Alice S. Carter

Early development of executive function: A problem-solving framework

Executive function (EF) accounts have now been offered for several disorders with childhood onset (e.g., attention-deficit/hyperactivity disorder, autism, early-treated phenylketonuria), and EF has been linked to the development of numerous abilities (e.g., attention, rule use, theory of mind). However, efforts to explain behavior in terms of EF have been hampered by an inadequate characterization of EF itself. What is the function that is accomplished by EF? The present analysis attempts to ground the construct of EF in an account of problem solving and thereby to integrate temporally and functionally distinct aspects of EF within a coherent framework. According to this problem-solving framework, EF is a macroconstruct that spans 4 phases of problem solving (representation, planning, execution, and evaluation). When analyzed into subfunctions, macroconstructs such as EF permit the integration of findings from disparate content domains, which are often studied in isolation from the broader context of reasoning and action. A review of the literature on the early development of EF reveals converging evidence for domain-general changes in all aspects of EF.

The Vineland Adaptive Behavior Scales: Supplementary norms for individuals with autism

Vineland Adaptive Behavior Scales Special Population norms are presented for four groups of individuals with autism: (a) mute children under 10 years of age; (b) children with at least some verbal skills under 10 years of age; (c) mute individuals who are 10 years of age or older; and (d) individuals with at least some verbal skills who are 10 years of age or older. The sample included 684 autistic individuals ascertained from cases referred for the DSM-IV autism/PDD field trial collaborative study and five university sites with expertise in autism. Young children had higher standard scores than older individuals across all Vineland domains. In the Communication domain, younger verbal children were least impaired, older mute individuals most impaired, and younger mute and older verbal individuals in the midrange. Verbal individuals achieved higher scores in Daily Living Skills than mute individuals. The expected profile of a relative weakness in Socialization and relative strength in Daily Living Skills was obtained with age-equivalent but not standard scores. Results highlight the importance of employing Vineland special population norms as well as national norms when evaluating individuals with autism.

Language Delay in a Community Cohort of Young Children

OBJECTIVE To document the prevalence of expressive language delay in relation to age and gender in 12- to 39-month-old children. To document the characteristics, particularly social competence and emotional/behavioral problems, related to deficits in expressive language. METHOD Parents of an age- and sex-stratified random sample of children born at Yale New Haven Hospital between July 1995 and September 1997 who lived in the New Haven Meriden Standard Metropolitan Statistical Area were enrolled when their children were 12 to 39 months of age (79.8% participation;N = 1,189). The main outcome for these analyses is expressive language delay measured by the MacArthur Communicative Development Inventory, short forms. RESULTS Expressive language delays range from 13.5% in 18- to 23-month-olds to 17.5% in children 30 to 36 months of age. By 18 to 23 months, children are more likely to experience delays if they come from environments characterized by low education, low expressiveness, poverty, high levels of parenting stress, and parents who report worry about their childrens language problems. When social competence is adjusted for in the multivariable model, behavior problems are no longer associated with language delay, suggesting that poor social competence rather than behavior problems may be the critical early correlate of low expressive language development. CONCLUSIONS Expressive language delays are prevalent problems that appear to be associated with poor social competence. Given that such problems may be risk factors for social and emotional problems, early identification is critical.

Mother-infant reengagement following the still-face: The role of maternal emotional availability an infant affect regulation☆

Abstract This study investigated how the early mother-infant relationship supports an infants ability to regulate emotion following the disruption of normal interaction. The responses of 29 4-month-old infants and their economically disadvantaged, predominantly minority mothers were examined during the “still-face” paradigm. Mothers were asked to play with their infants for 5 min, maintain a still, affectless expression for 2 min, and resume play for 3 min. Specifically, the relation between dyadic emotional availability in play and the infants behavior in the period following the still-face, when mothers reengaged with their infants, was explored. Dyadic interaction during play was coded with a scale measuring maternal sensitivity, intrusiveness, and hostility, as well as child responsiveness. The infants affect and gaze were coded in real time across all three episodes. A new, global coding scheme, which incorporated aspects of reunion behavior codes from Ainsworths Strange Situation paradigm, was used to measure infant behavior in the reengagement period. The major finding was that at age 4 months, infants of mothers who were more sensitive in play reengaged following the still-face using a more well-regulated, interpresonally oriented style, whereas infants of mothers who were less sensitive exhibited high amounts of avoidant and/or resistant behaviors in reengagement. In addition, exploratory longitudinal data revealed some predictive validity of the 4-month reengagement codes to 12-month Ainsworth attachment scales.

Preliminary acceptability and psychometrics of the infant–toddler social and emotional assessment (ITSEA): A new adult‐report questionnaire

The preliminary acceptability, internal consistency, test–retest reliability, and validity of the Infant–Toddler Social and Emotional Assessment (ITSEA), a parent-report questionnaire concerning social-emotional problems and competencies, were examined in a sociodemographically diverse pediatric sample of 214 parents of 12- to 36-month-olds. Results supported the ITSEAs acceptability and preliminary internal consistency, test–retest reliability, and validity. Most parents had a positive response to the ITSEA, found the questions easy to understand, and would consider recommending it to a friend. Confirmatory factor analyses supported 16 conceptually hypothesized problem and competence scales. Most scales had strong internal consistency, good to excellent 2-week test–retest reliability, and moderate 1-year test–retest reliability. Significant correlations among ITSEA scales and parent reports of child temperament and problem behaviors supported the ITSEAs validity. Psychometric findings are viewed as preliminary due to the relatively small sample size. Parents reported greater competence and more maladaptive behaviors in older children than younger children. Consistent with observational studies, boys lagged behind girls in certain parent-reported competencies, including empathy, compliance, prosocial peer interactions, and emotional awareness. Parent reports yielded empirically coherent problem and competence scales and domains, suggesting the early emergence of parental perceptions of organized and differentiated clusters of social-emotional behaviors.

Body Mass Index, Eating Attitudes, and Symptoms of Depression and Anxiety in Pregnancy and the Postpartum Period

Objective: This report describes associations between body mass index (BMI; kg/m2), eating attitudes, and affective symptoms across pregnancy and the postpartum period in a sample of 64 women. Methods: As part of a larger study, women were recruited during pregnancy and followed prospectively to 14 months postpartum. Measures included self-reported prepregnancy and 4-month postpartum BMI as well as pregnancy, 4-month, and 14-month postpartum eating attitudes (EAT), depressive symptoms (CES-D), and anxiety symptoms (STAI). Results: During pregnancy, symptoms of depression or anxiety were not significantly correlated with concurrent eating attitudes or measures of BMI. However, at 14 months postpartum, measures of eating attitudes and both depression and anxiety symptoms were associated. Measures of BMI were associated with depressive and anxiety symptoms at both 4 and 14 months postpartum. Four-month eating attitudes and BMI predicted 14-month postpartum depressive symptoms, beyond pregnancy, and 4-month postpartum measures of affective symptoms. Results suggested that overweight women were at risk for elevated anxiety at 4 months and depressive symptoms at both 4 and 14 months postpartum. Conclusions: These results provide evidence for a significant, albeit moderate, relationship between BMI, eating attitudes, and symptoms of depression and anxiety in the postpartum period that are not present during pregnancy.

Visual-motor Integration functioning in children with Tourette syndrome

A neuropsychological model of visual-motor integration skill was proposed and tested in 50 children with Tourette syndrome (TS) and 23 unaffected control children matched for age. Children with TS performed significantly worse than control children on the Beery Visual-Motor Integration (VMI) Test. Consistent with the proposed model, visuoperceptual and fine-motor coordination subprocesses were significant predictors of VMI scores. However, the subprocesses did not fully account for the diagnostic group difference on the VMI. These results suggest that the integration of visual inputs and organized motor output is a specific area of neuropsychological weakness among individuals with TS.

Anxiety and Sensory Over-Responsivity in Toddlers with Autism Spectrum Disorders: Bidirectional Effects Across Time

This report focuses on the emergence of and bidirectional effects between anxiety and sensory over-responsivity (SOR) in toddlers with autism spectrum disorders (ASD). Participants were 149 toddlers with ASD and their mothers, assessed at 2 annual time points. A cross-lag analysis showed that anxiety symptoms increased over time while SOR remained relatively stable. SOR positively predicted changes in anxiety over and above child age, autism symptom severity, NVDQ, and maternal anxiety, but anxiety did not predict changes in SOR. Results suggest that SOR emerges earlier than anxiety, and predicts later development of anxiety.

A Prospective Longitudinal Study of Gilles de la Tourette's Syndrome

OBJECTIVE The goals of this study were to estimate the frequency of Gilles de la Tourettes syndrome (TS), tics, and other behavioral disorders among children at risk for TS and to examine the association of family functioning with childrens diagnostic status and social-emotional functioning. METHOD A prospective longitudinal design was used. Young children who were not displaying any tic behaviors but who had a first-degree relative with TS were recruited. Childrens diagnostic status, social-emotional functioning, and family functioning were assessed with the Schedule for Tourette and Other Behavioral Syndromes, Vineland Adaptive Behavior Scales, Child Behavior Checklist, the Harter Self Perception Profile, and Family Environment Scale. RESULTS Increased rates of tic disorders, obsessional and anxiety symptoms, and attentional and speech difficulties were observed. Family functioning, independent of parental psychopathology, was associated with attention-deficit and anxiety disorders, decreased adaptive and increased maladaptive behaviors, and lower self-esteem but not tic spectrum or learning disorders. CONCLUSIONS The observed rates of tic disorders add support for an autosomal dominant mode of transmission. Family functioning appears to play an important role in non-tic disorders as well as adaptive and maladaptive behaviors. Family, cognitive-behavioral, and interpersonal therapies should be considered to address the social-emotional difficulties that often accompany TS.

Eating attitudes and behaviors in pregnancy and postpartum: global stability versus specific transitions.

Global changes in eating attitudes were examined prospectively across pregnancy and 4 months postpartum in a sample of 90 women. In addition, specific changes in dieting behavior and weight/shape satisfaction were assessed at 4 months postpartum for concurrent and retrospective time points. Measures included the Eating Attitudes Test (EAT) and weight/shape satisfaction in pregnancy and at 4 months postpartum, as well as prepregnancy, pregnancy, and postpartum weight loss efforts. While global EAT scores were stable across time, dieting scores (Factor I) increased between pregnancy and postpartum. Weight/shape satisfaction was higher in pregnancy, and satisfaction was related to EAT scores at 4 months postpartum but not during pregnancy. Prepregnancy dieters and nondieters were best discriminated by higher weights, elevated pregnancy dieting scores, and lower postpartum weight/shape satisfaction. Results emphasize the importance of looking beyond changes in global eating attitudes and behaviors to more specific eating concerns or behaviors. Lastly, the results have implications for identifying women at risk for eating-and weight-related concerns during this period of rapid physical change.