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Does Early Enrichment Foster Later Mental Health?

Malnourished children who entered a 2-year enrichment program at age 3 had better mental-health scores at ages 17 and 23 than malnourished controls.

Poor nutrition and low hemoglobin levels have been associated with later cognitive impairments in a Mauritian birth cohort (Journal Watch Psychiatry Jul 24 2003). In the same cohort, these researchers compared how malnutrition at age 3 years or a 2-year enrichment program starting at age 3 affected rates of schizotypal personality and antisocial behaviors at ages 17 and 23. Poor nutrition was indicated by stunting, reduced weight for height, low hemoglobin, stomatitis, and depigmented or sparse hair.

One hundred randomly selected children (cases) entered the enrichment program, which included nutritious lunches, physical exercise, and enhanced education. Community controls were matched on various socioeconomic and health measures. Complete behavioral data were available for 83 cases and 355 controls at age 17 and for 75 cases and 294 controls at age 23. The children were grouped as follows: cases who were malnourished at age 3 who received enrichment, nonmalnourished cases who received enrichment, malnourished controls without enrichment, and nonmalnourished controls without enrichment.

At age 17, malnourished cases had lower scores for conduct disorder, motor excess, and cognitive disorganization than malnourished controls. At age 23, malnourished cases had lower scores for total schizotypy and interpersonal deficits than did malnourished controls. Rates for conduct disorder at age 23 were significantly lower by self-report (but not by court records) in cases than in controls.

Comment: Given the multimodal approach, it is not possible to tease out whether specific parts or the totality of the enrichment program accounted for the outcomes. Still, other researchers have found that exercise and environmental enrichment benefit animal hippocampal neurogenesis. The authors note that the role of nutrition in personality development is controversial, and we do not know why a 2-year intervention would have long-term benefits. This work's greatest importance may lie in the simplicity of the overall findings: providing children with nutritious diets and enriched environments is associated with greater mental health and better social behaviors later in life.

— Barbara Geller, MD

Published in Journal Watch Psychiatry October 23, 2003

Citation(s):

Raine A et al. Effects of environmental enrichment at ages 3-5 years on schizotypal personality and antisocial behavior at ages 17 and 23. Am J Psychiatry 2003 Sep; 160:1627-35.

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