Babies at Double Hazard: Early Development of Infants at Biologic and Social Risk

Abstract

From the population of a neonatal intensive care unit, 114 infants and their families were followed from birth to age 3½ years. Infants showing massive brain damage at birth and/or severe mental retardation at 7 months of age were excluded from this analysis. The remainder were predominantly poor and nonwhite. The group showed normal cognitive development through age 15 months. By 28 months of age and thereafter, a severe decline in cognitive status proved to be associated with social class. In addition, serious behavioral maladjustment led to improverished cognitive development. The incidence of maladjustment was unrelated to social class. The impact of maladjustment on test scores was significant in all classes, but greater for the higher rather than the lower socioeconomic social groups. Neither neurologic pathology (excepting severe brain damage) nor gestational age (small for gestational age [SGA] vs appropriate for gestational age [AGA]) had a significant effect on IQ scores at 3½ years of age. It is suggested that environmental deficits and stresses impair early cognitive and psychosocial development for both full-term and premature infants, but that the latter group is more vulnerable to environmental insufficiencies than are full-term babies.

Children's intellectual and emotional-behavioral adjustment at 4 years as a function of cocaine exposure, maternal characteristics, and environmental risk.

“…More current factors, such as present maternal characteristics, appear to have a greater impact on children's intellectual and emotional- behavioral adjustment. This pattern is consistent with prior research showing that current environmental factors are generally better predictors of developmental outcomes than are early biological risk factors such as perinatal medical problems (Adams et al, 1994; Escalona, 1982; Werner, Bierman, & French, 1971), low birth weight (Brooks-Gunn, Klebanov, & Duncan, 1996; Ornstein, Ohlsson, Edmonds, & Asztalos, 1991), prenatal substance exposure (Hurt et al, 1998, 2001), and other biological risk factors (e.g., Sameroff & Chandler, 1975). Such findings are consistent with the general notion that current context is more important than past events in influencing current behavior (Lewis, 1997).…”

Certain conditions originating in the perinatal period.

“…All of these studies found some outcome related to sociodemographic factors (e.g., income, maternal education, race, or gender), usually in addition to an association with perinatal risk variables (e.g., extremely low birthweight, IVH). However, in some children, social factors were better predictors or major determinants of outcome (Botting et al, 1998;Campbell et al, 1993;Carter, Resnick, Ariet, Shieh, & Vonesh, 1992;Cohen & Parmelee, 1983;Escalona, 1982;Hack et al, 1992;Hille et al, 1994;Msall et al, 1993Msall et al, , 1991Msall et al, , 1994Piecuch et al, 1997;Resnick et al, 1990;Resnick et al, 1998;Vohr et al, 1992). Some evidence also exists for an interactive model, with socioeconomic and cultural factors predicting poor performance on some measures to a greater degree among children with medical problems or only among those with lower birthweights (Levy-Schiff, Einat, Mogilner, Lerman, & Krikler, 1994; Monset-Couchard, de Bethmann, & Kastler, 1996; Resnick et al, 1990).…”

Health and environmental effects on the academic readiness of school-age children.

“…Interactions between biological and environmental risk have been reported in the literature. There is a tendency for the effects of perinatal stress to be more severe for children of low socioeconomic status (SES; Cohen et al, 1986; Escalona, 1982; Ricciuti & Scarr, 1990; Werner et al, 1968; Wilson, 1985). The development of high SES infants born weighing less than 1,750 g catches up with that of normal birth weight children by school age, whereas low SES low birth weight infants do not show similar “catch-up” development (Wilson, 1985).…”

“…There is empirical evidence that exposure to identical biological hazards has a differential impact on development depending on the socioeconomic status of the child. Children from lower socioeconomic homes are at greater risk of developmental compromise as a result of perinatal complications (Werner et al, 1968), low birth weight (Escalona, 1982; Wilson, 1985), perinatal cytomegalovirus infection (Hanshaw et al, 1976), as well as prenatal and postnatal lead exposure (Bellinger, 1989). The bulk of the available empirical evidence has supported the conclusion that children living in poverty are at double jeopardy for poor development because of more frequent exposure to risk factors as well as more severe effects of such exposure.…”