Children's cortisol levels and quality of child care provision.

BACKGROUND: Cortisol levels are increasingly being used as an indicator of stress levels. Research suggests that children who attend child care demonstrate higher cortisol levels than children in their homes, suggesting that child care acts as a risk factor for poor child outcomes. However, it is also suggested that quality influences outcomes. METHODS: Cortisol levels were measured through samples of saliva taken from children (3-5 years of age) attending long-day care centres in Perth, Western Australia. Quality of the programme was measured using industry national quality assurance indicators designed for child care centres. The analysis employed a 2 (time of collection: average am cortisol, average pm cortisol) by 3 (centre quality: high, satisfactory, unsatisfactory) split plot ANOVA with repeated measures on the time factor. RESULTS: Cortisol levels of children attending high-quality programmes demonstrated a decline across the child care day. Levels in children attending unsatisfactory programmes demonstrated an increase across the day. CONCLUSIONS: Although we do not yet know how high, and for how long, cortisol levels need to be elevated for risk of undesirable outcomes to increase, this research signals the importance of emphasizing the need for high-quality care for young children.

Subclinical rhythmic EEG discharge of adults: SREDA in two children.

Subclinical rhythmic electroencephalogram (EEG) discharge is an uncommon rhythmic EEG pattern that has been reported to occur in adults. It is thought to be a nonspecific finding with little clinical significance. This article reports this EEG pattern in two children and suggests it be called subclinical rhythmic EEG discharge of adults and children.

Thyroid function in a population of children with attention deficit hyperactivity disorder.

OBJECTIVE: To determine the prevalence of thyroid hormone abnormalities and generalized resistance to thyroid hormone in a population of children with attention deficit hyperactivity disorder (ADHD) as compared to reference ranges determined from a control population and hence to determine if routine thyroid hormone screening in children with non-familial ADHD is indicated. METHOD: Children attending the State Child Development Centre in Perth, Western Australia with ADHD, as defined by the Diagnostic and Statistical Manual of Mental Disorders (fourth edition) provided the study population. The control population consisted of 353 normal children with a history of allergy in whom radioallergosorbent (RAST) testing was being performed. RESULTS: The prevalence of thyroid hormone abnormalities in the study population was 2.3% (95% CI 0.6%, 5.7%). There were no cases of generalized resistance to thyroid hormone. The prevalence of thyroid hormone abnormalities in the general population of children and adolescents has been reported to vary between 1 and 3.7%. CONCLUSION: Routine thyroid hormone screening is not indicated in children with non-familial ADHD.

Improving outcome for Western Australian infants with birthweights 500-999 g.

OBJECTIVE: To assess changes in survival and disability in liveborn extremely low birthweight infants (500-999 g) in Western Australia, 1980-1987. DESIGN: Cohort study comparing two periods, 1980-1983 (P1) and 1984-1987 (P2). PARTICIPANTS: All 586 liveborn extremely low birthweight infants in WA in 1980-1987 (266 in P1, 320 in P2). MAIN VARIABLES EXAMINED: Birthweight, place of birth, age at death, neurosensory examination findings and scores on the Griffiths Mental Development Scales or other standardised test results. RESULTS: 482/586 infants (82%) were born at King Edward Memorial Hospital (KEMH), a level III referral centre, and a further 4% were transferred there after birth. The proportion born at KEMH increased from 78% in P1 to 86% in P2. Survival increased from 35% to 43% overall. In those below 800 g birthweight, survival doubled from 14% to 29%. There was no change in the age at death for non-survivors. Follow-up information was known for 222 of the 229 survivors at median ages of 46 months (P1) and 43 months (P2). Disability rates in infants below 800 g birthweight remained static (P1, 26%; P2, 28%), but fell in those of 800-999 g birthweight from 24% to 13%. Overall, survival free of disability increased from 26% to 34%. CONCLUSION: Increased survival rates occurred without any increase in the rate or severity of disability in survivors.

The effectiveness of early intervention: a critical review.

The following principles are now clearly defined in the management of children with developmental delay: (1) Multidisciplinary teams are more effective than individual therapeutic approaches. (2) The whole development of the child needs to be considered rather than a single deficient area alone. (3) Home-based programmes are more effective in the young preschool child than centre-based programmes alone. (4) Parent involvement in partnership with professionals is essential for sustained progress. (5) Maximum effectiveness is achieved when parental skills are increased. (6) Programmes commencing earlier in preschool years are more effective than those that commence late. This concept has been recently challenged and evidence supports benefits for the disadvantaged rather than the disabled. White also contends that there is 'simply not enough information to be confident about the long-term impact of early intervention with handicapped children and evidence in support of many of the commonly held positions about mediating variables (e.g. parental involvement, age at start) is either non-existent or contradictory. Early intervention is clearly effective in offering parental support, fostering parent/child relationships and diminishing anxiety even for those programmes that have not at present been proven in altering the developmental disability. Programmes that involve high cost, disrupt total family functioning, deflect scarce resources away from more proven areas of effectiveness should be discouraged, and they should never cause guilt in either parent or professional when they seem ineffective. Future research should include investigation of outcomes other than cognitive and physical functioning alone. We should be warned from the somewhat crisp statement of Mark Twain: 'There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment in fact'.(ABSTRACT TRUNCATED AT 250 WORDS)

Early behaviour, development and parenting in a very low birthweight infant group.

Thirty-seven mothers, their very low birthweight infants and a matched group of term infants of normal birthweight and their mothers were seen when the infants were 12 months old (corrected for prematurity). Data were collected about infant behaviour and development, mother-infant interaction in a free-play situation, and parenting behaviour indicating child-centred care. Findings for the mother-infant dyads in the two birthweight groups were compared to determine the extent to which the data supported possible outcomes of: differences in behaviour/development only, differences in behaviour/development compounded by disturbances of interaction or parenting, or interaction/parenting disturbances despite apparently normal behaviour and development. Results of this analysis indicated significantly poorer scores for the very low birthweight infants on measures of behaviour and development only. Recent reports that interactional problems, which commonly exist early on, resolve through a process of mother-infant adaptation are discussed in light of the findings of this study. The need to consider developmental problems and interactive failure jointly if early intervention is to be offered is also examined.

Developmental assessment of twenty in vitro fertilization (IVF) infants at their first birthday.

The pregnancy details, delivery outcome, and developmental status as measured on the Griffiths Developmental Scales are provided on the first 20 infants reaching their first birthday following in vitro fertilization-embryo transfer (IVF-ET) within the PIVET Programme. An increased rate of preterm delivery, intrauterine growth retardation, and cesarean sections was noted. One significant and two minor abnormalities were detected and only one infant was slightly under the expected developmental assessment at 1 year on the corrected general quotient of the Griffiths Developmental Scales for children.