Child's Future Development Research Articles

The Long–Term Consequences of Early Childhood Trauma: A Case Study and Discussion

There is a great need to better understand the impact of traumatic events very early in life on the course of children's future development. This report focuses on the intriguing case of a girl who witnessed the murder of her mother by her father at the age of 19 months and seemed to have no recollection of this incident until the age of 11, when she began to exhibit severe symptoms of posttraumatic stress disorder (PTSD) in response to a traumatic reminder. The case presentation serves as the basis for a discussion regarding pertinent issues involved in early childhood trauma. This case and accompanying discussion were originally presented at the 19th Annual Meeting of the International Society for Traumatic Stress Studies and were transcribed and revised for use in this article. Specific topics include early childhood memory and trauma, learning and the appraisal of danger, and PTSD and traumatic grief in early childhood. Clinical and public health implications are also discussed. This case illustrates the dramatic impact that “preverbal” traumatic memories can have on children's later functioning and speaks to the importance of assisting very young children in the immediate aftermath of traumatic events.

The diagnosis of hearing loss in children: Common presentations and investigations

Summary Hearing loss is a common disorder in the paediatric community, with between 1 and 3 per 1000 live births being affected with severe-to-profound loss. Without early diagnosis, the sequelae of this condition can affect the child's social and future professional development. Paediatricians may be the first clinicians to review and suspect hearing problems and therefore need a framework for further investigation and management. This article aims to give clinicians an overview of the management of hearing loss in children and to provide a logical approach to the detection, investigation and diagnosis of hearing impairment. The relevance of the early diagnosis cannot be overstated in order to negate and treat this disability, with its potential profound consequences.

Cochlear implantation in children: Implications for the primary care provider

To define hearing loss (HL), discuss the impact of HL on child development, and review the literature on cochlear implantation in children. The criteria for and the benefits and limitations of cochlear implantation in children, as well as the implications for the primary care provider with regard to children who have cochlear implants, are presented. Review of published literature on the topic. A child's future development depends greatly on speech and language skills. Any type of HL can impact and may even hinder speech and language acquisition. It is therefore crucial to enforce early identification of HL. For severe to profoundly hearing-impaired children, cochlear implantation serves as an avenue for hearing and language development. Nurse practitioners ought to be up to date with criteria for and the benefits and risks of cochlear implantation. Health-related issues, such as vaccination, otitis media, and meningitis, must be assessed for and managed promptly.

“In these bleak days”: Parent methamphetamine abuse and child welfare in the rural Midwest

This report describes the impact of parent methamphetamine abuse on the development and well-being of school-aged children, and considers implications for culturally appropriate child welfare services. Thirty-five adult informants from several, adjacent rural Midwestern counties in the United States were interviewed as part of a larger ethnographic study. These child welfare workers, other community professionals (educators, counselors, law enforcement personnel, and substance abuse treatment providers), and foster caregivers described their experiences with families involved with methamphetamine. Overall, informants described that children are brought by their methamphetamine-abusing parents into a rural drug culture characterized by distinct, antisocial beliefs and practices. Children's experience of this culture includes environmental danger, chaos, neglect, abuse, loss, and isolation. Informants believed that children develop antisocial beliefs and practices such as lying, stealing, drug use, and violence through direct teaching by their parents and, indirectly, through observing parents' own antisocial behavior. Informants described children as displaying psychological, social, and educational disturbances. They also described individual variation in functioning across children that they attributed, in part, to individual (e.g., temperament, intelligence), familial (e.g., extended family), and community (e.g., school) characteristics. Informants noted a need for effective child mental health services in the area, and for ensuring a positive environment for children's future development through education of the children, foster parents and other community members.

A comparative study of Malay-operated and Chinese-operated childcare centres in the state of Melaka, Malaysia

Demand for childcare services in Malaysia is increasing. With the changing demographic landscape and increasing knowledge of the importance of early childhood education, provision of alternative childcare services has never been more significant. Children younger than four years of age are placed in registered childcare centres while their parents work. Some children stay in the centres for half a day while others spend most of their time there. Hence, a great deal of learning takes place in these centres. The kinds of activities and how these activities are implemented may have a major influence on children's future development. Observations carried out in childcare centres in Melaka, one of the 13 states in Malaysia, revealed that there were wide variations in the services provided by Chinese and Malay childcare owners. There are 59 centres registered with the Department of Welfare, Melaka: one is Indian operated, 13 are Malay operated and the rest are Chinese operated. This paper highlights the differences in care provision between Malay-operated and Chinese-operated childcare centres along the following dimensions: (i) structured activities; (ii) toys, equipment and facilities; (iii) physical set-up; (v) division of duties among childcare providers; and (vi) availability of childcare principals or owners. This paper argues that the dimensions listed contribute to quality childcare. Recommendations are included to ensure consistency of care in these two ethnic-based childcare provision.

Group‐based parent‐training programmes for improving emotional and behavioural adjustment in 0–3 year old children

The objectives of this Campbell systematic review are as follows: To establish whether group‐based parenting programmes are effective in improving the emotional and behavioural adjustment of children less than three years of age; To assess the role of parenting programmes in the primary prevention of emotional and behavioural problems. The findings of this review provide some support for the use of group‐based parenting programmes to improve the emotional and behavioural adjustment of children under the age of 3 years. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of such problems. Furthermore, there are limited data available concerning the long‐term effectiveness of these programmes, and the results from the two studies for which data were available produced borderline insignificant findings. Further research is required.SynopsisParenting practices play a significant role in the development of emotional and behavioural problems in children, and parenting programmes which are aimed at the parents of infants and toddlers thereby have the potential to prevent the occurrence of such problems. The findings of this review provide some support for the use of group‐based parenting programmes to improve the emotional and behavioural adjustment of children under the age of 3 years. The limited evidence available concerning the extent to which these results are maintained over time, however, is equivocal, and it may be that during this period of rapid change in the infant's development, further input at a later date is required. More research is needed before questions of this nature can be answered.AbstractBackgroundEmotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become adjusted, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social functioning which will in turn influence the child's future development and in particular, their mental health. Parenting programmes may therefore have a role to play in improving the emotional and behavioural adjustment of infants and toddlers.ObjectivesThe objectives of this review are as follows: To establish whether group‐based parenting programmes are effective in improving the emotional and behavioural adjustment of children less than three years of age To assess the role of parenting programmes in the primary prevention of emotional and behavioural problems. Search strategyA range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC.Selection criteriaOnly randomised controlled trials of group based parenting programmes were included, and studies that had used at least one standardised instrument to measure emotional and behavioural adjustment.Data collection & analysisThe treatment effect for each outcome in each study was standardised by dividing the mean difference in post‐intervention scores for the intervention and treatment group by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented, with 95% confidence intervals. Where appropriate the results have been combined in a meta‐analysis using a random effects model.Main resultsFive studies were included in the review, and there were sufficient data from five studies to combine the results in a meta‐analysis. Meta‐analyses were conducted for both parent‐reports and independent assessments of children's behaviour. The result for parent reports shows a nonsignificant result favouring the intervention group (ES −0.29, CI −0.55 to 0.02). The result for independent observations of children's behaviour shows a significant result favouring the intervention group (ES −0.54, CI −0.84 to −0.23). A meta‐analysis of the limited follow‐up data available shows a small non‐significant result favouring the intervention group (ES −0.24, CI −0.56 to 0.09).Reviewers' conclusionsThe findings of this review provide some support for the use of group‐based parenting programmes to improve the emotional and behavioural adjustment of children under the age of 3 years. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of such problems. Furthermore, there are limited data available concerning the long‐term effectiveness of these programmes, and the results from the two studies for which data were available produced borderline insignificant findings. Further research is required.

Group-based parent-training programmes for improving emotional and behavioural adjustment in 0-3 year old children.

Mental health problems in children are common. Research suggests that parenting has an important role to play in helping children to become well adjusted adults, and that the first few months and years of a child's life are especially important in establishing patterns of emotional, cognitive and social functioning which will in turn influence the child's future development and in particular, their mental health. Parenting programmes may therefore have a role to play in improving the mental health of infants and toddlers. The objectives of this review are as follows: a) To establish whether group-based parenting programmes are effective in improving the mental health of children less than three years of age b) To assess the role of parenting programmes in the primary prevention of mental health problems A range of biomedical and social science databases were searched including MEDLINE, EMBASE, CINAHL, PsychLIT, Sociofile, Social Science Citation Index, ASSIA, the Cochrane Library including SPECTR, CENTRAL, National Research Register (NRR) and ERIC. Only randomised controlled trials were included and studies had to include at least one standardised instrument measuring some aspect of infant mental health. The treatment effect for each outcome in each study was standardised by dividing the mean difference in post-intervention scores for the intervention and treatment group, by the pooled standard deviation, to obtain an effect size. The results for each outcome in each study have been presented with 95% confidence intervals. Where appropriate the results have been combined in a meta-analysis using a random effect model. A total of five studies were included in the review. The 5 included studies provided a total of 36 assessments of infant and toddler mental health including emotional and behavioural adjustment, and sleep patterns. All of the results apart from 6 showed positive findings favouring the intervention group. While some of findings were non-significant, most of the effect sizes were large and the wide confidence intervals crossing the zero that were obtained in a number of the studies, were very probably due to small sample sizes. There was sufficient data from four studies to combine the results in a meta-analysis. The results of the meta-analysis show a significant difference in children's emotional and behavioural adjustment favouring the intervention group. Overall, the limited follow-up data provide equivocal evidence concerning the maintenance of these effects over time. The results of this review suggest that parenting programmes can be effective in improving the mental health of infants and toddlers. There is, however, insufficient evidence to reach any firm conclusions regarding the role that such programmes might play in the primary prevention of mental health problems. Furthermore, there is insufficient evidence to know whether the short-term benefit of these programmes is maintained over time, and further research is required.

Particularities of morphogenesis of human fetus brain

The review is devoted to the basic events of human fetal CNS development. The cellular processes of two broad phases of cerebral morphogenesis cytogenesis/histogenesis and differentiation/growth are described. In this review we also concern the main regressive events in the CNS development such as programmed cell death (apoptosis), axonal pruning and synaptic elimination. Different environmental factors may effect human brain development even from its early stages causing brain injury that can result in major or minor cerebral malformations. So, the knowledge of the main questions of fetal brain morphogenesis can helpto prevent some abnomalities of CNS in the future child development.

Child Abuse: Focus on a Team Approach for School Teachers and Counsellors

Although laws protecting children from abuse have become commonplace at least since the colonial era, the legal concept of “mandatory reporting” is relatively new in Africa. The author argues that child abuse refers to more than physical injuries—the term encompasses a compilation of significant events, that interact with the child's ongoing development to interrupt, alter, or impair her or his psychological development. This article provides a selective review of child abuse and emphasizes the need for standard procedures for referral, medical provisions, and legal reporting. Toward this end, issues of establishing the dimensions of child maltreatment were reviewed in order to understand the social and cultural nature of child abuse. Recommendations are offered for integrating critical issues for the present and future development of child abuse into practica training, legislation and scope of practice.

Child care arrangement and preschool development.

Baseline data from the Canadian National Longitudinal Survey of Children and Youth were used to evaluate the associations between child care arrangement and poor developmental attainment (PDA). A weighted total of 521,800 children aged 2 to 3 years were studied (N = 2,709). PDA was assessed by age-standardized motor and social development score. Children were grouped by the predominant type of arrangement: care by someone in the child's own home, in another home (family child care), at a child care centre, or none (child care exclusive to parents). Controlling for socioeconomic status, biological factors and maternal immigration, family dysfunction, hostile parenting and low neighbourhood safety were correlated with PDA and positive parent-child interaction decreased the odds of PDA. Whereas centre child care arrangements were beneficial to development overall (OR = 0.41, 99% CI = 0.18, 0.93), an interaction existed between type of child care and maternal depression; among children with depressed mothers, centre child care was associated with increased odds of PDA. Findings suggest that the associations between child care arrangement and child development involve interactions of factors that influence a child's home environment. Future child development studies exploring these interactions are warranted.

IDENTIFYING COMMON PEDIATRIC NEUROSURGICAL CONDITIONS IN THE PRIMARY CARE SETTING

The primary care setting is crucial to the diagnosis and treatment of pediatric neurosurgical conditions. The scope of this article is to present common pediatric neurosurgical diagnoses and their typical presentation to assist the primary care advanced practice nurse in making timely and appropriate referrals. The complications from delayed treatment can be significant for the child's future development. Conditions that are addressed include cutaneous stigmata related to occult spinal cord defects, common birth-related trauma, craniosynostosis, positional molding, torticollis, hydrocephalus, mild head injury, and brain tumors.

The Physical Health of Rural Mothers and Their Low Birth Weight Children

The purpose of this research was to examine the physical health of rural mothers and their low birth weight children (<2,500 gm). The health of rural mothers is of concern because rural families have poorer health than urban ones, and as the primary caregiver for the low birth weight child, mother's health affects the child's care and potentially the child's health. In this cross-sectional, exploratory study, in-home interviews were conducted with 48 mothers between 2 weeks and 18 months after their children were discharged from their birth hospitalization. Mothers' physical health and their perceptions of their children's health were assessed. The mothers were more concerned about their children's health than their own (p = .0005). The concerns included uncertainty about the children's future health, growth, and development. Suggestions for community health care providers are addressed.

Book Reviews

Pain, Distress and the Newborn Baby by Margaret Sparshott is destined to become a required text for all neonatal intensive care students as well as a valued guide for paediatric and neonatal nurses, medics and midwives. This well researched and referenced text sensitively addresses the problem of the inevitable pain and distress experienced by preterm and ill neonates, as a direct result of the treatment designed to maintain life and prevent long term damage. The author draws on her own extensive experience in the field of neonatal nursing to examine whether the trauma and suffering experienced by the ill neon ate affect the child's future psychological health and development. By also acknowledging the anxiety and stress which neonatal staff feel as a result of necessary medical and nursing procedures, Ms Sparshott offers very practical suggestions for creating a supportive and nourishing environment within the neonatal unit.

A semistructured interview with parents‐to‐be used during pregnancy: Preliminary data

The aim of this paper is to describe The Clinical Interview for Parents during Pregnancy (CGG—Colloquio per Genitori in Gravidanza). The interview was developed in the context of a longitudinal research study, carried out in the first 2 years of the child's life. The study was aimed at investigating fathers' attitudes and behavior toward child care and the possible influence of these attitudes and behavior on the child's current and future development. This was also compared with mothers' attitudes and behaviors. This work provides the background rationale for the content of the CGG and the discussion of the interview. The CGG was administered to 90 middle-class Italian couples expecting their first baby, who were recruited from childbirth classes to participate in the study. The sample did not include women at risk during pregnancy. We chose to investigate three areas: couples' ability to foresee their own function after the child's birth; the activities they expected to share with their baby; their capacity to anticipate their child's physical and psychological characteristics. Responses were subjected to quantitative content analysis. We describe the utility of such analysis. Finally, we review clinical and research meanings and applications of the CGG. © 1997 Michigan Association for Infant Mental Health

Homelessness as One Component of Housing Instability and Its Impact on the Development of Children in Poverty

The number offamilies with children living in poverty and experiencing housing instability and homelessness has increased dramatically over the last two decades. Current public policy decisions will lead to further increases. Understanding the impact of this instability on the emotional, behavioral, and cognitive development of children is imperative. Few studies cn'tically examine the effects ofinstability on both domiciled and homeless children. This research examined the effects of homelessness and housing instability on 133 children 8 to 12 years of age living in poverty. Results indicate that whether a child is currently homeless is not as significant as overall stability which may have a long ranging effect on a child's future development.

Putting a Child in Day Care: Issues for Working Parents

In 1981, more than half the mothers in the United States were employed outside the home. By 1990, it was predicted that 70% of children would have two working parents. The number has been increasing each year since World War II, and 10 times as many mothers of small children work now as did in 1945. Now it is more culturally acceptable than even before for mothers to have jobs. Even so, there is still a strong bias against mothers leaving their babies in substitute care unless it is absolutely necessary. Society does not yet whole-heartedly support working mothers and their choices about substitute care. We do not have enough studies yet to know about the issues for the infant. The studies we do have are likely to be biased or based on experiences in special, often privileged populations. We need to know when it is safest for the child's future development to have to relate to two or three caregivers; what will be the effects of a group care situation on a baby's development; when babies are best able to find what they need from caregivers other than their parents; when parents are best able to separate from their babies without feeling too grieved at the loss. In a word, we need information on which to base general guidelines for parents. For it could be that the most subtle, hard-to-deal-with pressure on young adults comes indirectly from society's ambivalent and discordant attitudes, which create a void of values in which the building and nurturing of a family becomes very difficult.

Factors Associated with Maternal Rating of Infant Health in Central Harlem

Maternal perceptions of infant health are strongly associated with the use of health services and may influence the child's future health and development. The extent to which such perceptions reflect infant health problems or a response to environmental stress in the mother's life is unclear. Because this issue may be especially important in disadvantaged groups for which both high levels of infant morbidity and environmental stress are common, we have explored the correlates of maternal perceptions of infant health among 367 mothers of 12-month-olds in central Harlem. Lower ratings of infant health were associated with such indicators of morbidity as problems in the neonatal period, hospitalization, and one or more episodes of illness. They were also associated with lower family income and the mother's rating of her own health in the bivariate analyses, but not in multivariate analyses. Neither maternal mental health, social support, nor environmental stress appeared to influence maternal rating of child health. These findings indicate that a mother's ratings of her infant's health relate specifically to the child's morbidity, independent of her own health and environmental stress. Moreover, within disadvantaged communities, infants of the poorest mothers may experience greater levels of morbidity.

Abusive parents' perceptions of child problem behaviors: an example of parental bias.

The behavior of children in 21 child abusive and 21 nonabusive matched comparison families were compared using home observations performed by professional independent observers and parental report measures (Becker Bipolar Adjective Checklist, Child Behavior Checklist, Parent Daily Report). Parental report measures of child conduct problems differed significantly between the two groups, independent observations showed few significant differences in rates of either child or parental behaviors. Results are discussed in terms of the validity of parental perceptions and reports of child problem behaviors, the informativeness of differing reports for diagnosis and clinical treatment, and the need to gather corroboration across various sources and settings before clinical decisions are made that may irrevocably alter a child's future development.

Deaf children's expression of communicative intentions

This study investigated the expression of communicative intentions by 3-year-old hearing-impaired children who were learning a system for manually coded English. Children were videotaped in their homes, interacting with their mothers. Children's communicative expressions were identified and coded according to a system modified from those developed to describe hearing children's pragmatic functioning. Between 4.5 and 5.5 communicative expressions were produced per minute. A large proportion of the expressions consisted of social or imperative intentions while a much smaller proportion were used for heuristic or informational purposes. Implications for the deaf children's future language use and development are discussed. The data presented provide some guidelines for pragmatic expectations for young deaf children and may help clinicians to identify deaf children who have developmental problems in addition to their hearing loss.

Dysmorphology: an approach to diagnosing children with structural defects of the head and neck.

In dealing with a child with a structural defect, an overall diagnosis must be formulated. Such a diagnosis makes it possible to provide genetic counseling for the parents and an accurate prediction relative to such a child's future development. Because there are a great many abnormalities involving the head and neck, it is hoped that the approach set forth in this article will allow for a systematic narrowing of the diagnostic possibilities. Nomenclature is established. Prenatal-onset defects are described, including both single primary defects (malformations and deformations) and multiple malformation syndromes (chromosomal abnormalities, genetic disorders, defects resulting from teratogenic factors, and disorders of unknown etiology). Genetic and environmental factors of postnatal developmental problems are also discussed.