Barry Nurcombe

Minimizing Adverse Effects of Low Birthweight: Four-Year Results of an Early Intervention Program

The outcome of an early intervention program for low-birthweight (LBW) infants was examined in this study. The intervention consisted of 11 sessions, beginning during the final week of hospitalization and extending into the home over a 3-month period. The program aimed to facilitate maternal adjustment to the care of a LBW infant, and, indirectly, to enhance the childs development. Neonates weighing less than 2,200 grams and under 37 weeks gestational age were randomly assigned to experimental or control conditions. A full-term, normal birthweight (NBW) group served as a second control. 6-month analyses of dyads who completed all assessments over a 4-year period (Ns = 25 LBW experimental, 29 LBW control, and 28 NBW infant-mother dyads) showed that the experimental group mothers reported significantly greater self-confidence and satisfaction with mothering, as well as more favorable perception of infant temperament than LBW control group mothers. A progressive divergence between the LBW experimental and LBW control children on cognitive scores culminated in significant group differences on the McCarthy GCI at ages 36 and 48 months, when the LBW experimental group caught up to the NBW group. Possible explanations for the observed delay in the emergence of intervention effects on cognitive development and the mediating role of favorable mother-infant transactional patterns are discussed in light of recent evidence from the literature.

Seven-Year Outcome of the Vermont Intervention Program for Low-Birthweight Infants

We compared 24 low-birthweight subjects of an experimental intervention (LBWE), 32 no-treatment controls (LBWC), and 37 normal birthweight (NBW) subjects. The intervention involved 7 hospital sessions and 4 home sessions in which a nurse helped mothers adapt to their LBW babies. At age 7, LBWE scored significantly higher than LBWC on the Kaufman Mental Processing Composite (p less than .001), Sequential (p = .02), and Simultaneous (p = .001) Scales, after statistical adjustments for socioeconomic status. LBWE did not differ from NBW (F less than 1). These results bear out a divergence between the LBWE and LBWC that first became statistically significant at age 3. The findings suggest that the intervention prevented cognitive lags among LBW children, and that long-term follow-ups are needed to evaluate the developmental effects of efforts to overcome major biological and environmental risks.

An Intervention Program for Mothers of Low-Birthweight Infants: Preliminary Results

Mothers of low-birthweight babies born at the Medical Center Hospital of Vermont during a 21-month period were randomly assigned to experimental ( N = 34) and control ( N = 40) groups. Forty-one normal-birthweight controls were also recruited. Experimental mothers received an 11-session intervention program which emphasized maternal sensitivity and responsiveness to infant social signals. This paper analyzes the impact of the program, by 6 months, on maternal adaptation and psychopathology, and on infant cognitive development and temperament.

The ritual abuse of children: clinical features and diagnostic reasoning.

A case of alleged ritual sexual abuse is presented. Clinical recognition and diagnostic reasoning are discussed. After a brief account of modern satanism, it is concluded that, although the evidence for the occurrence of ritual abuse is sketchy, a high index of suspicion is appropriate.

The Validity of the Diagnosis of Major Depression in Childhood and Adolescence

This chapter concerns the question of whether, in children and adolescents, major depression can be discriminated from other forms of misery. Beginning with a description of the historical evolution of the question, it sets out the criteria by which a categorical depressive disorder could be validated and analyzes the empirical evidence for and against the hypothesis that there is indeed a distinct depressive disorder in childhood and adolescence. The chapter ends with a consideration of “dysthymia,” a classificatory wasteland into which many problems have been dumped.