The infant or young child with developmental delay

The practitioner should attempt to identify the infant and young child with developmental delay as early as possible, so that appropriate services can be provided. Ongoing surveillance is required, rather than one-time screening. The practitioner should also serve as an advocate for children with developmental delay. He or she should ensure that appropriate services exist within the child's community and that they are readily accessible. This requires ongoing communication not only with the child and the family, but also with schools and community agencies.

Children's understanding of illness: developmental aspects

Acutely and critically ill children, like adults, want information about their illness. Children put information they gather into the context of their understanding of the world around them, which is influenced by their level of cognitive development. The development of their understanding of the world is also apparent in their understanding of their bodies and of illness etiology, prevention, and cure. Research generally supports the expected developmental progression of children's understanding of body parts and functions and of illness etiology. Implications for practice are provided.

Play and preschool children with autism

OBJECTIVES

This research focused on two questions. First, how does the play of children with autism differ from that of normally developing children? Second, what are the relationships between play performance and adaptive abilities?

METHOD

Nine children with autism and nine children without dysfunction were matched by mental age, gender, and socioeconomic status. Play performance was determined from videotapes of children playing in their homes. Parents provided information on children's adaptive abilities.

RESULTS

The children with autism differed from their peers on the total play score and the participation dimension of the Preschool Play Scale. Communication, as measured by the Vineland Adaptive Behavior Scales, was the adaptive ability most highly associated with play performance of the children with autism.

CONCLUSION

The results suggest that deficits in social development are a primary feature of autism. The findings support the use of play to evaluate and develop the interpersonal skills and habits of preschool children with this disorder.

Young children's comprehension of pretend episodes: the integration of successive actions

In 3 experiments, children's comprehension of successive pretend actions was examined. In Experiment 1, children (25-38 months) watched 2 linked actions (e.g., a puppet poured pretend cereal or powder into a bowl, and then pretended to feed the contents of the bowl to a toy animal). Children realized that the pretend substance was incorporated into the second action. In Experiment 2, children (24-39 months) again watched 2 linked actions (e.g., a puppet poured pretend milk or powder into a container, and then pretended to tip the contents of the container over a toy animal). They realized that the animal would become "milky" or "powdery." In Experiment 3, children (25-36 months) drew similar conclusions regarding a substitute rather than an imaginary entity. The results are discussed with reference to children's causal understanding, their capacity for talking about objects and events in terms of their make-believe and real status, and the processes underlying pretense comprehension.

Transfer in young children's understanding of spatial representations

The creative and flexible use of symbols is a unique human ability. In order to use a symbol, one must understand the basic relation between the symbol and what it represents. How do young children come to appreciate such relations? One possibility is that insight into one symbolic relation helps children appreciate different ones. The 3 studies presented here support this possibility. In Experiments 1 and 2, both 2.5- and 3.0-year-old children showed transfer from an easy task that required appreciation of a model-room symbolic relation to a more difficult one, one that children their age typically do not appreciate. In Experiment 3, 2.5-year-olds showed transfer between symbol types: Experience with a model-room relation helped them appreciate a map-room relation. These transfer effects are consistent with the claim that early experience with symbolic relations contributes to symbolic sensitivity, a basic readiness to recognize that one object or event may stand for another.

Biological and environmental correlates of developmental outcome of prematurely born infants in early adolescence

Examined the role of biological factors (birth weight and perinatal medical complications) and psychosocial factors (maternal attitudes, paternal involvement, mother's personal state, marital adjustment, family relations, and socioeconomic status) in predicting long-term outcome of 90 Israeli adolescents born prematurely at very low birth weight (VLBW). As compared with 90 adolescents born full-term at normal birth weight (NBW), the VLBW children scored lower on all measures except reading comprehension. IQ, visual-motor coordination, and hyperactive behavior were predicted by both biological and psychosocial variables, visual memory by biological variables, and reading comprehension by psychosocial variables. The findings support chiefly the main effects model of developmental psychopathology (i.e., biological and psychosocial variables are additive in predicting outcomes), but also the interactional model (e.g., SES was influential in predicting visual-motor coordination and hyperactive behavior in the VLBW group but not in the NBW group).

Early recognition of autism. Parental reports vs clinical observation

OBJECTIVE

To determine which behavioral characteristics of autism are apparent in early childhood and to examine the relative contributions of clinical observation and parental reports to early identification of autism.

DESIGN

Blinded comparison of behavioral data obtained through parental reports and clinical observation.

SETTING

Child development referral center.

PATIENTS

Twenty-six children (23 boys and three girls) younger than age 48 months with a clinical diagnosis of autism.

SELECTION PROCEDURES

Consecutive sample.

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Social interaction, communication, and activities and interests were evaluated using standard diagnostic criteria for autism. Results suggested that deficits in the areas of social interaction, imitation, play, and nonverbal communication are more prominent than insistence on sameness and routines in young children with autism. Also, parental reports and clinical observation appear to detect different aspects of abnormal behavior patterns in this sample.

CONCLUSIONS

Improved awareness of the early signs of autism should help physicians recognize this disorder in a timely manner. Further research may identify how observation of play and parental reports might be incorporated efficiently into a physician's repertoire of developmental and behavioral screening tools.

Cultural transmission of a sign language when deafness is caused by recessive alleles at two independent loci

Two unlinked autosomal loci are assumed to affect the ability to hear in such a way that homozygosity for the recessive allele at either locus causes deafness. The five deaf genotypes are subject to the same negative selection due to a lower likelihood of marriage, but unmarried deaf persons remain socially active and participate in the cultural transmission of sign languages. Marriages are assortative for deafness or for hearing, and mutation occurs irreversibly from the dominant to recessive allele at each locus at the same rate. At mutation-selection balance, the fully polymorphic equilibrium is symmetrical. Based on this genetic model, we consider the relative importance of various forms of cultural transmission as they affect the persistence of sign languages. Horizontal transmission is shown to be effective when deaf children are able to interact with many peers. This observation is especially pertinent if assortative meeting of deaf children occurs, for example, at schools for the deaf. Oblique transmission can also be effective, but the literature suggests that this kind of transmission plays only a minor role. It is necessary, however, that some form of cultural transmission occur between generations. Thus, vertical transmission is a critical factor, despite the fact that parent-child transmission is often interrupted due to the recessive inheritance of deafness. In particular, the contribution of vertical transmission is enhanced by assortative mating for deafness.

Emotional and behavioral problems and severe academic delays among sheltered homeless children in Los Angeles County

OBJECTIVES

Few studies have estimated the extent of specific emotional, behavioral, and academic problems among sheltered homeless children. The objectives of this study were to describe such problems, identify those children with the problems, and evaluate the relationship between child problems and use of physical and mental health services.

METHODS

From February through May 1991, 169 school-age children and their parents living in 18 emergency homeless family shelters in Los Angeles County were interviewed. To evaluate the answers, interviewers used standardized measures of depression, behavioral problems, receptive vocabulary, and reading.

RESULTS

The vast majority (78%) of homeless children suffered from either depression, a behavioral problem, or severe academic delay. Among children having a problem, only one third of the parents were aware of any problem, and few of those children (15%) had ever received mental health care or special education.

CONCLUSIONS

Almost all school-age sheltered homeless children in Los Angeles County have symptoms of depression, a behavioral problem, or academic delay severe enough to merit a clinical evaluation, yet few receive specific care. Programs targeted at sheltered homeless school-age children are needed to close this gap.

Social competence deficits in adolescents at risk for schizophrenia

Social competence in subjects at risk for schizophrenia and affective disorder and in normal-comparison subjects was examined in childhood and adolescence. Based on interviews with the parents of the subjects and with the children and adolescents themselves, subjects at risk for schizophrenia had poorer overall social competence than subjects at risk for affective disorder and comparison subjects in early adolescence and adolescence but not in childhood. In analyses of specific aspects of social competence, the adolescents at risk for schizophrenia had significantly poorer peer relationships and decreased hobbies/interests than the adolescents at risk for affective disorder and the normal-comparison adolescents. With respect to school adjustment, however, the two groups of adolescent offspring of parents with psychiatric disorders had significantly poorer adjustment than the comparison adolescents but did not differ from each other on this measure. These results suggest that various aspects of poor social competence may precede the onset of schizophrenia and play an important role in its development.

Pediatric airway in health and disease

The most common cause of pediatric anesthetic morbidity is the failure to adequately oxygenate. Problems with pediatric airways are the major cause of this inability to provide adequate oxygenation. Problems with pediatric airways and the diseases that affect them require not only knowledge about their pathophysiology but also considerable hands-on experience and respect for the complications that subsequently occur. It is hoped that by sharing knowledge and experiences, pediatricians can improve the care all of us strive to give our young patients.

The size illusion in children from five years of age and adults

First it was established that the size illusion occurs not only when complex patterns are presented kinaesthetically but even with simple stimuli such as straight lines and circles. Thus it was established that information overload is not the underlying cause of the illusion. The size illusion was investigated in children aged from five to twelve years and in adults. The stimulus circle was presented in passive kinaesthetic, sequential visual, in combined kinaesthetic and sequential visual, in static visual, and in combined kinaesthetic and static visual conditions either at fast or at slow speeds. A between-subjects design was used. In all conditions where the stimulus presentation included the kinaesthetic modality alone or in combination with visual or sequential visual conditions, size overestimation was found, while in the sequential visual and static visual conditions overestimation of the size of the stimulus was absent. Further, the kinaesthetic illusion was stable across the age range tested, indicating that the illusion is a property of the kinaesthetic system and is not influenced by learning, ie is hard wired.

Psychosocial development of urban children (below 2 years) using culture appropriate indicators of development

Six hundred essentially normal children 15 days-2 years were randomly assessed for their nutritional and developmental status. Measurement of the mid-upper-arm circumference using the Jellife's technique was employed for a quick nutritional survey. For developmental assessment, the WHO suggested culture appropriate psychosocial Basic Test Battery was used. Shakir's classification of the results did not reveal any malnutrition. Analysis of the data revealed 'at par' performances in Gross Motor, Hearing and Self Help skills and delays in Vision and Fine Motor, Language and Concept Skills. Social skills were particularly advanced.

An exploratory study of mirror-image shape discrimination in young children: vision and touch

30 children (18 boys and 12 girls) with a mean age of 4 yr., 8. mo. were subjects in an experiment testing the relative dominance of visual and tactual modalities in mirror-image shape discrimination. The sets of unfamiliar stimuli (written and wooden letters of the English alphabet, P, B, C, U, R, F) were presented to the children randomly. Children matched the stimulus with either another visual or another tactual shape. Analysis suggests touch is not inferior to vision in mirror-image shape discrimination. These results are different from those of previous reports comparing tactual and visual discrimination with nonmirror-image patterns.

Prepubescent children may have specific deficits in olfactory sensitivity

In three age groups (mean ages 9, 15, and 20 years, ns = 58, 58, 112) olfactory sensitivity to 5 odorants was assessed. The prepubescent children showed no loss in sensitivity to the odor of amyl acetate but were inferior in detection of the other 4 odorants, in particular, in detection of 2 musk odors. The results suggest odorant-specific receptor development during puberty. However, it is emphasized that several factors should be better controlled before it can be concluded that changes with age can be used as a model to increase knowledge of olfactory function.

Maternal vitamin A status and its importance in infancy and early childhood

Early fetal vitamin A supplies must be regulated to avoid teratogenic consequences from too little or too much. Late in gestation, adequate maternal vitamin A status is important for newborn reserves and for sustaining adequate breast-milk concentrations. Vitamin A supplements are not needed for most pregnant women in Western countries who consume the recommended dietary allowance during their reproductive years. Increased consumption of vitamin A-rich foods can meet increased needs during lactation. Women in developing countries whose habitual intakes are near basal needs should receive an additional 100 micrograms retinol equivalents (RE) during pregnancy and 300 micrograms RE during lactation. Supplements not above 3000 micrograms RE (10,000 IU) daily are safe for fertile women where circumstances preclude obtaining the needed increment through diet. The first postpartum month is the only safe period during which to provide deficient lactating women with a single high-dose supplement to benefit the mother and breast-feeding infant for several months.

Developmental outcome of infants with neonatal polycythemia

The study of the developmental outcome of neonatal polycythemia was performed on 47 polycythemic and 21 controlled infants who were born at the same period of time. It was found that at the age of 1 1/2 to 2 years the number of infants with abnormal DQ was higher in the group of total polycythemic infants (47%) and in the group of asymptomatic polycythemic infants (45%) than that of the control groups (19% and 5.6% of the groups including twin sibs and excluding twin sibs respectively). There was no difference in the developmental test between the symptomatic and asymptomatic patients. In asymptomatic infants the benefit of partial plasma exchange transfusion on developmental outcome was not found and only low birthweight and small for gestational age infants are the risk factors for poor developmental outcome.

Height and weight measurements of male Turkish adolescents according to biological maturation

Eight hundred and seventy-nine Turkish male adolescents aged between 11 and 19 years were investigated with respect to their physical development. Bone ages were considered as well as chronological ages in determining biacromial (BAC), biiliac lengths (BIC) and chest circumference (CC). Different bone and chronological ages were obtained at the same chronological age (CA) and bone age (BA) columns. The importance of bone ages in evaluating an adolescent's physical development was shown to be as important as the chronological ages. In this study, the mean BAC, BIC and CC values between the same CA but different BA groups showed statistically significant differences (P < 0.001). When the measurements of two consecutive age groups who had the same CA and BA and who were found to be statistically significant (P < 0.05) were compared, the maximum increments in BAC and BIC values which were between 13 and 14 years of age (2 and 1.4 cm, respectively) were similar to the maximum increment in height and weight of Turkish male adolescents found between 13 and 14 years of BA. The maximum increment in CC values which were between 14 and 15 years and 15 and 16 years (4.1 cm each) was 1 year after the maximum increment in height and weight for BA of Turkish male adolescents (13-14 years) and was similar to maximum weight increment for CA which was between 15 and 16 years.

The development of eye alignment, convergence, and sensory binocularity in young infants

PURPOSE

To measure and compare the development of ocular alignment, sensory binocularity, and convergence in infants during the first 5 months of life.

METHODS

Healthy infants were tested between 2 and 21 weeks of age. Ocular alignment was measured by the Hirschberg test; convergence was determined by visual examination as an illuminated toy approached an infant's face; and sensory binocularity was measured by preferential looking for fusible versus rivalrous gratings. In experiment 1 we compared the proportion of infants at different ages demonstrating orthotropic ocular alignment with those showing convergence. In experiment 2, we compared the age of onset of convergence to that of sensory binocularity.

RESULTS

Experiment 1: Most infants were orthotropic during the first month, and almost all of the others showed small amounts of exotropia. None of the infants showed accurate convergence until 6 weeks of age. By 4 months of age virtually all were orthotropic and had good convergence. Experiment 2: The onset of sensory binocular fusion occurred at 12.8 +/- 3.3 weeks. Full convergence did not occur until 13.7 +/- 3.2 weeks, although the first signs of convergence occurred slightly earlier. For individual infants there was a high correlation between the age of onset of sensory binocularity and convergence, and both onsets occurred earlier in girls than in boys.

CONCLUSIONS

Ocular alignment did not require the development of binocularity mechanisms, and the development of binocularity mechanisms did not await the onset of good ocular alignment. The relatively sudden onset of binocularity, both sensory (preference for fusion and stereopsis) and motor (convergence) at about 3 months of age and the high correlation between these measures indicate a common causal mechanism that probably involves refinements in striate cortex circuitry.

The effects of child temperament, maternal characteristics, and family circumstances on the maladjustment of school-age children

Eighty-nine mothers with children between the ages of 8 and 11 years reported perceptions of their child's adjustment and temperament, and described concurrent family circumstances such as socioeconomic status, level of parental distress, major life events experienced, maternal hassles, and their own psychiatric symptoms. A conceptual model hypothesizing the direct and indirect effects of family circumstances, maternal characteristics, and child temperament on the maladjustment of school-age children was tested using causal modeling with residual analysis. Fifty-six percent of child externalizing behavior was directly explained by the negative reactivity and nonpersistence of the child's temperament, and maternal hassles. A total of 33% of the variance of internalizing behavior was explained by the direct effects of negative reactivity of the child's temperament and maternal hassles. For both externalizing and internalizing behavior, a total of 54% of the variance in maternal hassles was explained by three variables: maternal psychiatric symptoms contributed 34%, major life events added 15%, and the intensity of the mother's temperament added an additional 5%. These three variables have a direct effect on maternal hassles and together had an indirect effect of .24 on child externalizing behavior through maternal hassles. Likewise, they have a direct effect on maternal hassles and together had an indirect effect of .31 on child internalizing behavior through maternal hassles.

Developmental issues in young children's learning of sexual abuse prevention concepts

This research is an item analysis of a measure of knowledge of sexual abuse prevention concepts, the Children's Knowledge of Abuse Questionnaire (C.K.A.Q.), which was utilized in an evaluation of an elementary school program. The literature review highlights developmental theories that distinguish between children in Grades 1, 3, and 6 (N = 111). These theories may explain the obtained differences in children of various ages in learning core prevention concepts. The findings are of interest in three ways: inspection of differences in the ease with which the children of each age group responded to specific items even before seeing a prevention program; identification of items in which there was significant improvement after the children participated in the prevention program; and evidence to suggest that children of different ages responded differentially to certain prevention concepts. The implications for the development, presentation and evaluation of child abuse prevention programs are discussed.