Learning opportunities and responsive caregiving
Authors: Jena D Hamadani, Helen Baker-Henningham, Fahmida Tofail, Syeda F Mehrin, Sally Grantham-McGregor
Journal: The Lancet Global Health (2019)

The Comment by Frances Aboud and Aisha Yousafzai (March 1, p e294–95)1Aboud FE Yousafzai AK Scaling up child psychosocial stimulation programmes for young children.Lancet Glob Health. 2019; 7: e294-e295Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar on our Article (March 1, p e366–75)2Hamadani JD Mehrin SF Tofail F et al.Integrating an early childhood development programme into the Bangladeshi primary health care services: a cluster randomised trial.Lancet Glob Health. 2019; 7: e366-e375Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar on an early childhood intervention in Bangladesh contains some misunderstandings, which might limit its use by others. Aboud and Yousafzai1Aboud FE Yousafzai AK Scaling up child psychosocial stimulation programmes for young children.Lancet Glob Health. 2019; 7: e294-e295Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar suggest that our curriculum does not include responsive caregiving. We believe that distinguishing between early learning opportunities and responsive caregiving is misleading, because they complement each other. Early learning opportunities should be provided by a responsive caregiver, which is a crucial component of this curriculum. The intervention does not consist of training children, rather it is designed to support mothers to interact and play with their child, using developmentally appropriate play materials. Aboud and Yousafzai suggest that children learn language from caregivers verbally responding to them.1Aboud FE Yousafzai AK Scaling up child psychosocial stimulation programmes for young children.Lancet Glob Health. 2019; 7: e294-e295Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar Hence, the large language benefits we found provide evidence that caregivers increased their responsivity with the intervention.2Hamadani JD Mehrin SF Tofail F et al.Integrating an early childhood development programme into the Bangladeshi primary health care services: a cluster randomised trial.Lancet Glob Health. 2019; 7: e366-e375Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar Aboud and Yousafzai report that the intervention includes activities resembling the Bayley test.1Aboud FE Yousafzai AK Scaling up child psychosocial stimulation programmes for young children.Lancet Glob Health. 2019; 7: e294-e295Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar Designing play programmes that do not include these types of activities (eg, blocks, puzzles, and books) is difficult and probably inappropriate. Our child development intervention2Hamadani JD Mehrin SF Tofail F et al.Integrating an early childhood development programme into the Bangladeshi primary health care services: a cluster randomised trial.Lancet Glob Health. 2019; 7: e366-e375Summary Full Text Full Text PDF PubMed Scopus (50) Google Scholar is the only intervention in low-income and middle-income countries that has shown comprehensive benefits (eg, intelligence quotient, mental health, and wages) up to the age of 22 years,3Gertler P Heckman J Pinto R et al.Labor market returns to an early childhood stimulation intervention in Jamaica.Science. 2014; 344: 998-1001Crossref PubMed Scopus (287) Google Scholar, 4Walker SP Chang SM Vera-Hernández M Grantham-McGregor S Early childhood stimulation benefits adult competence and reduces violent behavior.Pediatrics. 2011; 127: 849-857Crossref PubMed Scopus (155) Google Scholar showing its appropriateness. The sustainability of benefits is frequently used to justify expansion of early childhood development interventions.5WHOUN Children's FundWorld Bank GroupNurturing care for early childhood development: a framework for helping children survive and thrive to transform health and human potential. World Health Organization, Geneva2018Google Scholar Our intervention has been adapted to include an age range of 18 months in a group session. A best intervention probably does not exist and several different approaches are likely to be effective, which might vary by context and available resources. The present curriculum was adapted to the local context and run in 16 countries. It has also been scaled up in Peru and plans are afoot scale up in China and Bangladesh. We declare no competing intrerests. Scaling up child psychosocial stimulation programmes for young childrenPsychosocial stimulation has been shown to be crucial for the cognitive and language development of children younger than 3 years. In low-income and middle-income countries, 43% of children younger than 5 years are not reaching their potential mental development.1 It is recognised that children need nutrition, psychosocial stimulation, and security to thrive. How should these programmes be implemented at larger scales, and what delivery model should be used to maximise access to services, equity, and cost-effectiveness? Full-Text PDF Open Access