Defined as poor growth in the absence of adequate biological explanation, Failure-to-thrive ("FTT") has been linked to depressed immunologic resistance and activity level, cognitive/academic deficits, and behavior problems. The role of familial components has long been implicated, and intervention efforts are often targeted toward maternal and familial issues. The findings of one study suggest that among low-socioeconomic standing families of children with FTT, home intervention may be most useful among mothers with low negative emotional temperament. The study also highlights the importance of conducting follow-up assessments in the evaluation of home intervention services (Journal of Pediatric Psychology, 22:5 pp 651-668).
At baseline all child participants were diagnosed with FTT of non-medical origin. Study recruitment criteria included weight-for-age below the 5th percentile and weight-for-height below the 10th percentile. Birth weight was appropriate for gestational age, and there were no congenital problems or handicapping. Most caretakers were in their early 20s, had limited education, and had never been married (83%). A comprehensive evaluation was conducted prior to treatment, one year after recruitment and again when the children turned age 4 when data were available on 74 subjects.
Two types of risk (demographic and maternal negative affectivity) were explored. Demographic risk was calculated by summing positive indicators on six risk categories. Poverty was the most common, followed by high household density, and maternal education. Maternal psychological functioning was measured using subscales of the Brief Symptom Index with a composite score combining depression, hostility, and anxiety.
Two levels of intervention were examined. All families were enrolled in a multidisciplinary growth and nutrition clinic and received ongoing nutritional, medical, and behavioral intervention. Half of the families were also randomly assigned to a home-intervention group whose goals were to provide maternal support and promote parenting, child development, and utilization of formal and informal resources. One-hour weekly home visits were included for 1 year. Child developmental outcome, child interactive behavior, and child behavior at play were assessed at the end of the intervention period and at age 4.
Results at age 4, however, show that all children who received the home-based intervention had higher scores on motor development than those who received only the clinic intervention. Children of mothers who evidenced low levels of negative emotionality were more able to benefit from the in-home component of the intervention. These children showed higher scores than other home-intervention children in cognitive development and behavior during play.
The fact that this pattern occurred in two contexts (standardized developmental assessment and videotaped interaction with parent) adds to the strength of the finding that maternal psychological functioning moderates the impact of early intervention on the development and interactive behavior of 4-year-old children. The authors state that, nevertheless, wide variability in performance remained, suggesting that other child and family factors may influence response to intervention.
The study indicates that targeted and assertive intervention in appropriate family systems may therefore head off eventual termination of parental rights and the emotional consequences that follow.
