NEW DIRECTIONS IN FAILURE TO THRIVE. Implications for Research and Practice

Transcription

1 NEW DIRECTIONS IN FAILURE TO THRIVE Implications for Research and Practice

2 NEW DIRECTIONS IN FAILURE TO THRIVE Implications for Research and' Practice Edited by Dennis Drotar School of Medicine Case Western Reserve University Cleveland, Ohio PLENUM PRESS. NEW YORK AND LONDON

3 Library of Congress Cataloging in Publication Data NIMH Workshop on New Directions in Failure to Thrive (\984: Washington, D.C.) New directions in failure to thrive. "Based on the proceedings of the NIMH Workshop on New Directions in Failure to Thrive, held October 9-10,1984, in Washington, D.C."-T.p. verso. Sponsored by the Prevention Research Center, National Institute of Mental Health. Includes bibliographical references and index. I. Failure to thrive syndrome-congresses. 2. Failure to thrive syndrome-research Congresses. I. Drotar, Dennis. II. United States. National Institute of Mental Health. Prevention Research Center. Ill. Title. RJ135.N ISBN-13: e-isbn-13: DOl: / Based on the proceedings of the NIMH Workshop on New Directions in Failure to Thrive, held October 9-10, 1984, in Washington, D.C Plenum Press, New York Softcover reprint of the hardcover 1st edition 1985 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without,written permission from the Publisher

4 This work is dedicated to the families of failure to thrive infants and those professionals who have made a commitment to them in their clinical work and research. It is hoped that the ideas, research, and approaches to intervention presented in this book will serve to enhance the lives of failure to thrive children by facilitating more effective research and clinical intervention.

5 PREFACE Failure to thrive affects the lives of many infants and young children at critical times in their development and represents a significant public health problem in the United States. Moreover, this condition is invisible and can affect children for long periods of time before it is recognized. The long-term psychosocial sequelae of failure to thrive have only begun to be recognized but may be more severe than first realized. We do know that the costs to society in terms of acute pediatric hospitalization and long-term rehabilitation, foster care, and mental health treatment of young children who present with failure to thrive are considerable. Children who are diagnosed with failure to thrive represent a special challenge and opportunity for intervention, especially preventive intervention, because it is quite possible that many of the long-term consequences of this condition on psychological development can be lessened via early recognition and intervention. However, the potential for preventive intervention in failure to thrive has been limited by the state of the art in scientific knowledge and practice. Despite the frequency with which failure to thrive is encountered in ambulatory and inpatient settings, there is little scientific information to guide practitioners. Research on the causes and consequences of failure to thrive has been very much limited by small sample sizes, lack of common definitions, and short follow-up periods. Uncertainties in the science of failure to thrive coincide with the considerable practical difficulties involved in diagnosis and inte~vention. Professionals from a variety of disciplines are called upon to make very difficult decisions concerning intervention, hospitalization and sometimes even foster care placement in the absence of suitable information to guide them. Because the families of failure to thrive infants are beset by many problems which limit their capacities to respond to treatment, professionals who work with failure to thrive infants and their families must design treatment approaches which can be accepted and utilized by family members. The present volume presents a comprehensive description of research and practice in failure to thrive from the vantage point of an interdisciplinary group of professionals, each of whom have made a commitment to work with children affected by this condition and their families. This book is intended to stimulate research and practice in failure to thrive by presenting a detailed view of concepts, research methods, and questions to be solved. This work is based on the principle that the considerable challenges of research and practice concerning failure to thrive will not be solved by professional disciplines working in isolation. Rather, knowledge will be advanced by information sharing, interdisciplinary collaboration, and cross-center problem solving. It was in this spirit that the Prevention Research Center of the National Institute of Mental Health vii

6 sponsored the conference: "Innovations in Research and Practice in Failure to Thrive: Implications for Prevention," held in Washington, D.C. in October, 1984 which stimulated the present volume. The hard work of the many individuals who participated in the development of this conference and the culmination of this volume is gratefully acknowledged. Dennis Drotar vrn

7 ACKNOWLEDGEMENTS The work presented in this book represents the labors of a number of individuals who deserve special acknowledgement. Morton Silverman, formerly Director of the Prevention Research Center of the National Institute of Mental Health played a major role in the development of the conference which provided the impetus for the present volume. Vicki Levin, Program Specialist in Infancy at the Prevention Research Center, has been a tireless advocate for infants at risk and a facilitator of collaboration and information exchange among her grantees. Her support is gratefully acknowledged. The contributors to this volume put forth a singular effort in their writing. The final product is a testimonial to them. A number of people provided special help to me in writing and editing. The past and present staff of the Infant Growth Project have been a source of insight and support throughout the course of this work. Juanita Warren and Claire Svet contributed significantly to this work in their typing of the seemingly endless chapter drafts. Finally, a very special acknowledgement is given to Mary Ball whose labors of typing and editing this entire volume were of the highest quality and very much appreciated. ix

8 CONTENTS Introduction Research on the Prevention of Psychological Disorders of Infancy: A Federal Perspective M.M. Silverman and V.S. Levin Biologic Risks in "Nonorganic" Failure to Thrive: Diagnostic and Therapeutic Implications D.A. Frank Failure to Thrive and Preventive Mental Health: Knowledge Gaps and Research Needs D. Drotar CONCEPTUAL MODELS: RESEARCH IMPLICATIONS 45 Organic Concomitants of Nonorganic Failure to Thrive: Implications for Research.. W.G. Bithoney and H. Dubowitz Failure to Thrive: An Expanded Conceptual Model E.F. Gordon and D.M. Vazquez Zinc Nutrition in Children Who Fail to Thrive P.H. Casey, W.R. Collie and W.M. Blakemore RESEARCH REPORTS: STUDIES OF RISK AND OUTCOME 87 Toward a Semispecific, Multidimensional, Threshold Model of Maltreatment..... K.B. Sherrod, S. O'Connor, W.A. A1temeier, III, and P. Vietze A Transactional Model of Failure to Thrive: A Look at Misc1assified Cases... R.H. Bradley and P.M. Casey xi

9 Early Preventive Intervention in Failure to Thrive: Methods and Early Outcome D. Drotar, C.A. Malone, L. Devost, C. Brickell, C. Mantz-Clumpner, J. Negray, M. Wallace, J. Woychik, B. Wyatt, D. Eckerle, M. Bush, M.A. Finlon, D. El-Amin, M. Nowak, J. Satola, and J. Pallotta Extended Hospitalization of Failure to Thrive Infants: Patterns of Care and Developmental Outcome.. L. Singer RESEARCH REPORTS: METHODS 155 Growth Data Analysis in Failure to Thrive Treatment and Research..... K.E. Peterson, J.M. Rathbun, and M.G. Herrera Home Observation of Parent-Child Transaction in Failure to Thrive: A Method and Preliminary Findings M.A. Finlon, D. Drotar, J. Satola, J. Pallotta, B. Wyatt, and D. El-Amin DIAGNOSIS AND INTERVENTION: PEDIATRIC MANAGEMENT... Comprehensive Pediatric Management of Failure to Thrive: An Interdisciplinary Approach C. Berkowitz A Strategy for Managing Nonorganic Failure to Thrive Based on A Prospective Study of Antecedents W.A. Altemeier, III, S. O'Connor, K.B. Sherrod, T.D. Yeager, and P.M. Vietze PSYCHOSOCIAL DIAGNOSIS AND INTERVENTION Diagnostic Classification: The Current Challenge in Failure to Thrive Syndrome Research J. Woolston A Developmental Classification of Feeding Disorders Associated with Failure to Thrive: Diagnosis and Treatment I. Chatoor, L. Dickson, S. Schaeffer, and J. Egan The Etiology of Failure to Thrive: An Interactional Developmental Approach A.F. Lieberman and M. Birch xii

10 Behavioral Approaches to the Treatment of Failure to Thrive T.R. Linscheid and L.K. Rasnake The Family Context of Failure to Thrive 295 D. Drotar, J. Woychik, C. Mantz-C1umpner, C. Brickell, J. Negray, M. Wallace, and C.A. Malone Issues in the Treatment of Emotional and Behavioral Disturbances in Failure to Thrive J.M. Rathbun PRIMARY PREVENTION 315 Primary Prevention of Failure to Thrive 317 J.S. Brams and D.L. Coury Primary Prevention of Failure to Thrive: Social Policy Implications.. D.A. Frank, D. Allen, and J.L. Brown Failure to Thrive and the Economically Depressed Community.... E.F. Gordon and D.M. Vazquez CONFERENCE SUMMARY Summary of Discussion at NIMH Conference: "New Directions in Failure to Thrive Research: Implications for Prevention," October, 1984 D. Drotar Contributors Index xiii