Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Psychology



First Advisor

Janet M. Kulberg


This study examined the relationship between at-birth risk factors and three year child developmental outcome. The purpose of this study was to design a multifactor risk screening system to identify those children who are at risk for developmental delay and behavior problems in Rhode Island. The sample was drawn from three separate datasets: the Rhode Island Universal Newborn Screening (Level One) database (N=27,282), the Early Intervention (El) database (N=l ,793), and the Maternal Lifestyle Study Providence/Teen samples (N= 311). Study One investigated the predictive probability of Level One for EI eligibility by age three. Results showed that Level One has inadequate sensitivity (65%) and a high percentage of false negatives (35%) predicting eligibility for EI services. Study Two investigated the utility of Level One screening to predict EI eligibility and neurodevelopmental outcome by 36 months. Results showed that Level One screening identified 84% of the high-risk sample as Risk-Positive, double that in the general population. The large Risk-Positive rate translated into a corresponding sensitivity for EI eligibility of 88% and the percentage of false negatives of 12%. Level One risk designation did discriminate between children with behavior problems at age three. No significant differences were found between Risk-Positive and Risk-Negative groups in three-year cognitive, motor, adaptive, or communication development. Study Three investigated the design of a newborn screening for EI eligibility that did not rely on predictors heavily influenced by socioeconomic factors. Logistic regression analyses revealed that a socioeconomic insensitive risk algorithm included measures of biological risk. A second model of EI eligibility was designed that combined both biological and parental/environmental predictors. This model produced a screening with sensitivity rate of 70% and false negative rate of30%. Study Four investigated the use of biological, and parental/environmental variables, and measures of infant behavior to predict age three developmental outcome. High sensitivity (99%) and low false positives (1%) were produced. Results showed that including measures of infant behavior reduced the percentage of false positives to create a more accurate screening. Related findings are discussed along with implications for policy and future research.



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