Extreme deprivation in early childhood--II. Theoretical issues and a comparative review

Developmental Models and Early Experience

This paper attempts to describe links between the transactional or dialectical and the mechanistic models of development and to provide a rationale for why both types are useful. Examples of data sets, deriving principally from the early experience literature, are provided which conform to both, and it is concluded that the applicability of the model for describing behavioral development is strongly influenced by where the individual stands on three empirical dimensions: (1) the relative power of the environments that the individual is exposed to; (2) the plasticity of the individual's behavior; and (3) the deviation of the individual from developmental norms. These factors crucially affect the degree of reciprocity found in organism-environment interactions, and the results suggest that differences between developmental models are reconcilable.

The Identification of Special Educational Needs

The publication in the United Kingdom in 1978 of the Warnock Report (Department of Education and Science, 1978) provided a landmark in the development of both resources for and conceptualization of children with special educational needs. Not only did it provide the basis for legislation in the form of the 1981 Education Act, but it also altered the way in which the issue of special education was viewed. For present purposes, the major aspect was the assertion that about one in six children would have special educational needs at any one time, and about one in five sometime during their school lives.

Translation gone awry: differences between commonsense and science

A general assumption is that science is just organised commonsense. It is noted that translation involves a two-way pathway between basic laboratory science and patient care, and that some scientific findings have implications for prevention rather than treatment. A succinct critique follows on the key features that differentiate science and commonsense. The main part of the paper discusses six rather different examples of translation that went awry because people treated science and commonsense as equivalent. Examples based on empirical evidence of translation going awry include (i) the claim that only early intervention can bring lasting benefits; (ii) the claim that the main policy goal for children should be the elimination of all stresses; (iii) the claim that exposure in utero to maternal smoking causes ADHD and conduct disturbance; (iv) the claim that tax benefits should be used to encourage couples to marry; (v) the effects of profound institutional deprivation are similar to those of any adversity; and (vi) environmental effects are largely independent of genetic influences. Much of science is 'unnatural' in the sense that technical tools (such as imaging or DNA) are employed, or because animal models are used, or because unusual comparisons are made. Science cannot be based solely on an inductive process; rather, there must be some form of experiment and the testing of two or more alternative explanations. Translation needs to be based on top quality science and an appreciation that even the best science needs to take account of multiple strategies and multiple evaluations.

The role of deprivation, abuse, and trauma in pediatric catatonia without a clear medical cause

OBJECTIVE

Catatonia is considered a unique syndrome of motor signs, at times life-threatening when aggravated by autonomic dysfunction and fever, but eminently treatable with specific medical treatments, if recognized early. Catatonia commonly occurs in children and adolescents with a wide range of associated disorders. The role of deprivation, abuse, or trauma in the development of pediatric catatonia is examined.

METHOD

Reports considering deprivation, abuse, or trauma as precipitants of catatonia in pediatric cases are culled from the classic writings on catatonia and from a selective review of modern contributions.

RESULTS

Kahlbaum gave trauma a central role in catatonia in many young adult cases. Kanner described children with psychogenic catalepsy. Anaclitic depression, a condition found by Spitz in deprived institutionalized children, strongly resembles stuporous catatonia. Leonhard considered lack of communication with the mother or substitute mother as an important risk factor for childhood catatonia. Children including those with autism who experience emotional and physical trauma sometimes develop catatonia. The clinical descriptions of children with classic catatonic syndromes and those of contemporary refugee children with a syndrome labeled Pervasive Refusal Syndrome are similar.

CONCLUSION

The literature supports the view that deprivation, abuse, and trauma can precipitate catatonia in children and adolescents.

Resilience and development: Contributions from the study of children who overcome adversity

This article reviews the research on resilience in order to delineate its significance and potential for understanding normal development. Resilience refers to the process of, capacity for, or outcome of successful adaptation despite challenging or threatening circumstances. Three resilience phenomena are reviewed: (a) good outcomes in high-risk children, (b) sustained competence in children under stress, and (c) recovery from trauma. It is concluded that human psychological development is highly buffered and that long-lasting consequences of adversity usually are associated with either organic damage or severe interference in the normative protective processes embedded in the caregiving system. Children who experience chronic adversity fare better or recover more successfully when they have a positive relationship with a competent adult, they are good learners and problem-solvers, they are engaging to other people, and they have areas of competence and perceived efficacy valued by self or society. Future studies of resilience will need to focus on processes that facilitate adaptation. Such studies have the potential to illuminate the range and self-righting properties of, constraints on, and linkages among different aspects of cognitive, emotional, and social development.

Health before and after adoption from Eastern Europe

DESIGN

A population-based study of pre-adoption, arrival and post-adoption health.

AIM

To report prenatal and postnatal background factors, morbidity, growth and development in adoptees from Eastern Europe.

SUBJECTS AND METHODS

All 99 children born in Eastern Europe between 1990 and 1995 and adopted to western Sweden during 1993-1997 were invited to participate in the study. Altogether, 76 (77%) participated. Medical records from the birth countries, from the examination at arrival and from medical reports made during a mean post-adoption period of 5 years were evaluated.

RESULTS

Low birth weight (< or = 2500 g) occurred in 48%. Congenital malformations were found in 22%. The biological mothers of 33% of the children had been considered alcoholics, and 16% of the children's mothers had been diagnosed with a psychiatric disability. A high incidence of infectious diseases, neurodevelopment disorders and growth retardation had been noted during the pre-adoption period. Upon arrival in Sweden 75% were diagnosed with a medical condition, most often an infection. After a 5-year post-adoption period, small head circumference was associated with alcohol exposure during pregnancy and 46% had at least one neurodevelopment or behavioural disorder.

CONCLUSION

Adverse prenatal and perinatal factors, congenital malformations and post-adoption neurodevelopment disorders were common. Adoptees and adopters have complex needs for health support and information.

Do the Effects of Early Severe Deprivation on Cognition Persist Into Early Adolescence? Findings From the English and Romanian Adoptees Study

Cognitive outcomes at age 11 of 131 Romanian adoptees from institutions were compared with 50 U.K. adopted children. Key findings were of both continuity and change: (1) marked adverse effects persisted at age 11 for many of the children who were over 6 months on arrival; (2) there was some catch-up between ages 6 and 11 for the bottom 15%; (3) there was a decrease of 15 points for those over 6 months on arrival, but no differentiation within the 6-42-month range; (4) there was marked heterogeneity of outcome but this was not associated with the educational background of the adoptive families. The findings draw attention to the psychological as well as physical risks of institutional deprivation.

Holding on to childhood language memory

While early language experience seems crucial for mastering phonology, it remains unclear whether there are lasting benefits of speaking a language regularly during childhood if the quantity and quality of speaking drop dramatically after childhood. This study explored the accessibility of early childhood language memory. Specifically, it compared perception and production of Korean speech sounds by childhood speakers who had spoken Korean regularly for a few years during childhood to those of two other groups: (1) childhood hearers who had heard Korean regularly during childhood but had spoken Korean minimally, if at all; and (2) novice learners. All three groups were enrolled in first-year college Korean language classes. Childhood speakers were also compared to native speakers of Korean to see how native-like they were. The results revealed measurable long-term benefits of childhood speaking experience, underscoring the importance of early language experience, even if such experience diminishes dramatically beyond childhood.

Children's play

This paper draws upon research from a number of disciplines to examine the significance of children's play. It concludes that play may well be central to normal personality development. However, its place in contemporary Western society is not secure, perhaps risking the development and well-being of urban and disadvantaged children in particular.

Testing hypotheses on specific environmental causal effects on behavior

There have been strong critiques of the notion that environmental influences can have an important effect on psychological functioning. The substance of these criticisms is considered in order to infer the methodological challenges that have to be met. Concepts of cause and of the testing of causal effects are discussed with a particular focus on the need to consider sample selection and the value (and limitations) of longitudinal data. The designs that may be used to test hypotheses on specific environmental risk mechanisms for psychopathology are discussed in relation to a range of adoption strategies, twin designs, various types of "natural experiments," migration designs, the study of secular change, and intervention designs. In each case, consideration is given to the need for samples that "pull-apart" variables that ordinarily go together, specific hypotheses on possible causal processes, and the specification and testing of key assumptions. It is concluded that environmental risk hypotheses can be (and have been) put to the test but that it is usually necessary to use a combination of research strategies.

How can we boost IQs of "dull children"?: A late adoption study

From 5,003 files of adopted children, 65 deprived children, defined as abused and/or neglected during infancy, were strictly selected with particular reference to two criteria: (i) They were adopted between 4 and 6 years of age, and (ii) they had an IQ <86 (mean = 77, SD = 6.3) before adoption. The average IQs of adopted children in lower and higher socioeconomic status (SES) families were 85 (SD = 17) and 98 (SD = 14.6), respectively, at adolescence (mean age = 13.5 years). The results show (i) a significant gain in IQ dependent on the SES of the adoptive families (mean = 7.7 and mean = 19.5 IQ points in low and high SES, respectively), (ii) IQs after adoption are significantly correlated with IQs before adoption, and (iii) during adolescence, verbal IQs are significantly lower than performance IQs.

How specific are "specific developmental disorders"? The relevance of the concept of specific developmental disorders for the classification of childhood developmental disorders

The concept of "specific developmental disorder" (SDD) refers to delays in developmental domains such as language and speech development, motor coordination or the development of scholastic skills, in the absence of sensory deficits, subnormal intelligence or poor educational conditions. The key element in this concept is the notion of a discrepancy between observed and expected level of development. In DSM-III-R and ICD-10, SDD serves as a conceptual umbrella, suggesting that the subsumed disorders are of the same type. In DSM-IV, the SDD umbrella is not used explicitly, but the notion of a discrepancy is present in the categories of Learning Disorders, Motor Skill Disorder and Communication Disorders, suggesting a close relationship between these disorders. One of the advantages of the use of SDD as a unifying concept is that it contributes to the standardisation of the description of the various disorders. However, based on reviews of research regarding the reliability and validity of the SDD categories, we argue that the application of a unifying SDD concept has been premature. For each of the categories for disorders in scholastic skills, language, speech and motor coordination, the notion of a discrepancy between observed and expected level of development should be elaborated and tested more thoroughly, before SDD can be used as a unifying concept in classification.

Developmental factors influencing aggression. Animal models and clinical correlates

Clearly, models of developmentally induced aggression in animals can give us important insights into the factors inducing aggression in children. Several such models have been produced, and the neurochemical substrates eliciting the aggressive behavior have been identified. In many cases, the serotonergic system is involved. In the future, these animal models may also prove useful in identifying appropriate treatments.

Mother-child interaction and the cognitive and behavioural development of four-year-old children with poor growth

A whole population inner-city survey identified 23 stunted, otherwise healthy, children with persistently poor growth from infancy to 4 years. Their cognitive development was significantly retarded relative to a matched comparison group. Unstructured home observations were used to create transcripts of verbal and nonverbal mother-child interactions. In both groups child behavioural adjustment was linked to maternal negativity, and cognitive performance was correlated with quality of stimulation. The developmental delay associated with chronic failure to thrive appeared more likely to arise from other influences, perhaps a previous biological insult, than to contemporaneous parenting practices.

Case report: successful treatment of a case of extreme isolation

Tom, aged 10, presented as a stiff, plump boy with a very awkward gait and a completely blank facial expression. He was terrified of other children and could allow no one closer than an arm's length away from him. It transpired that for most of his life he had been kept "safe" in his bare room by his parents whose firstborn child had died. After 8 years of treatment he is now studying at a university and although he lives at home he seems to have made some friends. His facial expressions and tone of voice are now appropriate.

Cause and course of psychopathology: some lessons from longitudinal data

Case-control studies of clinic samples constitute the usual research method for the investigation of the causes and course of psychiatric disorder. However, they carry substantial disadvantages and if causal hypotheses are to be tested in rigorous fashion, it is necessary to use longitudinal research strategies applied to epidemiologically based samples. Their advantages are reviewed with respect to the use of 'experiments of nature' for testing causal mechanisms through the study of within-individual change over time in relation to some prospectively measured alteration in the risk variable. Attention is drawn to the value of longitudinal data in studying the processes involved in 'escape' from risk; in examining differential vulnerability to risk experiences; in validating diagnostic categories; in investigating the timing of disorders; and in evaluating the role of variables that cannot be recalled. The data from a range of longitudinal studies are used to note some of the key implications for developmental and psychopathological concepts.

[The outcome of deprived infants: a retrospective study]

What happens to deprived children when they grow up? The authors tried to answer this question by initially selecting 34 subjects clearly identified as suffering a deprivation syndrome in their youth. Following theoretical considerations, the authors formulated hypotheses which they attempted to verify by comparing the nine adult subjects available who had suffered deprivation during their youth with whom they were able to establish contact with nine others diagnosed as neurotic (the control group). The authors predicted that the deprived subjects would present more disability as adults than the neurotic ones. They were predicted to be more inclined towards delinquency and depression. It was hypothesized that they would not drift into psychosis, psychosomatic illness or become "young chronics". We did not expect that they would move very much on the social scale. The authors seized the opportunity to learn more about the satisfaction with the psychiatric interventions experienced during their youth. In this study, the authors used a questionnaire and four scales of the MMPI to compare the two groups. The deprived subjects demonstrated more maladaptation with a strong tendency towards delinquency and possibly depression. They were not mobile on the social scale, and did not drift into psychosomatic illnesses or become "young chronics" but some psychosis was observed among them. In the final discussion, the authors discuss the limitations of the study due to the size of the sample and problems of the methodology, along with ways that this could be strengthened in order to more successfully answer some of the questions raised.

Developmental psychiatry: a perspective

A brief historical introduction to developmental psychology puts twentieth century views into perspective. The ideas of continuity, critical periods and predictability are examined. The case for a developmental perspective of human development is argued, and the tenets underlying such a model are suggested. The utility of the study of human development is discussed.

Psychomotor and mental development during infancy. Relation to psychosocial conditions and health. Part IV of a longitudinal study of children in a new Stockholm suburb

This article presents the fourth substudy in a Swedish research project of a birth cohort of children in a newly-built Stockholm suburb. The aims are to follow and to describe their mental development by prospective methods. Here we present the results of the one-year follow-up. The children's mental development, measured with the Griffiths' Development Scales, and their behaviour in the test situation and during the home visit are described. These results are related to various psychosocial background factors (such as the parents' ages, number of siblings, form of custody), home environment factors (the parents' mental disease, addictions and criminality) and the children's physical health and development. Children with deviant behaviour during the home visits are described separately. Of 640 women who paid their first visit to the maternal welfare centers in a new Stockholm suburb during one prospective year, 532 (85%) were interviewed with regard to 41 stress factors forming a "Life stress score" (LSS). The interviews were supplemented with data from hospital, social welfare and police records concerning the expectant mother and the father. The 532 mothers were divided into three groups according to the degree of psychosocial stress (194 without psychosocial stress, 171 with severe psychosocial stress and 167 in an intermediate group). The pregnancies and deliveries of all mothers were evaluated. The physical health and development (using information from the child welfare clinics) and the mental health and development (using information from home visits and testings) were studied during infancy in 452 children (226 boys and 226 girls)--i.e. 77% of all children born in the suburb during the year. The children were tested with the Griffiths' Development Scales and their behaviour during the test was observed on home visits by the same psychologist (L.N.) at the age of 10 months (79 boys, 73 girls) or 14 months (92 boys, 107 girls), or about the age of 18 months (55 boys, 46 girls). The test results are mainly reported by descriptive methods. In summary, the results of the evaluation of the children's mental health during the first year of life, generally showed average developmental quotients. However, 20% of the children had values below the average. Thirty-two per cent of the children with low test results (less than -1 standard deviation on the total test) came from homes with serious psychosocial stress and 29% from homes with a mild degree of psychosocial stress. Of the nine children who had generally very low scores in the Griffiths' evaluation, seven came from homes with psychosocial stress.(ABSTRACT TRUNCATED AT 400 WORDS)

The autistic child's theory of mind: a case of specific developmental delay

In previous tests of the lowest level of a "theory of mind" (i.e. first-order belief attribution), 80% of autistic children were found to be impaired relative to a non-autistic mentally-handicapped control group. The present study examines the 20% of autistic children who have a theory of mind at the lowest level, and tests their ability to use a theory of mind at higher levels (i.e. second-order belief attribution). This autistic subgroup, in comparison to Down's Syndrome and normal control groups, was found to be severely impaired at the higher level. Autism is discussed as a possible case of specific developmental delay.

Thirty years of child psychology: a selective review

A selective review of the literature in child psychology over the last 30 years reveals substantial changes in methodology, in analysis and the interpretation of findings. Evidence on the multifactorial nature of development is drawn from genetic/environmental research, longitudinal studies and a consideration of potential long-term effects of early experience, including planned intervention. It is increasingly recognized that individuals play some part in causing their own development, via ongoing transactional processes. Eight themes form the basis for discussion, including the belated emergence of Piaget's theory and the changing outlook for the mentally retarded. In addition, the explosion of research upon infancy and the growing influence of behavioural psychology are noted.

Adam--a severely-deprived Colombian orphan: a case report

The case study of Adam, a severely-deprived Colombian orphan, is presented. At 16 months of age the child was suffering from severe marasmic malnutrition, his development was about the level of a 3-month old, he had been physically neglected and was emotionally withdrawn. Adam was adopted at 34 months of age. At 8 years of age his Full-Scale WISC-R-IQ was 113 and at 10 years of age he scored 100% on the Michigan Assessment Test. Now at 13 years 10 months he is functioning at the 8th grade school level, which is appropriate for his age, and his weight and height are in the 50th centile range.

Family and school influences on cognitive development

Family and school influences on cognitive development are reviewed in terms of the empirical research findings on (i) variations within the ordinary environment; (ii) family intervention studies; (iii) the effects of abnormal environments; (iv) extreme environmental conditions; (v) variations within the ordinary school environment; and (vi) preschool and school intervention studies. It is concluded that environmental effects on IQ are relatively modest within the normal range of environments, but that the effects of markedly disadvantageous circumstances are very substantial. Cognitive development is influenced both by direct effects on cognition and by indirect effects through alterations in self-concept, aspirations, attitudes to learning and styles of interaction with other people.

Developmental paediatrics in primary care: what should we teach?

There is little agreement about what constitutes good developmental paediatric practice at the level of primary care. Many of the available screening tests are intrinsically unsatisfactory or badly performed, but screening is only a small part of developmental paediatrics. Every primary care doctor should be familiar with the scientific basis of the subject even if a decision is made not to embark on a formal screening programme.

Family and school influences on behavioural development

Research findings are reviewed with respect to possible family and school influences on behavioural development, but with special reference to socially disapproved conduct. The hypothesis that statistical associations between environmental variables and children's disorders represent causal connections is considered in terms of the three main alternatives--hereditary influences, the effect of children on their parents, and the operation of some third variable. It is concluded that each has some validity but that nevertheless there are true environmental effects. The mechanisms underlying their operation are discussed with respect to parental criminality, family discord, weak family relationships, ineffective discipline, and peer group influences. Individual differences in response to adversity are discussed in terms of age, sex, temperament, genetic factors, coping processes, patterning of stressors, compensatory good experiences and catalytic factors. The various ways in which environmental effects may persist over time are considered in terms of linkages within the environment as well as within the child. It is concluded that long-term effects are far from independent from intervening circumstances.

Extreme deprivation in early childhood--I. Diverse outcomes for three siblings from an extraordinary family

An unusual family is described which has been studied for several years. Accounts are given of the later development of two sisters who had suffered severe social and emotional deprivation in infancy. One girl appears to have completely recovered. The other remains handicapped, mainly in language skills, and shows a variety of autistic features. She is also microcephalic as is their mother. The development of a half brother who was raised elsewhere is recounted. He is an albino, severely mentally retarded and autistic. The later discrepancies in development of these children are discussed, with reference to former case studies of extreme deprivation in early childhood.