Human immunity to the meningococcus. II. Development of natural immunity

Results of the present study suggest that natural immunity to meningococcal disease is initiated, reinforced, and broadened by intermittent carriage of different strains of meningococci throughout life. In young adults, carriage of meningococci in the nasopharynx is an efficient process of immune sensitization. 92% of carriers of serogroup B, C, or Bo meningococci were found to develop increased titers of serum bactericidal activity to their own meningococcal isolate, and 87% developed bactericidal activity to heterologous strains of pathogenic meningococci. The rise in bactericidal titer occurred within 2 wk of onset of the carrier state, and was accompanied by an increase in titer of specific IgG, IgM, and IgA antibodies to meningococci. In early childhood, when few children have antibodies to pathogenic meningococci, active immunization seems to occur as a result of carriage of atypical, nonpathogenic strains. Immunity to systemic meningococcal infection among infants in the neonatal period is associated with the passive transfer of IgG antibodies from mother to fetus. The antigenic determinants which initiate the immune response to meningococci include the group-specific C polysaccharide, cross-reactive antigens, and type-specific antigens.

Elevated amygdala response to faces following early deprivation

A functional neuroimaging study examined the long-term neural correlates of early adverse rearing conditions in humans as they relate to socio-emotional development. Previously institutionalized (PI) children and a same-aged comparison group were scanned using functional magnetic resonance imaging (fMRI) while performing an Emotional Face Go/Nogo task. PI children showed heightened activity of the amygdala, a region that supports emotional learning and reactivity to emotional stimuli, and corresponding decreases in cortical regions that support perceptual and cognitive functions. Amygdala activity was associated with decreased eye-contact as measured by eye-tracking methods and during a live dyadic interaction. The association between early rearing environment and subsequent eye-contact was mediated by amygdala activity. These data support the hypothesis that early adversity alters human brain development in a way that can persist into childhood, and they offer insight into the socio-emotional disturbances in human behavior following early adversity.

Telomere length and early severe social deprivation: linking early adversity and cellular aging

Accelerated telomere length attrition has been associated with psychological stress and early adversity in adults; however, no studies have examined whether telomere length in childhood is associated with early experiences. The Bucharest Early Intervention Project is a unique randomized controlled trial of foster care placement compared with continued care in institutions. As a result of the study design, participants were exposed to a quantified range of time in institutional care, and represented an ideal population in which to examine the association between a specific early adversity, institutional care and telomere length. We examined the association between average relative telomere length, telomere repeat copy number to single gene copy number (T/S) ratio and exposure to institutional care quantified as the percent of time at baseline (mean age 22 months) and at 54 months of age that each child lived in the institution. A significant negative correlation between T/S ratio and percentage of time was observed. Children with greater exposure to institutional care had significantly shorter relative telomere length in middle childhood. Gender modified this main effect. The percentage of time in institutional care at baseline significantly predicted telomere length in females, whereas the percentage of institutional care at 54 months was strongly predictive of telomere length in males. This is the first study to demonstrate an association between telomere length and institutionalization, the first study to find an association between adversity and telomere length in children, and contributes to the growing literature linking telomere length and early adversity.

Gastroesophageal reflux among severely retarded children

Of 136 institutionalized severely retarded children, 20 (15%) had recurrent vomiting. Of these 20, 15 had gastroesophageal reflux diagnosed by x-ray examination, acid reflux text, or both. Esophagitis was noted by endoscopy in ten of 14 patients with GER. Four patients were anemic and six had had one or more episodes of aspiration pneumonia in the 12 months prior to study. Reduced basal lower esophageal sphincter pressure was the most common manometric abnormality noted in the patients with GER. Responses of the LES to bethanechol and swallow were normal, as was the basal pressure of the upper esophageal sphincter. Abnormal propagation of esophageal peristalsis was seen in six patients, all of whom had moderate or severe esophagitis. When compared to the nonvomiting retarded patients, the GER patients had significantly lower mental age and higher incidence of scoliosis. Patients with GER who had basal LES pressure less than 10 mm Hg did not improve with medical management. Recurrent vomiting is a common and serious problem in severely retarded children, the organic cause of which can be demonstrated by the application of appropriate investigative techniques.

A comparison of the electroencephalogram between institutionalized and community children in Romania

Electroencephalographic (EEG) data were collected from a sample of institutionalized infants and young children in Bucharest, Romania, and were compared with EEG data from age-matched children from the local community who had never been institutionalized and who were living with their families in the Bucharest area. Compared with the never-institutionalized group, the institutionalized group showed a pattern of increased low-frequency (theta) power in posterior scalp regions and decreased high-frequency (alpha and beta) power, particularly at frontal and temporal electrode sites. This finding is consistent with EEG studies of children facing environmental adversity and children with learning disorders. The institutionalized group also showed less marked hemispheric EEG asymmetries than the never-institutionalized group, particularly in the temporal region. The results are discussed in the context of two models: that the pattern of EEG in the institutionalized children reflects a maturational lag in nervous system development, or that it reflects tonic cortical hypoactivation.

Hyperserotonemia and amine metabolites in autistic and retarded children

Mean whole blood serotonin (5-HT) levels were elevated in groups of autistic and severely retarded children. Eight of 27 (30%) individual autistic children, 13 of 25 (52%) severely retarded children, two of 23 (9%) mildly retarded children, and none of the control children had statistically significant blood 5-HT levels elevations (hyperserotonemia). Hyperserotonemic autistic children excreted more urinary 5-HT, 5-hydroxyindoleacetic acid (5-HIAA), tryptamine, and vanillylmandelic acid than did mildly retarded children with normal blood 5-HT levels. Rates of depletion and repletion of blood 5-HT levels in these two groups following reserpine therapy were identical. Oral tryptophan administration doubled urinary 5-HIAA excretion in both groups and raised urinary 5-HT levels in hyperserotonemic autistic children, but lowered urinary 5-HT in mildly retarded, normal blood 5-HT children. No clear mechanism for hyperserotonemia was found; the rationale for further investigations is discussed.

Reducing aggressive and self-injurious behavior of institutionalized retarded children through reinforcement of other behaviors

Aggressive and self-injurious behaviors of four retarded children were reduced by combining various techniques with the differential reinforcement of other behaviors (DRO). In one study, aggressive responses of a severely retarded child were reduced when DRO was combined with a 30-sec timeout. In a second study, various aggressive classroom behaviors were reduced when the child was told "no" for an inappropriate response but earned puzzle pieces for periods of time when inappropriate responses resulted did not occur. Exchangeable tokens were given to a third subject for every 15 min in which aggressive responding did not occur, while each inappropriate response resulted in the loss of all tokens accrued. Responding was decreased to a level far below baseline. For a fourth child, self-injurious responses were followed by "no", and intervals of time in which no self-injurious responding occurred earned candy. The rate of this behavior reduced significantly. In each case, the DRO procedure combined with the other techniques proved to be manageable for the teacher and successful in reducing the inappropriate behavior.

Acquisition of matching to sample via mediated transfer

Two severely retarded Down's-syndrome boys learned a matching-to-sample performance through mediated transfer. The transfer paradigm involved three sets of stimuli, one auditory set (A) and two visual sets (B and C). The subjects were taught directly to do B-A and C-B matching, but experienced no direct association between C and A. They acquired the ability to do C-A matching without having been taught that performance directly. They also learned indirectly to name some of the visual stimuli, but naming was apparently not the mediator in the emergent C-A matching. The use of words and letters as stimuli highlighted the possible relevance of mediated associations in the indirect acquisition of elementary reading comprehension and oral reading. The acquisition of matching via mediated transfer also raised some new considerations concerning the role of coding responses in arbitrary matching to sample.

The prevalence of early childhood autism: comparison of administrative and epidemiological studies

The results of surveys and inquiries to identify autistic children, carried out in England and Wales, the U.S.A. and Denmark, are compared. Three studies, in each of which either a total population of children or a wide range of handicapped children was screened, using case-note inspection and interviews, all estimated the prevalence of the autistic syndrome to be between four and five children per 10,000 aged under 15 years. Inquiries that counted diagnosed cases only or that relied upon local authority records produced much lower prevalence rates for the autistic syndrome. The reasons for this are examined, and the implications for prevalence studies of handicapping conditions are discussed.

Unraveling child abuse

This paper attempts to clarify the dynamics of child abuse, and to suggest approaches to primary prevention. Child abuse is redefined, within egalitarian value premises, as inflicted gaps in children's circumstances that prevent actualization of inherent potential. Levels of manifestation and causal dimensions of child abuse are identified, and their multiple interactions are traced. Primary prevention is shown to be essentially a political, rather than a purely technical or professional, issue.

Growth and associations between auxology, caregiving environment, and cognition in socially deprived Romanian children randomized to foster vs ongoing institutional care

OBJECTIVES

To determine effects of improved nurturing compared with institutional care on physical growth and to investigate the association between growth and cognitive development.

DESIGN

A randomized controlled trial beginning in infants (mean age, 21.0 months; range, 5-32 months), with follow-up at 30, 42, and 54 months of age.

SETTING

Institutionalized and community children in Bucharest, Romania.

PARTICIPANTS

One hundred thirty-six healthy institutionalized children from 6 orphanages and 72 typically developing, never-institutionalized children.

INTERVENTION

Institutionalized children were randomly assigned to receive foster care or institutional care as usual.

OUTCOME MEASURES

Auxology and measures of intelligence over time.

RESULTS

Growth in institutionalized children was compromised, particularly in infants weighing less than 2500 g at birth. Mean height and weight, though not head size, increased to near normal within 12 months in foster care. Significant independent predictors for greater catch-up in height and weight included age younger than 12 months at randomization, lower baseline z scores, and higher caregiving quality, particularly caregiver sensitivity and positive regard. Baseline developmental quotient, birth weight, and height catch-up were significant independent predictors of cognitive abilities at follow-up. Each incremental increase of 1 in standardized height scores between baseline and 42 months was associated with a mean increase of 12.6 points (SD, 4.7 points) in verbal IQ (P < .05).

CONCLUSIONS

Foster care had a significant effect on growth, particularly with early placement and high-quality care. Growth and IQ in low-birth-weight children are particularly vulnerable to social deprivation. Catch-up growth in height under more nurturing conditions is a useful indicator of caregiving quality and cognitive improvement.

A five- to fifteen-year follow-up study of infantile psychosis

Surprisingly little is known about the course of intellectual development in children with infantile psychosis. Kanner (1943; Kanner and Lesser, 1958) has stated explicitly in several papers that “even though most of these children are initially considered feeble-minded, they are all unquestionably endowed with good cognitive potentialities, which are masked by the basic disorder” (original italics—Kanner and Lesser, 1958). The expectation would seem to be that the child's IQ, should fluctuate with the course of the psychosis, particularly the autistic aspects, but this has not been tested. It has been suggested (Anthony, 1958) that an intelligence test result in a young child with infantile psychosis is most unreliable and virtually meaningless if the child is without speech. Perhaps because most investigators have shared this view, neither of the two major follow-up studies of children with infantile psychosis, that of Kanner's cases (Eisenberg, 1956; Eisenberg and Kanner, 1956; Kanner, 1943 and 1949; Kanner and Eisenberg, 1955; Kanner and Lesser, 1958) and that of psychotic children seen by Creak (1962, 1963a and b) has included information on IQ changes.

The timeout ribbon: a nonexclusionary timeout procedure

Recently, the use of timeout rooms has been questioned by various agencies, and some have adopted policies that prohibit or greatly restrict exclusionary timeout. The present study developed a timeout procedure that did not require removal of the misbehaver from the learning environment. The procedure was applied to the disruptive behaviors of five severely retarded children in an institutional special-education classroom. An observer prompted all teacher behaviors related to the procedures to assure their precise implementation. After baseline, a reinforcement-only condition was implemented. Each child was given a different colored ribbon to wear as a tie and received edibles and praise every few minutes for good behavior and for wearing the ribbon. When timeout was added, a child's ribbon was removed for any instance of misbehavior and teacher attention and participation in activities ceased for three minutes or until the misbehavior stopped. Reinforcement continued at other times for appropriate behavior. An ABCBC reversal design was used to demonstrate control of the behavior by the conditions applied. On average, the children misbehaved 42% and 32% of the time during the baseline and reinforcement conditions respectively but only 6% of the time during the timeout conditions. A followup probe during the new school year revealed that the teacher was able to conduct the procedure independently and that the children's disruptive behaviors were maintained at low levels. The practicality and acceptability of the procedure were supported further by the successful implementation of the procedure by a teacher in another state and by responses to a questionnaire given to 40 mental health professionals. The ribbon procedure appears to be a viable form of timeout, provided that disruptive behaviors during timeout can be tolerated within the setting, or a backup procedure such as exclusionary timeout can be tolerated within the setting, or a backup procedure such as exclusionary timeout is available when needed.

X-linked mental retardation

A survey of the mentally retarded children with an IQ between 30 and 55 born in a 10-year period (1955-64) and now of school age was carried out in New South Wales. The number of propositi who had a similarly affected sib of the same sex was ascertained; 58 boys had a similarly affected brother(s) and 22 girls had a similarly affected sister(s). It is suggested that the excess of affected brothers represents X-linked forms of mental retardation. An estimate of prevalence rate was calculated from the brother pair excess and was found to be 0·74/1000 males. The calculated incidence of X-linked forms of mental retardation appeared to account for most of the male excess found in the survey and suggests that 1 in every 5 of the mentally retarded boys in the IQ range in this survey may be retarded on the basis of genes on the X chromosome.