Mitigating HPA axis dysregulation associated with placement changes in foster care

Maltreated foster children often exhibit alterations in diurnal hypothalamic-pituitary-adrenal (HPA) axis activity that are characterized by lower cortisol levels upon waking and smaller declines in morning-to-evening cortisol levels. Previous research has shown that this dysregulated pattern is associated with high caregiver stress levels over the course of foster care placements. In contrast, therapeutic interventions that emphasize consistent and responsive caregiving have been associated with more regulated cortisol rhythms. In this paper, two related issues were explored: whether placement changes (i.e., moving between foster homes or from a foster home to a permanent placement) were associated with more blunted daily cortisol rhythms and whether a caregiver-based intervention exerted a protective effect in this context. Because the intervention program has components specifically designed to prepare foster children for placement changes and to maintain consistent parenting techniques despite them, a prevention effect on HPA axis dysregulation during placement changes was hypothesized. The results of linear mixed modeling analyses showed that placement changes predicted dysregulation in cortisol rhythms in the regular foster care group but not in the intervention foster care group. These findings are discussed in terms of implications for child welfare policy and practice.

From Scribbles to Scrabble: Preschool Children's Developing Knowledge of Written Language

The purpose of this study was to concurrently examine the development of written language across several writing tasks and to investigate how writing features develop in preschool children. Emergent written language knowledge of 372 preschoolers was assessed using numerous writing tasks. The findings from this study indicate that children possess a great deal of writing knowledge before beginning school. Children appear to progress along a continuum from scribbling to conventional spelling, and this progression is linear and task dependent. There was clear evidence to support the claim that universal writing features develop before language-specific features. Children as young as 3 years possess knowledge regarding universal and language-specific writing features. There is substantial developmental continuity in literacy skills from the preschool period into early elementary grades. Implications of these findings on writing development are discussed.

Mathematical skills in 3- and 5-year-olds with spina bifida and their typically developing peers: a longitudinal approach

Preschoolers with spina bifida (SB) were compared to typically developing (TD) children on tasks tapping mathematical knowledge at 36 months (n = 102) and 60 months of age (n = 98). The group with SB had difficulty compared to TD peers on all mathematical tasks except for transformation on quantities in the subitizable range. At 36 months, vocabulary knowledge, visual-spatial, and fine motor abilities predicted achievement on a measure of informal math knowledge in both groups. At 60 months of age, phonological awareness, visual-spatial ability, and fine motor skill were uniquely and differentially related to counting knowledge, oral counting, object-based arithmetic skills, and quantitative concepts. Importantly, the patterns of association between these predictors and mathematical performance were similar across the groups. A novel finding is that fine motor skill uniquely predicted object-based arithmetic abilities in both groups, suggesting developmental continuity in the neurocognitive correlates of early object-based and later symbolic arithmetic problem solving. Models combining 36-month mathematical ability and these language-based, visual-spatial, and fine motor abilities at 60 months accounted for considerable variance on 60-month informal mathematical outcomes. Results are discussed with reference to models of mathematical development and early identification of risk in preschoolers with neurodevelopmental disorder.

Emotional reactivity, regulation and childhood stuttering: a behavioral and electrophysiological study

The purpose of this preliminary study was to assess whether behavioral and psychophysiological correlates of emotional reactivity and regulation are associated with developmental stuttering, as well as determine the feasibility of these methods in preschool-age children. Nine preschool-age children who stutter (CWS) and nine preschool-age children who do not stutter (CWNS) listened to brief background conversations conveying happy, neutral, and angry emotions (a resolution conversation followed the angry conversation), then produced narratives based on a text-free storybook. Electroencephalograms (EEG) recorded during listening examined cortical correlates of emotional reactivity and regulation. Speech disfluencies and observed emotion regulation were measured during a narrative immediately after each background conversation. Results indicated that decreased use of regulatory strategies is related to more stuttering in children who stutter. However, no significant differences were found in EEG measurements of emotional reactivity and regulation between CWS and CWNS or between emotion elicitation conditions. Findings were taken to suggest that use of regulatory strategies may relate to the fluency of preschool-age children's speech-language output.

LEARNING OUTCOMES

The reader will be able to (1) describe emotional reactivity and regulation processes, (2) discuss evidence for or against the relations of emotional reactivity, regulation and stuttering, (3) understand how multiple measures can be used to measure emotional reactivity and regulation.

The structure of executive function in 3-year-olds

Although the structure of executive function (EF) during adulthood is characterized by both unity and diversity, recent evidence suggests that preschool EF may be best described by a single factor. The latent structure of EF was examined in 228 3-year-olds using confirmatory factor analysis. Children completed a battery of executive tasks that differed in format and response requirements and in putative working memory and inhibitory control demands. Tasks appeared to be age appropriate, with adequate sensitivity across the range of performance and without floor or ceiling effects. Tests of the relative fit of several alternative models supported a single latent EF construct. Measurement invariance testing revealed less proficient EF in children at higher sociodemographic risk relative to those at lower risk and no differences between boys and girls. At 3years of age, when EF skills are emerging, EF appears to be a unitary, more domain-general process.

Association between depression severity and amygdala reactivity during sad face viewing in depressed preschoolers: an fMRI study

BACKGROUND

Previous research has indicated that symptom severity and amygdala reactivity during the viewing of facial expressions of emotion are related in depression. However, it remains unclear how early in development this can be detected.

METHODS

A sample of 11 depressed preschoolers (4.5±0.8; 6 males) participated in an fMRI experiment where they viewed facial expressions of emotion. A region of interest approach was used in order to examine the relationship between amygdala activation and depression severity. Additional whole-brain analyses were conducted and the results of these analyses were examined for potential relationships with depression severity.

RESULTS

Findings indicated that depressed preschoolers exhibited a significant positive relationship between depression severity and right amygdala activity when viewing facial expressions of negative affect. In addition, we found a significant positive relationship between degree of functional activation in the occipital cortex while viewing faces and level of depression severity.

LIMITATIONS

Additional research including a larger sample of depressed preschoolers, as well as a healthy comparison group, is needed to replicate the current findings and examine their specificity at this age.

CONCLUSIONS

This is the first study directly examining brain function in depressed preschoolers. The results suggest that, similar to older children and adults with depression, amygdala responsivity and degree of depression severity are related as early as age 3.

The effects of napping on cognitive function in preschoolers

OBJECTIVE

To determine the relationship between napping and cognitive function in preschool-aged children.

METHODS

Daytime napping, nighttime sleep, and cognitive function were assessed in 59 typically developing children aged 3 to 5 years, who were enrolled in full-time childcare. Participants wore an actigraphy watch for 7 days to measure sleep and napping patterns and completed neuropsychological testing emphasizing attention, response control, and vocabulary. Parents of participants completed behavior ratings and sleep logs during the study. Sleep/wake cycles were scored with the Sadeh algorithm.

RESULTS

Children who napped more on weekdays were also more likely to nap during weekends. Weekday napping and nighttime sleep were inversely correlated, such that those who napped more slept less at night, although total weekday sleep remained relatively constant. Weekday napping was significantly (negatively) correlated with vocabulary and auditory attention span, and weekday nighttime sleep was positively correlated with vocabulary. Nighttime sleep was also significantly negatively correlated with performance, such that those who slept less at night made more impulsive errors on a computerized go/no-go test.

CONCLUSIONS

Daytime napping is actually negatively correlated with neurocognitive function in preschoolers. Nighttime sleep seems to be more critical for development of cognitive performance. Cessation of napping may serve as a developmental milestone of brain maturation. Children who nap less do not appear to be sleep deprived, especially if they compensate with increased nighttime sleep. An alternative explanation is that children who sleep less at night are sleep deprived and require a nap. A randomized trial of nap restriction would be the next step in understanding the relationship between napping and neurocognitive performance.

Strengthening families of children with developmental concerns: parent perceptions of developmental screening and services in Head Start

OBJECTIVE

The authors investigated perceptions of parents with children in the Head Start program about the processes of detection and intervention for developmental concerns.

DESIGN

Descriptive, qualitative study.

SETTING

A large, urban Head Start agency, operating 14 centers and annually serving more than 1200 predominantly Latino children. During 2008-2009, a collaborative partnership with academicians from UCLA was created to evaluate their model of developmental screening and referrals. PARTICIPANTS AND PROCEDURES: We conducted 5 focus groups with a total of 30 parents of Head Start children with developmental concerns. Parents were asked about where they go for information when they have concerns, how they perceived the developmental screening process and services, and how children and families have changed after being in the Head Start program. Focus groups were recorded, transcribed and translated into English, then coded in ATLAS.ti using the domains above and sorted into themes for analysis.

RESULTS

Parents perceived the screening process as both diagnostically and therapeutically important, with multiple benefits ranging from closer parent-teacher relationships to improved parenting and understanding of developmental interventions. Families focused their discussion on the importance of social-emotional and behavioral development, with school readiness and improved expressive language as important but secondary outcomes.

CONCLUSIONS

For families of children with developmental and behavioral risks or concerns, a structured developmental screening process in a preschool setting, such as that provided by Head Start, may serve as a vital gateway for identifying and addressing concerns and promoting social-emotional learning, parent engagement, language development and school readiness.

Measuring physical activity in preschoolers: Reliability and validity of The System for Observing Fitness Instruction Time for Preschoolers (SOFIT-P)

The purpose of this study is describe the initial feasibility, reliability, and validity of an instrument to measure physical activity in preschoolers using direct observation. The System for Observing Fitness Instruction Time for Preschoolers was developed and tested among 3- to 6-year-old children over fall 2008 for feasibility and reliability (Phase I, n=67) and in fall 2009 for concurrent validity (Phase II, n=27). Phase I showed that preschoolers spent >75% of their active time at preschool in light physical activity. The mean inter-observer agreements scores were ≥.75 for physical activity level and type. Correlation coefficients, measuring construct validity between the lesson context and physical activity types with and with the activity levels, were moderately strong. Phase II showed moderately strong correlations ranging from .50 to .54 between the System for Observing Fitness Instruction Time for Preschoolers and Actigraph accelerometers for physical activity levels. The System for Observing Fitness Instruction Time for Preschoolers shows promising initial results as a new method for measuring physical activity among preschoolers.

Predictive validity of DSM-IV oppositional defiant and conduct disorders in clinically referred preschoolers

BACKGROUND

Diagnostic validity of oppositional defiant and conduct disorders (ODD and CD) for preschoolers has been questioned based on concerns regarding the ability to differentiate normative, transient disruptive behavior from clinical symptoms. Data on concurrent validity have accumulated, but predictive validity is limited. Predictive validity is critical to refuting the hypothesis that diagnosing ODD and CD in young children leads to pathologizing normal behavior. ODD and CD have emerged as gateway disorders to many forms of adult psychopathology. Establishing how early we can identify symptoms and disorders that herald poor prognosis is one of the most important goals for research on etiology and prevention.

METHODS

Subjects were 3-5-year-old consecutive referrals to a child psychiatry clinic (n=123) and demographically matched children from a pediatric clinic (n=100). A diagnostic interview was used to assess DSM-IV ODD and CD in a prospective follow-up design from preschool to school age. Stability of ODD and CD diagnoses and level of impairment were tested as a function of preschool diagnosis.

RESULTS

Over 80% of preschoolers diagnosed with ODD and approximately 60% of preschoolers diagnosed with CD met criteria for the same disorder during follow-up. Impairment over time varied significantly as a function of stability of diagnosis across three years.

CONCLUSIONS

These results provide the first evidence of the predictive validity of DSM-IV ODD and CD in clinically referred preschool children. The findings challenge the assumption that symptoms of disruptive behavior disorders that occur during the preschool period tend to be transient.

The relationship between infant lung function and the risk of wheeze in the preschool years

RATIONALE

There is evidence that perinatal lung development predicts childhood wheeze. However, very few studies have examined whether preschool wheeze is associated with lower premorbid lung function in early infancy, and as yet there is no information relating atopic and non-atopic preschool wheeze to early lung development.

OBJECTIVE

To examine the association between premorbid infant lung function and preschool wheeze, and to explore associations with atopic and non-atopic wheeze phenotypes.

METHODS

Infant lung function was measured in 147 healthy term infants aged 5-14 weeks. Rapid thoracoabdominal compression was performed during tidal breathing and at raised volume to measure maximal expiratory flow at functional residual capacity (V' max FRC) and forced expiratory volume in 0.4 sec (FEV(0.4)). Atopic status was determined by skin prick testing at 3 years and wheeze ascertained from parental questionnaires (1 and 3 years).

MEASUREMENTS AND MAIN RESULTS

Lower early infancy V' max FRC was associated with wheeze in both the first and third years of life (P=0.002 and 0.006, respectively). Lower early infancy FEV(0.4) was associated with wheeze in the first year (P=0.03). Compared to non-atopic children who did not wheeze, non-atopic children who wheezed in their third year of life had lower FEV(0.4) (P=0.02), while FEV(0.4) values of atopic children who wheezed were not significantly different (P=0.4).

CONCLUSIONS

Lower premorbid infant lung function was present in infants who subsequently wheezed during the first and third years of life. Lower FEV(0.4) in early infancy was associated with non-atopic wheeze but not atopic wheeze at 3 years of age.

Assessing disordered thoughts in preschoolers with dysregulated mood

There is rising interest in identifying precursors to bipolar disorder symptoms, including thought disorder. Thought disorder is identified in adults through self-report and in school-aged children through parent report and child story-telling. This study is an exploration to determine if preschoolers with mood dysregulation have evidence of disordered thoughts using a story-stem completion method. Participants included two groups of 3.5-6 year-old children: 20 with mood dysregulation including manic symptoms and 11 typically developing comparison children. Children were administered story completion narratives including one story where the child character accidentally cuts him/herself while pretending to cook. The children were asked to complete the stories and their responses were analyzed for atypical themes consistent with disordered thoughts such as violence or bizarreness outside of the story or props coming to life. Thirty-five percentage of symptomatic preschoolers versus 0% of typically developing preschoolers ascribed independent actions to inanimate props (p = 0.03). Eighty percentage of symptomatic preschoolers versus 9% of typically developing preschoolers utilized props in a violent or bizarre manner outside the central story (p < 0.001). Preschool children with symptoms of dysregulated mood express themes related to the unusual use of story props which may indicate disordered thoughts. This preschool expression of dysregulated mood appears similar to and possibly continuous with school-age and adult versions of bipolar disorder.

Communication Input Matters: Lessons From Prelinguistic Children Learning to Use AAC in Preschool Environments

This study reports on the communication produced by 30 children learning to communicate with AAC in their preschool classrooms, as well as the communication input provided by educators. All of the children were communicating with less than 20 different words, symbols, or signs at the time of observation. Characteristics of participants' preschool classrooms were also measured with the ECERS-R. Relationships between ECERS-R scores, communication input to children, and child communication rate were explored through correlation analyses. Results indicated that child communication rates in their classrooms were low and that the majority of child communication was in response to educators' initiations. Only the amount of adult input to children was significantly related to child communication rates. ECERS-R scores were not related to any observed communication variables. Results provide a base of comparison for future studies as well as demonstrating need to provide more communication input within preschool classrooms.

Delivering Child Community Psychology Services in the Community: Experiences from the NIPPERS Project

BACKGROUND

  The NIPPERS (Nursery Intervention Project for Parents & Education Related Services) was a novel community psychology service based in nursery settings in socio-economically disadvantaged, inner-city areas in London.

METHOD

  The service included consultation work with nursery staff, structured parenting groups and individual sessions for parents.

RESULTS

  The delivery of the clinical service and research evaluation underwent several changes in the first phase of the project, in particular to ensure that the service was acceptable and accessible to families and staff. Although take-up of community services was higher than in the local clinic-based services, it was not taken up by some 40% of parents. Due to the allocation design, it was not possible to measure the effectiveness of the intervention.

CONCLUSIONS

  The NIPPERS service was successful in delivering a community child psychology service to families with high levels of early child behavioural problems at high risk for continuing difficulties.

Growth hormone treatment does not affect incidences of middle ear disease or hearing loss in infants and toddlers with Turner syndrome

CONTEXT

No randomized, controlled, prospective study has evaluated the effect of growth hormone (GH) on the rates of middle ear (ME) disease and hearing loss in girls with Turner syndrome (TS).

DESIGN

A 2-year, prospective, randomized, controlled, open-label, multicenter, clinical trial ('Toddler Turner Study'; August 1999 to August 2003) was carried out.

SETTING

The study was conducted at 11 US pediatric endocrine centers.

SUBJECTS

Eighty-eight girls with TS, aged 9 months to 4 years, were enrolled.

INTERVENTION

The interventions comprised recombinant GH (50 microg/kg/day, n = 45) or no treatment (n = 43) for 2 years.

MAIN OUTCOME MEASURES

The outcome measures included occurrence rates of ear-related problems, otitis media (OM) and associated antibiotic treatments, tympanometric assessment of ME function and hearing assessment by audiology.

RESULTS

At baseline, 57% of the girls (mean age = 1.98 +/- 1.00 years) had a history of recurrent OM, 33% had undergone tympanostomy tube (t-tube) insertion and 27% had abnormal hearing. There was no significant difference between the treatment groups for annual incidence of OM episodes (untreated control: 1.9 +/- 1.4; GH-treated: 1.5 +/- 1.6, p = 0.17). A quarter of the subjects underwent ear surgeries (mainly t-tube insertions) during the study. Recurrent or persistent abnormality of ME function on tympanometry was present in 28-45% of the girls without t-tubes at the 6 postbaseline visits. Hearing deficits were found in 19-32% of the girls at the annual postbaseline visits. Most of these were conductive deficits, however, 2 girls had findings consistent with sensorineural hearing loss, which was evident before 3 years of age.

CONCLUSIONS

Ear and hearing problems are common in infants and toddlers with TS and are not significantly influenced by GH treatment. Girls with TS need early, regular and thorough ME monitoring by their primary care provider and/or otolaryngologist, and at least annual hearing evaluations by a pediatric audiologist.

The effectiveness of CBT in 3-7 year old anxious children: preliminary data

INTRODUCTION

While CBT has been found to be an effective treatment for anxious older children, it has not been empirically validated in children younger than 8 years. In this study we report on an open pilot trial to establish whether a modified form of CBT can benefit young children.

METHODS

Participants were 37 anxious children aged 37-89 months attending a university anxiety specialty clinic. Symptom severity and functioning were assessed before and after treatment by independent evaluators. Feasibility and acceptability of the intervention were high. Parents attended part of each treatment session and were considered part of the treatment team.

RESULTS

Patients exhibited significant improvement from pre - to post-treatment assessments after an average of 8.3 treatment sessions, using the Strengths and Difficulties Questionnaire (SDQ) and the Global Assessment of Functioning Scale (GAF) ratings.

CONCLUSIONS

A modified form of CBT with active parent involvement may be a useful tool in treating anxiety disorders in preschool and early school aged children.

Child and Informant Influences on Behavioral Ratings of Preschool Children

This study investigated relations among teacher, parent, and observer behavioral ratings of 3- and 4-year-old children using intraclass correlations and ANOVA. Comparisons within and across children from middle- (N =166; Mean age 54.25 months, SD = 8.74) and low-income (N =199; Mean age 51.21 months, SD = 7.22) backgrounds revealed significant agreement between the raters but also considerable differences in both ranking and absolute scores between raters. Teachers and parents consistently rated children from low-income classrooms as having more behavioral problems and fewer prosocial behaviors. Results are conceptualized with respect to how differential expectations, comparison groups, and types of interaction with children can affect the evaluation of child behavior. Results point to the need for multiple sources of evaluation when assessing a child for behavioral difficulties, particularly in children from lower income backgrounds.

25-hydroxyvitamin D status of healthy, low-income, minority children in Atlanta, Georgia

OBJECTIVES

The goals were to determine the prevalence of vitamin D deficiency among minority children in a southern US city, to examine differences in serum 25-hydroxyvitamin D levels between non-Hispanic black and Hispanic children, and to determine dietary sources of vitamin D.

METHODS

Low-income, minority children (N = 290; mean age: 2.5 +/- 1.2 years) were recruited during well-child clinic visits. Serum 25-hydroxyvitamin D and calcium levels were measured and dietary information was assessed.

RESULTS

The mean 25-hydroxyvitamin D(3) level was 26.2 +/- 7.6 ng/mL, whereas 25-hydroxyvitamin D(2) was not detected. Overall, 22.3% of children had deficient serum 25-hydroxyvitamin D(3) levels (< or =20 ng/mL), 73.6% had less-than-optimal serum 25-hydroxyvitamin D levels (< or =30 ng/mL), and 1.4% had low serum calcium levels (< or =9 mg/dL). A significantly larger proportion of non-Hispanic black children, compared with Hispanic children, had vitamin D deficiency (26% vs 18%; P < .05). Age and season of recruitment were significantly associated with vitamin D deficiency and low serum calcium levels. Older children (> or =3 years) were less likely to have vitamin D deficiency (odds ratio [OR]: 0.89 [95% confidence interval [CI]: 0.81-0.96]; P < .001). Study enrollment during spring and summer reduced the likelihood of vitamin D deficiency by approximately 20% (spring, OR: 0.85 [95% CI: 0.73-0.98]; P = .03; summer, OR: 0.82 [95% CI: 0.73-0.92]; P < .01). Fortified milk provided most dietary vitamin D (62%), with Hispanic children reporting greater intake.

CONCLUSIONS

Suboptimal vitamin D status was common among apparently healthy, low-income, minority children. Age and season were significant predictors of vitamin D deficiency.

Phonological awareness and types of sound errors in preschoolers with speech sound disorders

PURPOSE

Some children with speech sound disorders (SSD) have difficulty with literacy-related skills, particularly phonological awareness (PA). This study investigates the PA skills of preschoolers with SSD by using a regression model to evaluate the degree to which PA can be concurrently predicted by types of speech sound errors.

METHOD

Preschoolers with SSD (n = 43) participated in PA and speech sound production assessment. Errors from a 125-item picture naming task were coded in 2 ways: (a) considering all consonant errors equally (percentage of consonants correct [PCC]) and (b) using a 3-category system that captures component features of sound errors (typical sound changes, atypical sound changes, and distortions). PA tasks included rhyme matching, onset matching, onset segmentation and matching, and blending.

RESULTS

Variance in a PA composite score could be predicted partly by vocabulary and age (33%). Atypical sound changes accounted for an additional 6% of variance in PA, but distortions and typical errors did not account for significant variance. When the same consonant errors were analyzed using PCC, speech errors did not predict significant variance in PA.

CONCLUSIONS

Poorer PA is associated with lower receptive vocabularies and more atypical sound errors. Results are interpreted in the context of the accuracy of phonological representations.

Influenza Transmission in Preschools: Modulation by contact landscapes and interventions

Epidemiologic data suggest that schools and daycare facilities likely play a major role in the dissemination of influenza. Pathogen transmission within such small, inhomogenously mixed populations is difficult to model using traditional approaches. We developed simulation based mathematical tool to investigate the effects of social contact networks on pathogen dissemination in a setting analogous to a daycare center or grade school. Here we show that interventions that decrease mixing within child care facilities, including limiting the size of social clusters, reducing the contact frequency between social clusters, and eliminating large gatherings, could diminish pathogen dissemination. Moreover, these measures may amplify the effectiveness of vaccination or antiviral prophylaxis, even if the vaccine is not uniformly effective or antiviral compliance is incomplete. Similar considerations should apply to other small, imperfectly mixed populations, such as offices and schools.

Changes in body mass index z score over the course of the academic year among children attending Head Start

OBJECTIVE

We tested the hypothesis that among 3- to 5-year-old children attending Head Start, body mass index z score will decline during the academic year and increase during the summer.

METHODS

We used retrospective longitudinal growth data collected over 5 academic years from 1914 children (51% boys, 62% white) enrolled in a Michigan Head Start program. Changes in body mass index (BMI) z score, calculated as annual rate of change, during 2 academic years and the intervening summer were assessed by piecewise linear regression analysis. Potential covariates were gender, single-parent status, program year, race/ethnicity, age at initial enrollment, and family income (divided by household size).

RESULTS

Mean BMI z score at the start of Head Start enrollment was 0.52 (95% confidence interval [95% CI] 0.39 to 0.65). Mean annual rates of BMI z score change were: -0.07 (95% CI -0.28 to 0.14) during the first year of enrollment, 0.62 (95% CI -0.0005 to 1.23) over the summer, and -0.82 (95% CI -1.50 to -0.13) during the second year of enrollment. The effect was most robust among girls of minority race/ethnicity.

CONCLUSIONS

Head Start is associated with a shifting of BMI z scores toward the norm among low-income preschool-aged children, particularly among girls of minority race/ethnicity.

Cognitive development after traumatic brain injury in young children

The primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3-6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent-child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes.

Childhood stuttering and dissociations across linguistic domains: a replication and extension

The purpose of this investigation was to replicate the methods of Anderson, Pellowski, and Conture (2005) to determine whether a different sample of preschool children who stutter (CWS) exhibit more dissociations in speech-language abilities than children who do not stutter (CWNS; Study 1) and to examine the relation between dissociations and specific characteristics of stuttering (e.g., most common disfluency type) using a much larger sample size (Study 2). Participants for Study 1 were 40 CWS and 40 CWNS between the ages of 3;0 and 5;11. Participants for Study 2 were the same as for Study 1 plus the 45 CWS and 45 CWNS used by Anderson et al. (2005) for a total of 85 CWS and 85 CWNS. Participants were administered five standardized speech-language (sub)tests and a conversational speech sample was obtained from each participant for the analyses of speech disfluencies/stuttering. Standard scores from the standardized speech-language tests were analyzed using a correlation-based statistical procedure (Bates, Applebaum, Sacedo, Saygin, & Pizzamiglio, 2003) to identify possible dissociations among the speech-language measures. Findings from Study 1 supported Anderson et al.'s findings that CWS exhibited significantly more speech-language dissociations than CWNS. Results from Study 2 further revealed that CWS who exhibited dissociations were more likely to exhibit non-stuttered (other) disfluencies as their most common disfluency type. Findings provide further support for the possibility that dissociations among various aspects of the speech-language system may contribute to the difficulties that some children have establishing normally fluent speech.

EDUCATIONAL OBJECTIVES

The reader will be able to: (a) summarize findings from previous studies examining the speech and language performance of children who do and do not stutter; (b) describe the concept of "dissociations" in the speech and language skills of young children; (c) compare the results of the present study with previous work in this area; and (d) discuss speculations concerning the manner in which dissociations might affect fluency development in children who stutter.

An evaluation of two emergent literacy screening tools for preschool children

Children's reading success in early elementary school can be predicted from their emergent literacy skills. Consequently, there has been an increased focus on early childhood education as a means of identifying children at risk for later reading difficulty. Because diagnostic measures are impractical for this use, emergent literacy screening tools have been developed. In this study, 176 preschool children ranging in age from 42 to 55 months were administered the Revised Get Ready to Read! (GRTR-R), the Individual Growth and Development Indicators (IGDIs), and a diagnostic measure at two time points. Results indicated that GRTR-R either matched or outperformed IGDIs in terms of test-retest reliability and concurrent validity.

Internalizing disorders in early childhood: a review of depressive and anxiety disorders

This article reviews the use of the broad category of internalizing disorders and data on young children using this definition. It also reviews the emerging support for more specific internalizing diagnoses in very young children. The current empiric database on nosology and treatment of mood and anxiety disorders in young children is examined, and a clinical case example is included. Identification of recent advances in the understanding and treatment of anxiety disorders in young children and areas in which future studies are needed also are explored.