Sarale E. Cohen

Stress responses after pediatric bone marrow transplantation: preliminary results of a prospective longitudinal study.

This paper reports the preliminary findings of a longitudinal prospective study of young children undergoing bone marrow transplantation. Symptoms of post-traumatic stress were seen in these children up to 12 months after transplant. The bone marrow transplantation survivors demonstrated more denial and avoidance and fewer arousal symptoms than has been noted in children traumatized by a violent life threat, such as a sniper attack. These data suggest the use of post-traumatic stress as a model in understanding some of the symptoms of pediatric bone marrow transplantation survivors and may be applicable to other children exposed to the double life threat of serious illness and intensive medical intervention.

Maternal Sensitivity during Infancy and Subsequent Life Events Relate to Attachment Representation at Early Adulthood.

A prospective longitudinal research study of 86 prematurely born children from birth to age 18 years provided empirical evidence for continuity from infancy experience to representations of attachment at age 18 years. Young adults whose representation of attachment was dismissing had been objectively observed during infancy, 16-17 years earlier, to receive less sensitive maternal care than those infants who were later judged at early adulthood to have secure or preoccupied representations. Infancy experience alone did not differentiate young adults with secure representations from those with preoccupied representations. Rather, adverse life events through age 12, particularly parental divorce, reduced the likelihood of secure representations and increased the likelihood of preoccupied representations. The absence of adverse life events did not increase the likelihood of security for those who had not experienced early sensitive caregiving.

Cognitive development in preterm infants: birth to 8 years.

This report summarizes the outcome at age 8 of a group of preterm infants followed intensively from birth. The study was designed primarily to follow the processes of interaction between biological and environmental factors in determining the childhood outcome of infants born preterm rather than to report the incidence of particular types of outcomes for special subgroups of infants. A high percentage of the children were performing within the normal range. Social factors played a major role in determining the outcome regardless of neonatal complications. Functional assessment of newborn visual attention and sleep organization showed a modest relation to outcome. A subgroup of preterm infants from Spanishspeaking families, for cultural and language integration reasons, followed a somewhat different course from infancy to childhood outcome than did the group from English-speaking families. The results suggest that in longitudinal studies of preterm infants, different cultural and language groups should be analyzed separately so that one may understand the developmental processes and outcomes.

Preterm birth: Hazardous obstetrical and postnatal events as related to caregiver-infant behavior

It has been suggested that diminished caregiver-infant interaction is likely with biologically-at-risk infants. This paper examines the question: Does the presence of adverse conditions surrounding the pregnancy and birth interfere with caregiver-infant interaction with preterm infants? Birth weight, gestational age, length of hospitalization, hazardous obstetrical, and postnatal events in a sample of 123 preterm infants were correlated with caregiver and infant behaviors in naturalistic observations in the home when the infants were one-month-old. Caregiver behaviors were related to prior events such that the infants who had experienced a more hazardous biological course received more social interaction as well as routine caretaking. Infant behaviors were also related to prior obstetrical and postnatal events. Infants with a more hazardous course had a shorter period of wakefulness and were less irritable during their awake time. The results suggested that hazardous obstetrical and postnatal events tended to alter infant behaviors and enhanced, rather than diminished, caregiver-infant interaction with preterm infants, at least 1 month of age.

Why does infant attention predict adolescent intelligence

Abstract Ninety-three 18-year-olds were tested with measures thought to tap information processing, sustained attention, executive function, and intelligence. The visual fixation patterns and home rearing conditions of these adolescents, born preterm, had been observed in early infancy. Infant fixation durations were negatively associated with information processing, executive function, and intelligence scores but did not predict ability to sustain attention. Continuity between infant attention and adolescent intelligence was moderated by qualities of the home environment so that “short-looking infants” whose caregivers vocalized a great deal had mean intelligence quotients that were 20 points higher than “long-looking infants” with less vocal caregivers. The results suggest that at least some of the continuity between infant attention and adolescent intelligence stems from infant capacities to process information efficiently and to inhibit prepotent responses and that this continuity is affected by caregiver responsiveness.

Continuity in cognitive abilities from infancy to 12 years of age

Abstract The aim of this study was to determine the nature of the continuity between a measure of duration of fixation at infancy and later cognitive competence. Sixty-seven 12-year-olds, born preterm and followed from birth, were tested with measures of information processing, sustained attention, and capacity to use relevant and irrelevant novel information. As hypothesized, short fixation durations were predictive of accuracy on a speeded information processing task requiring focused attention and were unrelated to sustained attention at 12 years. Neonates who fixated visual stimuli briefly were also more successful at adolescence on verbal analogies in which novel information was irrelevant than those who as neonates looked for long durations at unchanging visual stimuli. Intelligence at age 12 was a function of the characteristics of the infant and of the caregiving environment considered jointly.

Caregiving behaviors and early cognitive development as related to ordinal position in preterm infants.

Naturalistic home observations of 54 preterm infants and their caregivers were made when the infants were 1, 3 and 8 months of age. Differences were found in the kinds of everyday transactions which occur with preterm infants raised with and without siblings. At 1 month of age the care of firstborn and later-born infants was similar in most ways. At 3 months and 8 months firstborn infants clearly received more responsive care and more stimulation from their mothers than later-born infants. Furthermore, the firstborn infant received more social transactions from anybody. Firstborn preterm infants obtained higher Gesell developmental scores than later-born infants, replicating results reported with infant test performance of full-term infants.

Biosocial factors in early infancy as predictors of competence in adolescents who were born prematurely

ABSTRACT. In a prospective longitudinal study of a cohort of 105 subjects born prematurely, competence was assessed from infancy through late adolescence. A biosocial model guided the research. Neohatal neurobehavioral organization (a composite of term visual attention, amount of time in active sleep, and 407 EEG pattern) and early social stimulation (the amount of talking the mother addressed to the infant during a home observation when the infant was 1 month old) in conjunction with social class were used to predict competence at key age periods through late adolescence. Intellectual competence, school achievement, social competence, and self perception of cognitive competence were studied. The results indicate that measures taken in the early infancy period were predictive of later competence, particularly intellectual competence, above and beyond social class. Twenty-eight percent of the variance in 48-year IQ scores was explained by the predictor variables. The study highlights the importance of directing efforts to improve the social environment of both the infant and the family. J Dev Behav Pediatr 16:36–41, 1995. Index terms: prematurity, competence, biosocial factors, late adolescence

Task persistence in 2-year-old preterm infants in relation to subsequent attentiveness and intelligence

Abstract Task persistence was measured in 2-year-old, preterm infants whose behaviors were rated by their mothers at age 5 years. The Gesell Developmental Scale was also administered at age 2 and the Stanford-Binet at ages 3 and 5 years. Two-year-olds who persisted longer at opening a plexiglas box that contained a toy and waited to request help were rated as showing fewer behavior problems on the Conners Scale and as more likely to complete their work at age 5 than 2-year-olds who focused for a shorter period and asked for help more quickly. While task persistence assessed on both tasks was associated with cognitive abilities measured concurrently and subsequently, stability in persistence independent of competence and intelligence seemed to be maintained over the 3-year period.

Prediction of Low and Normal School Achievement in Early Adolescents Born Preterm

The study examined low school achievement in a group of early adolescents born preterm, who had participated in a prospective longitudinal study from birth through 12 years of age. Multivariate analyses were used to compare adolescents with low school achievement, of normal-or-above intelligence, to adolescents with no achievement problems. Significant group differences were found in a number of domains in early adolescence, including verbal comprehension, attentional processes, social competence, self-perception, maternal responsiveness, and ratings of problematic behavior. Biological and social factors in infancy were associated indirectly with school achievement. A comparison of differences between groups with newly emergent and persistent achievement problems indicated that the persistent group had lower IQ scores and was lower in neonatal organization. There was some overlap between children with achievement problems and children with behavior problems; however the low achievement group was less cognitively competent and showed poorer attentional skills.