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Assessed mothers who did and did not identify their children as vulnerable on a number of variables including perception of their child's behavior problems and their own sense of parental control. Children were also examined to determine their developmental abilities. Participants included 50 preschoolers who were born prematurely, their mothers, and their medical care providers. The mothers' response to the Vulnerable Child Scale was used to identify children as vulnerable and nonvulnerable. Mothers who perceived their children as vulnerable also rated them on the Child Behavior Checklist 2/3 as having more somatic problems and as being more aggressive, destructive, and poorly socialized. Additionally, these mothers expressed a diminished sense of parental efficacy and less control of their child's behavior as measured by the Parental Locus of Control Scale. However, results from the McCarthy Scales of Children's Abilities and the medical care provider's questionnaire revealed no differences between the groups of children. Overall findings suggest preschoolers born prematurely whose mothers perceive them as vulnerable are at risk for the Vulnerable Child Syndrome described by Green and Solnit (1964).

Fifty-four depressed and non-depressed mothers were interviewed when their infants were 3 and 12 months of age. The depressed mothers assigned greater vulnerability scores and their infants engaged in less exploratory play and had lower Bayley mental and motor scores. The depressed mothers' vulnerability scores at 3 months were related to less exploratory play in their infants as well as lower Bayley mental scores at 12 months.

Objectives: To evaluate psychosocial morbidity in pediatric primary care and to determine displaced health care utilization. Design and Setting:A cross-sectional sample of parentchild dyads was screened using the Pediatric Symptom Checklist (PSC) at 6 pediatric sites of a health maintenance organization (HMO). Cost and utilization data were retrieved from regional databases for this sample.Participants: Parent-child dyads from an HMO in northern California (N = 1840). The children ranged in age from 2 to 18 years.Results: In all, 13.0% of children exhibited psychosocial dysfunction. The rate of children's chronic illness was 18.4%. Multiple regression analyses measured utilization and cost of health and psychiatric care for the selected population for the previous year; the average log cost of health care per child was $393. The average health care cost for children with anxious, depressed symptoms was $805. Chronically ill children were the highest utilizers of health care, with an average log cost of $1138. When psychosocial dysfunction was present, regression models showed that health care spending was highest for young children.Conclusions: Health care utilization was higher for children with psychosocial morbidity, was higher among younger children, and decreased with age as psychiatric costs progressively increased.Arch Pediatr Adolesc Med. 2000;154:261-266

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