Judy Howard

Characteristics of attachment organization and play organization in prenatally drug-exposed toddlers

Prenatally drug-exposed toddlers were compared to preterm toddlers of similar low socioeconomic status, ethnicity, and single-parent households on intellectual functioning, quality of play, and security of attachment to the primary caregiver. The drug-exposed toddlers had significantly lower developmental scores, less representational play, and the majority had insecure, disorganized, avoidant attachments. In all areas investigated, the prenatally drug-exposed toddlers showed more subtle behavioral deficits within each domain. Although developmental quotients were within the average range, they were significantly lower than the preterm comparison group and did not adequately represent the more evident deficits seen through play in an unstructured situation. Unstructured assessments that required the childs initiation, goal setting, and follow-through were more revealing of developmental disorganization within and among domains than were adult structured assessments such as developmental tests. While modest differences were seen in structured tasks, the marked differences between the drug-exposed and preterm groups were most evident in the unstructured tasks. The lack of coherence across developmental domains was illustrated by the large difference between developmental quotient scores and the poor performance in the cognitive representional competencies demonstrated in play. Insecurity and disorganization in attachment were found to compromise further the development of the drug-exposed toddlers.

Quality of attachment and home environments in children prenatally exposed to PCP and cocaine

Quality of attachment, disorganization in attachment, and the contribution of caregiver interactions in the home were investigated for infants prenatally exposed to PCP and cocaine and their caregivers. The drug-exposed infants were compared with infants of similar ethnicity, socioeconomic status (SES), and living in the same geographical area of the city with non-substance-abusing mothers. The majority of drug-exposed infants were insecurely attached to their caregivers and did not differ in the percentage of security in the three caregiving environments in which the infants were growing up: biologic mother care, kinship care, or foster mother care. The majority of drug-exposed children were disorganized. Change in caregivers during the first year was not found to be related to the rate of insecurity in any of the caregiving environments. The majority of the non-drug-exposed comparison infants were securely attached, and only a small percentage were disorganized. The high incidence of insecurity in the drug-exposed group is discussed in relation to maternal and environmental circumstances that can alter the assumption of security in attachment for the majority of children and caregivers toward insecurity in attachment.

Psychopathology, mother–child interaction, and infant development: Substance-abusing mothers and their offspring

The course of severe depressive symptoms from pregnancy to 6 months postpartum, as well as the occurrence of severe paranoid symptoms prenatally, were examined by the Millon Clinical Multiaxial Inventory I and the Beck Depression Inventory, in 78 women who were heavy, chronic cocaine users and who retained custody of their children after birth. Six months postpartum, the quality of caregiving was observed and assessed in the home, and the children were assessed on the Bayley MDI Index in the laboratory. Mothers who were depressed and paranoid prenatally, regardless of whether the depression continued to 6 months postpartum, were less sensitive in caregiving than women without severe symptoms of paranoia or depression during pregnancy or those who reported only depression that lifted by 6 months postpartum. Mothers who were depressed prenatally and continued to be depressed by 6 months postpartum, regardless of the presence or absence of paranoia, had infants who earned lower Bayley MDI scores than the offspring of women without severe psychological symptoms or women whose depression had lifted. Severe depressive symptoms during pregnancy, if they did not continue to 6 months postpartum, did not appear to adversely influence either caregiving or infant functioning.

Placement with substance-abusing mothers vs. placement with other relatives: Infant outcomes☆

Evaluating a subset of participants from a larger research project concerning comprehensive drug treatment services for pregnant substance-abusing women and their offspring, this investigation compared those mothers who retained custody of their infants following delivery with those who lost custody and whose infants were placed in the care of other relatives. There were no differences between the groups with respect to maternal demographics, substance abuse (as assessed by self-report prenatally and urine toxicology screens at birth), or mental health status, or with respect to newborn characteristics (including gestational age, birthweight, medical risk status). Further, caregiving behaviors of mothers and relative caregivers showed no significant differences at 6 months. Infants who remained in the care of their biological mothers, however, demonstrated better cognitive development than infants in the care of relatives at 6 months. There was also a discrepancy in terms of safety at 6 months, in that there were three deaths and two reported cases of suspected child abuse/neglect among infants in the care of their mothers, and no deaths and no reports of suspected abuse among infants in relative foster care.

Using knowledge to cope with stress in the NICU: how parents integrate learning to read the physiologic and behavioral cues of the infant.

Parental stress in the NICU has at least a short-term impact on the establishment of the parent-child relationship and potential repercussions on long-term child development outcomes. One way to help parents mitigate stress is to help them learn what they need to know about their infant’s condition and care. In this article, we examine how learning to read the infant’s physiologic and behavioral cues helps parents cope with stress. We view parental learning as a process in which parents target specific domains of information for learning according to the temporal relevance of the domain to their concerns. It is important that we recognize the fluidity of the process and anticipate what parents need to learn at different times during hospitalization. The NICU staff assumes a crucial role in reducing parental stress by delivering information that is relevant to the parents’ needs and by helping parents understand this information.

Teacher-Facilitated Microcomputer Activities: Enhancing Social Play and Affect in Young Children with Disabilities.

When young children with disabilities are unable to participate in learning experiences with their peers, they often lose critical opportunities to develop and practice many of the social and academic skills they will need in order to succeed in school and everyday life. This study evaluated the extent to which computer-based activities, facilitated by a teacher within a classroom setting, can enable young children with disabilities to share in these important experiences. Changes in the social play behaviors, social pretend behaviors, communication, and affect exhibited by young children with disabilities were examined in both computer and non-computer play activities. Results indicated that computer-based activities represented a context in which toddlers and preschool-aged children with disabilities exhibited more sophisticated levels of play behaviors and more positive, interactive social behaviors.

Behavioral and Socioemotional Outcomes Through Age 5 Years of the Legacy for Children Public Health Approach to Improving Developmental Outcomes Among Children Born Into Poverty

OBJECTIVES We evaluated Legacy for Children, a public health strategy to improve child health and development among low-income families. METHODS Mothers were recruited prenatally or at the birth of a child to participate in Legacy parenting groups for 3 to 5 years. A set of 2 randomized trials in Miami, Florida, and Los Angeles, California, between 2001 and 2009 assessed 574 mother-child pairs when the children were 6, 12, 24, 36, 48, and 60 months old. Intent-to-treat analyses from 12 to 60 months compared groups on child behavioral and socioemotional outcomes. RESULTS Children of mothers in the intervention group were at lower risk for behavioral concerns at 24 months and socioemotional problems at 48 months in Miami, and lower risk for hyperactive behavior at 60 months in Los Angeles. Longitudinal analyses indicated that children of intervention mothers in Miami were at lower risk for behavior problems from 24 to 60 months of age. CONCLUSIONS Randomized controlled trials documented effectiveness of the Legacy model over time while allowing for implementation adaptations by 2 different sites. Broadly disseminable, parent-focused prevention models such as Legacy have potential for public health impact. These investments in prevention might reduce the need for later intervention strategies.

Legacy for ChildrenTM: a pair of randomized controlled trials of a public health model to improve developmental outcomes among children in poverty

BackgroundOne in five Americans under age 18 lives in a family below the Federal poverty threshold. These more than 15 million children are at increased risk of a wide variety of adverse long-term health and developmental outcomes. The early years of life are critical to short- and long-term health and well-being. The Legacy for ChildrenTM model was developed in response to this need and marries the perspectives of epidemiology and public health to developmental psychology theory in order to better address the needs of children at environmental risk for poor developmental outcomes.Methods/designThe Legacy for ChildrenTM group-based parenting intervention model was evaluated as a pair of randomized controlled trials among low-income families in Miami and Los Angeles. The study was designed to allow for site-stratified analysis in order to evaluate each model implementation separately. Evaluation domains include comprehensive assessments of family, maternal, and child characteristics, process outcomes, and prospective programmatic cost. Data collection began prenatally or at birth and continues into school-age.DiscussionThe societal costs of poor developmental outcomes are substantial. A concerted effort from multiple sectors and disciplines, including public health, is necessary to address these societal concerns. Legacy uses a public health model to engage parents and promote overall child well-being in families in poverty through rigorous evaluation methodologies and evidence-based intervention strategies. This study collects rich and modular information on maternal and child outcomes, process, and cost that will enable a detailed understanding of how Legacy works, how it can be refined and improved, and how it can be translated and disseminated. Taken together, these results will inform public policy and help to address issues of health disparities among at-risk populations.Trial registrationNCT00164697

Prenatal exposure to drugs and its influence on attachment.

An increasing number of children are exposed to drugs prenatally and are being reared in substance-abusing families. The long-term effects of prenatal drug exposure on the intellectual, social, and emotional development of children remain undetermined. Preliminary findings in this study suggest effects in the intellectual, social and emotional domains of development. The impact of prenatal illicit drug exposure on intellectual, social and emotional development was investigated in a sample of 18 18-month-old toddlers who had been prenatally exposed to a variety of drugs including cocaine, heroin, methadone, and PCP. These 18 children lived in a variety of child rearing environments including foster care, extended family care, and biological mothers. In previous studies, poor prenatal care and difficult perinatal events have been implicated in negative developmental outcomes for drug-exposed children. Therefore, the drug-exposed toddlers were compared to a biological high-risk sample of preterm children who weighed less than 2000 grams at birth with the majority experiencing respiratory distress, and a nonrisk sample of fullterm children. Security and insecurity in the attachment relationship between the child and caregiver was assessed in the laboratory by the standardized paradigm known as the Strange Situation. Developmental scores were determined by the standardized Gesell and Bayley developmental assessment procedures. The content, organization, and quality of the children’s spontaneous play activity was assessed in a fifteen-minute laboratory session with a variety of age-appropriate toys in an open floor space area. The drug-exposed toddlers deviated from the comparison groups in several ways. Only a few of the drug-exposed toddlers displayed the interactive behaviors that are typically expected at this age, such as greeting and moving closer, and seeking close physical contact with the caregiver when she returns after a short separation. The majority of the drug-exposed children did not show the strong feelings of pleasure, anger and distress in relation to novel toys and the caregiver’s departure and return that the Strange Situation is designed to elicit. For the most part they remained affectively neutral throughout the procedure. The drug-exposed toddlers showed a higher proportion of insecure attachments than the high-risk preterm or fullterm comparison groups. The highest percentage of insecure drug-exposed toddlers was in the subgroup being raised by their biological mothers. In all cases but one, these mothers continued to abuse drugs. The one mother of the secure drug-exposed toddler stopped using drugs after the child‘s birth and had a significantly shorter history of drug abuse prior to the birth of her child. In all other cases chronicity of drug abuse

Cross-cultural comparison of the neurobehavioral characteristics of Chinese and Japanese neonates

Background : Similarities and differences in the neurobehavioral repertoire of neonates from different cultures have been noted using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). By identifying the behavioral attributes of newborns that are seen more universally versus those that are culture‐specific, comparative studies increase understanding of the roles of cultural factors in shaping the behavioral trajectory of infants. This study compared the neurobehavioral characteristics of neonates in Chengdu, China and Nagasaki, Japan.