Value of parents' estimates of children's developmental ages.

OBJECTIVE: To determine whether parents' estimates of children's developmental ages can function as a prescreening technique. DESIGN AND PARTICIPANTS: Parents of 234 children from birth to 77 months of age seeking well-child care in pediatric offices were queried in two separate studies. In the first study, parents were asked to give an estimate of their child's overall developmental age and, in the second study, to estimate ages in each of six developmental domains. Children were administered a range of screening measures of intelligence, speech-language, and adoptive behavior. RESULTS: The overall age-estimate, if less than chronologic age, was 75% sensitive to likely developmental problems and, if equal to or greater than chronologic age, was 90% specific in identifying children likely to have typical development. Age estimates for each developmental domain were 81% sensitive to likely developmental problems if less than chronologic age in the domains of fine motor, language, grass motor, or behavior, and 62% specific if equal to or greater than chronologic age. Estimates at or below chronologic age in receptive language or personal-social domains were 90% sensitive and 43% specific in identifying likely behavior problems. There were no differences in the accuracy of parents estimates on the basis of children's age, gender, race, parents' level of education, or parenting experience. CONCLUSION: Parents' overall age-estimates provided a sensitive and specific indicator of global developmental status, but insufficient information about strengths and weaknesses to enable focused referrals for services. In contrast, discrete patterns of age estimates in each developmental domain sensitively discriminated children with developmental versus behavioral problems, although specificity was limited. Age estimates appear to be a potentially helpful method for identifying a subset of children in need of thorough screening, although further research is needed on a larger sample given diagnostic rather than screening tests.

Results of radiotherapy for thyroid ophthalmopathy.

Between October, 1978 and August, 1986, 35 patients with thyroid ophthalmopathy were treated with radiotherapy. Twenty-eight patients had treatment with corticosteroids prior to radiotherapy and either progressed on steroids or relapsed during tapering. Seven patients with contraindications to steroids were treated primarily with radiotherapy. After radiotherapy, 25 patients (71%) did not require any further steroids or orbital decompression and ten (29%) failed. Patients who required steroids or decompression for active disease after radiotherapy were considered treatment failures. A total of 14 (40%) patients required eye muscle or lid surgery for correction of stable soft tissue defects after radiotherapy, more commonly in patients treated with radiotherapy after steroids or decompression than those irradiated primarily; the median time between radiotherapy and surgery was 8 months (range 1-48). Various factors were examined for prognostic significance in predicting radiotherapy failure. Review of the interval between onset of eye disease and radiotherapy demonstrated that six of ten (60%) failures versus only five of 25 (20%) successful treatments received radiotherapy within 6 months of onset of eye disease. No relation between outcome and sex, age or hyperthyroid versus euthyroid Graves' disease was apparent. Radiotherapy has been used for patients with thyroid ophthalmopathy who failed steroids, decompression, or had steroid contraindications. Morbidity of radiotherapy was minimal and most patients were spared the morbidity of continued steroid therapy.

Antecedents of child abuse.

The qualities of parents who batter their children have been determined by interviewing known abusers. Because most studies lack controls and because family characteristics may be changed by abuse, a prospective study was instituted. Fourteen hundred low-income mothers were interviewed in a prenatal clinic, and the characteristics of 23 reported for abuse within two years were compared to the characteristics of the remaining mothers. The predominant antecedents of child abuse were: unwanted pregnancy, aggressive tendencies, and aberrant childhood nurture in which disturbed family relationships were more important than outright abuse. Abusive mother had slightly less self-esteem. Factors which increased exposure between parents and children seemed to increase risk for abuse. In contrast to retrospective findings, abusive mothers did not differ in support available from others, age, education, isolation, family alcohol or drug problems, and expectations of child development.