Maternal coping strategies and emotional distress: results of an early intervention program for low birth weight young children.

Several questions were examined with Infant Health and Development Program (IHDP) data (N = 843). Are effects of intervention services found for maternal emotional distress and coping strategies, and are these effects different for different groups of mothers? Do maternal distress, coping, and life events moderate (or mediate) the intervention effects reported earlier for children's test scores and behavior problems (IHDP, 1990)? The intervention reduced maternal distress, especially for women with less than a high school education. Maternal distress did not moderate or mediate the influence of the intervention on child outcomes. Maternal coping was not influenced by the intervention and did not moderate the influence of the intervention on child outcomes. Life events moderated the influence of the intervention on children's test scores; the intervention was more effective for children whose mothers had fewer life events.

Effects of combining public assistance and employment on mothers and their young children.

One goal of recent welfare reform legislation is to move welfare-dependent mothers with young children into the paid labor force. However, prior to the new legislation, many welfare-dependent women were already engaged in employment activities. In this paper we examine whether child or maternal well-being is influenced by a mother's strategy of combining work and public assistance receipt in the late 1980s. Measures of well-being include children's cognitive test scores and behavior problems, parenting behavior, and maternal mental health, social support, and coping strategies collected when children were 2 1/2 to 3 years of age. Data from the Infant Health and Development Program (a sample of low birthweight, premature infants born in 8 sites in 1985) were used to identify low-income families (incomes under 200% of the poverty threshold; N = 525). Comparisons were made among mothers in the following groups: (a) Work Only, (b) Some Work-Some Welfare, (c) Some Work-No Welfare, (d) No Work-No Welfare, and (e) Welfare Only. Mothers in the Some Work-Some Welfare group had children with cognitive and behavioral scores similar to children whose mothers were in the Work Only group; these two groups also had similar mental health, social support, and coping scores. However, not working and receiving welfare (Welfare Only) was associated with negative cognitive and behavioral outcomes for children, with less stimulating home learning environments, lower maternal mental health, less social support, and more avoidant coping strategies. We discuss the proposition that welfare and work may be complementary rather than opposing strategies, in terms of putting together a family income package.

The contribution of neighborhood and family income to developmental test scores over the first three years of life.

The effects of neighborhood and family income and family risk factors on developmental test scores at ages 1 through 3 are examined using a subsample (N = 347) from the Infant Health and Development Program. Beneficial effects of low numbers of risks were found for scores at ages 1 through 3. Family poverty was associated with lower scores at ages 2 and 3. Neighborhood affluence was associated with higher scores at age 3. The family risks-test score association at ages 1 through 3 and family income-test score association at ages 2 and 3 were mediated by home environment. Mediated effects were stronger for family income-test score associations at age 3 than for neighborhood income. Moderating effects of family risk on family and neighborhood income effects revealed an interaction between family poverty and risks for scores at age 3. Explanations for the early links between family risks and test scores and the later links between income and test scores are discussed.

Health care use of 3-year-old low birth weight premature children: effects of family and neighborhood poverty.

OBJECTIVE: The objective of this study was to examine the effect of family and neighborhood income on health care use of young children born prematurely and of low birth weight (N = 619). DESIGN: A birth cohort was enrolled in a clinical randomized trial of early childhood educational and family services. SETTINGS/PARTICIPANTS: Infant Health and Development Program provided a sample of low birth weight premature infants stratified by clinical site, birth weight, and treatment group. Maternal reports of health care use, family income, and heath insurance were obtained at 12, 24, and 36 months of corrected age. Neighborhood income was based on census tract residence at birth. MAIN OUTCOME MEASURES: Maternal reports of hospitalizations, doctor visits, and emergency department visits were used; data were averaged over the child's first 3 years of life. RESULTS: Children from poorer families were more likely to be hospitalized and to have more emergency department visits than were children from more affluent families. Residence in poor and middle-income neighborhoods was associated with more emergency department visits than residence in affluent neighborhoods. Families in middle-income neighborhoods reported more doctor visits than families in poor or affluent neighborhoods. CONCLUSION: Neighborhood residence influences health care use by poor and nonpoor families and by insured and uninsured families. The use of the emergency department for low birth weight premature children in middle-income and poor neighborhoods is discussed.

Ethnic differences in children's intelligence test scores: role of economic deprivation, home environment, and maternal characteristics.

We examine differences in intelligence test scores of black and white 5-year-olds. The Infant Health and Development Program data set includes 483 low birthweight premature children who were assessed with the Wechsler Preschool and Primary Scale of Intelligence. These children had been followed from birth, with data on neighborhood and family poverty, family structure, family resources, maternal characteristics, and home environment collected over the first 5 years of life. Black children's IQ scores were 1 SD lower than those of white children. Adjustments for ethnic differences in poverty reduced the ethnic differential by 52%. Adjustments for maternal education and whether the head of household was female did not reduce the ethnic difference further. However, differences in home environment reduced the ethnic differential by an additional 28%. Adjustments for economic and social differences in the lives of black and white children all but eliminate differences in the IQ scores between these two groups.

Classroom behavior of very low birth weight elementary school children.

OBJECTIVE: To examine the effect of birth weight on the classroom behavior of children during elementary school (N = 1120; mean age = 9.16 years). DESIGN: The study used an inception cohort. SETTING/PARTICIPANTS: Participants were from two previously studied multi-site cohorts: very low birth weight (VLBW) children referred to participating intensive care units and heavier low birth weight (HLBW) children from a stratified random sample of births in geographically defined regions. Teacher reports of children's behavior were obtained for 80% of those eligible. Information was obtained for 137 children who were extremely low birth weight (ELBW, < or = 1000 g at birth), 223 who were other very low birth weight (OVLBW, 1001 to 1500 g), 434 who were HLBW (1501 to 2500 g), and 326 who were normal birth weight (NBW, > 2500 g). MAIN OUTCOME MEASURES: The child's teacher provided reports of language and attention in the classroom, behavior problems, and social competence. RESULTS: Comparisons were made among the four birth weight groups: ELBW, OVLBW, HLBW, and NBW. The ELBW children had lower attention and language skills, overall social competence, scholastic competence, and athletic ability than all other birth weight groups as measured by classroom teachers, even when controlling for neonatal stay, child's gender and ethnicity, and maternal education. All low birth weight (LBW) children had lower attention and language skills and scholastic competence and higher daydreaming and hyperactivity scores than NBW children. White children and children with more educated mothers generally had greater language and attention and social competence scores and fewer behavior problems; girls had fewer behavior problems than boys. Neonatal health was generally not associated with outcomes, except that healthier children had lower anxiety scores. The classroom behavior of LBW (< 2500 g) children was rated by teachers as poor, even for children who had not failed a grade; LBW children who are on grade level still may be at risk for school problems. Differences between ELBW and NBW children persisted for overall language and attention and social competence scores even when additional controls were added for sociodemographic and familial variables. Of these variables, maternal depression and home environment were significantly associated with social competence scores.

School achievement and failure in very low birth weight children.

The extent to which low birth weight confers a risk for poor school function remains an important question. Children (N = 1868) in four birth weight categories [extremely low birth weight (ELBW; children weighed < or = 1000 g at birth, n = 247), other very low birth weight (1001 through 1500 g, n = 364), heavier low birth weight (1501 through 2500 g, n = 724), and normal birth weight (NBW > 2500 g, n = 533)] were compared on indicators of school achievement which included grade failure, placement in special classes, classification as handicapped, and math and reading achievement scores (Woodcock-Johnson Battery). Our results indicate that as birth weight decreases, the prevalence of grade failure, placement in special classes, and classification as handicapped increases, even when controlling for maternal education and neonatal stay. Moreover, ELBW children score lower than all other birth weight groups on math and reading achievement tests. Even among children with IQ scores above 85, ELBW children still obtain lower math scores than NBW children, suggesting the potential for future educational needs.

Economic deprivation and early childhood development.

We consider 3 questions regarding the effects of economic deprivation on child development. First, how are developmental outcomes in childhood affected by poverty and such poverty correlates as single parenthood, ethnicity, and maternal education? Second, what are the developmental consequences of the duration and timing of family economic deprivation? And, third, what is the comparative influence of economic deprivation at the family and neighborhood level? We investigate these issues with longitudinal data from the Infant Health and Development Program. We find that family income and poverty status are powerful correlates of the cognitive development and behavior of children, even after accounting for other differences--in particular family structure and maternal schooling--between low- and high-income families. While the duration of poverty matters, its timing in early childhood does not. Age-5 IQs are found to be higher in neighborhoods with greater concentrations of affluent neighbors, while the prevalence of low-income neighbors appears to increase the incidence of externalizing behavior problems.

Enhancing the development of low-birthweight, premature infants: changes in cognition and behavior over the first three years.

The Infant Health and Development Program is a randomized clinical trial to test the efficacy of educational and family support services and pediatric follow-up offered in the first 3 years of life on reducing the incidence of developmental delay in low-birthweight (LBW), preterm infants in 8 clinical sites (N = 985). Effects of the intervention on cognitive and behavior problem scores over the 3 years are examined. Significant intervention effects were seen on cognitive scores at 24 and 36 but not 12 months of age; effect sizes were similar at both ages. These effects persist when controlling for earlier cognitive scores. At 24 and 36 months, behavior problem scores for the intervention group were significantly lower than for the follow-up group; the intervention was more efficacious for children with higher initial behavior problem scores. Results are discussed in terms of timing and targeting of services for LBW and disadvantaged children.

Effects of early intervention on cognitive function of low birth weight preterm infants.

The Infant Health and Development Program is a randomized clinical trial to test the efficacy of educational and family support services and pediatric follow-up, offered during the first 3 years of life, in reducing the incidence of developmental delay in low birth weight preterm infants at eight clinical sites (N = 985). It was hypothesized that larger intervention effects would be found for the domains in which low birth weight preterm infants are known to have problems, specifically visual-motor and spatial skills and receptive language skills. These analyses explore the effects of the Infant Health and Development Program on different domains of cognitive functioning. Cognitive domains are identified by means of factor analysis of the intelligence tests used at 12, 24, and 36 months (Bayley Scales of Infant Development (including the Mental and Motor scales) at 12 and 24 months; the Stanford-Binet, Peabody Picture Vocabulary Test, and Beery Test of Visual Motor Intergration at 36 months). Our results reveal that, although intervention benefits accrue across cognitive domains at 24 and 36 months, gains are most pronounced for receptive language and visual-motor and spatial skills.