Receipt of Early Intervention Services Before Age 3 Years and Performance on Third-Grade Standardized Tests Among Children Exposed to Lead

Abstract

IMPORTANCEResearch has shown that early intervention programs can improve academic outcomes of children with developmental delays. It has been suggested that similar programs may combat the deleterious effects of lead on children's neurodevelopment. However, to our knowledge, there are no published studies examining this possibility.OBJECTIVE The objective of this study was to estimate the association between receipt of early intervention services and third-grade standardized test scores among children exposed to lead before age 3 years. DESIGN, SETTING, AND PARTICIPANTSCohort study including children born in New York City, New York, from 1994 to 1998 within an administrative data linkage of birth, lead monitoring, early intervention, and education data systems. Participants had a blood lead level of 4 μg/dL or greater at any point before age 3 years and later attended public school in New York City.EXPOSURES Any use of early intervention services from birth through age 3 years. MAIN OUTCOMES AND MEASURESChildren who did or did not receive early intervention services were matched using propensity scores. Linear and log-binomial regression were used to estimate the association between receipt of early intervention services before age 3 years and standardized test scores in math and English-language arts in third grade.RESULTS There were 2986 children exposed to lead who received early intervention services before age 36 months. Of these children, 2757 were propensity score-matched to 8160 children who did not receive services. Children who received early intervention services did 7% (95% CI, 3%-12%) of an SD better on math and 10% (95% CI, 5%-14%) of an SD better on English-language arts tests than children who did not receive services. In addition, children who received services were 14% (95% CI, 9%-19%) and 16% (95% CI, 9%-23%) more likely to meet test-based standards in math and English-language arts, respectively, than children who did not receive services. These associations became larger in magnitude when analyses were restricted to children with higher blood lead levels.CONCLUSIONS AND RELEVANCE By leveraging existing public health data, this study found evidence that receipt of early intervention services may benefit the academic performance of children exposed to lead early in life.

Action anthropology and public policy change: Lead poisoning in Syracuse, NY

“…EI is a federal program aimed at reducing developmental delay in at‐risk infants and toddlers (New York State Department of Health, 2023). A study conducted in New York City enrolled any child with a lead level of 4 mcg/dL or greater into EI (Stingone et al., 2022). Children who received the services ( n = 2757), compared with children who did not ( n = 8160) were 14% (95% CI, 9%–19%) and 16% (95% CI, 9%–23%) more likely to score at or above grade level in math and English‐language arts on standardized 3rd grade exams.…”

Promise of Early Intervention for Children Exposed to Lead

“…Though these secondary prevention efforts were widely accepted as the right path forward to provide support for Flint families, research has been lacking on the efficacy of therapy and education programs, such as EI, for children with a history of lead exposure. The study by Stingone et al 4 is the first to prove the benefits of such intervention and bolsters the foundation for a new national gold standard for serving children and families who continue to be poisoned by lead because of decades of insufficient primary prevention strategies.…”

“…2 Subsequent advances in the method allowed high-resolution karyotype analysis and extended the utility to even small regions of the chromosome being deleted, duplicated, or rearranged. 3 This was followed in the late 20th century by application of diagnosisrelated tests based on fluorescence in situ hybridization 4 or other specific assays, and now we have such tools as seizure panels. 5 Microarray has also been an important contributor but with the introduction of whole-exome sequencing and even wholegenome sequencing, it is clear that up to one-third of disorders in the newborn period may be missed without the more comprehensive testing.…”

Environmental contaminants and child development: Developmentally‐informed opportunities and recommendations for integrating and informing child environmental health science

“…Specialized early intervention (EI) services for young children may also be more successful when families trust and feel supported by their providers, reflecting relational health between families and providers (Jimenez et al., 2012 ; Miller, Stein et al., 2022 ). A recent analysis found that EI services, which entail individualized service plans tailored to child and family needs, mitigated the impact of lead exposure on later math and reading scores (Stingone et al., 2022 ). Thus, in addition to identifying and eliminating the physical sources of environmental exposures when possible (e.g., as with the Flint Water Crisis), providing individual, developmentally‐tailored interventions—including those that address relational health across CSE contexts during early childhood—may be promising strategies for addressing impacts of exposure.…”