Risk Factors for Deficits in Early Cognitive Development
The current emphasis on risk assessment, a methodology introduced in the early fifties (1), has been attributed to a decreased public tolerance for exposure to potentially harmful events, particularly if the exposure is perceived as involuntary and widespread (2). Efforts to identify risk factors are certainly not new, nor have they been unproductive. What has become increasingly urgent is the need to carry out the complex tasks involved in quantifying risks so that their relative importance can be evaluated. It is well-recognized that all segments of the population are not at equal risk following similar exposure to an injurious event. Examples of susceptible subpopulations are pregnant women, infants, and young children. In this paper, methods of identifying and evaluating risk factors for cognitive deficits in infancy and early childhood are illustrated by findings from a large-scale longitudinal study of the developmental consequences of complications in pregnancy and the perinatal period. Between 1959 and 1974, the offspring from 53,043 pregnancies were followed from gestation through eight years of age in the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke. Women in the study were selected by site of prenatal care. Abnormal outcomes of particular interest were cerebral palsy, mental retardation, congenital malformations, and learning disorders. Causes of perinatal death and prematurity were also investigated, as were factors related to physical and cognitive growth. The goals of the Perinatal Project were heavily influenced by the work of Lilienfeld, and Knobloch and Pasamanick and colleagues who carried out a series of retrospective studies to investigate the concept of a continuum of reproductive casualty, an hypothesis that complications in pregnancy and the perinatal period can produce a spectrum of abnormalities ranging from fetal or neonatal death through severe to mild neurological deficit (3,4).
KeywordsCerebral Palsy Cognitive Deficit Fetal Alcohol Syndrome Discriminant Function Analysis Severe Mental Retardation
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- 2.The risks of assessing risks. Br. Med. J., 281:1374 (1980)Google Scholar
- 4.Nelson, K.B: The ‘continuum of reproductive casualty.’ In Clinics in Developmental Medicine No. 27, Studies in Infancy, Ed. by R. MacKeith and M. Bax. Spastics International Medical Publications, London, p. 100 (1968)Google Scholar
- 7.Broman, S.H.: Birthweight, infant development and preschool IQ. Unpublished manuscript (1973)Google Scholar
- 8.Little, W.J.: On the influence of abnormal parturition, difficult labor, premature birth, and asphyxia neonatorum on the mental and physical condition of the child, especially in relation to deformities. Trans. Obstet. Soc. London, 3:293 (1862)Google Scholar
- 10.Broman, S.H.: Perinatal anoxia and cognitive development in early childhood. Chapt. 3 in Infants Born at Risk, Ed. by T. Field. Spectrum Publications, Jamaica, New York, p. 29 (1979)Google Scholar
- 11.American Academy of Pediatrics, Committee on Drugs. Effect of medication during labor and delivery on infant outcome. Pediatrics, 62:402 (1978)Google Scholar
- 12.Broman, S.H. and Brackbill, Y.: Obstetric medication and early development. In T. Sedick (Chair), The international year of the child: A retrospective consideration of perinatal factors influencing pregnancy outcome and development. Symposium presented at the annual meeting of the American Association For the Advancement of Science, San Francisco (1980)Google Scholar
- 13.Broman, S.H.: Perinatal antecedents of severe mental retardation in school-age children. Paper presented at the 86th annual convention of the American Psychological Association, Toronto (1978)Google Scholar
- 16.Leviton, A., Gilles, F.H., and Dooling E.: Epidemiology of the perinatal telencephalic leukoencephalopathy characterized by hypertrophic astrocytes and amphophilic globules. Neurology (Minneap.), 29:571 (1979)Google Scholar
- 17.Broman, S.H.: Early development and family characteristics of low achievers: A multivariate analysis. Paper presented at the Scientific Research Workshop on Neurological Aspects of Learning and Behavior Disorders, 15th International Conference of the Association for Children with Learning Disabilities, Kansas City, Mo. (1978)Google Scholar