Keith G. Scott

The Adaptive Social Behavior Inventory (Asbi): A New Assessment of Social Competence in High-Risk Three-Year-Olds

This article describes a new inventory for preschool social development. Scale construction was undertaken as an ancillary project in a multi-site study of early intervention for high-risk infants. Scale development began with extensive review; piloting was conducted to ensure appropriateness for mothers of varying educational levels. Descriptive and psychometric data on the 30-item inventory are presented for the sample of 545 3-year-olds. The three subscales are Express, Comply, and Disrupt. Intercorrelations among the scales are reported, as well as correlations with other competence variables. Differences are noted for gender and site, but not birthweight. Potential value of the inventory is discussed.

Identification of early risk factors for language impairment.

The current study is a population-based investigation of birth risk factors for school-identified specific language impairment (SLI). The sample consisted of 244,619 students (5,862 SLI) born in Florida between 1989 and 1990 who were in the Florida public school system at ages 6-7. Epidemiological measures of effect were used to investigate both individual- and population-level risk for SLI. Very low birth weight (VLBW), low 5-min Apgar score, late or no prenatal care, high birth order, and low maternal education were associated with highest individual-level risk. Low maternal education and having an unmarried mother was associated with the highest population-level risk. The results not only suggest who needs to be screened for a future developmental disability, but identify a group of children who are at-risk for an SLI placement in school. Early intervention services for these children may be the most effective approach to reducing the incidence of school-identified SLI.

The Use of Epidemiological Methodology as a Means of Influencing Public Policy

To best influence policymakers, researchers need to provide information and measures of effects that reflect the nature of policy decisions. Specifically, policymakers are often interested in factors associated with changes in the number of cases or rate of disorders in a community. Regression/analysis of variance (ANOVA) models, which focus on the prediction of means, slopes, and variances, do not directly address such questions. In contrast, epidemiological statistics, which focus on differences in proportions of cases, do provide such information. Three epidemiological measures of effect (the risk-ratio, the odds-ratio, and the population attributable fraction) are reviewed; their value as tools for informing public policy is discussed; and examples are provided illustrating their use. Researchers are encouraged to consider adopting an epidemiological perspective as part of their work.

Risk Assessment in Preschool Children: Research Implications for the Early Detection of Educational Handicaps.

Epidemiological techniques were used to reanalyze selected published studies that had screened preschool or kindergarten children. Subjects had been longitudinally tracked to determine results of the screens through the identification of educationally at-risk children. Using published results, a reanalysis of the studies was performed to include sensitivity, specificity, positive predictive value, relative risk ratio, and odds ratio. A comparison of these values was used to discuss and compare the predictive validity and risk indices of the studies. Further interpretation suggested a paradigm shift away from longitudinal studies for screening instrument testing. Methodological considerations emphasizing risk analysis and design modifications are discussed.

Early risk factors for mental retardation: role of maternal age and maternal education.

The predictive value of maternal age and education in relation to rates of administratively defined mental retardation in a 3-year birth cohort (N = 267,277) was studied. Low maternal education placed individuals at increased risk for both educable mentally handicapped (EMH) and trainable mentally handicapped (TMH) placements. Older maternal age was associated with increased risk of mental retardation, but for individuals with EMH, this age effect was only seen in the lowest education group. In terms of population-level risk, it was younger mothers with 12 years of education or less whose births were associated with the greatest proportion of mental retardation. From a public policy viewpoint, children born to mothers with low levels of education are an important group to target for prevention/early intervention efforts.

The effects of biological and social risk factors on special education placement : Birth weight and maternal education as an example

The effects of birth weight (BW) and maternal education (ME) on special education placement at age 10 were studied. Epidemiologic methods quantified risk to the individual and to the population using an electronically linked, county-wide database of birth and school records. A dose-response relationship was found between BW and ME. High ME may serve as a buffer for children with a biological risk for developmental delays. A clinically important finding was that children born with very low BW to mothers with low ME were at a high level of individual risk for receiving special education services. However, such children accounted for a small number of the overall cases. The largest percentage of children receiving special education services had the single risk factor of low ME. From a public policy standpoint, children born to mothers with low levels of education are an important group to target for early intervention.

Public Health Approach to the Study of Mental Retardation.

We applied a public health approach to the study of mental retardation by providing a basic descriptive epidemiological analysis using a large statewide linked birth and public school record database (N = 327,831). Sociodemographic factors played a key role across all levels of mental retardation. Birthweight less than 1000 g was associated with the highest individual-level risk, but the impact varied considerably, depending on maternal educational level. Low maternal education was associated with the largest effects at the population level for mild and moderate/severe mental retardation. Focusing exclusively on specific biomedical causes is of little use in developing public health plans; a broader biosocial perspective reflecting the interactive complexity of the risk factors comprising the various etiological patterns is needed.

Comparison of Referral Rates for Preschool Children at Risk for Disabilities Using Information Obtained From Birth Certificate Records

This study demonstrates the utility of integrating birth certificate record data with an existing disability-tracking database for the purpose of evaluating early identification efforts. The authors examined referral rates of preschool-age children for several known disability risk factors. Low birthweight, low maternal education, and prematurity were associated with increased odds of referral. The authors also examined referral rates for gender, race, and ethnicity. The odds of referral for boys were nearly twice those for girls. Compared to White children, the odds of referral were greater for Native American children and lower for Black and Asian/Pacific Island children. Odds of referral for non-Hispanic/non-Haitian children were greater than those for Hispanic or Haitian children. Identifying factors that are associated with the likelihood of referral will alert clinicians, parents, teachers, and policy makers to the existence of biasing factors and can be used to further improve Child Find procedures.

Influence of birth weight on educational outcomes at age 9 : The Miami site of the Infant Health and Development Program

&NA; The Miami site of the Infant Health and Development Program, an early intervention for infants born low birth weight (LBW) and preterm, was investigated. Analyses unique to this sample were required because it was the only site that selected a normal birth weight (NBW) comparison group and had the lowest sociodemographic characteristics. Epidemiological methods determined the effects of LBW and early intervention on school outcomes. Children born LBW who did not receive intervention had an increased risk of scoring below the 10th percentile on achievement tests and were placed in special education three times more often than their peers born NBW. The school outcomes of children born LBW who received intervention were consistently better than those who did not, but were worse than children born NBW; however, differences did not reach statistical significance. Children born LBW who did not receive intervention are at significant risk for poor school outcomes compared with their peers born NBW.

Effects of Three Levels of Early Intervention Services on Children Prenatally Exposed to Cocaine

Cocaine use during pregnancy is a high-risk indicator for adverse developmental outcomes. Three levels of intervention (center, home, and primary care) were compared in a full service, birth to age 3, early intervention program serving children exposed to cocaine prenatally. Data were collected on 130 children from urban, predominantly poor, primarily minority families. At 36 months, statistically significant, moderate to large intervention effects were found for cognition, receptive and expressive language, and gross motor development. Small effects were observed for behavior problems, and no statistically significant effects were found for fine motor or prosocial skills. Center-based care was most effective for improving language. These findings provide support that the center- and home-based early intervention programs examined in this study had positive effects on children at risk due to prenatal cocaine exposure.