The developmental status and adaptive behavior of homeless and low-income housed infants and toddlers.

OBJECTIVES: This study describes the development status of 127 homeless and 91 low-income housed infants and toddlers. METHODS: The Bayley Scales of Infant Development and the Vineland Screener were used to gather data. RESULTS: There were no differences between homeless and low-income housed children. However, younger children in both groups performed better than the older children on most summary scores. CONCLUSIONS: Homeless and low-income housed children did not differ in their cognitive and motor skills. However, older children scored lower than younger children on most measures of development status, suggesting that the cumulative effects of poverty may increase with time.

The plight of extremely poor Puerto Rican and non-Hispanic white single mothers.

Using data from a case-control study of family homelessness in Worcester, Massachusetts, this analysis compares the economic, psychosocial and health characteristics of 159 Puerto Rican and 170 Non-Hispanic White poor, single mothers. When compared to Non-Hispanic Whites, the Puerto Rican mothers had more children, less education, fewer work experiences, fewer social supports, and more English language problems. Although the absolute rates were high in both groups, Puerto Rican mothers had experienced less violence and suffered fewer mental health problems, with the exception of major depression, than Non-Hispanic Whites. In addition, Puerto Rican mothers were less likely to use traditional health services. These findings suggest that to escape poverty, Puerto Rican mothers need a unique combination of educational opportunities (including English as a Second Language), job training, and child care.

An integrative model for the study of developmental competencies in minority children.

In this article a conceptual model for the study of child development in minority populations in the United States is proposed. In support of the proposed model, this article includes (a) a delineation and critical analysis of mainstream theoretical frameworks in relation to their attention and applicability to the understanding of developmental processes in children of color and of issues at the intersection of social class, culture, ethnicity, and race, and (b) a description and evaluation of the conceptual frameworks that have guided the extant literature on minority children and families. Based on the above considerations, an integrative conceptual model of child development is presented, anchored within social stratification theory, emphasizing the importance of racism, prejudice, discrimination, oppression, and segregation on the development of minority children and families.

Behavioral intervention and post-natal growth in full-term intrauterine growth retarded (IUGR) infants.

The purpose of this study was twofold: (1) to describe the patterns of post-natal growth in full-term infants as a function of IUGR and (2) to assess the impact of an individualized behavioral feeding intervention with the mothers on these patterns of infant growth. Eighty-eight (88) full-term infants, including 54 with IUGR, half of whom received behavioral intervention were included. Weight, length, skinfold thickness, head circumference and Ponderal Index were measured at birth and at 1, 4, 8, 12, and 18 months. Results show positive intervention effects between birth and 1 month in weight, length, skinfold thickness, and Ponderal Index. However, there were no intervention effects at subsequent ages. No evidence was found for catch-up growth in full-term IUGR infants in weight, length, and head circumference. We conclude that an individualized behavioral feeding intervention can accelerate early growth in IUGR infants, but the positive effects on growth are only seen while the intervention lasts (between birth and 1 month). On most parameters of physical growth, there is no lasting catch-up growth over the first 18 months in IUGR full-term infants.

Psychological distress in mothers of preterm infants.

The purpose of this study was to identify infant and maternal characteristics that predict psychological distress among mothers of preterm infants admitted to the neonatal intensive care unit (NICU). Infant characteristics included birth weight, gestational age, and ventilatory support, and maternal characteristics included age, parity, and socioeconomic status. Mothers (n = 142) completed questionnaires including a demographic form, the Parental Stressor Scale, and the Symptom Checklist 90-R. In hierarchical regression analyses, maternal NICU-specific distress was more strongly predicted by infant characteristics [F(3,135) = 6.80, p < .05] with maternal variables covaried. Maternal general psychological distress was more strongly predicted by maternal characteristics [F(3,135) = 6.05, p < .05]) with infant variables covaried. Twenty-eight percent of mothers reported clinically significant psychological distress compared with 10% in a normative population. Psychological distress among mothers of preterm infants appears to be common and deserves clinical consideration. The use of standardized questionnaires as part of the assessment process may improve case identification and psychosocial service delivery in the NICU.

Adolescent development and transitions to motherhood.

OBJECTIVE: To use both qualitative and quantitative methods to examine the experience of motherhood during adolescence and to evaluate developmental influences on the concept of maternal role. DESIGN: (1) A grounded theory approach was initially used to generate a hypothesis. Focus groups and individual interviews were analyzed for concept and theme. (2) A quantitative method using correlational analysis was used to test the hypothesis generated by qualitative study. A structured interview using five specific, scored questions about self and about motherhood was used to examine the relationship between developmental complexity of responses to questions about self and questions about motherhood. SETTING AND PARTICIPANTS: The qualitative study involved group and individual interviews with 42 teenage mothers. The quantitative study involved individual interviews with 25 mothers, ages 14 to 18 years, at an innercity clinic for young parents and their infants. Race and ethnicity were heterogeneous, and 100% received Aid to Families With Dependent Children. RESULTS: The major hypothesis generated from the qualitative analysis was that an adolescent mother's conceptualization of her maternal role is related to her own psychosocial and cognitive development. The quantitative study revealed a strong correlation between the developmental complexity of responses to questions about self and the complexity of responses to questions about motherhood (r2 = .81). CONCLUSION: The experience of motherhood and the conceptualization of the maternal role in adolescence is related to young mothers' psychosocial cognitive development.

Developmental outcome as a function of the goodness of fit between the infant's cry characteristics and the mother's perception of her infant's cry.

OBJECTIVE: To determine whether the "goodness of fit" between infant cry characteristics and the mother's perception of the cry is related to developmental outcome at 18 months of age. DESIGN: This was a prospective, longitudinal study from birth to 18 months performed in a blinded manner. SETTING: The study was conducted in a maternity hospital, including normal and special care nurseries and a laboratory for developmental follow-up. PATIENTS: The 121 term and preterm infants and their mothers were selected to meet medical criteria. MEASUREMENT: Acoustic analysis of 1-month infant cry and the mother's perception of the same cry was used to divide subjects into four groups representing matches and mismatches between infant cry characteristics and maternal cry perception. Primary outcome measures of cognitive, language, motor, and neurologic outcome were administered at 18 months. Caretaking environment measures were also recorded. RESULTS: Statistically significant (P < .05) findings showed that matched groups scored higher on measures of language and cognitive performance than infants in the mismatch groups, with a particular advantage for infants in the matched group in which mothers accurately perceived the higher-pitched cries of their infants. There were no differences between the groups in biologic or sociodemographic factors. Group differences were observed in social support and maternal self-esteem. CONCLUSIONS: Matches and mismatches between infant cry characteristics at 1 month and the mother's perception of the cry are related to cognitive and language outcome at 18 months in term and preterm infants. This relation is probably due to transactional processes in which developmental outcome is affected by the clarity of the infants' signals and by the ability of the mother to accurately perceive her infant's signals. The mother's ability to read her infant's cues may be affected by factors such as social support and self-esteem.

Outcome of extremely low-birth-weight infants: 1980-1990.

Neonatal and follow-up data of infants from the special care nursery whose birth weights were < 750 g, born between 1980 and 1990, were reviewed. There was a 20% relative improvement in the odds of surviving the neonatal period, a 16% improvement in the odds of being discharged and a 19% improvement in the odds of surviving until 2 years of age with each consecutive year. Home oxygen use increased significantly over the study period. The neurodevelopmental outcomes of infants were similar over the 11-year period, with 53% being classified as neurologically normal, with a mean developmental index of 83 at 1 to 2 years of age. We conclude that there has been an improved survival of infants with birth weights < 750 g in our institution, and that the overall incidence of serious neurodevelopmental deficits among survivors has remained stable.

Effects of intraventricular hemorrhage and socioeconomic status on perceptual, cognitive, and neurologic status of low birth weight infants at 5 years of age.

A prospective longitudinal study assessed the effects of intraventricular hemorrhage (IVH) and socioeconomic status on the perceptual, cognitive, and neurologic status of preterm infants at 5 years of age. The preterm group consisted of infants with no IVH, grade I to II IVH, and grade III to IV IVH; a control group of normal term infants was also studied. Outcome was evaluated at 3, 4, and 5 years of age. Twenty-four percent of infants with grade III to IV IVH had abnormal neurologic diagnoses at 5 years of age. Correlations of predictor variables including IVH status, latency of visual evoked response, days of hospitalization, and socioeconomic status with 5-year neurologic outcome indicated that IVH status and visual evoked response at 1, 2, and 3 years continued to have an effect on neurologic outcome, but socioeconomic status and days of hospitalization did not; socioeconomic status did have a significant effect on the McCarthy cognitive scores but not on the perceptual scores at 5 years. Multiple regression analyses revealed that duration of hospitalization (reflecting neonatal morbidity), visual evoked response, and socioeconomic status all have independent effects on the cognitive index, whereas only duration of hospitalization has an independent effect on the perceptual index. These data support the concept that a complex interaction of biologic and environmental risk factors determines the degree of recovery from IVH by high-risk preterm infants.

Factors affecting parents' perceptions of temperament in early infancy.

Parents' perceptions of temperament in their three-month-old infants were examined in relation to prenatally measured parental characteristics and to objective indices of infant behavior at three months. Infant behavior and parental characteristics appear to make independent contributions to parents' perceptions in early infancy.

[Early intervention in infants with intrauterine growth retardation: its effects on neuropsychological development]. / Intervención temprana en infantes con retraso en crecimiento intrauterino: sus efectos en el desarrollo neuropsicológico.

Forty-eight term infants in a tertiary center in Puerto Rico during 1985-86 were monitored prospectively since birth completing a neuropsychological evaluation using the Mental Developmental Index of Bayley Scales. All infants were free from perinatal complications and chronic diseases by clinical evaluation. 25 infants with intrauterine growth retardation (IUGR) and 23 adequate for gestational age (AGA) infants were evaluated. Fourteen IUGR infants were controls and eleven IUGR infants were intervened. However, all AGA infants were used as controls. Mother-infant relationship at one month was scored and none of intervened infants had poor neuropsychological behavior with normal or near normal MDI values. Other relationships and possible explanations are discussed in the article.

Developmental outcome of minority infants: a process-oriented look into our beginnings.

This article reviews the literature on the development of children of minority status from birth to 3 years of age (infants). 5 major sources of influence on the developmental outcome of minority infants are proposed: cultural beliefs and caregiving practices, health status and health care practices, family structure and characteristics, socioeconomic factors, and biological factors. It is suggested that differences exist between minority and Anglo families in their developmental goals and interactions during the infancy period. The health status of some minority groups places these infants in an at-risk category for neurodevelopmental problems. The family context is characterized by younger mothers, a higher percentage of single heads of households, but also large, extended families. Socioeconomic factors have a pervasive influence on both infants and parents, and the contribution of biological factors is suggested but poorly understood. It is concluded that these factors act synergistically to place these infants in alternative (not necessarily deviant) developmental pathways, or in "at-risk" categories for neurodevelopmental problems, while canalization processes are operating to insure that major developmental milestones are achieved.

Language and neurodevelopmental outcome of low-birthweight infants at three years.

Forty low-birthweight (LBW) infants (28 AGA, 12 SGA) and 16 fullterm infants have been followed for three years with neurological, developmental, language, behavior and audiometric assessments. Only two (5 per cent) of the LBW infants were neurologically abnormal at three years. The AGA infants continued to lag cognitively and in receptive language in comparison with the fullterm infants. Socio-economic factors had a significant effect on the language development of all three groups. Short gestation and neurological status at eight months continued to have a significant effect on language performance. A variety of behavioral characteristics correlated with cognitive and language scores, and impaired middle-ear status was associated with lower cognitive function. These data support the concept that language development of LBW infants is influenced by perinatal, neurological and socio-economic factors, and by behavioral characteristics and middle-ear status.

Neurologic and developmental status related to the evolution of visual-motor abnormalities from birth to 2 years of age in preterm infants with intraventricular hemorrhage.

We prospectively and longitudinally evaluated neurologic status, cognitive status, and visual-evoked responses in 63 premature infants with cerebral intraventricular hemorrhage, 27 premature infants without hemorrhage, and 22 full-term normal infants. We hypothesized that severe intraventricular hemorrhage (grades III and IV) is associated with impaired visual-motor function, in part because of compression-related injury of the periventricular white matter by ventricular dilation. Infants with grade III or IV hemorrhage had significantly more neurologic sequelae at term and at 3, 7, 12, and 24 months; lower Bayley mental and motor scores at 3, 7, and 12 months; more abnormality on Kohen-Raz subscales for eye-hand coordination, object manipulation, and object relations at 3, 7, and 12 months; and lower Mullen vision-receptive and vision-expressive coordination scores at 24 months. The 12-month visual-evoked response correlated with the 24-month vision-receptive and vision-expressive organization scores for infants with grade III or IV intraventricular hemorrhage (r = -0.49, p less than 0.01, and r = -0.40, p less than 0.05, respectively). The data confirm our hypotheses of increased cognitive and neurologic sequelae, and increased abnormality of visual-motor coordination, during the first 2 years of life in infants with severe (grade III or IV) intraventricular hemorrhage.

Behavioral characteristics and early temperament of premature infants with intracranial hemorrhage.

Behavioral characteristics of 12 full-term and 44 premature infants with and without intracranial hemorrhage (ICH) were studied. Cranial ultrasonography prospectively documented Grade I-II ICH in 14, Grade III-IV in 19 and no ICH in 11 premature infants. Examination at corrected age of 40 +/- 2 weeks using the Neonatal Behavioral Assessment Scale showed that infants in the ICH groups had lower levels of arousal and more abnormal reflexes than full-terms. Infants with ICH III-IV displayed less optimal motor responses than full-term infants and diminished orientation responses, especially to visual stimuli. Thus, lower level of arousal, immature motoric processes, and poor visual orientation differentiated premature with ICH from full-term infants, although premature infants without these sequelae, did not differ significantly from full-term infants. The above may represent early manifestations of visual-perceptual and motor problems noted in the follow-up of ICH infants. Further, neonatal behavior was found to affect parent ratings of infant temperament (via the Bates Infant Characteristics Questionnaire) at 3 months corrected age, and the relationships between neonatal behavior and parental ratings differed depending upon the infant's gestational age and severity of hemorrhage. We conclude that neonatal behaviors are less optimal in premature infants, and least optimal in premature infants with severe intracranial hemorrhage when compared to fullterm infants.

Language development of low-birthweight infants at two years.

Fifty low-birthweight (LBW) and 18 fullterm normal infants were prospectively evaluated at eight months and two years of age for language development and neurodevelopmental status. The LBW cohort was divided into those who were appropriate for gestational age (AGA) (N = 35) and small for gestational age (SGA) (N = 15) to assess the effect of intra-uterine growth retardation on language development within a premature population. LBW SGA infants lagged significantly behind term infants in both receptive and expressive language, but to a lesser degree than LBW AGA infants. Multiple regression analyses of gestational age, Hollingshead socio-economic status score, and eight-month neurological score as independent variables, and the receptive and expressive language scores as dependent variables, indicated that these three predictor variables had a significant cumulative effect on language development. Language was delayed in 28 per cent of the LBW children at two years.

Behavioral responsiveness in preterm infants with intraventricular hemorrhage.

Preterm infants with varying degrees of intraventricular hemorrhage (none, n = 21; grade I to II, n = 22; grade II to IV, n = 24) and a group of full-term infants (n = 21) were compared with regard to behavioral responsiveness and parental reports of the infant's temperament. Behavioral responsiveness was assessed during the presentation of 15 visual, auditory, and tactile stimuli at 3 months of age (corrected age for preterm infants). Summary scores for positive and negative responsiveness, as well as sociability, soothability, and overall activity levels, were derived from behavioral observations by coders who were unaware of the infant's characteristics. The Bates Infant Characteristic Questionnaire was completed by the main care giver and scored on four summary variables: fussy-difficult, unadaptable, dull, and unpredictable. Preterm infants, regardless of the presence or severity of intraventricular hemorrhage, showed less positive responses and less overall activity in response to stimulation. Infants with grade I to II intraventricular hemorrhage were less sociable and more difficult to soothe than full-term control infants. Individual differences in positive, negative, sociability, and soothability were related to the questionnaire scores of fussy-difficult and unadaptability. Both prematurity and degree of intraventricular hemorrhage affect behavioral responsiveness and these individual differences are related to parental reports of the infant's temperament.

Mothers of preterm and full-term infants on home apnea monitors.

We prospectively studied the stress perception of ten mothers of preterm infants on apnea monitors (birth weight, 1255 +/- 295 g) and ten mothers of term infants on monitors (3156 +/- 700 g) and compared them with 15 mothers of preterm infants (1450 +/- 305 g) and 15 mothers of term infants (3360 +/- 595 g) not on monitors. The Life Experience Survey, a stress assessment questionnaire, and the social support questionnaire of Henderson were administered to the 50 mothers. Stress perception scores were higher for mothers of infants on monitors than for mothers of infants not on monitors. Regression analyses indicated that mothers of infants on monitors experienced less perceived stress when they received greater support. Mothers of infants on monitors who experienced less stress reported greater general life satisfaction and greater satisfaction with parenting.