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Effects of the proximal home environment on language and behavioral outcomes in children prenatally exposed to cocaine
Early Child Development and Care
Abstract
Proximal environmental variables illustrate aspects of the environment that are experienced directly and specifically by the child. The current study examined the associations between three proximal environmental variables: (1) quality of the home environment, (2) regularity of family routines and (3) frequency of parenting daily hassles and cognitive, language and behavioral outcomes in 36‐month‐old children who were prenatally exposed to cocaine and participating in an early intervention program. The quality of the home environment predicted expressive language and internalizing behavior problems, while daily hassles and family routines only predicted internalizing behavior problems. The results suggest that interventions aimed at changing proximal environmental variables may have positive implications for children who are at‐risk for developmental delay.
... The quality of caregiving environments children live in varies from one home to another. Bono et al. (2008), referred to the quality of the caregiving environment as the extent to which environments provides children with optimal factors that promotes their development. Our aim in this study is to measure the quantity and quality of stimulants available in the caregiving environment of children with behavioural problems, more specifically the quantity and quality of stimulants in home environments of children who get enrolled into facilities that offer special education in Bratislava, Slovakia. ...
OBJECTIVES: The aim of the article is to answer the research question: “Which resilience protective factors do social workers working with families at risk identify within the scope of their profession?" THEORETICAL BASE: This text focuses on the concept of resilience in the context of the well-being of social workers. METHODS: Six focus groups with a total of 38 participants were conducted in the Czech Republic among social workers providing services to families in need. OUTCOMES: The research focuses on positive aspects of professional activity, as they may play a key role in the resilience process. Thematic analysis yielded the following themes: (1) connectedness, (2) education and professional experience, and (3) resources based on cooperating with clients. SOCIAL WORK IMPLICATIONS: Among the research implications we point out the dynamic aspect of resilience as well as the need for support from other environments to manage professional problems, because resilience is not an individualized concept.
... Elardo, Bradley, and Caldwell ( 1977 ) found signifi cant relations between scores on the Infant-Toddler HOME and children's scores on the Illinois Test of Psycholinguistic Abilities at age three. Others have also found signifi cant relations between HOME scores and language competence during the fi rst 3 years of life (Bee et al., 1982 ;Bono, Dinehart, Dobbins, & Claussen, 2008 ;Chapin & Altenhofen, 2010 ;Molfese, Holcomb, & Helwig, 1994 ;NICHD Early Childcare Research Network, 2002 ;Oxford & Spieker, 2006 ;Stein et al., 2008 ;Wu, Bradley, & Chiang, 2011 ). Similar relations were obtained for children throughout early and middle childhood (Bradley & Caldwell, 1984a, 1984bDuhan & Punia, 1998 ;Fuligni, Han, & Brooks-Gunn, 2004 ;Jackson & Roberts, 2001 ;Lewis et al., 2011 ;Molfese, DiLalla, & Lovelace, 1996 ;Paxon & Schady, 2007 ;Pinto, Pessanha, & Aguiar, 2013 ;Siegel, 1979 ;Son & Morrison, 2010 ;Terrisse, Roberts, Palacio-Quintin, & MacDonald, 1998 ). ...
Children’s environments contain a diverse array of actions, objects, events, and conditions that have the potential to influence the development of math skills. The focus of this chapter is on the HOME Inventory and what research using the HOME reveals about relations between children’s home environments and their competence in mathematics. Studies show that socioemotional and structural features of the home are associated with math competence just as are access to learning materials and efforts on the part of parents to provide enriching experiences. Provision of stimulation during the second and third years of life shows a stronger relation to math than does stimulation during early infancy. It also appears that some of the relations are indirect via language and cognitive processing skills. Although research is limited, research using the HOME suggests that the broad affordances of the home environment matter as regards the early development of math competence.
Research has shown the importance of routines for optimal child development. A systematic review can offer a detailed overview of the evidence linking routines to child outcomes, particularly in high‐risk settings. This review aimed to elucidate the association between daily routines and child development and to pinpoint the protective role of routines in high‐risk environments. A search of PubMed and PsycINFO databases yielded literature from 1950 to June 2020. Out of 4297 initial hits, 170 studies met the selection criteria. Findings mainly indicate that routines are associated with positive developmental outcomes in children, covering cognitive, self‐regulation, social–emotional, academic skills, and overall mental and physical health. The results also underline the protective power of routines in challenging environments. The study suggests possible mechanisms through which routines influence child outcomes and recommends avenues for future research, supporting evidence‐based strategies to encourage parental use of routines.
Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center- and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.
Despite recent studies that failed to show catastrophic effects of prenatal cocaine exposure, popular attitudes and public policies still reflect the belief that cocaine is a uniquely dangerous teratogen.
To critically review outcomes in early childhood after prenatal cocaine exposure in 5 domains: physical growth; cognition; language skills; motor skills; and behavior, attention, affect, and neurophysiology.
Search of MEDLINE and Psychological Abstracts from 1984 to October 2000.
Studies selected for detailed review (1) were published in a peer-reviewed English-language journal; (2) included a comparison group; (3) recruited samples prospectively in the perinatal period; (4) used masked assessment; and (5) did not include a substantial proportion of subjects exposed in utero to opiates, amphetamines, phencyclidine, or maternal human immunodeficiency virus infection.
Thirty-six of 74 articles met criteria and were reviewed by 3 authors. Disagreements were resolved by consensus.
After controlling for confounders, there was no consistent negative association between prenatal cocaine exposure and physical growth, developmental test scores, or receptive or expressive language. Less optimal motor scores have been found up to age 7 months but not thereafter, and may reflect heavy tobacco exposure. No independent cocaine effects have been shown on standardized parent and teacher reports of child behavior scored by accepted criteria. Experimental paradigms and novel statistical manipulations of standard instruments suggest an association between prenatal cocaine exposure and decreased attentiveness and emotional expressivity, as well as differences on neurophysiologic and attentional/affective findings.
Among children aged 6 years or younger, there is no convincing evidence that prenatal cocaine exposure is associated with developmental toxic effects that are different in severity, scope, or kind from the sequelae of multiple other risk factors. Many findings once thought to be specific effects of in utero cocaine exposure are correlated with other factors, including prenatal exposure to tobacco, marijuana, or alcohol, and the quality of the child's environment. Further replication is required of preliminary neurologic findings.
Attempted (a) to replicate or modify parent-child relationships found in 2 previous studies by D. Baumrind (see record
1967-05780-001) and D. Baumrind and A. E. Black (see record
1967-10271-001); and (b) to differentiate further among patterns of parental authority and measure their effects upon the behavior of preschool children. Data were based upon observational procedures, and were analyzed for boys and girls separately. Ss were 146 white preschool children and their families. Results include the following: (a) authoritative parental behavior was clearly associated with independent, purposive behavior for girls but only associated with such behavior for boys when the parents were nonconforming; (b) authoritative parental control was clearly associated with all indexes of social responsibility in boys compared to authoritarian and permissive parental control, and with high achievement in girls, but not with friendly, cooperative behavior; and (c) contrary to expectations, parental nonconformity was not associated with lack of social responsibility in either boys or girls. (45 ref.) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article brings together information from our experience of providing research-based intervention to more than 600 children who were prenatally exposed to cocaine and from the research literature on the effects of prenatal cocaine exposure. Based on our experience and this literature, it is now clear that there are no large negative independent effects of cocaine exposure and that there is no crack baby syndrome. However, many of these children who have been exposed to cocaine are at risk for poor developmental outcomes, particularly in the area of language development, primarily because of the environmental factors that are associated with parental substance abuse. As our intervention research shows, early intervention can be effective in ameliorating some of this risk. Suggestions are made regarding programmatic steps that should be taken next to further improve program effectiveness and enhance the knowledge base.
The importance of major life stress and minor daily hassles associated with parenting was studied in 74 mothers and their 5-year-old children. Of interest were the relative and absolute contributions of the stress factors to indices of parental, child, and family functioning. Mothers completed questionnaires regarding stressors, aspects of parenting and individual psychological status, social support, family functioning, and child behavioral status. Mother-child pairs were also observed in interactions in a laboratory setting. Analyses indicated that life stress and parenting daily hassles significantly predicted aspects of child, parent, and family status. Hassles, however, proved to be a more powerful stress construct. Further analyses indicated that mothers' social support moderated the influence of hassles on indices of maternal behavior. The results are discussed in relation to the potential for minor parenting stresses to influence microsocial processes within parent-child relationships and contribute to dysfunction in children and families.
To evaluate the efficacy of home intervention with drug-abusing women on parenting behavior and attitudes, and on children's development.
A randomized, clinical trial of 60 drug-abusing women recruited prenatally and randomized into an intervention (n = 31) or comparison (n = 29) group. There were no group differences in gestational age, 1-minute Apgar scores, duration of hospital stay, or neonatal abstinence score. Intervention infants were slightly heavier (P = .098) and had slightly lower 5-minute Apgar scores (P = .089). Most mothers were single, African-American, multiparous, and non-high school graduates from low income families. Approximately 40% of the women were human immunodeficiency virus (HIV)-positive, all admitted to either cocaine and/or heroin use, and 62% had a history of incarceration. Intervention and comparison group women did not differ on any background variables.
All children received primary care in a multidisciplinary clinic. Biweekly home visits were provided by a nurse beginning before delivery and extending through 18 months of life. The intervention was designed to provide maternal support and to promote parenting, child development, the utilization of informal and formal resources, and advocacy.
Behavioral measures included self-reported ongoing drug abuse, compliance with primary care appointments, and an observation of the child-centered quality of the home (HOME Scale). Parenting attitudes were measured by the Child Abuse Potential Inventory (CAPI) and the Parenting Stress Index. The CAPI was administered before initiating the intervention and the Parenting Stress Index was administered when the children were 3 months of age. Both scales were repeated when the children were 18 months of age. Developmental status was measured with the Bayley Scales of Infant Development administered at 6, 12, and 18 months.
Repeated measures multivariate analyses of variance were used to examine changes in parenting attitudes and children's development. Analyses of covariance were used to examine compliance with primary care appointments and the quality of the home. Logistic regression was used to examine ongoing drug abuse. Birth weight and maternal education were used as covariates in all analyses. To control for social desirability, the faking-good index of the CAPI was included as a covariate in analyses involving self-report measures.
Women in the intervention group were marginally more likely to report being drug-free (P = .059) and were compliant with primary care appointments for their children (P = .069). Based on the HOME Scale, women in the intervention group were more emotionally responsive (P = .033) and provided marginally more opportunities for stimulation (P = .065). At 18 months parents reported more normative attitudes regarding parenting and more child-related stress than they had initially, but the differences were not related to intervention status. At 6 months infants in the intervention group obtained marginally higher cognitive scores (P = .099); at 12 and 18 months there were no differences.
The findings suggest a cautious optimism regarding the efficacy of early home intervention among drug-abusing women in promoting positive behaviors. Subsequent investigations of home intervention should include larger sample sizes and more intensive options.
This study examined the drug use patterns of pregnant women in two inner city sites, selected to overrepresent cocaine users. Women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy. There was little difference in the patterns of drug use in the two study sites, Trenton, New Jersey, and northwestern Philadelphia. A number of demographic and lifestyle variables of cocaine users, soft drug users (cigarettes, alcohol, and/or marijuana), and abstainers were compared. The cocaine-using group was significantly older and had more children, had less stable and more isolated living situations, was less likely to be employed and more likely to be receiving public assistance during pregnancy, and was more likely to have a higher drug- and alcohol-using social environment and family history than soft drug users or abstainers. Of significance was that many of the high-risk lifestyle factors exhibited by cocaine users were also seen, albeit to a lesser extent, among the soft drug users. These findings have implications for the timing of intervention strategies that would be most effective.
A family process model was tested, linking adequacy of family financial resources to academic and psychosocial adjustment among 156 African American 6- to 9-year-old children with single mothers who lived in the rural South. Seventy five percent of the sample lived in poverty. Lack of adequate financial resources was associated with more depressive symptoms and lower self-esteem among mothers. Self-esteem was linked with family routines and mother–child relationship quality. The paths from mother–child relationship quality and family routines to child academic and psychosocial adjustment were mediated by the development of child self-regulation. An alternative partially mediated model improved the fit of the data for families with boys.
Recent research consistently reports that persistent poverty has more detrimental effects on IQ, school achievement, and socioemotional functioning than transitory poverty, with children experiencing both types of poverty generally doing less well than never-poor children. Higher rates of perinatal complications, reduced access to resources that buffer the negative effects of perinatal complications, increased exposure to lead, and less home-based cognitive stimulation partly account for diminished cognitive functioning in poor children. These factors, along with lower teacher expectancies and poorer academic-readiness skills, also appear to contribute to lower levels of school achievement among poor children. The link between socioeconomic disadvantage and children's socioemotional functioning appears to be mediated partly by harsh, inconsistent parenting and elevated exposure to acute and chronic stressors. The implications of research findings for practice and policy are considered.
Socioeconomic status (SES) is one of the most widely studied constructs in the social sciences. Several ways of measuring SES have been proposed, but most include some quantification of family income, parental education, and occupational status. Research shows that SES is associated with a wide array of health, cognitive, and socioemotional outcomes in children, with effects beginning prior to birth and continuing into adulthood. A variety of mechanisms linking SES to child well-being have been proposed, with most involving differences in access to material and social resources or reactions to stress-inducing conditions by both the children themselves and their parents. For children, SES impacts well-being at multiple levels, including both family and neighborhood. Its effects are moderated by children's own characteristics, family characteristics, and external support systems.
Children with intellectual disability are at heightened risk for behaviour problems and diagnosed mental disorder.
The present authors studied the early manifestation and continuity of problem behaviours in 205 pre-school children with and without developmental delays.
Behaviour problems were quite stable over the year from age 36-48 months. Children with developmental delays were rated higher on behaviour problems than their non-delayed peers, and were three times as likely to score in the clinical range. Mothers and fathers showed high agreement in their rating of child problems, especially in the delayed group. Parenting stress was also higher in the delayed group, but was related to the extent of behaviour problems rather than to the child's developmental delay.
Over time, a transactional model fit the relationship between parenting stress and behaviour problems: high parenting stress contributed to a worsening in child behaviour problems over time, and high child behaviour problems contributed to a worsening in parenting stress. Findings for mothers and fathers were quite similar.
This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N = 37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers'.
Poor children confront widespread environmental inequities. Compared with their economically advantaged counterparts, they are exposed to more family turmoil, violence, separation from their families, instability, and chaotic households. Poor children experience less social support, and their parents are less responsive and more authoritarian. Low-income children are read to relatively infrequently, watch more TV, and have less access to books and computers. Low-income parents are less involved in their children's school activities. The air and water poor children consume are more polluted. Their homes are more crowded, noisier, and of lower quality. Low-income neighborhoods are more dangerous, offer poorer municipal services, and suffer greater physical deterioration. Predominantly low-income schools and day care are inferior. The accumulation of multiple environmental risks rather than singular risk exposure may be an especially pathogenic aspect of childhood poverty.
For more than half a century there has been a keen interest in the relation between socioeconomic status (SES) and child development. Researchers throughout the social sciences and health professions have long considered SES to be one of the major influences on child well-being. For the past decade, there has been a concerted effort to identify the processes and factors that mediate the relation, with the hope not only of advancing science but of constructing policies and programs that benefit children. The number of candidate processes proposed for consideration is legion, some occurring prior to birth (e.g., inadequate nutrition and drug exposure during pregnancy), and still others occurring at later points in development (e.g., peer group affiliations, exposure to environmental teratogens, and the quality of school curricula), others occurring throughout postnatal development (e.g., the quality of parental language, the availability of social support, parental responsiveness, and the availability of material resources; see Bradley & Corwyn, 2002, for a review). Researchers in sociology, psychology, economics and nutrition, as well as other social and health sciences have offered many models (some quite simple, others quite elaborate) depicting links among SES, various mediation processes, and different developmental outcomes (e.g. Baum, Garofalo, & Yali, 1999; Brody et al., 1994; DeGarmo, Forgatch, & Martinez, 1999; Dodge, Petit, & Bates, 1994; Conger, Ge, Elder, Lorenz, & Simons, 1994; Levanthal & Brooks-Gunn, 2000; McLoyd, 1998).
Prenatal cocaine exposure is an indicator for adverse developmental outcomes. To prevent developmental disabilities, an early intervention program for children birth to 3 years was developed that included three groups: center-based, home-based, and primary care comparison. The intervention was implemented across 10 years and data were collected on 342 children and families who were primarily urban, poor, and members of traditionally underrepresented groups. At 36 months of age, center and home-based intervention participants had more advanced cognitive and language abilities and fewer behavior problems than the primary care group participants. In addition, center-based participants had more advanced language abilities than home-based participants. The findings indicate that the early intervention impact is sustainable over time and has a positive effect on children at risk due to prenatal cocaine exposure. Copyright 2005 by the Division for Early Childhood, Council for Exceptional Children.
To the Editor: The meta-analysis by Dr Frank
and colleagues1 concluded that cocaine exposure
in utero does not affect physical or behavioral development in offspring.
As pointed out by the authors, many inconsistent observations have been reported
in the clinical literature, and confounding factors, such as polydrug use,
further complicate the interpretation of these studies.It was disappointing, however, that the authors did not highlight the
results of recent studies in which children have been prospectively followed
up. These studies have shown subtle but consistent deficits in cognitive and
attentional processes in 6- and 7-year old children,2- 4
effects that may become more prominent as their cognitive and social development
continues. Cocaine has potent effects on neurotransmitters with known effects
on the development of limbic cortical circuitry.5
Thus, it is not surprising that in utero exposure to cocaine might lead to
cognitive and emotional difficulties in older children and even into adulthood—impairments
that simply cannot be assessed in younger children nor with crude global measures.
Thus, the conclusions drawn by the authors may be premature.
This study examined the relationship of father-child and mother-child interactions, perceptions of parenting stress, socioeconomic status, and prematurity to development of 44 healthy preterm and 49 full-term Canadian children at 4 years of age. Preterm or full-term birth, infant sex, and parental age accounted for 30-32% of the variance in cognitive and motor scores, respectively, on the McCarthy Scales of Children's Abilities. Parenting stress, father-child interactions at 12 months, and preterm and full-term birth accounted for 19% of the variance for expressive language on the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P). For receptive language on the CELF-P, mother-child interaction at 12 months, mother's spousal relationship, and preterm and full-term birth accounted for 13% of the variance. Addressing early parent-child interaction and perceptions of parenting stress may improve child language development.
Context Maternal use of cocaine during pregnancy remains a significant public
health problem, particularly in urban areas of the United States and among
women of low socioeconomic status. Few longitudinal studies have examined
cocaine-exposed infants, however, and findings are contradictory because of
methodologic limitations.Objective To assess the effects of prenatal cocaine exposure on child developmental
outcomes.Design Longitudinal, prospective, masked, comparison birth cohort study with
recruitment in 1994-1996.Setting Obstetric unit of a large US urban teaching hospital.Participants Four hundred fifteen consecutively enrolled infants (218 cocaine-exposed
and 197 unexposed) identified from a high-risk, low–socioeconomic status,
primarily black (80%) population screened through clinical interview and urine
and meconium samples for drug use. The retention rate was 94% at 2 years of
age.Main Outcome Measures The Bayley Mental and Motor Scales of Infant Development, assessed at
6.5, 12, and 24 months of corrected age.Results Controlled for confounding variables, cocaine exposure had significant
effects on cognitive development, accounting for a 6-point deficit in Bayley
Mental and Motor Scales of Infant Development scores at 2 years, with cocaine-exposed
children twice as likely to have significant delay (mental development index
<80) (odds ratio, 1.98; 95% confidence interval, 1.21-3.24; P = .006). For motor outcomes, there were no significant cocaine effects.Conclusions Cocaine-exposed children had significant cognitive deficits and a doubling
of the rate of developmental delay during the first 2 years of life. Because
2-year outcomes are predictive of later cognitive outcomes, it is possible
that these children will continue to have learning difficulties at school
age.
Theories of child development tend to be rational rather than empiric and lack clear guidelines for deciding which services should be included in an intervention program. This article presents a model based on a public health approach that is empirically driven with correspondence rules relating the independent to the dependent variables. The Linda Ray Intervention Program will be used to illustrate the public health approach to intervention design that also incorporates aspects of child development theories. The program was designed to provide a total service intervention for infants exposed to cocaine in utero from low socioeconomic status, inner-city neighborhoods.
(C)1998Aspen Publishers, Inc.
In a prospective study of 137 children (47 with cystic fibrosis, 48 with congenital heart disease, 42 with no chronic illness), four domains were examined as predictors of parent-reported behavioral problems, particularly internalizing problems, at 4 years of age: child health, child temperament, parent-child relationships, and family environment. Family environment, as measured by the Parenting Stress Index at 1, 2, and 3 years, was the most powerful predictor. This suggests that this index is useful as an early screen for children at risk for behavioral problems and that a reduction of parenting stress is an appropriate target of preventive interventions. J Dev Behav Pediatr 18:304-313, 1997.
(C) Lippincott-Raven Publishers.
In order to explore the possible confounding effects of age, race, sex, and socioeconomic status on developmental outcomes of prenatal cocaine exposure, two matched samples of preschoolers (20 children with cocaine/polydrug in utero exposure and 20 children with no prenatal drug exposure) were compared on the Stanford-Binet: 4th ed. (S-B: 4th ed.), Social Skills Rating System, Vineland Adaptive Behavior Scale—Survey Form, Preschool Language Scale: 3rd ed. (PLS: 3rd ed.), and the Child Behavior Checklist. None of the 40 children had attended or were currently enrolled in preschool programs. Both groups had scores approximately one standard deviation below the expected mean in social skills, auditory comprehension, and expressive language. Likewise, externalizing behavior difficulties were approximately one standard deviation above the mean for both groups. Results suggest in utero drug exposure had no independent impact on cognitive, social, language, and behavioral developmental outcomes when the confounding variables of age, ethnicity, gender, and SES were controlled. © 1997 John Wiley & Sons, Inc.
Changes in rituals and routines between drinking and sobriety were examined in families in treatment due to paternal alcohol abuse. Information was gathered through a semistructured family interview. Recurrent disruptions of rituals and routines were found between different phases in the drinking cycle. Disruptions were found typically with regard to the fathers’ participation in rituals and routines, the parental roles and responsibility, the affective quality of the rituals, and the general family climate. Four categories of families were distinguished based on amount and type of disruptions in family rituals and routines (i.e. protecting, emotional disruptive, exposing, and chaotic families). Implications for intervention are described.
A study of 143 families and their preschool-age children was undertaken to examine the relationship between the family environment and children’s language and literacy skills. This research was guided by three models hypothesized by Snow, Barnes, Chandler, Goodman, and Hemphill (1991) to explain the family’s contribution to children’s acquisition of language and literacy. The three theoretical models examined in this study were: Family as Educator, Resilient Family, and Parent–Child Care Partnership. Confirmatory factor analysis (CFA) and structural equation modeling were used to estimate latent constructs and structural models, respectively. Results showed that only the Family as Educator model was significantly related to child language and literacy outcomes (i.e., book-related knowledge, receptive language skills, and expressive language skills). Implications for future researchers and educational practice are discussed.
The purpose of this article was to specify the relation between parenting stress and the early behavioral organization of 2-year-olds. Twenty-seven families provided assessments of parental stress and child behavior problems. In addition, observations of toddler pretend play and autonomy development were conducted. Mothers who reported higher level of stress within areas of life related to parental adjustment (e.g., relationship with spouse, social isolation, health) had toddlers who exhibited more externalizing and total behavior problems. In addition, mothers who reported higher levels of stress in relation to their toddler (e.g., perceptions of reinforcement from child) were more likely to have toddlers who exhibited behavior problems, less pretend play, and less usage of self-assertion during home observations. Finally, fathers who reported higher levels of stress in relation to their toddler also reported more behavioral problems.
Social competence has been suggested to serve a protective function in emotional functioning and may compensate for some deleterious experiences. This study found that adherence to family routines and older fathers were significant predictors of preschool social competence. The subjects were 91 black children enrolled in a metropolitan Head Start program who were rated for social competence by their teachers.
Groups of mother-preterm (N=26) and mother-full-term (N=34) infant pairs were followed longitudinally from 1 to 24 months corrected age. Measures of maternal attitudes, psychosocial factors, and family demographics were collected at 1, 8, and 18 months, mother-infant behavioral interactions were observed at 4, 8, 12, and 24 months, and infant developmental assessments were conducted at 4, 12, and 24 months. At 24 months, mothers' perception of their family systems was assessed. Results indicated that groups of mother-preterm and mother-full-term infants did not differ in perception of family style or in behavioral interactions at age 2. Correlations between family style and mother-infant behavior at age 2, however, indicated that family style was related significantly more often to measures of mother preterm interaction than mother-full-term interaction. Early maternal attitudes, psychosocialfactors (e.g., social support), and behavioral interactions were related to family style at age 2 for both groups, although again relationships were more often found in the preterm groups. The results are discussed within a transactional framework, suggesting the differential importance of family functioning to high-risk infant development and parent-child relationships. The results also suggest that certain social con texts are specifically related to the development of the family system in both risk and nonrisk groups.
Children participating in a longitudinal study of risk for serious mental disorder were assessed at 48 months of age. Six risk factors were defined: negative life events, e.g., illness/injury to the child; maternal hospitalizations, for all reasons; number of children in the family; maternal psychiatric status; maternal cognitive orientation toward child-rearing; and single-parent family. The results show that the number of risk factors is negatively related to social and intellectual adjustment; a rigid conforming maternal cognitive orientation is associated with diminished intellectual and social performance; maternal psychiatric status is associated with lessened social performance. Additionally, the combination of a rigid conforming maternal cognitive orientation with negative life events is associated with diminished social adjustment. A discussion examines these results in a context defined by developmental and crisis theory.
This paper describes the conceptual foundation underlying the development of the Family Routines Inventory, a new instrument designed to measure the extent of predictability or routinization in the daily life of a family. The primary impetus for the development of this instrument is a theoretical perspective in which family routines are regarded as behaviors which may protect the health and well-being of family members by providing stability and continuity during periods of stressful change.
To test the efficacy of temporally patterned kinesthetic and auditory stimulation for promoting development of infants born prior to term, 88 preterm infants, below 35 weeks gestation, were assigned to 1 of 4 experimental or control groups. Control subjects received regular hospital care; fixed interval subjects received 15 min of rocking/heartbeat stimulation each hour; self-activating subjects received 15 min rocking/heartbeat when inactive for 90 sec, but only for 1 stimulation period per hour. Assessments included measures of neurological functioning, sleep-wake activity, mother-infant interaction, and mental and motor development at 8 and 24 months. All experimental infants, compared to controls, showed decreased rates of activity while in the hospital, fewer abnormal reflexes, and better orienting responses. At 24 months, experimental infants scored significantly higher on the Mental Development Index of the Bayley Scales. Few differences were found in parent-infant interaction patterns. The results indicate that both temporal patterning and contingent responsiveness in the preterm infant's early environment contribute positively to some aspects of the development of such infants.
In 2 earlier investigations, we found that scores on the HOME Inventory administered during the first 2 years of life were substantially correlated with intelligence test scores at ages 3 and 4 1/2. In the current investigation, HOME scores in first 2 years showed similar relations to SRA Achievement Test scores during the first grade. In general, findings from this study were like those from the earlier investigations except that the subscale, "maternal responsivity," showed a weaker relation to achievement than IQ; while the "variety of stimulation" scale showed a stronger relation. Of all the HOME subscales, "play materials" revealed the strongest correlation with first-grade achievement. When 12-month Bayley MDI scores were partialed out of the HOME/achievement relation, little reduction was noted in the magnitude of the correlation; however, when 3-year IQ or subsequent HOME scores were partialed out, little residual correlation was noted.
This report builds upon pertinent theoretical considerations regarding the nature and importance of routinization within families and describes the development and validation of a standardized inventory to measure family routines. The Family Routines Inventory (FRI) measures 28 positive, strength-promoting family routines, those observable, repetitive behaviours which involve two or more family members and which occur with predictable regularity in the daily life of a family. The 28 routines were selected from an extensive list of 104 routines obtained through family interviews. Scoring options for the inventory were identified based on their face validity and consistency with the underlying theoretical construct. The inventory was subsequently administered to a diverse group of families for reliability and validity testing. This testing identified an optimal scoring method (frequency score) for the inventory and revealed that the Family Routines Inventory, which measures the extent and importance of routinization within a given family, appears to be a reliable and valid measure of family cohesion, solidarity, order and overall satisfaction with family life.
Interaction during feeding sessions between preterm infants and their mothers and that between full-term infants and their mothers were compared. (Mothers and babies were from a low-income, inner-city population.) When the children were about 3 years old, they attended a day camp for 3 weeks, during which their cognitive ability (Stanford-Binet) and social ability (both social competence and social participation) were assessed. Early interaction was quite different for preterms and full-terms, but in general it did not predict either social or cognitive ability at age 3. Birth status (preterm/full-term) did predict cognitive (but not social) ability: preterms scored lower. Finally, the children of mothers who were more emotionally and verbally responsive during a home visit at 20 months exhibited more social and cognitive ability at age 3. These results suggest that the baby, within broad normal limits, may be "buffered" against any long-term consequences of interaction during the first few months of life.
This study investigated whether disruption of family-of-origin rituals and routines would mediate the relationship between family history of parental problem drinking (FH+, FH-) and two outcomes in adult offspring: adult children of alcoholics (ACOA) personality attributes and drinking problems. The self-reports of 143 students and 129 outpatients indicated that disruption of family routines and rituals mediated the relationship between family history status and both ACOA traits and problem drinking. These results suggest that the mediating effect of family-of-origin rituals and daily routines may explain some of the heterogeneity in adult outcomes of offspring from FH+ families, in both student and clinical samples.
To identify perinatal factors that are predictive of disruption in primary caregiving among infants of substance abusing women.
A randomized longitudinal cohort study. One hundred and fifty two mother/infant dyads were assessed for evidence of disruption of primary caregiving or neglect during the first 18 months of life, defined by mother's inability to provide care. Data analyzed included neonatal characteristics, urine toxicology at delivery, maternal history of drug use, maternal depression, social support, and social and health history.
Sixty-six infants (43.4%) had disruption in their primary care during the first 18 months of their life, 86 infants (56.6%) remained in the care of their mothers. Women who were younger, were heroin users, had two or more children, had other children in foster care, and reported depressive symptoms were least likely to provide ongoing primary care for their infant.
Although all infants born to substance abusing women are at a high risk for disruption in the continuity of their primary caregiving, maternal demographic and psychosocial factors present at delivery can predict which infants are likely to experience an early disruption in their primary caregiving. Identifying these families can enable health care providers to monitor them more closely and, when appropriate, encourage support from the extended family.
Children with in utero cocaine exposure may be at risk for adverse neurodevelopmental outcome. To evaluate such outcome in young children, we administered the Battelle Developmental Inventory (BDI) to a group of inner-city children with (COC) and without (CON) in utero cocaine exposure at ages 3 and 5 years. Sixty-five COC and 68 CON, similar at age of testing, were evaluated at both time points by examiners masked to child group status. Both groups scored poorly and worsened over time. Although Total BDI raw scores were lower in the COC group than in the CON group at 3 years, this difference was related to postnatal environmental factors, caregiver (p = .022), and home environment (p = .010), not to in utero cocaine exposure (p = .88). At 5 years, the Total BDI score was related to the home environment (p < .001) but not to the caregiver (p = .36) or in utero cocaine exposure (p = .83). We conclude that inner-city children are at risk for adverse developmental outcome regardless of in utero cocaine exposure.
Alcohol and other drug use during pregnancy represents a major public health concern. This article characterizes a sample of 240 pregnant opioid- or cocaine-dependent women enrolled in the initial residential component of a comprehensive substance abuse treatment program for pregnant women. Data were collected using the Addiction Severity Index, Psychosocial History Form, and Structured Clinical Interview for DSM-III-R. Patients' substance use history, psychiatric comorbidity, social support network, employability, current and previous pregnancies, child custody arrangements, and the father of the current pregnancy, are described to assist providers in tailoring treatment to the specific needs of this population.
This prospective study examined the effects of ongoing maternal drug use, parenting attitudes, and a home-based intervention on mother-child interaction among drug-using women and their children. At 2 weeks postpartum, mothers and infants were randomly assigned to either an Intervention (n = 67) or Control (n = 64) Group. Intervention families received weekly visits until 6 months postpartum and biweekly visits from 6 to 18 months by trained lay visitors. The home intervention was designed to increase maternal empowerment and promote child development. Control families received brief monthly tracking visits. Mother-child interaction was evaluated at 18 months through observation of play. Mothers who continued to use cocaine and/or heroin had lower competence scores (p <.05); poor parenting attitude was also associated with lower competence scores during mother-child interaction (p <.05). Although the intervention had no measured effect, ongoing maternal drug use and poor parenting attitudes were associated with less optimal maternal behavior during mother-child interaction.
To assess teratogenic effects of cocaine exposure and maternal psychological distress on birth outcomes, we conducted a longitudinal prospective study of 415 infants (218 cocaine-exposed--CE, 197 nonexposed--NE). Drug exposure was determined through a combination of maternal self-report, urine, and meconium screens. Maternal psychological distress postpartum was evaluated through a standardized, normative, self-report assessment. An extensive set of confounding variables was controlled, including severity of exposure to alcohol, tobacco, marijuana and other drugs, maternal age, race, parity, number of prenatal care visits, educational, marital, and socioeconomic status, and verbal and nonverbal intelligence. CE infants were smaller on all birth parameters and more likely to be preterm, small for gestational age, and microcephalic than NE infants. Forty-one percent of cocaine users had clinically significant psychological symptoms, compared to 20% of a high-risk comparison group of noncocaine users. Consistent with a teratologic model, cocaine exposure independently predicted offspring birthweight, length, and head circumference. Maternal psychological distress self-reported postnatally also independently predicted head circumference. Tobacco, alcohol, and marijuana exposures were also significant independent predictors of some fetal growth parameters. In addition, maternal distress symptoms, which may be reflective of maternal mental health disorders or responses to stress, added significantly to the risk for poorer fetal growth.
A considerable body of research suggests that children who are prenatally exposed to alcohol and other drugs are also at risk for receiving poor quality parental care. Previous research in human behavioral teratology has focused on postnatal environment as a potential confounding factor. Yet, developmental theory suggests that development proceeds as a series of transactions between children's characteristics and their environments. In order that possible teratologic effects not be underestimated, future work needs to give more consideration to ways in which parental care may be influenced by child behavior and to ways in which postnatal environment might moderate the expression of teratologic effects. Studies must focus on the role of prenatal drug exposure within a broader system of variables that includes factors present in children's environments over time.
The present study estimates the longitudinal effects of in utero cocaine exposure on language functioning at 3, 5 and 7 years of age in an urban sample of 443 full-term children (236 cocaine-exposed and 207 noncocaine-exposed) participating in the Miami Prenatal Cocaine Study. The sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview and urine and meconium toxicology assays. Language functioning was measured at ages 3 and 5 years using the Clinical Evaluation of Language Fundamentals-Preschool (CELF-P) and at age 7 years using the Core Language Domain of the NEPSY: A Developmental Neuropsychological Assessment. Longitudinal Generalized Linear Model and Generalized Estimating Equations (GLM/GEE) analyses revealed an association between prenatal cocaine exposure and deficits in total language functioning after statistically controlling for child sex, visit age, prenatal exposure to alcohol, marijuana and tobacco and over 20 additional medical and sociodemographic covariates drawn from potentially confounding influences assessed at birth and follow-up visits (D=-0.17; 95% CI=-0.32, -0.03; P=.019). The link from prenatal cocaine exposure to later language deficits does not appear to be mediated by cocaine-associated deficits in birth weight, length or head circumference. Overall, the evidence tends to support an inference of a stable cocaine-specific effect on indicators of language functioning during early childhood through age 7 years.
The theoretical framework for many of the early studies of prenatal cocaine exposure has been rooted in the basic concepts of teratology/developmental toxicology. Few have published longitudinal analyses of the complex interplay between the relative effects of prenatal cocaine exposure and perinatal and environmental factors on development. The purpose of this paper was to use structural equation modeling to describe the direct and indirect effects of prenatal drug exposure on developmental outcome from birth to age 6 months. Key variables considered for study include prenatal drug exposure, perinatal medical characteristics, maternal/caregiver/family characteristics, the home environment, and neurobehavioral outcomes. We prospectively enrolled 154 predominantly crack-using women. A priori exclusion criteria included: <18 years old, major illnesses diagnosed prior to pregnancy, chronic use of legal drugs, and any use of illicit drugs other than cocaine and marijuana. From the pool of noncocaine users, 154 subjects were matched to users on pregnancy risk, parity, race, and socioeconomic status. At the end of each trimester, experienced staff conducted private interviews prompting memory of amount and timing of past drug use. Urine specimens were collected at two unanticipated times; positive screens were confirmed by gas chromatography/mass spectroscopy. Measures analyzed include medical (birth) and developmental (birth, 1 month, 6 months) assessments, all performed by blinded evaluators, as well as caregiver characteristics and environmental factors (birth, 1 month). A series of four theoretical models was tested, one for each time point (birth, 1 month, 6 months) and a longitudinal model spanning birth to 6 months. Key findings include direct effects of prenatal cocaine exposure on development at birth in the birth model and on development at birth and 6 months in the longitudinal model. In addition, indirect effects of prenatal cocaine exposure were identified on development at birth, 1 month, and 6 months, mediated through the prenatal use of alcohol and tobacco and the birth head circumference. Implications of these and other findings, including the advantages and limitations of structural equation modeling, are discussed.
A variety of family processes have been hypothesized to mediate associations between income and young children's development. Maternal emotional distress, parental authoritative and authoritarian behavior (videotaped mother-child interactions), and provision of cognitively stimulating activities (Home Observation for Measurement of the Environment [HOME] scales) were examined as possible mediators in a sample of 493 White and African American low-birth-weight premature infants who were followed from birth through age 5. Cognitive ability was assessed by standardized test, and child behavior problems by maternal report, when the children were 3 and 5 years of age. As expected, family income was associated with child outcomes. The provision of stimulating experiences in the home mediated the relation between family income and both children's outcomes; maternal emotional distress and parenting practices mediated the relation between income and children's behavior problems.
The current study is a population-based investigation of birth risk factors for school-identified specific language impairment (SLI). The sample consisted of 244,619 students (5,862 SLI) born in Florida between 1989 and 1990 who were in the Florida public school system at ages 6-7. Epidemiological measures of effect were used to investigate both individual- and population-level risk for SLI. Very low birth weight (VLBW), low 5-min Apgar score, late or no prenatal care, high birth order, and low maternal education were associated with highest individual-level risk. Low maternal education and having an unmarried mother was associated with the highest population-level risk. The results not only suggest who needs to be screened for a future developmental disability, but identify a group of children who are at-risk for an SLI placement in school. Early intervention services for these children may be the most effective approach to reducing the incidence of school-identified SLI.
Context:
Because of methodological limitations, the results of the few prospective studies assessing long-term cognitive effects of prenatal cocaine exposure are inconsistent.
Objective:
To assess effects of prenatal cocaine exposure and quality of caregiving environment on 4-year cognitive outcomes.
Design:
Longitudinal, prospective, masked comparison cohort study from birth (September 1994-June 1996) to 4 years.
Setting:
Research laboratory of a US urban county teaching hospital.
Participants:
A total of 415 consecutively enrolled infants identified from a high-risk population screened for drug use through clinical interview, urine, and meconium screens. Ninety-three percent retention for surviving participants at 4 years of age resulted in 376 children (190 cocaine-exposed and 186 nonexposed).
Main outcome measure:
The Wechsler Preschool and Primary Scales of Intelligence-Revised.
Results:
After control for covariates, prenatal cocaine exposure was not related to lower full-scale IQ (cocaine exposed [80.7] vs nonexposed [82.9]; P =.09) scores or summary verbal (cocaine exposed [79.9] vs nonexposed [81.9]; P =.11) or performance (cocaine exposed [85.5] vs nonexposed [87.5]; P =.18) IQ scores at age 4 years. However, prenatal cocaine exposure was related to small but significant deficits on several subscales (mean [SE]): visual-spatial skills (cocaine exposed [7.3 (0.22)] vs nonexposed [8.2 (0.22)]; P =.01), general knowledge (cocaine exposed [6.1 (0.18)] vs nonexposed [6.7 (0.17)]; P =.04), and arithmetic skills (cocaine exposed [6.2 (0.20)] vs nonexposed [6.8 (0.20)]; P =.05). Prenatal cocaine exposure was also associated with a lower likelihood of achievement of IQ above normative means (odds ratio, 0.26 [95% confidence interval, 0.10-0.65]; P =.004). The quality of the caregiving environment was the strongest independent predictor of outcomes. Cocaine-exposed children placed in nonrelative foster or adoptive care lived in homes with more stimulating environments and had caregivers with better vocabulary scores, and they attained full-scale and performance IQ scores (83 and 87, respectively) similar to nonexposed children in biological maternal or relative care (full-scale IQ, 82; performance IQ, 88) and higher than cocaine-exposed children in biological maternal or relative care (full-scale IQ, 79; performance IQ, 84).
Conclusions:
Prenatal cocaine exposure was not associated with lower full-scale, verbal, or performance IQ scores but was associated with an increased risk for specific cognitive impairments and lower likelihood of IQ above the normative mean at 4 years. A better home environment was associated with IQ scores for cocaine-exposed children that are similar to scores in nonexposed children.
This study utilized data from representative probability samples of five social service and health care populations and the general population to assess the prevalence of parent and family-related problems that are known to place children at risk for mental and developmental disorder. Risk factors were analyzed according to a theoretical conceptual framework. Chi-square analysis was used to determine how subsamples of the five clinical populations differed from a subsample of the general population on a set of eight risk factors. Results indicated that compared to the general population, the percentage of respondents with family-related risk factors was significantly higher across the five clinical subsamples. Findings suggest that a fruitful way to identify and intervene with children at risk for mental and developmental disorder may be in conjunction with services that treat their parents. Joint parent-child interventions that aim at prevention as well as treatment can be designed.