velopmental disability. They are also at risk for chron-
ic lung disease, deafness, and brain hemorrhages,
which add to their developmental risk. Infants with
severe lung disease or neonatal seizures are at
increased risk. Some infants have metabolic or endo-
crine disorders such as hypothyroidism or phenylke-
tonuria, which place them at increased risk without
appropriate intervention. Lastly, acquired infections
in infancy, particularly involving the brain, can result
in compromised development. Children with devel-
opmental delay due to biological risk factors are often
diagnosed in infancy.
Compromised developmental outcome is due to
both biologic and environmental risk factors. Over
time, environmental influences affect the develop-
ment of biologically at-risk children. The environ-
ment has the potential to maximize or minimize early
developmental delays. Environmental risk factors are
cumulative, with each having a small incremental ef-
fect on cognitive abilities. The adverse effects of a
poor environment become increasingly more evident
from about two years of age onward. This influence
is most strongly seen in the areas of verbal and gener-
al cognitive development. As children age, the tests
used to measure intelligence place more and more
emphasis on language, and therefore the environ-
mental influences assume greater importance. The
reverse is also true: A good environment can have a
temporizing effect on the degree of developmental
disability, but it does not determine whether the dis-
ability occurred. Environmental influence seems to be
minimized when the biologic risk is severe.
Environmental risk factors are legion and varied.
First, consider that the environment includes care-
giver-child interactions, family resources, physical
properties, and organization. Within the area of care-
giver-child interaction is parenting ability. Limited
parenting ability, whether due to youth, inexperi-
ence, mental retardation, illicit drug abuse, or mental
illness, is a risk factor for developmental disability. In-
adequate supervision can lead to accident and injury.
Child neglect or abuse increases the risk of develop-
mental compromise. Additionally, parenting ability
can be limited due to physical separation because of
divorce or incarceration. Caregiver-child interactions
also include disciplinary techniques and the family’s
beliefs and attitudes. All of these can affect develop-
ment.
Many children at risk of developmental disability
often live in families with limited resources, frequent-
ly referred to as low socioeconomic status. Housing,
financial statuses, maternal education, availability of
medical insurance, and availability of appropriate
play materials are all part of family resources. Home-
lessness, poverty, low maternal education, single par-
ent families, and lack of medical insurance have all
been associated with increased risk of developmental
compromise. Unavailability of medical insurance usu-
ally means that preventative medical care, when most
developmental surveillance takes place, and prenatal
care are not obtained. Additionally, a family’s ability
to cope when suffering from stressful life events, such
as divorce, loss of a job, or death, depends on their
own resources and access to external sources of sup-
port.
Additional environmental influences impacting
development are the physical properties of the envi-
ronment, such as personal space, crowding, and ex-
cessive noise. The level of organization is also an
influence. This includes the predictability, structure,
and regularity of the home. Over many years, chil-
dren who live in poor or disorganized families are at
increased risk of slower cognitive development and
diminished school performance when compared to
their peers from more advantaged families.Intervention and Rehabilitation
The prevention of developmental disabilities
starts before conception. Good nutrition and ade-
quate prenatal care are essential components of a
healthy pregnancy, assuring the best outcome for an
infant, regardless of additional risk factors or disabili-
ties. With improvements in neonatal intensive care
and the care of premature infants, there is hope that
the risks associated with prematurity will diminish.
Influencing development in children’s lives re-
quires a societal commitment to the prevention and
rehabilitation of developmental disabilities. In 1997,
the Individuals with Disabilities Education Act (IDEA)
amendments (PL 105-17) re-established the right to
a free and appropriate education for all school-age
children, regardless of their disability. Additionally,
the federal government provides financial assistance
to states for the development of early intervention
programs for infants and toddlers with known devel-
opmental delays or disabilities and their families. At
each state’s discretion, infants and toddlers consid-
ered at risk for developmental disabilities may be en-
rolled in early intervention programs.
Early intervention programs are a system of ther-
apeutic and educational programs that work with an
infant or young child, from birth to age three, and
their family to prevent or minimize adverse
developmental outcomes for that child. An infant-
toddler specialist typically assists families. Therapeu-
tic approaches could include physical therapy, occu-
pational therapy, or speech and language therapy for
the child. These services can be provided through a
center-based or home-based model and include en-HIGH RISK INFANTS 187