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The Legacy for Children™ Randomized Control Trial

Effects on Cognition Through Third Grade for Young Children Experiencing Poverty

Perou, Ruth, PhD*; Robinson, Lara R., PhD*; Danielson, Melissa L., MSPH*; Claussen, Angelika H., PhD*; Visser, Susanna N., DrPH; Scott, Keith G., PhD; Beckwith, Leila, PhD§; Katz, Lynne, EdD; Smith, D. Camille, EdS*

Journal of Developmental & Behavioral Pediatrics: May 2019 - Volume 40 - Issue 4 - p 275–284
doi: 10.1097/DBP.0000000000000656
Original Article

Objective: In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children's cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade.

Methods: Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade.

Results: Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site.

Conclusion: Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.

*National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA;

National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention, Fort Collins, CO;

Linda Ray Intervention Center, University of Miami, Miami, FL;

§Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.

Address for reprints: Ruth Perou, PhD, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS-E87, Atlanta, GA 30333; e-mail:

Disclosure: The authors declare no conflict of interest.

See the Video Abstract at

Received October 12, 2018

Accepted January 03, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.