Heidelise Als

The Infant's Response to Entrapment between Contradictory Messages in Face-to-Face Interaction

The normal feedback infants receive from their mothers in face-to-face interaction was distorted by having the mothers face their infants but remain facially unresponsive. The infants studied reacted with intense wariness and eventual withdrawal, demonstrating the importance of interactional reciprocity and the ability of infants to regulate their emotional displays.

Toward a synactive theory of development: Promise for the assessment and support of infant individuality

A theoretical model to understand and assess the individual infant is presented. Its focus is on the dynamic, continuous interplay of various subsystems within the organism: the autonomic system, the motor system, the state organizational system, the attentional-interactive system, and the self-regulatory system. The organism forges ahead negotiating emerging developmental agenda while simultaneously seeking to attain a new level of modulated, functional competence. Developmentally salient aspects of the environment are actively sought as fuel in this process. This synactive model of development promises to be helpful in identifying specific ingredients of the early developmental process and in structuring specific supports for preventive and ameliorative work when difficulties in differentiation and regulation are identified. An assessment procedure to systematically identify difficult areas of modulation integration is briefly described and examples of environmental structuring are given.

A three-center, randomized, controlled trial of individualized developmental care for very low birth weight preterm infants: medical, neurodevelopmental, parenting, and caregiving effects.

ABSTRACT. Medical, neurodevelopmental, and parenting effects of individualized developmental care were investigated in a three-center, randomized, controlled trial. A total of 92 preterm infants, weighing less than 1250 g and aged less than 28 weeks, participated. Outcome measures included medical, neurodevelopmental and family function. Quality of care was also assessed. Multivariate analysis of variance investigated group, site, and interaction effects; correlation analysis identified individual variable contributions to significant effects. The results consistently favored the experimental groups. The following contributed to the group effects: shorter duration of parenteral feeding, transition to full oral feeding, intensive care, and hospialization; lower incidence of necrotizing enterocolitis; reduced discharge ages and hospital charges; improved weight, length, and head circumferences; enhanced autonomic, motor, state, attention, and self-regulatory functioning; reduced need for facilitation; and lowered family stress and enhanced appreciation of the infant. Quality of care was measurably improved. Very low birth weight infants and their parents, across diverse settings, may benefit from individualized developmental care.

Regional brain development in serial magnetic resonance imaging of low-risk preterm infants.

OBJECTIVE. MRI studies have shown that preterm infants with brain injury have altered brain tissue volumes. Investigation of preterm infants without brain injury offers the opportunity to define the influence of early birth on brain development and provide normative data to assess effects of adverse conditions on the preterm brain. In this study, we investigated serial MRI of low-risk preterm infants with the aim to identify regions of altered brain development. METHODS. Twenty-three preterm infants appropriate for gestational age without magnetic resonance–visible brain injury underwent MRI twice at 32 and at 42 weeks’ postmenstrual age. Fifteen term infants were scanned 2 weeks after birth. Brain tissue classification and parcellation were conducted to allow comparison of regional brain tissue volumes. Longitudinal brain growth was assessed from preterm infants’ serial scans. RESULTS. At 42 weeks’ postmenstrual age, gray matter volumes were not different between preterm and term infants. Myelinated white matter was decreased, as were unmyelinated white matter volumes in the region including the central gyri. The gray matter proportion of the brain parenchyma constituted 30% and 37% at 32 and 42 weeks’ postmenstrual age, respectively. CONCLUSIONS. This MRI study of preterm infants appropriate for gestational age and without brain injury establishes the influence of early birth on brain development. No decreased cortical gray matter volumes were found, which is in contrast to findings in preterm infants with brain injury. Moderately decreased white matter volumes suggest an adverse influence of early birth on white matter development. We identified a sharp increase in cortical gray matter volume in preterm infants’ serial data, which may correspond to a critical period for cortical development.

The Brazelton Neonatal Behavioral Assessment Scale (BNBAS)

SummaryThe Brazelton Neonatal Behavioral Assessment attempts to capture the behaviors of the neonate as he defends himself from intrusive, negative stimuli, and controls interfering motor and autonomic responses in order to attend to important social and nonsocial stimuli. In order to conceptualize the 26 behavioral items and 20 reflex scores, four clusters or typologies have been identified which help to reduce the data for analytic purposes with small numbers of subjects. So far few long-term validation studies have been completed, although the scale is in use in many different areas, such as obstetrical medication, predicting to neurological deficits, cross-cultural differences, and with low birth weight infants.

Prediction of dyslexia in kindergarten boys.

This study followed 163 boys from kindergarten through fourth grade. A battery of neurospychological and preacademic tests and electrophysiological measures (BEAM) were administered in kindergarten, and reading tests at grade 4, in an attempt to delineate precursors of dyslexia. Three of the kindergarten tasks (giving sounds associated with letters, rapid naming of numbers, and finger localization) differentiated dyslexics from normal readers with 98 percent correct classification. The tasks primarily involve grapheme-phoneme associations, storage and retrieval of phonological information in long-term memory, and verbal labeling. Results are interpreted as confirming the role played by phonological processing tasks in the prediction of dyslexia. Preliminary BEAM results for visual evoked potential topography suggest a significant increment in the distribution of this potential in the left parietal and frontal region, and, for auditory evoked potential topography, a significant difference between the two groups in the right posterior hemisphere.

Toward a Research Instrument for the Assessment of Preterm Infants’ Behavior (APIB)

Recent advances in the care of premature infants have led to rapid increases in survival rates. This in turn has led to a growing demand for intervention at earlier and earlier stages aimed at preventing developmental dysfunction and supporting optimal development. The demand for support and intervention necessitates early assessment procedures on which to base appropriate intervention and with which to assess individual progress. This demand, as Thoman and Becker (1979) point out, reflects a profound change in the assumptions about early infancy, namely that assessment and support at this early stage of life can effect significant changes in the developmental course of the infant. This assumption is confronted at present with a remarkable lack of predictive success associated with many of the present assessment procedures (see McCall’s review, 1976; Lewis’s review, 1973). As one might expect, prediction at the extreme low end of the continuum is most reliable (Honzik, 1976); yet even with complex statistical procedures applied to comprehensive and cumulative batteries of assessments the diagnostic measures at best have been able to account for one tenth of the variance in the major outcome measures at two years, as, for instance, reported in the UCLA Infant Project (Sigman & Parmelee, 1979). Sigman and Parmelee conclude from their extensive study of preterm infants that the “nature of the outcome measurements should be broadened to include social, motivational, and personal qualities of the infant as well as more stable intellectual assessment” (p. 215), and they conclude that predictions which do not take into account the ongoing transactions between child and environment are bound to be weak, since early diagnosis is complicated by the responsiveness of the environment and the adaptability of the human infant.

Effectiveness of individualized neurodevelopmental care in the newborn intensive care unit (NICU)

The individual infants neurodevelopmental process provides an integrative framework for the delivery of medical care needed to assure the infants survival and quality of outcome. The infants neurobehavioral functioning and expression provides an opportunity for caregivers to estimate the individual infants current strengths, vulnerabilities and threshold to disorganization, as well as to identify the infants strategies in collaborating in his or her best progression. This perspective supports caregivers in seeing themselves in a relationship with the infant, and in considering opportunities to enhance the infants strengths and reduce apparent stressors in collaboration with the infant and the family. The results of several randomized studies supporting the effectiveness of such a neuro developmental approach to NICU care will be presented, and suggest implications for staff education and nursery‐wide implementation.

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

The current study reports the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) at 8 years of age for a randomized controlled trial of 38 very early born (≤29 weeks postmenstrual age), high-risk preterm infants. It was hypothesized that the experimental group at school age in comparison with the control group would perform significantly better neuropsychologically and neuroelectrophysiologically. Twenty-two (11 control, 11 experimental) children of the original 38 (18 control, 20 experimental) participants were studied at school age with a detailed neuropsychological battery and with EEG spectral coherence measures. Results indicated significantly better right hemisphere and frontal lobe function in the experimental group than the control group, both neuropsychologically and neurophysiologically. Neurobehavioral and physiological results in the newborn period successfully predicted the beneficial brain function effects at age 8 years. Results support the conclusion that the NIDCAP intervention has lasting effects into school age.

Linguistic profiles of dyslexic and good readers

Linguistic profiles of 60 boys with average intelligence were examined at kindergarten, grade 2, and grade 4. The subjects were 7 dyslexic, 7 mildly dyslexic, 30 average, and 16 good readers, defined in terms of the discrepancy between standardized reading and intelligence scores. Across the three ages, reader groups did not differ in language comprehension, but did differ in confrontation and rapid automatized naming (RAN), three syntactic measures, and verbal memory. Group strengths and weaknesses were, with few exceptions apparent in kindergarten and maintained throughout. The kindergarten tasks which most effectively predicted reading group membership at grade 4 were giving letter sounds, and rapid naming; these predicted 4th grade reading group at close to 100 percent accuracy. The study, together with a further comparison of average and high IQ good readers, provides an interesting contrast between the role of RAN and Confrontation naming in reading.