Effect of congenital heart defects on language development in toddlers with Down syndrome.

BACKGROUND: Down syndrome (DS, OMIM #190685) is the most commonly identified genetic form of intellectual disability with congenital heart defect (CHD) occurring in 50% of cases. With advances in surgical techniques and an increasing lifespan, this has necessitated a greater understanding of the neurodevelopmental consequences of CHDs. Herein, we explore the impact of CHD on language development in children with DS. METHODS: Twenty-nine children with DS were observed systematically in parent-child interactions using the Communication Play Protocol to evaluate their language use; they also completed the Mullen Scales of Early Learning and MacArthur Communication Development Inventory. Mean ages were 31.2 months for children with DS and CHD (DS + CHD, n = 12) and 32.1 months for children with DS and a structurally normal heart (DS - CHD, n = 17). RESULTS: Compared with the DS - CHD controls, the DS + CHD group revealed lower scores in multiple areas, including fine motor skills and expressive and receptive vocabulary. Whereas most differences were not statistically significant, the Communication Development Inventory word count and symbol-infused joint engagement differed significantly (P < 0.01) and marginally (P = 0.09) between groups. CONCLUSIONS: Finding that CHDs may account for part of the variation in language delay allows us to consider the specific mechanisms underlying the impact of CHDs on language acquisition in children with DS. Conclusions from this first study on early language outcomes of children with DS + CHD may be useful for clinicians in providing developmental surveillance and early intervention programmes with specific emphasis on language therapy as part of long-term follow-up for children with DS + CHD.

Spontaneous facial expressivity in children with acquired brain injury.

OBJECTIVES: To investigate spontaneous facial behavior during social interaction in children with acquired brain injury (ABI), and to explore possible links between ABI, facial expressivity, and caregiver-reported social competence. DESIGN: Between-group comparisons using t tests, within-group comparisons using correlational analyses, correlational analyses of independent variables and outcome measures. PARTICIPANTS: Sixteen school-aged children with ABI and 32 normally developing children of comparable age and gender. MAIN OUTCOME MEASURE: Aspects of facial expressivity derived from coding scheme designed for this study. RESULTS: Children with ABI were less expressive overall and tended to shift expressions less often than normally developing children. Several measures of expressivity were correlated with measures of social competence. CONCLUSIONS: Brain injury inhibits production of some aspects of spontaneous facial expression. Results are suggestive of links between facial behavior and social skills.

Effects of racial socialization and racial identity on acculturative stress in African American college students.

The aim of this study was to determine if racial identity mediates the relation between racial socialization and acculturative stress in African American university students, once demographic factors are accounted for. In a sample of 84 participants, significant relations were found between racial socialization and acculturative stress, racial socialization and racial identity, and racial identity and acculturative stress. Partial support for a mediational model was found, with the best predictors of acculturative stress being immersion attitudes and internalization attitudes.

Correlates of high-risk sexual behaviour among Canadian men of South Asian and European origin who have sex with men.

A sample of 98 Canadian homosexual and bisexual men, 46 of South Asian and 52 of European origin, who had sex with other than an exclusive primary partner were asked about their high-risk sexual behaviours during the previous six months. They were also queried about internalized homophobia, acculturation to the gay community, and for South Asians acculturation to the majority culture. Participants who reported more internalized homophobia were more likely to engage in both high-risk anal and oral sex. South Asian men exhibited significantly greater levels of homophobia. In addition, South Asian men who were less acculturated to the majority culture were more likely to engage in both types of high-risk sex. These data suggest a need to address internalized homophobia in HIV prevention programmes with homosexual and bisexual men generally, and further suggest the need to target less acculturated South Asian men in particular.

OTS: a program for converting Noldus Observer data files to SDIS files.

A program for converting Noldus Observer data files (ODF) to sequential data interchange standard (SDIS) files is described. Observer users who convert their data files can then take advantage of various flexible and powerful data modification and computational procedures available in the Generalized Sequential Querier, a program that assumes SDIS-formatted files.

Determining the power of multiple regression analyses both with and without repeated measures.

Power analysis guides researchers in planning how much data to collect. This article describes BW-Power, a computer program for the Windows 95 environment that performs power analyses for research designs that may or may not include both between- and within-subjects factors. We discuss how BWPower easily accommodates both between- and within-subjects factors and provide examples of BWPower's use in performing power analyses on designs with only between-subjects factors, designs with only repeated measures, and with mixed between- and within-subjects designs. We highlight the major features of BWPower's user interface, such as the ability to iteratively increment or decrement the number of subjects and the automatic recalculation of power when the number of subjects or effect sizes is changed.

Consideration of alternative accounts of gender-linked speech patterns in individuals with mental retardation.

Several preliminary reports have reported the existence of gender influences on the communication patterns of individuals with mental retardation. This study considers two alternative hypotheses to the conclusion that the reported effects were attributable to gender. Two studies extend a previous analysis by further exploration of the original transcripts (Study 1) and addition of participants (Study 2). In Study 1, the possibility of influences from adult partners is analyzed. In Study 2, the association of syntactic development and gender-linked effects is examined. Both alternatives are rejected on the basis of these extended analyses.

Psychological adaptation and adjustment of mothers of children with congenital heart disease: stress, coping, and family functioning.

OBJECTIVE: Investigate support for the transactional stress and coping model for mothers of children with congenital heart defects, in accounting for the variance in maternal adjustment. METHODS: Participants were 52 mothers of children recruited from a university medical center. Measures included illness variables, cognitive processes (i.e., appraisals of stress, expectations, methods of coping, family functioning, and maternal psychological adjustment). RESULTS: Maternal adjustment was associated with high levels of daily stress and palliative coping techniques and was not significantly associated with severity of the cardiac defect. Together, the variables of the model accounted for approximately 38% of the variance in maternal adjustment. CONCLUSIONS: The findings are in accord with previous research among other chronically ill populations in suggesting an association between stress, coping, and maternal adjustment. Within the limitations of the study, the data were interpreted to support the utility of theoretical models in identifying areas in need of intervention across chronic illness groups.

Maternal drug use during pregnancy: are preterm and full-term infants affected differently?

This study examined whether preterm infants are more vulnerable to the effects of prenatal drug exposure than are full-term infants. The sample of 235 low-income African American mothers and their infants included 119 cocaine-polydrug users, 19 alcohol-only users, and 97 nonusers; 148 infants were full term and 87 were preterm. Direct effects of exposure on birth weight, birth length, ponderal index, and irritability were moderated by length of gestation: Fetal growth deficits were more extreme in later-born infants, whereas increases in irritability were more extreme in earlier born infants. Effects of exposure on cardiorespiratory reactivity to a neonatal exam were not moderated by length of gestation. In general, effects of exposure occurred for both cocaine-polydrug and alcohol only users and so could not be unambiguously attributed to either of these drugs alone.

Stress, coping, HIV status, psychosocial resources, and depressive mood in African American gay, bisexual, and heterosexual men.

The associations between stress, physical health, psychosocial resources, coping, and depressive mood were examined in a community sample of African American gay, bisexual, and heterosexual men (N = 139). Data were collected from physical exams and in-person interviews. In our theoretical framework, depressive mood scores were regressed first on stressors, next on psychosocial resources, and finally on coping strategy variables. Results revealed that psychosocial resources mediate the effects of stressors, including health symptoms, hassles, and life events, on depressive mood. There were no significant differences in depressive mood associated with HIV status or sexual orientation. Results are discussed in terms of community interventions needed to provide social support as a buffer between stress and psychological distress in African American men.

An analysis of a behavioral intervention for children undergoing venipuncture.

An examination of factors was conducted to determine the effectiveness of the distraction component of a behavioral intervention (use of a party blower). In one condition, parents were instructed to coach children in the use of a party blower and to praise child cooperation. In a second condition, nurses were instructed to assist parents in coaching the child. Parents used the coaching skills they learned and got their children to use the distraction technique. Use of the distraction technique was associated with less crying. Encouragement from a health care professional and intervention early in the procedure did not enhance the intervention's effectiveness. Older children and children who were less distressed during the initial phase of the procedure were less likely to reject the intervention.

Adult-directed communications of youth with mental retardation using the system for augmenting language.

This study characterizes the success and effectiveness of adult-directed communications of youth with mental retardation and little or no functional speech who used the System for Augmenting Language (SAL), in concert with vocalizations and gestures, to communicate over a 2-year period. Subjects were introduced to the SAL, a speech-output communication device used during daily interactions, to encourage attempts at communication either at home or school. All subjects used the SAL at home and at school during the second year. Results indicate that subjects used the SAL with their extant forms of communication, particularly vocalizations. Extant communications were more successful than SAL communications, although the environment influenced the success of all the youth's communications. The SAL, however, was more effective than vocalizations or gestures in conveying information and interacting with adults in both environments. Maintenance, generalization, and implications for practice are discussed.

Culture and domestic violence: the ecology of abused Latinas.

This study examined the predictors of domestic violence within a sample of 60 immigrant Latinas, of whom 30 had sought assistance for abuse and 30 had sought other family services. Hypotheses were derived from several frameworks relevant to understanding abuse--intrapsychic (learned helplessness), interpersonal (family violence), and feminist theory. Findings related to the specific formulations were subsequently combined into a model of abuse in which the mutuality of communication within the couple mediates the effects of husband's intoxication and environmental stressors on the occurrence/severity of abuse. The study points out the inadequacy of relying on any one existing theory and supports the idea of taking an ecological approach to the study of abuse in specific populations.

Adult-child interaction during invasive medical procedures.

Adult-child interactions during stressful medical procedures were investigated in 43 pediatric patients videotaped during a venipuncture procedure in the course of cancer treatment. Relations among six adult behavior categories (explain, distract, command to engage in coping behavior, give control to the child, praise, and criticize/threat/bargain) and three child behavior categories (momentary distress, cry/scream, and cope) were examined using correlational and sequential analysis. Results indicated that adult distraction resulted in increased child coping and reduced momentary distress and crying. Adult explanations, although a likely response to child distress and crying, did not result in a reduction of these behaviors. Attempts to give the child control reduced child crying. Implications for clinical interventions during painful medical procedures are discussed.

Crying in !Kung San infants: a test of the cultural specificity hypothesis.

The pattern of crying and fretting behavior during the first two years is described for 46 !Kung San infants from a hunter-gatherer society in northwestern Botswana. Despite markedly different caretaking practices predisposing to quieter infants, crying and fretting were significantly greater during the first three months, and a peak pattern was present. Measurement of crying 'intensity' indicated that it was predominantly short and fretful. The results support the concept that the early peak pattern is not specific to infants in western industrialized societies, and may represent a behavior universal to the human species. The caretaking differences between societies primarily appear to affect crying duration rather than its frequency and pattern in early infancy.

Kung infancy: the social context of object exploration.

The present study consists of new analyses of systematic observations of Kung infants made by Konner during the late 1960s and early 1970s. Our intent was to examine claims about the role of object sharing in development by describing how Kung infants develop interest in objects and how their caregivers act toward them when they are engaged in object-related acts. Results indicated that infants first displayed sustained interest in objects beginning at 4 months of age and that, beginning at about 8 months, they also began to engage in relational play and to give objects to others. Others tended to ignore infants during episodes of object manipulation and play, but moments of object offering were often socially embedded. These findings provide support for claims that there are universal changes in infants' involvement with objects and that their involvement is channeled in a culturally relevant manner by their caregivers.

The incidence of AIDS among blacks and Hispanics.

Compared with whites, the acquired immune deficiency syndrome (AIDS) has affected blacks and Hispanics disproportionately. The cumulative incidence (CI) for black men was 2.6, and for Hispanic men 2.5, times the rate for white men. Intravenous (IV) needle use alone does not account for this difference. Not counting IV needle-using cases, the CIs for black and Hispanic men were 1.7 times the CI for white men. Although there were fewer cases in women than men, the white-to-minority disparity was greater for women. The CIs for black and Hispanic women were 12.2 and 8.5 times, respectively, the CI for white women. Prevention programs are urgently needed and should focus on risky behavior (IV needle sharing and receptive anal intercourse), not just risk groups.

AIDS statistics and the risk for minorities.

Analysis of the AIDS case data for the United States reported to the Centers for Disease Control reveals quite different risk group profiles for minorities and for whites. A much higher percentage of minority male AIDS cases are heterosexual, the ratio of bisexual to homosexual cases is two to three times higher, and IV needle use is a greater risk factor in minority populations. Among women and children with AIDS, 75% and 82% respectively are minorities. Whites at risk for AIDS tend to be concentrated in the gay community but blacks at risk for AIDS are dispersed throughout the entire community. As a result, AIDS education programs aimed a gay populations do not reach most of the minority populations at risk. AIDS prevention programs need to take this fact into account.