Interrogating the validity of cumulative indices of environmental and genetic risk for negative developmental outcomes

Indices of cumulative risk (CR) have long been used in developmental research to encode the number of risk factors a child or adolescent experiences that may impede optimal developmental outcomes. Initial contributions concentrated on indices of cumulative environmental risk; more recently, indices of cumulative genetic risk have been employed. In this article, regression analytic methods are proposed for interrogating strongly the validity of risk indices by testing optimality of compositing weights, enabling more informative modeling of effects of CR indices. Reanalyses of data from two studies are reported. One study involved 10 environmental risk factors predicting Verbal IQ in 215 four-year-old children. The second study included an index of genetic CR in a G×E interaction investigation of 281 target participants assessed at age 15 years and then again at age 31 years for observed hostility during videotaped interactions with close family relations. Principles to guide evaluation of results of statistical modeling are presented, and implications of results for research and theory are discussed. The ultimate goals of this paper are to develop stronger tests of conjectures involving CR indices and to promote methods for improving replicability of results across studies.

Relationship-based intervention for children who were prenatally alcohol exposed in South Africa

BACKGROUND

This early intervention study investigated the effectiveness of a relationship-based, developmental enhancement process for children who were prenatally exposed to alcohol in the South African context.

METHODS

Groups were created according to the child's level of risk for alcohol-related developmental issues based on each mother's alcohol use during pregnancy as assessed using the Alcohol Use Disorders Identification Test (AUDIT). Primary caregiver/child dyads were the focus of the intervention and child development was monitored by the Ages and Stages Questionnaire (ASQ). Eighteen caregiver/child dyads were in the heavily alcohol-exposed group, and 20 caregiver/child dyads were in the no or light alcohol-exposure group. The Home Observation Measurement of the Environment (HOME) was measured pre and post intervention.

RESULTS

The results indicated significant improvements in the home environment (p < .001) post-intervention for the entire cohort. For the total HOME score, there was a statistically significant main effect for time (pre- vs post-test), F(1, 36)= 65.205, p < .001, partial η2 = .64. with 99% confidence limits from .35 to .78. The offspring and parents from both the heavy alcohol exposure group and the no/low alcohol exposure group benefitted from the intervention over the duration of the intervention. Of the HOME domains affected, responsivity was the most improved in the households. The children's scores on the ASQ varied substantially over the months of the intervention, and the offspring of the heavy exposure group often performed significantly worse than the no/low exposure group. Nevertheless, further analysis revealed that children with the lowest performance at baseline improved their performance on most ASQ domains throughout the intervention and performed significantly better on all ASQ domains over time and at completion of the intervention.

CONCLUSIONS

This relationship-based, early intervention program for children resulted in benefits to all of the children over time.

The home environment and its relation to bottle feeding outcomes in the first year of life

BACKGROUND

The home environment and caregiver interactions have an impact on infant development. However, there is a paucity of research surrounding the home environment and its relation to early feeding outcomes within the first year of life. Therefore, the aim of this study was to examine the relationship between the home environment and infant bottle feeding outcomes at 3 and 12 months of age.

METHODS

Seventy-two full-term infants completed this study at 3 months of age and fifty-five infants completed the study at 12 months. Data in the current study were collected from a larger, ongoing study completed in the infant's home at 3 and 12 months of age. The Infant-Toddler Home Observation for Measurement of Environment Inventory (IT-HOME) was utilized to assess the infant's home environment. The Oral Feeding Skills (OFS) scale was completed while the infant was observed during a bottle feed. Caregivers completed a questionnaire about their infant's feeding abilities via the Neonatal Eating Assessment Tool (Neo-EAT) at 3 months and Pediatric Eating Assessment Tool (Pedi-EAT) at 12 months.

RESULTS

At 3 months of age, the IT-HOME Involvement subscale was associated with an increase in the amount of milk provided in the infant's bottle. There were no significant associations between the IT-HOME and caregiver report of feeding at 3 months of age. At 12 months of age, the IT-HOME Acceptance subscale was associated with an increase in oral transfer rate and the IT-HOME Variety subscale was associated with a decrease in oral transfer rate. Additionally, the IT-HOME Organization subscale was associated with caregiver report of feeding on the following Pedi-EAT scales: Mealtime Behaviors, Selective Restrictive Eating, and Oral Processing at 12 months.

CONCLUSIONS

These findings reveal that the home environment is significantly related to different infant bottle feeding outcomes over the first year of life. At 3 months, IT-HOME Involvement was associated with the amount of milk offered in the bottle, whereas at 12 months of age, subscales of the IT-HOME were associated with oral feeding transfer rate and caregiver report of feeding. Clinically, these findings point to the importance of considering the infant's bottle feeding skills in conjunction with certain aspect within the infant's environment. Additional research is needed to further explore these relationships in greater detail, with a larger sample size and across patient populations.

What matters most for early childhood development? Evidence from Malda district, India

BACKGROUND

The early period of a child's life is considered to be the most important developmental stage throughout the lifespan. Around 250 million children of age below five years in low-and middle- income countries (LMICs) are at risk of not attaining their developmental potential. A cross-sectional case study was conducted to assess the early childhood developmental (ECD) status and to investigate the factors influencing the same in Malda, India.

METHODS

Information on 731 pre-school children aged 36 to 59 months was collected in 2018 using a structured questionnaire following a multi-stage, stratified simple random sampling procedure. ECD was measured following the UNICEF's Multiple Indicator Cluster Survey, which monitors early child development in LMICs. A path analysis using structural equation modelling was carried out to examine the relationship between possible associated factors and ECD status.

RESULTS

It has been found that only about 25% of children are developmentally on track of literacy-numeracy domain of ECD. Although, in the other domains, the situation is better. Results of the path analysis revealed that there are certain proximal factors, i.e., home environment, mother's time for care, having home tuition and attending private pre-school, which are influenced by certain distal factors and subsequently affecting ECD. The total effects revealed that place of residence (urban or rural) affects ECD mostly (Coef. -0.87, p = <0.001) directly or via mothers' time for stimulating activities, home environment and having home tuition for children. Further, it revealed that private pre-schools (Coef. 0.76, p = <0.001) and home tuition (Coef. 0.43, p = <0.001) also play a significant role in ECD.

CONCLUSION

Urgent attention from policymakers or other stakeholders is needed to promote ECD for the betterment of children and society of Malda district. In addition to that, special attention needs to be given to the children who belong to Muslim families, socially deprived communities and living in rural areas.

Effect of the START-Play Physical Therapy Intervention on Cognitive Skills Depends on Caregiver-Provided Learning Opportunities

AIMS

This study evaluated whether caregiver-provided learning opportunities moderated the effect of START-Play physical therapy intervention on the cognitive skills of young children with neuromotor delays, and whether START-Play impacted caregiver-provided learning opportunities over time.

METHODS

One hundred and twelve children with neuromotor delays (7-16 months) participated in a multisite randomized clinical trial evaluating the efficacy of START-Play. Children were assessed at baseline and 3 (post intervention), 6, and 12 months post baseline. Cognition was scored from the Bayley Scales of Infant & Toddler Development, Third Edition, cognitive scale. The proportion of time caregivers spent providing learning opportunities was coded from a 5-minute caregiver-child free play interaction.

RESULTS

Baseline caregiver-provided learning opportunities moderated the 3- and 12-month effects of START-Play on cognition. Cognitive gains due to START-Play were more pronounced for children whose caregivers provided more learning opportunities. START-Play did not impact caregiver-provided learning opportunities over time.

CONCLUSIONS

START-Play may have a lasting effect on children's cognition, but this effect is contingent on caregivers providing their child with ample opportunities to practice cognitive skills. Strategies for improving caregivers' uptake and transfer of START-Play principles to their daily routines should be evaluated.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02593825.

The Home Environments of Young Blind Children

The aim of this study was to identify specific aspects of the home environment related to the development of young children with visual impairments. The subjects of the study were 18 mothers and their legally blind children, aged 20–36 months, with no other handicapping conditions. The overall home environments were found to be consistently favorable, despite the differences in the parents’ socioeconomic status. However, they were not significantly related to any developmental scores except for the positive relationship between the emotional and verbal responsiveness of some mothers and the expressive pragmatic language abilities of their children.

Validation of the Inventaire du Milieu Familial Questionnaire (French version of the Infant/Toddler HOME) into the Brazilian Portuguese language

OBJECTIVE

To validate the Brazilian Portuguese version of the Family Environment Assessment questionnaire (Inventaire du Milieu Familial).

METHODS

The validation process was carried out in two stages. First, translation and back-translation were performed, and in the second phase, the questionnaire was applied in 72 families of children between 0 and 24 months for the validation process. The tool consists of the following domains: mother's communication ability; behavior; organization of the physical and temporal environment; collection/quantity of toys; maternal attitude of constant attention toward her baby; diversification of stimuli; baby's behavior. The following was performed for the scale validation: 1 - content analysis (judgment); 2 - construct analysis (factorial analysis - Kaiser-Meyer-Olkin, Bartlett, and Pearson's correlation tests); 3 - criterion analysis (calculation of Cronbach's alpha coefficient, intraclass correlations, and split-half correlations).

RESULTS

The mean age of the children was 9±6.7 months, and of these, 35 (48.6%) were males. Most correlations between items and domains were significant. In the factorial analysis of the scale, Kaiser-Meyer-Olkin values were 0.76, Bartlett's test showed a p-value<0.001, and correlation between items and domains showed a p-value<0.01. Regarding the validity, Cronbach's alpha was 0.92 (95% CI: 0.89-0.94). The intraclass correlation among the evaluators was 0.97 (0.96-0.98) and split-half correlations, r: 0.60, with p<0.01.

CONCLUSIONS

The Portuguese version of the Inventaire du Milieu Familial showed good to excellent performance regarding the assessed psychometric properties.

Measuring home environments across cultures: Invariance of the HOME scale across eight international sites from the MAL-ED study

The home environment provides the context for much of a child's early development. Examples of important aspects of the home environment include safety, cleanliness, and opportunities for cognitive stimulation. This study sought to examine the psychometric properties of an adapted form of the Home Observation for the Measurement of the Environment (HOME; Caldwell & Bradley, 1984, 2003) across the eight international sites of the MAL-ED project (Dhaka, Bangladesh; Vellore, India; Bhakatapur, Nepal; Naushahro Feroze, Pakistan; Fortaleza, Brazil; Loreto, Peru; Venda, South Africa; Haydom, Tanzania), to identify a factor structure that fit the data at all sites, and to derive a subset of items that could be used to examine home environmental characteristics across sites. A three-factor structure (i.e., Emotional and Verbal Responsivity; Clean and Safe Environment; Child Cleanliness) was identified, and partial measurement equivalence/invariance across sites was supported. Overall, these findings lend support for the use of portions of this abbreviated and adapted version of the HOME for use among heterogeneous, cross-cultural groups in low- and middle-income nations.

The relationship between maternal responsivity, socioeconomic status, and resting autonomic nervous system functioning in Mexican American children

Adversity, such as living in poor socioeconomic conditions during early childhood, can become embedded in children's physiology and deleteriously affect their health later in life. On the other hand, maternal responsivity may have adaptive effects on physiology during early childhood development. The current study tested both the additive and interactive effects of socioeconomic status (SES) and maternal responsivity measured at 1year of age on resting autonomic nervous system (ANS) function and trajectory during the first 5years of life. Participants came from a birth cohort comprised of Mexican-origin families living in California. Children's resting ANS functioning (respiratory sinus arrhythmia; RSA; pre-ejection period; PEP; and heart rate; HR) was collected at 1, 3.5, and 5years of age (N=336) and modeled across time using Hierarchical Linear Modeling. Consistent with hypotheses, results showed that low SES predicted flatter trajectories of resting HR and PEP over early childhood (i.e., patterns of consistently higher heart rate; shorter PEP), whereas children who experienced positive maternal responsivity had steeper trajectories in RSA and PEP over time (i.e., increasing parasympathetic activation; decreasing sympathetic activation). The interaction between SES and maternal responsivity significantly predicted RSA intercept at age 5, such that among children living in low SES environments, high maternal responsivity mitigated the negative effect of poverty and predicted higher resting RSA at 5years of age. Results are consistent with the early life programming theory that suggests that environmental influences become biologically embedded in the physiology of children living in socially disadvantaged contexts, and identify increased maternal responsivity as a developmental mechanism that could offset the deleterious effects of low SES.

The Mother-Child Relationship and Other Antecedents of Academic Performance: A Causal Analysis

Observational measures of mother-child interaction, home environment, demographic variables, and maternal attitudes were used in developing two causal models for classroom and achievement test performance for 86 Mexican American children. These models were tested by path analysis. Maternal attitudes stressing independence and achievement, and years of mother's education promoted the child's intellectual performance at 3 years of age, and also contributed to a mother-child interaction style thought to promote cognitive competence. Performance on an achievement test and in the classroom during the elementary school years was also positively influenced by maternal education and early intellectual stimulation of the child. In addition, performance in the classroom was less language bound and more influenced by maternal attitudes than was achievement test performance. These results are discussed in light of previous research and the relationship between maternal child rearing and various indices of cognitive development.

The Relationship of Infants' Physical Environment to Their Binet Performance at 21/2 Years

Most of the available evidence relating early experience to subsequent cognitive development has been concerned with interpersonal interaction variables. In the present paper the relationship of physical environment parameters to development was considered. Subjects were 23 infants who had previously taken part in a longitudinal project which included measurements of the child's physical environment between 12 and 24 months. These measurements were related to the infant's Binet performance at 31 months of age. Results indicated that some physical environment parameters including the presence of audio-visually responsive toys and a lack of overcrowding were related to subsequent Binet performance all across the second year of life. Other items were related to subsequent development only at certain time periods. A breakdown by sex suggested that female development was sensitive to environmental parameters at an earlier age than males and that females were uniquely sensitive to variety/change in their environment. Implications of these findings for early remediation were considered.

Early Environmental Experiences and School Achievement in the Second Grade: An Israeli Study

This study was an attempt to replicate, in an Israeli sample, findings from American studies regarding the relationship of demographic variables, the quality of the early environment, and sociocognitive growth in children. In the first part of the study, the environment of 178 2-year-old Israeli children was assessed. Families with higher social status (SES) and fewer children were significantly more likely to provide enriching environmental experiences to their 2-year-old. In the second phase of the study, 149 of the sample were located and their school achievement assessed at the end of Grade 2. Path analysis revealed that the family's SES and number of children had both a direct and an environmentally mediated effect on children's achievement in school, and that differences in the quality of the environment at 2 years accounted for a large part of the variability in achievement both between and within social classes. As in the American studies, free exploration of developmentally challenging objects, and in particular fine-coordination toys and picture-books, was an important feature of a good rearing environment. In addition, contact with peers and extrafamilial care in the 3rd year were found also to have some unique predictive power of sociocognitive performance. The results are congruent with a model that SES and family configuration have a decisive effect on child-rearing practices and the latter, in turn, determine the course of children's cognitive and social development. The possibility was entertained that class-related differences in parental concepts of age-appropriateness contribute to the SES differences in the type of environmental experiences accorded to young children.

Using the HOME Inventory with Infants in Costa Rica

This study determined the psychometric properties of the HOME (Home Observation for Measurement of the Environment) Inventory in a Latin American sample. HOME data for 183 healthy Costa Rican infants were compared to the original HOME standardisation sample from Little Rock. The Costa Rican total HOME average of 29.8 ± 6.7 was similar to the scores of families in Little Rock (mean = 31.2 ± 7.3). Measures or internal consistency and factor structure were similar in US and Costa Rican samples. In contrast to these similarities, Costa Rican HOME scores showed no significant correlation with developmental test scores in infancy (Bayley MDI), and the correlation with Full Scale IQ (WPPSI) at five years was modest, albeit statistically significant (r = 0.28, P < 0.05). These relationships were similar to those of Mexican-American children in a recent collaborative study by Bradley et al., 1989 and not as strong as for US white and black populations. However, when the concept of outcome was broadened beyond IQ scores to include child health and development in general, the HOME seemed sensitive to important environmental differences in this Costa Rican group. Lower HOME scores related to a shorter duration of breastfeeding and differentiated children with iron deficiency anaemia in infancy, a condition associated with long-lasting developmental disadvantage. Thus, the HOME was helpful in identifying children at risk for delayed development in this Latin American sample.

Does Out-of-home Care Affect Compliance in Preschoolers?

When they averaged 28 and 40 months of age, 140 Swedish children were observed with their mothers in two situations (a problem-solving task and a clean-up session) designed to allow the assessment of their compliance with maternal demands. Individual differences in their behaviour were then related to measures of the quality of care received by them both at home and in alternative care settings when they averaged 16, 28, and 40 months of age, the amount of social support reportedly received by the mothers, the children's ages, and the amount of early out-of-home care received. Analyses using partial least squares (PLS) analyses showed that children were more compliant in the task situation at 40 months when they had experienced high quality care at home, when they were older, and when they had experienced less out-of-home care prior to 24 months of age. Variations in maternal behaviour in these settings were predicted by the same set of variables, suggesting that parent-child harmony, rather than compliance, was being studied. No consistent dimension of compliance was evident at 28 months.

Maternal IQ, the Home Environment, and Child IQ in Low Birthweight, Premature Children

The study examined the extent to which aspects of the home environment play a mediating role in the relation between maternal and child IQ. The procedure of establishing mediation developed by Baron and Kenny was followed using 608 low birthweight, premature infants from eight different sites. Regression analyses indicated that both maternal IQ and Infant/ Toddler HOME scores obtained at 12 months made significant contributions to 3 year child IQ scores. Maternal IQ and Early Childhood HOME scores obtained at 36 months also both made significant contributions to 3 year child IQ scores. There was a significant "indirect" or mediated affect associated with HOME scores at both time points. Structural equation models were used to confirm information developed in the regression analyses. The fit of the model was good for the total sample and for a sample of children and mothers whose IQs were both greater than 70. A stronger indirect effect was noted at three years as compared to one year.

The Consistency of the Home Environment and Its Relation to Child Development

The study examined the relation of the consistency of the home environment during the first two years of life and children's intelligence test performance at age three for 72 black and white children. Little residual relation between 6-month Caldwell HOME scores and 3-year IQ scores was observed when 12-month HOME scores were partialled out. However, the residual between 12-month HOME and IQ was significant with 6-month HOME partialled out. Some residual relation was observed between 12-month HOME and 3-year IQ with 2-year HOME partialled out. A number of race and sex differences in the relation between HOME scores and IQ were observed with the relation being slightly higher for blacks than whites, especially during the first year of life. Black males showed the most atypical pattern of performance among the four race/sex subgroups

Mothers' Interactional Style and Children's Competence at 3 Years

This study asked how mothers' style of interaction related to their children's competence-both competence on traditional cognitive tests and competence during play. Forty-four mothers and their 3-year-old children were observed in their homes while engaged in structured and unstructured tasks and unstructured play. Maternal directiveness and affective tone were assessed, as well as maternal perceptions of their children's intrinsic motivation. At school the children were given the McCarthy Scales of Children's Abilities, and their play was observed. Results indicated that both maternal directiveness and affective tone related to children's cognition, particularly nonverbal cognition; in addition, maternal affective tone related to children's play. Theoretical models of the development of children's competence were evaluated by means of path analysis. For perceptual performance ability, direct paths of influence were found for maternal directiveness and socioeconomic status (SES); whereas for children's verbal ability, direct paths were found for maternal affective tone, maternal perceptions, and SES. Direct paths of influence were also found from maternal affective tone and directiveness to children's play.

The Origins of Young Children's Perceived Control: Mother Contingent and Sensitive Behavior

The notion that caregiver sensitive and contingent behavior is closely related to children's perceived control has been proposed both by theorists interested in the effects of parent-child interactions and by those focusing on the origins of control beliefs. The present study investigated this relationship by analyzing the interactions between mothers and their 3-1/2-to 4-1/2-year-old children ( N = 120) during a problem-solving task. First, using separately derived indices of contingency, sensitive responsiveness, and sensitive initiation, a correlational analysis revealed that children's perceived control (assessed using an open-ended measure) was most closely related to mother sensitive initiation; all three mother behaviors were interrelated and correlated with child active engagement in the problem-solving task. Second, a conditional probability analysis showed that the relation between mother sensitive initiation and child engagement was reciprocal in that mother sensitive initiation increased the probability of child active engagement and child passivity increased the probability of mother low sensitive initiation. The advantages of a differentiated conception of caregiver behavior and of perceived control are discussed.

Optimising motor learning in infants at high risk of cerebral palsy: a pilot study

BACKGROUND

The average age for the diagnosis of cerebral palsy (CP) is 19 months. Recent neuroplasticity literature suggests that intensive, task-specific intervention ought to commence as early as possible and in an enriched environment, during the critical period of neural development. Active motor interventions are effective in some populations, however the effects of active motor interventions on the motor outcomes of infants with CP have not been researched thoroughly, but pilot work is promising. The aim of this study was to determine the short- term effects of "GAME"; a new and novel goal-oriented activity-based, environmental enrichment therapy programme on the motor development of infants at high risk of CP and test study procedures for a randomized controlled trial (RCT).

METHODS

Pragmatic 2-group pilot RCT to assess motor outcomes, goal attainment, parent well-being and home environment quality, after 12-weeks of GAME intervention versus standard care. GAME included: creation of movement environments to elicit motor behaviours; parent training in motor learning and task analysis; frequent practice of motor tasks using a programme that was individualised to the child, was varied and focused on self-initiated movement. Data were analyzed using multiple regression.

RESULTS

Thirteen infants were consented, randomised, treated and completed the study. At study conclusion, the GAME group (n = 6) demonstrated an advantage in Total Motor Quotient of 8.05 points on the Peabody Developmental Motor Scale-2 (PDMS-2) compared to the standard care group (n = 7) (p < .001). No significant differences existed between groups on any other measure.

CONCLUSIONS

GAME appears to offer a promising and feasible new motor intervention for CP, with favourable short-term motor outcomes. A pressing need exists for an adequately powered RCT with long-term end points, to determine if GAME may advance these children's motor trajectory.

A community-based study of early childhood sensory stimulation in home environment associated with growth and psychomotor development in Pakistan

OBJECTIVES

Sensory stimulation (SS) is a non-nutritional modifiable risk factor for early childhood development. We assessed SS in home environment and examined its influence on physical growth and psychomotor development (PD).

METHODS

A cross-sectional study was conducted in 26 communities in Pakistan among children aged <3 (n = 1,219). They were assessed at home visits using (1) Bayley's Infant Developmental Scale for PD, (2) home observation for measurement of the environment inventory for SS, (3) anthropometry and (4) socio-economic questionnaire.

RESULTS

In rural homes, SS provided was lower as compared to urban counterparts (Adj mean diff: 4.47, 95 % CI 3.78, 5.16) and showed an association with stunting (Adj mean diff: -1.30, 95 % CI -1.93, -0.66), and underweight (Adj mean diff: -1.04, 95 % CI -1.71, -0.38) not explained by type of neighbourhood or socio-economic status. SS was associated with PD more than combined contribution of socio-economic status and rural-urban factors (Adj mean diff: 0.47, 95 % CI 0.30, 0.63).

CONCLUSIONS

SS in rural homes may be a significant factor influencing the child development. There is a need to corroborate these results by additional research for integration in health policy initiatives.

Mother-child interactions and the associations with child healthcare utilization in low-income urban families

Studies have demonstrated that low-income families often have disproportionately high utilization of emergency department (ED) and hospital services, and low utilization of preventive visits. A possible contributing factor is that some mothers may not respond optimally to their infants' health needs, either due to their own responsiveness or due to the child's ability to send cues. These mother-child interactions are measurable and amenable to change. We examined the associations between mother-child interactions and child healthcare utilization among low-income families. We analyzed data from the Nurse-Family Partnership trial in Memphis, TN control group (n = 432). Data were collected from child medical records (birth to 24 months), mother interviews (12 and 24 months postpartum), and observations of mother-child interactions (12 months postpartum). We used logistic and ordered logistic regression to assess independent associations between mother-child interactions and child healthcare utilization measures: hospitalizations, ED visits, sick-child visits to primary care, and well-child visits. Better mother-child interactions, as measured by mother's responsiveness to her child, were associated with decreased hospitalizations (OR: 0.51; 95% CI: 0.32, 0.81), decreased ambulatory-care-sensitive ED visits (OR: 0.65, 95% CI: 0.44, 0.96), and increased well-child visits (OR: 1.55, 95% CI: 1.06, 2.28). Mother's responsiveness to her child was associated with child healthcare utilization. Interventions to improve mother-child interactions may be appropriate for mother-child dyads in which child healthcare utilization appears unbalanced with inadequate primary care and excess urgent care. Recognition of these interactions may also improve the care clinicians provide for families.

Environmental influences on early language development: The context of social risk

The impact of environmental risk on toddlers' cognitive and linguistic development was investigated in a longitudinal study of 78 high-risk families. The risk factors examined were family social status, mother's psychosocial functioning, and quality of dyadic involvement at 1 year of age (including measures of mother-infant interaction and infant-mother attachment security). Child outcome measures included the Bayley MDI (at 24 months) and the Preschool Language Scale (at 36 months). The data indicate that dyadic involvement was an important mediator in the relation between environmental risk and subsequent child competence. Specific relations among early interactive experiences, infant attachment security, and subsequent cognitive and linguistic gain were examined within a framework of risk and protective factors. The results suggest that secure attachment may operate as a protective factor, but only among the more extreme cases in this exclusively high-risk sample.

The influence of wakeful prone positioning on motor development during the early life

OBJECTIVE

The "Prone to Play" campaign was proposed and has been ongoing since 2001, but the causal and dosage effects of wakeful prone positioning on motor development are still unclear. The purpose of this longitudinal cohort study was to investigate the effects of prone wakeful positioning at 3 to 6 months of age on motor development during the 6 to 24 months age bracket.

METHODS

Two hundred eighty-eight full-term newborns were recruited at birth and followed up at 4, 6, 12, and 24 months of age respectively. Data on experience, duration, and preference of prone wakeful positioning were collected at 4 and 6 months of age. The acquisition ages of prone specific and nonprone milestones were collected and analyzed to evaluate the impact of wakeful prone positioning on motor development during early life. Gross motor developmental quotients (GMDQ) and fine motor developmental quotients (FMDQ) of the Comprehensive Developmental Inventory for Infants and Toddlers were assessed at ages 6 and 24 months.

RESULTS

The prone duration significantly affected the acquisition ages of 3 prone specific milestones (rolling, crawling-on-abdomen, crawling-on-all-fours) and sitting; without affecting the other 2 nonprone specific milestones (walking and transferring objects), GMDQs and FMDQs. The infants of prone preference achieved prone specific milestones earlier than those of nonprone preference. The prone experience affected the crawling-on-abdomen acquisition age, but not the other motor outcomes.

CONCLUSION

Wakeful prone positioning promotes prone-specific motor milestones in early infancy. "Prone to play for a certain amount of time in an interactive and supervised environment" might be advocated.

Associations between content types of early media exposure and subsequent attentional problems

OBJECTIVE

Television and video/DVD viewing among very young children has become both pervasive and heavy. Previous studies have reported an association between early media exposure and problems with attention regulation but did not have data on the content type that children watched. We tested the hypothesis that early television viewing of 3 content types is associated with subsequent attentional problems. The 3 different content types are educational, nonviolent entertainment, and violent entertainment.

METHODS

Participants were children in a nationally representative sample collected in 1997 and reassessed in 2002. The analysis was a logistic regression of a high score on a validated parent-reported measure of attentional problems, regressed on early television exposure by content and several important sociodemographic control variables.

RESULTS

Viewing of educational television before age 3 was not associated with attentional problems 5 years later. However, viewing of either violent or non-violent entertainment television before age 3 was significantly associated with subsequent attentional problems, and the magnitude of the association was large. Viewing of any content type at ages 4 to 5 was not associated with subsequent problems.

CONCLUSIONS

The association between early television viewing and subsequent attentional problems is specific to noneducational viewing and to viewing before age 3.

Prenatal exposure to methylmercury and child development: influence of social factors

BACKGROUND

In the Seychelles Child Development Main Study (SCDS), at 19 months of age, enhanced MDI scores were associated with increasing methylmercury (MeHg) exposure in higher caregiver IQ groups at several levels of family income. We performed a similar analysis of the 66-month evaluations to determine if the modifying influences of social and environmental factors were consistent with those previously observed.

METHODS

Prenatal MeHg exposure was determined by analysis of maternal hair growing during pregnancy. Children in the cohort (N=711) were evaluated for cognitive ability (McCarthy Scales of Children's Abilities), language development (Preschool Language Scale), drawing and copying (Bender Gestalt Test), scholastic achievement (the Woodcock-Johnson Test of Achievement), and behavior (the Child Behavior Checklist). Interactions between prenatal MeHg exposure and caregiver intelligence, socioeconomic status (SES), home environment, and gender were examined by multiple regression analysis.

RESULTS

The median prenatal MeHg exposure was 5.9 ppm (range=0.5-26.7 ppm). Gender significantly influenced the association between prenatal exposure and drawing and copying; however, the effects were not consistent. Prenatal exposure interacted with one or more social or environmental covariates for general cognitive ability, overall language ability, and prearithmetic achievement. Again, the effects were not consistent across either endpoints or covariate categories.

CONCLUSIONS

Evidence of a small influence by social and environmental variables at 66 months is neither internally consistent nor consistent with earlier results. Overall, a consistent pattern of effect modification (EM) has not been observed, suggesting that the results may be due to chance.

Evaluation of Uncontrolled Confounding in Studies of Environmental Exposures and Neurobehavioral Testing in Children

BACKGROUND

Neurobehavioral tests are commonly used in studies of children exposed to low-level environmental concentrations of compounds known to be neurotoxic at higher levels. However, uncontrolled or incomplete control for confounding makes interpretation of results problematic because effects of confounders are often stronger than the effects of primary interest. We examined a priori the potential impact of confounding in a hypothetical study evaluating the association of a potentially neurotoxic environmental exposure with neurobehavioral function in children.

METHODS

We used 2 outcome measures: the Bayley Scales of Infant Development Mental Development Index and the Stanford-Binet Intelligence Scale Composite Score. We selected 3 potential confounders: maternal intelligence, home environment, and socioeconomic status as measured by years of parental education. We conducted 3 sets of analyses measuring the effect of each of the 3 confounding factors alone, 2 confounders acting simultaneously, and all 3 confounders acting simultaneously.

RESULTS

Relatively small differences (0.5 standard deviations) in confounding variables between "exposed" and "unexposed" groups, if unmeasured and unaccounted for in the analysis, could produce spurious differences in cognitive test scores. The magnitude of this difference (3-10 points) has been suggested to have a meaningful impact in populations. The method of measuring confounders (eg, maternal intelligence) could also substantially affect the results.

CONCLUSIONS

It is important to carefully consider the impact of potential confounders during the planning stages of an observational study. Study-to-study differences in neurobehavioral outcomes with similar environmental exposures could be partially explained by differences in the adjustment for confounding variables.

The Home Observation for Measurement of the Environment Revisited

This review describes the Home Observation for Measurement of the Environment (HOME). After describing the structure of the instrument, it shows how it has been used successfully in studies on normally developing children and on samples drawn from high-risk populations. These are followed by studies showing how the HOME has been used to evaluate interventions. Although most interventions are not designed primarily on the basis of the HOME outcomes, the instrument has been used as a measure of the effectiveness of the intervention schedule. HOME has been used extensively in research to reveal relationships between several aspects of the home environment and children's developmental outcomes. The very good relationship between HOME scores and children's measures of developmental competence has also been found in non-normative populations and research has attempted to identify the specific aspects of the home environment, as indexed by the HOME subscales that reveal the strengths or the weaknesses of homes of at-risk populations.

Sleep-wake patterns in preterm infants and 6 month's home environment: implications for early cognitive development

AIMS

This study examined the relationship between early organization of sleep-wake states and developmental outcome at 6-month-old premature infants.

STUDY DESIGN

This was a prospective randomized study that evaluated the sleep-wake states of healthy premature infants in the nursery environment for two successive 72-h periods, at 32 and 36 weeks gestational age.

SUBJECTS

Thirty-four healthy premature infants.

OUTCOME MEASURES

Three sleep-wake parameters: percent of quiet sleep, activity level and total amount of sleep, were studied with miniature activity monitors attached to the infant's ankles. The rearing environments of the infants were also assessed at 6 months of age, using the HOME Inventory. Finally, child developmental status was recorded by means of the Mental Development Index (MDI) of the Bayley Scales for Infant Development, at a chronological age of 6 months.

RESULTS

Lower total time spent in night sleep, higher mean level of night activity level, and a later rich home environment were all predictive of higher Bayley scores (MDI) at a chronological age of 6 months. Regression analysis indicated that early biological maturity was more strongly related to the child's developmental status than later home environment, although both contributed to the prediction.

CONCLUSIONS

These results suggest that biological factors may be significant predictors early in development, whereas the impact of environmental influences increases with development.

Environmental exposure to polychlorinated biphenyls and quality of the home environment: effects on psychodevelopment in early childhood

BACKGROUND

There is uncertainty whether environmental levels of exposure to polychlorinated biphenyls (PCBs) adversely affect mental and motor development in early childhood. We aimed to establish whether such an effect is of only prenatal or additional postnatal origin, and if a favourable home environment can counteract this effect.

METHODS

Between 1993 and 1995 we recruited 171 healthy mother-infant pairs and prospectively measured psychodevelopment in newborn infants aged 7, 18, 30, and 42 months. We estimated prenatal and perinatal PCB exposure of newborn babies in cord blood and maternal milk. At 42 months we measured postnatal PCB concentrations in serum. At 18 months the quality of the home environment was assessed using the Home Observation for Measurement of the Environment scale. Mental and psychomotor development of the children were assessed using the Bayley Scales of Infant Development until 30 months and the Kaufman Assessment Battery for Children at 42 months.

FINDINGS

Negative associations between milk PCB and mental/motor development were reported at all ages, becoming significant from 30 months onwards. Over 30 months, for a PCB increase from 173 (5th percentile) to 679 ng/g lipids in milk (95th percentile) there was a decrease of 8.3 points (95% CI -16.5 to 0.0) in the Bayley Scales of Infant Development mental scores, and a 9.1 point decrease (95% CI -17.2 to -1.02) in the Bayley Scales of Infant Development motor scores. There was also a negative effect of postnatal PCB exposure via breastfeeding at 42 months. Home environment had a positive effect from 30 months onwards (Bayley Scales of Infant Development mental score increase of 9.4 points [95% CI 2.2-16.7]).

INTERPRETATION

Prenatal PCB exposure at current European background levels inhibits, and a favourable home environment supports, mental and motor development until 42 months of age. PCB exposure also has an effect postnatally.

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.

Perceived stress, social support, and affectionate behaviors of adolescent mothers with infants in neonatal intensive care

INTRODUCTION

This article focuses on affectionate behaviors of adolescent mothers with their infants in a neonatal intensive care unit (NICU). Hypotheses derived from behavioral science theory posited the direct influence of social support and perceived stress on affectionate behaviors, the statistical interaction of social support and perceived stress on affectionate behaviors, and perceived stress as a mediator of the relationship between social support and affectionate behaviors.

METHOD

Subjects were enrolled from July 1993 through September 1994. Information about perceived stress and social support was obtained twice by means of an interview. Affectionate behaviors were measured by NICU nurse observations. Analyses were conducted on subsamples ranging from 57 to 107 subjects.

RESULTS

All hypotheses were rejected. Neither social supports nor perceived stress were related to affectionate behaviors, and no statistical interactions among the 3 variables were identified.

DISCUSSION

The findings are considered in the context of the methodology used, stress and social support theory, and implications for practice and future research.

Self-injurious behaviour: reviewing evidence for best practice

This article brings together some of the research literature from the last 15 years concerning self-injurious behaviour (SIB) in people with learning disabilities. There is a focus on medical, biological and psychological research literature because of the important contribution these disciplines have made to the understanding of such behaviours. The article also explores contemporary evidence for the management of people with learning disabilities who present with SIB. The care and management of this group of people presents learning disability nurses with distinctively distressing challenges. Within the article definition, prevalence, topography, causation and evidence for best practice are outlined. The article concludes with a brief exploration of the role of the learning disability nurse in contributing to the health and wellbeing of this group of people.

The relation of problem behaviors in preschool children to depressive symptoms in mothers and fathers

The relation of maternal and paternal depressive symptoms to problem behaviors in a nonclinical sample of preschool children was examined. Data were collected from 46 women, their husbands, and their 4-year-old, first-born children. Observed maternal restrictive and punishing behavior and attachment security of the child were considered additional sources of risk for externalizing and internalizing problem behaviors. Different predictors for child externalizing and internalizing behaviors were identified via hierarchical multiple regression analyses. Maternal and paternal depressive symptoms and maternal restrictive and punishing behavior emerged as salient predictors of child internalizing behaviors. For externalizing behaviors, there were significant gender differences: For girls, maternal depressive symptoms made a significant contribution to the model; the model for boys was not significant. The results perhaps reflect different etiological pathways for externalizing and internalizing behaviors, supporting the suggestion that those behaviors are distinct clinical phenomena, even among very young children. The findings also suggest that nonclinical levels of parental symptomatology show systematic relations to children's problem behaviors.