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Who Are They?

Hallam Hurt, MD; Elsa Malmud, PhD; Leonard E. Braitman, PhD; Laura M. Betancourt, BA; Nancy L. Brodsky, PhD; Joan M. Giannetta, BA

Arch Pediatr Adolesc Med. 1998;152:993-997.

Objective  To define characteristics that differentiate inner-city children with Average or above-Average Full Scale IQ scores (90) from those with below-Average scores (<90).

Design  As part of a prospective study of children with and without in utero cocaine exposure tested at age 4 years on the Wechsler Preschool and Primary Scales of Intelligence–Revised, we found that, taken together, only 32 (21%) scored at or above 90 whereas 118 (79%) scored below 90. The groups (IQ90 and IQ<90) were compared on prenatal, natal, and postnatal factors.

Setting  A study center in an inner-city hospital.

Participants  One hundred-fifty children of low socioeconomic status, 34 weeks' gestational age or older, and nonasphyxiated at birth, who had intelligence testing at age 4 years; 150 caregivers (biological and foster).

Main Outcome Measures  Association of Full Scale IQ with prenatal, natal, and postnatal characteristics (including caregiver-child interaction measured by the Parent Caregiver Involvement Scale [PCIS], and home environment measured by the Home Observation for Measurement of the Environment [HOME]).

Results  The group of children with IQs at or above 90 (n=32) did not differ from the group with IQs below 90 (n=118) in prenatal or natal characteristics (all P .18) or proportion in foster care, attendance at day care or Head Start, continued caregiver cocaine use, or parental IQ. Children with IQs at or above 90 had more developmentally appropriate interaction by caregivers (P=.043) and higher scores on 6 of 8 subscales and Total HOME (P.05) than the group of children with IQs below 90.

Conclusions  Two postnatal factors, home environment and caregiver-child interaction, were associated with Full Scale IQ scores at or above 90 whereas prenatal and natal factors were not. These potentially malleable postnatal factors can be targeted for change to improve cognitive outcome of inner-city children.

From the Division of Neonatology (Drs Hurt, Malmud, and Brodsky, and Mss Betancourt and Giannetta), and Office for Research and Development (Dr Braitman), Albert Einstein Medical Center, and the Department of Pediatrics, Temple University School of Medicine (Drs Hurt and Brodsky), Philadelphia, Pa.

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