Brief report: birth status, medical complications, and social environment: individual differences in development of preterm, very low birth weight infants.

OBJECTIVE: To assess whether medical complications mediate the relationship between birth status (i.e., birth weight and gestational age) and developmental outcome of preterm, very low birth weight (VLBW) infants, as well as the role of the early social environment (maternal distress and social support) in infant development. METHOD: Birth status and medical complication information was collected during the child's NICU stay. Maternal distress was assessed with the Beck Depression Inventory and the Parenting Stress Index at 4 months corrected infant age. Social support was measured with the Dunst Scales at 4 months corrected age. Child development measures were collected at 4 and 13 months corrected age (Bayley MDI and PDI), and at 36 months chronological age (PPVT-R and Achenbach CBCL). RESULTS: Medical complications mediated the birth status-outcome relationship at 4 and 13 months, but not at 36 months. The 36-month outcomes were predicted by 4-month maternal distress and social support. CONCLUSIONS: Prematurity and VLBW are indirectly related to early developmental outcome through their association with medical complications. However, by 36 months, developmental outcomes are more closely related to aspects of the early social environment than to early physiological factors.

Prenatal maternal predictors of cognitive and emotional delays in children of adolescent mothers.

The present study examined relationships among prenatal characteristics of 121 adolescent mothers-including cognitive readiness for parenting, intelligence, social support, and personal adjustment-and intellectual-linguistic development, social-emotional functioning, and adaptive behavior in their children at three years of age. Only 28% of the children scored within normal ranges on all three types of outcomes. Intellectual and linguistic delays were predicted best by prenatal measures of maternal Performance IQ and social support from extended family. Socioemotional problems were predicted best by maternal internalizing problems and social support from partner and friends. Adaptive behavior was associated with parenting style. Implications for the early identification of high-risk children--and associated intervention programs--are discussed.

A longitudinal analysis of maternal abuse potential and developmental delays in children of adolescent mothers.

OBJECTIVE: This project was designed to examine the impact of adolescent mothers' abuse potential on the development of preschool children. The specific aims were to demonstrate relationships between maternal abuse potential and developmental problems in preschool children, to examine these relationships across time, and to determine whether maternal abuse potential predicted developmental delays after controlling for problematic parenting orientations. METHOD: Using a longitudinal design, we examined 146 first time mothers and their children. Maternal abuse potential was assessed when children were 1, 3, and 5 years old; problematic parenting orientation was assessed when the children were 6 months old; and child development (i.e., IQ, adaptive behavior, and behavior problems) was assessed at ages 3 and 5. RESULTS: Regression analyses revealed significant relationships between maternal abuse potential and a variety of developmental problems. Path analyses revealed unidirectional relationships between abuse potential predicting IQ and adaptive behaviors. Further analyses indicated that maternal abuse potential at 1 and 3 years predicted intelligence and adaptive behavior at ages 3 and 5, even when problematic parenting orientation was controlled. In contrast, children's behavioral problems at ages 3 and 5 was better accounted for by problematic parenting orientation than by abuse potential. CONCLUSIONS: The results of this study revealed that developmental delays in children of adolescent are related to abuse potential. Two pathways were found for predicting developmental delays: One pathway linked child abuse potential with IQ and adaptive functioning: the other pathway showed that problematic parenting orientation accounted for the development of emotional and behavioral problems.

Transient posterior knee pain with the meniscal arrow.

A 31% incidence of focal posterior knee pain was noted in our initial experience with all-inside meniscal repair using the absorbable Meniscal Arrow system (Bioscience, Tampere, Finland). The pain was transient, resolved by 6 months in all cases, and was unrelated to the length of implant. A typical case is presented to assist surgeons in counseling patients who experience transient posterior knee pain after meniscal repair with this system.

Predicting adolescent mothers' transition to adulthood.

This study investigates the relation among prenatal maternal resources (including intellectual ability, cognitive readiness for parenting, personal adjustment and social support), maternal perceptions about parenting and children's temperament when children were 6 months of age, and individual differences in the adaptation of 90 adolescent mothers 3 years after the birth of their first child. It was hypothesized that adolescent mothers¿ pre-existing resources and emerging perceptions about parenting determine not only their children's but also their own later adaptation to critical life events. Maternal resources uniquely predicted later maternal cognitive functioning, personal adjustment, and child abuse potential, whereas maternal perceptions uniquely predicted maternal demographic status 3 years after childbirth. Moreover, maternal perceptions were found to mediate the influence of maternal resources on parent-child interactional styles. The unique roles that maternal resources and perceptions played in determining later maternal functioning are discussed.

Adolescent mothers and child abuse potential: an evaluation of risk factors.

This research examines maternal and child factors that place adolescent mothers at risk for abusing their children. Using a longitudinal design, relationships among four risk factors (social supports, maternal psychological adjustment, maternal preparation for parenting, and child temperament), maternal psychological predisposition for aggressive coping (perceptions of stress and endorsements of punitive parenting), and maternal abuse potential were examined in a sample of 75 primiparous adolescent mothers and their children. Preparation for parenting, a construct which included knowledge and attitudes about children's development, was the strongest direct predictor of abuse potential; however, its effects were also partially mediated by the mother's psychological predisposition for aggressive coping. Similarly, the effects of child temperament on abuse were mediated by the mother's psychological predisposition for aggressive coping. Implications for designing intervention programs, and identifying at-risk adolescents, were also discussed.

PIP: The capability of four contextual risk factors (social support, maternal psychological adjustment, maternal preparation for parenting, and child temperament) as well as maternal predisposition for aggression (stress perception and endorsement of punitive parenting) to predict child abuse potential in adolescent mothers was investigated in 75 mother-child dyads. These pairs were drawn from a larger, longitudinal study on adolescent parenting conducted in Indiana and South Carolina (US). Mothers averaged 17.3 years of age at delivery and were predominantly (64%) African-American. Data were collected prenatally, at 6 months, and at 12 months. Compared to the general teen population, mothers showed above-average levels of financial stress and internalizing psychological problems (e.g., depression); they were uncertain about their roles as parents and rated their infants as difficult. A higher score on the risk composite was significantly (p 0.01) associated with a higher score on the abuse potential index. Also significant (p 0.001) was an association between the risk composite and a predisposition for aggressive coping. However, separate analyses revealed that the four risk factors were not equally effective in predicting child abuse potential. Abuse potential was significantly related only to parenting preparation (p 0.001). Endorsement of punitive parenting was an influential mediator of the relationships between risk factors. These findings suggest a need for interventions aimed at educating teens about child development and realistic expectations, expanding their repertoire of parenting skills, and teaching them to control aggression.

Personal adjustment during pregnancy and adolescent parenting.

This study examined "naturally occurring differences" in personal adjustment (social competence, behavior problems, and problem-solving skills) among representative groups of pregnant and nonpregnant adolescents and pregnant adults. Differences in parenting stress and parenting style were also assessed among a subsample of adolescent and adult mothers. Finally, the relationship between prenatally assessed personal adjustment and parenting was evaluated in the adolescent mother group. The contributions of important demographic characteristics (socioeconomic status and race) to both between- and within-group relationships were examined. Results suggested that pregnant adolescents were less socially competent and less proficient in their problem solving than their nonpregnant peers and that they exhibited more behavioral problems than a pregnant adult comparison group. Adolescent mothers displayed higher levels of parenting stress and were less responsive and sensitive in interactions with their infants than adult mothers. Support for the hypothesized link between prenatally assessed personal adjustment and adolescent parenting stress was found, whereas no relationship between socioeconomic status and race and parenting stress was established. These results suggest that intervention with young mothers identified during pregnancy as having personal problems might forestall parenting problems that arise during early child rearing.

Unraveling the "new morbidity": adolescent parenting and developmental delays.

PIP: Baumeister's concept of the "new morbidity" pertains to the linkages between poverty, adolescent mothers, and a series of developmental delays in their children. Outlined are three possible causes of the mild mental retardation and learning disabilities that are found disproportionately among the offspring of adolescents. First, there may be a direct genetic transmission of mild mental retardation. Second, adolescent mothers are likely to have a lack of support from a social network, be unprepared cognitively and emotionally to assume responsibility for child rearing, and to look to an infant to meet their own needs. Third, the interaction of genetic and environmental deficits leads to a parenting style that deprives the child of stimulation that could potentially overcome these deficits. A secure mother-infant attachment relationship provides the foundation for the development of social, emotional, attentional, and self-regulatory processes. When this attachment relationship is insecure, as a result of the mother's unreadiness to parent, the child cannot proceed to exploration of the environment--a critical component of cognitive development. If the infant has a difficult temperament, the risk of physical and emotional abuse increases, further compromising the child's future development. By 3 years of age, many of these children are showing declines in mental functioning, delays in receptive language skills, and poor motor and social skills. Research is urged to identify events in this chain that can be targeted for early intervention.^ieng

Self-regulation and mental retardation.

The educational and research implications of defining mental retardation as a self-regulatory disorder were explored. Behavioral, social-learning, and cognitive conceptualizations regarding the structure and development of self-regulation were examined. Emphasis was placed on showing how these conceptualizations compliment each other. Several perspectives were presented, specifically, that both the essential components of the self-regulatory system along with the environments that promote self-regulated behavior must be isolated. Self-regulation was described as a complex skill that develops like other skills and can be taught through behavioral techniques. Self-regulation was suggested to basically be a linguistically guided process. The assertion was made that individuals with retardation, because of their extensive language deficiencies, are delayed in developing self-regulatory control. The role of life experience and motivational processes in the development of self-regulation was also stressed.

Teaching severely retarded persons to sign interactively through the use of a behavioral script.

The direct and generalized effects of a program for teaching severely mentally retarded individuals to sign interactively with one another in several social play situations was examined. As part of the teaching program, a behavioral script specifying the responses to be made was employed. The results indicated that participants showed an increase in their signing skills in a training play situation, generalized use of these skills in a second play situation, and maintained the trained skills over a two to four month period. Directions for future research are discussed.

Self-instruction, individual differences, and mental retardation.

A general theoretical framework to guide research on self-instructional training was presented. The theory emphasizes that in evaluating self-instructional programs, more attention must be given to the developmental characteristics of the persons to be trained and suggests that self-instruction will be particularly useful to young nonretarded children, mentally retarded persons, and, more generally, individuals who have limited linguistic skills and a limited knowledge base. Further, retarded children taught to self-instruct will show better attention, memory, and motivation and manifest less impulsive behavior, maladaptive perseveration, and field dependency when taught through a self-instructional in contrast to an external instructional format. Empirical support for this theory was examined and recommendations for future research made.

Predicting and understanding developmental delay of children of adolescent mothers: a multidimensional approach.

Divergent literatures on potential relationships among psychological, biological, and contextual factors that may contribute to mental retardation and other types of developmental delay in the children of adolescent mothers were reviewed. A linear model was proposed to describe the direct and indirect effects of learning ability, maternal health, social support, personal adjustment, cognitive readiness for parenting, and infant characteristics on adolescent parenting and child development. Because the validity of the model can be determined through the use of causal modeling (LISREL), it holds the potential for determining a unique set of risk factors that may produce developmental delay in children of adolescent mothers. These factors can serve as the targets in designing intervention programs for such mothers.

A comparison of external and self-instructional teaching formats with mentally retarded adults in a vocational training setting.

A theory recently proposed by Whitman postulates that self-instructional training procedures should have special utility for low ability individuals. Although past studies have shown that self-instructional training programs can be employed to improve the performance of mentally retarded individuals in work situations, research has not examined whether this training format is superior to external instruction. To test Whitman's theory, mentally retarded adults were taught to perform a complex sequencing task through one of two training formats: self-instruction or external instruction. Performance was evaluated through the examination of accuracy measures obtained during training, maintenance, and generalization assessments. Results indicated that participants receiving self-instructional training were able to achieve and sustain a higher level of performance than participants receiving external instruction. While self-instructionally trained subjects also showed superior performance on the generalization assessment, these results were not statistically significant. Secondary analyses revealed that higher ability participants, self-instructionally trained participants, and participants who reached criterion on the training and generalization tasks self-verbalized more frequently during the various assessments. In contrast to prediction, there was no significant difference in the length of time required to train individuals in the two instructional groups.

Far-field behavior of injection-locked semiconductor laser arrays.

We have developed a computer model of injection-locked gain-guided semiconductor arrays to explain some experimental observations: the creation of a single-lobed far field from a normally double-lobed far field; the increase in the divergence angle of the far-field lobe(s); the shifting of power from one off-axis lobe to the other; and the regression back to a double-lobed far field when the ratio between array power and injection power becomes too large. The model is then extrapolated to look at properties of the index-guided case: inefficient end-element injection but an on-axis single-lobed center-element injection.

Increasing verbal interaction among elderly socially isolated mentally retarded adults: a group language training procedure.

The present study examined the effectiveness of a group language training procedure for directly increasing and generalizing the rate of verbal interaction among four elderly, socially isolated, moderately mentally retarded men. A withdrawal of treatment design was used to examine the effect of the procedure that used verbal prompts. behavioral rehearsal, and contingent social praise. Changes in behavior were examined in two generalization settings, one similar to the training environment (Generalization I) and the other arranged as part of the subjects' daily routine (Generalization II). Baseline data indicated no verbal interaction among the subjects. During treatment the training procedure increased the rate of subjects' verbal interactions not only in the training situation, but also in the two generalization settings. An analysis of the data obtained during the Generalization II situation indicated that subjects' verbal interaction increased not only among themselves, but with nonsubject peers present in this setting. Follow-up data showed that increases in rates of verbal interaction were maintained four months after the cessation of training. The implications of the results for program generalization and work with the language deficient individual is discussed.

A participative management approach for improving direct-care staff performance in an institutional setting.

The present study evaluated a participative management approach for increasing the frequency of interactions between institutional staff and severely/profoundly retarded residents. The participative management approach involved teaching staff how to use self-monitoring, standard setting, self-evaluation, and self-reinforcement procedures. These procedures were then used by staff with minimal involvement of supervisory personnel. Although supervisors provided feedback and praise to staff for using these self-management behaviors, feedback and praise were never dispensed contingent on staff interactions with residents. Results indicated that during the participative management program there was an increase in staff interactions that were contingent on appropriate resident behavior. The increase in this type of staff interaction was accompanied by an increase in appropriate resident behavior. Follow-up data on both staff and resident behaviors, although showing moderating trends, suggested generally good maintenance of the initial behavior changes. Acceptability data suggested that staff were quite receptive to the program. The advantages of participative management procedures for improving staff performance in residential settings are discussed.

An institutional staff training and self-management program for developing multiple self-care skills in severely/profoundly retarded individuals.

Although considerable attention has been given to the development of institutional staff training and management programs, the generalized effects of such programs on staff and resident behavior have seldom been examined. This study evaluated a program for teaching institutional staff behavioral training and self-management skills during self-care teaching sessions with severely and profoundly retarded residents. Following baseline observations in three self-care situations (toothbrushing, haircombing, handwashing), four direct care staff were sequentially taught to use verbal instruction, physical guidance, and contingent reinforcement in the toothbrushing program. During maintenance, staff were simultaneously taught to record, graph, and evaluate resident and their own behavior in the toothbrushing sessions. Staff were taught use of the training and self-management skills through a sequence of written instructions, videotaped and live modeling, rehearsal, and videotaped feedback. Observer presence and experimenter supervision were gradually decreased during the maintenance condition. Results indicated that during training and maintenance staff: (a) learned to use the training skills appropriately and consistently in the example situation (toothbrushing); (b) applied the skills in the generalization situations (haircombing and handwashing); and thereafter (c) maintained consistent and appropriate use of the skills with infrequent supervision. In addition, important changes in retarded residents' independent self-care responding occurred as staff training skills developed. Results are discussed in terms of their implications for future research and continued development of effective staff training and management programs.

Improving classroom behavior in mentally retarded children through correspondence training.

Except for a few studies, most research investigating correspondence training procedures has been more analogue in nature. The purpose of the present set of studies was to examine whether a "say-do" correspondence training technique could be used with children in special education classes to improve classroom behavior. The specific behaviors targeted for change included: out-of-seat behavior (Experiment 1), sitting posture (Experiment 2), and on-task behavior (Experiment 3). The say-do procedure used in Experiment 1 resembled that of previous studies, whereas that in Experiment 2 was more elaborate in the specificity of verbal statements required from the children and the feedback given them. The training procedure in Experiment 3 used a format similar to the say-do approach, but stressed visual rather than verbal cuing because it was used with nonverbal children. All three studies used single-subject designs and examined maintenance and/or generalization questions. Experiments 2 and 3 also evaluated whether concomitant changes in performance on academic tasks occurred. The results of the three studies provide strong evidence that correspondence training can be effectively used with educationally handicapped children. Moreover, the successful modification of the "say-do" to a "show-do" procedure in Experiment 3 points out the flexibility of the correspondence training approach.