Assessment at 5 months

Of the 65 children that were offered supplementation in April 2005, 47 children completed the treatment period - 72% of the group. 15 children withdrew early from the trial out of choice, and a further three have been excluded from the analysis of results due to lack of assessment data. The children's parents completed rating scales of their child's level of concentration and behaviour, and the children were assessed on a number of developmental assessments, including expressive and receptive language ability.

Parental behaviour ratings before and after supplementation

Behaviour

At baseline, 47% of children were rated as having 'poor' or 'very poor' behaviour by their parents. Only 17% of parents rated their children's behaviour as 'good' of 'very good'.
After supplementation, only 4% of children had 'poor'/'very poor' behaviour ratings. 91% of those children who had poor behaviour at baseline, improved to 'moderate' or 'good' after supplementation.

Concentration

66% of children at the beginning of the trial had 'poor'/'very poor' concentration

After supplementation, 79% of children had 'good'/'very good' levels of concentration

All children who were rated as 'poor' concentrators at baseline, have improved to moderate or good after 5 months
Parental concentration ratings before and after supplementation

Language development

Language development of the 47 children taking supplementation was compared with an age-matched control group who, apart from not taking the supplement, were accessing the same opportunities via Sure Start. (These opportunities include: training for parents, nursery/playgroup experiences and specialist language support). In order to measure receptive language ability, children were required to listen to and understand a series of instructions. Expressive language ability was based on the communication skills of the child through spoken word.

We had previously standardised the assessments using 400 pre-school children in the county - a good representative population - which were sampled primarily from nurseries across Durham. This enabled our group comparisons to be made against local rather than national norms.

At baseline, the treatment and control groups were comparable on expressive language ability (18.1 months versus 19.4 months) and receptive language (19.5 months versus 20.5 months).

In both groups, children's language ability was significantly below that expected for their age.

After the first 5 months, children taking the supplement made an average 7 month improvement in receptive language ability, and a nearly 9 month improvement in expressive language ability ' above what would be expected in the 5 month period.
In the same period, the matched control group made an expected gain of 5 months' improvement in expressive language, and less than expected 4 month improvement in receptive language.
Statistical analysis demonstrated that the improvements in the supplemented group were significantly greater in both expressive language (p < 0.00001) and receptive language (p < 0.0001) than those seen in the control group of children.

Qualitative observation

We observed that the impact of the supplement in reducing excitability and improved concentration in the children lead to a fundamental shift towards more qualitative time spent at home, where parents were more able to engage their youngsters in activities such as role play, form-boards and most importantly sitting with them to read books.

It appeared that the improvement in the child-parent bond in these crucial early years, played the most fundamental role in facilitating the remarkable changes we have seen in the development of the children's language skills. Parents attending training on developing language skills and receiving regular support from family workers, reported that the improvements in their children's concentration enabled them to utilise their newly learnt skills.

The 8 months' improvement in expressive language in the five month period of the study reflects considerable progress, particularly as these children were between 18 months and 2.5 years at the time of assessment. Although the 5 month gain in the control group was significantly less than the active supplement group, this was still impressive considering that the children were well behind their chronological age at baseline. This suggests that the support from Sure Start workers has also been positive.