Selected Abstracts from PediatricsCASEY, P. H., BRADLEY, R. & WORTHAM, B. (1984), Social and

nonsocial home environments of infants with nonorganic failure­to-thrive. 73:348-353.

Nonorganic failure-to-thrive (NOFT) is a clinical syndrome that ispoorly understood and inadequately studied. Because empirical dataare lacking, an attempt was made to identify differentiating aspectsof the mother-infant interaction and environment of infants withNOFT compared with those of matched infants who grew normally.Prospectively, 23 infants who were suffering from NOFT werechosen in a referral clinic. Each infant was matched with a controlsubject with normal growth by age, sex, and race of the infant andfamily income, maternal education, and number of people living inthe household. An assistant who was unaware of infant growthstatus visited the homes of these infants within 3 weeks of diagnosisand gathered: the Home Observation for Measurement of the En­vironment (HOME); the Coddington Life Events Record; and theIndex of Parent Attitude Scales. The total HOME Inventory andthe subscales entitled Maternal Acceptance of the Child, Organi­zation of the Physical Environment, and Emotional Responsivitywere significantly less favorable (p < 0.05) in the NOFT group.There were no group differences in the Life Events Record and theParent Attitudes Scales. A discriminant function analysis correctlyplaced 32 of the 46 infants into failure-to-thrive and control groups.It is concluded that certain aspects of the home environments ofinfants with NOFT differ from those of infants of similar socioec­onomic status who grow normally.

McANARNEY, E. R., LAWRENCE, R. A., ATEN, M. J. & IKER, H. P.(1984), Adolescent mothers and their infants. 73:35~-,362.

It is unclear why children of adolescent mothers experience moredevelopmental problems than children of adult mothers. There hasbeen minimal systematic investigation of whether there is a rela­tionship between the young age of the mother and her motheringbehaviors. Our data fail to demonstrate any relationship betweenadolescent maternal age and the counts of maternal behaviors 3days following birth. Seventy-five normal primiparous mothers lessthan 20 years old were videotaped with their normal infants for 10min in a standardized laboratory setting during the 3 days followingbirth. The frequency of maternal behaviors was counted from thevideotapes by trained observers. Future studies of primiparousadolescent mothers should consider the effects of maternal race/culture and socioeconomic status on their mothering behaviors. Therelationship between adolescent maternal age and the vocalizationsexpressed by the mother to her infant should also be exploredfurther.

THOMSON, M. W. & KRAMER, M. S. (1984), Methqdologic stand­ards for controlled clinical trials of early contact and maternal­infant behavior. 73:294-300.

To provide an objective evaluation of published studies on the effectof early contact on subsequent maternal-infant behavior, a set of11 methodologic standards generally applicable to controlled clinicaltrials of perinatal care was developed. Sixteen reports of earlycontact trials were assessed and 7 of the 11 standards were foundto be satisfactorily fulfilled. The four "problem" standards were:adequate definition of subjects, randomization, subject bias, andtreatment contamination (care giver) bias. Of the five best trialsfulfilling eight or more of the standards, three reported a beneficialeffect of early contact, while two demonstrated no effect. Theevidence that early contact improves subsequent maternal-infantbehavior thus remains inconclusive. It is urged that for futureresearch in this domain more attention be given to adequate subjectdefinition, strict randomization procedures, and safeguards againstbias by the subjects or their care givers.

370

GOLDBERG, I. D., ROGHMANN, K. J., McINERNY, T. K. & BURKE,J. D. (1984), Mental health problems among children seen inpediatric practice: prevalence and management. 73:278-293.

An ambulatory care survey involving 40% of all pediatricians inMonroe County, N.Y., was conducted between January and Decem­ber 1979 to obtain an estimate of the prevalence of mental healthproblems among children seen by pediatricians. If a child with sucha problem was identified, the pediatrician described the problem indetail, its impact on the family and the patient, and the actiontaken to handle the problem. The weighted 40% probability samplewas representative of all pediatric practices in the county. Duringthe 2 months for which each of the 30 pediatricians reported on allvisits, there were 21,575 visits made by 18,351 children. There were935 children detected at their first visit as having a problem, andanother 48 children at a repeat visit during the reporting period.This is equivalent to a point prevalence at time of first visit of5.09%. There was considerable variation between pediatricians:group practitioners reported a point prevalence of 4.06%, solopractitioners reported 5.06%, and health center pediatricians re­ported 7.33%. High rates were reported among children 7 to 14years old (8.0%), boys (6.2%) compared with girls (3.9%), those onMedicaid (8.3%), and those whose presenting complaint was achronic physical disorder (13.1%). The slightly higher rate amongblacks than whites appeared to be related to the generally lowersocioeconomic status among blacks. The rate among children inone-parent families was twice as high as in two-parent families.With regard to the mental health problem, most frequent diagnoses(primary or secondary) were adaptation reaction (31.5% of "prob­lem" children), speech and language disorder (18.4%), other specificlearning disorder (17.1 %), hyperkinetic disorder (16.8%), and con­duct disorder (14.7%). Functional impairment was moderate orsevere in more than half the affected children; most frequenttreatment provided by the pediatriCians was supportive therapy orcounseling (81.4%); drugs were prescribed for 11.3% of the affectedchildren, amphetamines for 4.7%.

STEIN, R. E. K. & JESSEP, D. J. (1984), Relationship betweenhealth status and psychological adjustment among children withchronic conditions. 73:169-174.

The extent to which children's psychological adjustment is affectedby the presence ofchronic physical illness is a subject of controversy.Data obtained at entry to a study of children with chronic illnessshow that among the 81 children 2:5 years of age there is littlerelationshipbetween psychological adjustment and traditional mor­bidity measures such as days hospitalized and days in bed. Thereis, however, a moderate but significant relationship between psy­chological adjustment and both the number of days absent fromschool and the child's functIonal status: children who have moreabsences and those with poor functional status have poorer psycho­logical adjustment. The data also suggest that these relationshipsmay differ in size within demographic subgroups of the population,something that may explain current controversies over the relation­ship between the child's chronic condition and psychological ad­justment.

JAY, M. S., DuRANT, R. H., SHOFFITT, T., LINDER, C. W. & Lrrr,I. F. (1984), Effect of peer counselors on adolescent compliancein use of oral contraceptives. 73:126-131.

Poor compliance with contraceptive regimens has been shown to bean important antecedent of adolescent pregnancy. The purpose ofthis study was to test prospectively the effect of a peer v nursecounseling program on adolescent compliance with the use of oralcontraceptives. Fifty-seven females aged 14 to 19 years from a lowersocioeconomic background were randomly assigned to a peer (N =

SELECTED ABSTRACTS 371

26) or nurse (N = 31) group. At the initial visit and at 1-, 2-, and4-month follow-up visits, subjects received Ortho-Novum 1/35 com­bined with a tablet marker and were counseled by a nurse or peer.Noncompliance was measured using a Guttman scale consisting of:(1) avoidance of pregnancy, (2) appointment adherence, (3) pillcount, and (4) urinary fluorescence for riboflavin. At the first andsecond follow-ups, the adolescents counseled by a peer had a signif­icantly (p ::s 0.038) lower noncompliance level than the nurse­counseled group. Adolescents with more frequent sexual activity (p

::s 0.027), with one sexual partner (p < 0.04), and who worried thatthey might become pregnant· (p ::s 0.01) had significantly lowerlevels of noncompliance when counseled by a peer than by a nurse.At the fourth month follow-up, adolescents who expressed feelingsof hopelessness about the future had significantly (p ::s 0.036) higherlevels of noncompliance when counseled by a nurse than whencounseled by a peer. These results suggest that incorporating a peercounselor into the health care team may be an effective method ofincreasing adolescent compliance.

THE MARGARET S. MAHLER LITERATURE PRIZE

The Literature Prize Committee of the Margaret S. Mahler Psychiatric Re­search Foundation is now accepting papers to be considered for the 1984 annualprize of $500 which will be awarded to the author of an original paper judged tobe the best by the Committee.

Papers should deal with clinical, theoretical or research issues related to Dr.Mahler's concept of separation-individuation in child development.

Pre-published papers may be submitted provided that they have been publishedwithin the year in which the Prize is awarded. Papers must be received byDecember 31, 1984, to be considered for this year. The Prize will be conferred atthe annual Margaret S. Mahler Child Development Symposium held in Phila­delphia in April or May, 1985.

Six copies of the paper should be submitted for consideration to:Dr. Marjorie Harley, ChairpersonLiterature Prize Committee201 St. Martins RoadBaltimore, MD 21218