INNER-CITY ACHIEVERS - WHO ARE THEY

Objective: To define characteristics that differentiate inner-city chi ldren with Average or above-Average Full Scale IQ scores (greater than or equal to 90) from those with below-Average scores (<90). Design: A s part of a prospective study of children with and without in utero co caine exposure tested at age 4 years on the Wechsler Preschool and Pri mary Scales of Intelligence-Revised, we found that, taken together, on ly 32 (21%) scored at or above 90 whereas 118 (79%) scored below 90. T he groups (IQ greater than or equal to 90 and IQ<90) were compared on prenatal, natal, and postnatal factors. Setting: A study center in an inner-city hospital. Participants: One hundred-fifty children of low s ocioeconomic status, 34 weeks' gestational age or older, and nonasphyx iated at birth, who had intelligence testing at age 4 years; 150 careg ivers (biological and foster). Main Outcome Measures: Association of F ull Scale IQ with prenatal, natal, and postnatal characteristics (incl uding caregiver-child interaction measured by the Parent Caregiver Inv olvement Scale [PCIS], and home environment measured by the Home Obser vation for Measurement of the Environment [HOME]). Results: The group of children with IQs at or above 90 (n = 32) did not differ from the g roup with IQs below 90 (n = 118) in prenatal or natal characteristics (all P greater than or equal to.18) or proportion in foster care, atte ndance at day care or Head Start, continued caregiver cocaine use, or parental IQ. Children with IQs at or above 90 had more developmentally appropriate interaction by caregivers (P = .043) and higher scores on 6 of 8 subscales and Total HOME (P less than or equal to.05) than the group of children with IQs below 90.Conclusions: Two postnatal factor s, home environment and caregiver-child interaction, were associated w ith Full Scale IQ scores at or above 90 whereas prenatal and natal fac tors were not. These potentially malleable postnatal factors can be ta rgeted for change to improve cognitive outcome of inner-city children.