Mary L Courage

• PhD
• Professor at Memorial University of Newfoundland

Although very young children have unprecedented access to touchscreen devices, there is limited research on how successfully they operate these devices for play and learning. For infants and toddlers, whose cognitive, fine motor, and executive functions are immature, several basic questions are significant: (1) Can they operate a tablet purposefull...

Over the past decade, preschool children have had increasing experience with storybooks in an electronic format. These reading sessions are usually guided by an adult who keeps the child’s attention focused as the story unfolds. Occasionally, children are given a tablet or smartphone to operate on their own when the adult is not available to scaffo...

Attention changes dramatically over the period of infancy and early childhood. Infants have poor vision at birth and attend primarily to salient physical characteristics of their environment. Attention in very young infants is influenced strongly by behavioral state, such that very young infants show nonspecific orienting only during their limited...

Infants and toddlers spend 1–2 h a day engaged in screen media. Although most of them view television, their access to newer mobile technologies such as tablets and smartphones is increasing. They are also exposed to over 5 h daily of background television intended for adults. This amount of screen time has prompted a debate about the positive and...

The increasing frequency of student multitasking during study has raised concerns about its impact on their learning outcomes. To address this, performance on an academic task was examined. Students were instructed either to attend to two simultaneous sources of information (text article, documentary video) for later test or to attend to the text b...

Preschool children's attention, engagement, and communication during readings from comparable electronic and paper storybooks, and their recall of story content were assessed. Seventy-nine preschoolers listened to one story on a tablet and another in paper format. The e-book contained multimedia and interactive features that activated story-related...

Current work, play, and learning environments require multitasking activities from children, adolescents and adults. Advances in web-enabled and multi-function devices have created a perceived need to stay “wired” to multiple media sources. The increased demand that these activities place on information processing resources has raised concerns abou...

Despite the development of experimental methods capable of measuring early human color vision, we still lack a procedure comparable to those used to diagnose the well-identified congenital and acquired color vision anomalies in older children, adults, and clinical patients. In this study, we modified a pseudoisochromatic test to make it more suitab...

This chapter reviews past research and theory related to the early development of attention beginning with the most commonly used behavioral measures of infant visual attention. The developmental course of visual attention in infancy and early childhood is then described with a focus on the relevant behavioral and psychophysiological findings and r...

Purpose: Although a great variety of pediatric tests of visual acuity exist, few have been compared directly within the same patients or have been evaluated directly against an adult gold standard. Methods: Right eyes from 80 3- to 5-year-old preschoolers were tested at 3 m with the two current pediatric optotype tests-the Patti Pics and the Lea...

Purpose In the quest to develop a contrast sensitivity test that combines experimental rigor with clinical ease of use and interpretability, we (VSS 2009) reported on a new prototype test which consists of classic Landolt C optotypes that are created with luminance modulated sine-waves. In the present work, we have improved the technical aspects of...

The aim of the study was to assess and characterize visual functioning in children with fetal alcohol spectrum disorder (FASD) using a broader and more inclusive range of measures than has been reported previously. Standard tests of visual functioning were used to assess 21 children (11 females, 10 males) with FASD and 21 sex- and age-matched compa...

The effect of background television on 6- and 12-month-olds’ attention during 20 min of toy play was examined. During the first or second half of the session, a clip from a variety of commonly available television programs was presented. The duration and frequency of infants’ looks to the toys and to the television indicated that regardless of age...

Purpose: Despite the importance of optics in the development of human vision and visual functioning, few extensive, long-term studies exist on refractive changes during infancy and early childhood. However, with the emergence of portable, held-hand, non-cycloplegic autorefractors, it is now feasible to provide early normative data. Such information...

Purpose. Autism spectrum disorder (ASD) is an increasingly diagnosed neurodevelopmental disorder, with an incidence in children now greater than 1%. Surprisingly, given the assumption that ASD impacts the processing of visual stimuli, systematic studies of even basic visual functioning have yet to be conducted on this population, and the limited av...

Purpose: Current tests of spatial contrast sensitivity (CS) fall into two categories, those that employ luminance-modulated sine-wave gratings (e.g., the FACT chart), or those that use recognizable Snellen-like optotypes (e.g., the Pelli Robson chart). Both forms possess distinct advantages but an ideal test would combine the desired characteristic...

In this study, we had 3 major goals. The 1st goal was to establish a link between behavioral and event-related potential (ERP) measures of infant attention and recognition memory. To assess the distribution of infant visual preferences throughout ERP testing, we designed a new experimental procedure that embeds a behavioral measure (paired comparis...

The recent increase in the availability of infant-directed video material (e.g., Baby Einstein) and the corresponding increase in the amount of time that infants and toddlers spend viewing them have prompted concern among parents and professionals that these media might impede aspects of cognitive and social development. In contrast, supporters and...

For some time now, questions have been asked about the impact of television and video materials on the cognitive and social development of preschoolers and older children. More recently, these same questions have been asked in relation to the extensive exposure to these media that infants and toddlers are currently experiencing. To answer these que...

Purpose: We have been attempting to develop an efficient psychophysical test of spatial contrast sensitivity (CS) for use with pediatric patients. To date, our CS card test (VSS, 2004) satisfies most of these requirements, except that it provides only rough estimates of CS threshold due to large step size and limited contrast range. Here we report...

Purpose: The emergence of new time-efficient, portable, and user-friendly psychophysical technologies for young children now creates the possibility of mass screening programs for detecting early eye and visual dysfunction. Recent experimental work suggests that vision screening in 3–5 yr-old preschool children is feasible and that it can prevent o...

The pattern of 6- and 18-month-old infants' and their parents' attention to toys, a commercially available infant-directed video, and each other were examined in a 20 min free-play context as a function of whether the television was on or off. The results indicated that infants at both ages directed significantly more of their attention to the toys...

Women with low incomes are at higher risk to have low-birthweight (LBW) babies and less likely to participate in prenatal support programmes than women with higher incomes. This study examined birth outcomes among participants in the Newfoundland and Labrador Mother-Baby Nutrition Supplement (MBNS), a prenatal programme for women with low incomes t...

Executive functions (EF) are those higher-level cognitive activities that include the monitoring and self-regulation of attention, thought, and action, and the ability to plan behavior and to inhibit inappropriate responses. These cognitive control processes are voluntary and effortful and have been described as providing a system for overriding ro...

The fate of our earliest autobiographical memories has been a matter of intense speculation for over a century (e.g., Freud, 1905/1953; Henri & Henri, 1895). The enduring interest in this topic has become stronger over the past few decades as important mental health and forensic questions on the accuracy and durability of adults’ memories of childh...

The development of attention in the infant can be characterized by changes in overall arousal (attentiveness) and by changes in attention's effect on specific cognitive processes (e.g., stimulus orienting, spatial selection, recognition memory). These attention systems can be identified using behavioral and psychophysiological methods. The developm...

During early infancy, spatial vision is very immature and infants possess relatively high levels of spherical (primarily hyperopic) and astigmatic refractive error. Although optical error is the primary contributor to impaired spatial vision in adults and older children, the role that “front end” immaturities play in infantile visual limitations ha...

ABSTRACT—The debate about the potential of television and video material to enhance or diminish cognitive development in infants and toddlers has been complicated by speculation regarding the relation between early exposure to these media and the developing brain. Those on both sides of the debate draw on findings from developmental and neuroscienc...

Mary L. Courage, PhD, is a professor of developmental psychology at Memorial University in Canada and holds a cross-appointment in the Faculty of Medicine (Pediatrics) at Memorial. She was educated at Memorial University and at the University of Alberta in Canada. For the past 20 years, she and colleagues have conducted research on the early develo...

Currently, there is a lack of adequate data on pediatric eye and vision disorders in Canada, particularly in the province of Newfoundland and Labrador. In the present study, we estimate the prevalence of eye and vision disorders among young children who participated in a vision screening program in the St. John's, Newfoundland, metropolitan region....

The Randot Preschool Stereoacuity Test is a widely used three-book test for the assessment of binocular status. Using a prototype, we previously reported high testability in children as young as 3 years, validity data, and some normative data. Here we report extensive normative and validity data for the final version of the test. In addition, we re...

To determine whether trends of increasing overweight and obesity reported for older children and adults are evident in Canadian preschoolers. A sample of 3857 preschool-aged children (51.1% boys) in the Province of Newfoundland and Labrador, born in 1984 and measured in 1987-1989, was selected from government archival records. The sample of 4161 ch...

To examine the development of look duration as a function of age and stimulus type, 14- to 52-week-old infants were shown static and dynamic versions of faces, Sesame Street material, and achromatic patterns for 20 s of accumulated looking. Heart rate was recorded during looking and parsed into stimulus orienting, sustained attention, and attention...

We assessed the retest variability of a new contrast sensitivity (CS) card procedure and its ability to predict spatial resolution. Twenty-four 3-month-olds were tested twice with the CS cards and once with the Teller acuity cards (TAC) within a single session. Coefficient of repeatability (COR) analysis revealed that retest variability of the new...

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comp...

Eye research in infants who experience significant perinatal complications has been restricted to evaluation of structural ocular disease and spatial vision, and results show that these aspects of vision are at increased risk for abnormal or delayed development. To expand upon previous work, a battery of 17 vision tests was employed to assess, comp...

A study was conducted to evaluate the (1) developmental course and (2) the temporal sequencing of visual (mirror, photo) and verbal (personal pronoun use) measures of self-recognition as well as the ability to locate a toy from its mirror image in relation to the child's own mirror image. A microgenetic approach was adopted to assess 10 toddlers bi...

A study was conducted to evaluate the (1) developmental course and (2) the temporal sequencing of visual (mirror, photo) and verbal (personal pronoun use) measures of self-recognition as well as the ability to locate a toy from its mirror image in relation to the child's own mirror image. A microgenetic approach was adopted to assess 10 toddlers bi...

More and more school-aged children in Canada and elsewhere are becoming overweight or obese. Many countries are now reporting a similar trend among preschool children. However, little information is available on the prevalence of overweight and obesity among preschool children in Canada. In addition, available data are based on reported rather than...

A longstanding issue in psychology has been, When does human memory begin? More particularly, when do we begin to remember personal experiences in a way that makes them accessible to recollection later in life? Current popular and scientific thinking would have us believe that memories are possible not only at the time of our birth, but also in ute...

Over the past three decades impressive progress has been made in documenting the development of encoding, storage, and retrieval processes in preverbal infants and children. This literature includes an extensive and diverse database as well as theoretical conjecture about the underlying processes that drive early memory development. A selective rev...

Individual differences in infants’ attentional style at 3.5 months are only moderately stable across the first postnatal year. However, infants designated as short lookers based on a pattern examination pretest task at 3.5 months had better recognition memory at 1 year and were briefer in toy examination on post-habituation tests than were long loo...

The authors review competing theories concerning the emergence and early development of autobiographical memory. It is argued that the differences between these accounts, although important, may be more apparent than real. The crux of these disagreements lies not in what processes are important, but rather, the role these different processes play i...

To test whether iron supplementation affects hematologic, biochemical, and developmental status in term breast-fed infants. Term breast-fed infants (n=77) were randomly selected to receive either 7.5 mg per day of elemental iron as ferrous sulfate or placebo from 1 to 6 months of age. Investigators and families were unaware of group assignment. Com...

Using a time-efficient psychophysical procedure, 4–6-, 7–9-, and 10–11-week-old human infants were tested with chromatic stimuli which fell directly on adult protanopic (LWS cone-deficient) and deuteranopic (MWS cone-deficient) confusion axes, as well as with off-axis stimuli. Ten to eleven week olds discriminated all stimuli, but performance dimin...

Both eyes of 74 healthy 2-12-month-old human infants were refracted twice with the new Welch Allyn SureSight non-cycloplegic autorefractor. At least one reliable estimate of sphere and cylinder was obtained from both eyes of all babies attempted, and 88% of infants contributed two estimates from each eye. These measurements were collected in less t...

Despite the emerging scientific and clinical importance of measuring human contrast sensitivity (CS), developmental data are sparse, especially those obtained with a single methodology. We used a new, time-efficient, psychophysical card procedure to evaluate binocular CS in groups of 20 4- to 9-yr-olds and 10 adults. Combined with data from infants...

The authors review several key areas of early cognitive development in which an abrupt shift in ability at the end of the second year of life has been traditionally assumed. These areas include deferred imitation, self-recognition, language, and categorization. Contrary to much conventional theorizing, the evidence shows robust continuities in all...

The authors review several key areas of early cognitive development in which an abrupt shift in ability at the end of the second year of life has been traditionally assumed. These areas include deferred imitation, self-recognition, language, and categorization. Contrary to much conventional theorizing, the evidence shows robust continuities in all...

Based on results from an earlier prototype, custom software and printing techniques were developed to construct a new card-based test of contrast sensitivity (CS) for nonverbal subjects. Compared with the prototype, the new CS card test contains three improvements: (1) larger, more salient test gratings; (2) higher contrast warm-up cards for each s...

Using a paired-comparison procedure, we examined the effect of familiarization variables on 3.5-month-old infants' (n = 120) retention of dynamic visual stimuli after 1-min, 1-day, and 1-month delays. The proportion of total looking time to the novel stimulus revealed novelty, null, and familiarity preferences after 1-min, 1-day, and 1-month delays...

In 3 experiments, kindergarten and second-grade children's retention was examined in the context of 2 distinctiveness manipulations, namely, the von Restorff and bizarre imagery paradigms. Specifically, children learned lists of pictures (Experiments 1a and 1b) or interactive images (Experiment 2) and were asked to recall them 3 weeks later. In Exp...

Retest variability of a new infant contrast sensitivity (CS) card procedure was assessed by binocular measurement of a group of 20 6-month-olds twice within a 1-week period. Coefficient of reliability analyses showed that within-subject variability between tests was only slightly less than variation across subjects, which suggests that results from...

We assessed binocular grating visual acuity with the Teller acuity cards (TAC) in 3-36-month-olds at risk for visual disorders. After 3-8 years, each child was assessed with the TAC and with a battery of tests of spatial and non-spatial vision. The initial TAC score: (1) was uncorrelated with any of the later measures; (2) had low positive, but hig...

To improve test efficiency, we modified our previously introduced contrast/color card test by including a patterned test stimulus and reducing the number of stimuli in both experimental phases. Compared with the prototype, completion rate improved substantially (79 vs. 37%) but test time decreased only modestly (19 vs. 21 min). Achromatic contrast...

Using paired-comparisons, 3-month-olds' (n = 148) recognition of dynamic visual events was investigated after retention intervals of 1 minute, 1 day, and 1 and 3 months (Experiment 1) and 1 minute, 1 day, and 1 week (Experiment 2). Participants were either tested at each retention interval (Multiple Tests) or tested at one interval (Single Test). T...

The effects of feeding breast milk (BM), commercial formula (F), or evaporated cow milk (EM) formula on visual acuity and erythrocyte phosphatidylethanolamine fatty acid levels were examined in fullterm infants. Visual acuity was assessed at 3, 6 (BM, F, EM), and 18 (BM, EM) months, and erythrocyte phosphatidylethanolamine levels were determined at...

Groups of newborn human infants (N = 180) were habituated to large 16 degrees achromatic ("white") lights of varying luminance (0.35 to 1.16 log cd/m2) and then tested for recovery of habituation to 16 degrees green (dominant lambda = 545 nm), yellow (dominant lambda = 585 nm) or red (dominant lambda = 650 nm) lights which varied in the level of ex...

We investigated the possibility that age differences in infants' long-term retention are artifacts of correlated differences in learning rates or learning opportunities (over-learning). Using path analytic procedures, these possibilities were examined in two experiments in which 15- and 18-month-olds (Experiment 1) and 12- and 15-month-olds (Experi...

The authors provide a new framework that integrates autobiographical memory with other early achievements (e.g., gesturing, language, concept formation). In this theory, the emergence and early development of autobiographical memory does not require the invocation of specialized neurological or multiple memory mechanisms but rather arises as a natu...

A new contrast sensitivity (CS) card test was used to estimate contrast sensitivity in 18 infants and children with Down syndrome (DS). The results showed that although the overall shape of the contrast sensitivity functions (CSFs) of the subjects with DS was the typical inverted-U, their CSFs were depressed in comparison to control subjects and th...

The authors provide a new framework that integrates autobiographical memory with other early achievements (e.g., gesturing, language, concept formation). In this theory, the emergence and early development of autobiographical memory does not require the invocation of specialized neurological or multiple memory mechanisms but rather arises as a natu...

The increased viability of extremely low birth weight (ELBW) infants (those weighing less than 1,000 g) and the associated increased risk of visual impairment has highlighted the need for reliable indices of visual functioning for this population. By use of the Teller Acuity Cards, we assessed grating visual acuity in 26 survivors of extreme premat...

Purpose. We devised (Adams et al.. 1994, Vis. Res.) a new card technique which measures infants' chromatic-achromatic discrimination more efficiently than do traditional psychophysical measures. However, the prototype required 21 min and many subjects failed to complete the test, thus limiting its potential clinical utility. Justified by the result...

Purpose Although human contrast sensitivity (CS) has been measured with various methods at specific ages during infancy and childhood, no study has yet used the same method to trace its development from birth to maturity. Comprehensive normative data would be a significant contribution given the emerging importance of CS to the understanding of cri...

A recently developed psychophysical "card" technique was used to evaluate monocular contrast sensitivity in ninety 3-, 6-, 12-, 24-, and 36-month-old human infants. Results showed that for 3-, 6-, 24-, and 36-month-olds, monocular contrast sensitivity functions were very similar to binocular contrast sensitivity functions estimated in a previous ex...

Quantitative data on the early morphological development of the human retina show that the peripheral region is relatively more mature than the central region. These results have stimulated researchers to compare the development of visual functions in the central and peripheral regions of the visual field. Here, we used preferential looking to eval...

Combining a habituation-recovery paradigm with procedures to minimize brightness cues, we evaluated 1-3-month-olds' ability to discriminate among broadband mid- and long-wavelength stimuli. One-month olds showed evidence of discriminating a red (dominant lambda = 650 nm) from green (dominant lambda = 545 nm) but failed to discriminate either of the...

We investigated the presence of intrusions in preschoolers’ memories for traumatic incidents by examining 30-, 36-, and 48-month-olds’ initial and 6-month recall of traumatic events that required emergency room treatment. The basic findings were (1) the number of preschoolers who produced an intrusion at the 6th month’s interview declined with age,...

We used a new time-efficient method to evaluate chromatic-achromatic discrimination in newborn (n = 36) and 1-month-old (n = 34) human infants. Results showed that 74% of newtons discriminated a 10.5 × 17.5 deg broadband red patch from all relative luminances of an achromatic background, but only 14% of newborns did so with a blue, 36% with a green...

The authors used the Teller acuity cards to assess the visual acuity of 51 infants and children with Down syndrome aged between two months and 18 years. The success rate and test times were comparable to those reported for normally developing children. Even those subjects in the study who were free of ocular disorders and/or who were wearing optica...

Effects of reinstatement were examined in 2.5-yr-olds' (Exp 1) and 3.5-yr-olds' (Exps 2 and 3) long-term retention. Children learned object–location pairings and, 3 wks later, were provided with postevent information consistent with the originally acquired pairings. One week later (4 wks since acquisition), children were given 4 test trials. Analys...

Historical and current theories of infantile amnesia are examined. To evaluate the viability of these theories, as well as the phenomenon of infantile amnesia itself, a review of memory development from birth through the preschool years is provided, including an overview of relevant perceptual and neurological maturation. In the context of this rev...

We used a new card procedure to evaluate binocular contrast sensitivity (CS) in 24- and 36-month-old children. The test consists of 40 large (50 by 28 cm) matteboard cards, each of which contains a sine wave grafting with 1 of 5 spatial frequencies (0.4, 0.8, 1.6, 3.2, and 4.8 cpd at 80 cm) and with 1 of 8 contrast levels [from 33% (CS = 3) to 0.4%...

We used a new time-efficient procedure to obtain binocular contrast sensitivity functions (CSFs) from 80 infants aged 1-, 3-, 6-, and 12-months-old. The test consisted of 5 sets of large (50 by 28 cm) cards constructed by mounting a 7.2 degrees circular sine wave grating with 1 of 5 spatial frequencies (0.3, 0.6, 1.2, 2.4, and 3.6 cpd at 60 cm) ont...

We have developed a new test which can rapidly evaluate basic color vision in individual infants. The test consists of a series of large cards constructed with Munsell Hues. It uses a modified preferential looking procedure (FPL) and, to control brightness cues, incorporates a two-phase systematic variation of luminance. First, we evaluate an infan...

Several photoreceptoral and neural models have been proposed to account for the development of human vision. To further evaluate those applicable to color vision, the present study examined 40 neonates' (mean age=3.2 days) chromatic-achromatic discriminations in the mid-spectral region by using an habituation procedure and measures to minimize achr...

We used the Teller Acuity Cards (TAC) to test 7 groups of 20 healthy infants and children ranging in age from 1 week to 36 months. We also tested 27 of these children at least twice within their first year. We had two primary goals: (1) to provide normative data on the development of visual acuity as assessed with the new version of the TAC (Vistec...

We used the Teller Acuity Cards to assess visual acuity in children with severe neurological handicaps (N = 12), all of whom had been previously untestable. With every child we were able to obtain at least one estimate of visual acuity, even with those described as likely having little or no visual function. However, in all cases, performance was p...

We used FPL to assess 1-, 2-, and 3-month-olds' visual acuity at 20° in the binocular and monocular peripheral fields. Acuities were very poor at 1 month under both binocular and monocular viewing conditions but improved steadily over the next 2 months. Three-month-olds showed better acuity for gratings located in the temporal than in the nasal vis...