School-age Period Research Articles

Maternal Smoking During Pregnancy, Behavioral Problems and School Performances of Their School-Aged Children

Child behavior and school performance is influenced by many genetic and environmental factors including prenatal exposure to chemical neurotoxins contained in cigarette smoke. The European Longitudinal Study of Pregnancy and Childhood (ELSPAC) prospective study which in the Czech Republic incorporates a cohort of children born in the years 1991/2 in Brno city and the Znojmo district also allows to analyze the relationships between prenatal cigarette smoke exposure and the occurrence of behavior and learning disorders. Using questionnaires repeatedly filled in by teachers and investigation protocols performed by research team workers data for the Brno sample of children was collected on the occurrence of signs indicating more serious problems with school assignment fulfilling and behavior disorders in the childrens' 8, 11 and 13 years of age. According to mothers' statements about their smoking behavior during pregnancy, the children were divided into two groups: prenatally exposed and non-exposed. The frequency differences of individual traits were evaluated in the SPSS statistical program (Pearson's chi2 test and linear associations, probability relations). In the ELSPAC study set the occurrence of inferior schoolwork performance evaluated based on term-report grades was more frequent in children prenatally exposed to mothers' smoking, along with more frequently diagnosed disorders which to significant extent implicate these inferior results and also special care needs occurred more frequently when compared to their peers born to non-smoking mothers. In the prenatally exposed subset also more frequent occurrence of various signs characterizing behavior disorders including attention disorders, hyperactivity, aggressiveness and signs of delinquency behavior were recorded. The Czech ELSPAC cohort confirmed the results of other studies; within it was documented that children born to smoking mothers have more frequent behavioral problems and problems with fulfilling their school assignments in the school age period.

The association of early blood oxygenation with child development in preterm infants with acute respiratory disorders

The potential negative impact of early blood oxygenation on development of specific cognitive and motor outcomes in children born at very low birth weight (VLBW; 1000–1500g) has not been examined even though these infants are exposed to varying durations and amounts of oxygen as part of their neonatal care. While this is the largest group of preterm infants, they receive much less research attention than extremely low birth weight infants (ELBW<1000g).Although neonatologists are questioning the routine use of oxygen therapy for all neonates, research has focused primarily on the more medically fragile ELBW infants. To date there are no systematic studies available to guide decision making for oxygen supplementation for a large segment of the preterm infant population. The aim of the present study was to determine if there is an association between blood oxygenation in the first 4h of life and specific cognitive and motor skills in preterm infants with acute respiratory disorders but no severe intracranial insult using a selected cohort from a longitudinal study children recruited in 1991 and 1992 designed to examine the role of biological immaturity as defined by gestational age and parenting in development. From this cohort, 55 children had acute respiratory disorders without severe intracranial insult. Of these, 35 children had at least one partial pressure of oxygen obtained from arterial blood (PaO2) during the first 4h of life as part of their clinical care. Higher early PaO2 values were associated with lower impulse control and attention skills in the elementary school age period. Models that were examined for relations between PaO2 values that also included birth weight and parenting quality across the first year of life revealed that higher PaO2 remained associated with impulse control but not attention skills. Birth weight was not associated with any outcomes. These results suggest that hyperoxia may be a risk factor for developmental problems that are not expressed until school age.

ACQUIRED IMMUNITY IN A HOLOENDEMIC SETTING OF PLASMODIUM FALCIPARUM AND P. VIVAX MALARIA

Most of what we presume to understand of naturally acquired immunity to Plasmodium falciparum malaria comes from studies in sub-Saharan Africa. The virtual absence of P. vivax malaria from most of that region leaves three important questions not addressed: 1) What is naturally acquired immunity to P. vivax malaria; 2) do the mechanisms of natural immunity to P. falciparum and P. vivax malaria differ, and 3) what influence does one species exert on acquisition of immunity to the other? Naturally acquired immunity requires repeated and frequent exposure to infection, and few places offer sufficient exposure to both P. falciparum and P. vivax to allow examination of these questions. The certainty of naturally acquired immunity to P. vivax malaria derives almost entirely from studies of neurosyphilis patients treated by repeated exposure to induced infections by P. vivax. As with P. falciparum, a half dozen or so exposures over a relatively brief period resulted in far lower density parasitemia and no fever. In terms of understanding naturally acquired immunity, the neurosyphilis work has two important sources of sample bias: 1) all subjects were adults, and 2) homologous strains of parasites were usually used. These biases, combined with the relatively rapid onset of immunity in the clinic, ironically share some responsibility for the long-held belief that immunity acquired by natural infections required more than a dozen or so years of chronic, heavy exposure. The rapid onset of immunity in neurosyphilis patients was attributed to the use of homologous strains, and the seemingly slow onset of immunity in exposed populations was attributed to the heterologous nature of wild strains. This framework allowed elegant theories of susceptibility driven by antigenic polymorphism and variability, but it also failed to answer critical questions. Do children differ inherently from adults in their immune management of repeated infections? Do children enjoy rapid onset of clinical immunity when challenged with homologous strains? Is onset of clinical immunity in adults rapid with challenge by heterologous strains? These gaps in understanding could only be addressed with studies in natural settings. In this issue of the journal, Michon and others1 follow a cohort of school age children in holoendemic Papua New Guinea having a remarkably high and largely equal number of exposures to P. falciparum and P. vivax. Their work provides a rare glimpse at naturally acquired immunity to P. vivax malaria and allows an insightful contrasting look at the same in P. falciparum malaria. Their cohort of children was at equivalent risk of acquiring either P. vivax or P. falciparum infections from the local vector populations but 21 times more likely to develop an overt clinical response to P. falciparum than to P. vivax. The ability to regulate parasite densities of P. vivax was also evident after nine years of age and there was no evidence of P. falciparum density regulation throughout the school age period. The occurrence of a more complete clinical and anti-parasitic immunity earlier in life for P. vivax compared with P. falciparum despite comparable levels of exposure suggests different mechanisms of acquired immunity for the two most common malaria parasites. Whether these are host-response, individual parasite, or combined exposure related remains uncertain but merit more detailed epidemiologic investigation. These observations buttress similar conclusions from other studies, and emphasize the apparently strict homology of immunity within these species and perhaps the distinct immune mechanisms at work between species. Collins and Jeffery described essentially similar observations in neurosyphilis patients2, and corroboration from natural settings gives weight to the experimental findings. The results reported by Michon and others derive from an elegant field epidemiology study of infection and disease incidence. These detailed cohort studies provide us with a wealth of information under conditions of natural exposure and provide not only insights into the immuno-epidmiology of infection and disease but also a reliable measure of public health burdens. These study designs should be encouraged across a wider range of transmission settings and dominant vector species ecologies to improve the externality of single observations. The spatial congruence of major public health infections has led to a renewed interest in the epidemiology and control of polyparasitic disease, including interactions and public health outcomes associated with P. falciparum malaria and human immunodeficiency virus3,4 or P. falciparum malaria and soil-transmitted helminths.5,6 Perhaps one of the largest and largely ignored coincidental distributions of different parasites is the overlap between P. vivax and P. falciparum. It has recently been estimated that 1.98 billion people are at possible risk of both parasites worldwide.7 Now would be a good time to increase efforts to understand the epidemiology of two of the most significant parasite species sharing the widest global reach. Paradoxically, the neglected epidemiology and immunology of P. vivax malaria may be effectively leveraged to more fully understand acquired immunity to P. falciparum malaria.

The Role of Early Maternal Responsiveness in Supporting School-Aged Cognitive Development for Children Who Vary in Birth Status

To examine the relation between the pattern of maternal responsiveness that children experienced in the infancy, preschool, and school-age periods and growth in cognitive skills across 3-10 years of age and determine whether the relation differs by birth status. In 1990-1992, 360 children varying in birth status (very low birthweight [VLBW]; demographically matched controls) were recruited to examine parenting and birth status influences on development. This report includes children with observations of parenting at 6, 12, and 24 months and 3, 4, 6, 8, and 10 years and cognitive skills evaluated at 3, 4, 6, 8, and 10 years of age (71% of original cohort). Four groups of mothers varying in the pattern of responsiveness displayed across the infancy and the preschool period were found. When controlling for school-age parenting and economic status, children parented with higher levels of responsiveness across both developmental periods, irrespective of birth status, showed higher levels in development than those who experienced responsiveness in only 1 development period or minimal responsiveness. Greater benefit was found for consistency in responsiveness for children born VLBW with less, versus more, severe neonatal complications. Inspection of the means showed that higher risk birth status combined with minimal responsiveness resulted in cognitive scores, on average, 14 points lower than when parented with consistently higher responsiveness. Cognitive development for children born at VLBW, particularly those with less severe complications, are supported by consistently responsive parenting across early childhood in similar ways to those born at term. This effect persisted through 10 years of age even after school-age parenting and economic level. These findings have important implications for the timing (across early childhood) and content (responsive interactive behaviors) of early intervention to enhance the outcomes for children born at VLBW.

Consequences of Uteroplacental Insufficiency on Developmental and Intellectual Performances

After completing this article, readers should be able to: 1. Explain why the difference between small for gestational age and intrauterine growth restriction is important for determining time of delivery. 2. Describe the potential developmental consequences of placental insufficiency. 3. Delineate the hypotheses underlying the association between prenatal stress and developmental outcome. Deprivation of supplies is the common pathogenic factor for fetuses experiencing placental insufficiency, even if all do not exhibit hypotrophy at birth or accelerated maturation as a response to stress. Nearly one century ago, placental insufficiency was remarkably described by the French obstetrician Pierre Budin: “They are tiny, puny infants with great vitality. Their movements are untiring and their crying lusty, for their organs are quite capable of performing their allotted functions. These infants will live, for although their weight is inferior … their sojourn in the womb was longer.” (1) Since then, normative growth curves and precise determination of gestational age (GA) have permitted consensual categorization of newborns, the last advance being the identification of an intrauterine growth restriction (IUGR) subgroup among the small-for-gestational age (SGA) group (10th percentile). (2) However, this categorization remains unsatisfactory when dealing with the very preterm group for several reasons, including unknown GA in many cases and inadequacy of the current growth curves in the low range of GA. Why is it so important to make a distinction between SGA and IUGR infants? First, the cause is different: genetic factors explain a large proportion of cases in SGA infants and epigenetic factors are involved in IUGR fetuses. This current conception is elegantly summarized by Fowden: “Normal fetal growth depends on an adequate supply of nutrients and on a strict temporal relationship between tissue accretion and differentiation. During early development, the pattern of intrauterine growth is largely determined by the fetal genome but, as size …

Infant-mother attachment classification: Risk and protection in relation to changing maternal caregiving quality.

The relations between early infant-mother attachment and children's social competence and behavior problems during the preschool and early school-age period were examined in more than 1,000 children under conditions of decreasing, stable, and increasing maternal parenting quality. Infants' Strange Situation attachment classifications predicted mothers' reports of children's social competence and teachers' reports of externalizing and internalizing behaviors from preschool age through 1st grade. These relations appeared to be mediated by parenting quality; main effects of attachment classification disappeared when effects of parenting quality were controlled. Interactions were also observed. For example, when parenting quality improved over time, teachers rated children with insecure infant-mother attachments lower on externalizing behaviors; when parenting quality decreased, teachers rated insecure children higher on externalizing behaviors. In contrast, children classified as securely attached in infancy did not appear to be affected by declining or improving parenting quality.

Dimensions of child maltreatment and children's adjustment: Contributions of developmental timing and subtype

This investigation examined the dimensions of developmental timing, subtype, and severity of maltreatment and their relations with child adaptation. The 814 children who participated in a summer day camp, 492 of whom were maltreated and 322 of whom were nonmaltreated comparison children, were assessed by camp counselors on their internalizing and externalizing symptomatology, aggressive, withdrawn, and cooperative behavior, and on personality dimensions of ego resiliency and ego control, and were rated by peers on disruptive, aggressive, and cooperative behavior. The severity within each subtype of maltreatment and the developmental period in which each subtype occurred were examined through hierarchical regression analyses. Additionally, children with similar timing or subtype patterns were grouped to explore diversity in outcomes. Results highlighted the role of severity of emotional maltreatment in the infancy-toddlerhood period and physical abuse during the preschool period in predicting externalizing behavior and aggression. Severity of physical neglect, particularly when it occurred during the preschool period, was associated with internalizing symptomatology and withdrawn behavior. Additionally, maltreatment during the school-age period contributed significant variance after earlier maltreatment was controlled. Chronic maltreatment, especially with onset during infancy-toddlerhood or preschool periods, was linked with more maladaptive outcomes. The implications of measuring multiple dimensions for improving research in child maltreatment are discussed.

Children of Parapartum Mentally Ill Mothers: A Follow-Up Study

A 2-year cohort of children (n = 75) of hospitalised first-episode parapartum mentally ill mothers in the mid-1970s in Stockholm were studied. The children were followed up during the school-age period from 1982 through 1992, and they were studied with regard to health development, academic achievement and family situation. Comparisons were made with matched controls. Data were collected from hospital case notes, the local tax authorities and school reports. No significant differences were found between the index children and the controls regarding the number of inpatient care episodes or days of inpatient care during the follow-up period. Nor was any significant difference found between the index and the control children regarding academic achievement as measured by the mean of all marks. Four index children and 2 controls were studying in schools for the mentally retarded. Seventy-four percent of the children of the patients were living with their mother, compared to 95% of the controls (p < 0.001). In conclusion, the children of mentally ill mothers in this longitudinal study did as well as the controls. The reason might be the social support provided by society (when needed) for these high-risk families in Sweden.

Drawing Abilities in Williams Syndrome: A Case Study

Children with Williams syndrome (WS) have been reported to exhibit an unusual cognitive profile characterized by marked preservation of linguistic abilities and poor visuospatial abilities against a backdrop of generalized mental retardation. Much of the data documenting this profile come from studies of older children and adults with WS. Very few studies have reported findings from the preschool and early school-age period. As a result, little is known about the early development of cognitive processes in children with WS. Capirci, Sabbadini, and Volterra (1996) reported data from a longitudinal case study of early language development in a young child with WS. This article presents the longitudinal profile of visuospatial abilities in this same child. Data on copying and free drawing collected over a period extending from late preschool to early school age are reported. It is clear from these data that this child does indeed exhibit deficits in visuospatial abilities. Her performance clearly improved with age, but deficits persist.

Early developmental precursors of externalizing behavior in middle childhood and adolescence.

This study examined the infancy- and toddler-age precursors of children's later externalizing problem behavior. Risk constructs included suboptimal patterns of observed caregiver-child interaction and the caregiver's perception of child difficultness and resistance to control. In addition, a novel dimension of caregiver-child relationship quality, the caregiver's perception of her toddler's unresponsiveness to her, was examined as a possible precursor of children's externalizing behavior. Externalizing problem outcomes were assessed throughout the school-age period and again at age 17, using multiple informants. As toddlers, children at risk for later externalizing behavior were perceived as difficult and resistant to control, and relationships with their caregivers were relatively low in warmth and affective enjoyment. Finally, the caregiver's perception of her toddler as emotionally unresponsive to her was a consistent predictor of later externalizing behavior, suggesting that negative maternal cognitions associated with child conduct problems may begin in toddlerhood. These predictive patterns were similar for boys and girls, and with minor exceptions, generalized across different subdimensions of externalizing problem behavior. Our findings underscore the importance of the infancy and toddler periods to children's long-term behavioral adjustment, and indicate the desirability of further research into the nature of caregivers' early perceptions of child unresponsiveness.

Neighborhood Attributes as Determinants of Children's Outcomes: How Robust Are the Relationships?

Estimates of neighborhood effects on children's outcomes vary widely among the studies that seek to identify their existence and magnitude, reflecting substantial variation in data and model specification. Here, we review that literature, and ask if the disparity in estimates of neighborhood effects may reflect the differences among studies in the specification of family characteristics, and hence omitted variables bias. We report a systematic set of robustness results for three youth outcomes (high school graduation, the number of years of completed schooling, and teen nonmarital childbearing) using data on about 2,600 children from the Panel Study of Income Dynamics. We observe these children over a period of at least 21 years and have included an extensive set of neighborhood variables for these individuals measured over the entire school-age period. We measure the relationship of these neighborhood variables to the three outcomes, moving from basic models containing no individual and family characteristic variables to models containing an extensive set of individual and family statistical controls. We conclude that the reliability of estimates of these impacts may be an artifact of the degree to which family background is characterized in model specification. Confidence that reported neighborhood effects reveal true relationships requires statistical controls for the full range of family and individual background that may also influence children's attainments; not all variables with coefficients showing asterisks have significant effects.

Measurement of impulsivity: construct coherence, longitudinal stability, and relationship with externalizing problems in middle childhood and adolescence.

This study focused on the assessment of impulsivity in nonreferred school-aged children. Children had been participants since infancy in the Bloomington Longitudinal Study. Individual differences in impulsivity were assessed in the laboratory when children were 6 (44 boys, 36 girls) and 8 (50 boys, 39 girls) years of age. Impulsivity constructs derived from these assessments were related to parent and teacher ratings of externalizing problems across the school-age period (ages 7-10) and to parent and self-ratings of these outcomes across adolescence (ages 14-17). Consistent with prior research, individual measures of impulsivity factor-analyzed into subdimensions reflecting children's executive control capabilities, delay of gratification, and ability or willingness to sustain attention and compliance during work tasks. Children's performance on the main interactive task index, inhibitory control, showed a signficant level of stability between ages 6 and 8. During the school-age years, children who performed impulsively on the laboratory measures were perceived by mothers and by teachers as more impulsive, inattentive, and overactive than others, affirming the external validity of the impulsivity constructs. Finally, impulsive behavior in the laboratory at ages 6 and 8 predicted maternal and self-ratings of externalizing problem behavior across adolescence, supporting the long-term predictive value of the laboratory-derived impulsivity measures.

The development of drawing in children with congenital focal brain injury: Evidence for limited functional recovery

Children with pre- or perinatal injury to right hemisphere (RH) brain regions show impairment of spatial integrative functions similar to that observed among adults with comparable injury. Unlike adults, children show considerable improvement with development on a range of spatial construction tasks which require spatial integration. Such gains could reflect true recovery of spatial integrative abilities. Alternatively, the improvement could be more limited in scope, reflecting the development of compensatory strategies which are task specific and allow the children to circumvent, rather than overcome, their primary spatial disorders. The studies presented here examined this distinction within the context of drawing tasks in which the child was first asked to draw a house and then an impossible house. The impossible house task was designed to examine the extent to which children rely on graphic formulas in generating organized drawings. The results showed that while all of the children with RH injury make considerable progress in free drawing into the school age period, they are very reliant on the use of graphic formulas. When given a task which requires them to alter their drawings, they did not change the spatial configuration of the depicted object. Rather they found alternate ways to render the object ‘impossible’.

カルシウムの摂取不足による下顎頭軟骨の成長に関する実験的研究

Calcium deficient food and low calcium-deficiency food were given for three weeks to Wistar rats of 6-week old corresponding to human school age period and to those 9-week old corresponding to adulthood, and bone debility was induced in them. Then a singular therapy with standard food containing calcium was used, and formation of bone matrix affecting the growth of cartilage of mandibular condyle was investigated. The results were as follows : I. Body weight The rats, 6-week old and 9-week old, were divided into their respective groups and maintained to 12-week old and 15-week old. As a result, no significant differences (p<0.01) were found in any group. The body weight was 6-week old<9-week old. II. Radiological findings 6-week old In the calcium deficient food group as compared with the controls, the trabeculae were found increased in the central and posterior portions but running irregularly. The low calcium-deficiency food group showed the same regularity of trabeculae as the controls. 9-week old In the calcium deficient food group as compared with the controls, the osseous layer was uneven in thickness and the trabeculae were running irregularly. The low calcium-deficiency food group showed about the same findings as the controls. III. Findings on Ca and P analysis on the X-ray Microanalyzer Relative Ca ratio and P ratio were determined by quantitative analysis by point analysis. 6-week old The controls and low calcium-deficiency food group showed about the same relative Ca ratios, but the calcium deficient food group showed low values. Relative P ratios were in the order of the low calcium-deficiency food group>controls>calcium deficient food group. 9-week old Relative Ca ratios were in the order of controls>calcium deficient food group=low calcium-deficiency food group. Relative P ratios were in the order of controls>low calcium-deficiency food group>calcium deficient food group. IV. Histopathological findings 6-week old In the calcium deficient food group as compared with the low calcium-deficiency food group, chondroclasts were restricted in the hypertrophic chondrocyte layer, and intrachondral ossification directly below the invasion zone was decreased. 9-week old In the calcium food group as compared with the controls, intrachondral ossification was restricted. In the low calcium-deficiency food group as in the controls, calcification of the matrix in growing chondrocyte layer was progressed and growth of the mandibular condyle by the mechanism of intrachondral ossification was seen. V. Hematologic findings 6-week old and 9-week old No changes were found in electrolyte in blood serum and in biochemical examinations in any group. Comparison between 6-week old and 9-week old K was high in value (p<0.01) for 6-week old in the low calcium-deficiency food group. Cl was high in value (p<0.01) for 6-week old in the controls and calcium deficent food group. CPK was high in value (p<0.01) for 9-week old in all groups. ALP was high in value (p<0.01) for 6-week old in all groups. On the basis of the foregoing findings, growth of the cartilage of mandibular condyle is affected by insufficient intake of calcium in the growing stage. In the low calcium-deficiency food group especially, findings of recovery of formation of bone matrix related to growth of the cartilage of mandibular condyle were evident.

Economic Hardship and the Development of Five- and Six-Year-Olds: Neighborhood and Regional Perspectives

The present study examines the association between neighborhood characteristics and the development of 5- and 6-year-olds. We also explore how region might moderate the effects of neighborhoods on children, thus considering both larger (regional) and smaller (community) contexts of families. We find that structural aspects of the neighborhood at the census tract level are associated with child development in the early school-age period. For the sample as a whole, neighborhood factors play a role in both cognitive and socioemotional outcomes, even when family factors are controlled. Yet only modest support for neighborhood influences on child development is evident in our main effects models. It appears that neighborhood influences on child development are underestimated or masked unless the associations are examined separately by two areas of the United States: the Midwest and Northeast versus the South and West. Significant associations between neighborhood variables and children's development are seen in the Northeastern and Midwestern regions, but less so in the Southern and Western regions of the United States. Greater economic and social resources as measured by average neighborhood SES (income, education, occupation) and greater ethnic congruity as measured by more neighbors of the same racial heritage as the child are related to higher cognitive functioning, but only in the Northeast and Midwest. Furthermore, children in these regions show more competent behavioral functioning when the relative presence of adults to children in the neighborhood is higher. In these regions, African-American but not white children show higher levels of behavior problems when community male joblessness rates are higher. We speculate about processes that might underlie these neighborhood and regional effects and point to directions for further research.

Child development and long-term outcomes: A population health perspective and summary of successful interventions

Studies of socioeconomic gradients in mortality in wealthy societies reveal that they have been persistent, and included most of the principal causes of death, even during the era when these principal causes of death have entirely changed. This observation has led to an interest in the ways in which the diversity of conditions of life, unfolding over the life cycle, can become embedded in human biology and subsequently affect health status and vitality. There is evidence that childhood experiences affect subsequent health status (as well as well-being and competence) in profound and long-lasting ways. Conflicting explanatory models of the impact of childhood experiences have been advanced, whose conflicts are political in nature, in that they reflect divergent beliefs about how human potential expresses itself, and, also, about the nature of the obligations which members of society have to one another. Notwithstanding these conflicts, a body of evidence derived from intervention studies in the post-neonatal, preschool, and school age periods suggest that performance in two basic domains of child development, the cognitive and the social-emotional, can be modified in ways which improve health, well-being, and competence in the long-term.

The Development of the Individual, the Personality, the Subject of Activity, and Individuality During Adulthood and Aging

In the history of developmental psychology as a branch of psychological science, the characteristics of adults have served as standards against which the different periods of growth, maturation, and the shaping of the personality in childhood, adolescence, and youth have been measured. Adulthood itself has traditionally been regarded as a stable period. For example, the French psychologist E. Claperede [23] characterized maturity as a state of mental ossification in which development ceased. Ebbinghaus [56] distinguished three periods in the development of memory and regarded the period between the ages of 25 and 50 as invariable in terms of that particular mental function. Piaget [31] considered the principal stages in the development of intelligence to be the preschool and school-age periods, in which development of the operational mechanism of intellectual activity was completed.

Attachment and teacher-reported behavior problems during the preschool and early school-age period

AbstractThe association between attachment and behavior problems was examined for a nonclinical, diverse sociocconomic status (SES) French-Canadian sample of 77 children. Attachment classifications were assigned on the basis of reunion behavior with mother when the children were between 5 and 7 years of age. Teachers rated children's problem behavior using the Socioaffective Profile within 3 months of the attachment assessment (Time 2) and 2 years earlier (Time 1). Results indicated that children with a D classification were more likely than secures or other insecure groups (A or C) to be classified in the problem group at both ages. A majority (80%) of the D group showed problem behavior at some point during the 3–7 year period compared with a minority of A, B, or C children. However, only about 30% of controlling children (like other insecures) had stable problems. Analyses of subclinical scores showed that both controlling and avoidant groups were lower than secures in social competence at Time 1. At Time 2, A group children were lower in externalizing behavior, and C group children were higher. These results extend the association between the D classification and maladaptation previously found for clinical and high-risk samples to a nonclinical, mixed SES sample.

Developmental trends in visuospatial analysis and planning: I. Copying a complex figure.

An existing scoring system was used to assess the accuracy of the children's ability to copy the Rey-Osterrieth Complex Figure. The authors also developed additional measures to more precisely describe the process used by children in copying this figure. The findings suggest that children between the ages of 6 and 9 break the figure up into simple components but improve in their ability to integrate the figure with age. Younger children demonstrated a similar pattern of performance when copying the main features of the Rey-Osterrieth Complex Figure in isolation. The results of this study suggest that when faced with tasks requiring more advanced types of spatial analysis, children adopt strategies that proved successful when they were younger. Children have a variety of spatial analytic strategies available by age 6, but the strategy that they use is a function of pattern complexity and the capabilities of the child. The Rey-Osterrieth Complex Figure was designed more than 50 years ago for assessing visuospatial construction, planning, and memory in both adults and children (Osterrieth, 1944; Rey, 1941; see Corwin & Bylsma, 1993, for a translation). There have been several attempts to describe developmental change in copying the Rey-Osterrieth Complex Figure, but the complexity of the form has made this a difficult task. Four published studies have reported that until approximately age 9, most children use a piecemeal approach (Karapetsas & Kantas, 1991; Kirk, 1985; Osterrieth, 1944; Waber & Holmes, 1985). In this approach, details are juxtaposed, one next to the other without any apparent overall plan, yet the figure is often globally recognizable. After age 9, productions have been described as more configurational; that is, most participants start their drawing with the base rectangle or a detail that adjoins the rectangle and complete the large rectangle before drawing the rest of the figure. Although these are valid and useful descriptions of performance in the school-age period, they present an incomplete picture of children's performance on the figure in terms of both the range of strategies children adopt in copying this complex visual pattern at each age and the systematic patterns of developmental change evident across the age span. Examination of the existing developmental data from the figure suggests that by age 6, children attend to and attempt to reproduce both the elements and the overall configuration of the pattern (Karapetsas & Kantas, 1991; Kirk, 1985; Oster

The school-age child: Putting it all together

The school-age period offers many opportunities to the pediatrician for creative, interesting evaluations and interventions. Many problems are not apparent in bold colors but rather in muted pastels. Often we are aware of an at-risk status, but let it ride because there are other more acute concerns going on with children in infancy and adolescence. Awareness of the consolidation of growth, the coordination of cognitive and other functions and the establishment of self-awareness and self-esteem during this period should help pediatricians focus their efforts on ensuring that the children's physical, cognitive, and psychological foundations are built firmly and maintained solidly. Far from being a period of "latency," school age is a critical era in the development of children, and pediatricians have a responsibility to participate actively in that development.