about their current life situation revealed numerous differences between the two treatment groups. For those who received the Abecedarian Early Education, relative to those who did not, they showed higher or improved outcomes that included 43,44 • Stronger positive social relationships in adulthood with both their mothers and their fathers (or parent surrogates) -with highest level ratings of 85.7% versus 58.3%; • Overall, more favorable ratings of their health -52.4% at the high levels versus 36.1%; • Higher percentage with bank accounts, especially having a savings account -92.9% versus 66.7%; and • Higher rates of being employed full-time -78.6% versus 61.1%.

These findings indicate that the middle age indicators of strengths and assets were consistently higher for those in the early education group, although we note that many of those in the Health/Social Services group also provide a positive appraisal of their finances, careers, families, and accumulated assets -much higher than the levels of their parents when they were born in the early 1970s. Other interesting findings were that the geographic dispersion of those in the early education group was significantly greater than for those in the comparison group, and that they were more likely to have their home address be in a zip code associated with higher median incomes, higher employment, higher education, lower crime rates, and lower rates of teen pregnancies and singleparent households.

Finally, through the transcribed dialogues with study participants, we learned that many of those from the early education group showed concern for helping others, either through their chosen careers or volunteer activities or both, and reported active civic engagement, from higher levels of voting to expressing concern about families and children as a societal issue. We also found out that there were some individuals, from both treatment groups, whose lives were facing considerable difficulties and uncertainties. Although there were more severe problems -primarily lack of employment, chronic diseases, and serious family strains -among those who did not receive the early education program, we were impressed that almost all of these individuals reported strategies they were planning to overcome these life challenges, including obtaining more secondary education and/or vocational training and seeking professional help to resolve some of their longstanding personal challenges. Further, the vast majority of the study participants, regardless of their treatment group assignment, expressed gratitude for and positive impressions about having participated in the study throughout their lives, often telling us about the types of help they and/or their parents had received. In the future, we will share a full report on these firsthand accounts and personal insights the study participants shared with us.

Early Childhood Education that Promotes Lifelong Learning, Health, and Social Wellbeing

In conclusion, from these assessments at age 40, we continued to find multiple outcomes that indicate there have been long-term, real-world practical benefits associated with the different early care and learning opportunities experienced by these individuals. We do not claim, and never have, that all of the group differences can be directly linked solely to receiving a high-quality early childhood education; rather, we think that high amounts of positive learning experiences in a socially responsive daily environment can set the stage for increased benefits when the children enter into a high quality public education system, with cumulative and cascading benefits into multiple domains of life.

Estimated Return-on-Investments from the Abecedarian Project and Project CARE

Cost/Benefit analyses have become an expected feature for public policies concerning child and family programs, particularly for economically poor families. This work applied to early childhood education was pioneered by Barnett 45

Is the Abecedarian Approach Relevant to Today?

We began the Abecedarian Project and its varied replications in the 1970s and 1980s, when there were many differences from today in the U.S. and world populations, from maternal employment patterns, the child care and public education workforces, and family structure to the availability of scientific methods to document the neurodevelopmental patterns, biologically and behaviorally, in young children. One of our greatest honors and challenges has been reflecting on the relevance and practical utility of what these longitudinal RCTs have revealed. We have worked closely with scores of local communities, states, and now more than a dozen foreign countries in developing and launching "real world" treatments that build on our findings, as well as those of other developmental scientists. We also have led Congressionally-mandated evaluation studies of major multi-year investments evaluating different models of providing early childhood and elementary school age interventions. Our thoughts about this issue of current relevancy emanate from a long history; at times we remain optimistic about the future of children, while we sometimes are disappointed about the limited success of many well-intentioned and well-funded efforts.

Conclusions

In this paper, we have shared our broad conceptual framework that was designed for use worldwide. Strategizing to improve the future for children is a monumental and highly complex endeavor. The findings we have summarized here are shared in the spirit of contributing potentially useful information for others. We strongly endorse the position that a systematic and comprehensive approach that begins early in development is among the most promising strategies to improve important lifelong outcomes for children and families from all walks of life. . Leadership at the highest level was stable, highly engaged, and deeply knowledgeable about the content of the program. Program leaders had a strong professional stake in the conduct of the project.

2. The content of the programs was based on existing scientific findings and scientific theory about children's development, rather than ideology or philosophy alone.

3. The programs were relatively intensive --often engaging program children and/or family members over a fairly long period of time. Although program dosage is extremely difficult to equate across different types of programs for different types of children and families, in general higher intensity programs tend to yield higher benefits.

4. Multiple features and components were specified in the program to achieve maximum desired experiences for children, along with flexibility for intended individualization of the standardized protocol.

That is, children's intertwined development and needs were recognized; this usually necessitated engagement of experts from diverse disciplines and specialty areas.

5. Before the program was implemented, it was supported by both external peer review (content experts) and by respected members or opinion leaders in the local community (local endorsement).

6. Program staff received strong training and professional development related to the intervention, and this included provision of active, ongoing supports and systematic supervision with feedback.

7. Implementation of the program was actively monitored by leaders, which helped to detect and resolve problems early as well as to reward staff. Performance expectations were clear to staff, as well as the immediate goals for improving children's education and health outcomes.

8. High levels of participation among all children and families were strongly supported from the very beginning and at all stages, including strategic plans to overcome the most likely potential barriers to full participation (e.g., transportation, illness policies, hours of operation, program schedule).

9. Children's progress was frequently assessed by objective and unbiased methods, and valued as vital to understanding whether the program was able to achieve its intended benefits on children's lives. Evaluation was not viewed as something that was "externally imposed," or something that was intrusive or competed with program resources for children.

10. The information gathered about the program and about children's progress was analyzed and reported to both the program leadership team and to external groups, as appropriate, including presentation at leading professional organizations.

11. Program developers recognized that replication of the program would be an important next step if the results affirmed benefits to children and families. Thus, the program's content and procedures were documented sufficiently to allow replication.

12. The leadership had sufficient levels of resources and direct control over expenditures so that the key components of the planned program would be delivered, while knowing that they could rapidly make adjustments if and when problems occurred. The scale of these programs was small to moderate, and there was a good perceived match between resources available and the expectations for implementation.

Early Childhood Education that Promotes Lifelong Learning, Health, and Social Wellbeing

Acknowledgements

Acknowledgments:We are deeply appreciative of the families and children who participated in the Abecedarian Project, Project CARE, and the Infant Health and Development Program; your willingness to help advance scientific understanding of the factors that promote positive health and education throughout the lifespan has the foundation of all we have learned.We extend gratitude to our long-term colleagues on these studies, especially Joseph Sparling, Frances Campbell, Margaret Burchinal, and Donna Bryant, as well as many students and colleagues who have contributed original ideas to the conceptual framework, the methods, and the data analyses of the Abecedarian Project and its variations over the past five decades.The Frank Porter Graham Child Development Institute, the Civitan International Research Centre, and the Fralin Biomedical Research Institute at Virginia Tech have provided outstanding environments and supports for continuation of this research and for dissemination and implementation of its findings.

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Abstract screening pilot

Abstract screening results

Extraction pilot

Extraction results

Research report

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