Harolyn M. E. Belcher

Intelligence and school readiness in preschool children with prenatal drug exposure.

This prospective, longitudinal study examined factors affecting intelligence and school readiness in children 4-5 years of age with prenatal cocaine/opiate exposure. Intelligence and school readiness scores were not significantly different for the drug-exposed group (N=104) than for unexposed, demographically matched controls (N=35), although both groups scored slightly below average. Caregivers of drug-exposed children scored significantly lower in intelligence and reading achievement than caregivers of controls; both were below average. Caregiver reading scores accounted for the largest variance in both child intelligence and school readiness; for school readiness, birth weight also contributed but was less important in the model. Neither prenatal drug exposure nor continuing caregiver drug use was significant in the regression analyses. The relationship between child scores and caregiver reading achievement is consistent with studies showing the importance of a stimulating, supportive home environment, and suggests interventions to foster caregiver literacy skills and facilitate caregiver-child cognitive interactions such as reading to the child.

Risky Business: Trauma Exposure and Rate of Posttraumatic Stress Disorder in African American Children and Adolescents

Demographics, parental risk factors, and experiencing interpersonal trauma (domestic violence, community violence, and physical and sexual abuse) are related to childhood posttraumatic stress disorder (PTSD). Little is known about these factors and the risk of PTSD in African American children. This study examined associations between PTSD symptoms and gender, age, parent mental illness, parent substance abuse, and interpersonal trauma in African American children. Participants were 257 children and adolescents, ages 8-17 years (M = 11.7, SD = 2.5), who received outpatient mental health treatment. Being female and witnessing domestic violence was associated with more PTSD symptoms. Exposure to community violence and physical abuse increased the odds of clinically significant PTSD symptomatology by more than 2 times. The rate of PTSD (16%) was lower in the current study than in other same-age study populations (25%-40%). Risk factors and identification strategies for PTSD are discussed.

Prenatal Drug Exposure: Effects on Cognitive Functioning at 5 Years of Age

The goal of this cross-sectional study was to compare cognitive functioning at age 5 years in prenatal drug-exposed children with nondrug-exposed children from a comparable inner-city environment. Children with prenatal drug exposure scored significantly lower on measures of language, school readiness skills, impulse control, and visual attention span/sequencing than controls matched for age and socioeconomic status. Intelligence, visual-motor, manual dexterity, and sustained attention scores were not significantly different between groups. The total sample scored significantly below the normative mean on standardized measures of intelligence, language, school readiness, visual-motor skills, impulse control, and sustained attention, with 40% scoring at least 1 standard deviation below the mean (IQ < 85) on a measure of intelligence. Findings suggest that children with prenatal drug exposure are at increased risk for learning and attention problems and are in need of close developmental surveillance and possible intervention to support school success and improve behavioral outcome.

Spectrum of Early Intervention Services for Children With Intrauterine Drug Exposure

Intrauterine illicit drug exposure may lead to a variety of adverse neurobehavioral and neurodevelopmental outcomes. Providing early intervention to reduce the impact of maternal substance abuse on the developing fetus may have significant benefits for the child and family. In this article, we report on 3 promising intervention programs designed to improve the well-being of parents with drug dependence and their children. The initiation of these programs spans from pregnancy through early childhood. All 3 programs are community-based, using comprehensive culturally relevant developmental models. The first program was developed to provide comprehensive care for pregnant women with drug dependence and their newborns. Project STRIVE (Support, Trust, Rehabilitation, Initiative, Values, and Education) provided substance abuse treatment, intensive center- and home-based social work, and parent education onsite at a high-risk obstetric and pediatric clinic. The second program, the Early Infant Transition Center, enrolled newborns with a history of neonatal abstinence syndrome and their mothers. Based in a renovated rowhouse in East Baltimore, one block away from a major urban hospital, the Early Infant Transition Center provided 24-hour nursing care, oncall physicians and nurse practitioners, social workers, parent education, and onsite sleeping accommodation for parents during their infants recovery. The third program, Home-U-Go Safely, used community-based nurses to give home-based health monitoring, education, and support to new mothers with a history of cocaine and/or opiate dependence.

Study protocol for a comparative effectiveness trial of two parent training programs in a fee-for-service mental health clinic: can we improve mental health services to low-income families?

BackgroundUntreated behavioral and mental health problems beginning in early childhood are costly problems affecting the long-term health and wellbeing of children, their families, and society. Although parent training (PT) programs have been demonstrated to be a cost-effective intervention modality for treating childhood behavior problems, they have been less effective for children from low-income and underserved racial and ethnic populations. The purpose of this randomized trial is to compare the effectiveness, cost, and social validity of two manualized evidence-based PT programs that were developed and tested on different populations and employ different delivery models: (1) The Chicago Parent Program (CPP), a group-based program developed in collaboration with a community advisory board of African-American and Latino parents; and (2) Parent-Child Interaction Therapy (PCIT), an individualized parent-child coaching model considered to be ‘the gold standard’ for parents of children with externalizing behavior problems.MethodsThis trial uses an experimental design with randomization of parents seeking behavioral treatment for their 2- to 5-year-old children at a mental health clinic in Baltimore, MD (80% African-American or multi-racial; 97% receiving Medicaid). Using block randomization procedures, 262 parents are randomized to CPP or PCIT. Clinicians (n = 13) employed in the mental health clinic and trained in CPP or PCIT are also recruited to participate. Primary outcomes of interest are reductions in child behavior problems, improvements in parenting, perceived value of the interventions from the perspective of parents and clinicians, and cost. Parent distress and family social risk are assessed as modifiers of treatment effectiveness. We hypothesize that CPP will be at least as effective as PCIT for reducing child behavior problems and improving parenting but the programs will differ on cost and their social validity as perceived by parents and clinicians.DiscussionThis is the first study to compare the effectiveness of a PT program originally designed with and for parents from underserved racial and ethnic populations (CPP) against a well-established program considered to be the ‘the gold standard’ (PCIT) with a high-risk population of parents. Challenges related to conducting a randomized trial in a fee-for-service mental health clinic serving urban, low-income families are discussed.Trial registrationNCT01517867

Using the Clinical Linguistic and Auditory Milestone Scale for Developmental Screening in High-Risk Preterm Infants

Eighty-one preterm infants (mean gestational age 29 weeks, range 24-36 weeks) discharged from The Johns Hopkins Hospital Neonatal Intensive Care Unit were followed up sequentially from birth to 2 years of age by use of the Clinical Linguistic and Auditory Milestone Scale (CLAM,S) to evaluate language development. Children were studied during three time intervals: Interval 1: 3-5 months chronologic age (CA); Interval 2: 9-14 months (CA); and Interval 3: 18-24 months (CA). Psychometric test scores were compared with CLAMS Language Quotients (LQ) by use of full, partial (75%, 50%, 25%), and no ‘correction’ for weeks of prematurity to determine whether ‘correcting’ for prematurity would yield a more accurate estimate of eventual cognitive outcome. CLAMS LQ at Interval 1 was highly correlated with CLAMS LQ at Interval 2 and CLAMS LQ at Interval 2 correlated well with CLAMS LQ at Interval 3 (r=0.57 and 0.64, respectively, P=0.0001). Correlations indicated that there was an orderly, sequential development of language in the preterm infant. CLAMS evaluations correlated significantly with psychometric test results during Interval 2 and Interval 3 (r=0.34, P<0.02 and r=0.75, P=0.0001, respectively). The CLAMS proved to be a useful instrument for monitoring preterm language development in the primary pediatric care setting.

Neighborhood environment and urban schoolchildren's risk for being overweight.

Purpose. Child and adolescent obesity is increasingly prevalent and predisposes risk for poor physical and psychosocial health. Physical and social factors in the environment, such as neighborhood disorder, may be associated with childhood obesity. This study examines the association between living in a disordered neighborhood and being overweight among a sample of urban schoolchildren. Design. Baseline interview data, including height, weight, and hip circumference, were obtained from 313 elementary school–aged participants in a community-based epidemiologic study. Setting. The setting was Baltimore, Maryland, a large metropolitan city. Subjects. Subjects were elementary school students ages 8 to 12 years. Measures. To assess neighborhood characteristics, independent evaluators conducted objective environmental assessments using the Neighborhood Inventory for Environmental Typology instrument on the block faces (defined as one side of a city block between two intersections) where the children resided. Analysis. Logistic regression models with generalized estimating equations were used to examine the association between neighborhood disorder and children being overweight. Results. Neighborhood disorder showed a trend toward a statistically significant association with being overweight during childhood (odds ratio [OR], 1.03; confidence interval [CI], .99–1.07; p = .07) in the unadjusted model. Gender was significantly associated with being overweight, with female gender increasing the odds of being overweight by 50% in the sample (OR, 1.50; CI, 1.18–1.92; p < .01). After controlling for race, age, and comparative time spent on a sport, multivariable analyses revealed that gender (adjusted odds ratio [AOR], 2.42; CI, 1.63–3.59; p < .01) and neighborhood disorder (AOR, 1.09; CI, 1.03–1.15; p < .01) were associated with being overweight. Further, an examination of interactions revealed girls (AOR, 2.40; CI, 1.65–3.49; p < .01) were more likely to be overweight compared with boys (AOR, 2.20; CI, 1.57–3.11; p < .01) living in neighborhoods with the same level of neighborhood disorder. Conclusion. Results suggest neighborhood hazards warrant additional consideration for their potential as obesogenic elements affecting gender-based disparities in weight among urban schoolchildren. Future studies in this area should include longitudinal examinations.

Comparison of Intelligence, School Readiness Skills, and Attention in In-Utero Drug-Exposed and Nonexposed Preschool Children

Children with in-utero drug exposure (IUDE) may be at risk for poor neurodevelopmental outcomes. The objective of this study was to determine the association between IQ school readiness skills, and self-regulation behavior in IUDE children (n=103) and non IUDE-exposed children (n=33) at age 4 years. Mean IQ or school readiness scores did not significantly differ by IUDE exposure; however, both groups scored approximately 1 standard deviation below the mean for both IQ and school readiness skills. The IUDE group earned a significantly higher mean score (thereby performing poorer) than the nonexposed group on focusing and inattentive behavior. Factors associated with poor school readiness skills for all children (IUDE exposed and nonexposed) were not attending a preschool program and lower caregiver education level. Assuring high-risk children are identified and referred for early intervention services as well as treated for inattention behavior is crucial for their academic success.

Behavioral Problems and Service Utilization in Children with Chronic Illnesses Referred for Trauma-Related Mental Health Services.

Objective: Given its prevalence and impact on health and well-being, childrens exposure to traumatic experiences is of growing importance to pediatricians and other medical providers. Little is known, however, about the traumatic experiences profiles, trauma-related sequelae, and service use patterns of youth with chronic or recurrent medical problems/disabilities. This study aimed to fill this research gap. Method: Participants were children less than 18 years of age who were referred for assessment and/or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s) (n = 9885; mean = 11 years, SD = 4.3; 52.3% girls). Generalized linear mixed models were used to examine associations among types of trauma, emotional and behavioral problems, and rates of service utilization adjusting for treatment center-level random effects, demographic characteristics, and the total number of types of trauma exposures. Results: Among children seeking treatment for traumatic stress, those with comorbid medical problems/disabilities had different demographic characteristics, different types of trauma exposure, and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities. Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures, associated symptoms, and higher levels of behavioral problems at home, school, or day care. Those with medical disorders/disabilities were at 30% to 40% higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms, used more medical and mental health services for trauma, and had more emotional and behavioral concerns. Conclusion: Given that pediatricians are more likely to see children with medical disabilities and concerns than those without, there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience. Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions.

How do we assess family supports and fairness in early intervention

Public Law 99-457 extended the landmark Public Law 94-142 legislation to include early intervention for infants and toddlers with or at-risk for development of developmental disabilities. Currently over 300,000 infants and toddlers and their families in the United States receive services through Part C of the Individuals with Disabilities Education legislation. The law fostered interagency collaborations and included the childs parent or caregiver as an integral part of the intervention team. This article reviews the 26 years of legislation associated with educating young children with disabilities and the resulting early intervention service delivery system. Analyses and review of studies of Part C services are offered to inform policies that enhance early identification, family engagement, and intervention delivery.