Early child stimulation and attention-related executive functions at 11 years: 2004 Pelotas birth cohort study


The study aimed to explore associations between socioeconomic position (SEP) indicators, early child stimulation (ECS) and attention-related executive functions (EF) at age 11. Children born in Pelotas, Brazil, in 2004, were recruited to a birth cohort (n = 4231, non-response rate at recruitment < 1%) and followed from birth to age 11. SEP variables were family income and maternal schooling. At the 24 and 48-month follow-ups, five markers of cognitive stimulation and social interaction were recorded and positive answers were summed to a score ranging from 0 to 5. At age 11, attentional-switching and control, and selective-attention were assessed using the adapted Test-of-Everyday-Attention-for-Children (TEA-Ch). We used multivariable logistic regression models and mediation analysis to investigate potential mediator role of ECS in the association between SEP and EF. 3106 children were included in the analyses. Less than 7% of the more stimulated individuals showed low performance in attention-related EFs at age 11 compared with almost 20% in the bottom groups of stimulation. Higher child stimulation scores were associated with fewer impairments in attentional-control (OR adj 0.84; CI 95% 0.72–0.98) and attentional-switching (OR adj 0.85; CI 95% 0.73–0.99). Mediation analysis suggested that for attentional-switching, ECS mediated almost 20% of the total protective effect of maternal schooling for impaired EF. Assuming causal relationships, if maximum stimulation was provided to all children, the advantageous effect of maternal schooling on EF would be reduced by 47%. ECS may represent a protective factor for cognitive impairments in childhood and can be easily implemented at relatively low cost.

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The authors would like to thank the participating families and staff who collaborated in the various stages of the 2004 Pelotas Birth Cohort study.


This article was conducted with data from the Pelotas (Brazil) birth cohort study, conducted by the Postgraduate Program in Epidemiology of the Federal University of Pelotas, with the support of the Brazilian Association of Public Health (Abrasco). Previous phases of the study were funded by the World Health Organization, Program of Support to Nucleus of Excellence (PRONEX), Brazilian National Research Council (CNPq), Ministry of Health and Pastoral of the Child. The mental health component in the 11-year follow-up was funded by the São Paulo Research Foundation (FAPESP; Grant number 2014/13864-6). The present analyses were funded by the CNPq (Grant no. 426024/2016-8).AM, FCB, ISS and AJDB are supported by the CNPq. JM is supported by São Paulo Research Foundation (FAPESP; Grant number 2017/22723-5).

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AM, RMP, CLM and AJDB participated in the design of the study, undertook the analysis, interpreted the results and drafted the first version of the article. JMM, CLM, TNM, ISS and FCB collaborated in the interpretation of the findings and writing of the article. All authors approved the final version of the manuscript submitted.

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Correspondence to Jessica Mayumi Maruyama.

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Matijasevich, A., Pearson, R.M., Loret de Mola, C. et al. Early child stimulation and attention-related executive functions at 11 years: 2004 Pelotas birth cohort study. Eur Child Adolesc Psychiatry 29, 1265–1276 (2020). https://doi.org/10.1007/s00787-019-01440-3

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  • Cohort
  • Cognitive impairments
  • Stimulation
  • Early adolescence
  • Mediation analysis