The "diff-if". Use of microcomputer analysis to triage blood specimens for microscopic examination

Increasingly, all automated blood counts are not accompanied by a microscopic white blood cell differential. A popular strategy is to obtain a manual differential if any part of the automated blood count and differential is outside specified limits (the "diff-if" strategy). The authors compared two sets of criteria to triage blood counts for manual differentials: previously recommended numeric values, and the analysis of a microcomputer program. In a population of subjects with a high percentage of hematologic disorders, the microcomputer program and the numeric criteria were equally specific (excluding normal blood smears); the program was more sensitive for bands, immature granulocytes, monocytes, nucleated red blood cells, reticulocytosis, teardrops, red blood cell fragments, and hypersegmented neutrophils. The numeric criteria were more sensitive for eosinophilia (less than 1.0 X 10(9)/L) and mandated fewer manual differentials. In a population of predominantly normal subjects, the program was more sensitive for increased bands and equally sensitive for eosinophilia, the only abnormalities observed on the smear. In a population of subjects with predominantly abnormal blood counts, but excluding most primary hematologic disorders, there were few blood smears with abnormalities beyond eosinophilia or increased bands. In both of these groups, the computer program mandated more manual differentials than did the numeric criteria. The authors conclude that microcomputer analysis by the program tested was more sensitive than numeric criteria to identify specimens with abnormal blood smears. Specificity depended on the patient population. The choice of a triage strategy should be based on the individual laboratory's patient population.

Evaluation of BCDE, a microcomputer program to analyze automated blood counts and differentials

A microcomputer program (BCDE) has been developed to analyze automated blood cell counts and differentials' similarity to normal values or to 36 disease categories. In 50 normal subjects, the analytic program listed the correct diagnosis as the first diagnosis in 49 cases (the only diagnosis in 44) and second of two diagnoses in one case. In 182 subjects with known hematologic disorders, the correct diagnosis was listed first in 134 and second or third in an additional 40. Subjects with iron deficiency, heterozygous thalassemia, immune thrombocytopenia, anemia of chronic disease, reactive thrombocytosis, acute infection, and chronic leukemia had the disorder identified as the most likely one by the analytic program with both sensitivity greater than 80% and specificity greater than 98%. Subjects with acute leukemia, folate deficiency, sickle cell anemia, cytotoxic chemotherapy, and chronic liver disease had the disorder identified as most likely by the program with a sensitivity less than 80%. In a different 11 cases with known hematologic status, a panel of 37 physicians identified the disorder(s) or normality only 72% of the time, whereas the analytic program listed the correct diagnosis first in 10 of 11 (91%). The analytic program appears useful for both triage of normal from abnormal data and for the initial differential analysis of abnormal data.

Mother-child interaction at age two years and perceived difficult temperament

The current study investigated a hypothesized link between early child temperament and later problem behavior. Early temperament was assessed at ages 6, 13, and 24 months via mother ratings on age-appropriate versions of the Infant Characteristics Questionnaire. The 24-month form was developed in this study. Factor analyses of the questionnaire indicated a clear difficultness factor that was similar in content across all 3 ages. The 6-, 13-, and 24-month difficultness factors were correlated with home observation measures of mother-toddler interaction at age 24 months. Home observation indexes focused on situations where the mother tried to control the toddler's "trouble" behavior. Children rated by their mothers as difficult at 24 months were found to approach "mild trouble" more frequently than children perceived as easy or average. Furthermore, their mothers used intrusive control tactics more frequently than mothers of easy or average children. Analysis of behavior sequence variables showed that difficult children resisted their mothers' control attempts significantly more often than easy or average children, that is, had more conflict with the mothers. The 6- and 13-month difficultness scores predicted both the 2-year-old difficultness rating and the observed conflict indexes. It is suggested that the conflict observed in the interaction between the difficult 2-year-olds and their mothers is conceptually similar to the conflictual behavior characteristic of older, clinically referred, socially aggressive children and their mothers. Thus, the conflicted interactions found at age 2 years may represent an empirically based link between difficult infant temperament and the development of childhood problem behavior.

Continuity of individual differences in the mother-infant relationship from six to thirteen months

The current study searched for continuities in mother-infant interaction observed at home, maternally perceived infant difficultness, and infant developmental competency. Also assessed were the possible moderator variables of maternal report of satisfaction with adjustment to the infant and background characteristics, for example, SES, presence of other young children, and infant gender. 128 dyads were assessed at ages 6 and 13 months. Many of the variables used to evaluate continuity were composites based on factor analysis. Bivariate correlations between 6- and 13-month variables produced a complex picture. In broad overview, as predicted by the prior literature, they indicated some degree of stability for mother variables and markedly less for the infant variables. Canonical correlation analysis yielded 3 significant canonical variates, producing a more integrated picture. The dimensions of continuity revealed by these variates were (1) Affectionate, Intellectually Stimulating Mothering, which had modest-to-moderate links to the indexes of infant competence; (2) Infant Temperamental Difficultness, which was determined mainly by consistency in mother report on 2 age-adjusted versions of the Infant Characteristics Questionnaire but which also contained loadings for objectively observed infant fussing, crying, and social demandingness; and (3) an unnamed dimension which resembles a pattern of intense involvement, both positive and negative, seen in older, clinically referred families.

The cries of infants of differing levels of perceived temperamental difficultness: acoustic properties and effects on listeners

The meaning of mother perceptions of their infants' temperamental difficultness was explored in 3 ways. (1) Subjective ratings were elicited from unrelated mothers of infants (N = 45) who listened to the cries of 4-6-month-old infants perceived by their own mothers as having difficult, average, or easy temperament (N = 4 per category). Subjects rated the difficult- and average-group cries as more irritating and spoiled sounding than the easy-group cries, and more likely to be due to emotional or psychological causes. However, there were no differences in the subjects' hypothetical interventions. (2) The meaning of the difficultness designations was also tested by measuring the acoustic properties of the cries of the 12 infants using sound spectrographs. The clearest difference was that the more difficult groups showed increased amounts of pausing within and between cry sounds, which is interpreted as adding a sense of urgent demand to the cry communication. (3) The study also considered the effects of a variety of listener background, personality, and attitude variables. The listener's perception of the difficultness of her own 4-6-month, firstborn infant was not related to ratings of the cries, but her prior experience with infants and level of self-described empathy were related to the ratings. For example, the more experienced the listener, the less the easy and average infants' cries were rated as spoiled, and the more the difficult infants' cries were seen as spoiled.

Dimensions of individuality in the mother-infant relationship at six months of age

Prior studies on mothers and infants have explored a great many individual variations. To date, however, the empirically based meaningfulness of these variations is quite limited. The current study attempts to achieve a relatively comprehensive empirical description of the mother-infant relationship at the age of 6 months, with special focus on possible correlates of infant developmental competence. 168 mother-infant pairs contributed data on a wide variety of measures, including the following categories: (a) observed interactions, at home and in the laboratory; (b) mother perception of the infant's temperament, mother personality, social support, and family adjustment to the new baby; (c) infant performance on the Bayley test; and (d) background variables such as birth order and economic status. Relationships among the various measures were modeled with factor analytic methods and interpreted in connection with current research issues. The most important findings are the following: (1) The main factor is widely generalizable dimension in maternal behavior of warm, responsive interaction with the infant. (2) Some elements of this main factor overlap with another factor indexing the extent to which mother impresses observer as educationally stimulating. Social class was associated with this teaching factor, but not with the first, more affection- and play-oriented, dimension. (3) Mother perceptions of difficult temperament in the infant were associated with objectively observed crying and fussing but were essentially independent of the major dimensions of maternal behavior. (4) Observed active and happy behaviors of the infant were somewhat related to normative status on the Bayley test, but neither active and happy behavior nor Bayley score correlated with the important dimensions of maternal behavior.

Adult individual differences as moderators of child effects

Experimentally varying child behavior stimuli and then assessing the extent to which adult individual differences (especially in cognitions) moderate the effect of the child on the adult is a variation on the usual methods in child effects research. This method allows description of the role of child effects in more complex adult-child systems. Existing literature incorporating this approach is reviewed, with emphasis on the moderating effects of sex, personality, and perceptions. A previously unreported study is described as an example of a multivariate approach to exploring the relationships between adult individual differences and the effects of infant stimuli. The study suggests that experienced caregivers who do not have much liking for infants see themselves as likely to provide appropriate, but minimally social care for an infant. Conversely, the study suggests that inexperienced adults who like infants very much see themselves as providing more extensive and social caregiving, although it would not always be appropriate to the infant's state.

Gender typing of game choices and qualities of boys' play behavior

Relationships between gender choices and both movement patterns and social behavior were studied in first- and second-grade boys. Three-child, structured play groups were each composed of a boy whose mother saw him as high masculine in play preference on the Games Inventory, one seen as average, and one low masculine. Behaviors rated from videotapes included gender presentation variables, (e.g., leg separation), indicators of dominance and personal comfort (e.g., range of movements), and indicators of social skill and peer response (e.g., interaction initiations). The low masculine boys were found to be the most feminine in their gender presentation, least dominant and aggressive, and the lest socially successful of the boys. The greatest difference was between the low and the high masculine boys. The average masculine boys' scores were generally intermediate, but more similar to the low masculine boys on some variables and more similar to the high masculine boys on others. These conclusions apply to a grou interaction play task, but not to an initial noninteractive play task. A secondary study in which girls played with low and average masculine boys is also reported. Here it was found that low masculine boys were generally intermediate between average boys and girls on gender presentation and dominance variables, but lowest of the groups on social interaction variables.

Measurement of infant difficultness

The Infant Characteristics Questionnaire (ICQ) was developed as a short, factor-analytic screening device for difficultness. Responses of 322 mothers of 4-6-month-old infants suggested that they regard the fussy, hard-to-soothe, labile infant as difficult. Mother report on the ICQ, particularly on the main fussy-difficult factor was found to have adequate reliability over time and convergence with the Carey Survey of Temperamental Characteristics, with father report on the ICQ, and, to a lower degree, with home data collected by independent observers. It was also found that mother characteristics may affect perceptions of infant difficultness: multiparous, extraverted mothers tended to rate their infants as easy.

Gender-deviant boys compared with normal and clinical control boys

The physical movement and social characteristics of effeminate behavior-problem, referred boys (N = 13) were compared with those of normal boys (N = 25) and boys (N = 12) referred for nongender problems. Parent reports, observer ratings, and videotapes were collected in a series of structured tasks. As expected, mothers described gender-problem sons as much more feminine than the other two groups in interests, activities, and mannerisms. Gender-problem sons were also seen as relatively inactive and introverted. Further, they were nonsignificantly lower than the clinical control boys in perceived behavior problems, but both groups had marginally more problems than the normal boys. Gender-problem and clinical control boys both showed more body constriction than normal boys in ratings of a videotaped interview. They also both showed less ideal ball-throw form than normal boys on a set of variables scored with slow-motion video. However, in a set of behaviors directly rated in the various tasks, the gender-problem boys gave a uniquely general impression of uncoordination. The groups did not differ on seven additional variables.

Human figure drawings of gender-problem and school-problem boys

In this study 19 boys aged 4 through 13 years referred for gender problems were compared with 35 similar-aged boys referred for school problems on variables derived from sets of human figure drawings. The results indicated that gender-problem boys, relative to school-problem boys, were more likely to draw female figures in response to a Draw-a-Person (DAP) instruction, were more likely to draw figures with good rather than average body proportion, tended to draw more articles of clothing on their figures, and tended to draw their female figures larger than their male figures. There were no differences between the groups in the frequency of emotional disturbance indicators, frequency of age-expected or age-exceptional figure details, and total number of body features. These results are discussed in terms of their implications for the validation of the DAP procedure, their contribution to an understanding of boyhood effeminacy, and their implications for the role of the DAP test as a clinical assessment procedure only in conjunction with other sources of information.