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Biomedical subjects

J P Shonkoff

Publications and source records attributed to J P Shonkoff.

10 recordsLinked to original sources
PubMed1992

Development of infants with disabilities and their families: implications for theory and service delivery.

This Monograph presents the results of a nonexperimental, longitudinal investigation of developmental change in 190 infants and their families after 1 year of early intervention services. The Early Intervention Collaborative Study (EICS), conducted in association with 29 community-based programs in Massachusetts and New Hampshire, was designed to assess correlates of adaptation in young children with disabilities and their families over time, to inform social policy by analyzing the influences of family ecology and formal services on child and family outcomes, and to generate conceptual models to guide further investigation. The study sample (mean age at entry = 10.6 months) includes 54 children with Down syndrome, 77 with motor impairment, and 59 with developmental delays of uncertain etiology. Data were collected during two home visits (within 6 weeks of program entry and 12 months later) and included formal child assessments, observations of mother-child interaction, maternal interviews, and questionnaires completed independently by both parents as well as monthly service data collected from service providers. Child and family functioning varied considerably. Developmental change in the children (psychomotor abilities, adaptive behavior, spontaneous play, and child-mother interaction skills) was influenced to some extent by gestational age and health characteristics, but the strongest predictor of change was the relative severity of the child's psychomotor impairment at study entry. Families demonstrated generally positive and stable adaptation (in terms of the effect of rearing a child with disabilities on the family, parenting stress, and social support), despite persistent challenges with respect to mother-child interaction and differences in reported stress between mothers and fathers. Documentation of services revealed that early intervention is a complex and multidimensional experience that spans multiple public and private systems. Vulnerable and resilient subgroups within the sample were identified, and different correlates of adaptive change were demonstrated. Results of data analyses suggest new perspectives on the study of early childhood disability. The implications of the findings for developmental theory and social policy are discussed.

Adaptation, Psychological↗
PubMed1990

Point-counterpoint.

Explore the source record for details and available documents.

Child, Preschool↗
PubMed1989

Early intervention for vulnerable infants and their families: an emerging agenda.

Early childhood development is a complex dynamic process that begins at birth and unfolds in a transactional manner as infants interact with their environment. Children are highly adaptive organisms with powerful homeostatic mechanisms; consequently, most high-risk infants do well. Environmental factors are powerful mediators in this process, and a supportive and responsive environment may alleviate many early developmental insults, while a deficient environment can exacerbate developmental weaknesses. Available data suggest that appropriately designed early intervention services can be effective in facilitating both child and family adaptation for a variety of target groups. However, many important questions remain unanswered. For example, although interventions have been shown to improve cognitive function, effects in other important areas such as social and emotional functioning and family coping have not been well studied. Information about the impact of family variables is also incomplete as is our knowledge about which services work best for which children and families. Finally, the influence of protective factors in the child and in the environment requires further exploration. The perinatologist can make several critical contributions to the comprehensive care of high risk infants beyond their medical management. He or she can play a pivotal role in identifying those neonates who need early intervention on the basis of their biologic vulnerability, their environmental risk factors, or both. Perinatologists are also in the best position to facilitate early entry into an appropriate service system and can be important collaborators in providing comprehensive services and long-term follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Child Health Services↗
PubMed1987

Early intervention for disabled infants and their families: a quantitative analysis.

In an evaluation of 31 selected studies, statistical procedures for synthesizing data (meta-analysis) were used to assess the effects of early intervention services on disabled children younger than 3 years of age and on their families. Results indicate that early intervention is effective in promoting developmental progress in infants and toddlers with biologically based disabilities. Programs that served a heterogeneous group of children, provided a structured curriculum, and targeted their efforts on parents and children together appeared to be the most effective. Definitive evaluation of the efficacy of early intervention programs is tempered by the restricted range of outcomes measured and by a paucity of information about the children and families enrolled in such programs, as well as about the specific nature of the services received. Despite their limitations, available data provide the basis for a rational pediatric approach to early intervention programs, while highlighting specific directions for further investigation.

Age Factors↗
PubMed1979

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.

Child↗
PubMed1979

Primary care approaches to developmental disabilities.

Ninety-seven board certified pediatricians who spend at least 75% of their professional working hours involved in the delivery of primary care in New England were interviewed to explore their attitudes and current clinical approaches to developmental disabilities. The majority of the pediatricians relied exclusively on clinical judgment and general observations for assessing developmental problems in their offices. Responsibility for preschool screening for potential learning problems and the assessment of school failure were considered appropriate pediatric concerns. Reported customary approaches to a variety of developmental problems were not affected by the size of the practice nor by the socio-economic status of the patient population. Patterns of referral for consultation appeared to be more dependent on the nature of the suspected disorder than on the characteristics of the physicians or their practices. The need for more rigorous training in the developmental aspects of child health has been emphasized. In order to meet this challenge, more precise techniques for pediatric developmental assessment and more conclusive evaluations of specific interventions will have to be produced.

Attitude of Health Personnel↗