搜索结果：Toddlers

OBJECTIVE: To conduct a randomized, controlled trial to evaluate the efficacy of the Early Start Denver Model (ESDM), a comprehensive developmental behavioral intervention, for improving outcomes of toddlers diagnosed with autism spectrum disorder (ASD). METHODS: Forty-eight children diagnosed with ASD between 18 and 30 months of age were randomly assigned to 1 of 2 groups: (1) ESDM intervention, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents for 2 years; or (2) referral to community providers for intervention commonly available in the community. RESULTS: Compared with children who received community-intervention, children who received ESDM showed significant improvements in IQ, adaptive behavior, and autism diagnosis. Two years after entering intervention, the ESDM group on average improved 17.6 standard score points (1 SD: 15 points) compared with 7.0 points in the comparison group relative to baseline scores. The ESDM group maintained its rate of growth in adaptive behavior compared with a normative sample of typically developing children. In contrast, over the 2-year span, the comparison group showed greater delays in adaptive behavior. Children who received ESDM also were more likely to experience a change in diagnosis from autism to pervasive developmental disorder, not otherwise specified, than the comparison group. CONCLUSIONS: This is the first randomized, controlled trial to demonstrate the efficacy of a comprehensive developmental behavioral intervention for toddlers with ASD for improving cognitive and adaptive behavior and reducing severity of ASD diagnosis. Results of this study underscore the importance of early detection of and intervention in autism.

In an effort to move incidental teaching research to practical applications for toddlers with autism, a comprehensive early intervention model was developed for use in the natural environments of a childcare center and children's homes. Based on the premise that social readiness will best be achieved by providing early social learning opportunities, the center based component of the model targets the developmental needs of an inclusive group of children with and without autism. The home based component involves parents of children with autism as key participants in their children's learning and prepares them to be effective advocates in their children's futures. The curriculum addresses what it is that toddlers need to learn, what environmental arrangements provide the most powerful teaching opportunities, and how teachers and parents can most effectively teach children to progress at their optimum pace. Outcome data are presented that documents an impact on the language and social behavior of participating toddlers with autism. Two of the more controversial Walden curriculum components are discussed. Current impediments to system change are considered in the hope that appropriate and effective early intervention may become available to all children with autism.

A state-of-the-art social robot was immersed in a classroom of toddlers for >5 months. The quality of the interaction between children and robots improved steadily for 27 sessions, quickly deteriorated for 15 sessions when the robot was reprogrammed to behave in a predictable manner, and improved in the last three sessions when the robot displayed again its full behavioral repertoire. Initially, the children treated the robot very differently than the way they treated each other. By the last sessions, 5 months later, they treated the robot as a peer rather than as a toy. Results indicate that current robot technology is surprisingly close to achieving autonomous bonding and socialization with human toddlers for sustained periods of time and that it could have great potential in educational settings assisting teachers and enriching the classroom environment.

OBJECTIVES: Recognizing the negative effects of television on children, the American Academy of Pediatrics (AAP) recommends that children 2 years and older watch <2 hours of television per day and that children younger than 2 years watch no television. However, relatively little is known about the amount of television viewed by infants and toddlers. The objective of this study was to describe the prevalence and correlates of television viewing that exceeds the AAP guidelines for 0- to 35-month-olds and to examine the trajectory of a child's viewing over time. METHODS: Data from the National Longitudinal Survey of Youth, 1990 to 1998, were used to analyze reported television viewing at 0 to 35 months of age and to follow the trajectory of a child's viewing from infancy through age 6. Logistic regression models were used to determine risk factors associated with greater television viewing at 0 to 35 months and the association of early viewing habits with school-age viewing. RESULTS: Seventeen percent of 0- to 11-month-olds, 48% of 12- to 23-month-olds, and 41% of 24- to 35-month-olds were reported to watch more television than the AAP recommends. Compared with college graduates, less-educated women were more likely to report that their children watched more television than recommended. Children who watched >2 hours per day at age 2 were more likely to watch >2 hours per day at age 6 (odds ratio: 2.7; 95% confidence interval: 1.8-3.9), controlling for maternal education, race, marital status and employment, household income, and birth order. CONCLUSIONS: A substantial number of children begin watching television at an earlier age and in greater amounts than the AAP recommends. Furthermore, these early viewing patterns persist into childhood. Preventive intervention research on television viewing should consider targeting infants and toddlers and their families.

OBJECTIVE: This study compared effects of two parent-mediated interventions on joint engagement outcomes as augmentations of an early intervention program for toddlers with autism spectrum disorder (ASD). METHOD: Participants included 86 toddlers (range 22-36 months) with ASD and their primary caregiver. Caregiver-child dyads were randomized to receive 10 weeks of hands-on parent training in a naturalistic, developmental behavioral intervention (joint attention, symbolic play, engagement and regulation-JASPER) or a parent-only psychoeducational intervention (PEI). Dose was controlled in terms of researcher-parent contact and early intervention services received by the child. RESULTS: Results yielded significant effects of the JASPER intervention on the primary outcome of joint engagement. The treatment effect was large (Cohen's f² = .69) and maintained over the 6-month follow-up. JASPER effects were also found on secondary outcomes of play diversity, highest play level achieved, and generalization to the child's classroom for child-initiated joint engagement. The PEI intervention was found to be effective in reducing parenting stress associated with child characteristics. All secondary effects were generally small to moderate. CONCLUSIONS: These data highlight the benefit of a brief, targeted, parent-mediated intervention on child outcomes. Future studies may consider the combination of JASPER and PEI treatments for optimal parent and child outcomes. Trial registry no. NCT00999778.

OBJECTIVES: To determine the frequency and location of bruises in normal infants and toddlers, and to determine the relationship of age and developmental stage to bruising. DESIGN: Cross-sectional survey. SETTING: Community primary care pediatric offices. SUBJECTS: Children younger than 36 months attending well-child care visits. METHODS: Prospective data collection of demographics, developmental stage, and presence and location of bruises. Any medical condition that causes bruises as well as known or suspected abuse was also recorded. A chi2 test or Fisher exact test was used to determine the significance of differences. MAIN OUTCOME MEASURES: Presence and location of bruises as related to age and developmental stage. RESULTS: Bruises were found in 203 (20.9%) of 973 children who had no known medical cause for bruising and in whom abuse was not suspected. Only 2 (0.6%) of 366 children who were younger than 6 months and 8 (1.7%) of 473 children younger than 9 months had any bruises. Bruises were noted in only 11 (2.2%) of 511 children who were not yet walking with support (cruising). However, 17.8% of cruisers and 51.9% of walkers had bruises (P<.001). Mean bruise frequency ranged from 1.3 bruises per injured child among precruisers (range, 1-2 bruises) to 2.4 per injured child among walkers (range, 1-11). The most frequent site of bruises was over the anterior tibia and knee. Bruises on the forehead and upper leg were common among walkers, but bruises on the face and trunk were rare, and bruises on the hands and buttocks were not observed at any age. There were no differences in bruise frequency by sex. African American children were observed to have bruises much less frequently than white children (P<.007). CONCLUSIONS: Bruises are rare in normal infants and precruisers and become common among cruisers and walkers. Bruises in infants younger than 9 months and who are not yet beginning to ambulate should lead to consideration of abuse or illness as causative. Bruises in toddlers that are located in atypical areas, such as the trunk, hands, or buttocks, should prompt similar concerns.

This study explores the effects of training parents to administer focused stimulation intervention to teach specific target words to their toddlers with expressive vocabulary delays. Twenty-five mothers and their late-talking toddlers were randomly assigned to treatment and delayed-treatment (control) groups. Vocabulary targets were individually selected for each toddler based on the child's phonetic repertoire and parent report of vocabulary development. Following treatment, mothers' language input was slower, less complex, and more focused than mothers in the control group. Concomitantly, their children used more target words in naturalistic probes, used more words in free-play interaction, and were reported to have larger vocabularies overall as measured by parent report. In addition, the treatment had an effect on language development-children in the experimental group used more multiword combinations and early morphemes than children in the control group. The implications of these results are discussed with regard to the role of focused stimulation intervention for children with expressive vocabulary delays.

OBJECTIVE: This study validates the Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F), a screening tool for low-risk toddlers, and demonstrates improved utility compared with the original M-CHAT. METHODS: Toddlers (N = 16,071) were screened during 18- and 24-month well-child care visits in metropolitan Atlanta and Connecticut. Parents of toddlers at risk on M-CHAT-R completed follow-up; those who continued to show risk were evaluated. RESULTS: The reliability and validity of the M-CHAT-R/F were demonstrated, and optimal scoring was determined by using receiver operating characteristic curves. Children whose total score was ≥ 3 initially and ≥ 2 after follow-up had a 47.5% risk of being diagnosed with autism spectrum disorder (ASD; confidence interval [95% CI]: 0.41-0.54) and a 94.6% risk of any developmental delay or concern (95% CI: 0.92-0.98). Total score was more effective than alternative scores. An algorithm based on 3 risk levels is recommended to maximize clinical utility and to reduce age of diagnosis and onset of early intervention. The M-CHAT-R detects ASD at a higher rate compared with the M-CHAT while also reducing the number of children needing the follow-up. Children in the current study were diagnosed 2 years younger than the national median age of diagnosis. CONCLUSIONS: The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the 2-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention. Widespread implementation of universal screening can lower the age of ASD diagnosis by 2 years compared with recent surveillance findings, increasing time available for early intervention.

A prospective longitudinal design was employed to ascertain whether different types of behavioral inhibition (i.e., traditional, peer-social) were stable from toddler to preschool age, and whether inhibited temperament and/or parenting style would predict children's subsequent social and behavioral problems. At Time 1, 108 toddlers (54 males, 54 females) and their mothers were observed in the Traditional Inhibition Paradigm and in a toddler-peer session; then at age 4 years, 88 children were observed with unfamiliar peers, and maternal ratings of psychological functioning were obtained. How mothers and their toddlers interacted was also observed. Results revealed meaningful connections between toddler inhibition, maternal intrusive control and derision, and nonsocial behaviors at age 4. Both forms of toddler inhibition predicted socially reticent behavior during free play at 4 years. If mothers demonstrated relatively high frequencies of intrusive control and/or derisive comments, then the association between their toddlers' peer inhibition and 4-year social reticence was significant and positive; whereas if mothers were neither intrusive nor derisive, then toddlers' peer inhibition and 4-year reticence were not significantly associated. Thus, maternal behaviors moderated the relation between toddlers' peer inhibition and preschoolers' social reticence.

OBJECTIVES: To determine the prevalence of vitamin D deficiency and to examine whether 25-hydroxyvitamin D (25OHD) concentration varies as a function of skin pigmentation, season, sun exposure, breastfeeding, and vitamin D supplementation. DESIGN: Cross-sectional sample. SETTING: Urban primary care clinic. PARTICIPANTS: Healthy infants and toddlers (N = 380) who were seen for a routine health visit. OUTCOME MEASURES: Primary outcomes were serum 25OHD and parathyroid hormone levels; secondary measures included data on sun exposure, nutrition, skin pigmentation, and parental health habits. Wrist and knee radiographs were obtained for vitamin D-deficient participants. RESULTS: The prevalence of vitamin D deficiency (< or =20 ng/mL) was 12.1% (44 of 365 participants), and 146 participants (40.0%) had levels below an accepted optimal threshold (< or =30 ng/mL). The prevalence did not vary between infants and toddlers or by skin pigmentation. There was an inverse correlation between serum 25OHD and parathyroid hormone levels (infants: r = -0.27, P < .001; toddlers: r = -0.20, P = .02). In multivariable models, breastfeeding without supplementation among infants and lower milk intake among toddlers were significant predictors of vitamin D deficiency. In vitamin D-deficient participants, 3 participants (7.5%) exhibited rachitic changes on radiographs, whereas 13 (32.5%) had evidence of demineralization. CONCLUSIONS: Suboptimal vitamin D status is common among otherwise healthy young children. Predictors of vitamin D status vary in infants vs toddlers, information that is important to consider in the care of these young patients. One-third of vitamin D-deficient participants exhibited demineralization, highlighting the deleterious skeletal effects of this condition.

The early emergence and developmental implications of externalizing behavior problems in toddlers and preschoolers are discussed with an emphasis on which young children are truly at risk for continuing problems. The extant literature is reviewed with a focus on the stability of early externalizing behavior and the diverse pathways that young children, primarily boys, with early-emerging problems may follow. Findings from a number of studies, both epidemiological and high risk, suggest that the small subgroup of boys with multiple risk factors that include especially high levels of early hyperactivity and aggression, and high levels of negative parenting and family stress, are most likely to evidence continuing problems at school entry. Sociodemographic and neighborhood influences are also discussed, as are implications for future research and policy.

Although adults generally prefer helpful behaviors and those who perform them, there are situations (in particular, when the target of an action is disliked) in which overt antisocial acts are seen as appropriate, and those who perform them are viewed positively. The current studies explore the developmental origins of this capacity for selective social evaluation. We find that although 5-mo-old infants uniformly prefer individuals who act positively toward others regardless of the status of the target, 8-mo-old infants selectively prefer characters who act positively toward prosocial individuals and characters who act negatively toward antisocial individuals. Additionally, young toddlers direct positive behaviors toward prosocial others and negative behaviors toward antisocial others. These findings constitute evidence that the nuanced social judgments and actions readily observable in human adults have their foundations in early developing cognitive mechanisms.

Language learning takes place in the context of social interactions, yet the mechanisms that render social interactions useful for learning language remain unclear. This study focuses on whether social contingency might support word learning. Toddlers aged 24-30 months (N = 36) were exposed to novel verbs in one of three conditions: live interaction training, socially contingent video training over video chat, and noncontingent video training (yoked video). Results suggest that children only learned novel verbs in socially contingent interactions (live interactions and video chat). This study highlights the importance of social contingency in interactions for language learning and informs the literature on learning through screen media as the first study to examine word learning through video chat technology.

The toddler years can be a particularly stressful time for all parents, however, parents of children with disabilities may experience additional sources of stress. Recent literature on early education for children with disabilities promotes inclusion with typical peers with increases in the availability of inclusive programs. However, little is known about early intervention inclusion programs and parental factors such as stress and adaptability. The current study expands the research for children with disabilities by investigating the associations of having a young child with an Autism Spectrum Disorder (ASD) on multiple dimensions of parental stress for mothers and fathers and how participation in an inclusive toddler program may be related to these stress levels. Results for this community sample are consistent with previous research indicating that that both mothers and fathers of children with ASD report significantly elevated levels of both child and parent related stress in comparison with parents of typically developing toddlers. Following their child's participation in the inclusion program, mothers of children with ASD report significant reductions in child-related stress but no reductions in the parent-related stress domain. No changes were seen with either child or parent domain for fathers. Lastly, a child's level of social skills was a significant predictor of child-related maternal stress for children with autism. This pattern was not seen in fathers of these children. Implications for early intervention program modifications, such as increasing family support and incorporating adjunctive parent interventions for parents with elevated levels of stress are discussed.

Viewing data were reported every 3 months beginning at 6 months of age by the parents of 51 infants and toddlers. Viewing logs were coded for program, content, and intended audience. Using hierarchical linear modeling techniques, growth curves examining relationships between television exposure and the child’s vocabulary knowledge and expressive language skills were modeled. Parent’s education, child’s home environment, and child’s cognitive performance were statistically controlled. The findings support the importance of content and program type when describing media effects. At 30 months of age, watching Dora the Explorer, Blue’s Clues, Arthur, Clifford, or Dragon Tales resulted in greater vocabularies and higher expressive language scores; watching Teletubbies was related to fewer vocabulary words and smaller expressive language scores; watching Sesame Street was related only to smaller expressive language scores; and viewing Barney &amp; Friends was related to fewer vocabulary words and more expressive language. Reasons for differences are discussed.

The Circle of Security intervention uses a group treatment modality to provide parent education and psychotherapy that is based on attachment theory. The purpose of this study was to track changes in children's attachment classifications pre- and immediately postintervention. Participants were 65 toddler- or preschooler- caregiver dyads recruited from Head Start and Early Head Start programs. As predicted, there were significant within-subject changes from disorganized to organized attachment classifications, with a majority changing to the secure classification. In addition, only 1 of the 13 preintervention securely attached children shifted to an insecure classification. Results suggest that the Circle of Security protocol is a promising intervention for the reduction of disorganized and insecure attachment in high-risk toddlers and preschoolers.

Although developmental psychologists traditionally explore morality from a learning and development perspective, some aspects of the human moral sense may be built-in, having evolved to sustain collective action and cooperation as required for successful group living. In this article, I review a recent body of research with infants and toddlers, demonstrating surprisingly sophisticated and flexible moral behavior and evaluation in a preverbal population whose opportunity for moral learning is limited at best. Although this work itself is in its infancy, it supports theoretical claims that human morality is a core aspect of human nature.

Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6-1.2 mg(-1) · kg(-1) · day(-1)). Marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg(-1) · kg(-1) · day(-1). Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

Abstract This study was designed to examine parenting self‐efficacy beliefs as correlates of mothers' competence in parenting toddlers and as predictors of toddlers' behavior and development. Sixty‐eight predominantly middle‐class mother–toddler pairs participated in this study. Mothers completed questionnaires, toddlers were administered the Bayley Scales of Infant Development (BSID‐II), and each dyad participated in the Crowell Procedure, which is designed to observe parent and toddler behaviors in a semistructured laboratory context. Although domain‐general and domain‐specific parenting self‐efficacy beliefs were not associated with parenting competence, domain‐specific beliefs were significantly related to toddlers' scores on the Mental Scale of the BSID‐II and several behaviors observed during the Crowell Procedure (Affection Towards Mother, Avoidance of Mother, Compliance, Enthusiasm, and Negativity). Implications of the findings are discussed. ©2003 Michigan Association for Infant Mental Health.