Lokking Back on Growing up Psychology Essay

I will attached all relavent course material for writing this essay later including my 1st and 2nd BFI

INSTRUCTIONS: For your critical analysis paper, you will be challenged to use what we learn in class to look back on your life and how it has shaped your personality. You will also look forward to think about who you want to be. Nathan Hudson and colleagues have challenged the notion that personality traits do not change. They found that with consistent behaviors and goals, traits do in fact change. This paper will be about a class project inspired by Dr. Hudson’s work.

Papers will be about your personality formation through the lens of a class topic, and personality change through the lens of our class project. In the first 1 or 2 weeks of the semester everyone will read the same articles; everyone will take the BFI and CBFI and save their scores, then decide what they want to focus on for change activities. After completing about 8 weeks of change activities, everyone will take the BFI again and score it. Your paper should cite primary sources. Sources will be cited throughout the paper and in the bibliography at the end of the paper. APA format is preferred, MLA is ok too.

To set up the Project/Experience:

If you see an area of personality you would like to change, choose activities (at least one per week) from the lists provided to do weekly for 7-8 weeks IF you don’t want to change anything about your personality, choose activities from any category you’d like to do. Then track how you feel after completing them to include in your analysis of the BFI scores at the beginning and end of the semester. 

For writing your paper:

If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
Support for PBS.org provided by:
What’s this?
This Emotional Life
Login
Search
Search
Attachment / Blog
If I Had Bad Parents, Will I Be a Bad Parent Too?
Tina Payne Bryson, Ph.D
Topics
Tags:
Attachment
This content is provided in conjunction with This Emotional Life’s Early Moments Matter initiative. Early Moments Matter
is dedicated to making sure that every child has the best possible chance at emotional well-being. Find out how to
receive the Early Moments Matter tool kit and provide one to a family in need.
This post was co-written with Daniel J. Siegel, M.D.
When we speak to groups of parents, someone will often ask us some version of the question that appears in the title
above. Our answer? It’s up to you.
If you weren’t parented well, that doesn’t mean you can’t be a good parent. In fact, while parenting is a complex subject
to research, there’s one main factor we can point to as a determinant when it comes to how well we’ll raise our kids.
As we explain in our upcoming new book The Whole-Brain Child (Delacorte Press; October 4, 2011) there are many
ways you can help your kids be happier, healthier, and more fully themselves. We focus on practical steps you can
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 1 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
take right away to make an immediate difference in their behavior, in your relationship with them, and in who they
become.
Now we want to take a few minutes and talk about the most important parenting step you can take within yourself.
When it comes down to it, the number-one factor in how well a person parents isn’t about how much effort they put into
being consistent, kind, or patient, with their children. All of that influences parenting, but what you need to know is
actually much simpler (if not easier), and more hopeful.
Research has repeatedly shown that when parents offer repeated, predictable experiences in which they see and
sensitively respond to their children’s emotions and needs, their children will thrive—socially, emotionally, relationally,
and even academically. And while it’s not exactly a revelation that kids do better when they enjoy strong relationships
with their parents, what may surprise you is what produces this kind of parent-child connection. The most important
factor when it comes to how you relate with your kids and give them all those advantages, is how well you’ve made
sense of your experiences with your own parents.
To understand how this works, we can look at the research of Attachment Science, a branch of Child Psychology. The
knowledge we’ve gained from this scientific field over the last few decades has profoundly affected the way we
understand parenting and child development, and yet few parents know about it.
Attachment Science: What It Means for You as a Parent
In the 1960s, researchers developed a fascinating and revealing test they began giving children right around their first
birthday. Throughout the child’s first year, trained observers made home visits to assess mother-infant interaction on a
standardized rating scale. Then, at the end of the year, each mother-infant pair was taken into a room for about twenty
minutes for a test known as the “Infant Strange Situation.” It focuses on what happens when babies are separated from
their mothers and left in a “strange situation”—either with strangers or alone. By looking at how one-year-olds react
when dealing with the stress of watching their mothers leave a room, and how they respond when the mothers return,
researchers can learn a great deal about the babies’ attachment system—the way they connect with their primary
caregivers, and to what degree they expect that their needs will be met in significant relationships.
Over the thousands of times these studies have been repeated, we’ve learned that the key to the experiment is the
reunion phase: how the child greets the returning mother, how easily the child’s distress is relieved, and how quickly
the child returns to playing with the toys in the room. (Incidentally, the same experiments have been performed with
fathers, with the same general results.)
Researchers who perform the Strange Situation experiment consistently find that about two thirds of the children show
what we call a secure attachment. That means they show clear signs of missing their mother while she’s gone, actively
greet her when she returns, then settle down quickly and return to their toys and activities once the mother is back in
the room. Researchers find that the securely attached children are the ones whose parents can read their children’s
cues and consistently meet their needs, particularly when the child requests connection.
The other children, the ones who show a non-secure attachment, fall into one of three groups. The children in the first
group demonstrate what’s called an avoidant attachment. They show practically no distress or anger when their mother
leaves, and ignore or even avoid her when she returns. As you might suspect, home observations show that the
parents seem indifferent to the child’s signals and needs. They meet their child’s physical needs and provide them with
toys and activities, but the child’s emotional needs are ignored, leaving the child to learn that this lack of connection
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 2 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
means that the relationship holds no real importance for the parent nor a source of soothing for the child. Essentially,
these children adapt to this kind of relationship with what’s called behavioral avoidance—they cope with their mother’s
lack of attunement by minimizing the response of their attachment system, in effect, acting as if they don’t care whether
she is in the room or not.
The second group of insecurely attached children reveals what came to be called ambivalent or anxious attachment.
Here the parents show their children neither consistent nurturing nor consistent indifference. Instead, what
characterizes the first year of life for these children is parental inconsistency: sometimes attuned, sensitive, and
responsive, and at other times not. Still at other times, parents in this grouping can be intrusive, pushing their own
emotional state into the interaction and leaving the child’s feelings out of the communication. As a result, relationships
in general cause this child great anxiety. In the Strange Situation, for example, the ambivalently attached infant often
seems wary or distressed even before the mother leaves. Then, once the mother returns, he remains inconsolable.
Instead of returning to the toys as a securely attached child would, he clings to his mother with concern or even
desperation. There appears to be a lack of trust in the reliability of the relationship, and as a result, even physical
contact with the mother fails to give the child a sense of relief. The ambivalently attached child is afraid to move his
attention away from his mother for fear that she might leave again while he’s not looking. Here the attachment system
is put on high-alert, maximizing a sense of anxiety around separation.
The most disturbing type of non-secure attachment is disorganized attachment, where a child has trouble with an
organized, effective response when the mother returns to the room. The child might appear terrified, then approach the
mother, then withdraw, then fall on the floor and cry, then freeze up. The child may even cling to the mother while
simultaneously pulling away. Disorganized attachment results when children find their parents severely unattuned,
when the parents are frightening, and when the parents themselves are frightened. Unlike the children in the other
types of attachment, who develop patterns—secure or insecure—for responding to and dealing with a sensitive,
disconnected, or inconsistent caregiver, here the child has trouble coming up with any organized and effective way to
cope with distress. Here the infant has had the experience of inner conflict of being with a parent who is a source of
terror, and a resolution to this biological paradox is not possible. One circuit says, “Go to the attachment figure to be
protected and soothed,” while another simultaneously says, “Get away from the source of terror!” It’s not possible to go
toward and away from the same individual, and the attachment adaption collapses into disorganization.
Many of the children who were studied in the initial Infant Strange Situation experiments have been followed over the
last quarter-century. Researchers have been intrigued to discover that despite all of the influences and experiences in
the lives of the children as they grew up, they remained for the most part in the same attachment categories, even into
adulthood. Scientists were also surprised to find that these categories of attachment are not determined by
temperament or other genetically influenced measures. Attachment categories are an outcome of experience with a
particular caregiver. And one child can have a particular attachment approach that is unique with each caregiver,
dependent on the experience with that individual over time. These learned patterns with the primary caregiver also
then go on to influence how the child will interact with others—children and teachers—as they move out into the world.
For example, the children securely attached to a primary caregiver generally grew up to enjoy good relationships, be
respected by their peers, meet their intellectual potential, and regulate their emotions well. In contrast, children with
non-secure attachment lived with a sense of disconnection from others (avoidant attachment), uncertainty
(anxious/ambivalent attachment), or severe challenges to their ability to regulate emotion and maintain mutually
engaging relationships with others (disorganized attachment). The children with avoidant attachment tended to be seen
as rigidly aloof, controlling, and unlikeable. Ambivalently attached kids became adults who lived with a sense of anxiety
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 3 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
and insecurity. And those with disorganized attachment zigzagged back and forth between chaos and rigidity, thus
encountering severe problems when it came to relating with others and regulating their emotions.
What do these often-repeated studies by attachment researchers show us? Well, again, it’s pretty consistent with what
we’d expect: sensitive, attuned parents who are emotionally responsive raise kids who are resilient and emotionally
healthy, and who generally grow up to be well-adjusted and happy adults. Of course genetics influence how a child
turns out, as does chance. But even as early as a child’s first birthday, it’s extremely clear how much their parents
influence their development and perspective on the world—both in childhood and as they become adults.
Creating a Coherent Life Story
What do we do with this knowledge? We know we want to be sensitive and attuned to our children, and to help them
grow up with a secure attachment. But what if we, ourselves, grew up with less-than-perfect parents who weren’t the
kind of consistent caregivers that produce secure attachment? What if we exhibit some of the characteristics of an
avoidant, or ambivalent, or disorganized attachment? Are we doomed to repeat the same patterns?
Attachment Science offers an incredibly hopeful response: “Absolutely not”. Yes, the way we were parented
significantly influences the way we view the world and how we come to parent our children. But what’s even more
important than the specifics of what happened to us is how we’ve made sense of our own childhood experiences.
When we come to make sense of our memories and how the past has influenced us in the present, we become free to
construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our
lives, we free ourselves from the prison of the past.
It all comes down to what we call our life narrative, the story we tell when we look at who we are and how we’ve
become the person that we are. Our life narrative determines our feelings about our past, our understanding of why
people (like our parents) behaved as they did, and our awareness of the way those events have impacted our
development into adulthood.
Our life narrative may limit us in the present, and may also cause us to pass down to our children the same painful
legacy that marred our own early days. For instance, imagine that your father had a difficult childhood in which his
parents lived in an emotional desert and were cold and distant, leaving him to weather life’s hardships on his own. If
they failed to pay attention to him and his emotions, he would be damaged in significant ways. Abuse, of course, would
injure him in whole other ways. As a result, he would grow into adulthood wounded and limited in his ability to give you
what you need as his child. He might rage, or maybe he would be simply incapable of intimacy and relationship. Then
you, as you became an adult and a parent yourself, would be in danger of passing down the same damaging patterns
to your own kids. That’s the bad news.
The good news, though—the better-than-good news—is that if you make sense of your experiences and understand
your father’s wounded nature, you can break the cycle of inherited non-secure attachment. It may require hard work on
your part, possibly even some help from a therapist. You’ll most likely need to deal with implicit memories that are
doing their work on you without your realizing it. The process may not be easy. But by understanding your own
experiences and learning to tell the story of your childhood, the joys as well as the pain, you can become the kind of
parent whose children are securely attached and connected to you in strong and healthy ways.
But what does it mean, specifically, to make sense of our life story? The key is to develop what’s called a “coherent
narrative,” where we reflect on and acknowledge both positive and negative aspects of our family experiences, so we
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 4 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
can show how these experiences led us to become who we are as adults. For example, a section of a coherent
narrative might sound something like this: “My mother was always angry. She loved us, there was never any doubt
about that. But her parents had really done a number on her. Her dad worked all the time, and her mother was a
closet alcoholic. Mom was the oldest of six kids, so she always felt like she had to be perfect. So she bottled
everything up, and her emotions just boiled over anytime something went wrong. My sisters and I usually took the
brunt of it, sometimes even physically. I worry that sometimes I let my kids get away with too much, and I think part of
that is because I don’t want them to feel that pressure to be perfect.”
Like many of us, this woman obviously had a childhood that was less-than-ideal. But she can talk clearly about it, even
finding compassion for her mother, and reflect on what it all means for herself and her children. She can offer specific
details about her experience, moving easily from memory to understanding. That’s a coherent narrative.
Many people who are securely attached as adults grew up with parents who, while not being perfect, did a good job
most of the time to consistently responding to their children’s needs. But other people are like this woman and achieve
what’s called “earned secure attachment,” which means that even though their parents didn’t present them with the kind
of childhood that would lead to secure attachment as adults, they overcame this major obstacle by making sense of
what they went through.
In contrast, adults who haven’t done the difficult emotional work of developing a coherent narrative and earning secure
attachment, are more challenged in specific ways when it comes to telling their life story in a way that makes sense.
When asked about their early family life, they may become lost in the details, even getting preoccupied with recent
events from their adult life. This is the pattern for a parent of a child with anxious/ambivalent attachment. Or a parent
might not be willing or able to recall emotional and relational details at all. This lack of recall of past events and an
expressed attitude that relationships are not important in life is the pattern found in parents of children who are
avoidantly attached to them. In the most severe cases, a person may have experienced trauma or loss as a child, so
clear communication about their past becomes filled with moments of disorientation or disorganization. In many ways,
these moments are thought to reveal unresolved trauma and grief as the common pathway in parents who have
children with a disorganized attachment.
Without a coherent narrative that gives us a foundation for understanding ourselves and how the past has impacted
who we are, we are often quite challenged to be fully present as a parent and remain receptive to who our child is.
When we haven’t made sense of the past, we are quite likely to repeat the mistakes of our own parents as we raise our
children.
But when we gather the courage to look at and get clear on our own past, and we develop the ability to narrate our own
stories in a clear and coherent way, we can begin to heal from our past wounds. In doing so, we prepare ourselves to
form a secure attachment with our children, and that solid relationship will be a source of resilience throughout their
lives. Research shows that even when parents have to “earn” their security later in life by creating a coherent narrative,
they can parent their kids as effectively as those who had more optimal childhoods, and raise children who feel loved
and securely attached.
We want to make this point as clearly as possible: Early experience is not fate. By making sense of your past you can
free yourself from what might otherwise be a cross-generational legacy of pain and insecure attachment, and instead
create an inheritance of nurturance and love for your children.
We hope you can sense our passion as we share with parents everywhere this awe-inspiring message of hope. Dan
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 5 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
and Mary Hartzell wrote a book, Parenting from the Inside Out, that focuses on this very message. If you’re interested
in delving deeper into the information we’re presenting here, this book is a great place to start.
Even if you experienced an enormous amount of pain, neglect, or chaos as a child, you now have the opportunity to
take those experiences and understand them, developing a coherent account of what happened to you. This coherent
narrative is the number one predictor of a strong attachment relationship with your children, and more than anything
else you can do, it gives them the opportunity to thrive in the different stages of their lives.
So that’s our most heart-felt message to anyone raising kids: Regardless of your upbringing, and whatever happened
to you in your past, you can be the loving, sensitive parent you want to be, and raise kids who are happy, successful,
and fully themselves. It all starts with reflecting on your experiences and developing a coherent life narrative. Then you
can feel confident that you’re ready to create the kind of relationship with your children that promotes integration and
well-balanced lives. As a result, you can all more easily survive the daily challenges, and truly thrive.
*Adapted in part from The Whole-Brain Child by Dan Siegel and Tina Payne Bryson.
Go to www.earlymomentsmatter.org to learn about attachment and to get an award-winning toolkit that introduces ways
in which parents and caregivers can help their children build secure attachments.
References:
Siegel, D.J., & Bryson, T.P. (2011). The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s
Developing Mind, Survive Everyday Parenting Struggles, and Help Your Family Thrive. New York, NY: Delacorte.
Siegel, D.J., & Hartzell, M. (2003). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You
Raise Children Who Thrive. New York, NY: Tarcher.
This Emotional Life is a co-production of the NOVA/WGBH Science Unit and Vulcan Productions, Inc. A Film by
Kunhardt McGee Productions. ©/™ 2009 WGBH Educational Foundation and Vulcan Productions, Inc. All Rights
Reserved.
This Web site was produced for PBS Online by elephants & ants.
Funding for This Emotional Life is provided by the Corporation for Public Broadcasting and Public Television Viewers.
Additional funding provided by the University of Phoenix and the Substance Abuse and Mental Health Services
Administration.
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 6 of 6
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
Well – Tara Parker-Pope on Health
JUNE 11, 2012, 2:48 PM
The Makings of Our Earliest Memories
By PERRI KLASS, M.D.
Like many other pediatricians, I do not wear a white coat. Many of us believe that babies and
small children suffer from a special form of “white coat syndrome,” that mix of trepidation
and anxiety that some adults experience — to the point of high blood pressure — in a medical
setting.
The pediatric version is easy to diagnose: Doctor in white coat walks into room, kid starts to
cry. I worry that a child like this has recalled shots or an unpleasant ear check and has
connected that memory to a particular garment, rather than to my face, or my exam room, or
my stethoscope.
But how realistic is that? Do babies remember past events? Starting when? Recent
investigations of memory formation raise fascinating questions about how young children
store and retrieve experiences and information.
In some ways, I believe we tend to exalt the memory-related feats of the infant and the
toddler. True, they can learn language, even more than one; sorting out words and syntax
from the surrounding noise is in many ways a defining human use of memory. Nora
Newcombe, a professor of psychology at Temple University, points out that there may be
evolutionary reasons that this kind of memory — semantic memory — is so strong in the
early years of life, when babies are faced with learning so many facts about the world.
And yet, every adult lacks memories from the very early years. Freud called it “infantile
amnesia,” describing “the peculiar amnesia which veils from most people (not from all!) the
first years of their childhood.” Not surprisingly, he felt we repress those early childhood
memories because they contain the beginnings of sexual feeling.
That particular theory has not held sway for many years, and in this era of measurement and
M.R.I.’s, we have come to a more anatomic understanding of the development of infant
memory. It is part of the larger picture of how different kinds of memory develop while the
brain undergoes remarkable periods of early growth and interconnection.
Several decades ago it was thought that very young infants did not have the capacity for
forming memories, said Patricia Bauer, a professor of psychology at Emory University. As
techniques have been developed for testing infants and very young children, it has been
found that “the neural structures creating those representations in infancy are qualitatively
the same as in older children and adults,” she said.
The crucial structure for episodic memory, the memory of autobiographical events, is the
hippocampus, that little curved ridge in the middle of the brain whose shape reminded a
1 of 3
3/30/13 3:37 PM
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
16th-century anatomist of a sea horse.
Dr. Bauer compared memory forming to making gelatin: “The experience is the liquid
gelatin; you pour it into a mold. The mold is the hippocampus, and it has to go through a
process of refrigeration known as consolidation.”
So memories can form in even very young children, it seems. But it is not clear that they can
be retrieved.
“Retrieval forms later,” said Charles Nelson, a professor of pediatrics at Harvard and Boston
Children’s Hospital. “You need an interconnected network of structures to retrieve things
from memory. When you are working on your computer, you know enough to save things to
your hard drive, but do you know enough to retrieve them?”
Recent research suggests that some of those very early memories may actually be held into
childhood, but then lost as children grow into adolescence. And research has also shown a
strong cultural component to the question of how far back children remember.
As a developmental psychologist, Carole Peterson, professor of psychology at Memorial
University of Newfoundland, is interested in the autobiographical stories that young children
tell. In 2011, she and her colleagues published a study of children’s memories.
Children ages 4 to 13 were asked about their earliest memories, and then those children were
asked the same question two years later. The older children were more likely to recall the
same memories, but the younger ones often gave completely different answers. When
prompted with the memories they recounted at the earlier interview, many could not recall
them at all.
So 3- and 4-year-olds do remember events from the very early years. “They clearly do have
the memories, they do have the language skills,” Dr. Peterson said. “But often, by the time
they grow up to be adults, those memories are gone. This age of earliest memory seems to be
a moving target.”
In studies comparing Chinese children with Canadian children, the Canadian children were
able to remember a year further back and to remember more. This may reflect differences in
how parents talk to children and in what kinds of stories and experiences are emphasized in
the two cultures.
Dr. Peterson said that two qualities predicted whether a child was more likely to hold on to a
particular memory. If the child mentioned emotion when describing a memory, it was much
more likely to stick. And if the memory was described coherently, with sequence and cause
understood, it was more likely to have been retained.
Parents who discuss memories with their children and ask who-what-when questions, she
said, can help children understand how memories work. “By making it more elaborative,
they’re showing children that good memories are structured, they have a context, a
chronological structure, they have important emotional points,” she said.
2 of 3
3/30/13 3:37 PM
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
The development of memory encompasses the development of language, the development of
consciousness, personality and personal narrative. Infants are not only figuring out a new
world, but also coming to understand their own independent existence, what one researcher
called “me-ness.”
And it is an enduring fascination that as adults, we cannot quite see back into the earliest
years of that formation, as the neurons branched and the gelatin cooled and we became our
early selves.
Copyright 2013 The New York Times Company
3 of 3
Privacy Policy
NYTimes.com 620 Eighth Avenue New York, NY 10018
3/30/13 3:37 PM
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
Support for PBS.org provided by:
What’s this?
This Emotional Life
Login
Search
Search
Attachment / Blog
If I Had Bad Parents, Will I Be a Bad Parent Too?
Tina Payne Bryson, Ph.D
Topics
Tags:
Attachment
This content is provided in conjunction with This Emotional Life’s Early Moments Matter initiative. Early Moments Matter
is dedicated to making sure that every child has the best possible chance at emotional well-being. Find out how to
receive the Early Moments Matter tool kit and provide one to a family in need.
This post was co-written with Daniel J. Siegel, M.D.
When we speak to groups of parents, someone will often ask us some version of the question that appears in the title
above. Our answer? It’s up to you.
If you weren’t parented well, that doesn’t mean you can’t be a good parent. In fact, while parenting is a complex subject
to research, there’s one main factor we can point to as a determinant when it comes to how well we’ll raise our kids.
As we explain in our upcoming new book The Whole-Brain Child (Delacorte Press; October 4, 2011) there are many
ways you can help your kids be happier, healthier, and more fully themselves. We focus on practical steps you can
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 1 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
take right away to make an immediate difference in their behavior, in your relationship with them, and in who they
become.
Now we want to take a few minutes and talk about the most important parenting step you can take within yourself.
When it comes down to it, the number-one factor in how well a person parents isn’t about how much effort they put into
being consistent, kind, or patient, with their children. All of that influences parenting, but what you need to know is
actually much simpler (if not easier), and more hopeful.
Research has repeatedly shown that when parents offer repeated, predictable experiences in which they see and
sensitively respond to their children’s emotions and needs, their children will thrive—socially, emotionally, relationally,
and even academically. And while it’s not exactly a revelation that kids do better when they enjoy strong relationships
with their parents, what may surprise you is what produces this kind of parent-child connection. The most important
factor when it comes to how you relate with your kids and give them all those advantages, is how well you’ve made
sense of your experiences with your own parents.
To understand how this works, we can look at the research of Attachment Science, a branch of Child Psychology. The
knowledge we’ve gained from this scientific field over the last few decades has profoundly affected the way we
understand parenting and child development, and yet few parents know about it.
Attachment Science: What It Means for You as a Parent
In the 1960s, researchers developed a fascinating and revealing test they began giving children right around their first
birthday. Throughout the child’s first year, trained observers made home visits to assess mother-infant interaction on a
standardized rating scale. Then, at the end of the year, each mother-infant pair was taken into a room for about twenty
minutes for a test known as the “Infant Strange Situation.” It focuses on what happens when babies are separated from
their mothers and left in a “strange situation”—either with strangers or alone. By looking at how one-year-olds react
when dealing with the stress of watching their mothers leave a room, and how they respond when the mothers return,
researchers can learn a great deal about the babies’ attachment system—the way they connect with their primary
caregivers, and to what degree they expect that their needs will be met in significant relationships.
Over the thousands of times these studies have been repeated, we’ve learned that the key to the experiment is the
reunion phase: how the child greets the returning mother, how easily the child’s distress is relieved, and how quickly
the child returns to playing with the toys in the room. (Incidentally, the same experiments have been performed with
fathers, with the same general results.)
Researchers who perform the Strange Situation experiment consistently find that about two thirds of the children show
what we call a secure attachment. That means they show clear signs of missing their mother while she’s gone, actively
greet her when she returns, then settle down quickly and return to their toys and activities once the mother is back in
the room. Researchers find that the securely attached children are the ones whose parents can read their children’s
cues and consistently meet their needs, particularly when the child requests connection.
The other children, the ones who show a non-secure attachment, fall into one of three groups. The children in the first
group demonstrate what’s called an avoidant attachment. They show practically no distress or anger when their mother
leaves, and ignore or even avoid her when she returns. As you might suspect, home observations show that the
parents seem indifferent to the child’s signals and needs. They meet their child’s physical needs and provide them with
toys and activities, but the child’s emotional needs are ignored, leaving the child to learn that this lack of connection
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 2 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
means that the relationship holds no real importance for the parent nor a source of soothing for the child. Essentially,
these children adapt to this kind of relationship with what’s called behavioral avoidance—they cope with their mother’s
lack of attunement by minimizing the response of their attachment system, in effect, acting as if they don’t care whether
she is in the room or not.
The second group of insecurely attached children reveals what came to be called ambivalent or anxious attachment.
Here the parents show their children neither consistent nurturing nor consistent indifference. Instead, what
characterizes the first year of life for these children is parental inconsistency: sometimes attuned, sensitive, and
responsive, and at other times not. Still at other times, parents in this grouping can be intrusive, pushing their own
emotional state into the interaction and leaving the child’s feelings out of the communication. As a result, relationships
in general cause this child great anxiety. In the Strange Situation, for example, the ambivalently attached infant often
seems wary or distressed even before the mother leaves. Then, once the mother returns, he remains inconsolable.
Instead of returning to the toys as a securely attached child would, he clings to his mother with concern or even
desperation. There appears to be a lack of trust in the reliability of the relationship, and as a result, even physical
contact with the mother fails to give the child a sense of relief. The ambivalently attached child is afraid to move his
attention away from his mother for fear that she might leave again while he’s not looking. Here the attachment system
is put on high-alert, maximizing a sense of anxiety around separation.
The most disturbing type of non-secure attachment is disorganized attachment, where a child has trouble with an
organized, effective response when the mother returns to the room. The child might appear terrified, then approach the
mother, then withdraw, then fall on the floor and cry, then freeze up. The child may even cling to the mother while
simultaneously pulling away. Disorganized attachment results when children find their parents severely unattuned,
when the parents are frightening, and when the parents themselves are frightened. Unlike the children in the other
types of attachment, who develop patterns—secure or insecure—for responding to and dealing with a sensitive,
disconnected, or inconsistent caregiver, here the child has trouble coming up with any organized and effective way to
cope with distress. Here the infant has had the experience of inner conflict of being with a parent who is a source of
terror, and a resolution to this biological paradox is not possible. One circuit says, “Go to the attachment figure to be
protected and soothed,” while another simultaneously says, “Get away from the source of terror!” It’s not possible to go
toward and away from the same individual, and the attachment adaption collapses into disorganization.
Many of the children who were studied in the initial Infant Strange Situation experiments have been followed over the
last quarter-century. Researchers have been intrigued to discover that despite all of the influences and experiences in
the lives of the children as they grew up, they remained for the most part in the same attachment categories, even into
adulthood. Scientists were also surprised to find that these categories of attachment are not determined by
temperament or other genetically influenced measures. Attachment categories are an outcome of experience with a
particular caregiver. And one child can have a particular attachment approach that is unique with each caregiver,
dependent on the experience with that individual over time. These learned patterns with the primary caregiver also
then go on to influence how the child will interact with others—children and teachers—as they move out into the world.
For example, the children securely attached to a primary caregiver generally grew up to enjoy good relationships, be
respected by their peers, meet their intellectual potential, and regulate their emotions well. In contrast, children with
non-secure attachment lived with a sense of disconnection from others (avoidant attachment), uncertainty
(anxious/ambivalent attachment), or severe challenges to their ability to regulate emotion and maintain mutually
engaging relationships with others (disorganized attachment). The children with avoidant attachment tended to be seen
as rigidly aloof, controlling, and unlikeable. Ambivalently attached kids became adults who lived with a sense of anxiety
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 3 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
and insecurity. And those with disorganized attachment zigzagged back and forth between chaos and rigidity, thus
encountering severe problems when it came to relating with others and regulating their emotions.
What do these often-repeated studies by attachment researchers show us? Well, again, it’s pretty consistent with what
we’d expect: sensitive, attuned parents who are emotionally responsive raise kids who are resilient and emotionally
healthy, and who generally grow up to be well-adjusted and happy adults. Of course genetics influence how a child
turns out, as does chance. But even as early as a child’s first birthday, it’s extremely clear how much their parents
influence their development and perspective on the world—both in childhood and as they become adults.
Creating a Coherent Life Story
What do we do with this knowledge? We know we want to be sensitive and attuned to our children, and to help them
grow up with a secure attachment. But what if we, ourselves, grew up with less-than-perfect parents who weren’t the
kind of consistent caregivers that produce secure attachment? What if we exhibit some of the characteristics of an
avoidant, or ambivalent, or disorganized attachment? Are we doomed to repeat the same patterns?
Attachment Science offers an incredibly hopeful response: “Absolutely not”. Yes, the way we were parented
significantly influences the way we view the world and how we come to parent our children. But what’s even more
important than the specifics of what happened to us is how we’ve made sense of our own childhood experiences.
When we come to make sense of our memories and how the past has influenced us in the present, we become free to
construct a new future for ourselves and for how we parent our children. Research is clear: If we make sense of our
lives, we free ourselves from the prison of the past.
It all comes down to what we call our life narrative, the story we tell when we look at who we are and how we’ve
become the person that we are. Our life narrative determines our feelings about our past, our understanding of why
people (like our parents) behaved as they did, and our awareness of the way those events have impacted our
development into adulthood.
Our life narrative may limit us in the present, and may also cause us to pass down to our children the same painful
legacy that marred our own early days. For instance, imagine that your father had a difficult childhood in which his
parents lived in an emotional desert and were cold and distant, leaving him to weather life’s hardships on his own. If
they failed to pay attention to him and his emotions, he would be damaged in significant ways. Abuse, of course, would
injure him in whole other ways. As a result, he would grow into adulthood wounded and limited in his ability to give you
what you need as his child. He might rage, or maybe he would be simply incapable of intimacy and relationship. Then
you, as you became an adult and a parent yourself, would be in danger of passing down the same damaging patterns
to your own kids. That’s the bad news.
The good news, though—the better-than-good news—is that if you make sense of your experiences and understand
your father’s wounded nature, you can break the cycle of inherited non-secure attachment. It may require hard work on
your part, possibly even some help from a therapist. You’ll most likely need to deal with implicit memories that are
doing their work on you without your realizing it. The process may not be easy. But by understanding your own
experiences and learning to tell the story of your childhood, the joys as well as the pain, you can become the kind of
parent whose children are securely attached and connected to you in strong and healthy ways.
But what does it mean, specifically, to make sense of our life story? The key is to develop what’s called a “coherent
narrative,” where we reflect on and acknowledge both positive and negative aspects of our family experiences, so we
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 4 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
can show how these experiences led us to become who we are as adults. For example, a section of a coherent
narrative might sound something like this: “My mother was always angry. She loved us, there was never any doubt
about that. But her parents had really done a number on her. Her dad worked all the time, and her mother was a
closet alcoholic. Mom was the oldest of six kids, so she always felt like she had to be perfect. So she bottled
everything up, and her emotions just boiled over anytime something went wrong. My sisters and I usually took the
brunt of it, sometimes even physically. I worry that sometimes I let my kids get away with too much, and I think part of
that is because I don’t want them to feel that pressure to be perfect.”
Like many of us, this woman obviously had a childhood that was less-than-ideal. But she can talk clearly about it, even
finding compassion for her mother, and reflect on what it all means for herself and her children. She can offer specific
details about her experience, moving easily from memory to understanding. That’s a coherent narrative.
Many people who are securely attached as adults grew up with parents who, while not being perfect, did a good job
most of the time to consistently responding to their children’s needs. But other people are like this woman and achieve
what’s called “earned secure attachment,” which means that even though their parents didn’t present them with the kind
of childhood that would lead to secure attachment as adults, they overcame this major obstacle by making sense of
what they went through.
In contrast, adults who haven’t done the difficult emotional work of developing a coherent narrative and earning secure
attachment, are more challenged in specific ways when it comes to telling their life story in a way that makes sense.
When asked about their early family life, they may become lost in the details, even getting preoccupied with recent
events from their adult life. This is the pattern for a parent of a child with anxious/ambivalent attachment. Or a parent
might not be willing or able to recall emotional and relational details at all. This lack of recall of past events and an
expressed attitude that relationships are not important in life is the pattern found in parents of children who are
avoidantly attached to them. In the most severe cases, a person may have experienced trauma or loss as a child, so
clear communication about their past becomes filled with moments of disorientation or disorganization. In many ways,
these moments are thought to reveal unresolved trauma and grief as the common pathway in parents who have
children with a disorganized attachment.
Without a coherent narrative that gives us a foundation for understanding ourselves and how the past has impacted
who we are, we are often quite challenged to be fully present as a parent and remain receptive to who our child is.
When we haven’t made sense of the past, we are quite likely to repeat the mistakes of our own parents as we raise our
children.
But when we gather the courage to look at and get clear on our own past, and we develop the ability to narrate our own
stories in a clear and coherent way, we can begin to heal from our past wounds. In doing so, we prepare ourselves to
form a secure attachment with our children, and that solid relationship will be a source of resilience throughout their
lives. Research shows that even when parents have to “earn” their security later in life by creating a coherent narrative,
they can parent their kids as effectively as those who had more optimal childhoods, and raise children who feel loved
and securely attached.
We want to make this point as clearly as possible: Early experience is not fate. By making sense of your past you can
free yourself from what might otherwise be a cross-generational legacy of pain and insecure attachment, and instead
create an inheritance of nurturance and love for your children.
We hope you can sense our passion as we share with parents everywhere this awe-inspiring message of hope. Dan
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 5 of 6
If I Had Bad Parents, Will I Be a Bad Parent Too? | This Emotional Life
2/13/15, 9:32 AM
and Mary Hartzell wrote a book, Parenting from the Inside Out, that focuses on this very message. If you’re interested
in delving deeper into the information we’re presenting here, this book is a great place to start.
Even if you experienced an enormous amount of pain, neglect, or chaos as a child, you now have the opportunity to
take those experiences and understand them, developing a coherent account of what happened to you. This coherent
narrative is the number one predictor of a strong attachment relationship with your children, and more than anything
else you can do, it gives them the opportunity to thrive in the different stages of their lives.
So that’s our most heart-felt message to anyone raising kids: Regardless of your upbringing, and whatever happened
to you in your past, you can be the loving, sensitive parent you want to be, and raise kids who are happy, successful,
and fully themselves. It all starts with reflecting on your experiences and developing a coherent life narrative. Then you
can feel confident that you’re ready to create the kind of relationship with your children that promotes integration and
well-balanced lives. As a result, you can all more easily survive the daily challenges, and truly thrive.
*Adapted in part from The Whole-Brain Child by Dan Siegel and Tina Payne Bryson.
Go to www.earlymomentsmatter.org to learn about attachment and to get an award-winning toolkit that introduces ways
in which parents and caregivers can help their children build secure attachments.
References:
Siegel, D.J., & Bryson, T.P. (2011). The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s
Developing Mind, Survive Everyday Parenting Struggles, and Help Your Family Thrive. New York, NY: Delacorte.
Siegel, D.J., & Hartzell, M. (2003). Parenting from the Inside Out: How a Deeper Self-Understanding Can Help You
Raise Children Who Thrive. New York, NY: Tarcher.
This Emotional Life is a co-production of the NOVA/WGBH Science Unit and Vulcan Productions, Inc. A Film by
Kunhardt McGee Productions. ©/™ 2009 WGBH Educational Foundation and Vulcan Productions, Inc. All Rights
Reserved.
This Web site was produced for PBS Online by elephants & ants.
Funding for This Emotional Life is provided by the Corporation for Public Broadcasting and Public Television Viewers.
Additional funding provided by the University of Phoenix and the Substance Abuse and Mental Health Services
Administration.
http://www.pbs.org/thisemotionallife/blogs/if-i-had-bad-parents-will-i-be-bad-parent-too
Page 6 of 6
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
Well – Tara Parker-Pope on Health
JUNE 11, 2012, 2:48 PM
The Makings of Our Earliest Memories
By PERRI KLASS, M.D.
Like many other pediatricians, I do not wear a white coat. Many of us believe that babies and
small children suffer from a special form of “white coat syndrome,” that mix of trepidation
and anxiety that some adults experience — to the point of high blood pressure — in a medical
setting.
The pediatric version is easy to diagnose: Doctor in white coat walks into room, kid starts to
cry. I worry that a child like this has recalled shots or an unpleasant ear check and has
connected that memory to a particular garment, rather than to my face, or my exam room, or
my stethoscope.
But how realistic is that? Do babies remember past events? Starting when? Recent
investigations of memory formation raise fascinating questions about how young children
store and retrieve experiences and information.
In some ways, I believe we tend to exalt the memory-related feats of the infant and the
toddler. True, they can learn language, even more than one; sorting out words and syntax
from the surrounding noise is in many ways a defining human use of memory. Nora
Newcombe, a professor of psychology at Temple University, points out that there may be
evolutionary reasons that this kind of memory — semantic memory — is so strong in the
early years of life, when babies are faced with learning so many facts about the world.
And yet, every adult lacks memories from the very early years. Freud called it “infantile
amnesia,” describing “the peculiar amnesia which veils from most people (not from all!) the
first years of their childhood.” Not surprisingly, he felt we repress those early childhood
memories because they contain the beginnings of sexual feeling.
That particular theory has not held sway for many years, and in this era of measurement and
M.R.I.’s, we have come to a more anatomic understanding of the development of infant
memory. It is part of the larger picture of how different kinds of memory develop while the
brain undergoes remarkable periods of early growth and interconnection.
Several decades ago it was thought that very young infants did not have the capacity for
forming memories, said Patricia Bauer, a professor of psychology at Emory University. As
techniques have been developed for testing infants and very young children, it has been
found that “the neural structures creating those representations in infancy are qualitatively
the same as in older children and adults,” she said.
The crucial structure for episodic memory, the memory of autobiographical events, is the
hippocampus, that little curved ridge in the middle of the brain whose shape reminded a
1 of 3
3/30/13 3:37 PM
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
16th-century anatomist of a sea horse.
Dr. Bauer compared memory forming to making gelatin: “The experience is the liquid
gelatin; you pour it into a mold. The mold is the hippocampus, and it has to go through a
process of refrigeration known as consolidation.”
So memories can form in even very young children, it seems. But it is not clear that they can
be retrieved.
“Retrieval forms later,” said Charles Nelson, a professor of pediatrics at Harvard and Boston
Children’s Hospital. “You need an interconnected network of structures to retrieve things
from memory. When you are working on your computer, you know enough to save things to
your hard drive, but do you know enough to retrieve them?”
Recent research suggests that some of those very early memories may actually be held into
childhood, but then lost as children grow into adolescence. And research has also shown a
strong cultural component to the question of how far back children remember.
As a developmental psychologist, Carole Peterson, professor of psychology at Memorial
University of Newfoundland, is interested in the autobiographical stories that young children
tell. In 2011, she and her colleagues published a study of children’s memories.
Children ages 4 to 13 were asked about their earliest memories, and then those children were
asked the same question two years later. The older children were more likely to recall the
same memories, but the younger ones often gave completely different answers. When
prompted with the memories they recounted at the earlier interview, many could not recall
them at all.
So 3- and 4-year-olds do remember events from the very early years. “They clearly do have
the memories, they do have the language skills,” Dr. Peterson said. “But often, by the time
they grow up to be adults, those memories are gone. This age of earliest memory seems to be
a moving target.”
In studies comparing Chinese children with Canadian children, the Canadian children were
able to remember a year further back and to remember more. This may reflect differences in
how parents talk to children and in what kinds of stories and experiences are emphasized in
the two cultures.
Dr. Peterson said that two qualities predicted whether a child was more likely to hold on to a
particular memory. If the child mentioned emotion when describing a memory, it was much
more likely to stick. And if the memory was described coherently, with sequence and cause
understood, it was more likely to have been retained.
Parents who discuss memories with their children and ask who-what-when questions, she
said, can help children understand how memories work. “By making it more elaborative,
they’re showing children that good memories are structured, they have a context, a
chronological structure, they have important emotional points,” she said.
2 of 3
3/30/13 3:37 PM
The Makings of a Memory Continue to Fascinate – NYTimes.com
http://well.blogs.nytimes.com/2012/06/11/the-makings-of-our-earlie…
The development of memory encompasses the development of language, the development of
consciousness, personality and personal narrative. Infants are not only figuring out a new
world, but also coming to understand their own independent existence, what one researcher
called “me-ness.”
And it is an enduring fascination that as adults, we cannot quite see back into the earliest
years of that formation, as the neurons branched and the gelatin cooled and we became our
early selves.
Copyright 2013 The New York Times Company
3 of 3
Privacy Policy
NYTimes.com 620 Eighth Avenue New York, NY 10018
3/30/13 3:37 PM
Academic Achievement Varies With Gestational Age Among Children Born at
Term
Kimberly G. Noble, William P. Fifer, Virginia A. Rauh, Yoko Nomura and Howard F.
Andrews
Pediatrics; originally published online July 2, 2012;
DOI: 10.1542/peds.2011-2157
The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2012/06/27/peds.2011-2157
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2012 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
ARTICLE
Academic Achievement Varies With Gestational Age
Among Children Born at Term
AUTHORS: Kimberly G. Noble, MD, PhD,a,b,c William P. Fifer,
PhD,a,d,e Virginia A. Rauh, ScD,f Yoko Nomura, PhD,g and
Howard F. Andrews, PhDb,d,h
Departments of aPediatrics, dPsychiatry, fPopulation and Family
Health, and hBiostatistics, and bG. H. Sergievsky Center, Columbia
University, New York, New York; cMorgan Stanley Children’s
Hospital of New York-Presbyterian, New York, New York; eNew
York State Psychiatric Institute, Sackler Institute for
Developmental Psychobiology, New York, New York; and
gDepartment of Psychiatry, Mount Sinai School of Medicine, New
York, New York
WHAT’S KNOWN ON THIS SUBJECT: Late preterm infants are at
risk for a variety of developmental impairments; however, little is
known about developmental differences among children born
within the term range of 37 to 41 weeks’ gestation.
WHAT THIS STUDY ADDS: This study links comprehensive birth
record data from 128 050 term births to children’s school records
8 years later. Analyses establish that, even among the “normal
term” range, gestational age is an important independent
predictor of academic achievement.
KEY WORDS
gestational age, developmental outcomes, risk factors, school
performance, reading achievement
ABBREVIATIONS
BOE—Board of Education
CTB—California Testing Bureau
DOHMH—Department of Health and Mental Hygiene
NYC—New York City
www.pediatrics.org/cgi/doi/10.1542/peds.2011-2157
doi:10.1542/peds.2011-2157
Accepted for publication Mar 27, 2012
Address correspondence to Kimberly Noble, MD, PhD, Assistant
Professor of Pediatrics, Columbia University, 630 W. 168th St, P&S
Box 16, New York, NY 10033. E-mail: kgn2106@columbia.edu
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2012 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.
FUNDING: Funding for this research was provided by the John
M. Driscoll, MD Scholars Program (K.G.N.), NIH grant
P01ES009600 (H.F.A. and V.A.R.), ACYF Head Start Bureau grant 90YD-0023 (H.F.A. and V.A.R.) and NIH grant R37 HD032773 (W.P.F.).
Funded by the National Institutes of Health (NIH).
abstract
OBJECTIVE: The goal of this study was to examine the degree to which
children born within the “normal term” range of 37 to 41 weeks’
gestation vary in terms of school achievement.
METHODS: This study analyzed data from 128 050 singleton births born
between 37 and 41 weeks’ gestation in a large US city. Data were
extracted from city birth records to assess a number of obstetric,
social, and economic variables, at both the individual and community
levels. Birth data were then matched with public school records of
standardized city-wide third-grade reading and math tests. Specifically,
we assessed (1) whether children born within the normal term range of
37 to 41 weeks’ gestation show differences in reading and/or math
ability 8 years later as a function of gestational age, and (2) the
degree to which a wide range of individual- and community-level
social and biological factors mediate this effect.
RESULTS: Analyses revealed that gestational age within the normal
term range was significantly and positively related to reading and math
scores in third grade, with achievement scores for children born at 37
and 38 weeks significantly lower than those for children born at 39, 40,
or 41 weeks. This effect was independent of birth weight, as well as
a number of other obstetric, social, and economic factors.
CONCLUSIONS: Earlier normal term birth may be a characteristic considered by researchers, clinicians, and parents to help identify children who may be at risk for poorer school performance. Pediatrics
2012;130:1–8
PEDIATRICS Volume 130, Number 2, August 2012
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
1
The developmental risks of early preterm birth are well established. Recently it has been recognized that even
late preterm infants, born from 34 to 36
weeks’ gestation, are at risk for adverse developmental outcomes.1–9 Less
clear, however, is the degree to which
developmental risk varies with gestational age among infants born “at
term,” between 37 and 41 weeks’ gestation. Brain development continues
throughout gestation, including rapid
growth in the final month of pregnancy.10,11 Yet children born from 37 to
41 weeks’ gestation are frequently combined into a single reference group in
studies investigating cognitive outcomes.1,3–6,8,9,12–14 It is unclear whether
this cut point of 37 weeks is appropriate,12 and the degree of heterogeneity
in academic achievement across this
5-week period of “normal” gestation remains largely uninvestigated.
This study uses a retrospective cohort
design to examine a large sample of
urban American children born across
the range of term gestation, to investigate whether earlier gestational age
at birth confers a continuum of risk for
poor academic achievement. Access to
a large data set linking comprehensive
birth records to school records affords
the unique opportunity to explore a wide
range of individual- and community-level
social and biological factors that may
mediate this effect.
Specification of Variables
METHODS
Population
The study sample consists of all singleton births born to mothers residing
in New York City (NYC) from 1988 to 1992
who (1) were between 37 and 41 weeks’
gestation, (2) subsequently enrolled in
third grade in NYC public schools from
1996 to 2000, and (3) for whom thirdgrade standardized reading or math
test scores were available. Birth records
from the NYC Department of Health and
Mental Hygiene (DOHMH) were matched
2
to NYC Board of Education (BOE) records,
as described previously.15,16 Briefly, a
data file from the DOHMH, containing the
full name, birth date, and gender of each
child was sent to the BOE to be matched
against a file containing information
on all children who have attended
NYC public schools. To be considered a
match, the DOHMH and BOE records
were required to be identical with respect to the first 6 characters of both
the first and last name; the month, day,
and year of birth; and gender. There
were 150 589 children whose data were
successfully matched in this manner.
Additional criteria for inclusion in the
study included having valid data for all
20 demographic and risk variables described in the next section, membership
in 1 of 4 major ethnic groups (Asian
American, non-Hispanic African American,
non-Hispanic white, Hispanic), and delivery within 1 of the 5 NYC boroughs. In
all, 128 050 (85.0%) met these criteria
and also had available reading test data.
A small number of these children did
not have available math test data, and
thus analyses involving math scores
included a slightly smaller sample of
127 532 children (84.7% of the full
matched sample). After matching, the
data were de-identified by the BOE and
made available for analysis, as part of
a protocol approved by the DOHMH, BOE,
and the Columbia University Institutional Review Board.
The outcomes of interest were the
child’s scores on the California Testing
Bureau (CTB) Achievement Test, a citywide proprietary standardized test
adapted from the Terra Nova test series specifically for the NYC BOE by CTB/
McGraw-Hill. The standardized reading
test measured students’ ability to understand continuous prose, focusing
on evaluating meaning of written text.17
The standardized math test measured
basic mathematical skills, such as computation and estimation.18 The CTB was
administered to all NYC public school
third-graders from 1996 to 2000. Because the scale of the CTB changed between 1996 and 1998, scores for each
year were converted to T scores (M = 50;
SD = 10) based on city-wide means and
SDs provided by the BOE.15
NYC hospitals abstract information
from the medical records of all deliveries, which is reported to the DOHMH.
We derived 20 variables representing
obstetric,individual-level,andcommunitylevel characteristics, many of which
conferriskforpoor schoolperformance,
as suggested by previous studies.15,16,19
Obstetric characteristics included gestational week at birth (defined by the
start of the week, ie, from 37 weeks,
0 days, to 37 weeks, 6 days), birth weight,
cesarean delivery, parity, low prenatal
care (#6 prenatal visits), and advanced
maternal age ($35 years).
Individual-level characteristics included
years of maternal education, Medicaid
status, teenage motherhood, marital
status, mother’s nativity (foreign-born),
history of maternal substance abuse
(including alcohol), history of maternal
smoking in pregnancy, child gender, and
mother’s race/ethnicity (African American
non-Hispanic, white non-Hispanic, Asian,
and Hispanic).
Community-level characteristics were
derived from US Census and NYC Department of Criminal Justice data, to
characterize the neighborhood in which
the mother resided at the time of delivery.
The unit of analysis for community-level
variables was the NYC Health Area, as
defined by the DOHMH. Each Health Area
contains ∼20 000 people and is an aggregate of 4 to 6 contiguous US census
tracts. Community-level variables included
percentage of residents living below the
federal poverty level, percentage who
immigrated within the previous 5 years,
percentage of housing units with .1
person per room, percentage of residents with stable housing for $5 years,
and neighborhood homicide rate.
NOBLE et al
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
ARTICLE
Data Analysis
TABLE 1 Summary Statistics for All Risk Factors (n = 128 050)
We first assessed whether, within the
“normal term” gestational range, there
existed a significant relation between
weeks of gestation at birth and thirdgrade reading and/or math scores.
Relative risk of reading and math deficits were then calculated for infants
born at each gestational week relative
to the reference of 41 weeks. Next, as
the relationship between gestational
age and school achievement scores
may be confounded by birth weight, the
models were expanded to include birth
weight. Last, we examined the effects of
all individual, community, and obstetric
characteristics described previously.
RESULTS
Table 1 describes the sample with respect to all obstetric, individual, and
community-level factors. These summary statistics reflect the striking diversity of the NYC population, with a
high proportion of mothers in various
risk groups.
Reading and math scores were, unsurprisingly, highly correlated (R = 0.694;
P , .001). Initial analyses consisted of 2
one-way analyses of variance, examining the effect of gestational week at
birth on third-grade reading and math
scores, respectively. Gestational age
within the normal term range was significantly and positively related to both
third-grade reading score (F [4, 128 045] =
21.635; P , 7.2 3 10218) and thirdgrade math score (F [4, 127 527] =
27.904; P , 3.4 3 10223), with scores
improving with each week of gestation,
as shown in Figs 1 and 2. Table 2 shows
that both reading and math scores for
children born at 37 and 38 weeks were
significantly lower than those of children born at any other week, adjusting
for multiple comparisons by using the
Bonferroni method. Differences among
children born at 39, 40, or 41 weeks’
gestation were not significant (although
in all cases, the nonsignificant trend was
Variable Description
Mean (SD) or Count/%
Obstetric factors
Gestational wk
37
38
39
40
41
Birth weight, g
Cesarean delivery
Parity
Low or no prenatal care
Advanced maternal age ($35 y)
Individual-level factors
Child gender
Male
Female
Race/Ethnicity
White non-Hispanic
African American non-Hispanic
Asian
Hispanic
Maternal education, y
Medicaid
Teenage mother
Mother unmarried
Mother foreign-born
Maternal substance use during pregnancy (including alcohol)
Maternal smoking during pregnancy
Community-level factors (mean % of community population)
Percent below poverty level
Percent recent immigrants (within previous 5 y)
Percent living in crowded housing units
Percent living in same house $5 y before census
Homicide rate (per 10 000 residents)
39.25 (1.2)
12 184/9.52
23 365/18.25
35 197/27.49
35 213/27.50
22 091/17.25
3328 (485)
19 624/15.3
1.94 (1.2)
30 982/24.2
14 711/11.5
61 775/48.2
66 275/51.8
34 950/27.3
42 875/33.5
11 847/9.3
38 378/30.0
12.0 (2.4)
48 113/37.6
14 409/11.3
53 991/42.2
62 845/49.1
3295/2.6
6723/5.3
22.7 (13.8)
6.0 (3.8)
17.2 (8.4)
58.5 (5.8)
1.4 (1.2)
Means and SDs are shown for continuous variables. Counts and percentages are shown for dichotomous variables. Mean
percentages are shown for community-level variables.
for greater reading and math scores at
later gestational ages).
We next assessed, for each week of
gestation, the relative risk of mild, moderate, and severe reading and math
impairments, defined as at least 1.0, 1.5,
and 2.0 SDs below the population average, respectively. Table 3 shows that
relative to children born at 41 weeks’
gestation, children born at 37 weeks
have a 14% greater risk of having at
least mild reading impairment, a 23%
increased risk of having at least moderate reading impairment, and a 33%
increased risk of having a severe reading impairment. Children born at 38
weeks’ gestation have an 8% increased
risk of at least mild reading impairment
and a 13% increased risk of at least
moderate reading impairment. Table 4
shows that children born at 37 weeks
have a 16% greater risk of having at
least mild math impairment and a 19%
increased risk of having at least moderate math impairment. Children born
at 38 weeks have a 12% increased risk of
having at least mild math impairment.
Because of the association between
birth weight and gestational age,14,20
birth weight was introduced into the
models. Both birth weight and gestational age were significant, independent predictors of reading score (birth
weight: b = 0.062; P , .0001; gestational age: b = 0.011; P , .0001) and
math score (birth weight: b = 0.092;
P , .0001; gestational age: b = 0.007;
P , .012).
PEDIATRICS Volume 130, Number 2, August 2012
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
3
be a significant predictor of school
achievement, even after adjusting for
these obstetric, individual-level, and
community-level characteristics.
DISCUSSION
FIGURE 1
Gestational week at birth was significantly and positively associated with reading score: (F [4, 128 045] =
21.635; P , 7.2 3 10–18). Error bars represent 61 SE.
FIGURE 2
Gestational week at birth was significantly and positively associated with math score: (F [4, 127 527] =
27.904; P , 3.4 3 10–23). Error bars represent 61 SE.
To elucidate the possible mechanisms
mediating the effect of gestational age
on school achievement, we next developed 3 general linear models. In
each model, both reading and math
scores were included as dependent
variables. The 3 models incorporated,
4
respectively, the obstetric, individuallevel, and community-level characteristics described previously. Most of
these variables were highly significant predictors of third-grade reading
and math scores. Table 5 shows that
gestational age at birth continues to
The American Academy of Pediatrics
and the National Institute of Child Health
and Human Development recently
classified infants born from 34 to 36
weeks’ gestation as “late preterm,”21
signaling an awareness that these infants are at increased risk for a number
of developmental outcomes, including
lower IQ,1,2 developmental delay,3,4 deficits in visuospatial and executive
function skills,5 reading difficulties,6,7
behavioral disorders,8 attention-deficit/
hyperactivity disorder,9 and even mental
retardation3,8 and cerebral palsy.3,8
Surprisingly, far less is known about the
degree to which earlier gestational age
confers risk among infants born at term,
from 37 to 41 weeks’ gestation.7,22–24
The brain continues to grow rapidly
during this time, with a nearly 50% increase in cortical gray matter,10 a nearly
threefold increase in myelinated white
matter,10 and increasing neuronal and
gyral differentiation.11 Further, among
term infants born from 37 to 41 weeks,
later gestational age is associated with
greater gray matter density in middle
childhood in bilateral superior and
middle temporal gyri, and the left parietal lobe.25 These regions have been
associated with reading26 and math
performance,27 respectively.
Based on this reasoning, we hypothesized that the commonly held belief that
children born between 37 and 41 weeks’
gestation will tend to develop “normally”
without any difference as a function of
the particular week of gestation may not
be accurate.
This study provides support for this
hypothesis. Among a sample of 128 050
children born at term, we found a significant, positive relationship between
gestational age at birth and third-grade
NOBLE et al
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
ARTICLE
TABLE 2 Difference in Reading and Math Scores by Week of Gestationa
Week
Gestation (I)
Week
Comparison (J)
37
38
39
40
Reading Scores
Math Scores
Mean Difference
(I 2 J)
SE
P
Mean Difference
(I 2 J)
SE
P
20.358
20.636
20.775
20.820
20.278
20.417
20.462
20.137
20.184
20.045
0.107
0.101
0.101
0.109
0.081
0.081
0.090
0.072
0.082
0.082
.001b
,.0001b
,.0001b
,.0001b
.001b
,.0001b
,.0001b
.055
.025
.582
20.445
20.732
20.822
20.871
20.287
20.377
20.426
20.090
20.139
20.049
0.097
0.092
0.092
0.098
0.073
0.073
0.082
0.066
0.075
0.075
,.0001b
,.0001b
,.0001b
,.0001b
,.0001b
,.0001b
,.0001b
.17
.063
.513
38
39
40
41
39
40
41
40
41
41
Children born at 37 and 38 weeks’ gestation score significantly lower on reading and math achievement tests than children
born at every other week.
a a set at 0.0025 to control for multiple comparisons (eg, 0.05/20).
b Significant when using Bonferroni correction for multiple comparisons.
school achievement. Each week of increased gestation from 37 to 41 weeks
showed an added benefit in both reading and math scores. Further, children
born at 37 or 38 weeks performed significantly worse than children born at
39, 40, or 41 weeks, and have a significantly increased relative risk of impaired
reading and math skills on standardized
school achievement tests.
These findings have important implications in considering the definition of
“term.” The intrauterine environment
likely supports typical brain development, which may be more likely to be
disrupted when children are born early,
even within the commonly defined period of term gestation. This disruption
may affect later academic achievement,
as our findings suggest.
The mechanisms underlying the effect
of gestational age at birth on school
achievement are likely multifactorial.
Because of the nature of this remarkable data set, in which birth records
containing a large set of variables were
matched with corresponding public
school records 8 years later, we were
able to examine the effects of a number
of obstetric, economic, and social characteristics. Indeed, nearly all characteristics assessed were highly significant
predictors of third-grade school achievement. Although a broad range of obstetric, individual-level, and community-level
socioeconomic and demographic characteristics were considered, the effect of
gestational age persisted even when
controlling for these potential mediating
factors. Future research is necessary to
investigate the causal mechanism(s)
explaining the relations described here.
More specifically, we may ask: Is there
a subtle yet meaningful risk of impaired
development caused by birth at 37 to 38
weeks, relative to birth in the 39- to 41week range? Or, is the apparent risk of
what might be called “early term birth”
(37 to 38 weeks’ gestation), seen in Figs 1
and 2, caused by the confounding effects
of other unmeasured factors, risks that
are themselves associated with both early
term birth and school performance?
Regardless of the mechanism, the evidence presented previously suggests
that it may be inappropriate to cluster
children born between 37 and 41 weeks’
gestation together as a single category
when considering developmental outcomes. This has several important
implications.
From a scientific perspective, the inappropriate grouping of heterogeneous
populations may lead to a loss of power
when investigating developmental differences. From a clinical perspective,
these data suggest that early term birth
may be a characteristic by which pediatricians may identify children who
may be at risk for poorer school performance. It should also be noted that
there is an increasing trend for performing elective early deliveries for
nonmedical reasons,28 contributing in
part to the fact that the most common
length of gestation for singleton births
has shifted from 40 to 39 weeks.28 Although further research is needed,
women or physicians seeking early delivery for social or logistical reasons
may wish to consider this finding, particularly before 39 weeks.
TABLE 3 Relative Risk of Mild, Moderate, and Severe Reading Impairment
Gestational Week
Not Impaired,
n (%)
At Least Mildly Poor
Reading, n (%)
Relative Risk
Mildly Poor
Reading (95% CI)
At Least Moderately
Poor Reading, n (%)
Relative Risk
Moderately Poor
Reading (95% CI)
Severely Poor
Reading, n (%)
Relative Risk
Severely Poor
Reading (95% CI)
37 (n = 12 184)
38 (n = 23 365)
39 (n = 35 197)
40 (n = 35 213)
41 (n = 22 091)
10 749 (88.2)
20 740 (88.8)
31 507 (89.5)
31 535 (89.6)
19 800 (89.6)
1436 (11.8)
2625 (11.2)
3690 (10.5)
3678 (10.4)
2291 (10.4)
1.14 (1.07–1.21)
1.08 (1.03–1.14)
1.011 (0.96–1.06)
1.007 (0.96–1.06)
n/a
660 (5.4)
1169 (5.0)
1647 (5.2)
1577 (4.5)
979 (4.4)
1.23(1.12–1.35)
1.13 (1.04–1.23)
1.05 (0.98–1.14)
1.01 (0.94–1.09)
n/a
283(2.3)
457 (2.0)
658 (2.1)
641 (1.8)
390 (1.8)
1.33 (1.14–1.54)
1.12 (0.98–1.28)
1.06 (0.93–1.20)
1.03 (0.91–1.17)
n/a
Relative risk of mild, moderate, and severe reading impairment for children born from 37 to 40 weeks’ gestation, relative to the reference group of 41 weeks’ gestation. Children born at 37 wk
are at increased risk for all levels of impairment. Children born at 38 wk are at increased risk for mild and moderate impairment. “Mildly poor reading,” “Moderately poor reading,” and
“Severely poor reading” are defined as scoring at least 1.0, 1.5, or 2.0 SDs below population average, respectively. “Not impaired” is defined as performance better than the mildly impaired
group. CI, confidence interval.
PEDIATRICS Volume 130, Number 2, August 2012
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
5
TABLE 4 Relative Risk of Mild, Moderate, and Severe Math Impairment
Gestational Week
Not Impaired, n (%)
At Least Mildly
Poor Math, n (%)
Relative Risk
Mildly Poor
Math (95% CI)
At Least Moderately
Poor Math, n (%)
Relative Risk
Moderately Poor
Math (95% CI)
Severely Poor
Math, n (%)
Relative Risk
Severely Poor
Math (95% CI)
37 (n = 12 119)
38 (n = 23 273)
39 (n = 35 074)
40 (n = 35 075)
41 (n = 21 991)
11 311 (93.3)
21 782 (93.6)
32 999 (94.1)
33 031 (94.2)
20 729 (94.3)
808 (6.7)
1491 (6.4)
2075 (5.9)
2044 (5.8)
1262 (5.7)
1.16 (1.07–1.27)
1.12 (1.04–1.20)
1.03 (0.96–1.10)
1.02 (0.95–1.09)
n/a
287 (2.4)
520 (2.2)
758 (2.2)
708 (2.0)
443 (2.0)
1.19 (1.02–1.38)
1.11 (0.98–1.27)
1.07 (0.95–1.21)
1.00 (0.89–1.13)
n/a
130 (1.1)
242 (1.0)
349 (1.0)
308 (0.9)
200 (0.9)
1.19 (0.95–1.49)
1.15 (0.95–1.39)
1.10 (0.92–1.31)
0.97 (0.81–1.16)
n/a
Relative risk of mild, moderate and severe math impairment for children born from 37 to 40 weeks’ gestation, relative to the reference group of 41 weeks’ gestation. Children born at 37 wk are
at increased risk for mild to moderate math impairment. Children born at 38 wk are at increased risk for mild math impairment. “Mildly poor math,” “Moderately poor math,” and “Severely
poor math” are defined as scoring at least 1, 1.5, or 2 SDs below population average, respectively. “Not impaired” is defined as performance better than the mildly impaired group. CI,
confidence interval.
TABLE 5 Models of Effects of Gestational Age on School Achievement, Controlling for Obstetric, Individual-Level, and Community-Level Characteristics
Model 1: Obstetric-level characteristics
Birth weight
Cesarean delivery
Parity
Low or no prenatal care
Advanced maternal age
Gestational wk
Model 2: Individual-level characteristics
Child gender (male)
Race/Ethnicity:
Black Non-Hispanic
Asian
Hispanic
Maternal education
Medicaid
Teenage mother
Mother unmarried
Mother foreign-born
Maternal substance use during pregnancy (including alcohol)
Maternal smoking during pregnancy
Gestational wk
Model 3: Community-level characteristics
Neighborhood poverty, %
Neighborhood foreign born, %
Neighborhood housing crowding, %
Neighborhood housing stability, %
Neighborhood homicide rate (per 10 000 residents)
Gestational wk
Adjusted Mean Square: Reading
Adjusted Mean Square: Math
F
P
34 150
5215
208 107
73 186
115 623
204
65 439
4009
156 073
70 518
84 422
208
451.757
34.027
1343.239
539.022
737.990
2.916
,.0001
,.0001
,.0001
,.0001
,.0001
.020
79 714
4674
1256.990
,.0001
239 432
240
188 223
452 097
25 579
357
39 845
2281
0
3102
116
309 123
60 305
180 582
329 967
13 291
1248
38 738
363
17
2664
169
2553.988
784.791
1612.586
3338.661
168.999
10.578
344.306
44.988
0.288
24.864
2.734
,.0001
,.0001
,.0001
,.0001
,.0001
,.0001
,.0001
,.0001
.749
,.0001
.027
108 295
6105
39 341
156
39 070
841
64 987
34 422
50 371
2196
61 566
830
679.034
287.809
376.147
39.765
448.677
0.016
,.0001
,.0001
,.0001
,.0001
,.0001
,.0001
Three multivariate general linear models were constructed including both math and reading scores as dependent variables. Independent variables included obstetric characteristics in model
1; individual-level characteristics in model 2; and community-level characteristics in model 3. Most of these characteristics were highly significant predictors of third-grade school
achievement. In each case, after adjusting for these potential mediators, gestational age at birth significantly predicted achievement test scores. Significance levels of multivariate tests
are reported by using Roy’s Largest Root. Follow-up univariate tests revealed that, when controlling for other obstetric factors, gestational week was a significant predictor of math (F = 2.870;
P , .022) but not reading (F = 2.310; P , .055). Similar univariate results were found when controlling for individual-level characteristics (math: F = 2.715; P , .028); reading: F = 1.468; P ,
.209). When controlling for community-level characteristics, univariate tests showed that gestational week was a significant predictor of both math (F = 12.052; P , .0001) and reading (F =
9.891; P , .0001).
This study has several limitations. Notably, although gestational age from 37
to 41 weeks showed a graded relationship with third-grade reading and
math scores, the effect size was small.
Many other social, economic, and obstetric factors predict academic achievement in elementary school; however, the
6
goal of this study was not to provide
a comprehensive model accounting for
the largest possible amount of variance
in school achievement. Rather, we
asked specifically whether there would
be a detectable difference in reading
and math achievement among children
born at different weeks of gestation
within the commonly accepted normal
range, and we have answered that
question in the affirmative. Given that
so many other powerful factors affect
school performance in the years between birth and third grade, the fact
that, 8 years later, we still observe statistically significant differences between
NOBLE et al
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
ARTICLE
children born only 1 week apart (eg, 38
vs 39 weeks), within the normal range of
gestational ages, is noteworthy. Further,
although the average difference in score
by gestational week was small, the
finding of a significantly increased relative risk for reading and math impairment renders these data clinically
relevant. For example, children born at
37 weeks’ gestation were found to be
33% more likely to experience a severe
reading deficit (defined here as 2 SDs
below the mean) relative to children
born at 41 weeks’ gestation. Of course,
this study’s large sample size provided
considerable statistical power. Thus,
although smaller increases in relative
risk were also detectable for more mild
deficits, the degree to which some of
these more moderate increases in risk
should translate to effects on clinical
decision-making is not yet clear.
Another limitation of the study may be
restricted generalizability. The sample
was obtained from birth records in a
large American city, consisting of a
relatively high proportion of minority
and disadvantaged families. The causes
underlying early term birth in this population (including whether early deliveries were performed on an elective
basis) are unknown. However, other recent population-based studies also indicate a negative impact on cognition
from birth at 37 to 38 weeks relative to
later birth in Denmark,7 Belarus,22
Switzerland,24 and Scotland,23 suggesting that the effect reported here may
indeed be robust.
This study involved secondary data in
which the primary measures were not
obtained by using rigorous research
methods. Birth record data were abstracted by hospitals, and more precise
information, such as whether gestational age was obtained by dates or
ultrasound, is not available. Additionally, it is likely that some gestational
ages may have been incorrectly assigned prenatally or in the delivery
room. Factors that could further illuminate underlying mechanisms, such
as the percentage of elective versus
emergent deliveries, are unknown. The
particular outcome measures used do
not reflect all aspects of reading or math
achievement, and effects on other skills
(writing, mathematical reasoning) are
unknown. Indeed, later editions of these
standardized tests have subsequently
been updated to reflect more current
educational testing practices, focusing
more, for instance, on abstract reasoning and solving real-life problems.18
scores unrelated to true reading and
math ability. These factors, together
with other unmeasured factors between
birth and age 8, contribute to measurement error, and therefore reduce
effect size. So although the error measurement inherent in the use of public
records is a necessary limitation in research of this type,29–31 we would argue
that because of the effect-attenuation of
this error measurement, the negative
impact of early term birth on academic
achievement is likely greater than the
small but significant effect we report
here.
CONCLUSIONS
Further, third-grade children taking
tests in a classroom are distractible
and not necessarily motivated to perform well, and differences between
schools, classes, and testing environments may create variability in test
Increased gestational age at birth has
a positive association with third-grade
reading and math scores among children born in the 37- to 41-week range,
commonly defined as term gestation.
From a public health perspective, this
may have important consequences,
particularly in the realm of identifying
children who may be at risk for poorer
school achievement. Elucidating the
mechanisms underlying this association
will requirefurtherresearch; however,in
light of the increasing trend for performing elective early deliveries for
nonmedical reasons, researchers, clinicians, and parents are urged to consider
this graded relationship between weeks
of gestation and school performance.
preterm infants. J Pediatr. 2009;154(2):
169–176
4. Morse SB, Zheng H, Tang Y, Roth J. Early
school-age outcomes of late preterm infants.
Pediatrics. 2009;123(4). Available at: www.
pediatrics.org/cgi/content/full/123/4/e622
5. Baron IS, Erickson K, Ahronovich MD, Coulehan
K, Baker R, Litman FR. Visuospatial and verbal
fluency relative deficits in ‘complicated’ latepreterm preschool children. Early Hum Dev.
2009;85(12):751–754
6. Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe
TL. School outcomes of late preterm
infants: special needs and challenges for
infants born at 32 to 36 weeks gestation.
J Pediatr. 2008;153(1):25–31
7. Kirkegaard I, Obel C, Hedegaard M,
Henriksen TB. Gestational age and birth
weight in relation to school performance of
10-year-old children: a follow-up study of
children born after 32 completed weeks.
Pediatrics. 2006;118(4):1600–1606
8. Moster D, Lie RT, Markestad T. Long-term
medical and social consequences of preterm birth. N Engl J Med. 2008;359(3):262–
273
REFERENCES
1. van Baar AL, Vermaas J, Knots E, de Kleine
MJ, Soons P. Functioning at school age of
moderately preterm children born at 32 to
36 weeks’ gestational age. Pediatrics. 2009;
124(1):251–257
2. Eide MG, Oyen N, Skjaerven R, Bjerkedal T.
Associations of birth size, gestational age,
and adult size with intellectual performance:
evidence from a cohort of Norwegian men.
Pediatr Res. 2007;62(5):636–642
3. Petrini JR, Dias T, McCormick MC, Massolo
ML, Green NS, Escobar GJ. Increased risk of
adverse neurological development for late
PEDIATRICS Volume 130, Number 2, August 2012
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
7
9. Linnet KM, Wisborg K, Agerbo E, Secher NJ,
Thomsen PH, Henriksen TB. Gestational
age, birth weight, and the risk of hyperkinetic disorder. Arch Dis Child. 2006;91(8):
655–660
10. Hüppi PS, Warfield S, Kikinis R, et al.
Quantitative magnetic resonance imaging
of brain development in premature and
mature newborns. Ann Neurol. 1998;43(2):
224–235
11. Adams-Chapman I. Neurodevelopmental
outcome of the late preterm infant. Clin
Perinatol. 2006;33(4):947–964, abstract xi
12. Kirby RS, Wingate MS. Late preterm birth
and neonatal outcome: is 37 weeks’ gestation a threshold level or a road marker
on the highway of perinatal risk? Birth.
2010;37(2):169–171
13. Santos IS, Matijasevich A, Domingues MR,
Barros AJ, Victora CG, Barros FC. Late
preterm birth is a risk factor for growth
faltering in early childhood: a cohort study.
BMC Pediatr. 2009;9:71
14. Gurka MJ, LoCasale-Crouch J, Blackman JA.
Long-term cognition, achievement, socioemotional, and behavioral development of
healthy late-preterm infants. Arch Pediatr
Adolesc Med. 2010;164(6):525–532
15. Rauh VA, Parker FL, Garfinkel RS, Perry J,
Andrews HF. Biological, social, and community influences on third-grade reading
levels of minority Head Start children:
a multilevel approach. J Community Psychol.
2003;31(3):255–278
8
16. Andrews H, Goldberg D, Wellen N, Pittman
B, Struening E. Prediction of special education placement from birth certificate data.
Am J Prev Med. 1995;11(suppl 3):55–61
17. Board of Education of the City of New York.
New Standards. Performance Standards for
English Language Arts. Assessment based on
standards. 1997. Available at: http://schools.
nyc.gov/offices/teachlearn/documents/
standards/ela/preface/11assessment.html.
2011. Accessed December 20, 2011
18. Frequently asked questions. In: TerraNova,
The Second Edition: California achievement
tests. Monterey, CA: CTB/McGraw-Hill; 2000
19. Goldberg D, McLaughlin M, Grossi M, Tytun
A, Blum S. Which newborns in New York
City are at risk for special education
placement? Am J Public Health. 1992;82(3):
438–440
20. Talge NM, Holzman C, Wang J, Lucia V,
Gardiner J, Breslau N. Late-preterm birth
and its association with cognitive and
socioemotional outcomes at 6 years of age.
Pediatrics. 2010;126(6):1124–1131
21. Raju TN. The problem of late-preterm (nearterm) births: a workshop summary. Pediatr
Res. 2006;60(6):775–776
22. Yang S, Platt RW, Kramer MS. Variation in
child cognitive ability by week of gestation
among healthy term births. Am J Epidemiol.
2010;171(4):399–406
23. Schofield TJ, Martin MJ, Conger KJ, Neppl
TM, Donnellan MB, Conger RD. Intergenerational transmission of adaptive functioning:
a test of the interactionist model of SES and
human development. Child Dev. 2011;82(1):
33–47
24. Yang S, Bergvall N, Cnattingius S, Kramer
MS. Gestational age differences in health
and development among young Swedish
men born at term. Int J Epidemiol. 2010;39
(5):1240–1249
25. Davis EP, Buss C, Muftuler LT, et al. Children’s brain development benefits from
longer gestation. Front Psychol. 2011;2:1–7
26. McCandliss BD, Noble KG. The development
of reading impairment: a cognitive neuroscience model. Ment Retard Dev Disabil Res
Rev. 2003;9(3):196–204
27. Dehaene S, Spelke E, Pinel P, Stanescu R,
Tsivkin S. Sources of mathematical thinking: behavioral and brain-imaging evidence.
Science. 1999;284(5416):970–974
28. Damus K. Prevention of preterm birth:
a renewed national priority. Curr Opin Obstet
Gynecol. 2008;20(6):590–596
29. Gould JB, Chavez G, Marks AR, Liu H. Incomplete birth certificates: a risk marker
for infant mortality. Am J Public Health.
2002;92(1):79–81
30. Buescher PA, Taylor KP, Davis MH, Bowling
JM. The quality of the new birth certificate
data: a validation study in North Carolina.
Am J Public Health. 1993;83(8):1163–1165
31. Reichman NE, Hade EM. Validation of birth
certificate data. A study of women in New
Jersey’s HealthStart program. Ann Epidemiol.
2001;11(3):186–193
NOBLE et al
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
Academic Achievement Varies With Gestational Age Among Children Born at
Term
Kimberly G. Noble, William P. Fifer, Virginia A. Rauh, Yoko Nomura and Howard F.
Andrews
Pediatrics; originally published online July 2, 2012;
DOI: 10.1542/peds.2011-2157
Updated Information &
Services
including high resolution figures, can be found at:
http://pediatrics.aappublications.org/content/early/2012/06/27
/peds.2011-2157
Subspecialty Collections
This article, along with others on similar topics, appears in
the following collection(s):
Developmental/Behavior
http://pediatrics.aappublications.org/cgi/collection/developme
ntal:behavior
Permissions & Licensing
Information about reproducing this article in parts (figures,
tables) or in its entirety can be found online at:
http://pediatrics.aappublications.org/site/misc/Permissions.xh
tml
Reprints
Information about ordering reprints can be found online:
http://pediatrics.aappublications.org/site/misc/reprints.xhtml
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2012 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.
Downloaded from pediatrics.aappublications.org at Columbia University on July 2, 2012
Pregnancy
If you are pregnant or even just thinking about it, now is the
time to begin caring for your unborn baby. Doing so involves
caring for your own health both before and during pregnancy.
It also involves learning about important pregnancy topics
and milestones. Taking these steps will help you to have a safe
pregnancy and healthy baby. Also, knowing what to expect will
help to ease any worries you might have so you can enjoy this
exciting time.
Your health before pregnancy
The chances of having a safe pregnancy
and healthy baby are best when pregnancy is planned. This way, you can take action early on to prevent health problems
that might affect you or your baby later.
If you are sexually active, talk to your
doctor about your preconception health.
Be sure to discuss your partner’s health,
too. Ask your doctor about:
L
L
L
L
Family planning and birth control.
Taking folic acid.
Vaccines you may need.
Managing health problems such as
diabetes, high blood pressure, thyroid
disease, obesity, depression, eating
disorders, and asthma. Find out how
pregnancy may affect, or be affected by,
health problems you have.
Preconception Health
This is a woman’s health before she
becomes pregnant. It means knowing
how health problems and risk factors
could affect a woman or her baby if
she becomes pregnant.
Pregnancy
L
L
Tests for hepatitis, HIV, and other
sexually transmitted infections (STIs).
Medicines you use, including overthe-counter, herbal, and prescription
drugs and supplements.
169
kee-toh-NUR-ee-uh) (PKU) or sickle
cell anemia (uh-NEE-mee-uh). (See
page 408 of the Appendix for more
information about genetic testing and
working with a genetic counselor.)
Unplanned Pregnancy
If you have an unplanned pregnancy,
start taking care of yourself right away.
You will feel good knowing that you
are doing all you can to care for your
unborn baby.
L
L
L
Ways to improve your overall health,
such as reaching a healthy weight,
making healthy food choices, being physically active, caring for your
teeth and gums, quitting smoking, and
avoiding alcohol.
How to avoid illness. Some infections, like cytomegalovirus (SEYEtoh-MEG-uh-loh-VEYE-ruhss), can
cause birth defects.
Health problems that run in your family, such as phenylketonuria (fee-nuhl-
L
Problems you have had with prior
pregnancies.
Becoming pregnant
You are most likely to become pregnant
if you have sex just before or just after
ovulation. Most women ovulate between
day 11 and day 21 of their menstrual
cycle. Count day one as the first day of
your last normal period. Most couples
who are trying are able to conceive
within 1 year. If you think you might be
pregnant, you can take a home pregnancy
test 1 to 2 weeks after a missed period.
Your doctor can confirm pregnancy with
a blood test and pelvic exam.
For at least 3 months before and throughout your pregnancy:
• Get 400 micrograms of folic acid daily to lower the risk
of certain birth defects, including spina bifida. Folic acid
pills are best. You can also take a multivitamin that contains at least 400 micrograms …

Order an Essay Now & Get These Features For Free:

Turnitin Report

Formatting

Title Page

Citation

Outline

Place an Order