Holly A. Ruff

DEVELOPMENTAL ABNORMALITIES IN INFANTS AND CHILDREN WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME (AIDS) AND AIDS‐RELATED COMPLEX

Children with acquired immune deficiency syndrome (AIDS) display two types of clinical picture: (1) a fullblown AIDS characterized by the presence of opportunistic infections and/or Kaposis sarcoma and (2) a prodromal stage now identified as AIDS‐related complex (ARC). Neurological complications have been identified in infants and children with the disease. This paper discusses the developmental abnormalities in 16 pediatric patients, seven with AIDS and nine with ARC, ranging in age from six months to six years. In all cases, the mothers of these children either had ARC, AIDS and/or used intravenous drugs. Developmental histories showed delayed acquisition of milestones in most children following the diagnosis of AIDS or ARC, with delayed motor milestones consistently noted in both groups. Several children with AIDS actually lost milestones as their illness progressed; this has not occurred in the ARC group. Psychometric testing revealed more severe cognitive dysfunction in the group with AIDS. Involvement of the central nervous system was documented clinically, radiologically, and/or electrophysiologically in all patients with AIDS. In the ARC group the course of the illness has shown greater variability. Medical and social factors that may contribute to the developmental abnormalities are discussed.

Early focused attention predicts outcome for children born prematurely.

ABSTRACT. There is evidence that early focused, but not casual, attention to objects reflects concurrent regulation of attention and active learning. Because attentional abilities are of particular relevance in preterm infants, we evaluated whether early focused attention would be a better predictor of later attention and cognitive function than casual attention in 55 children born at very low birth weight. Participants were tested initially at 7 months and then at 2, 3, and/or 4/5 years of age. Focused attention was defined as the duration of concentrated examination of objects during independent play. Outcome measures were maternal ratings on standard attention-deficit hyperactivity disorder rating scales and standardized cognitive assessments. Results indicate that 7-month focused attention was predictive of reported problems in hyperactivity/impulsivity at age 4/5 years and cognitive abilities at 2, 3, and 4/5 years; casual attention measures were not related to these outcomes. Early focused attention appears continuous with later attentional skills in at-risk infants and is related to cognitive abilities through the preschool years.

Early attention and negative emotionality predict later cognitive and behavioural function

Negative emotionality and poor attention may combine or interact as risk factors in development. Negative emotionality is considered a challenge for self-regulation, whereas good attention is a potential means of self-regulation. In the current study, composites of 1- and 2-year maternal ratings of negative emotionality and global ratings of observed attentiveness were predictors for 3.5-year cognitive and behavioural outcome for 75 children. Results of variable-based regression analyses indicated that early negativity and attentiveness predicted IQ and scores on a hyperactivity index; only negativity predicted a global measure of behaviour problems. Results of person-based analyses for groups formed by median splits on negativity and attention suggested that the More Negative/Less Attentive group had significantly poorer outcome than the other three groups combined (those with one or none of the two risk factors). Comparisons of mean differences also suggested a protective effect of greater attentiveness for more negative as opposed to less negative children for all outcomes. The results extend prior work in providing longitudinal data over the first 3 years and including both cognitive and behavioural outcomes.

Attention and organization of behavior in high-risk infants.

Preterm infants at 7 months, corrected age, and 7-month-old full-term infants were videotaped while they played with a series of novel objects for a minute apiece. Each infants videotape was scored for duration of examining (focused visual inspection), duration of mouthing, and duration of slapping or banging the objects. Full-term infants examined the objects significantly more than the preterms; the two groups showed equivalent levels of mouthing and banging. Each minute was then divided into 15-second segments. Only examining showed a decline over time, and then only for the full-terms. When the three behaviors were compared on the latency to the first episode of the behavior in each trial, it was found that the behavior of the full-terns was clearly differentiated in terms of sequence with examining having the shortest latency, mouthing the next shortest, and banging the longest. For the preterms, however, there were no differences among the mean latencies. The major difference between the two groups was in the latency to examine, which was significantly longer in the preterms. In general, the results for the preterms were not related to developmental level, but appeared to be due to deficits in both reactivity to stimulation and ability to sustain attention.J Dev Behav Pediatr 7:298-301, 1986.

Early intervention in the context of foster care

There may be a number of specific foster care models that would facilitate infant development. The important point is that the emphasis should shift from foster care as maintenance to foster care as active intervention. Several other recent developments in public policy and public opinion suggest that the time is ripe for such a change; the federal government has mandated provision of early intervention services for young children at risk, and there is renewed interest in breaking the cycle of disadvantage. At this point, we must deal with the reality of the large number of infants and young children who enter the foster-care system and who stay for substantial periods of time. This situation represents an opportunity for professionals and foster parents alike to play a crucial role in changing the potentially adverse course of development for many children. It is an opportunity too important to be lost.

Population-based data and the development of individual children: the case of low to moderate lead levels and intelligence.

This essay is an exploration of the problem of applying research results based on large numbers to the individual child and the childs development. The main argument of the article is that the results of population-based studies are not directly relevant to individuals and that attempts to apply findings to individual children are often based on misunderstandings about measurement, statistics, and the processes of development. Although research into the relationship of elevated lead levels and cognitive development serves as a specific context for exploring these general issues, the issues are germane to many areas of development and many potential influences. The goal of the article is to provide an explicit discussion of scientific issues presented to members of the public and potential sources of confusion.

The effects of low to moderate lead levels on neurobehavioral functioning in children: Toward a conceptual model

The purpose of this article is to present a working model of the way in which low to moderate levels of lead toxicity may affect the neurological and behavioral functioning of young children. The model is used to organize representative data on the subject, to evaluate the state of the field, and to suggest directions for future research.

DEVELOPMENTAL ABNORMALITIES IN CHILDREN WITH ACQUIRED IMMUNODEFICIENCY SYNDROM |[lpar]|AIDS|[rpar]|

An AIDS-like disease in infants was first described in 1982, with 2 types of clinical pictures reported: a full-blown syndrome and a prodromal stage. Some adults with AIDS have a progressive encephalopathy and suble cognitive changes. A study was initiated to determine whether 6 AIDS children, ages 10 mos. to 6 yrs. exhibited developmental abnormalities. Four children were hospitalized and 2 were examined in the OPD. Five had the full syndrome and 1 the prodrome. Parents used IV drugs in 5 cases, and in 2 cases mothers died of AIDS. Two children were siblings. Neurodevelopmental and psychological examinations were given using Bayley Scales for children < 30 months and the Stanford-Binet for older children. The 4 inpatients had microcephaly and failure-to-thrive; 3 had spasticity, 1 had seizures, and 1 regressed. All 4 scored < 50 on the Bayley. The 2 outpatients, each over 5 yrs., had IQs of 67 and 71, and scored well below normal on language tests. Therefore, all subjects were retarded. Whether this is due to AIDS itself or other factors is uncertain. A larger number of AIDS children and a comparison group of offspring of drug-addicted mothers without AIDS are being studied to clarify the etiology of the developmental abnormalities.