Overview of the Tracking the Outcome of Toddlers (TOT) study

Children growing up in poverty are at increased risk for poor cognitive outcomes, arguably one of the most critical issues facing our nation today. While many studies have shown that effects of poverty are apparent by age two years, far less is known regarding effects in children younger than two years. When do the effects of poverty first exert their effects? What cognitive systems are affected? Are changes detectable in the developing brain? What environmental factors are most influential?

This study will:

1) provide novel data regarding neural effects of poverty;

2) identify timing of effects and specific cognitive systems affected by poverty;

3) explore relation of neural structure and function with cognitive outcomes; and

4) assess mediation of poverty’s effects by maternal, child, and environmental factors.

Our long-term goals are to improve outcome of disadvantaged children through: 1) identifying the earliest time period at which, and specific systems for which, interventions can be implemented; and 2) designing interventions based on changes in the developing brain and on environmental risks most strongly associated with cognitive outcomes. We propose to accomplish these aims through enrollment of 60 healthy, African American female term gestation infants born into families with low (n=30) or high (n=30) income in a prospective study. Child assessments will be conducted from birth through age 12 months as follows: Neuroimaging: MRI (major white tracts, cortical regions and hippocampus) at 1 and 12 months; and Infant Development: general cognitive development, language, and executive function at 6 and 12 months. Maternal, child, and environmental factors considered mediators of the effects of poverty on child outcome will be assessed starting in the prenatal period and continuing through infant age 12 months. Maternal factors include nutrition, stress, depression, and IQ. Child factors include temperament, growth, and health. Environmental factors include parental education and occupation, home environment, and childcare. For evaluation of neural and cognitive outcomes, cross- sectional and longitudinal analyses will be conducted with income group as the primary independent variable, followed by mediational analysis.

This is the first prospective study that leverages the use of neuroimaging in the study of neural and cognitive outcomes of infants growing up in poverty. The inclusion of neuroimaging provides not only the first assessment of poverty’s effect on the developing brain of infants, but also an unprecedented opportunity to link brain structure and behavior, and in turn explore mediational mechanisms affecting development of very young children. Successful achievement of proposed aims not only will advance scientific knowledge but also be hypothesis generating regarding causality, reversibility, and prevention of injurious effects of poverty.

Source: NIH Research Portfolio Online Reporting Tools

Project number: 3R21HD072461-02S1

PI: Dr. Hallam Hurt