The operational effectiveness of Infant At Risk Registers was examined using record linkage techniques. Two operations were carried out: (a) the linkage of the 1965 Birmingham Observation Register with the 1968 file of `Defective Children' as notified to the Education Department; and (b) the file of maternity data for the whole of Birmingham in 1956, linked with the list of children receiving special education in 1968.
Positive associations were found between assessment of risk in the Observation Register and subsequent defects as notified to the Education Department at age 3; and between assessment of risk made on the basis of the maternity data and the likelihood of requiring special education at age 13. The main predictors were low birthweight, traumatic delivery, and the indices of social underprivilege.
However, none of these determinants were sufficient to justify the continuation of selective At Risk Registers whose purpose is defined in terms of prediction. They should be withdrawn or should be redesigned to the different purposes of registering the known handicapped, and extending developmental surveillance to all children, rather than concentrating it upon a few.