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Children’s Right to Thrive
Invest in Children
10th Annual MeetingNovember 20, 2009
Craig T. Ramey, Ph.D.
Sharon Landesman Ramey, Ph.D.Directors and Professors,
Georgetown University Center on Health and Education
It is the totality of a child’s
experience that lays the
foundation for a lifetime of
greater or lesser competency.Ramey & Ramey, 2000
Consequences of very low resource environments on children’s school entry
skills and later performance
• Delays of 1 to 2.5 years in overall academic and intellectual competence
• Marked reduction in vocabulary as well as expressive and receptive language skills
• Fewer skills in interacting with “teachers” and peers in a learning environment
• Lack of supportive learning at home and in summer further increases “the gap” over the first 4 years in school
Key Research Question for Abecedarian (ABC) Project
Can the cumulative developmental toll experienced by high-risk childrenbe prevented or reduced significantlyby providing systematic, high-quality, early childhood education frombirth through kindergarten entry?
Control Group _• Adequate nutrition• Supportive social services• Low-cost or free primary
health care
Abecedarian Preschool Program
Treatment Group _• Adequate nutrition• Supportive social services• Free primary health care• Preschool treatment:
Intensive (full day, 5 days/week,50 weeks/year, 5 years)
“Learningames” CurriculumCognitive / Fine MotorSocial / SelfMotorLanguageIndividualized pace
Campbell & Ramey, 1995American Educational Research Journal
Pre-K Educational Treatment prevents decline in children’s low-IQ classification (% with IQs <85)
Martin, Ramey, & Ramey, 1990American Journal of Public Health
Estimated Influences on IQ
Regression Coefficients (95% CI)
Age in MonthsEducational Preschool
Maternal IQ<70Positive Home Enviornment
12 + 7.9 1.0 + 4.9
24 + 12.7 - 4.3 + 5.1
36 + 18.6 - 8.2 + 8.6
48 + 13.2 - 11.7 + 8.9
Adapted from Martin, Ramey, & Ramey, American Journal of Public Health, 1996
Reading achievement scores are significantly higher for ABC children at 8, 12, 15, & 21yrs
Campbell & Ramey, 2001 Developmental Psychology
ABC educational program reduced grade repetition and special education placement
Ramey & Ramey, 1999 MR/DD Research Review
Key Findings from Abecedarian Project(“Abecedarian” …one who learnsthe basics such as the alphabet)
18 Months to 30 Years Old• Intelligence (IQ)• Reading and math skills• Academic locus-of-control• Social Competence• Years in school,
including college• Employment outcomes
• Grade Repetition• Special Education
placement• Teen Pregnancies• Smoking and drug
use• Teen depression
Plus benefits to mothers of these children (education, employment)
Ramey et al, 2000; Campbell et al, 2009
Project CARE
RCT designed to be a replication of
Abecedarian Project (ABC)
with an additional home visit group
to help mothers use the
ABC educational curriculum (6 wks– 5 yrs)
Abecedarian Project
Age in Months (assessment type)3(MDI) 6(MDI) 12(MDI) 18(MDI) 24(S-B) 36(S-B)
60
70
80
90
100
110
120
130Early Intervention
Follow-up
Ramey & Ramey, Preventive Medicine, 1998
Project CARE
Age in Months (assessment type)6(MDI) 12(MDI) 18(MDI) 24(S-B) 36(S-B)
60
70
80
90
100
110
120
130Early Intervention
Follow-up
Ramey & Ramey Preventive Medicine, 1998
Adapted from Wasik, Ramey, Bryant, & Sparling. Child Development, 1990
Infant Health and Development Program (IHDP)
•Designed to test the efficacy of ABC intervention
for children who were < 37 weeks
gestation and < 2500 gm at birth•Conducted at 8 sites•Intervention modified for biological risk factors•Intervention lasted only until 36 mos. CA
Infant Health and Development Program
(2001-2500 grams)
Children’s IQ at 36 months: Maternal Education X Treatment Group
70
75
80
85
90
95
100
105
110
Some HighSchool
High SchoolGraduate
Some College CollegeGraduate
Control
Intervention
(n=232)(n=162) (n=166)(n=104) (n=134)(n=63) (n=76)(n=48)
Infant Health and Development Program
Ramey & Ramey (1998), Preventive Medicine
Outcomes Affected Positively (*p<.01) by the Infant Health & Development Program
12 Months 24 Months 36 Months
Cognitive Development NS + +
Adaptive and Prosocial Behavior - - +
Behavior Problems - + +
Vocabulary - + +
Receptive Language - + +
Reasoning - - +
Home Environment NS - +
Maternal Interactive Behavior - - +
Maternal Problem Solving - - +
Ramey 1999, adapted from Gross, Spiker, & Haynes, 1997, Helping Low Birth Weight, Premature Babies
Did IHDP benefits last?
• Follow-up through age 18 showed significant benefits, particularly for children from low-resource families
• The dosage of the early intervention predicted magnitude of benefits, even after multiple adjustments for correlated variables
Differential response to early educational intervention
The children who benefited the most had: mothers with IQs below 70 mothers with low levels of education poor birth outcome indicators
(PI, Apgar, LBW) teen mothers
(Martin, Ramey, and Ramey, American Journal of Public Health, 1990; Ramey & Ramey, 2000)
Recent findings from Maryland and Louisiana Pre-K initiatives
• Strong visionary leadership and commitment to pre-K as a means of improving student achievement and “closing the gap” for children of poverty
• Willingness to conduct research that will provide timely information to inform changes in the classroom practices and policy
• The programs differ in ways that provide insights about benefits of full-day vs half-day pre-K and differential risk
Similarities in MD and LA Pre-K programs
• Implemented by public schools
• Certified early childhood teachers (full benefits, comparable salaries to other teachers)
• Classroom sizes of no more than 20
• Adult to child ratio of no more than 1 to 10
• Specified pre-K curriculum in resource-rich classrooms and high standards
• Ongoing professional development
• Strong focus on language and early literacy
Differences in MD and LA Pre-K
• MCPS Pre-K classrooms are half-day while LA classrooms are full-day
• Children in LA4 start at slightly lower levels than do children in MCPS
• MCPS classrooms serve more diverse children in terms of nationality and language backgrounds
• LA4 is not limited to “at risk” students, while MCPS currently is
• LA4 implemented longitudinal data collection from the beginning, for all children and for all classrooms, linked to later school progress
LA4 Study Design: Population-based, Cohort Sequential, Case/Control
Longitudinal Study
• Pilot year (Jan – May 2002) n=1358• Cohort 1 (2002-2003) n=3711• Cohort 2 (2003-2004) n=4767• Cohort 3 (2004-2005) n=4665• Cohort 4 (2005-2006) n=7998• Cohort 5 (2006-2007) n>10,000Note: LA legislature committed $82 million for
2007-2008 school year
DSC: Language National Percentile Ranks
31
14
50
10
50
10
50
10
50
10
0
10
20
30
40
50
60
Pre Post Pre Post Pre Post Pre Post Pre Post
Per
cen
tile
PilotHalf-Year (n=1358)
Cohort 1 Full Year (n=3711)
Cohort 2 Full Year (n=4767)
Cohort 3 Full Year (n=4665)
Cohort 4 Full Year (n=7898)
DSC: Print National Percentile Ranks
40
17
59
11
59
11
59
11
59
11
0
10
20
30
40
50
60
70
Pre Post Pre Post Pre Post Pre Post Pre Post
Per
cen
tile
PilotHalf-Year (n=1358)
Cohort 1 Full Year (n=3711)
Cohort 2 Full Year (n=4767)
Cohort 3 Full Year (n=4665)
Cohort 4 Full Year (n=7898)
DSC: Math National Percentile Ranks
30
11
46
5
46
5
52
5
52
5
0
10
20
30
40
50
60
Pre Post Pre Post Pre Post Pre Post Pre Post
Per
cen
tile
PilotHalf-Year (n=1358)
Cohort 1 Full Year (n=3711)
Cohort 2 Full Year (n=4767)
Cohort 3 Full Year (n=4665)
Cohort 4 Full Year (n=7898)
Louisiana Kindergarten Retention Rates (2003-04 Cohort)
7.4%
12.5%*
7.0%
8.0%*
0%
2%
4%
6%
8%
10%
12%
14%
Free and Reduced Meals* Non-Free and Reduced Meals
No Public Pre-K orHead StartLA 4
n = 22,105 n = 2,886 n = 13,257 n = 555
* p <.001
11.8%*
6.6%7.5%*
5.0%
0%
2%
4%
6%
8%
10%
12%
14%
Free and Reduced Meals* Non-Free and Reduced Meals
No Public Pre-K orHead StartLA 4
Louisiana Kindergarten Retention Rates (2004-05 Cohort)
n = 17,416 n = 3,132 n = 11,785 n = 666
* p <0.001
10.5%*
14.5%**
7.0%*
8.6%**
0%
2%
4%
6%
8%
10%
12%
14%
16%
Free and Reduced Meals** Non-Free and Reduced Meals*
No Public Pre-K orHead StartLA 4
Louisiana Special Education Placement Rates (2003-04 Cohort)
n =23,523 n=2,994 n =14,841 n=698
* p <.01
** p <.001
9.3%*
14.1%**
5.8%*
9.0%**
0%
2%
4%
6%
8%
10%
12%
14%
16%
Free and Reduced Meals** Non-Free and Reduced Meals*
No Public Pre-K orHead StartLA 4
Louisiana Special Education Placement Rates (2004-05 Cohort)
n =21,421 n=3,835 n =14,201 n=912
* p <.01
** p <.001
10
50
31
14
30
0
10
20
30
40
50
60
Pre Post
Nat
iona
l Per
cent
ile R
ank
LA4 Full-Year Full-Day Pre-KLA4 Half-Year Full-Day Pre-KMCPS Full-Year Half-Day Pre-K
A Comparison of Children’s Academic Progressin Pre-K Programs that differ in dosage
Why Some Well-Intended Early Childhood Programs Have Failed to Benefit Children
• Adult caregivers and teachers not well prepared
or supported in their everyday work • Dosage of early intervention and pre-K is too low• Inadequate instruction to promote cognitive, language,
early literacy, and early math skills • Ineffective communication with and engagement of
parents and other key service providers • Instruction is too harsh, rigid, or punitive
The future for our nation’s children
• Positive health and education outcomes can be achieved for all children – during pre-K years and beyond
• Benefits include much more than “academics”
• Language and reading success are key, because they influence all learning and social adjustment
• Strategic investments yield substantial social and fiscal benefits to society
For copies of this powerpoint presentation:
• Contact Drs. Craig and Sharon Ramey
• Georgetown University Center on Health and Education
• 202-687-2874
