1. Chapter 5 Environmental and Psychosocial Causes © Taylor & Francis 2015

2. ENVIRONMENTAL AND PSYCHOSOCIAL CAUSES Environmental Factors may occur pre-, peri-, or postnatally. Prenatal Causes occur prior to birth. Teratogens are any agents that may cause a defect in a developing fetus. Infections Toxoplasmosis is an infection carried in raw meat and cat feces. Rubella, or German measles, is an infection particularly problematic if contracted in the first trimester of pregnancy. Sexually transmitted infections © Taylor & Francis 2015

3. PRENATAL CAUSES HIV infection may be passed from mother to child and lead to future neurological damage. Radiation was first associated with birth defects following the bombings of Hiroshima and Nagasaki, although medical radiation exposure has been found to cause problems in fetuses, especially at an early gestational age. Malnutrition is a major concern in developing countries and worldwide. Maternal malnutrition during pregnancy is the lack of nutrition that may affect children prenatally and in combination with environmental deprivation after birth may be the most common cause of CIDs in the world. Low birth weight is an established risk factor closely associated with poor nutrition and inadequate maternal weight gain during pregnancy or may lead to being small for gestational age. © Taylor & Francis 2015

4. PRENATAL CAUSES Other factors affecting prenatal development include variables other than teratogens. Maternal and paternal age are related to higher risk of medical problems in newborns. Maternal age is the more significant single factor increasing the likelihood of preterm delivery. Paternal age is also a risk factor that is discussed more in- depth in Chapter 3. Adequate prenatal care is critical to normal development but may be less adequate in African-American women, indigent women, teen mothers, single women, and women with a sexually transmitted disease. © Taylor & Francis 2015

5. PRENATAL CAUSES Maternal health problems include endocrine, cardiovascular, and rheumatological disorders as well as anemia and may predispose an infant to preterm delivery and intra-uterine growth retardation. Drug and substance abuse during pregnancy represent major risk factors for fetuses with the prevalence increasing and the problem found in all socioeconomic strata and races. Methamphetamines, heroin, and PCP use all lead to increased risks of low birth weight and other conditions. Fetal Alcohol Syndrome results from consumption of alcohol during pregnancy, which leads to risk of low birth weight, developmental delay, and a variety of other conditions. Nicotine use can lead to increased risk of miscarriage and low birth weight. © Taylor & Francis 2015

6. PERINATAL CAUSES Perinatal causes are those that occur just prior to and during birth. Anoxia is a lack of oxygen to the brain that can lead to brain damage or death; asphyxia is generally more sudden and severe than anoxia. Apgar scores are derived from measures of a newborn’s heart rate, respiratory effort, muscle tone, gag reflex, and body color. Each measure receives a score from 0-2 and overall scores below 4 five minutes after birth are associated with increased risk of disability. Hypoxic Ischemic Encephalopathy is a condition that results from both inadequate oxygen and blood circulation to the brain. © Taylor & Francis 2015

7. PERINATAL CAUSES Prematurity is defined as being born before 36 weeks gestation and is a significant risk factor for a variety of conditions. Low birth weight is a weight of less than 2,500 grams or 5 ½ pounds at birth and is associated with a variety of conditions; very low birth weight occurs at 1,500 grams and extremely low birth weight at less than 1,000 grams. Metabolic disorders include hyperbilirubinemia or jaundice, which if untreated in the newborn can result in cerebral palsy and brain damage. © Taylor & Francis 2015

8. PERINATAL CAUSES Hypoglycemia refers to low blood sugar and can lead to brain damage if untreated. Seizures are neurological disturbances in the brain that may lead to brain damage. Congenital anomalies/defects can lead to hemorrhages, hypoglycemia, and infection. Birthing problems include risks associated with multiple births, abnormal presentation such as breech birth, and prolapsed umbilical cord. © Taylor & Francis 2015

9. POSTNATAL FACTORS Postnatal factors are those that occur just after birth and in the first few weeks of life. Quality of attachment refers to the degree to which parents and an infant develop a mutually satisfying and reciprocal relationship. Serious illnesses include encephalitis (an inflammation of the brain caused by infectious agents) and meningitis (an inflammation of the meninges or lining of the brain caused by viruses or bacteria). Poisoning can be caused by heavy metals such as lead or mercury; chemical agents such as cyanide, alcohol, or barbiturates; or organic agents such as herbicides and fertilizers and can lead to brain damage. © Taylor & Francis 2015

10. POSTNATAL FACTORS Malnutrition is most devastating prenatally but can lead to a reduction in brain cells if experienced during critical brain growth periods and is a leading cause of CIDs worldwide. Injuries – Abuse can lead to blows to the head resulting in brain damage; neglect may be more subtle but can still lead to CIDs. © Taylor & Francis 2015

11. PSYCHOSOCIAL FACTORS Psychosocial factors may be either social or psychological and associated with physical environment, language environment, and family interactions including abuse and neglect. Social correlates include socioeconomic status, low parental intelligence and educational level, family interactions, parental absence that can increase the risk of CIDs. Low socioeconomic status (SES) is a common and serious risk factor especially in combination with other environmental factors. Low SES alone creates stressors in families but may not alone account for subsequent developmental problems in children. Low SES may affect overall family functioning, parental ability to cope, and access to good health care and educational services, which in turn may affect overall development. © Taylor & Francis 2015

12. PSYCHOSOCIAL FACTORS Low parental intelligence and educational level have been researched extensively as risk factors and are associated with increased risk of CIDs for various possible reasons. Low SES and health care may be associated factors that influence child outcomes as a result of low parental educational level. The risk associated with these factors may be mediated through early intervention. Language Environment – A rich and responsive language environment where learning is verbally mediated and communication is encouraged are critical in cognitive development. © Taylor & Francis 2015

13. PSYCHOLOGICAL CORRELATES Psychological correlates include family interactions and abuse and neglect. Family interactions involve complex interaction among the family members and the environment including level of supports available for families and parental stress. Abuse may be emotional, sexual, or physical while neglect occurs more frequently although not exclusively in abusive families. Abuse may lead to anxiety, depression, substance abuse, aggression, and a cycle of generational abuse. Abuse may stem from a variety of factors with parents such as drug and alcohol abuse and parents may have unrealistic expectations of children. Neglect is associated with abuse and substance abuse as well as chronic depression in the mother. Children who are born with disabilities may create greater stress on families. © Taylor & Francis 2015

14. PREVENTIVE MEASURES Preventive measures should involve an ecological approach that addresses a host of factors; these can be primary, secondary, or tertiary measures. © Taylor & Francis 2015

15. PRIMARY PREVENTION Primary prevention includes strategies that actually prevent the development of a disease or condition. Good prenatal care is probably the most fundamental preventive measure. Immunizations, safety precaution, family planning, and birth control are other primary support measures to avoid disease or conditions. © Taylor & Francis 2015

16. SECONDARY PREVENTION Secondary prevention includes strategies that are used to prevent the emergence of disabilities when a condition exists that could lead to disabilities. Universal screening at birth can detect metabolic and other disorders. Follow-along services are often provided for infants with low birth weight or born prematurely. Early intervention services can be home- or center-based and have been shown to be effective in preventing disabilities. © Taylor & Francis 2015

17. TERTIARY PREVENTION Tertiary prevention includes strategies that may reduce but not eliminate the effects of a disability on an individual’s functioning. Treatment of physical disabilities, behavioral supports, educational and social strategies are examples of tertiary strategies that may lessen the effects of a disability. © Taylor & Francis 2015