PubMed Health⌕ Search

Biomedical subjects

H A Ruff

Publications and source records attributed to H A Ruff.

At least 19 recordsLinked to original sources
PubMed1996

Relationships among blood lead levels, iron deficiency, and cognitive development in two-year-old children.

The goals of this study were to explore the relationship of declining blood lead levels and cognitive development in 42 moderately lead poisoned children around 2 years of age and to investigate the potential interaction between iron and lead levels in the course of development. The cognitive functioning of children was assessed upon enrollment into a comprehensive intervention and 6 months later. The intervention consisted of chelation treatment, if appropriate, iron supplementation, if needed, and steps to eliminate the source of lead in the home environment. The children were referred because of blood lead levels between 25 and 55 mu g/dl; they were also selected on the basis of age between 18 and 30 months. The outcome measures were the global score on a standardized test of cognitive development and subscale scores for perceptual-motor and language functioning. Cognitive change over 6 months was related to an interaction between change in blood lead and initial iron status. Specifically, the change in standardized score (particularly change in perceptual-motor performance) was strongly related to change in blood lead in children who were iron sufficient at the outset: there was an increase of 1.2 points for every 1 mu g/dl decrease in blood lead. There was no such relationship in iron-deficient children. Secondary analyses suggested that 1) the change in cognitive functioning of iron-deficient children was related to change in hemoglobin, and 2) the decline in blood lead was less in iron-deficient than in iron-sufficient children. Thus, when iron is sufficient, changes in blood lead and changes in cognition are inversely related. When iron is deficient, other processes affect the outcome.

Chelation Therapy↗
PubMed1996

Moderate lead poisoning: trends in blood lead levels in unchelated children.

The appropriate clinical management of children who are moderately poisoned with lead (Pb) is under active investigation. To determine the pattern of change in blood Pb (BPb) levels in the absence of chelation therapy, we followed moderately Pb-poisoned children (initial blood Pb levels 1.21-2.66 mumol/l or 25-55 micrograms/dl) for 6 months with repeated BPb level measurements. Chelation therapy was not administered because all the children had negative lead mobilization tests indicating limited response to the chelating agent, calcium disodium edetate (CaNa2EDTA). Eligible children received the following interventions: notification of the health department to remediate lead hazards; reinforced educational efforts about the toxicity sources and treatment of Pb during 10 clinic and 3 home visits; and iron therapy for children with ferritin levels less than 16 micrograms/l. To quantify the lead paint hazards in the home, we combined a visual rating of the surfaces (intact to peeling) with an X-ray fluorescence (XRF) measurement of the lead content of the painted surface. The sum of these assessments is termed the home environmental score (HES). Data were analyzed from 79 children. BPb levels declined by 27%, on average, over 6 months. HES was correlated with BPb at enrollment, but neither the initial nor later HES measurements predicted BPb at other time points. The HES was highest at enrollment and declined by 50% and 75% at the second and third home visits, respectively. However, only a minority of the children (20%) achieved an HES of 0, indicating no lead paint hazards at home. Despite some ongoing Pb exposure, a parallel fall in BPb levels was observed in subgroups of children with either initially low or high HES (above or below the median HES of 37). Iron status did not account for the change in BPb levels. These data provide evidence that our measure, the HES, is quantifiably related to BPb levels in children, that this correlation is significant only prior to intervention; and that BPb levels decline in children who are moderately poisoned with Pb after they are enrolled in a comprehensive intervention program, even in the absence of chelation therapy and in the presence of ongoing lead paint exposure and Fe deficiency.

Chelation Therapy↗
PubMed1993

Declining blood lead levels and cognitive changes in moderately lead-poisoned children.

OBJECTIVE: To determine whether chelation therapy or biochemical changes during a lead-lowering intervention was associated with changes in cognitive functioning of moderately lead-poisoned children. It was hypothesized that cognitive performance would improve as blood lead level declined over time. DESIGN: Short-term intervention study with measures obtained before and after intervention. SETTING: Hospital specialty clinic and university research center. PATIENTS: A total of 154 previously untreated children referred to clinic with blood lead levels between 1.21 and 2.66 mumol/L (25 and 55 micrograms/dL) at time of enrollment. Ages ranged from 13 to 87 months. INTERVENTION: Enrolled children were treated with edetate calcium disodium (EDTA) if eligible and/or with orally administered iron supplement if iron deficient. For all children, housing inspections and abatement procedures were performed as necessary. MAIN OUTCOME MEASURES: Score on Bayley Mental Development Scale or Stanford-Binet Intelligence Scale (4th edition). RESULTS: There was no effect of edetate calcium disodium treatment per se. In the short term (7 weeks), changes in blood lead levels were not related to changes in cognitive scores. In the long term (6 months), however, changes in performance were significantly related to changes in blood lead level, even after controlling for confounding variables. The standardized score increased 1 point for every decrease of 0.14 mumol/L (3 micrograms/dL) in blood lead level. CONCLUSION: The results suggest an association between decreases in blood lead level and cognitive improvements in moderately lead-poisoned children.

Chelation Therapy↗
PubMed1990

Early intervention in the context of foster care.

There may be a number of specific foster care models that would facilitate infant development. The important point is that the emphasis should shift from foster care as maintenance to foster care as active intervention. Several other recent developments in public policy and public opinion suggest that the time is ripe for such a change; the federal government has mandated provision of early intervention services for young children at risk, and there is renewed interest in breaking the cycle of disadvantage. At this point, we must deal with the reality of the large number of infants and young children who enter the foster-care system and who stay for substantial periods of time. This situation represents an opportunity for professionals and foster parents alike to play a crucial role in changing the potentially adverse course of development for many children. It is an opportunity too important to be lost.

Child Abuse↗
PubMed1990

Long-term stability of individual differences in sustained attention in the early years.

The goal of this longitudinal study was to explore whether early measures of attention and inattention would be predictive of later attentiveness and whether there was any evidence of stable individual differences in attentiveness. Both full-term and preterm children were observed at 1, 2, and 3.5 years in free play and in more structured situations. For the group as a whole, and for full-terms separately, quantitative measures of inattention at 2 years were predictive of comparable measures at 3.5 years. For preterms separately, quantitative measures of inattention at 1 year were predictive of both behavior and the mothers' rating on the Conners Hyperactivity subscale at 3.5 years. Global, qualitative ratings of attentiveness at 1 and 2 years were predictive of mothers' ratings on the Conners at 3.5 years for the group as a whole and for full-terms separately. For full-terms only, the global ratings of attentiveness at 1 and 2 years were also predictive of 3.5-year quantitative measures of behavior. These data provide an encouraging base for further investigation of early individual differences in attentiveness and of possible early precursors of later attention deficits.

Attention↗
PubMed1990

The usefulness of reaction time tasks in studying attention and organization of behavior in young children.

Three studies explored reaction time procedures as a means of assessing sustained attention and response organization in preschoolers. In the first study, an auditory reaction time task was administered to 65 3.5-year-olds. Performance deteriorated over trials, paralleling results reported for older children and adults. Performance on the task was also related to the hyperactivity subscale of the Conners Parents' Questionnaire and to Stanford-Binet IQ. In a second cross-sectional study, performance on a visual reaction time task improved significantly from 2.5 to 4.5 years. A third study demonstrated individual stability and reasonable test-retest reliability for all measures. The results suggest that reaction time tasks can be usefully employed with young children to measure developmental changes and individual differences in sustained attention and organization of behavior.

Attention↗
PubMed1989

The infant's use of visual and haptic information in the perception and recognition of objects.

The purpose of this paper is to discuss the relationship between the haptic and visual systems during infant's bimodal interaction with objects. Four general topics are discussed: the role of exploratory activity in perception, the specific ways in which the two systems are related during exploration, developments over age in the relationship between the systems, and the impact of the organism/environment relationship on these developments.

Attention↗
PubMed1988

The influence of adult intervention on infants' level of attention.

The effects of adult intervention on infants' level of attention to objects were studied with 10-month-old infants. After a baseline measure of spontaneous attention was obtained, infants were randomly assigned to 1 of 4 conditions (low, medium, high intervention, or no-intervention control). Level of intervention was controlled by systematically varying the manner and frequency with which objects were presented, the extent to which the experimenter talked to the infant, and physical proximity. Infant attention was defined as duration of time spent examining objects. The overall duration of infant attention increased during medium intervention when compared to the control group. Baseline attention was then used to separate low and high attenders. Low attending infants attended more in medium and high intervention than in the low condition, while high attending infants were unaffected by intervention. The results show that level of intervention interacts with the child's spontaneous tendency to focus attention on objects.

Attention↗
PubMed1987

Stability of individual differences in infants' manipulation and exploration of objects.

The purpose of this study was to assess stability of manipulative behavior across time. 29 infants were seen at both 9 and 9.5 mo.; 20 of these infants were seen again at 12 mo. At each visit the infants were presented several objects for familiarization and tested for response to discrepant objects. Each trial was scored for the duration of looking, rotating the object, fingering, mouthing, and banging, the frequency of transferring the object from hand to hand, and the frequency of dropping, throwing and pushing the object away. Analysis of the data yielded moderate to high correlations between 9 and 9.5 mo. for all but one behavior. Correlations between 9 and 12 mo. were in the same range for most of the behaviors. On the test trials, there were fewer significant correlations. When the behaviors were separated into exploratory and nonexploratory categories, there was more stability for the nonexploratory behaviors; summary scores for both were concurrently related to Bayley Mental Development Index at 12 mo., but in opposite directions. The results suggest that there is stability in some manipulative behaviors, and further, that it is useful to conceptualize two types of manipulative behavior.

Child Development↗
PubMed1987

Developmental abnormalities in children with acquired immunodeficiency syndrome (AIDS): a follow-up study.

Developmental abnormalities in 16 pediatric patients with AIDS or AIDS-Related Complex (ARC) were previously described. Neurological deterioration was in evidence on follow-up in 9 of the children, 5 died since the original assessments were performed. Ten patients were reevaluated 14 months later by cognitive testing. Two showed greater progress than expected on the basis of earlier test results; 6 showed the expected level of developmental progress; and the remaining 2 showed regression in cognitive functioning. All patients who exhibited regression in their developmental course showed deterioration in their neurological examinations. Developmental progression was noted in some children who on follow-up serial examinations exhibited a clinically deteriorating neurological picture. Pediatric AIDS patients manifest variable neurodevelopmental courses. As a result, rehabilitative intervention services must be tailored to meet individual needs.

AIDS-Related Complex↗
PubMed1986

Attention and organization of behavior in high-risk infants.

Preterm infants at 7 months, corrected age, and 7-month-old full-term infants were videotaped while they played with a series of novel objects for a minute apiece. Each infant's videotape was scored for duration of examining (focused visual inspection), duration of mouthing, and duration of slapping or banging the objects. Full-term infants examined the objects significantly more than the preterms; the two groups showed equivalent levels of mouthing and banging. Each minute was then divided into 15-second segments. Only examining showed a decline over time, and then only for the full-terms. When the three behaviors were compared on the latency to the first episode of the behavior in each trial, it was found that the behavior of the full-terms was clearly differentiated in terms of sequence with examining having the shortest latency, mouthing the next shortest, and banging the longest. For the preterms, however, there were no differences among the mean latencies. The major difference between the two groups was in the latency to examine, which was significantly longer in the preterms. In general, the results for the preterms were not related to developmental level, but appeared to be due to deficits in both reactivity to stimulation and ability to sustain attention.

Attention↗
PubMed1986

Components of attention during infants' manipulative exploration.

The purpose of the project was to investigate attention in infants as they manipulate objects. It was hypothesized that examining, in contrast to other activity, reflects focused attention and active intake of information. The first study with 7- and 12-month-olds supported the hypothesis; examining declined with increasing familiarity, while other behaviors, such as mouthing and banging, did not, and examining occurred before other behaviors temporally. The latency to examine declined significantly with age. The second and third studies investigated the effects of age and familiarity on both latency to and duration of examining. Latency again decreased with age but did not change with increasing familiarity. In contrast, duration of examining did not vary systematically with age but declined sharply with familiarity. In a fourth study, latency to examine and duration of examining were related to different measures of attention at 3 1/2 years. The combination of results suggests that the latency and duration measures reflect different aspects of attention--a short-term reaction to object novelty and a more sustained response to the object and its characteristics.

Attention↗
PubMed1985

Developmental abnormalities in infants and children with acquired immune deficiency syndrome (AIDS) and AIDS-related complex.

Children with acquired immune deficiency syndrome (AIDS) display two types of clinical picture: a full-blown AIDS characterized by the presence of opportunistic infections and/or Kaposi's sarcoma and a prodromal stage now identified as AIDS-related complex (ARC). Neurological complications have been identified in infants and children with the disease. This paper discusses the developmental abnormalities in 16 pediatric patients, seven with AIDS and nine with ARC, ranging in age from six months to six years. In all cases, the mothers of these children either had ARC, AIDS and/or used intravenous drugs. Developmental histories showed delayed acquisition of milestones in most children following the diagnosis of AIDS or ARC, with delayed motor milestones consistently noted in both groups. Several children with AIDS actually lost milestones as their illness progressed; this has not occurred in the ARC group. Psychometric testing revealed more severe cognitive dysfunction in the group with AIDS. Involvement of the central nervous system was documented clinically, radiologically, and/or electrophysiologically in all patients with AIDS. In the ARC group the course of the illness has shown greater variability. Medical and social factors that may contribute to the developmental abnormalities are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Preterm infants' manipulative exploration of objects.

Because manipulative exploration of objects may be important to the infant's perception and conceptualization of objects, this study compared full-term infants with preterm infants who are considered to be at risk for cognitive deficits. 30 preterms at 9 months, with age corrected for prematurity, and 20 9-month-old full-terms were videotaped while they explored novel objects; the videotapes were scored for behaviors such as looking, handling, mouthing, turning the object around, fingering, transferring from hand to hand, and banging. There were no differences between the preterms and the full-terms. A "low-risk" subgroup and a "high-risk" subgroup of preterms were then compared with each other as well as to the full-terms. The low-risk subgroup was essentially the same as the full-terms. The high-risk preterms, however, fingered, rotated, and transferred the objects less than either the full-terms or the low-risk preterms. There was a relationship between manipulative exploration at 9 months and later cognitive functioning, suggesting that lower levels of manipulation may be one way in which cognitive deficits originate or are maintained.

Child, Preschool↗
PubMed1980

The development of perception and recognition of objects.

In this paper it is argued that the development of object perception in infancy involves the detection of structural invariants. Such detection is best understood in the context of dynamic events. Therefore, the role of continuous optical transformations in the infant's learning is emphasized. The effects of object motion and the infant's own activity are discussed in detail.

Child Development↗