Julius B. Richmond

Social changes among youth: The United States experience☆

The tremendous increase in research on adolescence over the past 20 years, and especially the last decade, has produced a great deal of knowledge about adolescent development and the development of problems during adolescence. This new knowledge should lead to more effective interventions. Although more research is needed on basic developmental processes and context influences, this is especially the case in the area of effective interventions. The next decade may bring significant new knowledge that will dramatically improve the lives of young people in the United States. This is desperately needed as the current status of youth must change.

An Idea Whose Time Has Arrived

A brief history of behavioral pediatrics provides the background for the definition and current status of the new discipline. The changing role of the pediatrician is reflected in the changing concerns of the field.

Programmed Day Care for the Very Young Child. A Preliminary Report

Since controversy continues regarding the influence of maternal deprivation on the very young child, a Center being set up at the State University of New York in Syracuse proposes to study this influence while providing quality day care for children primarily from low-income families in which the mother works. The status of research on maternal deprivation is surveyed, and the proposed Center program and research are described.

The epidemiology of learning disorders.

Impaired learning skills result in a serious loss of human potential and are particularly significant in our modern, technologically dominated society. The same basic epidemiologic methods which have proved of value in controlling disease and solving other social problems are applied to the study of disorders in learning.

Child and Adolescent Psychiatry: Toward the Twenty-first Century

&NA; The history of child and adolescent psychiatry is reviewed, from its beginning in the Hull House movement in Chicago a century ago through subsequent social and scientific transformations. The fields relationships to academic medicine, to progress in the basic sciences, and to child advocacy are described. Current challenges to the field, including the gaps in and barriers to care, the emergence of for‐profit enterprises, and the lack of consensus regarding health care regulation, are discussed in terms of the evolving social mission of the profession. Priorities for the next century are identified.

Infancy Intervention: Historical perspectives

The pressures by working parents have emphasized the need for out-of-home care infants. What we know historically about drastic and distressing outcomes of group care for infants without attention to their special developmental needs has important lessons for us. With such careful attention, as several pioneer infant enrichment day care programs suggest, we can be more hopeful about mitigating the impact of other-than-mother infancy group care. Societal cautions are suggested in moving ahead with increased use of day care for infants.

Cambios sociales en la juventud: La experiencia de los Estados Unidos

Resume El tremendo aumento de la investigacion sobre adolescencia en los ultimos veinte anos y especialmente en la ultima decada, ha producido gran cantidad de conocimiento sobre el desarrollo y problemas del adolescente. Este nuevo conocimiento debe llevar a intervenciones mas efectivas, mas investigacion en los procesos basicos del desarrollo, influencias del contexto, y sobre todo intervenciones efectivas. La proxima decada puede traer nuevas ensenanzas que mejoraran dramaticamente la vida de los jovenes en los EEUU. Esto se necesita con desesperacion ya que la condicion actual de la juventud debe cambiar.

602 THE EFFECT OF PRENATAL CARE UPON BIRTH WEIGHT SPECIFIC OUTCOME

It is generally accepted that variations in birth weight-specific mortality rates (BWSMR) are closely related to the nature and quality of medical care provided the neonate once born. However, the effect of prenatal care on BWSMR has not been well explored. We studied linked birth/neonatal death vital statistics files for the City of Boston for the years 1975–79. Logistic models were used to assess the influence of prenatal care adjusting for race, gestational age, maternal age, education, and family income.For the 329 deaths and 68,842 births analyzed, prenatal care was significantly related to overall neonatal survival (p < .001). However, its effect upon BWSMR was not uniformly significant:The data suggest that prenatal care does not greatly influence BWSMR at low birth weights. However, the adequacy of prenatal care services appears to strongly affect survival at birth weights above 2500g. Alterations in access to prenatal care could therefore influence both the distribution of low birth weight (LBW) births and the BWSMR of non-LBW neonates.

THE SIGNIFICANCE OF MOTHER-CHILD INTERACTION FOR THE UNDERSTANDING, OF CHILD ABUSE AND FAILURE-TO-THRIVE: A VIDEOTAPE ANALYSIS

Mother-child interaction and behavioral developmental characteristics of infants with diagnoses of child abuse and failure-to-thrive were examined in videotaped observations. 40 subjects, from a 400 case epidemiologic study of pediatric social illnesses were observed with their mothers in a laboratory playroom setting. These infants 12-30 months of age were studied on measures of separation protest, attachment and reunion behaviors tempo and organization of play. For comparison purposes a control group matched on age, sex, socio-economic status, age at hospitalization and length of hospitalization was observed.Analyses of the videotapes reveal important behavioral distinctions for the two groups in comparison to normal developmental age trends. This methodology permits a clearer understanding of the mother-child interaction as an important diagnostic issue. This suggests the need for integrating mother-child interactional issues with the more traditional focus on maternal psychopathology and social class in considerations of etiology. The value of this methodology for the behavioral study of clinical syndromes is illustrated with videotaped vignettes.

THE CENTRAL TASK OF CHILDHOOD—LEARNING THE PEDIATRICIAN'S ROLE *

In Erikson’s concept of the eight stages of man, the school years are defined as a period of industry.l The central task of this period is learning. The child learns in the formal, academic sense at school and in other structured learning situations; but he is also involved in social learning through recreation and other aspects of family and community life, activities that help to prepare him further for the adult world of work and play. The goal of those who work with children is to make possible the fullest development of each child’s potential for learning. Practitioners in the field of pediatrics have demonstrated particular interest in learning disabilities, as the factors that can affect learning have been shown to be closely related to their areas of concern; nutritional deprivation, prenatal and perinatal factors, developmental abnormalities, physical handicaps, toxic biological insults, and complex psychological issues have all been demonstrated to have adverse effects on the child’s ability to learn. The pediatrician is responsible for enhancing the functional capacity of the child in his biological, as well as psychosocial, development. Children come to him, not with the label of “minimal brain dysfunction,” but with problems in learning. The pediatrician’s conceptual and clinical task is to specify which of the many variables that affect or influence learning are impairing the learning capacities of these children. Because there is no clear-cut taxonomy of learning disorders, his task is complex. In dealing with children who manifest learning disorders, the pediatric clinician must integrate his knowledge of biology with an awareness of social and psychological factors, in order to make judgments concerning causation and management. He does not have the freedom of the investigator, who may focus on more limited problems, depending upon his own theoretical persuasion. Indeed, a research worker may be more effective if he concentrates on one factor of the problem at a time. Thus, investigators in our center are directing their interest to the evidence for structural or functional abnormalities