J. Kevin Nugent

Prenatal Organochlorine Exposure and Measures of Behavior in Infancy Using the Neonatal Behavioral Assessment Scale (NBAS)

Background Previous literature suggests an association between organochlorines and behavioral measures in childhood, including inattention. Objective This study was designed to assess whether prenatal organochlorine exposure is associated with measures of attention in early infancy. Methods We investigated an association between cord serum polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyl dichloroethene (DDE) levels and measures of attention from the Neonatal Behavioral Assessment Scale (NBAS) in a cohort of 788 infants born 1993–1998 to mothers residing near a PCB-contaminated harbor and Superfund site in New Bedford, Massachusetts. Results Medians (ranges) for the sum of four prevalent PCB congeners and DDE levels were 0.19 (0.01–4.41) and 0.30 (0–10.29) ng/g serum, respectively. For the 542 subjects with an NBAS exam at 2 weeks, we observed consistent inverse associations between cord serum PCB and DDE levels and NBAS measures of alertness, quality of alert responsiveness, cost of attention, and other potential attention-associated measures including self-quieting and motor maturity. For example, the decrement in quality of alert responsiveness score was −0.51 (95% confidence interval, −0.99 to −0.03) for the highest quartile of exposure to the sum of four prevalent PCB congeners compared with the lowest quartile. We found little evidence for an association with infant orientation, habituation, and regulation of state, assessed as summary cluster measures. Conclusions Our findings provide evidence for an association between low-level prenatal PCB and DDE exposures and poor attention in early infancy. Further analyses will focus on whether organochlorine-associated decrements in attention and attention-related skills in infancy persist in later childhood.

PREVENTIVE INTERVENTION WITH INFANTS AND FAMILIES - THE NBAS MODEL

A model for preventive intervention based on the use of the Neonatal Behavioral Assessment Scale (NBAS) is presented, and the conceptual framework underlying this approach is made explicit. The approach is based on the assumption that the neonatal period presents clinicians with a unique opportunity to influence parent-infant relations positively from the beginning. It is argued that especially under conditions of stress, this infant-centered but family-focused form of intervention can serve to prevent the compounding of problems that may occur when the caregiving environment is unable to adjust to the needs of the young infant. The aim of the NBAS-based approach is to sensitize parents to the communication cues and the unique adaptive capacities of their infants. It is the individualized nature of the NBAS-based approach that places it outside the domain of main-effects treatment modalities and renders it responsive to the particular needs of individual infants and their families. The model of intervention described herein is based on the development of a supportive therapeutic relationship between clinicians and parents and as such may serve as the first stage in a comprehensive follow-up program of support for infants and families. Guidelines for clinicians using the NBAS in clinical settings that follow from these assumptions are provided.

Classification of Attachment and Its Determinants in Urban Irish Infants

This study (part of the Dublin Child Development Study) had two aims: to establish the distribution of patterns of infant-mother attachment in an urban sample of Irish 18-month-old infants from predominantly working-class families and to examine factors which may influence the classification of attachment. Three main attachment groups were identified: 80% of infants., were classified as secure (B), 15% as insecure-avoidant (A) and 5% as insecure-resistant (C). According to Belsky and Isabella’s (1988) conceptual framework, individual differences in attachment quality are multiply determined by three distal sources of influence: mother characteristics, infant characteristics and social context. Preliminary results indicated that stability in family of origin, emotional stability at 3 weeks, as well as empathy and maternal confidence at 18 months, were significantly related to infant-mother attachment security. There was also some evidence that maternal report of neonatal fussy-difficultness and caretaking ...

Predicting Inhibited and Uninhibited Behaviour

Research carried out by Jerome Kagan and associates on the temperamental profiles of inhibited and uninhibited behaviour in children has established a strong link between high motor, high cry behaviours in response to novel stimuli at 4 months and inhibited reactions to the unfamiliar at 2 years, and low motor, low cry behaviours in response to novel stimuli at 4 months and uninhibited reactions to the unfamiliar at 2 years. A number of empirical rmdings and theoretical considerations suggested that Irish infants might be disproportionately more likely than V.S. infants to exhibit inhibited behaviour profiles. A sample of Irish infants (n=107) was assessed for motor and cry reactivity to novel stimuli and categorised into 4 different groups: (1) high motor, high cry, (2) high motor, low cry, (3) low motor, high cry and (4) low motor, low cry. The resulting data were compared to those of a matched V.S. sample. Only 7% of the Irish infants. compared to 23% of the V.S. infants, were placed in the high motor,...

Neurobehavioural and Medical Effects of Prenatal Alcohol and Cigarette Use: Data from the Dublin Child Development Study

A sample of Irish women (n=188) expecting their first babies provided information concerning their alcohol and nicotine use during pregnancy and the relationships between these variables and the birthweight, temperament at 3 weeks and neurobehavioural status (as measured by the Brazelton NBAS) of their babies was investigated. In the sample of women as a whole the levels of alcohol use (M= 0.09 oz AA/day) and cigarette consumption (only 7% defmed as heavy smokers) were low and the sample was unusual in the context of the existing literature on this topic, as all of the women claimed not to be using any drugs other than nicotine and alcohol. Despite the low levels of alcohol consumption during pregnancy in this sample, this variable was found to be associated with reductions in the birthweight and the neurobehavioural status of the baby, and cigarette consumption was associated with reduced birthweight, neurobehavioural status and some temperament ratings.

83 THE RELATION BETWEEN OBSTETRIC FACTORS, CULTURAL FACTORS AND NEWBORN BEHAVIOR

This study examines the effects of cultural and biomedical variables on newborn development by comparing a sample of Irish (n=48) and American (n=54) newborns on the Brazelton scale on day 1 and day 3. The contribution of biomedical variables was assessed by the Obstetric Complications Scale (Parmelee et al., 1976), so that subjects were selected on a basis of comparable obstetric histories. By controlling for as many confounding obstetric stress variables as possible, we were able to assess the contribution of other factors on newborn behavior. Labor and delivery management practices were therefore compared in both settings. Using the 7-point cluster scoring system developed by Lester et al. (1978), results showed that Irish infants scored significantly higher on the Orientation, Range of State, and Autonomic Regulation clusters. They were more responsive to both visual and auditory stimuli, were predominantly in quiet alert states, and showed fewer signs of physiological stress than American infants. These results may suggest that the forms of childbirth environments and different cultural attitudes towards pregnancy, labor and delivery have an effect on newborn behavior. We were therefore able to raise the possibility that the superior performance of the Irish infants in these areas may be due to the provision of an extremely supportive psychological environment with minimal technological intervention during labor and delivery.