In a prospective study, prenatal risk factors for mental retardation were identified in two large samples of white and black children followed from gestation to age 7 years in the Collaborative Perinatal Project. Important antecedents of severe and mild retardation include both characteristics of the family and complications of pregnancy.
For the severely retarded, a higher frequency of maternal seizures was a major discriminator in comparisons with higher IQ groups. For a subgroup of the severely retarded that was free of major neurological disorders, maternal urinary tract infection in pregnancy was an important independent risk factor.
Major prenatal discriminators between the mildly retarded and children at higher IQ levels were indices of maternal intelligence, education, socioeconomic status, and amount of prenatal care received.
These and other risk factors found in the samples studied suggest preventive strategies that could reduce the incidence of cognitive deficit in children.
The magnitude of the problem of mental retardation in our country hardly needs any exaggeration. The psychological burden that these parents carry has been varied. The present study was undertaken to delineate the psychological problems of parents of mentally retarded children and to establish whether these problems were more prevalent in the parents of mentally retarded children than in the parents of normal children. The material comprised of three groups of subjects: The first group comprised of parents of twenty students of a school for mentally handicapped children; the second group comprised of parents of ten mentally retarded children who were not institutionalised or attended any special school for mentally retarded in the past: the third group comprised of parents of twenty normal school going children. The results of the study conclusively proved that the parents of mentally retarded children had a higher prevalence of psychological morbidity than the parents of normal children. The commonest psychiatric disorder was Dysthymia followed by Generalised Anxiety Disorder and Moderate Depression.
Psychological morbidity; mental retardation; general health questionnaire (GHQ)
The aim of this study was to determine the prevalence, characteristics, and factors related to feeding problems among normal children, and the differences in feeding practices between those with and without feeding problems. Caregivers of 402 healthy children aged between one and four years of age were interviewed by pediatricians involved in the research. Data included the child’s medical history, food intake within a day, and feeding behaviors and practices. Parental socio-economic and demographic information, as well as information on parental education and occupation, and their concerns about feeding their children, was collected. Physical examination and anthropometric measurements were taken. The percentage of children identified as having feeding problems was 26.9%. The first child of a family had an increased risk of having feeding problems [P=0.032, odds ratio 1.68, 95% confidence interval (95%CI) 1.04-2.71]. Children with feeding problems were fed less frequently, were less likely to be fed at their own table or at the family table, and had mealtimes longer than 30 min when compared with children without feeding problems (P=0.015, 0.004 and 0.025, respectively). The results highlight that feeding problems in normally developing children are common. During consultations about feeding issues, pediatricians should focus on families with a first child. Topics such as frequency of meals per day, duration of mealtimes, and appropriate places for feeding should be discussed.
children; feeding problems; prevalence
The number of children of incarcerated parents in the U.S. has grown dramatically in recent years. These children appear to be at risk for various problems, and a number of family-focused preventive efforts have been attempted. The current study examines differences between incarcerated mothers, incarcerated fathers, and their families on factors that might be important to consider when creating the content and process of preventive intervention programs. Participants were 359 inmates (54% women; 41% minority) who were parents of children between the ages of 3 and 11 years and who parented their children prior to imprisonment. Mothers and fathers were similar on a number of dimensions including age, education-level, number and age of children, and family criminal history, but differences were observed on key variables relevant to outcomes for children and families, including employment history and income, substance use, mental health, trauma experiences and criminal history. Implications for prevention programs are discussed.
children; corrections; gender differences; incarcerated parents; prevention
Undetected and untreated developmental problems can have a significant economic and social impact on society. Intervention to ameliorate potential developmental problems requires early identification of children at risk of future learning and behaviour difficulties. The objective of this study was to estimate the prevalence of risk for developmental problems among preschool children born to medically low risk women and identify factors that influence outcomes.
Mothers who had participated in a prenatal trial were followed up three years post partum to answer a telephone questionnaire. Questions were related to child health and development, child care, medical care, mother's lifestyle, well-being, and parenting style. The main outcome measure was risk for developmental problems using the Parents' Evaluation of Developmental Status (PEDS).
Of 791 children, 11% were screened by the PEDS to be at high risk for developmental problems at age three. Of these, 43% had previously been referred for assessment. Children most likely to have been referred were those born preterm. Risk factors for delay included: male gender, history of ear infections, a low income environment, and a mother with poor emotional health and a history of abuse. A child with these risk factors was predicted to have a 53% chance of screening at high risk for developmental problems. This predicted probability was reduced to 19% if the child had a mother with good emotional health and no history of abuse.
Over 10% of children were identified as high risk for developmental problems by the screening, and more than half of those had not received a specialist referral. Risk factors for problems included prenatal and perinatal maternal and child factors. Assessment of maternal health and effective screening of child development may increase detection of children at high risk who would benefit from early intervention.
Current Controlled Trials ISRCTN64070727
Ocular problems are common in mentally retarded children. Due to population growth these problems are increasing. Prevalence rate is variable from region to region. Data on ocular problems in mentally retarded school children is lacking in this region.
The aim of the present study was to identify the ocular disorders in children with mental retardation attending special schools in a district and to study their relationship with the degree of retardation.
Materials and Methods:
A total of 241 mentally retarded school children in the age group of 6-16 years attending special schools for the mentally retarded children in a district in central India were examined by a team of ophthalmologist, psychiatrist, and a resident in ophthalmology department of a medical college. Complete ocular examination was done. Ocular problems were identified and categorized according to the intelligent quotient.
One hundred and twenty four children (51.45%) had ocular problems. Strabismus (10.37%) and refractive error (20.75%) were the common ocular problems seen in this study. An association was found between the severity of mental retardation and ocular problems (P<0.005). However, no association was seen between the severity of mental retardation and strabismus and refractive error.
A high prevalence of ocular problems was seen in mentally retarded school children. Children with mental retardation should undergo annual ophthalmological check up. Early detection and correction of ocular problems will prevent visual impairment in future.
Children; mental retardation; ocular disorder; refractive error; strabismus
Depression in fathers in the postnatal period is associated with an increased risk of behavioural problems in their offspring, particularly for boys. The aim of this study was to examine for differential effects of depression in fathers on children's subsequent psychological functioning via a natural experiment comparing prenatal and postnatal exposure.
In a longitudinal population cohort study (the Avon Longitudinal Study of Parents and Children (ALSPAC)) we examined the associations between depression in fathers measured in the prenatal and postnatal period (measured using the Edinburgh Postnatal Depression Scale), and later behavioural/emotional and psychiatric problems in their children, assessed at ages 3½ and 7 years.
Children whose fathers were depressed in both the prenatal and postnatal periods had the highest risks of subsequent psychopathology, measured by total problems at age 3½ years (Odds Ratio 3.55; 95% confidence interval 2.07, 6.08) and psychiatric diagnosis at age 7 years (OR 2.54; 1.19, 5.41). Few differences emerged when prenatal and postnatal depression exposure were directly compared, but when compared to fathers who were not depressed, boys whose fathers had postnatal depression only had higher rates of conduct problems aged 3½ years (OR 2.14; 1.22, 3.72) whereas sons of the prenatal group did not (OR 1.41; .75, 2.65). These associations changed little when controlling for maternal depression and other potential confounding factors.
The findings of this study suggest that the increased risk of later conduct problems, seen particularly in the sons of depressed fathers, maybe partly mediated through environmental means. In addition, children whose fathers are more chronically depressed appear to be at a higher risk of emotional and behavioural problems. Efforts to identify the precise mechanisms by which transmission of risk may occur should be encouraged to enable the development of focused interventions to mitigate risks for young children.
Depression; child behavioural problems; perinatal; fathers; ALSPAC
The investigation studies the perception and attitudes of patents towards their mentally retarded child. Thirty such children were followed up after one year of initial contact and the parents were interviewed. Parents of higher education had a more scientific perception. Most parents had unrealistic hopes and expectations, feelings of shame, guilt and self blame were predominant. Rejection, hostility neglect of child and other negative attitudes were significantly more often seen in younger parents, urbanites and those with higher education. The negative attitudes were more towards a child with additional psychiatric problems. This information could be of great advmuge in managing families with a retarded child.
A genetic study of children attending ESN(M) schools in Coventry has shown a recurrence risk of idiopathic mental retardation in sibs lying between 1 in 4 and 1 in 5. There was also a prevalence of mental retardation in other relatives that was greater than the population prevalence, and was less for second degree relatives than for first degree, and less still for third degree relatives. Recurrence in sibs was greater if more than one first degree relative was affected. There was no suggestion of a contribution by X linked genes, once the fragile X syndrome had been excluded. The presence of perinatal and other environmental factors in the index children did not alter the recurrence risk for sibs except for very low birth weight. There was a low recurrence rate of mental retardation in Asian families, suggesting that they had a different distribution of intelligence from non-Asian families.
Children with Autistic Disorder (AD) evidence more co-occurring maladaptive behaviours than their typically developing peers and peers with intellectual disability because of other aetiologies. The present study investigated the prevalence of Clinically Significant maladaptive behaviours during early childhood and identified at-risk subgroups of young children with AD.
Parents rated their child’s maladaptive behaviours on the Child Behaviour Checklist (CBCL) in 169 children with AD aged 1.5 to 5.8 years.
One-third of young children with AD had a CBCL Total Problems score in the Clinically Significant range. The highest percentage of Clinically Significant scores were in the Withdrawal, Attention, and Aggression CBCL syndrome scales. There was a high degree of co-morbidity of Clinically Significant maladaptive behaviours. Several subject characteristic risk factors for maladaptive behaviours were identified.
Findings highlight the need to include behavioural management strategies aimed at increasing social engagement, sustained attention and decreasing aggressive behaviour in comprehensive intervention programmes for young children with AD.
Keywords autism; autistic disorder; behaviour problems; children; child behaviour checklist; maladaptive behaviour
Aims and Objectives:
The aim of the study was to establish the prevalence of enuresis in school children and to determine contributing factors along with treatment methods used in these children.
Materials and Methods:
The parents of 1473 children aged between 6-10 years completed a self-administered semi-structured questionnaire. Socio-demographic profiles, enuresis data, medical and psychiatric disorders and family stressors were collected. The data was analyzed and the results presented.
The response rate was 89.22%. The overall prevalence of enuresis was 7.61%. Enuresis was more common in boys. A positive family history of enuresis was seen in 28.57% children; 14.29% of the children had daytime wetting as well. Only 24.11% of the parents had taken their child to a doctor for the problem. Family stressors, significant birth history and lower socioeconomic status was present to a larger extent in the enuretic group. Scholastic backwardness was also an important factor in this group.
This study reports on the prevalence of enuresis in school-going children and stresses on the need for parental education and awareness about this problem.
Enuresis; primary school children
Information about the extent of additional disabilities presented and experienced by the mentally retarded children is essential for proper health services planning for this group.
The objective of this case-control study was to identify the developmental milestones and additional disabilities of mildly mentally retarded male children. Sixty-nine parents of mildly mentally retarded male children (MMR group) and a similar number of matched parents of normal male children (control group) were interviewed and a questionnaire was completed.
Generally, the MMR group children smiled, sat, walked, talked and became continent for urine and bowel significantly later than the control group. Additional disabilities in the children of the MMR group were in the form of speech (65%), visual (28%), limb weakness (20%), hearing (16%), convulsive disorder (15%) and other disabilities (10%).
Well structured health education and I.Q. screening programs were recommended for early detection of mental retardation and subsequent entry to special education. Institutes for mentally retarded children in the Kingdom need to be better vocationally equipped. The role of Family and Community Physicians in early detection and management was also emphasized.
Mental Retardation; Disabilities; Saudi Arabia
numbers of children experience parental incarceration worldwide. Families and
children of prisoners can experience multiple difficulties after parental
incarceration, including traumatic separation, loneliness, stigma, confused
explanations to children, unstable childcare arrangements, strained parenting,
reduced income, and home, school, and neighborhood moves. Children of
incarcerated parents often have multiple, stressful life events before parental
incarceration. Theoretically, children with incarcerated parents may be at risk
for a range of adverse behavioral outcomes. A systematic review was conducted to
synthesize empirical evidence on associations between parental incarceration and
children's later antisocial behavior, mental health problems, drug use, and
educational performance. Results from 40 studies (including 7,374 children with
incarcerated parents and 37,325 comparison children in 50 samples) were pooled
in a meta-analysis. The most rigorous studies showed that parental incarceration
is associated with higher risk for children's antisocial behavior, but not for
mental health problems, drug use, or poor educational performance. Studies that
controlled for parental criminality or children's antisocial behavior before
parental incarceration had a pooled effect size of OR = 1.4
(p < .01), corresponding to about 10% increased risk for
antisocial behavior among children with incarcerated parents, compared with
peers. Effect sizes did not decrease with number of covariates controlled.
However, the methodological quality of many studies was poor. More rigorous
tests of the causal effects of parental incarceration are needed, using
randomized designs and prospective longitudinal studies. Criminal justice
reforms and national support systems might be needed to prevent harmful
consequences of parental incarceration for children.
parental incarceration; antisocial behavior; mental health; drug use; education
BACKGROUND—Submicroscopic subtelomeric chromosome defects have been found in 7.4% of children with moderate to severe mental retardation and in 0.5% of children with mild retardation. Effective clinical preselection is essential because of the technical complexities and cost of screening for subtelomere deletions.
METHODS—We studied 29 patients with a known subtelomeric defect and assessed clinical variables concerning birth history, facial dysmorphism, congenital malformations, and family history. Controls were 110 children with mental retardation of unknown aetiology with normal G banded karyotype and no detectable submicroscopic subtelomeric abnormalities.
RESULTS—Prenatal onset of growth retardation was found in 37% compared to 9% of the controls (p<0.0005). A higher percentage of positive family history for mental retardation was reported in the study group than the controls (50% v 21%, p=0.002). Miscarriage(s) were observed in only 8% of the mothers of subtelomeric cases compared to 30% of controls (p=0.028) which was, however, not significant after a Bonferroni correction. Common features (>30%) among subtelomeric deletion cases were microcephaly, short stature, hypertelorism, nasal and ear anomalies, hand anomalies, and cryptorchidism. Two or more facial dysmorphic features were observed in 83% of the subtelomere patients. None of these features was significantly different from the controls. Using the results, a five item checklist was developed which allowed exclusion from further testing in 20% of the mentally retarded children (95% CI 13-28%) in our study without missing any subtelomere cases. As our control group was selected for the "chromosomal phenotype", the specificity of the checklist is likely to be higher in an unselected group of mentally retarded subjects.
CONCLUSIONS—Our results suggest that good indicators for subtelomeric defects are prenatal onset of growth retardation and a positive family history for mental retardation. These clinical criteria, in addition to features suggestive of a chromosomal phenotype, resulted in the development of a five item checklist which will improve the diagnostic pick up rate of subtelomeric defects among mentally retarded subjects.
Keywords: submicroscopic subtelomeric rearrangements; clinical preselection; checklist; chromosome deletion.
incidence of school and behaviour problems at age 7 years in children
born between 32 and 35 weeks gestation, and investigate perinatal risk factors.
population consisted of all children born at 32-35 weeks gestation to
mothers resident in Oxfordshire in l990. General practitioners,
parents, and teachers were asked about health, behaviour, and education
by postal questionnaire. Teachers rated children on level of function
in six areas using a five point scale. They also completed the
Strengths and Difficulties behaviour questionnaire. Perinatal risk
factors were identified for children with poor school performance using
a univariate and multivariate analysis.
responses were obtained for 117 (66%) of the 176 children in the
cohort. Twenty nine (25%) required support from a non-teaching
assistant, five (4%) had required a statement of special educational
needs, and three (3%) were at special school. Poor outcome was
reported for 32% in writing, 31% in fine motor skills, 29% in
mathematics, 19% in speaking, 21% in reading, and 12% in physical
education. On the behaviour questionnaire, 19% of the cohort achieved
an abnormal hyperactivity score (population norm 10%). Multivariate
analysis showed perinatal variables that remained significant,
independent of other variables; they were discharge from the special
care baby unit > 36 weeks postconceptional age (odds ratio 4.15; 95%
confidence interval 1.43 to 12.05) and male sex (odds ratio 3.88; 95%
confidence interval 1.42 to 10.6).
CONCLUSION—Up to a
third of children born between 32 and 35 weeks gestation may have
school problems. As there are larger numbers in this gestational
category compared with smaller babies, this finding has implications
for educational services.
Emerging evidence suggests that early intervention and prevention programmes for mental health problems in the offspring of parents with depression are important. Such programmes are difficult to implement if children with psychiatric disorder are not identified and are not accessing services, even if their parents are known to primary care.
To investigate service use in children of parents who have recurrent depression, and factors that influence such contact.
Design and setting
A total of 333 families were recruited, mainly through primary health care, in which at least one parent had received treatment for recurrent depression and had a child aged 9–17 years.
Psychiatric assessments of parents and children were completed using research diagnostic interviews. The service-use interview recorded current (in the 3 months prior to interview) and lifetime contact with health, educational, and social services due to concerns about the child’s emotions or behaviour.
Only 37% of children who met criteria for psychiatric disorder were in contact with any service at the time of interview. A third, who were suicidal or self-harming and had a psychiatric disorder at that time, were not in contact with any service. Lack of parental worry predicted lower service use, with higher rates in children with comorbidity and suicidality.
Most children with a psychiatric disorder in this high-risk sample were not in contact with services. Improving ease of access to services, increasing parental and professional awareness that mental health problems can cluster in families, and improving links between adult and child services may help early detection and intervention strategies for the offspring of parents with depression.
adolescent; depression; early intervention; primary health care; risk
Although relations of various parental psychological problems and family functioning with child development are well documented, it remains unclear whether specific prenatal or specific postnatal risk factors are independently associated with child emotional and behavioural problems, or whether observed associations can be explained by general parental psychopathology. Using a stepwise approach, we examined the effects of prenatal and postnatal parental depressive symptoms, prenatal and postnatal hostility of the parents, as well as prenatal family functioning on the risk of child emotional and behavioural problems. This study was embedded in Generation R: a population-based cohort from foetal life onwards. Mothers and fathers of 2,698 children provided information about depressive symptoms, symptoms of hostility and family functioning during pregnancy and 3 years after birth. Mother and father each reported on child behaviour when the child was 3 years old. Parental depressive symptoms increased the risk of child emotional and behavioural problems, but this increase was explained by postnatal parental hostile behaviour. Postnatal symptoms of hostility of mothers (OR = 1.34, p value <0.001) and postnatal symptoms of hostility of fathers (OR = 1.30, p value <0.001) each contributed independently to the risk of child emotional and behavioural problems. Postnatal parental hostility is associated with an increased risk of child emotional and behavioural problems, independent of parental depressive symptoms. These findings suggest that prevention and intervention strategies should focus on psychological symptoms of both mothers and fathers, in particular on hostile behaviour, in families with young children.
Electronic supplementary material
The online version of this article (doi:10.1007/s00787-011-0178-0) contains supplementary material, which is available to authorized users.
Family functioning; Psychopathology; Depression; Hostility; Child emotional and behavioural problems
A register of children with cerebral palsy born to mothers resident in the Mersey region from 1966 to 1977 was compiled from health service records. Frequency distributions and prevalences of birth weight and gestational age differed for those with hemiplegia, diplegia, and quadriplegia. In particular, the children with diplegia showed a bimodal frequency distribution. Children of normal birth weight with diplegia had a higher prevalence of severe mental retardation than those of low birth weight. These differences may be due to survival bias and may not be of aetiological importance. Furthermore, the mothers of diplegic infants had a significantly higher proportion of spontaneous abortions, stillbirths, and low birthweight infants in their obstetric history. This suggests that prenatal factors predominate in the aetiology of diplegia.
Microdeletions within chromosome 15q13.3 are associated both with a recently recognised syndrome of mental retardation, seizures, and dysmorphic features, and with schizophrenia.
Methods and results
Based on routine diagnostic testing of ~8200 samples using array comparative genomic hybridisation, we identified 20 individuals (14 children and six parents in 12 families) with microdeletions of 15q13.3. Phenotypes in the children included developmental delay, mental retardation, or borderline IQ in most and autistic spectrum disorder (6/14), speech delay, aggressiveness, attention deficit hyperactivity disorder, and other behavioural problems. Both parents were available in seven families, and the deletion was de novo in one, inherited from an apparently normal parent in four, and inherited from a parent with learning disability and bipolar disorder in two families. Of the 14 children, six in five families were adopted, and DNA was available for only one of these 10 biological parents; the deletion was very likely inherited for one of these families with two affected children. Among the unavailable parents, two mothers were described as having mental retardation, another mother as having “mental illness”, and one father as having schizophrenia. We hypothesise that some of the unavailable parents have the deletion.
The occurrence of increased adoption, frequent autism, bipolar disorder, and lack of penetrance are noteworthy findings in individuals with deletion 15q13.3. A high rate of adoption may be related to the presence of the deletion in biological parents.
Unconfirmed histories of antisocial behaviours in unavailable biological parents raise the concern that future research may show that deletion 15q13.3 is associated with such behaviours.
To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and assess risk factors that can cause this disease.
After the determination of 15 primary schools in the provincial center of Ankara, questionnaires were given to 15,150 students to be answered by their parents. Detailed urologic history was obtained and physical examination applied to the students whose parents answered the questionnaire. After excluding children with polysymptomatic NE, 14060 questionnaires of MNE patients were evaluated. Demographic features with social and medical history of students and their parents, general approach of family to the children, school success of the students and general behavioral attitudes, method of toilet training and the presence of nocturnal enuresis were questioned.
MNE was determined in 9.0% (n: 1266) of the students and nocturnal enuresis frequency was higher in boys than girls (P<0.05). Univariate analysis revealed gender, method of toilet training, sleep problems, school success, and general approach of the family to children and general behavioral attitudes of the children as significant factors. In logistic regression analysis; age, male gender, toilette training with threatening method, deep sleeper, sleep walking, being introverted and shy, significantly increases the risk of nocturnal enuresis.
The current study suggests that the methods of toilet training are extremely important to prevent bedwetting and behavioral disorders due to enuresis. Parents should be well-informed about the appropriate toilet training method.
Enuresis; monosymptomatic; nocturnal
Despite numerous studies asserting the prevalence of marital conflict among families of children with attention-deficit hyperactivity disorder (ADHD), evidence is surprisingly less convincing regarding whether parents of youth with ADHD are more at-risk for divorce than parents of children without ADHD. Using survival analyses, this study compared the rate of marital dissolution between parents of adolescents and young adults with and without ADHD. Results indicated that parents of youth diagnosed with ADHD in childhood (n=282) were more likely to divorce and had a shorter latency to divorce than parents of children without ADHD (n=206). Among a subset of those families of youth with ADHD, prospective analyses indicated that maternal and paternal education level, paternal antisocial behavior, and child age, race/ethnicity, and oppositional-defiant/conduct problems each uniquely predicted the timing of divorce between parents of youth with ADHD. These data underscore how parent and child variables likely interact to exacerbate marital discord and, ultimately, dissolution among families of children diagnosed with ADHD in childhood.
ADHD; ODD/CD; Antisocial behavior; Divorce; Marital conflict
The study was carried out on children born over a 10 year period from 1981 to 1990 in a defined area known as Greater Manchester and referred to the Centre for Audiology or the Manchester Royal Infirmary for specialist audiological assessment. The children were investigated for possible congenital or intrauterine infection. Perinatal assessment was carried out in conjunction with paediatricians for adverse aetiological factors. Full medical histories were obtained with detailed family history relevant to hearing impairment and any associated condition or syndrome. Parents and siblings were examined and hearing assessed. A total of 339 cases was studied. Children with positive family history of deafness in parents or siblings, or both, constituted 23.3% of the cases (genetic group). Other aetiological groups showed the following distribution: cause unknown 33.9%; perinatal group 12.8%; congenital infections 8.2%; bacterial meningitis 6.5%; chromosomal anomalies 5.3%; syndromal group 5.3%; and miscellaneous group 4.7%. The high incidence of genetic causes indicates that steps should be taken to facilitate genetic counselling and conceivably to reduce the numbers affected.
Data drawn from the National Study of Health and Growth enabled an examination to be made of the attained height, weight for height, and triceps skinfold of children from one and two parent families. Children from one parent families were shorter than children from two parent families; however, once heights had been adjusted for birthweight, number of siblings, mother's height, father's height, and mother's education this was no longer the case. An examination of the adjusting factors showed that low birthweights and shorter parents accounted for the shorter stature of the one parent family children. An examination of weight for height and triceps skinfold measurements indicated an increased tendency towards obesity in the one parent family children, although this difference was not statistically significant. The higher prevalence of low birthweights and shorter parents that account for the shorter stature of one parent children are factors that cannot be ignored in a consideration of the health and growth of this group of children and obesity may be a potential health problem among the one parent family children.
This study evaluated how enrollment in special education services in 11 year old children relates to prenatal cocaine exposure, psychopathology, and other risk factors.
Participants were 498 children enrolled in The Maternal Lifestyle Study, a prospective, longitudinal, multisite study examining outcomes of children with prenatal cocaine exposure. Logistic regression was used to examine the effect of prenatal cocaine exposure and psychopathology on enrollment in an individualized education plan (a designation specific to children with special education needs), with environmental, maternal, and infant medical variables as covariates.
Prenatal cocaine exposure, an interaction of prenatal cocaine exposure and Oppositional Defiant Disorder, child Attention Deficit Hyperactivity Disorder, parent-reported internalizing behaviors, and teacher-reported externalizing behaviors, predicted enrollment in an individualized education plan. Other statistically significant variables in the model were male gender, low birth weight, being small for gestational age, white race, caregiver change, low socio-economic status, low child intelligence quotient, caregiver depression, and prenatal marijuana exposure.
Prenatal cocaine exposure increased the likelihood of receiving an individualized education plan with adjustment for covariates. Psychopathology also predicted this special education outcome, in combination with and independent of prenatal cocaine exposure.
cocaine; special education; behavior; prenatal substance exposure
The purposes of this 36-month study of children with first recognized seizures were: (a) to describe baseline differences in behavior problems between children with and without prior unrecognized seizures; (b) to identify differences over time in behavior problems between children with seizures and their healthy siblings, (c) to identify the proportion of children with seizures and healthy siblings who were consistently at risk for behavior problems for 36 months; and (d) to identify risk factors for behavior problems 36 months following the first recognized seizure. Risk factors explored included demographic (child age and gender, caregiver education), neuropsychological (IQ, processing speed), seizure (epileptic syndrome, use of antiepileptic drug AED, seizure recurrence) and family (family mastery, satisfaction with family relationships, parent response) variables.
Participants were 300 children ages 6 through 14 years with a first recognized seizure and 196 healthy siblings. Data were collected from medical records, structured interviews, self-report questionnaires, and neuropsychological testing. Behavior problems were measured using the Child Behavior Checklist and the Teacher’s Report Form. Data analyses included descriptive statistics and linear mixed models.
Children with prior unrecognized seizures were at higher risk for behavior problems at baseline. As a group, children with seizures showed a steady reduction in behavior problems over time. Children with seizures were found to have significantly more behavior problems than their siblings over time and significantly more children with seizures (11.3%) than siblings (4.6%) had consistent behavior problems over time. Key risk factors for child behavior problems based on both caregivers and teachers were: less caregiver education, slower initial processing speed, slowing of processing speed over the first 36 months, and a number of family variables including lower levels of family mastery or child satisfaction with family relationships, lower parent support of the child’s autonomy, and lower parent confidence in their ability to discipline their child.
Children with new-onset seizures who are otherwise developing normally have higher rates of behavior problems than their healthy siblings; however, behavior problems are not consistently in the at-risk range in most children during the first three years after seizure onset. When children show behavior problems, family variables that might be targeted include family mastery, parent support of child autonomy, and parent confidence in their ability to handle their children’s behavior.
First Seizures; Children; Behavior Problems; Processing Speed; Family Response