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Few investigations have examined the specificity of sequelae of very low birth weight (VLBW,1500 g) or sources of variability in outcome. To better understand the nature and determinants of outcome, we assessed neuropsychological and achievement skills at mean age 11 years in 62 children with750 g birth weight, 54 with 750-1499 g birth weight, and 66 term-born controls. Distinct cognitive constructs were identified by factor analysis, and the three birthweight groups were compared on these constructs and on composite measures of achievement. Although the group with750 g birth weight performed less well on all tests than term-born controls, group differences in a perceptual planning factor and in mathematics remained even when IQ was controlled, and deficits were more pronounced in mathematics than in reading. Results from structural equation modeling were consistent with the hypothesis that neuropsychological skills mediated the relationship between birth weight and achievement. The findings confirm the differential deficit hypothesis, support the need to consider multiple sources of variability in VLBW outcomes, and highlight the importance of neuropsychological constructs in developing an explanatory framework.

Recent advances in perinatal care have led to the survival of increasing numbers of children born at the lower limits of viability. Children with very low birth weight (LBW; less than 1,500 g, 3 lb 5 oz) have been studied extensively. Findings document poorer outcomes relative to normal birth weight term-born controls in neurologic and health status, cognitive-neuropsychological skills, school performance, academic achievement, and behavior. This report reviews current knowledge regarding LBW children, with special emphasis on outcomes for children with birth weight less than 750 g (1 lb 10 oz). Results from an ongoing longitudinal study suggest a gradient of sequelae, with poorer outcomes in less than 750 g birth weight children compared to both 750 g to 1,499 g birth weight children and term-born controls. Children with less than 750 g birth weight fail to catch up with their peers over time and may even be at risk for age-related increases in sequelae. Outcomes are highly variable but related to neonatal medical complications of prematurity and social risk factors. Further research is needed to understand the etiology and neuropathological basis of sequelae, the long-term developmental implications of LBW, and treatment needs.

Numerous studies have documented memory deficits in very low birthweight (VLBW, < 1500 g) children, yet we know little about the nature of these memory problems. To clarify memory sequelae and examine memory deficits in relation to the degree of low birth weight, we administered the California Verbal Learning Test-Children's Version (CVLT-C) to a regional sample of 57 < 750 g birthweight children and to groups of 53 750-1499 g birthweight children and 49 term-born controls. Group comparisons revealed significant differences between the < 750 g birthweight group and term-born children on measures of list learning, delayed recall, and inaccurate recall. In addition, the percentage improvement in correct recognitions relative to long-term delayed recall was greater in the < 750 g group than in the term-born controls. Similar differences were observed between VLBW children with and without abnormal neonatal cerebral ultrasounds (high- and low-risk groups). Differences in learning rate between the VLBW and term-born groups, and between high- and low-risk VLBW children, were evident even when vocabulary skill was covaried or when children with neurosensory deficits or IQ < 80 were excluded from analysis. The findings document deficits in verbal memory in the subset of VLBW children at greatest biological risk, and suggest that acquisition processes are selectively impaired.

Although attention deficit disorders are frequently diagnosed in low birth-weight children, it is not clear if attention problems are apparent in neuropsychological testing. The present study examined the performances of a regional sample of 68 children with birth weights

emphasis, however, on a systematic approach to content analysis, curriculum, and the process of education for handicapped students. Bruner (1968), in his book Toward a Theory of Instruction, defines instruction as "leading the learner through a sequence of statements and restatements of a problem or body of knowledge that increases the learner's ability to grasp, transform, and transfer what he is learning" (p. 45). Thus, from this perspective, instruction entails more than the mere transmission of skills and knowledge from teacher to student. The organization and transformation of information to be taught is a complex arrangement that we refer to as an instructional model.

Nancy K. Klein Department of Specialized Instructional Programs Cleveland State University Cleveland, Ohio A great journalist, Henry L. Mencken, once remarked that for every complex problem there was a simple solution. And that solution was probably wrong. Perhaps no where is this more true than in the field of special education, a technique developed to deal with those children euphemistically called "exceptional." While a few of these children vary from the norm by being of superior intellect, most suffer from limitations of learning ability or have sensory, physical and /or emotional problems. For a great many years our society chose to avert its attention from backward children, to shut them up in back rooms or even to pretend they did not exist. It is only quite recently that a growing awareness of this segment of our population has come to national attention. It has slowly sunk into our collective minds that such babies arrive at the homes of the well-born as well as in the slums, and that they, too, are citizens.