The at-risk infant: psycho-socio-medical aspects. - book reviews

The At-Risk Infant: Psycho/ Socio/Medical Aspects

Everyone talks about the need for multidisciplinary and integrated approaches to understanding complex developmental problems, but attaining this is another matter. Editors Shaul Harel, M.D., and Nicholas J. Anastasiow, Ph.D., have gathered the materials that provide the reader with this possibility. They have organized a set of readings which reflect an up-to-date range of approaches to investigating and understanding the atrisk infant. The papers were selected from the Second International Workshop on the "At-Risk Infant,' held in Jerusalem in 1983. Together, they challenge the reader to consider new or alternative ideas to approaching day-to-day work.

The range of articles is very broad and, for the most part, articles are well-written and very interesting. Not only are the foremost experts from various disciplines represented, but also an international array of researchers, including those from Belgium, England, France, Germany, Denmark, Holland, Portugal, Canada and Mexico, as well as Israel and the United States. Reading this book, therefore, takes oneon a "grand tour' of the field through the United States, Europe and Israel.

For the clinician, it is an exciting adventure broadening one's perspective on how researchers are attempting to study the etiology or underlying mechanisms of development. For the researcher, it is an opportunity to read about the scope of methodologies and other techniques being employed all over the world. For both, it is an opportunity to see the strengths and limitations of various research and intervention programs being implemented.

It is unlikely that anyone would read all 46 chapters, but the wide selection of developmental, psychosocial and neurological readings in this book stimulates the reader to explore further. Because most of the book is organized chronologically rather than conceptually, the reader may want to organize or select readings on the basis of issues or interests.

Three sections of the book are edited by distinguished experts in the field. The first, edited by Anastasiow, addresses ecological factors that foster development, such as adult and adolescent parent attitudes, mother-infant interaction, and various intervention approaches. Some of the authors, including Anastasiow, Hanes and Thormann, review conceptual approaches to parenting and parent attitudes that may be useful to intervenors working with parents. Thormann's study of pregnant adolescents' maternal attitudes begs for follow-up to test her interpretation of a single instrument. Others are concerned with the interaction of various high-risk factors. For example, Fox and Feiring studied how fathers, relatives and others respond to the mother of an ill or premature infant with gifts, services, counseling or money and how these supports relate to interactive behavior at three months. By going into the real world of the parents, these authors attempt to look at the more complex effects of mother-infant interaction.

In another chapter, Linda Siegel demonstrates how a risk index of reproductive, perinatal and demographic factors predicts to 6-year intellectual functioning far better than infant test scores. Her work does not go as far as Samaroff and Greenspan (1984), who found a 25-year-old increase in cognitive performance at four years when environmental risk factors in infancy were taken into account. Craig Ramey, Tiffany Field and others report on the greater benefits of intensive intervention at one or three years but little attention is given to identifying the specific components of the intervention that make it efficacious.

The lack of comprehensive approaches is the most glaring omission in the numerous studies in this book. Infants are still primarily treated as cognitive scores and parents as demographic or environmental characteristics with a range of activities. Where is the child emotionally? What kind of parent are we dealing with? What is the vehicle for change? It is Altmeier and Spivak who appreciate the significance of the long-term relationship in their work with highrisk parents to prevent child abuse or to support adolescents. But even they did not incorporate measures of this relationship, which is probably the central mechanism for change in parents and their abilities to support development.

Section II, edited by Leo Stern, groups studies of pregnancy and the perinatal period. These papers are extremely informative, bringing the reader up-to-date on such factors as smoking, drinking, seizures and other possible causes contributing to poor perinatal outcome. The most recent approaches to assessments and screening of neurological, auditory and metabolic functioning are presented in very clear and relevant chapters by such researchers as Dubowitz, Casaer, Fenichel and Lou. One interesting approach is presented by Jaffe and his colleagues in Israel who are studying unusual dermatoglyphics and tooth examination to determine when brain damage occurred in the fetus. Amiel-Tison outlines the neurological characteristics associated with abnormal outcome over a 7-year period, adding a long-term perspective to the other reports. Although she concludes with comments regarding limited plasticity of the brain, she strongly advocates intervention. The need for improved communication with obstetricians and parents emerges very clearly in many of the papers.

The last section, edited by Arthur Parmelee, includes 17 chapters concerned with follow-up, intervention and assessments in infancy and early childhood. The range and impact of the prospective studies are very impressive. What is most striking is the attention given to the assessments of different sensory systems, be they vision, hearing or speech, and the impact these functions have on the developing child. While these chapters give the reader a wider perspective, they tend to be isolated studies and make little attempt to integrate their work with other aspects of development. Still missing are papers focusing on the tactile, postural and vestibular systems and how all these sensory systems affect each other in development and interaction with parents.

Perhaps the most exciting chapter in this section is one by Klein and Feuerstein. They have identified some of the key factors in parent-child interaction that mediate learning and result in "smart children' because they teach children how to think, abstract and plan ahead. Mediated Learning Experience (MLE) provides a very powerful approach to intervention that should be seriously considered in this country, which has tended to remain very concrete in the interventions offered. Rose Bromwich also emphasizes the need to promote symbolic and representative play in handicapped infants as a means of enhancing development and promoting higher level functions.

Edited compilations are always difficult to summarize and too few authors could be included here. The editors might have attempted to integrate the chapters they selected more effectively and use them to pose challenges for the future. As it is, the reader must undertake this challenge alone, stopping at famous spots but able to explore other less known areas at leisure, packaging the tour as he or she wants. This book is ideal for the independent traveller.

COPYRIGHT 1985 U.S. Government Printing Office
COPYRIGHT 2004 Gale Group