Developmental Risks

Developmental risks are conditions acquired by a child before or after birth that cause developmental delays in later life. There are three major categories of developmental risk: established risk, biological risk, and environmental risk. Established risk is the possibility of hampered physical and cognitive development due to a diagnosed medical condition. Biological risk refers to infants who might eventually experience learning disabilities because of conditions they acquired before they were born. Environmental risk, on the other hand, refers to learning disabilities that can be caused by outside-world influences after a child is born. While there is little educators can do about most risk factors that affect a child, early intervention programs, like Head Start, may counteract these risks.

Overview

Developmental risk refers to the danger that a child may experience in impeded physical, cognitive, social, or psychological development, due to a condition acquired before or after birth. There are three major categories of developmental risk: established risk, biological risk, and environmental risk.

Established risk is the possibility of hampered physical and cognitive development due to a diagnosed medical condition, such as blindness, Down syndrome, or cerebral palsy. Biological risk is a phrase that came into use in the early 1960s and refers to infants who might eventually experience learning disabilities because of conditions they acquired before they were born. These disabilities can come as the result of genetically acquired defects, infections and premature birth. They can also come from unhealthy practices engaged in by the mother, such as abuse of alcohol, drugs, or smoking. Environmental risk, on the other hand, refers to learning disabilities that can come from outside-world influences after a child is born. For example, studies have shown that children are environmentally at risk when there is only one parent living at home, the family experiences poverty, or they receive inadequate love and nurturing.

Developmental risks can also lead to developmental delays, which indicate the presence of learning disabilities. A developmental delay is the repeated failure by a child to reach established benchmarks of normal physical and/or cognitive development on time. A learning disability is any disorder that impedes a child's ability to learn.

History

Research on biological risks began in 1920, forty years before the phrase "biological risk" would find its way into professional nomenclature. Studies done since then can be organized into four major periods. The first period, which lasted from 1920 until World War II, saw initial formal and systematic studies done of development in children without disabilities. During the 1920s, developmental theorist Arnold Gesell laid out basic guidelines for normal and abnormal development in children that are still in use. A proponent of "nativism," Gesell believed that babies enter the world already possessing knowledge of it. Though many of Gesell's contemporaries were in step with his theories, another movement, "behaviorism," believed that babies and young children are more influenced by their environment following birth.

By the 1930s, a number of child development laboratories were in full operation. In 1930, the White House convened its Conference on Child Health and Protection. Using data amassed from the previous decade, the conference made a monumental contribution to the field of early childhood development: the Children's Charter: a 19-item list delineating conditions that must exist in the areas of health, welfare, education, and protection, to promote the best possible developmental outcomes in children. And in 1935, the federal government enacted Title V of the Social Security Act, which gave money to states to provide additional welfare and health services to mothers and young children. The Children's Charter and Title V constituted a new focus government was placing on the education and wellbeing of all of society's children.

The second major research period began at the close of World War II and lasted until the early 1950s. Studies were done mostly on emotional and intellectual impairments resulting from physical handicaps, such as those caused by polio and cerebral palsy. While in the 1930s the government had stepped up to provide health and welfare services to children, in the 1940s it went further, and provided childcare. As men went overseas to fight World War II, many women were forced to leave their children at home and find jobs. The Lanham Act, passed in 1940, provided federal funding for childcare programs across the country. These programs became precursors for the federally funded early childhood intervention programs targeting at-risk children that would be launched twenty years later.

The third significant research period lasted from the late 1950s until the late 1960s and focused on perinatal risk factors. The term "perinatal" refers to development that takes place in a fetus from five months before birth until an infant is one month old. The reason for this new focus was a growing concern in the scientific community over the generally poor outcomes of preterm infants: babies born before the thirty-seventh week of gestational development and weighing 2,500 grams or less. In the past, preterm births had been linked to blindness, developmental delays, cerebral palsy, and other debilitating conditions. But studies would in time reveal that poor outcomes of many infants were due not only to being preterm and underweight, but also to inadequate nutrition, substandard care from poorly trained professionals, and questionable treatment methods. Because of advancements made in childcare and medicine in later years, preterm death rates would decline steadily and preterm survival and success would become more common.

The 1970s heralded a fourth research epoch in which new technology was used to study children with and without developmental delays. Researchers in the 1970s benefited tremendously from knowledge brought forth by studies done in the 1960s, and used it to make further strides. During this decade, scientists gained an increased understanding of the genetic origins of developmental delays and diseases. Significant advancements were also made in newborn intensive care technology and in the study of conditions in the uterus and how they affect an unborn child.

Modern doctors and pediatricians have the benefit of a wealth of new information and greatly improved pre- and neo-natal care technology. All of this has improved dramatically the survival odds of preterm babies and those born significantly underweight. Until recently, newborns deemed to have Extremely Low Birth Weight (ELBW) — weighing 800g or less — had almost no chance of survival, but the neonatal intensive care unit now offers hope.

Low infant birth weights fall into three categories: Low Birth Weight (LBW), at or under 2,500g; Very Low Birth Weight, at or under 1,500g; and ELBW. Developmental prospects for infants born weighing at least 2,500g have always been good, but these prospects diminish with LBW babies, more with VLBW infants, and are worst for ELBW newborns. As birth weight drops, the probability of developmental delays and other problems increases. Diagnoses for learning disabilities become more common, as does placement in special education programs.

Infant mortality, developmental delay, physical and cognitive disabilities, chronic health conditions, and academic failure have all been linked to children born preterm and underweight. For this reason, preterm and low-weight births and the biological risk factors that bring about these conditions are a chief concern in prenatal and neonatal research.

Further Insights

Biological Risk

A number of biological risk factors can lead to preterm and low-weight birth. For example, experts have found that children born to minority groups have a greater chance of being underweight. They found that only 6 percent of White babies are born under LBW, and only 1 percent VLBW, while these rates are almost double in infants born to minority groups.

Babies whose mothers used drugs can also be born underweight. A late-1980s study done by the Boston University School of Medicine examined 1,226 expectant mothers, 27 percent of whom used marijuana, and 18 percent, cocaine. It was found that babies born to cocaine-abusing mothers weighed an average of 93g less than those who did no drugs and were about 0.7 centimeters shorter in length. Babies whose mothers smoked marijuana were born 79g lighter and 0.5 centimeters shorter.

Another late-1980s study revealed that women who use cocaine during the first trimester of pregnancy risk causing subtle neurological damage to their babies. Researchers at Northwestern University Medical School in Chicago gave a neurological functioning test to infants of cocaine-abusing mothers. The babies were found to be less responsive to faces and voices and had problems being attentive.

A national study done in Norway between 1970 and 1991 revealed a significant link between smoking during pregnancy and reduced infant birth weight. The study, which polled almost 35,000 women, revealed that birth weights of infants born to smokers were, on average, 197 grams less than of those born to women who did not smoke. And this gap increased with age. Birth weights of babies born to smokers less than 20 years old were 182g less than of those born to non-smokers, while birth weights of infants born to non-smokers over 35 were 232g lower. The Norway study corroborated a wealth of research that has, since the late 1950s, shown maternal smoking to lower birth weights by an average of 200 g, with some studies reporting a reduction of between 90 and 300 g. Research has also revealed that infants of mothers who smoke enter the world with smaller head, chest, and shoulder circumferences, and are shorter in length.

Researchers in Norway also examined the effects of paternal smoking and found them to be nominal in cases where the mother was a non-smoker. Birth weights were diminished by only 7g — by 1g in cases where adjustments were made for maternal age. These low numbers, the study noted, might reflect efforts of husbands not to smoke near their wives during pregnancy. But when both parents smoked, the effects of paternal smoking increased dramatically, with an average reduction in birth weights of 54g — 48g when adjusted for maternal age. The study cited two possible reasons for the increase. First, female smokers tend to smoke more when married to male smokers than they would alone. Second, parents are apt to smoke more when together, which increases the amount of second-hand smoke a mother consumes on top of her own increased intake.

In addition to low birth weights, mothers who consume alcohol while pregnant put their babies at risk for a number of health problems, including fetal alcohol spectrum disorder (FASD). FASD is a group of disorders that includes alcohol-related neuro-developmental disorders (ARND) and fetal alcohol syndrome (FAS). ARND causes dysfunction and developmental delay in different areas of neurological development. FAS can result in developmental disabilities, growth abnormalities, and certain facial feature anomalies. Facial anomalies include a flattened philtrum (the concave area directly beneath the nose and above the upper lip); a thinner upper lip; and shortened eye widths. FAS is the western hemisphere's foremost cause of developmental delays.

Statistics show that FASD children are also two to three times as likely to be abused — physically, psychologically or sexually — by their parents. Many of these children are placed in foster care. Studies indicate that between 60 percent and 80 percent of abused children entering foster homes were mistreated by parents who used alcohol and drugs. Children who experience parental abuse and FASD, together or separately, will likely spend most of their lives experiencing developmental delays in the areas of language, cognition, and social skills. Also, many FASD children have underdeveloped hearing and are afflicted by frequent, painful, middle ear infections and hearing loss, which result in referrals to audiologists and speech therapists.

Environmental Risk

Armor posits a "top 10" list of risk factors that are strong determinants of a child's early cognitive development and eventual academic success or failure. The first nine factors are environmental, the last, biological. These factors also point to a child's verbal IQ by the time they reach age 5. They are, in order of significance:

• Parents' IQ

• Cognitive stimulation and early teaching done by parents and caregivers

• Nurturing and emotional support

• Highest level of education achieved by the parents

• Family's financial status

• Marital status of parents/number of parents living at home

• Mother's age at time of child's birth

• Number of siblings

• Quality of child's nutrition beginning with breast feeding

• Child's weight at birth

The most influential factor, parents' IQ, seems to imply a genetic predisposition toward high IQ, that is, that children inherit intelligence from their parents. This may be partially true, but points also to the kind of environment wrought for a child by more intelligent parents. Such adults are bound to draw on a larger vocabulary in discussing more complex concepts with children and in setting higher achievement standards.

Some factors can affect others on the list. A mother with a low level of education, for instance, might provide inadequate cognitive stimulation, be ignorant of good nutrition practices, or be incapable of creating a safe and nurturing environment. A VLBW child is even less likely to be successful in school if their mother is uneducated and their family impoverished. Conversely, high levels of maternal education can offset weak areas on the list. It is possible, in some cases, to gauge a child's overall levels of environmental risk, based solely on the mother's level of education.

Applications

Early Intervention Studies & Programs

While there is little educators can do about most risk factors that affect a child, much is being done to intervene on behalf of at-risk children before they reach kindergarten. One outgrowth of the government's increased involvement in the health and welfare of children during and after World War II was a general sentiment among citizens in the 1960s that it should also help disadvantaged children and their families. This zeitgeist — along with policymakers' growing concern over increased poverty and academic failure rates among poor children — led to the nation's first large-scale, early intervention studies and programs.

Initial Studies

The first major study done on early intervention was conducted in Ypsilanti, Michigan. In 1962, Ypslanti public schools launched the Perry Preschool Longitudinal Study, which examined 123 academically high-risk, African American children from low-income families. Children, ages 3 and 4, were given high-quality preschool services to determine whether environmental learning disabilities could be offset or even eradicated by intervention. The study followed 97 percent of these children until age 40, and found that as adults, they were more likely to have graduated high school, more apt to hold a job and earn more money, and had been less involved in criminal activity.

Head Start

Three years later the federal government launched its massive Project Head Start, which targeted environmentally at-risk children. Begun as an eight-week summer pilot, Head Start sought to counteract the effects of environmental risks—mainly from poverty and unstable family situations—on preschool-age children by offering them educational, health, nutritional, and psychological services. Head Start is still in operation and has expanded to run for the entire school year. Since its inception, the program has served more than 38 million children and their families. Research done on Head Start has revealed that early intervention does counteract developmental delays and improves cognitive functioning in children. Those who attend Head Start preschool programs score higher on preschool achievement tests and perform as well or better than their peers in kindergarten.

Later Studies

In 1971, the federal Office of Child Development commissioned a report on the state and progress of early intervention. The report revealed that though children participating in early intervention programs reap benefits, gains tend to fade by the time they enter second grade. The report recommended a broader, family-based intervention model, to prolong gains from early intervention preschool programs. A similar, but more in-depth review of Head Start was conducted in 1981 by the Administration for Children, Youth and Families. Like the 1971 report, this study found that at-risk children benefited from early intervention, but that gains faded during the first two or three years of school. In some cases, however, Head Start children were held back in grades less frequently throughout their school careers and were less apt to be placed in special education programs.

Viewpoints

Long-Term Effects of Environmental & Biological Risks

According to a 2004 study published in the Journal of the American Medical Association, the harmful long-term effects of cocaine use on unborn babies have, in past studies, been overestimated. The study — which profiled 376 preschoolers whose mothers abused cocaine while pregnant with them — revealed that these children scored lower than normal on general knowledge, math, and visual-spatial skill tests. But low test scores and IQs, it concluded, could in time be raised to the norm by good parenting, nurturing foster care, and regular verbal interaction with well-educated caregivers.

Bono, Sheinberg, Scott, and Claussen conducted a study of 600 children receiving intervention services after being exposed prenatally to cocaine. They concluded that although many subjects were at-risk for poor development—especially in the area of language—it was not necessarily due to in-utero cocaine exposure. Rather, the more significant determinant of developmental delay was the types of environment children must live in when their parents are addicted to drugs.

Some risks to which cocaine-exposed babies are exposed can be lessened through early intervention. Bono et al. found that children who received early intervention services before reaching 1 year of age exhibited better cognitive functioning and more language skills at age 3 than children who did not receive services. It was also observed that children receiving services at a center had more language ability than those getting home-based care.

Studies continue to be done on the long-term effects of environmental and biological risks. Some new evidence corroborates earlier findings; other data contradicts what is already known. But what remains true is that knowing a child's developmental risk profile can help greatly in understanding their unique needs and meeting them with appropriate support services.

Terms & Concepts

Behaviorism: A developmental theory which holds that children are molded more by their environments than by any preexisting knowledge they have at birth.

Biological Risk: Any number of conditions acquired by a fetus that can result in developmental delays after birth.

Developmental Delay: The repeated failure by a child to reach established benchmarks of normal physical and/or cognitive development.

Developmental Risk: When a child is in danger of developmental delay due either to a diagnosed disability, or to a condition acquired before or after birth.

Environmental Risk: When a child is in danger of developmental delay because of exposure to certain environmental influences.

Established Risk: Children with developmental delays attributed to diagnosed medical conditions such as Down syndrome.

Extremely Low Birth Weight (ELBW): A designation given to infants weighing 800g or less at birth.

Learning Disability: Any cognitive, neurological, or psychological disorder that hampers a child's ability to learn.

Low Birth Weight (LBW): The designation given to infants weighing 2,500g or less at birth.

Nativism: A developmental theory stating that all children enter the world already possessing knowledge of it.

Neonatal: Of or related to newly born children.

Perinatal: The period of development beginning approximately five months before the birth of a child and ending one month after.

Prenatal: Pertaining to the time before birth.

Preterm: Refers to babies who are born before the 37th week of gestational development and weigh 2,500 grams or less.

Very Low Birth Weight (VLBW): The designation given to babies weighing 1,500g or less at birth.

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Suggested Reading

Day, N. L., Jasperse, D., Richardson, G., Robles, N., Sambamoorthi, U., Taylor, P., Scher, M., Stoffer, & D., Cornelius, M. (1989). Prenatal exposure to alcohol: Effect on infant growth and morphologic characteristics. Pediatrics, 84, 536–541. Retrieved May 11, 2007 from EBSCO Online Database Academic Search Premier.

Jacobson, S. W., & Jacobson, J. L. (2001) Alcohol and drug-related effects on development: a new emphasis on contextual factors. Infant Mental Health Journal, 22, 416–430. Retrieved May 14, 2007 from EBSCO Online Database Academic Search Premier.

Mills, J. L., & Graubard, G. I. (1987). Is moderate drinking during pregnancy associated with an increased risk for malformations? Pediatrics, 80, 309–314. Retrieved May 12, 2007 from EBSCO Online Database Academic Search Premier.

Turygin, N., Matson, J. L., & Tureck, K. (2013). ADHD symptom prevalence and risk factors in a sample of toddlers with ASD or who are at risk for developmental delay. Research in Developmental Disabilities, 34, 4203–4209. Retrieved December 23, 2013 from EBSCO Online Database Education Research Complete.