Eloise C. Neebe

Relating quality of center-based child care to early cognitive and language development longitudinally.

How quality of center-based child care relates to early cognitive and language development was examined longitudinally from 6 to 36 months of age in a sample of 89 African American children. Both structural and process measures of quality of child care were collected through observation of the infant classroom. Results indicated that higher quality child care was related to higher measures of cognitive development (Bayley Scales of Infant Development), language development (Sequenced Inventory of Communication Development), and communication skills (Communication and Symbolic Behavior Scales) across time, even after adjusting for selected child and family characteristics. In addition, classrooms that met professional recommendations regarding child:adult ratios tended to have children with better language skills. Classrooms that met recommendations regarding teacher education tended to have girls with better cognitive and receptive language skills. These findings, in conjunction with the growing child-care literature, provide further evidence that researchers and policymakers should strive to improve the quality of child care to enhance early development of such vulnerable children.

Otitis Media, the Caregiving Environment, and Language and Cognitive Outcomes at 2 Years

Objective. To examine the relationship between otitis media with effusion (OME) and associated hearing loss between 6 and 24 months of age and childrens language and cognitive development at 2 years of age. Study Design. A prospective cohort design in which 86 African-American infants who attended group child-care centers were recruited between 6 and 12 months of age. Between 6 and 24 months, assessments included serial ear examinations using otoscopy and tympanometry, serial hearing tests, two ratings of the childrearing environment at home and in child care, and language and cognitive outcomes at 2 years. Results. Children experienced either unilateral or bilateral OME an average of 63% and reduced hearing sensitivity an average of 44% of the time between 6 and 24 months of age. Although proportion of time with OME or with hearing loss was modestly correlated with measures of language and cognitive skills, these relationships were no longer significant when the ratings of the home and child-care environments were also considered. Children with more OME or hearing loss tended to live in less responsive caregiving environments, and these environments were linked to lower performance in expressive language and vocabulary acquisition at 2 years. Conclusions. Both OME and hearing loss were more strongly related to the quality of home and child-care environments than to childrens language and cognitive development. Study results might be explained either by suggesting that children in less responsive caregiving environments experience conditions that make them more likely to experience OME and/or by suggesting that it may be more difficult for caregivers to be responsive and stimulating with children with more OME.

Social and family risk factors for infant development at one year: An application of the cumulative risk model

This study examined the utility of using a cumulative risk model for predicting cognitive and language outcomes in an infant sample. The sample was comprised of 83 biologically normal 12 month-old African-American infants who attended local child care centers. The sample was 53% female and approximately two-thirds fell within the lower socioeconomic strata. Ten social and family risk factors based on Sameroffs risk model were used to construct a Cumulative Risk Index: poverty status, maternal education less than high school, household size, unmarried mother, stressful life events, depressed maternal affect, mother-infant interactions, maternal IQ, the quality of the home environment, and quality of the day care environment. Outcome measures included the Mental Development Index from the Bayley Scales of Infant Development (MDI), the Total Score from the Communication and Symbolic Behavior Scale (CSBS), and the Receptive Communication Age score from the Sequenced Inventory for Communication Development-Revised (SICD-RCA). Results indicated that the Cumulative Risk Index was significantly correlated with the CSBS and SICD-RCA, but not with the MDI, with modest amounts of variance being accounted-for. Further, the predictive utility of the Cumulative Risk Index was slightly better than an overall regression model of prediction for the CSBS, but was outperformed by the regression model on the other two outcome measures.

Early Otitis Media with Effusion, Hearing Loss, and Auditory Processes at School Age

Objectives: To examine the effect of conductive hearing loss (HL) secondary to otitis media with effusion (OME) in the first 3 years of life on physiologic, peripheral, and higher-order behavioral auditory measures examined at school age. Methods: Peripheral hearing sensitivity for conventional and extended high-frequency audiometric ranges, physiologic (distortion product otoacoustic emissions, contralateral and ipsilateral acoustic middle ear muscle reflexes), auditory brain stem response (ABR), and higher-order auditory processing measures (masking level difference; Virtual Auditory Localization, Speech Intelligibility Gain; adaptive Pediatric Speech Intelligibility task) were examined at the end of the second grade of elementary school in two cohorts (North Carolina, N = 73, and New York, N = 59). All participants (mean age, 8 years) were followed prospectively in infancy and early childhood (7 to 39 months) for middle ear status and hearing loss (using pneumatic otoscopy/tympanometry and repeated conditioned behavioral audiometric response procedures). Multivariate analyses were conducted to address whether early OME and early conductive HL were related to physiologic, peripheral, and higher-order auditory processes. Results: Early hearing loss and OME were significantly associated with peripheral hearing at school age; extended high-frequency thresholds accounted for the result. Similarly, hearing loss in early life and OME were significantly associated with the acoustic middle ear muscle reflex: The contralateral stimulation condition accounted for the association. Significant associations with both early OME and early HL were also found for the auditory brain stem response measure and were explained by the correlations between early hearing loss and the ABR Wave V latency but not other ABR indices. There were no reliable associations between either early OME or early HL on any other auditory processes evaluated at the end of second grade. Conclusions: Extended high-frequency hearing and brain stem auditory pathway measures in childhood were significantly associated with children’s experiences with OME and hearing loss from 7 to 39 months of age. However, no significant associations were found for psychoacoustic measures of binaural processing or a behavioral adaptive speech-in-noise test at school age.

Otitis media in early childhood in relation to preschool language and school readiness skills among black children

Objective. To examine whether otitis media with effusion (OME) and associated hearing loss (HL) during the first 5 years of life were related to childrens language skills during the preschool years and to school readiness skills at entry to kindergarten. Methods. In a prospective study, the ears of 85 black children primarily from low-income families and recruited from community-based childcare programs were repeatedly examined from 6 months to 5 years of age for the presence of OME and from 6 months to 4 years of age for HL when well and ill with OME. Assessments were made annually of the childrens child-rearing environments at home and in childcare, and childrens language skills between 3 and 5 years of age and readiness skills in literacy and math were evaluated at entry into kindergarten. Results. Children had either bilateral or unilateral OME ∼30.4% and HL 19.6% of the observation time. OME and associated HL were significantly positively correlated with some measures of expressive language at 3 and 4 years of age; however, these direct relationships were no longer significant when the childs gender, socioeconomic status, maternal educational level, and the responsiveness and support of the home and childcare environments were also considered. Further, both OME and HL were moderately correlated with school readiness skills at entry to school, with children having more OME scoring lower in verbal math problems and with children with more HL scoring lower in math and recognizing incomplete words. These associations continued to remain significant even after partialing out the child and family background factors. Conclusions. There was not a significant relationship between childrens early OME history or HL and language skills during the preschool years. However, children with more frequent OME had lower scores on school readiness measures. These associations were moderate in degree, however, and the home environment was more strongly related to academic outcomes than was OME or HL. These results should be interpreted cautiously when generalizing to other populations.

A Longitudinal Study of Otitis Media With Effusion Among 2- to 5-Year-Old African-American Children in Child Care

Objective. To prospectively document the prevalence of otitis media with effusion (OME) in 86 African-American children between ages 2 and 5 years. Study Design. Eighty-six children in center-based child care whose ear status had been followed from infancy continued to be observed. Middle ear status was assessed by pneumatic otoscopy and tympanometry biweekly. Results. The prevalence of OME decreased as children became older. The mean proportion of examinations demonstrating bilateral OME (BOME) ranged from 12% between 24 to 30 months to 4% between 54 to 60 months of age. The mean proportion of exams revealing bilateral normal ears increased from 77% at 24 to 30 months to 88% at 54 to 60 months of age. Although 60 children had experienced BOME that lasted 4 months or longer in the 6- to 24-month age period, only 8 of these children experienced at least 4 months of continuous BOME between 24 to 60 months. Conclusions. The proportion of time with BOME decreased progressively with increasing age in this population. Only 8 of 60 children who had experienced more than 4 consecutive months of BOME before 2 years of age continued to manifest persistent effusion or experience recurrences of prolonged BOME after 2 years of age.

Assessing the Communication of African American One-Year-Olds Using the Communication and Symbolic Behavior Scales

This article describes the use of the Communication and Symbolic Behavior Scales (CSBS) to profile the communication, social, and symbolic abilities of African American 1-year-olds. The CSBS was ad...

A Longitudinal Study of Risk Factors for Otitis Media in African American Children

Objective: Otitis media with effusion (OME) is a common health care problem for children. The purpose of this study was to examinefactors that place children at risk for OME such as age, type of child care, number of people in the household, and smoking in thehousehold. Methods: Eighty-six African American children, enrolled in center-based child care in infancy, entered the study at a mean age of 8.2 months and were followed prospectively until 48 months of age. Ear status was documented biweekly using pneumatic otoscopy and tympanometry. Data on risk factors were collected every 6 months. Results: Results indicated that children had a marked decrease in the proportion of time with OME between 6 and 48 months. The rate of OME decline was faster in the first 2.5 years than in subsequent years. Children in center-based child care showed a slightly slower rate of decline than did children in non-center-based care. Longitudinal analysis indicated that the age of the child and the number of other children in the household were significant predictors of OME. For each additional child under 12 years of age in the home, there was a 2% increase in the proportion of time with OME. Conclusion: While attendance in group child care predicted a risk for OME, childrens age and the number of other children in the household were still contributing risk factors for OME.