Programs that Work
Infant Health and Development Program
Healthy and Safe Children
Children Ready for School
Children Succeeding in School
Students performing at grade level or meeting state curriculum standards
Children ages 0 to 5 exhibiting age-appropriate mental and physical development
Babies born weighing more than 5.5 pounds and improving outcomes for low birth weight babies
Age of Child
Early Childhood (0-8)
Type of Setting
Child Care / Preschool
Health Care Provider
Type of Service
Health Care Services
Type of Outcome Addressed
Cognitive Development / School Performance
Substance Use and Dependence
Evidence Level (What does this mean?)
Proven / Promising
The Infant Health and Development Program (IHDP) was an evaluation of a comprehensive early childhood intervention for low birth weight (less than or equal to 2,500 grams or about 5.5 pounds), and premature (less than or equal to 37 weeks) infants designed to reduce the infants’ health and developmental problems. The intervention was operated in eight medical institutions in Little Rock, Arkansas; New Haven, Connecticut; Miami, Florida; Cambridge, Massachusetts; Bronx, New York; Philadelphia, Pennsylvania; Dallas, Texas; and Seattle, Washington from 1985 to 1988. The IHDP was designed as a randomized clinical trial, and the participating sites were selected through a national competitive review.
The intervention conducted by IHDP combined early child development and family support services with pediatric follow-up. The program was initiated upon infants’ discharge from the neonatal nursery and continued until 36 months of age (child age was corrected for prematurity). The intervention services, provided free to participating families, consisted of three components: home visits, child attendance at a child development center, and parent group meetings. Infants participated in pediatric follow-up, which was comprised of medical, developmental, and social assessments, with referral for pediatric care and other services as indicated.
Participants in the IHDP study included low birth weight newborns. The mothers' average age at study enrollment was 25 years, and roughly 40 percent of the mothers had less than a high school education. Approximately half of the infants were male, 52 percent were African-American, 11 percent were Hispanic, and 37 percent were white or another race.
The IHDP evaluated a sample of participants from which infants were randomly assigned to intervention and control groups. The sample was selected according to the following process (IHDP, 1990): Infants were screened at birth for eligibility, including a total of 4,551 infants who would reach 40 weeks' post-conception age between January and October 1985 and whose birth weights were less than or equal to 2,500 grams (g). Of this sample, 3,249 infants were excluded by criteria related primarily to residence outside of the catchment area defined by distance from the early childhood education center, gestational age greater than 37 weeks, or hospital discharge before or after the study recruitment period. Nearly 45 percent of LBW infants are born after 37 weeks, and these infants are at an increased risk of health complications compared to full-term infants at a healthier weight (Hediger, Overpeck, et al. 2002). Infants with an illness or neurological deficit so severe as to prevent participation in the IHDP intervention (61 such infants) were also excluded from the study. Of the 1,302 infants who met the eligibility criteria for participation, the parents of 274 (21 percent) infants refused to give consent to be randomized into intervention or control groups. Among the 1,028 remaining infants who had both parental consent and were randomized, 43 withdrew before participating in the study. The remaining 985 infants constituted the primary analysis group.
The 985 infants were categorized into two birth weight groups: greater than 2,000g = "heavier" and less than or equal to 2,000g = "lighter." One-third of the sample came from the heavier group and two-thirds from the lighter group. Within each weight group, one-third of the subjects were randomized to the intervention group and two-thirds to the control group. The randomization procedures monitored balance between groups for birth weight, gender, maternal education (less than high school; high school graduate; some college, or more), maternal race (African-American, Hispanic, and white/other), primary language in the home, and infant participation in another study. Random assignment procedures resulted in 377 infants (142 heavier, 235 lighter) in the intervention group and 608 infants (220 heavier, 388 lighter) in the control group.
Children in both of the study groups were assessed by the project staff at eight clinic visits occurring at 40 weeks' post-conceptional age and at 4, 8, 12, 18, 24, 30, and 36 months. At each clinic visit, mothers were asked about their child's health and developmental functioning and about social and demographic characteristics of the family. Each clinic visit also included measurements of the child's growth. Cognitive assessments were completed at 12, 24, and 36 months, and behavioral data were measured at 24 and 36 months. In addition, the quality of each child's home environment was assessed at 12 and 36 months using the HOME inventory.
Although the baseline characteristics of the study sample varied greatly among the eight sites, the randomization procedure overall resulted in comparable intervention and control groups at study entry. Retention in the study was high; of the 985 infants in the primary analysis group, 908 were seen at 12 months, 875 at 24 months, and 913 at 36 months.
Key child outcomes measured included cognitive development (e.g., IQ, vocabulary, and visual-motor/spatial skills); behavioral competence (e.g., mother's reports of behavior problems, observations of child's behavior during problem-solving tasks, and observations of mother/child interaction); school achievement (e.g., school attendance and results from standardized achievement tests in reading and math); and health (e.g., mother's perception of child health, morbidity [presence or absence of health conditions], and functional status [limitations in activities of daily living due to health problems]). Study children have been followed through age 18.
The initial IHDP study reported on 36-month cognitive (IQ), behavioral (mother's reports of behavior problems), and health outcomes (morbidity, functional status, and maternal perception of child's health) for the full sample of infants (IHDP, 1990). Additional studies using the same national dataset examined two, three, five, eight and 18-year cognitive, behavioral and health outcomes for the same cohort (Brooks-Gunn, Liaw, and Klebanov, 1992; Brooks-Gunn et al., 1993; Blair, Ramey, and Hardin, 1995; Brooks-Gunn et al., 1994; McCarton et al., 1997; McCormick et al., 2006). The above studies all adjusted for attrition and stratified results by heavier low birth weight (2001-2499 g) and lighter low birth weight (<=2000g).
A number of studies used the IHDP data to assess the effects of the intervention on various subsamples of the original sample of infants. One study (McCormick et al., 1993) analyzed 36-month outcomes for the 280 very-low birth weight (between 1,001g and 1,500g) and extremely low birth weight (less than or equal to 1,000g) infants who were selected for the intervention group. No differences in demographic factors were found between intervention and control groups. Outcome measures included cognitive development, behavioral competence, and health.
Spiker, Ferguson, and Brooks-Gunn (1993) studied children's behavioral competence and mother-child interactions at 30 months of age. Of the 985 families in the IHDP study, videotapes of 683 mother/infant pairs (69 percent) were obtained, including 271 dyads from the intervention group and 412 dyads from the control group. Children and mothers were videotaped during an eight-minute free-play period, a clean-up period, and three different problem-solving tasks. Comparisons of initial status characteristics between the two treatment groups did not identify any significant differences. Child outcome measures included persistence with task (goal-directedness), percentage of time off-task, enthusiasm for task (quality of interest and enjoyment), and overall child behavior (summary of enthusiasm, persistence, cooperation with mother, and enjoyment of reward). Mother/child interactions were also assessed, including overall experience (overall quality of the problem-solving situation for affecting the child's sense of self as competent and enthusiastic) and mutuality (how well the mother and child worked together).
Bradley et al. (1994) focused on low-income infants enrolled in the study and classified children as "resilient" or not, based on whether they were functioning within acceptable ranges with respect to health and development. The sample consisted of the 410 infants from the larger study who were living in poverty (as defined by the 1985 US Census), including 167 in the intervention group and 243 in the control group. The authors assessed cognitive, behavioral, and health outcomes at 36 months.
Hollomon and Scott (1998) assessed school performance, attendance, and special education placement of 299 children at age 9 in the Miami site of the IHDP study. The sample consisted of three groups of children: (1) children born low birth weight and preterm who received no intervention (control group; 49 children); (2) children born low birth weight and preterm who participated in the intervention (intervention group; 42 children); and (3) children born full term and normal birth weight (NBW) (>2,500g) who received no intervention (NBW group; 360 children). The control and intervention group consisted of all those children from the Miami site of the IHDP whose 1993/1994 academic records could be tracked in the school system. Of the original 60 children in the control group, 82 percent were located, and of the initial 50 children who received the intervention, 84 percent were located. The sample of NBW children was chosen from hospital birth logs by selecting the next three births after the birth of an infant with low birth weight whose home address fell within the IHDP catchment area; 58 percent of the NBW children were tracked in the school system. Approximately 66 percent of the total sample was African-American, 26 percent was Hispanic, and 8 percent was white.
Finally, Bradley, Burchinal, and Casey (2001) assessed whether the children's home environment influenced the effects of the intervention on the children's 36-month IQ and behavior. The HOME Inventory was used to measure the quality and quantity of stimulation and support available to a child in his or her home environment. Of the 985 children constituting the primary analysis group for the IHDP, 819 were administered the HOME Inventory at 36 months (including 86 percent of those receiving the intervention at 36 months and 82 percent of those in the control group at 36 months). There were no significant differences in the demographic characteristics of those receiving HOME assessments and those with missing data.
Key Evaluation Findings
The IHDP study included children from eight different program sites. Multiple research studies have analyzed a variety of participant outcomes at different time intervals, ranging from 12 months to 18 years of age. The studies have shown effect sizes for cognitive development at 24 and 36 months that are "proven" according to Promising Practices criteria, and "promising" for behavioral changes. Through age 18, the intervention showed effects that are "promising" on cognitive development and achievement. There were no effects on health status, including growth.
The following findings are based on the national-level data from the IHDP study:
- 12-month outcomes
- No significant intervention effect was found for IQ (Brooks-Gunn et al., 1993, Blair, Ramey, and Hardin, 1995)
- 24-month outcomes
- Significant, positive effects were found across all cognitive domains assessed, which were IQ, vocabulary, receptive language, and visual-motor skills. (Brooks-Gunn, Liaw, and Klebanov, 1992; Brooks-Gunn et al., 1993)
- Results indicated the intervention was more efficacious for the heavier infants than for the lighter infants, and for African-American children compared to white or Hispanic children. (Brooks-Gunn, Liaw, and Klebanov, 1992; Brooks-Gunn et al., 1993)
- 36-month outcomes
- Mean IQ scores were significantly higher for the intervention children than for the control children in both the heavier-birth-weight group (mean score of 98.0 versus 84.8), and lower-birth-weight group (mean score of 91.0 versus 84.4) (IHDP, 1990; Brooks-Gunn et al., 1993; Brooks-Gunn et al., 1994; Bradley, Burchinal, and Casey, 2001)
- Follow-up IQ comparisons suggest that the intervention was most effective for infants with poorer quality home environments (i.e., children derive more benefit from the intervention if it offers supports not currently available in the child’s home environment). The association between quality of home environment and improved outcomes was not found for behavioral outcomes (Bradley, Burchinal, and Casey, 2001).
- The intervention group had significant, positive effects on all aspects of cognitive functioning, including vocabulary, receptive language, visual-motor/spatial skills, reasoning, the picture vocabulary test, and the Motor Integration Test (Brooks-Gunn, Liaw, and Klebanov, 1992; Brooks-Gunn et al., 1994)
- The intervention group had significantly lower behavioral problem scores than the control group (IHDP, 1990; Brooks-Gunn et al., 1993; Brooks-Gunn et al., 1994; Bradley, Burchinal, and Casey, 2001), and 36-month behavior scores indicated that the IHDP was more effective for African-American infants than for white infants (Brooks-Gunn et al., 1993)
- No significant differences were found between groups for functional status or for maternal perceptions of the child’s health. (IHDP, 1990)
- Lighter birth weight children in the intervention group reported higher morbidity scores (i.e., a higher presence of health conditions over three years) than did lighter birth weight children in the control group. No significant differences were found between groups for the heavier birth weight infants. (IHDP, 1990; Brooks-Gunn et al., 1993; Brooks-Gunn et al., 1994). McCormick et al. (1993) further stratified lighter low birth weight infants and found that the association was strongest among extremely low birth weight infants (less than or equal to 1,000g). The authors note that these results were due to an increase in brief illnesses and conditions, rather than a change in serious morbidity (IHDP, 1990). This issue is discussed further below, in the Issues to Consider section.
- The intervention was more effective for Hispanic children with respect to receptive language and for African-American children with respect to the picture vocabulary test and visual-motor/spatial skills (Brooks-Gunn, Liaw, and Klebanov, 1992).
- 5-year outcomes
- No significant differences between intervention and control groups overall were found for full-scale IQ, or for verbal or performance IQ subscales.
- When stratified by birth weight, significant differences in full-scale IQ were demonstrated for the heavy low birth weight intervention group (2001-2499g) compared with the treatment group (95 versus 92), and significant differences were also found in verbal IQ (94 versus 90). The same differences were not found for the lighter low birth weight group (Brooks-Gunn et al., 1994).
- There was a significant difference favoring the intervention group on the picture vocabulary test (Brooks-Gunn et al., 1994).
- No significant differences in behavioral measures were observed across intervention and control groups (Brooks-Gunn et al., 1994).
- There were no significant differences across control and intervention groups in number of hospitalizations (Brooks-Gunn et al., 1994).
- 8-year outcomes
- In the full sample and in the lighter low birth weight subgroup, there were no significant differences between the intervention and control groups for any of the cognitive, school performance, or behavioral outcome measures (McCarton et al., 1997).
- Differences favoring the intervention group were found within the heavier low birth weight subgroup, including full-scale IQ (mean score of 97 versus 92), verbal IQ (mean score of 99 versus 94), performance IQ (mean score of 95 versus 91), mathematics achievement, and the picture vocabulary test. No significant differences were found between groups for reading scores, or for the number of children that were required to repeat a grade (McCarton et al., 1997).
- Few significant differences were found between groups for health outcomes, with two exceptions. In the full sample, the intervention group received significantly fewer favorable ratings than the control group on the measure of physical functioning, and marginally significant lower maternal ratings assessing social limitations caused by physical health. (McCarton et al., 1997). These counterintuitive findings are discussed in the Issues to Consider section.
- 18-year outcomes
- The lighter low birth weight intervention group showed statistically significantly lower scores on the Woodcock-Johnson Test of Achievement in reading but no other significant differences in any of the outcome measures were observed for lighter low birth weight intervention children compared with the control group (McCormick et. al., 2006)
- The heavier low birth weight group showed significantly higher scores in math, vocabulary, and reduced scores on a scale of youth risk behaviors (McCormick et. al., 2006).
- Significantly more intervention group than control group infants were classified as being resilient (39 percent compared with 12 percent).
- Significantly more intervention group than control group infants scored above 85 on an IQ test (57 percent compared with 26 percent).
- Significantly more intervention group than control group infants scored less than 65 on the Total Problems scale of the behavioral outcome measure (85 percent versus 73 percent).
- There were no significant differences between groups with regard to health status or growth status.
Hollomon and Scott (1998) assessed school performance at age 9 among children that were in the Miami site of the IHDP. The authors reported the following:
- There were no significant differences between the three groups in terms of attendance records, rates of special education placement, and tests of reading, math computation, and math application.
Public and private early childhood programs
Funding for the Infant Health and Development Program was provided by the
- March of Dimes Foundation
- National Institute of Child Health and Human Development
- Pew Charitable Trusts
- Robert Wood Johnson Foundation
- Stanford Center for the Study of Families, Children, and Youth
- U.S. Department of Health and Human Services.
The specific curricula used in the IHDP were adapted for low birth weight infants from an early intervention with socially disadvantaged normal birth weight children called the Carolina Abecedarian Project. The Carolina Abecedarian Project is a "Proven" program on PPN. For more information, read the Carolina Abecedarian Project program summary. In addition, IHDP incorporated other treatment modalities such as parent support, parent problem solving, nurse support, and developmentally appropriate play materials.
Home Visits: The IHDP protocol specified weekly home visits for the first year, and biweekly visits thereafter. The home visitor provided parents with health and developmental information, along with family support. In addition, the home visitor implemented two specific curricula, the first of which emphasized cognitive, linguistic, and social development through games and activities for the parent to use with the child, while the second involved a systematic approach to help parents manage self-identified problems.
Child Development Centers: Beginning at 12 months and continuing until 36 months, the IHDP intervention children attended a Child Development Center five days a week for at least four hours a day. The teaching staff continued to implement the curriculum learning activities used by the home visitors and tailored the program to each child’s needs and developmental levels. Teacher-child ratios were one-to-three for children age 12 to 23 months and one-to-four for those age 24 to 36 months. Class sizes were six children for those under 24 months of age and eight children for those 24 to 36 months of age. Each site provided children with (optional) transportation in IHDP-operated vans.
Parent Groups: Beginning at 12 months, bimonthly parent group meetings provided parents with information on child rearing, health and safety, and other parenting concerns, along with some degree of social support.
Issues to Consider
This program received a "proven" rating for the indicators "Children ages 0 to 5 exhibiting age-appropriate mental and physical development," and "Babies born weighing more than 5.5 pounds and improving outcomes for low birth weight babies." The program received a "promising" rating for the indicator "Students performing at grade level or meeting state curriculum standards." The IHDP study used rigorous standards, including a randomized experimental design and longitudinal follow-up. Participants experienced significant gains across most of the cognitive outcomes through age 3 and across some of the behavioral outcomes, however the program's impacts at later ages are less consistent.
The studies (e.g., Brooks-Gunn Liaw, and Klevanov, 1992, and Brooks-Gunn et al., 1993) suggest that the intervention was more effective for African-American (and sometimes Hispanic) children than for white children. Another study (Bradley, Burchinal, and Casey, 2001) found that IQ improvements were greatest for infants with poorer quality home environments. In addition, several of the IHDP evaluations (e.g., Brooks-Gunn, Liaw, and Klevanov, 1992, Brooks-Gunn et al., 1993, and Brooks-Gunn et al., 1994) suggest that the intervention was less successful for children at greater biological risk (i.e., very-low birth weight infants) than for lower-risk children (the heavier low birth weight group).
At age 3, authors found that IHDP participants were more likely to have experienced illnesses than their counterparts in the control group (IHDP, 1990; Brooks-Gunn et al., 1993; Brooks-Gunn et al., 1994; McCormick et al., 1993). The authors speculate that this may be due to the fact that children who regularly attend child care are more likely to contract childhood illnesses than other children, or due to the fact that IHDP participants were in more frequent contact with professionals who might identify health conditions. Note that during the course of the trial there were no accidents or serious infectious epidemics noted by program staff.
At age 8, the intervention group received lower ratings than the control group on a measure of physical limitations in behavior, and the lighter low birth weight group received lower ratings than their control counterparts on measures of social limitations due to behavior. Similar to the findings at age 3, the authors speculate that mothers in the intervention group are "more accurate observers and reporters of their children's health-related behaviors" (McCarton 1997). No differences in illness or number of hospitalizations were noted for this group.
The success of the IHDP on cognitive outcomes may have been associated with the frequency with which families participated in program interventions. For example, Ramey et al. (1992) found that more-frequent participation resulted in significantly higher IQ scores than did less-frequent participation. Similarly, Blair, Ramey, and Hardin (1995) found that higher 36-month IQ scores in the intervention group were associated with the number of home visits received in the first year and with cumulative participation in the second and third years of the study.
Importantly, the effects of the IHDP on IQ for lighter low birth weight children appeared to fade after age 3 (e.g., Brooks-Gunn et al., 1994, McCarton et al., 1997, and Hollomon and Scott, 1998). Brooks-Gunn et al. (1994) found that, for the lighter low birth weight subsample of infants, differences between groups that were present at age 3 faded by age 5 for IQ, behavior, and morbidity outcomes. For the subsample of heavier low birth weight infants, significant, positive program effects were present at both ages 3 and 5 for IQ and behavior scores. As participants aged, fewer significant differences remained between the intervention and comparison groups. At age 8 years, McCarton et al. (1997) reported no significant differences for cognitive, behavioral, or academic outcomes for the lighter low birth weight subsample of infants, while the heavier low birth weight subsample of IHDP infants retained significant gains in IQ scores and math achievement scores and had a lower percentage of children requiring special education classes. In addition, Hollomon and Scott (1998) found no significant differences between the intervention and control groups at age 9 for attendance records, rates of special education placement, reading scores, or math achievement.
A number of additional evaluations have been conducted for this program (all of which included at least one of the original study authors), but we include here only those studies with methodologies meeting the Promising Practices Network criteria.
Little Rock, Arkansas
New Haven, Connecticut
Bronx, New York
Columbia University Teachers College
525 West 120th Street
New York, NY, 10027
Tel (212) 678-3369
Fax (212) 678-3676
Marie McCormick, MD, ScD
Department of Maternal and Child Health
Harvard School of Public Health
677 Huntington Avenue, 6th Floor
Boston, MA 02115
Tel (617) 432-3759
None at this time
Blair, Clancy, Craig T. Ramey, and J. Michael Hardin, "Early Intervention for Low Birthweight, Premature Infants: Participation and Intellectual Development,"
American Journal on Mental Retardation,
Vol. 99, No. 5, 1995, pp. 542-554.
Bradley, Robert H., Leanne Whiteside, Daniel J. Mundfrom, Patrick H. Casey, Kelly J. Kelleher, Sandra K. Pope, "Contribution of Early Intervention and Early Caregiving Experiences to Resilience in Low-Birthweight, Premature Children Living in Poverty," Journal of Clinical Child Psychology, Vol. 23, 1994, pp. 425-434.
Bradley, Robert H., Margaret R. Burchinal, and Patrick H. Casey, "Early Intervention: The Moderating Role of the Home Environment," Applied Developmental Science, Vol. 5, No. 1, 2001, pp. 2-8.
Brooks-Gunn, Jeanne, Cecilia M. McCarton, Patrick H. Casey, Marie C. McCormick, Charles R. Bauer, Judy C. Bernbaum, Jon Tyson, Mark Swanson, Forrest C. Bennett, David T. Scott, James Tonascia, and Curtis L. Meinert, "Early Intervention in Low-Birth-Weight Premature Infants: Results Through Age 5 Years from the Infant Health and Development Program," Journal of the American Medical Association, Vol. 272, No. 16, 1994, pp. 1257-1262.
Brooks-Gunn, Jeanne, Fong-ruey Liaw, and Pamela Kato Klebanov, "Effects of Early Intervention on Cognitive Function of Low Birth Weight Preterm Infants," Journal of Pediatrics, Vol. 120, No. 3, 1992, pp. 350-359.
Brooks-Gunn, Jeanne, Pamela Kato Klebanov, Fong-ruey Liaw, and Donna Spiker, "Enhancing the Development of Low-Birthweight, Premature Infants: Changes in Cognition and Behavior over the First Three Years," Child Development, Vol. 64, 1993, pp. 736-753.
Fewell, Rebecca R., and Keith G. Scott, "Cost Analysis Decisions for IHDP," in Ruth T. Gross, Donna Spiker, and Christine W. Haynes, eds., Helping Low Birth Weight, Premature Babies: The Infant Health and Development Program, Palo Alto, Calif.: Stanford University Press, 1997.
Hediger ML, Overpeck MD, Ruan WJ, Troendle JF. "Birthweight and gestational age effects on motor and social development." Pediatric and Perinatal Epidemiology, 2002;16(1):33-46.
Hollomon, Holly A., and Keith G. Scott, "Influences of Birth Weight on Educational Outcomes at Age 9: The Miami Site of The Infant Health and Development Program," Developmental and Behavioral Pediatrics, Vol. 19, No. 6, 1998, pp. 404-410.
Infant Health and Development Program, "Enhancing the Outcomes of Low-Birth-Weight, Premature Infants: A Multisite, Randomized Trial," American Medical Association Journal, Vol. 263, No. 22, 1990, pp. 3035-3042.
Liaw, Fong-ruey, and Jeanne Brooks-Gunn, "Cumulative Familial Risks and Low-Birthweight Children’s Cognitive and Behavioral Development," Journal of Clinical Child Psychology, Vol. 23, No. 4, 1994, pp. 360-372.
McCarton, Cecilia M., Jeanne Brooks-Gunn, Ina F. Wallace, Charles R. Bauer, Forrest C. Bennett, Judy C. Bernbaum, Sue Broyles, Patrick H. Casey, Marie C. McCormick, David T. Scott, Jon Tyson, James Tonascia, and Curtis L. Meinert, "Results at Age 8 Years of Early Intervention for Low-Birth-Weight Premature Infants," Journal of the American Medical Association, Vol. 277, No. 2, 1997, pp. 126-132.
McComick, Marie C., Jeanne Brooks-Gunn, Stephen L. Buka, Julie Goldman, Jennifer Yu, Mikhail Salganik, David T. Scott, Forrest C. Bennett, Libby L. Kay, Judy C. Bernbaum, Charles R. Bauer, Camilia Martin, Elizabeth R. Woods, Anne Martin and Patrick Casey. "Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program," Journal of Pediatrics, Vol. 117, No. 3, March 2006, pp. 771-780.
McCormick, Marie C., Cecelia McCarton, James Tonascia, and Jeanne Brooks-Gunn, "Early Educational Intervention for Very Low Birth Weight Infants: Results from the Infant Health and Development Program," Journal of Pediatrics, Vol. 123, No. 4, 1993, pp. 527-533.
Ramey, Craig T., Donna M. Bryant, Barbara H. Waski, Joseph J. Sparling, Kaye H. Fendt, and Lisa M. LaVange, "Infant Health and Development Program for Low Birth Weight, Premature Infants: Program Elements, Family Participation, and Child Intelligence," Pediatrics, Vol. 89, 1992, pp. 454-465.
Spiker, Donna, Joan Ferguson, and Jeanne Brooks-Gunn, "Enhancing Maternal Interactive Behavior and Child Social Competence in Low Birth Weight, Premature Infants," Child Development, Vol. 64, 1993, pp. 754-768.