CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
THE ENVIRONMENTAL IMPACT UPON COGNITIVE DEVELOPMENT:
AN INVESTIGATIVE STUDY OF HISPANIC HIGH RISK INFANTS
A thesis submitted in partial satisfaction of the
requirements for the degree of Master of Arts in
Education-Educational Psychology
by
Madeleine Distaso Bruning
January, 1983
The thesis of Madeleine Distaso Bruning 1s
approved:
Rose M. Bromwic"
California State University, Northridge
ii
DEDICATION
It is only with the heart that one can see rightly;
what is essential is invisible to the eye .
.
.
Men have
forgotten this truth, but you must not forget it.
Antoine de Saint Exupery
The Little Prince
I extend my deepest gratitude to Laura S. Finkleman
and the clinic families.
This project is dedicated to
their relentless courage in the face of disparaging hardships; to those who believe that humanistic support has
not been ameliorated by technology; to those who have not
forgotten to see with the eyes of their hearts.
iii
ACKNOWLEDGMENTS
The writer wishes to thank the individuals who contributed their time, thoughts and energy towards the
completion of this project.
Special gratitude is extended to:
Elizabeth C. Ringsmuth, for her consistent and
untiring guidance, assistance, and encouragement;
Rose M. Bromwich, for sharing her expertise and
insight throughout the years;
Elizabeth H. Brady, for her patience and support;
Roxane B. Spitzer, R.N. and Linda Burnes Bolton, R.N.
for their professional confidence and direction.
And finally, to my husband, Robert, for his unending
love and endurance through the duration of this project.
iv
TABLE OF CONTENTS
Page
Dedication
iii
Acknowledgments
iv
Table of Contents
v
List of Tables
vii
Abstract
viii
CHAPTER
1.
THE PROBLEM
1
Introduction to the Problem
1
Background of the Problem
2
Related Literature
Research Question
Statement of Hypothesis
2
4
4
Operational Definitions
2.
REVIEW OF THE LITERATURE
Cognitive Development in Low Birth
Weight Infants
5
7
7
Skeletal Correlations
Malnutrition
Perinatal Anoxia
Respiratory Distress Syndrome (RDS)
Central Nervous System
Reciprocity in Cognitive Development
12
Interaction Patterns Among Parents and
Premature Infants
13
Maternal Infant Interaction Patterns
Game Playing
Home Intervention Programs
UCLA Infant Studies Project
Developmental Trends
Birth Condition and Home Environment
Home Visitation
Physical Therapy
Summary of Literature Review
v
7
8
8
9
11
13
15
17
17
18
20
20
21
22
3.
METHOD
23
Setting
Subjects
23
23
Families
Infants
Mothers
Fathers
23
24
25
25
Instruments
Procedure
26
27
Home Visits
Clinic Visits
4.
28
28
RESULTS
30
Subpopulation of Suspect HOME and
Suspect MDI Scores
31
Subpopulation of Suspect HOME/Suspect
Bayley MDI
33
Subpopulation of Suspect HOME-Normal
Bayley MDI. Scores
36
Implications for Intervention Practices
37
Pre-Natal Care
Early and Primary Intervention
Assessment Tools
Implications for Continued
Investigation
Conclusion
37
37
38
38
39
REFERENCES
40
APPENDIX A
47
Lubchenco Scale
48
APPENDIX B
49
Bayley Scales of Infant Development
APPENDIX C
SO
58
Caldwell Home Inventory
59
APPENDIX D
60
Caldwell Home Observation for Measurement of
the Environment
v
vi
61
LIST OF TABLES
Page
Table 1:
Hispanic One Year Infant's Bayley
MDI Scores by Caldwell Home
Inventory Scores
Table 2:
30
Characteristics of Subpopulation
Suspect HOME/Suspect Bayley MDI
Scores
32
I.
.
~
vii
ABSTRACT
THE ENVIRONMENTAL IMPACT UPON COGNITIVE DEVELOPMENT:
AN INVESTIGATIVE STUDY OF HISPANIC HIGH RISK INFANTS
by
Madeleine Distaso Bruning
Master o£ Arts in Education
Educational Psychology
Early Childhood Education
The purpose of this study was to gather information
at one year of age about the psycho-social and cognitive
performance of 27 low socioeconomic Hispanic premature
infants.
The Caldwell Home Observation for Measurement
of the Environment was administered during a home visit.
The Bayley Scales of Infant Development were used during
the one year clinic visit to determine the mental developmental index.
The findings of this study suggest that a relationship between environment and subsequent mental development
may exist, but further investigation is required to determine statistical significance.
The study suggested that a
significant proportion of low birth weight infants and
their parents have special characteristics which necessitate early intervention from helping professionals.
Ad-
verse environmental factors may have influenced cognitive
development at one year CCA in four infants who were
neurologically normal upon discharge.
viii
The HOME scores
revealed that accessible play materials were few but
psychosocial interaction was adequately present.
Results
demonstrated that all infants with low Bayley MDI scores
also had suspect HOME scores.
ix
CHAPTER 1
THE PROBLEM
The primary purpose of this study was to provide
psycho-social and cognitive information about premature,
low-birth weight infants delivered by
Hispan~c
mothers of
low socioeconomic status, at one year of age.
Introduction to the Problem
During the past twenty years, technological advancement and progressive medical intervention have increased
.
survival rates of premature infants.
Helping-professionals
have become aware that intensive and comprehensive care of
premature, low-birth weight infants precipitates a psychosocial crisis for parents and the family unit.
Kaplan and
Mason (1960) defined four tasks of the mother of a premature infant: (1) at delivery, the mother experiences
anticipatory grief, as she hopes the infant will live, but
prepares for death; (2) the mother identifies and acknowledges failure to deliver a full term, healthy infant; (3)
as the infant's condition improves, the mother resumes the
process of relating to her infant; and (4) the mother
understands how the premature differs from the normal term
baby and prepares to care for her infant.
Although parental visitation to the infant in the ICU
may be encouraged, few opportunities may arise for the
provision of direct care-giving.
In addition, parents may
be unable to visit as frequently as desired due to limitations in transportation, economic resources or family
1
2
responsibilities.
In low socioeconomic settings, these
limitations also impede and impinge upon the parents'
ability to keep clinic appointments.
The family is further
encumbered by differences in language and cultural expectations.
Hospital discharge to the horne may be the initial
opportunity for newborn care giving by the parents.
Clinic
visits provide limited opportunities for observation and
intervention.
Horne intervention becomes a primary and
salient alternative in ·promoting physical, psycho-social
and cognitive development.
Inadequate resources in the horne environment may lead
to developmental delays in premature infants.
The Caldwell
Horne Observation for Measurement ofEnvironrnent (HOME) enables the helping professional to assess environmental
factors which influence a young child's cognitive and
psycho-social development.
Although the clinic setting
provides physical care, anticipatory health teaching and
developmental testing, opportunities for parent-child
interactions are limited and dependent upon compliance to
clinic appointments.
Therefore, horne assessments may be
the vital links in identifying causative factors which
relate to cognitive developmental delays in premature low
birth weight infants of low SES.
Background of the Problem
Related Literature
Premature infants and their parents were identified
as high risk dyads in the early 1900's with the advent of
3
neonatology.
Pierre Budin ( 190 7) , an obstetrician,
pioneered the specialty through intensive observation and
investigation of low birth weight infants and their
mothers.
In addition to gathering vital statistics, Budin,
(1907) made numerous observations.
He suggested that early
separation was physically and emotionally detrimental to
the maternal-infant dyad.
Budin, (1907) also observed that
premature, low birth weight infants failed to thrive during
prolonged separation from their mothers.
These initial
discoveries led to the supposition that environmental
factors enhanced or diminished neonatal outcome in terms
of mortality and morbidity (Budin (1907).
Although many
infants were nutritionally maintained by nursing personnel
in the hospital setting, Budin encouraged mothers to hold
and breastfeed their premature infants (Klaus and Kennel,
1976).
The primary and rudimentary findings motivated further investigation of possible relationships among obstetrical practice, maternal-infant interaction and specific
physiological needs of premature, low birth weight infants.
Budin's (1907) classic publication, The Nursling,
was an impetus for subsequent empirical research investigations which influenced the medical practice in caring
for premature infants.
The decreased mortality and morbidity rates result
from an integrated approach towards neonatal theory,
practice, intervention and management.
4
This progress has facilitated the survival of infants
with very low birth weights and shorter gestational
periods.
Consequently, recent follow-up studies have re-
vealed positive and negative relationships among gestational aget birth weight, length of hospitalization and a
multiplicity of. various physical, developmental and psychosocial sequallae associated with prematurity.
Existing literature addresses a preponderance of
follow-up studies designed to identify; investigate, and
correlate variables such as:
parental behavior towards
prematures; cognitive, sensorimotor and affective development in prematures; physical complications of prematurity;
and environmental factors which influence cognitive and
social affective maturation.
Conflicting findings appear
in the numerous studies focusing on developmental outcomes
of premature babies.
Post-natal intervention or enrich-
ment programs have used families of both high risk and
normal premature infants of varying socioeconomic status
and ethnicity.
Research Question
This study posed the following research question as
determined by the Bayley MDI and Caldwell HOME tests:
What is the relationship between low birth weight and cognitive development at one year of age in premature Hispanic
infants?
Statement of Hypothesis
A positive relationship will exist between environ1!
5
mental factors as measured by the Caldwell HOME Inventory
and cognitive development as measured by the Bayley Infant
Scales of Development (MDI) in premature, low birth weight
infants at one year of age of Hispanic families.
Operational Definitions
In differentiating normal and risk populations of
infants, several terms will be used throughout the text
for clarification.
Pre-term refers to a gestational period
ending before 37 weeks of pregnancy while term refers to a
gestational period ending between 38 and 41 weeks of
pregnancy (Korones, 1981).
Small for Gestational Age (SGA)
refers to a birth weight (in grams) which falls below the
tenth percentile based upon the number of weeks of gestation, while Appropriate for Gestational Age refers to a
birth weight (in grams) falling between the tenth and
ninetieth percentile based upon the number of weeks gestation (Korones, 1981).
Respiratory Distress Syndrome (RDS)
is an acute respiratory disorder which appears at birth or
-so6nafter delivery:
The- incidence-is a-lmo-st exclusive to
pre-term infants weighing 1000-1500 grams (2.2 to 3.5 lbs).
The syndrome is characterized by respiratory failure.
Pathogenic findings include cyanosis in room air (21~
oxygen) and or reticulogranular pattern on chest x-ray
("ground-glass").
These criteria are used for differential
diagnoses and are specific to RDS (Korones, 1981).
Respiratory Distress may be present soon after birth
and is characterized by dyspnea (difficult respirations)
6
tachypnea (respiratory rate above 60/min in newborn) ,.
intermittent apnea (cessation of respirations) as well as
retractions, nasal flaring and cyanosis (Korones, 1981).
Although the symptomatology of respiratory distress is
similar to RDS, the incidence is pervasive throughout all
gestational ages and weights and may be caused by various
etiologies including:
diaphragmatic hernia, tracheo-
esophageal fistulas, aspiration pneumonias and sepsis.
Therefore, a differentiating diagnosis is dependent upon
the presence of a
retic~logranular
pattern on x-ray, ges-
tational age assessment, and birth weight in conjunction
with presenting respiratory signs.
Corrected Chronological Age (CCA) refers to the
determination of age based upon gestational age (in weeks)
at the time of delivery in relation to the expected date
of delivery (EDD), that is, the chronological age (in
weeks) plus the number of weeks premature.
Premature infants frequently manifest jaundice or
hype-rbiT:inil::>iriemia: -- Tlie determinant ·values used in
screening neonates at risk are total bilirubin levels of
20 mg in the blood for term infant and 15 mg bilirubin in
the blood for a premature infant.
CHAPTER 2
REVIEW OF THE LITERATURE
The review of the literature has been organized into
three sections.
The first section, cognitive development
in low birth weight premature infants, includes contributing factors such as skeletal conditions, malnutrition,
reciprocity, perinatal anoxia, Respiratory Distress
Syndrome and Central Nervous System (CNS) disorders.
The
second section addresses interaction patterns among parents
and premature infants which includes game playing and
maternal-infant interactional patterns.
Finally, section
three discusses home intervention including The UCLA Infant
Studies Project, developmental trends, birth condition and
home environment, home visitation and physical therapy.
Cognitive Development in Low Birth
W~ight
Infants
Skeletal Correlations
Low birth weight has b~en associated with abnormal
neurological conditions with subsequent cognitive developmental deficits (Rubin and Rosenblatt, 1973).
Lubchenco
(1976) identified that low birth weight infants with
normal skeletal systems would probably have normal physical
growth and development.
Likewise, low birth weight infants
with normal head circumferences but less than average
length would also develop within normal limits.
However,
Lubchenco (1976) determined that infants who were small for
gestational age in all dimensions were likely to remain
small throughout early childhood.
7
8·
Malnutrition
Subsequent investigations revealed that brain cell
proliferation continues through infancy up to 15 months of
age (Klaus, 1979).
Furthermore, malnutrition occurring
~ny time during the first two years post-conception should
be considered a risk factor in neurophysiological
ment.
~evelop­
Sweet and Klaus (1979) suggest that total brain cell
deoxyribonucleic acid (DNA) content is linearly related to
head circumference.
Post mortem studies of marasmic in-
fants disclosed that brain weight and protein were reduced
proportionately to the head circumference.
These findings
(Sweet and Klaus, 1979) supported the use of head circumference as a valid diagnostic tool in determining postnatal brain growth.
Perinatal Anoxia
Broman (1979) followed the cognitive development of
children from the antenatal period to 7 years of age.
The
number of children ranged from 11,758-17,430 in the white
sample and 15,206-19,415 in the black sample.
The deter-
mination of perinatal anoxia was based upon 10 clinical
signs.
Bayley Mental Developmental Indices (MDI) scores
were obtained at 8 months.
This outcome was correlated
with neonatal predictors in relation to perinatal anoxia.
Stanford-Binet Intelligence scores were obtained at age 4
and the Wechsler Intelligence Scale for Children (WISC} at
age 7.
Socioeconomic effects were also identified and
investigated as environmental impact proved to be an
9
. important variable.
Broman (1979) discussed his findings
of anoxic infants.
Anoxic groups, particularly those with
RDS, had lower cognitive scores than infants who had not
suffered anoxia when examined at 7 years of age.
The
differences, though undramatic, were consistent with
ethnicity, sex, and socioeconomic status (SES) subgroup.
Results from all analyses indicated that neonates with
clinical signs of anoxia are at risk far less than normal
cognitive development.
However, the risk for serious cog-
nitive deficits is greater when other signs of central
nervous system impairment are also noted.
Respiratory
Di~tress
Syndrome (RDS)
Fields, Dempsey and Shuman (1979) studied 42 subjects
surviving RDS in relation to 21 infants who were free from
any neonatal complications.
made annually for four years.
Developmental assessments were
Premature infants were
chronologically corrected for age.
The results suggested
that RDS infants received lower Bayley Mental Development
Indices (MDI) and Psychomotor Developmental Indices (PDI)
scores during the first and second years, than the normal
conttols.
The four year results revealed that five of the
21 RDS subjects had language delays and hearing deficits,
while none of the controls demonstrated auditory or speech
problems.
Field, (1978) provides a perspective of maternal
assessment of term and pre-term infants with RDS.
The
assessments were made from an adaptation of the Neonatal
10
Behavior Assessment Scale (NBAS) (Brazelton, 1973).
The
mothers' assessments did not differ significantly from
that of trained clinicians.
Both mothers and clinicians
assigned lower scales to pre-term infants.
These scores
were then correlated with the Bayley PDI scores at eight
months.
The mother's assessment of the infant's tempera-
ment were made at four and eight months and these correlated with the clinician's ratings on the Brazelton NBAS
and eight-month Bayley Scales.
Field's (1978) findings
suggest that the mother's assessment is reliable and may
have some predictive validity during early infancy.
objectives of the study were to:
The
(1) determine the degree
of correspondence between mothers' and examiners' ratings
on different versions of the same scales, (2) determine
the consistency of mothers' ratings across a period of
time, and (3) determine the relationship between mothers'
ratings on behavioral and temperament measures and independent developmental assessments by trained examiners.
Relationships were drawn between the parent and clinician
ratings on the Brazelton NBAS and the mother's version
called the Mother's Assessment of the Behavior of the
Infant (MABI) , between early and later ratings by mothers
on both the MABI and the Infant Temperament Questionnaire
and between mothers' ratings of infant development versus
the clinician's ratings from measurements such as the
Bayley Scales of Infant Development.
Field (1978) suggests that the mothers' ratings of
.
·~-
11
infant temperament at 4 and 8 months significantly relate
to earlier measures of developmental status during infancy.
Therefore, mothers' assessments of their infants' behavior
and temperament during early infancy correlate positively
with assessments by trained clinicians.
Field (1978) con-
veys that the results are limited to white, middle class,
high school educated women and therefore cannot be generalized to other populations.
However, the assessment
skills in low socioeconomic, less educated mothers may
vary.
Central Nervous System
Recent studies on RDS survivors disclose congruent
results.
Sostek,_ Quinn and Davitt (1979) compared be-
havioral and neurological development in premature infants and term infants.
Both groups demonstrated a variety
of physiological complications.
118 infants.
The sample consisted of
Various socioeconomic and ethnic groups were
represented in the study.
The Brazelton NBAS and Bayley
MDI and PDI Scales were used as instruments to measure
cognitive performance.
The investigators concluded that
full term infants with central nervous system symptoms
attained higher scores on cognitive development indicators
than pre-term infants with similar neurophysiological disorders.
Inherent in this analysis is the premature's increased vulnerability to seizure activity or cerebral
hemorrhages due to the fragility of the immature central
12
nervous system vascular structure.
Anoxic episodes may be
directly or indirectly related to these complications.
Reciprocity in Cognitive Development
A longitudinal study of predominantly lower income
black infants and their caregivers was conducted by Yarrow,
Klein, Lomanaco and Morgan (1975).
The findings suggest
that a child's intellectual and social development occurs
in a field of reciprocal interactions with people and
objects in the environment.
Inherent in this interpreta-
tion is the principle that infants select and respond to
external stimuli and in turn, the infant will affect the
human environment.
Therefore, the child learns about the
world through active manipulation of the environment and
exploration of inanimate objects.
The infant elicits
stimulation from caregivers through signals which elicit
responsiveness.
Reciprocally, caregivers respond to the
infant's responsivity.
Yarrow's (1975) study illuminates the salience of
stimulation in early cognitive development and its impact
upon sustained intellectual growth.
Yarrow (1975) ex-
plains that the issue is not simply the child's intelligence quotient or capacity to develop perceptual discriminations.
The child must continue to receive stimulation
to become more receptive, as well as learning to adapt to
individuals and objects in the environment (Yarrow,
1975).
v
13
Interaction Patterns Among Parents and Premature Infants
Maternal Infant Interaction Patterns
Klaus and Kennel (1976) suggest that early and prolonged separation may lead to disturbed parent-child interactions.
This suggestion was based upon extensive research
conducted by numerous investigators over the past forty
years (Klaus and Kennel, 1976).
Bowlby (1958) describes
critical behaviors observed during the attachment process
and the effects of separation in terms of cognitive, motor
and affective development.
In concurrence, Kaplan and
Mason (1960) state that the initial maternal crisis is
separation from the infant which commences a behavioral
continuum of loss.
Brazelton's (1973) comprehensive re-
search on the infants' organization of behavior andresponsivity has influenced numerous investigative studies
concerning maternal-infant interaction.
The NBAS
(Brazelton, 1973) measures reflexive and motoric responses
in infants and has been used to examine interactional
patterns.
Field (1979) presents the summary results of numerous
longitudinal studies.
Field (1979) and her colleagues re-
port that the maternal interactions with high risk infants
were different, if not disturbed.
During feeding, the
mothers tended to distribute stimuli evenly during the
feeding interactions.
These mothers did not attempt to
soothe or quiet their offspring, and during face-to-face
interactions, preterm infants averted visual contact.
The
14
preterm infants and their mothers were more active and preterm males were particularly fussy and gaze averting.
A number of investigators have evaluated caregiving
of and competency in full term infants.
Cohen and Beckwith
(1979) observed groups of mothers with their
prematur~
in-
fants over a period of time and correlated behavioral interactions at one and two years of age using Gesell scores.
Cohen and Beckwith (1979) advise that it is unknown if
early experiences are critically important for the acqui-
.
sition of later competence.
However, early experiences and
interactions represent consistency of social transactions
which may have longitudinal and cumulative salience in the
development of competency.
Thus it may be possible. to
identify patterns of interaction within the first year that
are predictive of competency at. two years.
Interactional patterns of parents with hospitalized
premature infants were studied by Herzog (1979) in an
attempt to identify variables that create an impact upon
maternal and paternal attachment vehaviors.
One hundred
couples were interviewed to assess maternal-child,
paternal-child, and maternal-paternal interactions.
Herzog
emphasized that disorders of attachment processes were not
universal.
Two critical components enabled a mother to
overcome the disadvantages incurred by separation:
mother's affective state and the role of father.
the
Herzog's
(1979) findings partially contradict the reports of Klaus
and Kennel (1976) who state that an association between
15
early separation and eventual parenting disorders are
approximately related to an interruption in the attachment
process.
This theory is based upon the supposition that a
sensitive or critical period exists during the first few
hours in the post-natal period.
(Klaus and Kennel, 1976)
General investigators have produced data suggesting that
the timing of the first contact between infant and parent
was of crucial importance in the establishment of attachment.
Accordingly, lack of intimate contact could be pre-
dictive of subsequent parenting disorders.
(Ainsworth and
Bell, 1973; Sroufe, 1978; Minde, Trehub, Corter, Boukydis,
Celhoffer and Marton, 1978)
Game Playing
Game playing during infant/parent interaction provides
a context for learning conversational turn-taking and contingent responsivity.
Field (1979) provided descriptive
data on the kinds of games initiated by parents with high
risk premature, post-mature, and term infants.
Differen-
tiation between maternal and paternal game playing was also
examined during this investigation.
Separation versus non-
separation was explored as a significant variable.
Both groups of infants were also identified by their
mothers to be "difficult" babies.
The scales used to
determine the developmental stages of the infants were the
Brazelton NBAS and MABI.
Ratings taken at four months on
the Carey Infant Temperament Scale suggested that mothers
continued to view their babies as difficult.
The "normal"
16
population consisted of infants with an average weight of
3300 grams and 40 weeks gestation.
The total population
consisted of 60 infants, 20 infants in each group.
The
groups matched on demographic data.
The frequency of "universally" recognized infant
games were observed by trained observers who remained unaware of the purpose of the study.
Face-to-face inter-
action took place after the infant was fed and the parents
were acclimated to the laboratory environment.
These
sessions were videotaped and coded via 20 key EsterlineAngus event recorders by two observers simultaneously
viewing the tape.
The games included the following:
me a story", "I'm gonna get
you"~
"Tell
"Walking fingers"
(creepie crawlies), "So big", "Pat-a-cake", "peek-a-boo",
and "other" games.
The results showed that the mean percentage of time
playing games was 31% during the observed face-to-face interactions.
The remaining 69% of the time was character-
ized by infant/parent behaviors such as smiling, laughing,
making faces, sounds and conversations.
The fathers spent
more time playing games with at least full term male infants than did mothers and is consistent with the previous
studies cited by the author.
There was an absence of
difference between the two risk groups which indicated that
separation was not as important as earlier hypotheses may
indicate.
There seemed to be a correspondence between the
difficulties presented by these infants during early inter-
17
actions and the decreased playfulness of the experimental
parents than the control group.
Previous maternal assess-
ment and experience with the "difficult" infant seemed to
interfere with playful activity although the study did not
reveal pre-discharge education of the parents.
Home Intervention Programs
Home intervention programs have been developed to
meet a number of goals and objectives.
Home visitation
may reveal valuable assessment data for subsequent plan. ning, implementation and evaluation.
vention goals included:
The major home inter-
(1) to foster and enhance optimal
parental/infant interaction, (2) to assess physical,
social~
affective and cognitive developmental behaviors,
(3) to formulate intervention which facilitates optimal
growth and development in the cognitive and affective
domains and (4) to evaluate through measurable instrumentation, progression or regression of behaviors based upon
pre-determined
c~iteria.
UCLA Infant Studies Project.
According to Bromwich
(1981) , a primary goal for infant intervention programs is
the maintenance and reinforcement of positive interactions
between the mother and infant.
In the UCLA Infant Studies
Project, a widely cited educational intervention program,
Bromwich and Parmelee (1979) studied high risk infants
and their primary caregivers.
Subjects were divided by
socioeconomic status and severity of post-natal complications.
~
The two year follow-up program provided home
18
visits in addition to medical and nursing interventions.
The home visitors were engaged to enhance parent/infant
interactions in the social-affective, language and cognitive areas.
the
Bromwich and Parmelee (1979) reported that
in~ervention
group scored significantly higher on the
Beckwith 24 Month Home Observation measure than the nonintervention group.
Home intervention was also explored by ScarrSalapatek and Williams (1973).
The investigators provided
stimulation to infants during the home visit to explore
contingent stimulation and responsivity in relation to the
infant's effort to control the environment .
. Developmental Trends.
Medhoff-Cooper and Schraeder
(1982) examined low birth weight infants in the home to
identify developmental trends.
In addition, the study
investigated behavioral trends and parent-child interactions.
Assessment tools included _the Denver Develop-
mental Screening Test (DDST), Infant Temperament Questionnaire (ITQ) and HOME.
In this study, Medhoff-Cooper and
Schraeder (1982) report that 88% of the infants were
identified as high risk for developmental delays.
Very low birth weight infants in the sample were
characterized by low soothability, resistence to change,
withdrawing behavior and negative mood (Medhoff-Cooper
and Schraeder, 1982).
Medhoff-Cooper and Schraeder (1982) imply that early
intervention must begin in the acute-care setting.
19
Field, Widmayer, Stringer and Ignatoff (1980) focused
their home intervention study on developmental trends of
prematures with teenage, lower SES, black mothers.
The
control group consisted of adult black mothers of low SES.
Denver scores and face-to-face interactions were assessed
in the intervention and control group at four months.
Bayley (MDI), Caldwell, and Infant Temperament scores of
the same groups were evaluated at· 8 months.
Home visits
were initiated in the intervention with the following
goals: to educate mothers on developmental milestones and
child rearing practices to teach mothers age appropriate
stimulation exercises £or facilitating sensorimotor and ·
cognitive development, and to facilitate maternal-infant
interactions.
At the 8 month evaluation, Bayley (MDI), Caldwell
HOME and Carey Infant Temperament scores were significantly
higher in. the intervention sample.
(Field, Widmayer,
Stringer and Ignatoff, 1980).
Denhoff (1981) summarized the status of infant stimulation and enrichment programs to provide historical background.
Denhoff (1981) discloses that clinical findings
from infant and toddler programs varied considerably in
terms of validity, reliability and ability to be generalized pervasively.
However, positive outcomes were specif-
ically cited from preschool intervention and screening programs (Denhoff, 1981).
"
20
. Birth Condition and Home Environment.
Hayes (1980)
developed a study to address questions relating to neonatal
birth condition, stimulation and home environment.
Forty-
seven three year old children were studied, of which 17
received additional stimulation as newborns.
The remain-
ing 16 subjects received routine neonatal care.
The McCarthy Scales of Children's Abilities (MSCA)
and Caldwell HOME were used to assess developmental and
psycho-social differentiation.
The three subgroups in-
cluded: full-term, control; pre-term, control; and premature, stimulated.
The results indicated that term and
· preterm cognitive development was similar in females while
non-stimulated premature males attained significantly
lower scores than the non-stimulated full-term and
stimulated pre-term males (Hayes, 1980).
Home Visitation.
Home intervention advocates have
been used to provide early assessment with subsequent
prophylactic interventions.
Larson (1980) studied working
class maternal/infant dyads over an 18 month period.
The
purpose of the investigation was to validate the efficacy
of home visitors as well as assessment of the environmental factors which influence maternal infant interactions
and improved child rearing practices.
divided into three groups.
Subjects were
Group A received an antenatal
home visit at 7 months of pregnancy with subsequent followup visits for 6 months.
Group B received follow-up visits
for 6 months devoid of the antenatal visit and Group C
21
received no intervention.
The Caldwell HOME and Health
Status Inventory were used for correlation of statistical
efficacy of home visitation.
Larson (1980) conveys that home visitors can enhance
the quality of early environmental experiences through
astute assessment and timely intervention.
Although there
was no significant difference among the groups on the prenatal attitude questionnaire, significant differences were
shown in Group A, which had received the prenatal home
visit at seven months of pregnancy as well as follow-up
visits.
Physical Therapy.
Parental compliance to home physi-
cal therapy programs with the provision of home visitation
was studied by Mayo (1981) who designed a study to evaluate
the salience of one home visit.
The subjects consisted of
18 infants with confirmed delayed motor development.
infants were 36 months old or younger.
heterogeneous.
All
Diagnoses were
Mayo (1981) concluded that mothers of
_ severely delayed children complied to home physical therapy
significantly more than mothers of moderately delayed
children, regardless of an imposed home visit.
Although
the difference was not significant, mothers of moderatelydelayed children complied to the physical therapy program
to a higher degree when they received the home visit
(Mayo, 1981).
Forty-seven low income families with normal children
between the ages of 17-24 months were studied by Gray and
22
Ruttle (1980).
The purpose of the study was to maximize
the effects of a horne visitation program and enable mothers
to become effective educational change agents.
The Bayley
scales, Stanford Binet, Receptive Language, Slauson
Intelligence Test, Gilmer Test of Basic Concepts, Caldwell
HOME and Maternal Teaching Strategy Instrument were used
for baseline and progressive measurement.
Gray and Ruttle
(1980) explain that although they attained modest results,
it was encouraging to reveal that early intervention may
have longitudinal effects upon families after intervention
has ceased.
Summary of Literature Review
The review of the literature suggests that cognitive
development in low birth-weight premature infants is influenced by physiological complications, environmental
components and transactional relati6nships throughout
early childhood.
The quality of maternal infant inter-
action has been addressed throughout the literature, but
systematic and empirical studies are sparse.
Furthermore,
few follow-up studies have controlled for variance in
cultural expectations and child care practices, sample
size and influences from numerous independent variables.
Studies focusing on the use of the Caldwell HOME are
relatively absent.
However, the review of the literature supports that
environmental factors strongly influence cognitive development in high risk infants.
CHAPTER 3
METHOD
Setting
A comprehensive high risk infant follow-up clinic in
a Los Angeles County hospital serves infants with birth
weights of 1500 grams or less.
All infants were discharged
from special care nurseries and received an initial one
month post-discharge clinic evaluation.
The clinic
schedule consisted of monthly "well-child" examinations
with additional arrangements for "sick" visits.
The
routine "well-child" visit included: physical assessments;
vaccinations; nutritional guidance; developmental testing;
and individualized plans of care for psychosocial enhancement.
The home visitation program was a salient component
in assessing maternal-infant attachment, maternal-child
interaction and family patterns of interaction, communication and child-caring behaviors.
Subjects
Families.
Of the 27 families selected, 8.8% were of
Hispanic ethnicity or had Spanish surnames with Spanish as
a primary language.
A majority of the occupied single
family dwellings were located in the East Los Angeles and
San Gabriel Valley areas.
Most of the families experienced
problems related to social/economic status including lack
of adequate transportation, inadequate financial resources
and language limitations.
In addition to these factors,
families frequently moved from one dwelling to another.
23
24
The average annual income was between
$4~000-$8,000.
All
were nuclear families with the exception of one which included grandparents.
The average occupancy was four
persons per five rooms (excluding bathrooms).
Public
transit was the primary mode of transportation, although
private vehicles were used when available.
Infants.
All infants were discharged from neonatal
intensive care units with normal physical and neurological
findings.
A preponderance of the infants were male, 57%,
.
while 43% were female.
The average
gest~tional
age at
birth was 30.7 weeks with a mean birth weight of 1270
grams (approximately 2 pounds, 7 ounces).
Gestational age
was evaluated upon admission to the special care nurserie$
and determined by the Dubowitz or Lubchenco gestational age
assessment tools (Korones, 1981; see Appendix A).
Among
the infants, the following clinical characteristics were
present: 32% were SGA, 64% were AGA and 4% were LGA; the
mean Apgar score at delivery was 9 at five minutes and the
average length of hospitalization was thirty days.
In
addition to routine newborn care, infants received medical
interventions based upon confirmed diagnoses.
One infant
required assisted ventilation with oxygen for RDS and a
majority of the infants were treated with phototherapy for
hyperbilirubinemia.
One infant received a total exchange
blood transfusion for critically increased indirect
bilirubin levels.
Antibiotic therapy was initiated for infants with
&
25
confirmed bacterial or suspected viral sepsis.
All infants
required temperature regulation and were maintained in
Isolettes.
None.of the infants sustained thermoregulatory
insults (febrile or hypothermic states) during the hospitalization.
retained
All infants received glucose monitoring and
nor~al
serum glucose levels.
These clinical
characteristics were salient diagnostic components as infectious states and metabolic aberrations increases oxygen
and glucose consumption and therefore have a critical impact upon neurological outcome during the neonatal period.
Mothers.
All but one mother received antenatal care
prior to the third
tri~ester
of pregnancy through the Los
Angeles County Health Care Clinics.
One mother did not
receive prenatal care prior to delivery.
Upon antenatal
evaluation, 32% of the mothers were assessed "at risk" for
the following critical risk indicators:
inadequate nutri-
tion, iron-deficiency anemia, vaginal bleeding, substance
consumption (i.e., alcohol, drugs, cigarettes) and preeclampsia/toxemia of pregnancy.
Normal spontaneous vaginal
deliveries comprised 60% of the premature births, while the
remaining 40% were Ceasarian births.
Most (77%) of the mothers were educated in their
native countries and had completed high school.
With the
exception of one mother, all were primary caregivers and
were unemployed.
The average maternal age was 25 years old
and a majority (77%) were primaparas.
Fathers.
~
Approximately one-third (36%) of the fathers
26
were unemployed.
The remaining fathers were employed on a
full-time (44%) or part-time basis (20%).
Fathers were
rarely present during the home visits.
Instruments
Two instruments were used.
The 0-3 version of the
Caldwell Home Observation for Measurement of Environment
(HOME) was designed to assess and quantify the cognitive,
social and affective resources available to young children
in the home.
The instrument is composed of 45 items which
were empirically validated and standardized with low income black families in Little Rock, Arkansas.
(Caldwell,
1978).
The instrument's 45 items examine interpersonal and
person-object interactions through six subscales:
(1)
Emotional and verbal responsivity (11 points); (2) Avoidance of restriction and punishment (8 points); (3) Organization of physical and temporal environment (6 points);
(4) Provision of play materials (9 points); (5) Maternal
involvement with child (6 points); and (6) Opportunities
for variety in daily stimulation (5 points).
The reliability was calculated upon data retrieved
from 174 Little Rock, Arkansas families.
In determining
internal consistency, estimates were made for the total
scale and each subscale.
The coefficients ranged from
.38 to .89 (Caldwell, 1978).
A moderate to high degree of
stability was ascertained for all subscales, ranging from
r = .24 tor= .77.
27
Items are scored as YES or NO based upon·direct observation or reports from the mother.
Total scores were
determined by adding all YES responses for a maximum score
of 45.
A score of 34 or below was considered as a suspect
determination for environmental deficiencies.
The Bayley Mental Scale of Infant Development was used
to determine mental development.
mental developmental index (MDI) .
This instrument provides
The developmental
quotient derived from this test helps identify delays· in
development.
However, it does not predict I.Q. scores
(Intelligence Quotient) in childhood.
Normal mental development was indicated by scores of
85 and above, suspect for developmental delays included
scores of 84-69 and scores of 68 or below suggested subnormal cognitive performance.
The instrument assesses the
developmental status of infants from birth to 30 months.
The mental scale measures:
(1) sensory perceptual acuity;
(2) early acquisition of object constancy; (3) memory; (4)
learning; (5) problem solving ability; (6) vocalizations;
(7) the beginning of verbal communication; and (8) early
evidence of the ability to form generalization and
classifications.
Procedure
The infant received comprehensive service through the
county based clinic.
The services included:
sick and
well infant visits, complete physical and neurological
examinations, nutritional education, audiologic and
28
ophthomologic exams and routine immunizations.
Home Visits.
Home visits were implemented through
the clinic contacts as a monitoring procedure to evaluate
progress.
During the home visit, the mother learned skills
to enhance the physical and cognitive development of the
infant.
The primary goal was to promote, maintain and
reinforce positive and mutually satisfying interactions
between the mother and the infant.
Home visits were pre-
arranged by telephone whenever possible and the dyads were
visited during their daily routine.
were addressed during the home visit:
The following areas
familial concerns,.
physical space, environmental safety and provisions for
nutrition, hygiene and comfort.
The infants were specifically observed during the
daily routine to ascertain their usual responses to the
environment, usual sleeping, feeding, crying and elimination patterns and abilities to communicate comfort or discomfort.
Finally, the mothers were assessed for their abilities
to respond to the infant's cues, including sensitivity for
provisions of comfort, playtime and expressions denoting
enjoyment.
The duration of the home visit was approxi-
mately 1-1.5 hours.
The Caldwell HOME (0-3 version) was
administered at one year CCA during the home visit in conjunction with a bilingual patient advocate (clinic/home
visitor).
Clinic Visits.
In concurrence with the clinic pro-
29
cedure, the Bayley MDI score was obtained during the one
year CCA clinic visit.
A developmental psychologist
administered the Bayley Mental and Psychomotor Scales
in the presence of the mother.
During the testing, the
examiner evaluated age appropriate responses, i.e.,
inclusive to item 103 from a total of 163 items.
CHAPTER 4
RESULTS
It was hypothesized in this study that there is a
positive relationship between low birth weight and cognitive development at one year of age in Hispanic premature
infants.
Data analysis revealed that 48% (13 subjects) of the
subjects demonstrated normal Bayley MDI scores and HOME
scores while 37% (10 subjects) had suspect HOME scores
with normal Bayley MDI scores.
Fifteen percent (4 sub-
jects) received suspect HOME scores and obtained suspect
Bayley scores.
(See Table 1)
TABLE 1
Hispanic One Year Infant's Bayley MDI Scores
by Caldwell Horne Inventory Scores
Bayley MDI Scores
Caldwell HOME Scores
Normal
SusE.ect
Total
Normal
48%
0%
48%
Suspect
37%
15%
52%
Total
85%
15%
100%
n = 27
30
31
Subpopulation of Suspect HOME and Suspect MDI Scores
Data analysis revealed that of the 27 infants selected
for the study, four of the infants (15%) had suspect HOME
scores and obtained low Bayley MDI scores.
The following
characteristics were prevalent in this subgroup:
(1) all
infants were below 1400 grams at birth and.were less than
31 weeks gestation;
gestational age;
(2) two of the infants were small for
(3) all infants received Apgar scores of
9 at 5 minutes and were treated for hyperbilirubinemia;
(4) none of the infants had confirmed Respiratory Distress
Syndrome, according to the clinical criteria; and (5) none
of the infants were septic.
All of the infants in this subgroup were neurologically normal upon discharge (see Table 2).
The hospitaliza-
tion period was uneventful and none of the infants experienced anoxic episodes.
These post-natal findings do not
indicate that central nervous system
impairm~nt
is the
causation for the apparent cognitive developmental delays.
Furthermore, all of the infants were free from illness
during the first year of life.
Although the infants'
hospitalizations were essentially uneventful, maternal
factors demonstrate that none of the mothers received
antenatal care and one mother was a pre-eclamptic at
delivery.
None of the mothers abused substances during
their pregnancy, however, nutritional status was difficult
to ascertain because of the lack of antenatal assessments.
Three of the mothers were multiparas and were over 29
~
32
years old.
All of the mothers were unemployed and were the
primary caregivers.
One mother completed six years of
education, two received at least three years of education
while one did not attend school.
The annual income within
this subgroup was below $4,000.
TABLE 2
Characteristics of Subpopulation
Suspect HOME/Suspect Bayley MDI Scoresa
Characteristics of Infants
% Infants from Subpopulation
Birthweight
100% below 1400 grams
x = 1240 gms
Gestational Age
100% below 31 weeks gestation
x = 29 weeks
Small for Gestational Age
SO% SGA
Apgar 9 at 5 minute
100%
Pathology
RDS
0%
Hyperbilirubinemia
50% treated for hyperbilirubinemia
Sepsis
0%
Subsequent hospitalization
at one year post discharge
Upper Respiratory
Infections
0%
Failure to Thrive
0%
an = 4
33
Subpopulation of Suspect HOME/Suspect Bayley MDI
Positive responses or YES scores were prevalent
throughout the subscale items which elicit psychosocial
interaction between the mothers and infants.
In Subscale I - Emotional and Verbal Responsibility,
the mean score was 8.5.
A majority of the mothers pro-
vided positive verbal and responsive support to the infants
during the interview, praised the infant and kissed or
cuddled the infant at least once during the visit.
Sub-
scale II - Avoidance of Restriction and Punishment had a
mean score of 5.7.
Most of the mothers did not verbally
express annoyance, derogation or displeasure with their
infants nor was corporal punishment used as a disciplinary
measure.
Half of the mothers restricted activity more than
three times during the visit.
One mother reported having
a pet.
A mean score of 4.2 was achieved on Subscale· III Organization of Physical and Temporal Environment.
All
of the mothers had regular substitutes for the infants and
stated that infants were able to go to the grocery store
at least once a week.
However, only half of the infants
regularly attended scheduled clinic appointments or had
a special place for toys or personal possessions.
The
environment was safe and hazard-free in approximately
half of the homes.
Subscale IV elicits information about the provision
of appropriate play materials.
The mean score for this
34
subscale was 5.
Most of the infants had strollers, walkers
or mobile devices to encourage gross motor activity and
were provided with cuddly toys.
Approximately half of
the infants were provided with toys that encourage eyehand coordination and literary or musical manipulatives.
The mean score for Subscale V - Maternal Involvement
with Child was 3.5.
All of the mothers kept the infants
within visual range and most of the mothers consciously
encouraged developmental advancement.
Half of the mothers
reported speaking to the child during house work but none
of the mothers provided challenging toys for the acquisition of new skills.
Finally, Subscale VI - Opportunities for Variety in
Daily Stimulation presented a mean score of 3.2.
Paternal
caregiving occurred on a daily basis with all infants.
Both parents were present during a meal at least once a
day.
None of the mothers reported that stories were read
to the infants although all infants had 3 or
mo~e
books as
personal possessions.
A primary intervention was to provide the parent with
alternatives to reading that encourage language development (e.g., explaining the pictures in the book or identifying the caricatures in the story).
Allowing the child
to turn the pages or point to illustrations also encourages
fine motor and cognitive development.
These rudimentary
examples suggest that intervention must be primary and
specific.
35
The presence of other siblings did not seem to influence the quantity or quality of interactional patterns.
Mothers freely expressed pleasure verbally or through
gesture.
Paternal involvement was prevalent perhaps due
to the unemployment factor which increased the amount of
time the fathers spent at home.
Although all of the 27 families received home visitation during the first year, the suspect HOME/suspect Bayley
subpopulation experienced major financial limitations, that
is, had a total annual income of $4,000 or less.
This
overwhelming financial strain influenced the monitary
priorities set by the families.
The provision of commer-
cial books and toys was greatly limited in lieu of the
necessities for daily living.
Although toys and books are
available through public and philanthropic agencies, most
low socioeconomic families are unaware of these resources
or are apprehensive to use them until intervention occurs.
Opportunities for intervention and parent education are
limited to the clinic or home visits.
The high percentage
of non-compliance to clinic visits and familial mobility
compounds this inherent problem.
Items which elicit in-
formation about reading materials and sessions may be
inappropriate and unrealistic in low SES families.
Demographic data revealed that the completion of
formal education was limited and acquired in the native
country.
Therefore, the acquisition of books and the
ability to read seems limited to parents who are able to
36
meet the basic premises.
The reinforcement of mutually
satisfying activities which encourage cognitive development is consistent with the findings of Bromwich (1980).
Yarrow (1975) suggests that it may be meaningful to regard
the cumulative effects based upon consistency and continuity over a period of time.
Another explanation for the
acquired scores may relate to child-rearing practices in
Hispanic populations.
Cultural expectations and attitudes
strongly influence the type and degree of interpersonal
interactions.
Numerous investigators have assessed
cultural attitudes towards infant and child caregiving.
(Bromwich, 1980; Sroufe, 1978; Klaus and Kennel, 1976;
Field, 1980; Medhoff-Cooper, 1982).
Although the investigation was limited to 27 families,
a relationship existed between environmental factors and
cognitive development in 15% of the low birth weight,
premature infants of Hispanic families at 1 year CCA.
Subpopulation of Suspect HOME-Normal Bayley MDI Scores
In comparing the subpopulations, 10 infants (37%)
presented suspect HOME and normal Bayley MDI scores.
following characteristics were found:
The
all of the infants
weighed between 1401 and 1500 grams at birth with a gestational age between 31-32 weeks.
None of the infants had
RDS or-hyperbilirubinemia by the pre-determined criteria.
The annual family income was between $4,000-$8,000.
Eight
of the mothers received antenatal care with uncomplicated
pregnancies or deliveries.
All but one mother attended at
37
least 3 years of school.
Data analysis demonstrated that there was an absence
of suspect Bayley MDI scores with normal HOME scores.
All
infants with low Bayley MDI scores also received suspect
HOME scores.
A one-tailed t-test was used to determine whether
there were significant differences between the means on
the HOME and Bayley MDI scores in the two subpopulations,
i.e., Suspect HOME/Suspect Bayley MDI and Suspect HOME/
.
Normal Bayley MDI.
The one tailed t-test did not reveal significant
differences between the HOME and Bayley MDI scores in the
selected subpopulations.
However, the Caldwell subscores
in the Suspect HOME/Suspect Bayley MDI group suggests
some probable causes for the low HOME and Bayley MDI
scores.
Implications for Intervention Practices
Pre-Natal Care
The study supports other research findings that low
birth weight, premature infants are frequently delivered
by women who have not received antenatal care.
This indi-
cates that primary prophylactic programs may be salient in
the prevention of antenatal complications and premature
births in low SES populations.
Early and Primary Intervention
The literature validates that· cognitive development
in infancy and early childhood is significantly influenced
'
~
38
by environmental factors and anticipatory intervention
programs.
Parent education in visual, tactile and
auditory stimulation is a vital component of intervention
programs and may be achieved during regular and timely home
visits.
· The numerous adyerse effects experienced by low SES
populations necessitates support from community and social
agencies.
Regrettably, the provision of support services
have been minimized by the numerous state and federal
budgetary limitations and allocations.
Therefore,
effective intervention may be limited to target families
requiring food, shelter and medical assistance during
periods of economical constraint.
However, a portion of
the clinic visit should include direct and individualized
parent education and provide information of useful resources available in the various geographical areas.
Assessment Tools
The study revealed that the available environmental
and behavioral assessment tools are limited in their
ability to effectively screen various ethnic and low SES
populations.
The assessment process must focus upon the
accessibility of resources and promote creative use of
those resources.
Implications for Continued Investigation
There are few longitudinal studies in Hispanic low
birth weight premature infants.
A possible explanation is
the inability to obtain compliance from the population due
~
39
to increased mobility and diminished accessibility.
Standardized testing (Standford Binet or WISC) is commonly
initiated in the classroom setting.
Statistically signifi-
cant results may be difficult to attain and correlate in
light of the numerous variables.
Conclusion
Th~
study demonstrated that a significant proportion
of low birth weight infants and their parents have special
characteristics which necessitate early intervention from
helping professionals.
Adverse environmental factors may
have influenced cognitive development at one year CCA in
4 infants who were neurologically normal upon discharge.
The HOME scores revealed that accessible play materials
were few but psychosocial interaction was adequately
present.
Results demonstrated that all infants with low
Bayley MDI scores had suspect HOME scores.
!l
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and behavioral styles in very low birth weight infants.
Nursing Research, 1982, 31 (2), 68-72.
Minde, K., Trehub, S., Corter, C., Boukydis, C.,
Celhoffer, L. & Marton, P.
in the premature nursery:
Pediatrics, March, 1978,
@Nelson, M.
Mother-child relationship
An observational study.
~
(3), 373-379.
Bayley assessment of low birthweight infants.
In T.M. Field, A. Sostek, S. Goldberg & H.H. Shuman
(Eds.)
Infants Born At Risk, New York:
00'Connor, M.J.
Spectrum~
1979.
A comparison of pre-term and full-term
infants on auditory discrimination at four months on
Bayley Scales of Infant Development and at eighteen
months.
O'Pray, M.
Child Development, 1980,
(1), 81-88.
Developmental screening tools:
effectively.
126-130.
~
Using them
Maternal Child Nursing, 1980, 5 (3),
45
Roe, M.
& Chandler,
R.
Behavioral and neurological
tom~
parisons of neonates born to mothers of differing
social environments.
Development, 1977,
Child Psychiatry and Human
~
(1), 256-302.
& Rosenblatt,
Rubin, R.A.
C.
Psychological and education-
al sequalae of prematurity.
Pediatrics, 1973, 52 (3),
352-363.
Scarr-Salapetek, S.
&Williams,
M.L.
gram for low birth weight infants.
of Public Health, 1972,
~
A stimulation proAmerican Journal
(1), 662-667.
"'" Scarr-Salapetek, S. & Williams, M.L.
The effects of early
stimulation on low birthweight infants.
Child Develop-
ment, 1973, 44 (3), 94-101.
Seigel, E., Bauman, K.E., Schaefer, E.S., Saunders, M.M.
& Ingram,
D.D.
infancy:
Impact on maternal attachment, child abuse
Hospital and home support during
and neglect, and health care utilization.
1980,
~
Sigman, M.
Pediatrics,
(2)' 183-190.
& Parmelee,
A.H.
the high risk infant.
Goldberg
& H.H.
New York:
Snowman, M.K.
Longitudinal evaluation of
In T.M. Field, A. Sostek, S.
Shuman (Eds.)
Infants'Born At Risk.
Spectrum, 1979.
& Dibble,
M.V.
Nutrition component:
comprehensive child development,program.
A
Journal of
American Dietetic Association, 1979, 74 (3), 119-124.
II
46
a Sostek, A., Quinn, P.O.
& Davitt,
M.K.
Behavior, develop-
ment and neurological status of premature and full term
infants with varying medical complications.
Field, A. Sostek, S. Goldberg
&H.H.
Infants Born At Risk, New York:
Sroufe, A.L.
In T.M.
Shuman (Eds.),
Spectrum, 1979.
Attachment and the roots of competence.
Human Nature, October, 1978,
~
(1), 51-57.
Yarrow, L.J., Klein, R.P., Lomanaco, S.
& Morgan,
G.A.
Cognitive and motivational development in early childhood.
In B.L. Friedlander, G.M. Sterrit
(Eds.), Exceptional Infant, (Vol. 3).
Bruner/Mazel, 1975.
&
& G.E.
New York:
Kirk
Lv
V XIGNtrddV
48
LUBCHENCO SCALE
:
r·:··1·,
·: · . '
:.;. T : . i ' l :::, ! ~ ·?::-J · : l : I
~oanTT'F-:,= f
··1··'-,..f~.;-,:i. +::
t '"'· '==-=··+·:: -;;,_·;:: ·;t··.:· 4··= 5 :-:::·.j
:i .: ; ;
· i
i .: . f: : !
·: ~ -;J.:._,~-:-1
~irt~· ~ith~s pf: t~tne !&o~ •i'ni~•j 1··i
.:------r ·
!
·I ··
I ~ ~5~
! -~ I""~ .: I .:~-- . : ±·: : : !.: t : : :·d: : ! .: ;. ::J .:· i !
·':~ --~
c~,;;,f.n 1n;~"~'- ~t ;a;!,~ on~l '•ees r0 ; · : I
I
1
I
··:I
·
·I ·:
.
I
i ,:.
.'
•·
:: .;···:
::1 ·: ·! :::· ., .. ,
I
:.I· .. ·I : .I : ·L:: ·I :
lJ ··T"·:---r -~- ~--l'ffUjv-~kt~f·cf';~,--~-7 '~-:~t:=r:G
1
.
8
•
.
•
4000
--1.,
~-I : :;
.
0
!
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. ,.
:
0.;
:
,
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:· ..
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:
=~--:
:1·;:.:
·:::···1 . . .
! : ·· f 1 :
r .,
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:
-.
l
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:
=T '-~.
~!
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7'
I
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.
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.I·--~
, i
,
ij
!
I
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Cest.dcn:ai...Ai:e ' ;/ · 1 ·: i · :· ·I ··l
!. 1, ·:. ·l-~ ....
_; ·Il. :l:if.I ::_ -J~~~o~riAc,~--'"l"-~
I ::· .!..... . . .• . . 1
. .
• •
--;-;~ !t.an~ 'Por.
.
I
i
.. II
i
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i, __
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·:,
; l : ·'l,
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~ge:
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,..., ·:· I J:,u~rinnel
: ! ·: I . ·.·:_:
i
;
;
r-l:-r-~--·;··
l
~
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I :~ ,,
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-r·~i5oo
f/
'lm<..!·:!
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:/
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o
0
x;
i
; :<
!
; . _; : l ! .. ; . '. :...
+7 '~ ,.,_, T ;_.J
. 1_ :: ...'l:.,·:"" J,. .: --t;;~~
:\1:
·.:.:~:
,... •
=
:
i
1 :I! ,
·l : ! I
l · '·
•
1 II
'Gestational :Age
·.
= .:
0
_
IT!--:l::J·--,-~-.:.1".1
.
. . _. . .
~;.·i·!.t·!
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::
:
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0
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~---i~----:r-''-~-r;-=r-_:.L~.,
0
--- 4-~-7
--- ··-·-· ~·--+
~
'nnn
I
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I
o
.---_
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~~~M
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~----~ ·
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:;:
~
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r-~
t1
T-~---;~.;
j
---·---1--:
! . 3000
I
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= .. ,
·r~<4.,~T,-: ::r·t~J-'-'j=-:::1·:=j.:=-4:.di':=
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T~·:l :-.~·-''T},:.:J
:r:.·o ..
:f:::J. ~ =t ::~,_:-: ..
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: I : !
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'·j --i i ':; ·::; i ..
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.
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hl71'-:i_
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. L:l ,:l<J::;.J>i.·J·:j :, J:::J-::1··-J,-! .
l
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:l
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:
,~-"T
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I
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-4-,I-;;[:,j,:,,LL=:l,.:b-J:~,;E::l:~·!:-.':•
·.::: ·T::;-:r-:::·: r:~=-:~r., v:-r=m ':'J.,·.:;: ..-=J· .rd-:-::: '"'· ...
1· ~ .
·
·:". :t::,i- · i.:::L:l,~:L·I .:: :A-.::1:~-:L=>A .,i_J · ·l, 1-:-L .
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u:4r 4} ·~-~~
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: .
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617
a XIGNB:ddV
50
BAYLEY
SCALES OF
INFANT
DEVELOPMENT
NAME
AGE _ _SEX----
MENTAL SCALE
RECORD FORM
Day
yMe.th
Date Tested - - - - _ _
Date of Birth _ _ _ _ _ _
Row
s-
@).
........
Mental Scale - - ---(MDI)
Motor Scale
------
Age
Dewlop~~~oot
_.._. . ~POl)
• The standard score for the Mental Scale is caRed the MDI (for Mental
O...elopment Index); for the Motor Scale it is the PDI (for PsychOmotor
Development lnduj.
Manual for discussion.
s..
NOTES:
Nate.-lf both th~ MENTAL SCALE and the MOTOR SCALE ore adminia.r.d to the child, the information belovr need only be fiRed in on the
R.cord Form for the MENTAL SCALE.
ADDR~---------------------------------BIRTHPLACE _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
BIRTH WEIGHT
BIRTH ORDER _________
PRENATAL OR BIRTH DIFFICULTIES _ _ _ _ _ _ _ _ __
CHILD'S HEALTH _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
PARENrSNAME _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___
FATHEib EDUCATION
OCCUPATION __________
MOTHER: EDUCATION
OCCUPATION _ _ _ _ __
HOUSEHOLD COMPOSITION
01'-
Fotloor Motftoto
CJ,ock if , _
inH-holcl
All~
I
1
l
SiiiUnas
4
5
I
•
7
•
I
Chilclren
1
3
I
A. .
S.. (M for Male, F f.,. ........_,
eo...-.m.
I
PlACE OF TESTING _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
TI5RDBY______________________________
~··"'"'""~---
All ,.,.,... ~ .. Me ...,.. ol itth ,..,.. ,_,.. ....,. be ,..,...... ill.., fOfftl ef Dthttlft9 ., t.r • .., ett1er meNlo ..,_.c or
_ _~
_ _ r~i
__
_
_
MedlalliuJ, htdMd'-1. bMt Mit II....... ta, Allrl
~ift9,
... eMI
treltlftltuioft,
Ptf portr.-,.1 fW du•ilutiOft in
i~ dW. .e ... refrieMC .,.._, witHKt IMftlti.._ I• writlfMI f,.... the IMiali ...... s.. C.t•l. . for f...._ lllfori'IUitioll.
_,
-loU.S.A.
The l'tychological Corllonliar., -
York
511-101AS
!1-025<&3&
51
To score: Clleci P (Pouj or F (Foil). If "Other," morl 0 (Omit~ R (Refu..dj, or RPT (Reportecl by motherj.
A..
.... "---
"-
•llllll•ll9•
(w...thol
,
·-Title
A
R..,_g to aund of Dell
0.1
I
Quiets when picked up
0.1
c
Responcls to SOUAd of rattle
D
Responcls to sh.p sounci: dick of
li,htswitch
M-mary ~ of reel ring
E
RllfJCiftla penon -...tarily
D
l'roloniJed regard of reel ring
o.s
D
Horilutol..,. -aination: reel ring
0.7
F
Hom.nta~..,. -amation:
E
e.,.. follow I'IIO¥ing penon
E
RelpOIIds to voice
F
Vertical..,. -a&urtlon: li<Jht
I
0.1
%
3
$ltoo.
(.J-3J
4
0.1
(.J-4}
5
0.1
(.J-JJ
6
IU
(.f-JJ
7
G.4
(.J.2J
•
9
(.J-21
light
(.3-3}
10
0:1
(.3-2}
II
0.7
(.3-2}
1%
Q.l
(.3-31
13
0.9
6
* Vocall.s once or twice
(.$-31
14
1.0
D
Vertical ..,. coordination: ...a ring
F
Circulcw ..,. -ainotion: li'llht
D
Circular..,. -&ncrtion: .... ring
(.$-3}
IS
1.%
(.s.:Ji
16
1.%
(.5-3_1
17
1.3
&•
• Frw i...,_tfoll of ..............
E
Sociolllllile: Etolb and llllilel
D
r-.,..
F
TurN _,.. to light
(.$-3}
II
1.5
(..5-41
19
1.6
(~-41
ZD
1.6
to ...a riiiiJ
(..5-41
%1
1.6
6
• voc:oa. at 1aast 4 t i -
I
Anticipatory .........
(..5-51
%%
1.7
(J-4J
%3
1.7
Reacts to poper on f -
(.5-5}
%4
Blinb at shad- of hand
1.9
(J-41
%5
2.D
E
....., ............ ;....._.,.,.
(J.SJ
V"IIUGIIy ......... moiller
s-.
" :Otloeo
"-
52
• -·-·-· - - - . 1• ...,..,.,. \I"GGIJ."
,...
.._..
.._ ....
1.:1•
Na.
26
'"'2.1...... .....
Slhoo
E
Vtner;· mart 0 (Omit), R (Refused), or RPT (Reported by mother).
..
I - Tolle
Social smile: E smiles, quiet
s--
N-
" !Ofltw
(.1-(JJ
2.1
27
E
e Vocaliza to E's sociol smile and talk
(l.(JJ
2.2
21
AC
(.1-5)
29
_ _ Bell
Rattle
s-en. with eyes few sound (Specify)
Eyei follow pencil
2.3
(.1-J}
2.3
30
6
• Voca&- 2 d"'-t sounds
(l-$}
31
2.4
E
Roods ta disappeanmce off-
H
R. . . . cube
D'
Manipulates Nd ring
(J-5}
m*
2.5
(J-$}
2.6
33
(J-5}
2.6
34
AC
(l-5}
35
2.6
(J.(J}
36
2.8
(2-5}
37
3.1
(l-5}
liT
Aaticipatory adjustment ta lifting
c
Simple play with rattle
D•
Reaches few dantling ring
3.1
3.2
-
8
Follows bal w-Ily -
(2-5)
39
eta- from- object ta anotMr
61
table
• Fingers hand in ploy
(l.(JJ
3.2
40T
(J-5}
-41T
3.2
D'
Hood follow. dOIMJiing ring
I
Hood follows '1011ishi114J . , -
(l.(J}
42
3.3
6'
(2-(JJ
-43T
3.3
(24}
3.1
-44
(24}
-45
3.1
...
(241
3.1
(2-(JJ
-47
3.1
...
(241
6Z • ManipulaNs table edge slitfrtly
D'
6'
D'
eam. ring ta mouth
• IMpKts own hand~
c
Turns head ta sound of rattle
•••
H
Reaches for cuilo
-4.3
62 • Manipulates table edge ac:tmly
(2-7}
-·-
-
-··--
•lileyloe ......... i....w..t.lly.
&
__Left
_ _NoM
(2-(JJ
50
---
_ _Ri9ht
0 . . on dan9lin9 rift')
(CIIeck hand prefer•-!
Turns hood ta sound of bell
3.9
.,
* A - of draJwJe sifvation
A
(24}
-
----··--
;s.. lol...... CHptw 4,
fer...__
..t ''T."
53
,._
H
-
Eye-hand ~ination in reachi119
(2-6)
4.4
J
Regards pellet
K
Mirror image approacil
H
Picb up cube (Check hand pNferenceJ
Ap
1Ne.
51
52
....lhluthll
~~a,..
4.4
$ih.
I - Title
,
Sara
F
N-
IOttt.o
(2-7)
53
4.4
(2·11
54
4.6
_ _ Right
_ _ Left
_ _ None
(3-7)
55
4.6
SJ
(U)
* Vocaiisa attiiucl• (DescriaJ
Pleasure:
Disple_..:
Eag-:
Satishction:
56
4.7
H
.'RetaiM2~
(3-1)
57
&ploitive paper plcry
4.8
(3·71
5I
4.8
E'
• Discriminates sfrcm9en
c
Recovers rattle, in crib
H
Reach. penirientfy
E'
Uk.. fralic play
I
Tul'ftl head after fallen spaan
L
Ufh inverted cup
H
Reaches for 2nd cube
K
Smiles at rnimlr ilfta9e
(34)
59
4.9
(U)
60
5.0
(UJ
61
5.1
(U)
6Z
5.2
(U)
63
5.2
{U)
64
5.4
(UI
65
SA
(3-12}
66
SA
6Z
• Bangs in play
(U)
67
5.4
oz
Sustained iMpHtlon af ri119
oz
&plaitive string play
(U)
61
SA
(U)
69
5.5
6Z
• Transf.n abject hand ta hand
(U)
70
5.7
H
Picb up cua deftly and directly
oz
PuU. string: - - ""'
(U)
71
5.7
(U)
n
73
5.8
6Z
5.8
L
(4-IT)
•Mayloeo...,_.i~.
~
* Interest In saund production
(U)
Ufh cup with handle
-
54
-=
,..._....
"--To
Ap
1No.
74
_.R~e
5.1
Check P (Pau) or F (Fail). If "Other," mark 0 (Omit), R (Refused), or RPT (Ropomd by mother).
sa..
·11.4
,
1-Trllll
Attends to scribbling
.._
Score
"
Other
(4-101
75
6.0
I
Loob for fallon spoon
K
Playful , . . , - to mirror
H
Retains 2 of 3 cubes oifwod
A'
Manipulates boll: interest in detail
(~101
76
6.%
(4-121
77
u
(4-101
71
6.5
(~101
79
7.D
61
(~121
80
7.1
• voccm- • d"'-nt syllables
1)2
Pulls sfrin9 adoptively: , _ ring
E1
Coap•at01 in 9 -
H
.Attornpis to secure 3 cubes
A'
Rifl9s boll purposivoly
($.101
81
7.6
Not. skill at pat-a-cairo for
MatOI' Scale item 44
(~121
12
83
7.6
7.1
(~131
M
.
.
(~141
7.9
N
• u.t- solectivoly to familiar words
(~14)
II
7.9
61 • Says "cl.da" or equivalent
(~141
16
1.1
HI
u-tay
0
Fing.,.. halos in JM9 board
L
Plcb up cup: -
N
Responds to yorDa( .........
L
p
Puts cube in cup 011 COII'ItiiCIIId
(Nato number placed)
Loob for contents of boa
L
Stin with spaon in imitation
Q
Loob at picfuros in book
1\.4
Inhibits 011 COIIIIIICIIId
1\.4
Attempts to imitate scribble
HI
Unwrap~
(6-121
17
8.9
(6-121
81
9.D
cube
(6-141
19
9.1
(6-141
90
9.4
(6-131 -
91
9.5
Items 90, 100, 114
_No. of cubes
(8-14}
92
9.7
(8-151
93
10.0
(7-16}
94
10.1
(7-T7J
95
10.4
(7-151
96
10.5
cube
(8-17}
97
10.1
E1 -• Ropocris porf-laugltod at
(8-T7J
91
11.2
1\.4
Holds _.,... adapm.oly
(8-15}
-·--·-
• h4ey be...._.~-
- - '--·---
--
55
""l• "l"'nuoea1, or Krl lKeparted by mother)
·Ne.
99
100
...........
Ate
,..,.......,
•HII•w,.
.....
s-
•-ntt.
sm..
11.3
p
.
N-
em..
Plllhes car alomJ
{8-15}
11.8
Puts 3 or IliON cubes in a~p
L
(9-18}
101
12.0
61
• Jablsen apreaiveiy
p
u_...blueDo.
Q
r - pogn of book
(9-18}
102
12.0
(9-17}
103
12.0
(8-18}
104
12.2
Pats whistle doU. in imitation
(8-19}
lOS
12.4
Dangles ring by siring
[)2
(7-JIJ
106
12.5
N
• Imitates wwda (R~ wwda
used)
(9-18}
107
12.9
.
p
Puts beads in bOll (6 of 8)
0
" - I peg repecrieclly
J
Remo,..
R
Blue board: p t - I round block
{10..17}
108
13.0
-
(10-l7J
109
13.4
peu.t from bottle
(10..19}
110
13.6
(10..20}
Ill
13.8
(l0-19}
112
14.0
(10..21}
113
14.2
H'
...
(Specify)
Items 110, 121, 129, 142, ISS, IS9, 160
_ _No. round placed
_ _ Na. square r.acecl
Comp etian time
Builds tower of 2 cubes
(Note number of cubes!
Items Ill, 119, 143, 161
_ _ Na. of cubes
SfiOII*a- scribble
63 •
Say~ 2 wards (Note
L
Puts 9 cubes in cup
p
C...rounclbu
(10..23}
114
14.3
words!
H.-:1:
Reported:
(ll-20}
115
14.6
{10..20}
116
•. u - gestures to make _ .... know1l
14.6
(ll-19}
117
Ill
15.3
(ll-23J
N
16.4
0
Shows .no. ar ather clothing, or own
toy
Pegs placed in 70 seconcls (Note times)
(13-20}
119
16.7
H•
Builds tower of l cubes
s
Pink baarcl: places round block
(Specify)
R
Blue board: plac:es 2 round bloc:b
Items Ill, 123, 134, IS6
Trial
2
I
Time
3
-- -- --
(13-21}
120
16.8
(12-26}
121
17.0
{12-26}
----
• ..,.., ............. iiiCia-lly.
Items 120. 137, lSI
_ _ Round placed
_ _ AU placed
_ _ All placed (..,.-! board)
56
To ICON: Check P (Poss) or F (Faiq. If "Other," man 0 (Omit), R (Refused), or RPT (Reported by mother).
,._
..........
Age
1Ne.
122
123
(Mnthol
sa..
.._
s-.
p
F
Othe
Attains. toy with stick
17.0
(12·241
17.6
I - Toile
em..
0
Pe9J placed itt ~2 seconds
T
N - I object (Check objects named)
(14-22}
124
17.1
(13-21}
125
17.8
M
Imitates crayon stroke
u
Follows directions, doU
(Check parts pcnMd)
Items 12~. 131, 146
_ _ Ball
_ _Watch
_ _ P...cl1
_ _Scissors
_ _Cup
(13-261
126
17.1
(14-261
127
IU
(i3
(14-21}
121
19.1
u
(1.5-26)
129
19.3
130
19.3
• u- words ta rnake wcmts · Points to parts of doll
(Check parts recO<Jnized)
R
Blue boarcl: p i - 2 rouncl and
2 square blocks
v
Names I pictuN (Check list!
(14-30+1
_ _Cup
_ _Chair
_ _ Handkerchief
__ e.,..
_ _ Hair
_ _ Mauifl
_ _ Eon
_ _ Hands
_ _ Feet
_ _ Nose
Items 130, 132, 139,
1~1. 1~,
149
(14-21)
Names
D09
sh-
Cup
HOUH
Clock
Rq
Star
Laaf
Pun.
Book
-----------
No.Narn~
Ill
19.7
(14-30+)
Rncls 2 objects (Check successful
Trial
trials)
BaH
Rabbit
132
19.9
v
Points ta 3 pictuns (Check list at
item 130)
w
Broken doll: _.... ntarfJinally
0
Peg~
....
Differentiates scribble from stroke
(16-21)
Ill
19.9
I
Points
-----------
__No. Pointed
2
3
--- ---- --
(1.5-21)
IM
20.0
placed in 30 .-nels
(16-29)
135
20.5
(14-30"1")
136
20.6
(i3
• Sentence of 2 words
(16-30)
137
21.2
(J6-3o+)
131
21.~
s
Pink board: cornplem
T
Narnes2objects
v
Points ta 5 pictures (Check list at
item 130)
(16-30)
119
21.6
(l7-3o+)
-···--
• M., 1.. .......... iocici-"Y·
57
To score: Check P (Poal or F (Faiq. If "Other," mark 0 (Omit), R (Refused), or RPT (Repor+ecl by mother)•
·Na.
1-40
141
....
.... ....
(WOtlths)
etleto
21.9
w
Broken doD: mencla approximately
v
N - 3 pictures (Check list at
item 1301
R
Blue boorcl: places 6 blocks
HI
Builds to- of 6 cubes
X
Discriminates 2: cup, plate, boa
(Check which)
Items 144, 152
_ _ Cup
Plate
_ _ Box
y
N - waich, 4th picture (Check at
which named)
Items 145, ISO
_ _ 5th picture
4th picture
_ _ 3rd picture
2nd picture
"··(J$.30}
22.1
(J7-3o+J
142
22.4
,
·-title
sm..
~~.
sF
N-
IOtheo
(16-30+)
143
23.0
(17-3o+)
144
23.4
(16-30+)
145
23.8
(17-3o+)
1-46
24.0
T
Names 3 objects
M
Imitates rirokes: vertical and
horizontal
All
(17-3o+)
147
24.4
(19-3o+)
141
v
24.7
(19-3o+}
149
v
25.0
(19-3o+)
150
Points to 7 pictures (Check list at
item 130)
Names 5 pictures (Check Jist at
item 130)
25.2
y
Names waich, 2nd picture
s
Pink board: .........
X
Discrimincrtw 3: cup, plate, boa
w
Broken doll:_ mends aactly
HI
Train of cubes
R
Blue board: completes in 150 seconds
0
P.,. placed in 22 seconds
M
Folds paper
z
Understands 2 prepositions
R
Blue boorcl: completes in 90 seconcla
R
Blue ·boorcl: completes in 60 seconds
HI
Builda tower of 8 cubes
HI
Concept of-
z
Understands 3 prepasitiOftl
(JI-30+)
151
25.4
(18-3o+)
152
25.6
(18-3o+)
153
26.1
(16-3o+)
154
26.1
(19-3o+)
155
26.3
(19-3o+J
ISO
26.6
(19-3o+)
157
27.9
(22-3o+)
158
28.%
(22-3o+J
159
30.0
I
.
(22-3o+)
160
3o+
(22-3o+}.
161
3o+
(22-3o+)
162
3o+
(21-3o+)
163
-
3o+
23-3o+J
I
_ _ ....__! __ -------
-----
---
85
J XIUN3:ddV
59
CALDWELL HOME INVENTORY
HOME INVENTORY (Birch to Three)
Child's Name
Date of Interview--------------
Child's Birthdate - - - - - - - - - - - - - - - Interviewer ----------------------------Relationship of person
Place of
interviewed to child
Interview ---------------------------Family Composition
(Indic_a_t_e_p_e_r_s_o_n_s...,.li""vi-_,.n-g--l.""·n--=h-o_u_s_e..,.h_o..,l""d,....--=i-n..;.c"'l-u-=d..,.i-n-g-_-se_x
__a_n_d.,._.l_g_e__o""f=--c..,.h""i"'l-d""r_e_n...-)
Persons present in home at time of interview ------------------------------------------Comments -----------------------------------------------------
Scale·
I
Number of Items Correct (Subseales)
_..10
l
2
l
l
3
4
I
I
[
5
I
6
I
7
I
8
9
I
II I I I I I I I I I I I I***************** I
r
10
I
lt
I
:sssssa;
J
It IIIII/ '***********'\ §§@
II
l************* I'5§§§§{1,
III
1/ll!tl!fl!!lll*****************f~
IV
__..__.__._.__._,LIW:WJ
II!/1/I!I*********KKKKt~
v
P'************~~
VI
17/////t/1•••*************1~
Total[
~
,;
I
I
10
,.
13
30
35
40.
45
Number of Items Correct (Total Scale)
Lower
10%
l!!/l/11!/l/1/lll****************\~1
Lowe:q
Middle
Upper
25%
50%
Sub scale
I
II
III
25%
Raw Score
Percentil<!
Band
!1110tional and Verbal Rqi!Q_nsi'd..rr of Mother
Avoidance of Restriction and Punishment
Organization of the Physical and Temporal
Environment
IV Provision of Appropriate Play Materials
v Maternal Involvement with the Child
VI
Total
Upper
10%
Opportunities for VarietY in DailY Stimulation
I
09
a
XIGN3:dd\f
61
CALDWELL
HOME OBSERVATION FOR MEASUREMENT OF THE ENVIRONt,.ENT
INVENTOP.Y (Birth to Three) .
I.
1.
EMOTIONAL AND VERBAL RESPONSIVITY OF MOTHER
YES
NO
I
Mother spontaneously vocalizes to child at least twice
during visit (excluding scolding)
I
2. Mother responds to child's vocalizations with a verbal
response.
I
3. Mother tells child the name of some object during visit or
says name of person or om~ in a "teaching" style.
I
4. Mother's speech is distinct,_
~l~ar.
I
and audible.
I
T
5. Mother initiates verbal interchanges with observer--asks
questions, makes spontaneous comments.
6. Mother expresses ideas freely and easily and uses statements
of appropriate length for conversation (e.g., gives more
than brief answers1.
*7.
8.
Mother spontaneously praises child's qualities or behavior
twice during visit.
9. When speaking of or to child, mother's voice conveys
ositive feelin
10. Mother caresses or kisses child at least once during visit.
11.
shows some positive emotional responses to praise
of child offered bl visitor.
Moth~r
SUB SCORE
II. AVOIDANCE OF RESTRICTION AND PUNISHMEriT
12. Mother does not shout at child during visit.
13. Mother doesn't express overt annoyance with or hostility
toward child.
(*
Items from Categories I and II which may require direct questions.)
i
l
62
~.
Mother neither slacs nor scanks child durino visit.
3.
Mother reports that no more than one instance of
physical punishment occurred during the past week.
5.
Mother does not s:ol d or derocate child duri:-:-: v•; ~t.
7.
Mother does not interfere with child's actions or
restrict child's movements more than three times
during visit.
,
3. At least ten books are 2resent and visible.
1.
Fami~y
has a pet.
sussco;,::
III. ORGANIZATION OF PHYSICAL AN::l
TE~?JR.nL
EWIP':'~n:::r::-
,
--------------------------------------------------~
:J.
When mother is a~:ay, care is provided by one of three
regular substitutes.
1.
Someone takes child into grocery store at least or.:e
a week.
2.
Child gets out of house at least four
3.
Child
4.
Child has a special place in which to keep his toys
and "treasures."
5.
Child's play environment aopears safe and free of
i~
ti~es
a week.
taken regularly to doctor's office or
cli~ic.
hazar~s__,_
SU3SCORE
IV. PROVISION OF APPROPRIATE PLAY MATERIALS
:6.
Child has some muscle activity toys or eguipment.
:7.
Child has :Jush or
~.
Child has stroller cr waikei, kiddie car, scocter,
or triclcle.
E"~l
to·:.
__
:
63
YES
29.
NO
Mother provides toys or interesting activities for
child durina interview.
30. Provides learning equipment appropriate to age-cuddlv tov or role-olayinq toys.
31. Provides learning equipment appropriate to age-mobile table and chairs, high chair, olav oen.
32.
Provides eye-hand coordination toys--items to go in
and out of receotacle fit together tovs. beads.
33. Provides eye-hand coordination toys that permit
combinations--stacking or nesting toys, blocks or
buildina toxs.
34. Provides toys for
lit~_rature
or music.
I
I
i
I
.
I
SUB SCORE
l.
V. MATERNAL INVOLVEMENT WITH CHILD
35. Mother tends to keep child within visual
range and to look at him often.
36.
Mother "talks" to child while doing her work.
37. Mother consciously encourages developmental advances.
38. Mother invests "matur-ing" toys with value via her
attention.
39.
Mother structures child's
eriods.
40. Mother provides toys that challenge child to develop
new skills.
SUBSCORE
VI. OPPORTUNITIES FOR VARIETY IN DAILY STIMULATION
41.
Father provides some caretaking every day.
42.
Mother reads- stories at least three times weekly.
43. Child eats at least one meal per day with motner
..,....__.;&::...:..:fa,.ther •
44.
Familr visits or receives visits from relatives.
45. Child has three or more books of his own.
SUBSCORE
I
l