Neurodevelopmental outcome of fetuses referred for ventriculomegaly.

OBJECTIVE: To characterize the delivery and postnatal neurodevelopmental outcomes of fetuses referred for ventriculomegaly (VM). METHODS: Under an internal review board-approved protocol, pregnant women were referred for magnetic resonance imaging (MRI) after sonographic diagnosis of VM and classified into one of four diagnostic groups: Group 1, normal central nervous system (CNS); Group 2, isolated mild VM (10-12 mm); Group 3, isolated VM > 12 mm; and Group 4, other CNS findings. Pregnancy outcome was obtained. Follow-up visits were offered with assessment of neurodevelopmental, adaptive and neurological functioning at 6 months and 1 year and/or 2 years of age. Atrial diameter and VM group differences in developmental outcomes were evaluated using repeated measures logistic regression and Fishers exact test, respectively. RESULTS: Of 314 fetuses, 253 (81%) were liveborn and survived the neonatal period. Fetuses in Groups 4 and 3 were less likely to progress to live delivery and to survive the neonatal period (60% and 84%, respectively) than were those in Groups 2 or 1 (93% and 100%, respectively, P < 0.001). Of the 143 fetuses followed postnatally, between 41% and 61% had a Bayley Scales of Infant Development (BSID-II) psychomotor developmental index score in the delayed range (< 85) at the follow-up visits, whereas the BSID-II mental developmental index and Vineland Adaptive Behavior composite scores were generally in line with normative expectations. Among those that were liveborn, neither VM group nor prenatal atrial diameter was related to postnatal developmental outcome. CONCLUSIONS: Diagnostic category and degree of fetal VM based on ultrasound and MRI measurements are associated with the incidence of live births and thus abnormal outcome. Among those undergoing formal postnatal testing, VM grade is not associated with postnatal developmental outcome, but motor functioning is more delayed than is cognitive or adaptive functioning.

Prenatal cocaine exposure, child development, and the compromising effects of cumulative risk.

On the whole, the literature suggests that toddlers and young children who are exposed prenatally to cocaine exhibit few, if any, consistent differences in developmental functioning compared with demographically similar, nonexposed, age-matched controls. The paucity of cocaine-related findings does not mean that prenatally cocaine-exposed children are free from developmental problems. Cocaine-exposed infants may well have specific deficits that are masked by confounding factors in study designs; however, more important is the worrisome finding that the average performance of both drug-exposed and nonexposed children in the literature tends to be poorer than expectations for age. This problem likely stems from the fact that most study children in the literature (regardless of exposure status) come from low-income backgrounds and consequently have been exposed to multiple medical and social risk factors associated with long-term poverty. The fact that exposure to multiple risk factors has powerful, compromising effects on children's outcomes may overshadow any specific effects of prenatal cocaine exposure. The problem of high cumulative risk in the literature raises both methodologic and clinical issues. To disentangle the relationship among prenatal cocaine exposure and other comorbid risk factors in predicting children's outcomes, investigators in future studies should recruit samples with varying levels of accumulated risk. This increased range of risk will also permit researchers to evaluate the interaction of exposure status and risk status and identify specific protective factors that may contribute to resilient outcomes for these infants. This information will be helpful in the design and timing of intervention services for these high-risk infants and their families. On a clinical level, when exposed children present for interventional services, professionals must not limit their remedial efforts to drug treatment alone. Rather, clinicians should also view prenatal drug exposure as a possible marker for the presence of multiple medical and social risk factors (e.g., maternal psychopathology, social isolation, child maltreatment, domestic violence, or inadequate caregiving). Because any of these factors may place children in developmental jeopardy, these comorbid risk factors must be considered, together with prenatal drug exposure, and, when possible, treated. Although confronting this wide range of problems may seem overwhelming, many conditions associated with poverty are treatable. Moreover, from the perspective of the cumulative risk model, interventions are most likely to succeed if they attempt to reduce the overall burden of risk rather than targeting single risks.

Specificity of preventative pediatric intervention effects in early infancy.

The efficacy of two contrasting short term preventative interventions administered to a heterogeneous sample of new mothers during the perinatal period was evaluated. The first was infant-centered and used the Brazelton Neonatal Behavioral Assessment Scale (NBAS) as a method of highlighting newborn behavior to new mothers. The second was mother-centered and consisted of an in-depth interview focused on the mothers' concerns about parenting. Mothers were randomized into groups and were administered intervention by experienced clinicians at 3 days in the hospital and again at 14 and 30 days at home. Effects of intervention on maternal reports of parenting stress, mother-infant interactive behavior, and infant developmental quotient were evaluated at 4 months infant age. It was hypothesized that participation in the infant-centered intervention would be related to more positive maternal and infant outcomes at 4 months. It was also expected that the impact of each intervention would be moderated by differences in maternal and infant risk and parity. Hierarchical multiple regressions controlling for risk and parity yielded no significant main effects of intervention at 4 months. However, significant interactions of intervention with parity and risk were observed, indicating that intervention was beneficial for specific groups of mothers. These data suggest that early intervention should be tailored to the needs of individual groups of mothers.

Subsyndromal depressive symptoms and major depression in postpartum women.

This study documents differences in the psychosocial functioning of women three months postpartum with subclinical depression, major depression prior to the birth of the baby, major depression both pre- and post-birth, and no depression. An understanding of these differences may have implications for intervention insofar as maternal depression places at risk not only the mother's functioning but her infant's development, as well.

Talking about self and other: emergence of an internal state lexicon in young children with Down syndrome.

The ability to talk about the internal states (IS) of self and other is an age-typical development of early childhood that is thought to reflect young children's emergent self-other understanding. This study examined the emergence of an IS lexicon in a cross-sectional sample of young children with Down syndrome (DS) and a cognitively and demographically comparable group of normally developing (ND) children. Children's IS lexicons were derived from transcripts of their spontaneous utterances during two laboratory contexts: a mother-child emotions picture book task and semistructured play. Children with DS produced significantly fewer IS words and fewer IS word types than their MA-matched counterparts. Controlling for corpus size, children with DS also were less likely to attribute internal states to themselves and were more context bound in their use of IS language. In addition, children with DS also differed from ND children in the semantic content of their IS language, with proportionately higher rates of affective words and lower rates for words about volition ability, and cognition. For both the DS and ND groups, individual differences in IS language production were significantly related to general expressive language skills. However, dissociations were observed for the relation between children's IS word production and nonverbal symbolic play skills in the two groups. These findings suggest some degree of disorganization at the interface among symbolic domains for children with DS. Because IS language is critical to the regulation of social interaction and an early index of self-other differentiation and understanding, children with DS may be at risk for later compromises in self-organization.

Semantic development of African-American children prenatally exposed to cocaine.

Semantic content categories were described for the single word, multiple word, and verb relation utterances of 22 African-American 2-year-olds during a 90-min laboratory session. Half of the toddlers had been exposed prenatally to cocaine and half were unexposed, as documented by biological assay in the newborn period. The exposed and unexposed groups were carefully matched on demographic, medical, and proximal caregiving variables. Children's spontaneous utterances were transcribed from audio- and videotapes during the laboratory session and scored for semantic features by a team of reliable coders who were masked to child exposure status. General productive language features (utterance length, verbosity, and intelligibility) were also assessed. To evaluate general language and cognitive skills, the toddlers were evaluated with the Sequenced Inventory of Communicative Development-Revised (SICD-R) and the Bayley Scales of Infant Development (BSID). Although exposed and nonexposed toddlers exhibited similar sequences of semantic development, the exposed toddlers were more restricted and delayed in their semantic representations. No significant group differences were observed, however, for structural features of language (e.g., utterance length, distribution of utterance types) or for children's general language and cognitive functioning as assessed by standardized assessments (i.e., SICD-R, BSID). Thus, a history of prenatal cocaine exposure and associated risk factors (e.g., prenatal exposure to alcohol, diminished birth weight) are related to delays in early semantic development. Proposed diagnostic and treatment strategies are discussed.

Play-language relationships in young children with developmental delays: implications for assessment.

The purpose of this longitudinal study was to determine whether the reported parallels between symbolic play and normal language development were evidenced in 6 children with developmental delays of varying etiologies. Subjects' play and language behavior over a 6-month period was videotaped and analyzed during free play and modeling tasks. Although results supported the correspondences previously reported between normal language development and symbolic play, the variability across observations in the present subjects was more marked than expected. Implications for clinical assessment are discussed.