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Ping EY, Herriot H, Iacono V, Serravalle L, Ellenbogen MA. Hypothalamic-pituitary-adrenal axis function in the offspring of parents with bipolar disorder and the impact of the family environment: A pilot study of the Reducing Unwanted Stress in the Home (RUSH) prevention program. Psychoneuroendocrinology 2024; 171:107182. [PMID: 39357242 DOI: 10.1016/j.psyneuen.2024.107182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/07/2024] [Accepted: 09/08/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND The home environment of offspring of parents with bipolar disorder (OBD) has been characterized by high levels of stress and disorganization, which may impact development of the hypothalamic-pituitary-adrenal (HPA) axis and their subsequent risk for affective disorders. The present study examined the effects of a family-based preventative intervention on the OBD's HPA axis functioning and whether intervention-related changes in the home environment might have driven change in the HPA axis. METHODS Fifty-five children (6-11 years) were recruited from families having a parent with bipolar disorder (n=26) or families having two parents with no current mental disorders (n=29). Only those families with a parent having bipolar disorder participated in the preventative intervention. Both groups completed assessments at baseline, post-prevention, 3-, and 6-months post-prevention. At each assessment, family organization, control, cohesion, conflict, and expressiveness, in addition to childhood internalizing problems, were measured, and offspring saliva samples were collected across two consecutive days. RESULTS Hierarchical Linear Modelling found no significant differences in HPA axis functioning between groups at baseline or across time. Improvements in family organization, however, were associated with elevations in participants' cortisol awakening response (CAR; p =.004) and total daily output (p =.023), and a steepening of their diurnal slope (p =.003) across time. Similar findings were obtained for family cohesion with respect to CAR (p <.001) and, to a lesser degree, diurnal slope (p =.064). DISCUSSION HPA axis functioning did not differ between the OBD and healthy controls at baseline or in response to the preventative intervention. However, intervention-related improvements in family organization and, to a lesser degree, cohesion, were associated with adaptive changes in HPA functioning over time.
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Affiliation(s)
- Erin Yong Ping
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Heather Herriot
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Vanessa Iacono
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Lisa Serravalle
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Mark A Ellenbogen
- Department of Psychology, Concordia University, Montreal, QC, Canada.
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2
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Tong K, Fu X, Hoo NP, Kean Mun L, Vassiliu C, Langley C, Sahakian BJ, Leong V. The development of cognitive flexibility and its implications for mental health disorders. Psychol Med 2024:1-7. [PMID: 39247963 DOI: 10.1017/s0033291724001508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Affiliation(s)
- Ke Tong
- Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC), Nanyang Technological University, Singapore
| | - Xinchen Fu
- Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC), Nanyang Technological University, Singapore
| | - Natalie P Hoo
- Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC), Nanyang Technological University, Singapore
| | - Lee Kean Mun
- Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC), Nanyang Technological University, Singapore
- Early Mental Potential and Wellbeing Research (EMPOWER) Centre, Nanyang Technological University, Singapore
| | | | | | | | - Victoria Leong
- Cambridge-NTU Centre for Lifelong Learning and Individualised Cognition (CLIC), Nanyang Technological University, Singapore
- Early Mental Potential and Wellbeing Research (EMPOWER) Centre, Nanyang Technological University, Singapore
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3
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Kilgallon KB, Cheifetz IM. MRI measurement of cerebral perfusion in severe congenital heart disease: just the first step. Pediatr Res 2024:10.1038/s41390-024-03300-6. [PMID: 38849486 DOI: 10.1038/s41390-024-03300-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/06/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Affiliation(s)
- Kevin B Kilgallon
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ira M Cheifetz
- Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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4
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Lin A, Mertens AN, Rahman MZ, Tan ST, Il'yasova D, Spasojevic I, Ali S, Stewart CP, Fernald LCH, Kim L, Yan L, Meyer A, Karim MR, Shahriar S, Shuman G, Arnold BF, Hubbard AE, Famida SL, Akther S, Hossen MS, Mutsuddi P, Shoab AK, Shalev I, Rahman M, Unicomb L, Heaney CD, Kariger P, Colford JM, Luby SP, Granger DA. A cluster-randomized trial of water, sanitation, handwashing and nutritional interventions on stress and epigenetic programming. Nat Commun 2024; 15:3572. [PMID: 38670986 PMCID: PMC11053067 DOI: 10.1038/s41467-024-47896-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
A regulated stress response is essential for healthy child growth and development trajectories. We conducted a cluster-randomized trial in rural Bangladesh (funded by the Bill & Melinda Gates Foundation, ClinicalTrials.gov NCT01590095) to assess the effects of an integrated nutritional, water, sanitation, and handwashing intervention on child health. We previously reported on the primary outcomes of the trial, linear growth and caregiver-reported diarrhea. Here, we assessed additional prespecified outcomes: physiological stress response, oxidative stress, and DNA methylation (N = 759, ages 1-2 years). Eight neighboring pregnant women were grouped into a study cluster. Eight geographically adjacent clusters were block-randomized into the control or the combined nutrition, water, sanitation, and handwashing (N + WSH) intervention group (receiving nutritional counseling and lipid-based nutrient supplements, chlorinated drinking water, upgraded sanitation, and handwashing with soap). Participants and data collectors were not masked, but analyses were masked. There were 358 children (68 clusters) in the control group and 401 children (63 clusters) in the intervention group. We measured four F2-isoprostanes isomers (iPF(2α)-III; 2,3-dinor-iPF(2α)-III; iPF(2α)-VI; 8,12-iso-iPF(2α)-VI), salivary alpha-amylase and cortisol, and methylation of the glucocorticoid receptor (NR3C1) exon 1F promoter including the NGFI-A binding site. Compared with control, the N + WSH group had lower concentrations of F2-isoprostanes isomers (differences ranging from -0.16 to -0.19 log ng/mg of creatinine, P < 0.01), elevated post-stressor cortisol (0.24 log µg/dl; P < 0.01), higher cortisol residualized gain scores (0.06 µg/dl; P = 0.023), and decreased methylation of the NGFI-A binding site (-0.04; P = 0.037). The N + WSH intervention enhanced adaptive responses of the physiological stress system in early childhood.
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Affiliation(s)
- Audrie Lin
- Department of Microbiology and Environmental Toxicology, University of California, Santa Cruz, Santa Cruz, CA, USA.
| | - Andrew N Mertens
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Md Ziaur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sophia T Tan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Dora Il'yasova
- Department of Medicine, Duke University, Durham, NC, USA
| | - Ivan Spasojevic
- Department of Medicine, Duke University, Durham, NC, USA
- PK/PD Core Laboratory, Duke Cancer Institute, Durham, NC, USA
| | - Shahjahan Ali
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christine P Stewart
- Institute for Global Nutrition, University of California Davis, Davis, CA, USA
| | - Lia C H Fernald
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Lisa Kim
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Md Rabiul Karim
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sunny Shahriar
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Gabrielle Shuman
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Benjamin F Arnold
- Francis I. Proctor Foundation, University of California, San Francisco, CA, USA
| | - Alan E Hubbard
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Syeda L Famida
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Salma Akther
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Md Saheen Hossen
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Palash Mutsuddi
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Abul K Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Idan Shalev
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Leanne Unicomb
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Christopher D Heaney
- Department of Environmental Health and Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Patricia Kariger
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - John M Colford
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, CA, USA
| | - Douglas A Granger
- Institute for Interdisciplinary Salivary Bioscience Research, University of California, Irvine, Irvine, CA, USA
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Labella MH, Raby KL, Bourne SV, Trahan AC, Katz D, Dozier M. Is Attachment and Biobehavioral Catch-up effective for parents with insecure attachment states of mind? Child Dev 2024; 95:648-655. [PMID: 37603609 PMCID: PMC10879447 DOI: 10.1111/cdev.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 07/18/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023]
Abstract
Prior research suggests that attachment-based interventions, including Attachment and Biobehavioral Catch-up (ABC), may be less effective at enhancing parenting quality among parents who self-report having an insecure attachment style. The current study tested whether effects of ABC on parental behavior were moderated by categorical and dimensional measures of attachment obtained via Adult Attachment Interviews with 454 parents who were approximately 34 years old, primarily female, and predominantly White or African American. Parents randomized to ABC exhibited higher sensitivity and positive regard, and lower intrusiveness shortly after the intervention than parents randomized to the control intervention (|β|s = .10-.27). The effect of ABC on intrusiveness persisted 2 years later. Effects at either timepoint were not significantly moderated by parents' attachment representations.
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Affiliation(s)
- Madelyn H Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - K Lee Raby
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Stacia V Bourne
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Alec C Trahan
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Danielle Katz
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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6
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Miller KN, Bourne SV, Dahl CM, Costello C, Attinelly J, Jennings K, Dozier M. Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti. Dev Psychopathol 2024:1-10. [PMID: 38415397 PMCID: PMC11349935 DOI: 10.1017/s0954579424000245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Dante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child-Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues' work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children's attachment and self-regulatory capabilities. In the current study, we assessed adolescents' reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.'s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.
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7
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Bergsund HB, Drozd F, Olafsen KS, Nilsen KH, Linnerud S, Kjøbli J, Jacobsen H. The effect of relationship-based interventions for maltreated children and adolescents: a systematic review and meta-analysis. Dev Psychopathol 2023; 35:1251-1271. [PMID: 34779375 DOI: 10.1017/s0954579421001164] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Child maltreatment is characterized by a harmful relational environment which can have negative cascading consequences for the child's development. Relationship-based interventions may improve maltreated children's functioning by addressing key aspects of the parent-child relationship at various stages of development. The objective of the current study was to perform a systematic review on relationship-based interventions for maltreated children and a meta-analysis on the impact of these interventions on observed parent-child relational behavior. Data collection consisted of a comprehensive literature search in six databases and contacting experts in the field and hand searching relevant publications. In total, 5,802 abstracts were screened, of which 81 relevant publications were identified, representing 4,526 participants. The meta-analysis found large improvements in observed parent interactive behavior (g = 0.888), smaller improvements in child attachment (g = 0.403) and child interactive behavior (g = 0.274). The effect on parent interactive behavior was larger in interventions addressing middle childhood. Risk of bias assessments showed that a large number of studies suffer from poor reporting, which limits the conclusions of the findings. Future research should examine parent-child relationship behavior across multiple developmental stages, as well as the impact of developmentally appropriate intervention elements on maltreated children.
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Affiliation(s)
- Hans Bugge Bergsund
- Section for Infants and Young Children, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Filip Drozd
- Section for Infants and Young Children, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Kåre S Olafsen
- Section for Prevention and Treatment Research, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | | | | | - John Kjøbli
- Section for Prevention and Treatment Research, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Heidi Jacobsen
- Section for Infants and Young Children, Regional Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
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8
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Lee JJ, Flouri E. The relationship between diurnal cortisol slope and cognitive development among children maltreated as infants. CHILDREN AND YOUTH SERVICES REVIEW 2023; 148:106873. [PMID: 36876149 PMCID: PMC9983686 DOI: 10.1016/j.childyouth.2023.106873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Little is known about the role of hypothalamic-pituitary-adrenal (HPA) axis functioning for children's cognitive development, especially among vulnerable groups. The current study explores the relationship between diurnal cortisol slope and cognitive outcomes among children at the ages of 5 and 6 who have been maltreated as infants and involved with child protective services, using data from the National Survey of Child and Adolescent Well-Being (NSCAW) I (N=158). Multiple regression analyses showed that a greater decline in salivary cortisol from morning to evening was positively associated with scores on applied problems and expressive communication, even after adjustment for confounding. It was also associated with lower odds of cognitive disability. There were null associations with letter-word identification, passage comprehension, auditory comprehension, matrices, and vocabulary. Results suggest that children involved with child protective services as infants, and thus exposed early to likely 'toxic' levels of stressors, may face dysregulation of the HPA axis and particular difficulties in some aspects of cognitive function. Potential explanations and implications for policy are discussed.
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Affiliation(s)
- Jane Jiyoun Lee
- Child Maltreatment Solutions Network, Social Science Research Institute, Pennsylvania State University, 202 Henderson Building, University Park, PA, 16802
| | - Eirini Flouri
- Department of Psychology and Human Development, UCL Institute of Education, University College London, 20 Bedford, Way, London, WC1H 0AL
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Eiden RD, Ettekal I, Zhao J, Kelm MR, Nickerson AB, Ostrov JM, Schuetze P, Godleski S. Prenatal substance exposure, early-life adversity, and parenting: Associations with adolescent stress response. Dev Psychobiol 2023; 65:e22365. [PMID: 36811371 PMCID: PMC9971663 DOI: 10.1002/dev.22365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/18/2022] [Accepted: 11/30/2022] [Indexed: 01/12/2023]
Abstract
We tested a conceptual model examining associations between prenatal substance exposure and adolescent cortisol reactivity profiles in response to an acute social evaluative stressor. We included cortisol reactivity in infancy, and direct and interactive effects of early-life adversity and parenting behaviors (sensitivity, harshness) from infancy to early school age on adolescent cortisol reactivity profiles in model testing. Participants were 216 families (51% female children; 116 cocaine-exposed) recruited at birth, oversampled for prenatal substance exposure, and assessed from infancy to early adolescence (EA). Majority of participants self-identified as Black (72% mothers, 57.2% adolescents), and caregivers were primarily from low-income families (76%), were single (86%), and had high school or below education (70%) at recruitment. Latent profile analyses identified three cortisol reactivity patterns including elevated (20.4%), moderate (63.1%), and blunted (16.5%) reactivity groups. Prenatal tobacco exposure was associated with higher likelihood of membership in the elevated reactivity compared to the moderate reactivity group. Higher caregiver sensitivity in early life was associated with lower likelihood of membership in the elevated reactivity group. Prenatal cocaine exposure was associated with higher maternal harshness. Interaction effects among early-life adversity and parenting indicated that caregiver sensitivity buffered, and harshness exacerbated, the likelihood that high early adversity would be associated with the elevated and blunted reactivity groups. Results highlight the potential importance of prenatal alcohol and tobacco exposure for cortisol reactivity and the role of parenting as exacerbating or buffering the impact of early-life adversity on adolescent stress response.
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Affiliation(s)
- Rina D. Eiden
- The Pennsylvania State University, University Park, PA
| | | | - Junru Zhao
- University at Buffalo, The State University of New York, Buffalo, NY
| | | | | | - Jamie M. Ostrov
- University at Buffalo, The State University of New York, Buffalo, NY
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Schein SS, Roben CKP, Costello AH, Dozier M. Assessing Changes in Parent Sensitivity in Telehealth and Hybrid Implementation of Attachment and Biobehavioral Catch-Up During the COVID-19 Pandemic. CHILD MALTREATMENT 2023; 28:24-33. [PMID: 35081800 PMCID: PMC8841399 DOI: 10.1177/10775595211072516] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
During the COVID-19 pandemic, home visiting services for families with young children pivoted to continue providing services virtually. One such service was Attachment and Biobehavioral Catch-up (ABC), a brief prevention/intervention program targeting increased parental sensitivity. 70 families participated in a sensitivity assessment before and after receiving ABC. Forty-three families received the program fully through telehealth, and 27 families received the program through an in-person/telehealth hybrid format. Parent sensitivity was assessed pre- and post-intervention, and results suggested that when ABC was delivered through a telehealth or hybrid format, parents showed increased following the lead and decreased intrusiveness from pre- to post-intervention, with moderate effect sizes. Ongoing supervision in the model, weekly fidelity maintenance checks, and the flexibility of families and parent coaches likely contributed to the maintenance of significant change in parental sensitivity from pre- to post-intervention during the move from face-to-face home visiting to the provision of virtual services.
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Affiliation(s)
- Stevie S. Schein
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Amanda H. Costello
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Runze J, Pappa I, Van IJzendoorn MH, Bakermans-Kranenburg MJ. Conduct Problems and Hair Cortisol Concentrations Decrease in School-Aged Children after VIPP-SD: A Randomized Controlled Trial in Two Twin Cohorts. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15026. [PMID: 36429745 PMCID: PMC9690337 DOI: 10.3390/ijerph192215026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/13/2022] [Indexed: 06/16/2023]
Abstract
The Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) is effective in increasing parental sensitivity and sensitive discipline, and aims to decrease child behavior problems. Changes in quality of parenting may be accompanied by effects on child stress levels. However, studies of VIPP-SD effects on child behavior problems have shown mixed results and there are no studies to date of the effect of the intervention on children's stress levels, as measured by hair cortisol concentration (HCC). Furthermore, differences in intervention effectiveness may be explained by differential susceptibility factors. We hypothesized that the effects of the VIPP-SD on child behavior problems might be moderated by currently available child polygenic scores of differential susceptibility (PGS-DS). In the current pre-registered trial, we randomly assigned 40% of n = 445 families with school-aged twin children to the intervention group. The VIPP-SD was successful in decreasing both children's conduct problems and HCC. Effects were not moderated by available child PGS-DS. We conclude that a brief, home-based video-feedback parenting intervention can decrease child behavior problems and affect the child's stress-related neuroendocrine system as assessed with hair cortisol. In future studies, more specific PGS-DS for externalizing behaviors should be used as well as parental PGS-DS.
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Affiliation(s)
- Jana Runze
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
- Leiden Consortium on Individual Development, Leiden University and VU Amsterdam, 2311 EZ Leiden, The Netherlands
| | - Irene Pappa
- Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
- Leiden Consortium on Individual Development, Leiden University and VU Amsterdam, 2311 EZ Leiden, The Netherlands
| | - Marinus H. Van IJzendoorn
- Leiden Consortium on Individual Development, Leiden University and VU Amsterdam, 2311 EZ Leiden, The Netherlands
- Department of Psychology, Education, and Child Studies, Erasmus University Rotterdam, 3062 PA Rotterdam, The Netherlands
- Research Department of Clinical, Education and Health Psychology, Faculty of Brain Sciences, UCL, London WC1E 6BT, UK
| | - Marian J. Bakermans-Kranenburg
- Leiden Consortium on Individual Development, Leiden University and VU Amsterdam, 2311 EZ Leiden, The Netherlands
- Institute of Psychological, Social and Life Sciences, ISPA Lisbon, 1149-041 Lisbon, Portugal
- Center for Attachment Research, The New School for Social Research, New York, NY 10011, USA
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12
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Stoye DQ, Boardman JP, Osmond C, Sullivan G, Lamb G, Black GS, Homer NZM, Nelson N, Theodorsson E, Mörelius E, Reynolds RM. Saliva cortisol diurnal variation and stress responses in term and preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:558-564. [PMID: 35256524 PMCID: PMC9411886 DOI: 10.1136/archdischild-2021-321593] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 02/11/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine if preterm birth is associated with adaptation of the hypothalamic-pituitary-adrenal (HPA) axis and whether HPA axis programming relates to the degree of prematurity (defined as extremely preterm birth at <28 weeks or very preterm birth at 28-32 weeks gestation). DESIGN This study reports findings from a prospective birth cohort. Saliva cortisol concentrations were measured prevaccination and postvaccination, and in the morning and evening, at 4 months chronological age. SETTING Infants born at a single Scottish hospital. PARTICIPANTS 45 term-born, 42 very preterm and 16 extremely preterm infants. OUTCOMES Cortisol stress response to vaccination (postvaccination minus prevaccination cortisol concentrations), diurnal slope (log-transformed morning minus log-transformed evening cortisol values) and mean log-transformed daily cortisol. RESULTS Compared with infants born at term, infants born extremely preterm had a blunted cortisol response to vaccination (5.8 nmol/L vs 13.1 nmol/L, difference in means: -7.3 nmol/L, 95% CI -14.0 to -0.6) and a flattened diurnal slope (difference in geometric means: -72.9%, 95% CI -87.1 to -42.8). In contrast, the cortisol response to vaccination (difference in means -2.7 nmol/L, 95% CI -7.4 to 2.0) and diurnal slope at 4 months (difference in geometric means: -33.6%, 95% CI -62.0 to 16.0) did not differ significantly in infants born very preterm compared with infants born at term. CONCLUSIONS Infants born extremely preterm have blunted cortisol reactivity and a flattened diurnal slope. These patterns of HPA axis regulation are commonly seen after childhood adversity and could contribute to later metabolic and neurodevelopmental phenotypes observed in this population.
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Affiliation(s)
- David Q Stoye
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - James P Boardman
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK
| | - Clive Osmond
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Gemma Sullivan
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gillian Lamb
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Gill S Black
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
| | - Natalie Z M Homer
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Nina Nelson
- Department of Clinical and Experimental Medicine, Linköping University, Linkoping, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Elvar Theodorsson
- Division of Clinical Chemistry, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linkoping, Sweden
| | - Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Rebecca M Reynolds
- MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
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13
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Tabachnick AR, Eiden RD, Labella MH, Dozier M. Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants. Dev Psychobiol 2022; 64:e22286. [PMID: 35748625 PMCID: PMC9400098 DOI: 10.1002/dev.22286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 04/06/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022]
Abstract
Little is known about whether postnatal intervention enhances autonomic regulation among infants at risk for dysregulation due to prenatal opioid exposure. The present study evaluated the effects of modified Attachment Behavioral Catch-up (mABC) on autonomic regulation for opioid-exposed infants in a pilot randomized clinical trial. We hypothesized that, compared to a control intervention (modified Developmental Education for Families [mDEF]), mABC would be associated with higher resting respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP) as well as greater reactivity to and recovery from a social stressor (Still-Face Paradigm). Pregnant or peripartum women receiving opioid agonist therapy (61 mothers of 64 infants; final N = 36 infants) were randomly assigned to mABC or mDEF, 12-session home visiting programs beginning in the third trimester; mABC targets sensitive parenting, and mDEF targets cognitive and motor development. mABC was associated with significantly greater RSA reactivity and marginally greater PEP reactivity. In models accommodating missing data, mABC was additionally associated with significantly greater RSA recovery. In sensitivity analyses removing siblings, mABC predicted significantly enhanced PEP reactivity. Overall, in these preliminary analyses, mABC was associated with healthier autonomic regulation during a social stressor than mDEF. Thus, mABC may be a promising strategy to promote autonomic regulation among opioid-exposed infants through parenting intervention.
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Affiliation(s)
- Alexandra R. Tabachnick
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
| | - Rina Das Eiden
- Department of Psychology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Madelyn H. Labella
- Department of Psychological Sciences, William & Mary, Williamsburg, Virginia, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, Delaware, USA
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14
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Yarger HA, Lind T, Raby KL, Zajac L, Wallin A, Dozier M. Intervening With Attachment and Biobehavioral Catch-Up to Reduce Behavior Problems Among Children Adopted Internationally: Evidence From a Randomized Controlled Trial. CHILD MALTREATMENT 2022; 27:478-489. [PMID: 33882710 PMCID: PMC8535762 DOI: 10.1177/10775595211010975] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Children who have been adopted internationally often exhibit persistent behavior problems. The current study assessed the efficacy of the Attachment and Biobehavioral Catch-up intervention (ABC; Dozier & Bernard, 2019) for reducing behavior problems in 122 children adopted internationally. Behavior problems were measured via parent-report using the Brief Infant Toddler Social Emotional Assessment at a pre-intervention visit and after the intervention when children were between 18 and 36 months. Children's behavior problems were also observed using the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS) after the intervention when children were 48 and 60 months. Parents who received ABC reported fewer child behavior problems than parents who received the control intervention immediately after the intervention through 1.5 years post-intervention. Additionally, children whose parents received ABC exhibited fewer behavior problems within the parent context of the DB-DOS when they were 48 months old (2 years post-intervention) than children whose parents received the control intervention. There were no significant intervention effects on children's observed behavior problems within the examiner contexts. These results support the efficacy of ABC in reducing behavior problems among children adopted internationally. Trial registration: ClinicalTrials.gov NCT00816621.
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Affiliation(s)
- Heather A. Yarger
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Teresa Lind
- Department of Psychiatry, University of California, San Diego, CA, USA
- Child and Adolescent Services Research Center (CASRC), San Diego, CA, USA
| | - K. Lee Raby
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Lindsay Zajac
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Allison Wallin
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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15
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Regression in Early Childhood Development: An Unintended Outcome of Prolonged Hospitalization? J Pediatr Hematol Oncol 2022; 44:e795-e798. [PMID: 35129139 DOI: 10.1097/mph.0000000000002411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
This brief review outlines a novel case study with targeted literature search. Patient X was a 21-month-old male who was receiving ongoing treatment for stage M MYCN-amplified high-risk neuroblastoma. Patient X's mother was considering refusal of further cancer-directed therapy because of the child's developmental regression noted during his prolonged hospitalization. Given the underlying malleability of the developing brain in early childhood, access to supportive services that facilitate ongoing neurodevelopment in hospitalized young children is of utmost importance; such services further reduce parental stress and likely enhances parental and medical team efficacy of care.
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16
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Bourne SV, Korom M, Dozier M. Consequences of Inadequate Caregiving for Children's Attachment, Neurobiological Development, and Adaptive Functioning. Clin Child Fam Psychol Rev 2022; 25:166-181. [PMID: 35201540 DOI: 10.1007/s10567-022-00386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 11/03/2022]
Abstract
Given that human infants are almost fully reliant on caregivers for survival, the presence of parents who provide sensitive, responsive care support infants and young children in developing the foundation for optimal biological functioning. Conversely, when parents are unavailable or insensitive, there are consequences for infants' and children's attachment and neurobiological development. In this paper, we describe effects of inadequate parenting on children's neurobiological and behavioral development, with a focus on developing capacities for executive functioning, emotion regulation, and other important cognitive-affective processes. Most prior research has examined correlational associations among these constructs. Given that interventions tested through randomized clinical trials allow for causal inferences, we review longitudinal intervention effects on children's biobehavioral and cognitive-affective outcomes. In particular, we provide an overview of the Bucharest Early Intervention Project, a study in which children were randomized to continue in orphanage care (typically the most extreme condition of privation) or were placed into the homes of trained, supported foster parents. We also discuss findings regarding Attachment and Biobehavioral Catch-up, an intervention enhancing sensitivity among high-risk parents. We conclude by suggesting future directions for research in this area.
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Affiliation(s)
- Stacia V Bourne
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA.
| | - Marta Korom
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | - Mary Dozier
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
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17
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Roben CKP, Kipp E, Schein SS, Costello AH, Dozier M. Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants. Infant Ment Health J 2021; 43:173-184. [PMID: 34964152 PMCID: PMC9015513 DOI: 10.1002/imhj.21963] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Maintaining treatment fidelity when implementing evidence‐based interventions is a significant challenge. The inability to deliver in‐person services due to the COVID‐19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch‐Up (ABC) program is an evidence‐based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and “in‐the‐moment” commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5‐min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in‐the‐moment comments. On average, parent coaches were able to exceed in‐person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.
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Affiliation(s)
| | - Evan Kipp
- University of Delaware, Newark, Delaware, USA
| | | | | | - Mary Dozier
- University of Delaware, Newark, Delaware, USA
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18
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Conradt E, Crowell SE, Cicchetti D. Using Development and Psychopathology Principles to Inform the Research Domain Criteria (RDoC) Framework. Dev Psychopathol 2021; 33:1521-1525. [PMID: 35480855 PMCID: PMC9037759 DOI: 10.1017/s0954579421000985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIn 2010, the Research Domain Criteria (RDoC) were developed to advance our understanding of the pathophysiology of mental illness across multiple levels of analysis, ranging from cells to circuits to self-report instruments. Several conceptual RDoC-informed manuscripts have highlighted the importance of studying how developmental processes give rise to psychopathology. However, there are few empirical studies that integrate the RDoC framework with development and psychopathology principles. This special issue was developed to fill this empirical gap. In this introduction to the special issue, we describe how the developmental psychopathology field predates and informs the RDoC framework. We highlight three important ways in which developmental psychopathology and the RDoC framework can mutually inform one another, leading to novel discoveries to identify, prevent, and treat mental health problems across the life span.
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Affiliation(s)
| | - Sheila E Crowell
- University of Utah, Departments of Psychology, Psychiatry, OB/GYN
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19
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The ATTACH™ program and immune cell gene expression profiles in mothers and children: A pilot randomized controlled trial. Brain Behav Immun Health 2021; 18:100358. [PMID: 34647106 PMCID: PMC8501501 DOI: 10.1016/j.bbih.2021.100358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background Children exposed to adversity and toxic stress are at increased risk for poor health across the lifespan, possibly through alterations to immune pathways. Parenting interventions could buffer the effect of adversity on child immune activity. The purpose of this study was to test whether mothers and children who were randomly assigned to a parenting intervention (ATTACH™) had healthier post-intervention immune cell gene expression patterns, as indexed by the Conserved Transcriptional Response to Adversity (CTRA), compared with mothers and children in a wait-list control group. Methods A sample of 20 mother-child dyads were recruited from a domestic violence shelter in Calgary, AB, Canada. The ATTACH™ program is a 10-week psycho-educational intervention that fosters maternal reflective function, i.e. how to understand and respond to mental states. Dyads were randomly assigned to an intervention or wait-list group. Dried blood spots were collected from both groups post-intervention, subjected to RNA sequencing, and assessed for CTRA gene expression using mixed effect linear model analysis. Covariates were age, child sex, maternal race/ethnicity, and maternal medication use. Results In unadjusted models, differences by treatment group were detected, F(1,1794) = 4.26, p = .039. Mothers and children who completed the ATTACH™ intervention had lower CTRA scores, indicating healthier immune cell gene expression profiles (Mn = −0.36, SE = 0.17), compared with mothers and children in the wait-list control group (Mn = 0.11, SE = 0.15). Results persisted after controlling for covariates. Discussion ATTACH™ participation predicted healthier immune cell gene expression profiles post-intervention compared with wait-list controls. Parenting interventions could decrease the impact of toxic stress on maternal-child immune health. The ATTACH™ program is a reflective function parenting intervention. The ATTACH™ program predicted healthier immune cell gene expression in children. The ATTACH™ program predicted healthier immune cell gene expression in mothers. The ATTACH™ program could protect the health of families escaping domestic violence.
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20
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Longitudinal effects of maltreatment, intimate partner violence, and Reminiscing and Emotion Training on children's diurnal cortisol regulation. Dev Psychopathol 2021; 33:868-884. [PMID: 32665044 DOI: 10.1017/s095457942000019x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dysregulation in children's physiological stress systems is a key process linking early adversity to poor health and psychopathology. Thus, interventions that improve children's stress physiology may help prevent deleterious health outcomes. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal caregiving support by enhancing maltreating mothers' capacity to reminisce with their young children. This study evaluated associations between maltreatment, intimate partner violence, and the RET intervention with changes in children's diurnal cortisol regulation across the 1 year following the intervention, and the extent to which improvements in maternal elaborative reminiscing differed between intervention groups and mediated change in children's physiological functioning. Participants were 237 children (aged 36 to 86 months) and their mothers. Results indicated that the RET intervention was associated with significant positive change in elaborative reminiscing, which was sustained over time. Mothers' elaboration immediately after the intervention served as a mediator of RET's effects on improvements in children's diurnal cortisol regulation (steeper diurnal slopes) from baseline to 1 year following intervention. This suggests RET is effective in facilitating physiological regulation among maltreated children.
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21
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Labella MH, Eiden RD, Roben CKP, Dozier M. Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up. Front Psychol 2021; 12:675866. [PMID: 34489793 PMCID: PMC8418066 DOI: 10.3389/fpsyg.2021.675866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023] Open
Abstract
Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.
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Affiliation(s)
- Madelyn H. Labella
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Rina D. Eiden
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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22
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McMahon CA, Maxwell AM. Commentary on Guild et al. (2020): The Importance of Well-Designed Intervention Studies for Advancing Attachment Theory and its Clinical Applications. Res Child Adolesc Psychopathol 2021; 49:583-589. [PMID: 33294966 DOI: 10.1007/s10802-020-00702-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guild and colleagues (this issue) report results of a long-term follow up after a randomized trial of the effectiveness of an attachment-theory-informed psychotherapeutic intervention for mothers with depression and their toddlers. Their paper shows the intervention can increase the likelihood of secure attachment in children of depressed mothers and that secure attachment explains more optimal social-emotional functioning in middle childhood in the treated group. This commentary discusses the contribution of the paper by Guild and colleagues and their broader body of work to our evolving understanding of developmental processes underpinning social-emotional competence in children of depressed parents, and to several ongoing controversies in the field: 1) the relevance of attachment-theory-informed interventions in the context of maternal depression; 2) the evidence gap regarding the efficacy and effectiveness of attachment-theory-informed interventions, particularly with respect to sustained benefits; 3) cost-benefits of early interventions; and 4) the need for theory driven research that explains how and under what circumstances attachment is related to later child outcomes.
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Affiliation(s)
- Catherine A McMahon
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW, 2109, Australia.
| | - Anne-Marie Maxwell
- Centre for Emotional Health, Department of Psychology, Macquarie University, North Ryde, NSW, 2109, Australia
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23
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Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:702-713. [PMID: 32388694 DOI: 10.1007/s11121-020-01127-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.
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24
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Szenczy AK, Bernard K, Raby KL, Garnett M, Dozier M. Foster parent responsiveness and young children's diurnal cortisol production. Dev Psychobiol 2021; 63:1626-1634. [PMID: 33368174 PMCID: PMC8236069 DOI: 10.1002/dev.22074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/28/2020] [Accepted: 11/27/2020] [Indexed: 11/07/2022]
Abstract
Foster children are at risk for dysregulated hypothalamic pituitary adrenal (HPA) axis functioning, conferring risk for negative health outcomes. Responsive parenting may support young children's HPA axis regulation; however, few studies have examined the association between responsive parenting and cortisol production among children in foster care. In a sample of 97 foster parent-child dyads, we examined whether variation in foster parent responsiveness was linked to children's waking and bedtime levels of cortisol. Children's saliva samples were collected at wake-up and bedtime for three consecutive days. Foster parent responsiveness, as indicated by parent sensitivity, intrusiveness, and positive regard, was assessed during video-recorded semistructured play interactions between foster parents and children. Foster parent responsiveness significantly predicted children's waking cortisol levels (β = 0.26, p = .023). Follow-up analyses revealed that foster parent sensitivity uniquely predicted waking cortisol (β = 0.46, p = .006), over and above other dimensions of parenting, such that children with more sensitive foster parents had higher waking cortisol than children with less sensitive foster parents. The association between foster parent sensitivity and the waking-to-bedtime slope of cortisol across the day was nonsignificant. Findings suggest that sensitive caregiving may support foster children's healthy HPA axis functioning.
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Affiliation(s)
| | | | - K. Lee Raby
- Department of Psychology, University of Utah
| | - Mallory Garnett
- Department of Psychological and Brain Sciences, University of Delaware
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware
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25
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Reid BM, DePasquale CE, Donzella B, Leneman KB, Taylor H, Gunnar MR. Pubertal transition with current life stress and support alters longitudinal diurnal cortisol patterns in adolescents exposed to early life adversity. Dev Psychobiol 2021; 63:e22146. [PMID: 34053063 DOI: 10.1002/dev.22146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/23/2021] [Accepted: 05/14/2021] [Indexed: 11/05/2022]
Abstract
Current and early life stress (ELS) are associated with diurnal cortisol patterns, which themselves are associated with mental and physical health. The pubertal recalibration hypothesis suggests that the social environment can impact dysregulated cortisol patterns for previously ELS-exposed youth as they transition through puberty. This study examined longitudinal change in cortisol awakening response (CAR) and diurnal slope (DS) across puberty as a function of ELS in infancy, current stress, and social support (N = 290, 7-17 years). The CAR and DS were examined thrice annually with an accelerated longitudinal design with nurse-assessed puberty to assess associations between diurnal cortisol and pubertal recalibration with ELS and the current social environment. Exposure to ELS was associated with less steep DS but not changes in CAR, and no evidence of pubertal calibration was found. The DS became less steep for youth in later pubertal stages and as youth progressed through puberty. The CAR was steeper for youth in later pubertal stages. Across the cohort, current life stress and support were associated with changes in the DS and the CAR through the pubertal transition. The pubertal stage and the peripubertal and pubertal social environment may have important implications for adrenocortical functioning with or without exposure to ELS.
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Affiliation(s)
- Brie M Reid
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
| | - Carrie E DePasquale
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
| | - Bonny Donzella
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
| | - Keira B Leneman
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
| | - Heather Taylor
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota-Twin Cities, Minnesota, Minneapolis, USA
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26
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Vaughn-Coaxum RA, Weisz JR. Leveraging the developmental science of psychosocial risk to strengthen youth psychotherapy. Dev Psychopathol 2021; 33:670-683. [PMID: 33719995 DOI: 10.1017/s0954579420002035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
More than 50 years of randomized clinical trials for youth psychotherapies have resulted in moderate effect sizes for treatments targeting the most common mental health problems in children and adolescents (i.e., anxiety, depression, conduct problems, and attention disorders). Despite having psychotherapies that are effective for many children, there has been a dearth of progress in identifying the contextual factors that likely influence who will respond to a given psychotherapy, and under what conditions. The developmental psychopathology evidence base consistently demonstrates that psychosocial risk exposures (e.g., childhood adversities, interpersonal stressors, family dysfunction) significantly influence the onset and course of youth psychopathology. However, the developmental psychopathology framework remains to be well integrated into treatment development and psychotherapy research. We argue that advances in basic developmental psychopathology research carry promising implications for the design and content of youth psychotherapies. Research probing the effects of psychosocial risks on youth development can enrich efforts to identify contextual factors in psychotherapy effectiveness and to personalize treatment. In this article we review empirically supported and hypothesized influences of individual- and family-level risk factors on youth psychotherapy outcomes, and we propose a framework for leveraging developmental psychopathology to strengthen psychotherapies.
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Affiliation(s)
- Rachel A Vaughn-Coaxum
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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27
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Korom M, Dozier M. The importance of responsive parenting for vulnerable infants. ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 61:43-71. [PMID: 34266571 DOI: 10.1016/bs.acdb.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The quality of the early caregiving context sets the stage for the developing child's long term developmental trajectory. Infants are born highly dependent on parents and other caregivers for critical input for developing brain and behavioral systems. When infants experience early adversity, they are at risk for difficulties regulating behavior, emotions, and physiology. Parenting interventions have been developed to enhance parental responsiveness, thereby enhancing child outcomes. One such program, Attachment and Biobehavioral Catch-up (ABC), is a home visiting intervention designed to enhance parenting nurturance and sensitivity. In this paper, we will consider the importance of parental sensitivity and developmental consequences of sensitive and insensitive care. We will then describe interventions that target parental responsiveness and intervention effectiveness, focusing primarily on ABC. Public policy recommendations related to the importance of parental responsiveness will then be discussed.
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Affiliation(s)
- Marta Korom
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States.
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28
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Increasing secure base script knowledge among parents with Attachment and Biobehavioral Catch-up. Dev Psychopathol 2021; 33:554-564. [PMID: 33487189 DOI: 10.1017/s0954579420001765] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study evaluated whether Attachment and Biobehavioral Catch-up (ABC), a parenting intervention, altered the attachment representations of parents (average age of 34.2 years) who had been referred to Child Protective Services (CPS) due to risk for child maltreatment when their children were infants. Approximately 7 years after completing the intervention, parents who had been randomized to receive ABC (n = 43) exhibited greater secure base script knowledge than parents who had been randomized to receive a control intervention (n = 51). Low-risk parents (n = 79) exhibited greater secure base script knowledge than CPS-referred parents who had received a control intervention. However, levels of secure base script knowledge did not differ between low-risk parents and CPS-referred parents who had received the ABC intervention. In addition, secure base script knowledge was positively associated with parental sensitivity during interactions with their 8-year-old children among low-risk and CPS-referred parents. Mediational analyses supported the idea that the ABC intervention enhanced parents' sensitivity 7 years later indirectly via increases in parents' secure base script knowledge.
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Enhancing diurnal cortisol regulation among young children adopted internationally: A randomized controlled trial of a parenting-based intervention. Dev Psychopathol 2021; 32:1657-1668. [PMID: 33427179 DOI: 10.1017/s0954579420001303] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Children who have been adopted internationally commonly experience institutional care and other forms of adversity prior to adoption that can alter the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. In particular, internationally adopted children tend to have blunted diurnal declines compared to children raised in their birth families. The Attachment and Biobehavioral Catch-Up (ABC) intervention was developed to enhance young children's biological and behavioral regulation by promoting sensitive parenting. The current study used a randomized controlled trial to assess whether ABC improved the diurnal functioning of the HPA axis among 85 children who had been adopted internationally when they were between the ages of 4 and 33 months (M = 16.12). Prior to the intervention, there were no significant differences in diurnal cortisol production between children whose parents were randomly assigned to receive ABC and children whose parents were randomly assigned to receive a control intervention. After the intervention, children whose parents had received the ABC intervention exhibited steeper declines in cortisol levels throughout the day than children whose parents had received the control intervention. These results indicate that the ABC intervention is effective in enhancing a healthy pattern of diurnal HPA axis regulation for young children who have been adopted internationally.
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Environmental determinants of physiological reactivity to stress: The interacting effects of early life deprivation, caregiving quality, and stressful life events. Dev Psychopathol 2021; 32:1732-1742. [PMID: 33427173 DOI: 10.1017/s0954579420001327] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Children who spend their early lives in institutions experience profound psychosocial deprivation that is associated with altered stress response system development. Here, we used data from a longitudinal randomized controlled trial of foster care for institutionally reared children to examine whether caregiving quality and stressful life events (SLEs) in early adolescence (age 12) influence patterns of hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) reactivity. Controlling for the effect of institutional care, higher caregiving quality at age 12 was associated with heightened cortisol and SNS reactivity. However, moderation analysis revealed that the latter effect was only observed among never-institutionalized children, whereas ever-institutionalized children demonstrated a persistently blunted SNS response regardless of recent caregiving quality. Among institutionally reared children, SLEs interacted with prior random assignment to foster care, such that those placed in foster care early in development had a SNS response that approximated never-institutionalized children when SLEs at age 12 were low. In contrast, SNS reactivity was persistently blunted among those with prolonged deprivation, regardless of recent SLEs. Early-life deprivation is associated with persistent blunting of stress response systems, but normalization may be achievable if SLEs are limited following placement into enriched family-based care.
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Maltreatment timing, HPA axis functioning, multigenic risk, and depressive symptoms in African American youth: Differential associations without moderated mediation. Dev Psychopathol 2021; 32:1838-1853. [PMID: 33427169 DOI: 10.1017/s0954579420000589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Utilizing a large (N = 739), ancestrally homogenous sample, the current study aimed to better understand biological risk processes involved in the development of depressive symptoms in maltreated, African American children age 8-12 years. Maltreatment was independently coded from Child Protective Services records and maternal report. Self-reported depressive symptoms were attained in the context of a week-long, summer research camp. DNA was acquired from buccal cell or saliva samples and genotyped for nine polymorphisms in four hypothalamic-pituitary-adrenal (HPA)-axis-related genes: FKBP5, NR3C1, NR3C2, and CRHR1. Salivary cortisol samples were collected each morning (9 a.m.) and late afternoon (4 p.m.) throughout the week to assess HPA functioning. Results revealed that experiences of maltreatment beginning prior to age 5 were most predictive of depressive symptoms, whereas maltreatment onset after age 5 was most predictive of HPA axis dysregulation (blunted daytime cortisol patterns). Multigenic risk did not relate to HPA functioning, nor did it moderate the relationship between maltreatment and HPA activity. There was no mediation of the relationship between maltreatment and depressive symptoms by HPA dysfunction. Results are interpreted through a developmental psychopathology lens, emphasizing the principle of equifinality while carefully appraising racial differences. Implications for future research, particularly the need for longitudinal studies, and important methodological considerations are discussed.
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Challenges in researching the immune pathways between early life adversity and psychopathology. Dev Psychopathol 2021; 32:1597-1624. [DOI: 10.1017/s0954579420001157] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AbstractExposure to childhood adversity is a critical risk factor for the development of psychopathology. A growing field of research examines how exposure to childhood adversity is translated into biological risk for psychopathology through alterations in immune system functioning, most notably heightened levels of inflammation biomarkers. Though our knowledge about how childhood adversity can instantiate biological risk for psychopathology is growing, there remain many challenges and gaps in the field to understand how inflammation from childhood adversity contributes to psychopathology. This paper reviews research on the inflammatory outcomes arising from childhood adversity and presents four major challenges that future research must address: (a) the measurement of childhood adversity, (b) the measurement of inflammation, (c) the identification of mediators between childhood adversity and inflammation, and (d) the identification of moderators of inflammatory outcomes following childhood adversity. We discuss synergies and inconsistencies in the literature to summarize the current understanding of the association between childhood adversity, a proinflammatory phenotype, and the biological risk for psychopathology. We discuss the clinical implications of the inflammatory links between childhood adversity and psychopathology, including possibilities for intervention. Finally, this review conclude by delineates future directions for research, including issues of how best to detect, prevent, and understand these “hidden wounds” of childhood adversity.
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Caron EB, Lind TA, Dozier M. Strategies that Promote Therapist Engagement in Active and Experiential Learning: Micro-Level Sequential Analysis. CLINICAL SUPERVISOR 2021; 40:112-133. [PMID: 34248258 DOI: 10.1080/07325223.2020.1870023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Therapists' active learning increases treatment fidelity, but research is needed on supervisory strategies to engage therapists in active learning. This study used sequential analysis to examine consultant behaviors associated with increased and decreased probability of eliciting therapists' active learning. The study included 162 consultation sessions from 27 community therapists implementing Attachment and Biobehavioral Catch-up. Consultants' client discussion, information provision, and modeling were associated with reduced likelihood of active learning. Consultants' questions, engagement in active learning strategies, use of video, and silence were associated with greater likelihood of therapist active learning. These findings inform supervisors' attempts to encourage active learning.
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Affiliation(s)
- E B Caron
- Department of Psychological Science, Fitchburg State University
| | - Teresa A Lind
- Department of Child and Family Development, San Diego State University.,Child and Adolescent Research Center (CASRC)
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware
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Chernego D, Tumanian K, Muhamedrahimov R. The impact of early intervention program on cortisol production in foster care children. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:67-71. [DOI: 10.17116/jnevro202112111267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Garnett M, Bernard K, Hoye J, Zajac L, Dozier M. Parental sensitivity mediates the sustained effect of Attachment and Biobehavioral Catch-up on cortisol in middle childhood: A randomized clinical trial. Psychoneuroendocrinology 2020; 121:104809. [PMID: 32781397 PMCID: PMC7733705 DOI: 10.1016/j.psyneuen.2020.104809] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/11/2020] [Accepted: 07/21/2020] [Indexed: 12/23/2022]
Abstract
IMPORTANCE Parenting interventions have been found to normalize cortisol regulation among high-risk children early in development; it is important to investigate the sustainability of these effects and their mechanisms, given the maladaptive outcomes associated with cortisol dysregulation. OBJECTIVE To determine whether the Attachment and Biobehavioral Catch-up (ABC) intervention, implemented in infancy, predicts cortisol regulation in middle childhood via changes in early parental sensitivity. DESIGN Double blind randomized clinical trial design; started January 2006, the follow-up for this project concluded March 2016. SETTING Parents of children under age 2 referred from child protective services agencies in a large, mid-Atlantic city. PARTICIPANTS 103 parent-child dyads (45.6% female children) with histories of child protective services involvement, randomly assigned to receive ABC (n = 45) or a control intervention (n = 58); in infancy, the children's ages ranged from 1.60 to 25.30 months (M = 9.87 months); at the middle childhood follow-up, they ranged from 8.0 to 11.0 years old (M = 8.52 years). INTERVENTIONS Both conditions included 10-week, in-home, manualized interventions. The experimental condition, ABC, has 3 primary targets for parents: increasing nurturance to child distress, increasing following the child's lead, and decreasing frightening behavior. The control intervention, Developmental Education for Families (DEF), is an adaptation of a program focused on enhancing cognitive and language development. MAIN OUTCOMES AND MEASURES Parental sensitivity was coded from a semi-structured interaction task between the parent and child in early childhood. Middle childhood diurnal cortisol slopes were modeled by collecting salivary cortisol samples from children at wake-up and bedtime over the course of 3 consecutive days. RESULTS ABC participation in infancy was associated with increased parental sensitivity post-intervention, β = 0.28, p = .004, and this increased sensitivity predicted steeper decline across the day in children's cortisol concentration in middle childhood, β = -.53, p = .002. The indirect effect of ABC on cortisol regulation via sensitivity was significant, β = -0.15, p = .038. CONCLUSIONS AND RELEVANCE ABC has an indirect effect on middle childhood diurnal cortisol regulation via parental sensitivity; future research should seek to determine how this enhanced neurobiological regulation relates to children's behavioral, socioemotional, and psychological outcomes. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02093052.
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Affiliation(s)
- Mallory Garnett
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE, 19718, United States.
| | - Kristin Bernard
- Stony Brook University, Psychology B Building, Stony Brook, NY 11794, United States
| | - Julie Hoye
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19718, United States
| | - Lindsay Zajac
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19718, United States
| | - Mary Dozier
- University of Delaware, Department of Psychological and Brain Sciences, 108 Wolf Hall, Newark, DE 19718, United States
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Preliminary indications that the Attachment and Biobehavioral Catch-up Intervention alters DNA methylation in maltreated children. Dev Psychopathol 2020; 32:1486-1494. [PMID: 31854285 DOI: 10.1017/s0954579419001421] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Maltreatment during development is associated with epigenetic changes to the genome. Enhancing caregiving may mitigate these effects. Attachment and Biobehavioral Catch-Up (ABC) is an intervention that has been shown to improve parent-child relationships and a variety of biological and behavioral outcomes among children that are involved in Child Protective Services. This preliminary study, using a small sample size, explored whether children who received ABC exhibit different methylation patterns than those who received a control intervention. The participants included 23 children aged 6-21 months who were randomized to receive ABC (n = 12) or a control intervention (n = 11). While the children displayed similar methylation patterns preintervention, DNA methylation varied between the ABC and control groups at 14,828 sites postintervention. Functional pathway analyses indicated that these differences were associated with gene pathways that are involved in cell signaling, metabolism, and neuronal development. This study is one of the first to explore parenting intervention effects on children's DNA methylation at the whole genome level in infancy. These preliminary findings provide a basis for hypothesis generation in further research with larger-scale studies regarding the malleability of epigenetic states that are associated with maltreatment.
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Valadez EA, Tottenham N, Tabachnick AR, Dozier M. Early Parenting Intervention Effects on Brain Responses to Maternal Cues Among High-Risk Children. Am J Psychiatry 2020; 177:818-826. [PMID: 32731812 PMCID: PMC7716800 DOI: 10.1176/appi.ajp.2020.20010011] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Early adversity is correlated with increased risk for negative outcomes, including psychopathology and atypical neurodevelopment. The authors aimed to test the causal impact of an early parenting intervention (Attachment and Biobehavioral Catch-Up; ABC) on children's neural processing of parent cues and on psychosocial functioning in a longitudinal randomized clinical trial. METHODS Participants (N=68, mean age, 10.0 years [SD=0.8 years]) were 46 high-risk children whose parents were randomly assigned to receive either the ABC intervention (N=22) or a control intervention (N=24) while the children were infants, in addition to a comparison sample of low-risk children (N=22). During functional MRI scanning, children viewed pictures of their own mothers and of a stranger. RESULTS Children in the ABC condition showed greater maternal cue-related activation than children in the control condition in clusters of brain regions, including the precuneus, the cingulate gyrus, and the hippocampus, regions commonly associated with social cognition. Additionally, greater activity in these regions was associated with fewer total behavior problems. There was an indirect effect of early intervention on middle childhood psychosocial functioning mediated through increased activity in brain regions in response to maternal cues. CONCLUSIONS These results suggest that early parenting intervention (in this case the ABC intervention) can enhance brain regions supporting children's social cognitive development. In addition, the findings highlight these brain effects as a possible neural pathway through which ABC may prevent future behavior problems among high-risk children, yielding psychosocial benefits that endure through at least middle childhood without the need to intervene with the child directly.
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Yarger HA, Bronfman E, Carlson E, Dozier M. Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal. Dev Psychopathol 2020. [PMID: 31366415 DOI: 10.1017/s095457941900078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.
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Affiliation(s)
- Heather A Yarger
- Department of Psychology, University of Maryland, College Park, MD, USA
| | | | - Elizabeth Carlson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Martins RC, Blumenberg C, Tovo-Rodrigues L, Gonzalez A, Murray J. Effects of parenting interventions on child and caregiver cortisol levels: systematic review and meta-analysis. BMC Psychiatry 2020; 20:370. [PMID: 32669084 PMCID: PMC7362449 DOI: 10.1186/s12888-020-02777-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/05/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Nurturing care, in which children are raised in engaging and safe environments, may reduce child stress and shape hypothalamic-pituitary-adrenal axis functioning. Hence, parent-training programs may impact child cortisol levels, as well as behavioral, social and health outcomes. We conducted a systematic review of the impact of parent-training interventions on children's and caregivers' cortisol levels, and meta-analyzed the results. METHODS In January 2020, searches in PubMed, LILACS, ERIC, Web of Science, Scielo, Scopus, PsycNET and POPLINE databases were conducted, and two independent researchers screened the results for eligible studies - randomized trials that assessed the impact of parent-training interventions on child or caregiver cortisol levels. Random effects were used to pool the estimates, separately for children and caregivers, and for children's morning and evening cortisol levels, as well as change across the day. RESULTS A total of 27 eligible studies were found. Data from 19 studies were extracted and included in the meta-analyses, with 18 estimates of child cortisol levels and 5 estimates for caregiver cortisol levels. The pooled effect size (standardized mean difference) for the effects of parent training programs on morning child cortisol was 0.01 (95%CI: - 0.14 to 0.16; I2: 47.5%), and for caregivers it was 0.04 (95%CI: - 0.22 to 0.30; I2: 0.0%). Similar null results were observed for child evening cortisol and for the slope between morning and evening child cortisol. No evidence of publication bias was found. CONCLUSION Existing evidence shows no effect of parent-training interventions on child or caregiver post-intervention cortisol. Researchers are encouraged to adopt standardized protocols to improve evaluation standards, to test for intervention effects on psychosocial outcomes that are theorized to mediate the effects on biomarkers, and to use additional biomarkers for chronic stress.
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Affiliation(s)
- Rafaela Costa Martins
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil.
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil.
| | - Cauane Blumenberg
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luciana Tovo-Rodrigues
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Gonzalez
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Joseph Murray
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Rua Marechal Deodoro 1160, Pelotas, RS, 96020-220, Brazil
- Post-graduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Changing parental depression and sensitivity: Randomized clinical trial of ABC's effectiveness in the community. Dev Psychopathol 2020; 33:1026-1040. [DOI: 10.1017/s0954579420000310] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AbstractAttachment and Biobehavioral Catch-up (ABC) demonstrates efficacy in improving parent and child outcomes, with preliminary evidence for effectiveness in community settings. The objective of this study was to assess the effectiveness of a community-based ABC implementation in improving parent outcomes as well as to examine potential mediators and moderators of intervention effectiveness. Two hundred parents and their 5- to 21-month-old infants recruited from an urban community were randomly assigned to receive ABC or be placed on a waitlist. The majority of participants had a minority racial or ethnic background. Before intervention, parents completed questionnaires about sociodemographic risk and adverse childhood experiences. At both baseline and follow-up, parents reported depression symptoms and were video-recorded interacting with their infant, which was coded for sensitivity. The ABC intervention predicted significant increases in parental sensitivity and, among parents who completed the intervention, significant decreases in depression symptoms. Changes in parental depression symptoms did not significantly mediate the intervention effects on sensitivity. Risk variables did not moderate the intervention effects. The results indicate that ABC shows promise for improving parent outcomes in community settings, supporting dissemination.
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Changes in provider Fidelity after introducing a new model of intervention. CURRENT PSYCHOLOGY 2020; 41:3906-3915. [PMID: 32837130 PMCID: PMC7340763 DOI: 10.1007/s12144-020-00910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the impact of implementation fidelity on community-based outcomes, it is important to understand how fidelity may change over time as providers learn an intervention. Attachment and Biobehavioral Catch-up is an evidence-based early intervention that assesses fidelity during weekly supervision. Providers are first trained in the infant model, with toddler model training considered to be a separate, specialized opportunity. The current study examined changes in fidelity, measured by “in-the-moment” commenting, as providers moved from infant to toddler certification. An initial drop, with a subsequent increase, in commenting fidelity over the training year was expected. Results were consistent with our hypotheses, demonstrating a main effect of time, with most indices of commenting data initially decreasing and then increasing. These findings are consistent with research suggesting that fluctuation in fidelity is typical within community dissemination and suggests that ongoing supervision after the initial training is useful in facilitating successful skill development.
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Caron EB, Dozier M. Effects of Fidelity-Focused Consultation on Clinicians' Implementation: An Exploratory Multiple Baseline Design. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:445-457. [PMID: 30783903 DOI: 10.1007/s10488-019-00924-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Identification of effective consultation models could inform implementation efforts. This study examined the effects of a fidelity-focused consultation model among community-based clinicians implementing Attachment and Biobehavioral Catch-up. Fidelity data from 1217 sessions from 7 clinicians were examined in a multiple baseline design. In fidelity-focused consultation, clinicians received feedback from consultants' fidelity coding, and also coded their own fidelity. Clinicians' fidelity increased after fidelity-focused consultation began, but did not increase during other training periods. Fidelity was sustained for 30 months after consultation ended. Findings suggest that consultation procedures involving fidelity coding feedback and self-monitoring of fidelity may promote implementation outcomes.
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Affiliation(s)
- E B Caron
- Department of Psychiatry, University of Connecticut Health Center, 65 Kane St., Room 2031, West Hartford, CT, 06119, USA.
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, USA
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Labella MH, Lind T, Sellers T, Roben CKP, Dozier M. Emotion Regulation among Children in Foster Care Versus Birth Parent Care: Differential Effects of an Early Home-Visiting Intervention. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:995-1006. [PMID: 32419117 DOI: 10.1007/s10802-020-00653-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children involved with Child Protective Services (CPS) often show worse emotion regulation than non-involved children, with downstream effects on adaptive functioning. The current study uses two randomized control trials, one conducted with foster caregivers and one conducted with birth parents, to investigate the longitudinal effects of caregiver type (foster versus birth parent) and a home-visiting parenting intervention on emotion regulation among young children referred to CPS. Participants were 211 children referred to CPS during infancy or toddlerhood, of whom 120 remained with their birth parents and 91 were placed in foster care. Caregivers were randomly assigned to receive Attachment and Biobehavioral Catch-Up (ABC), a 10-session intervention designed to promote nurturing, sensitive, and non-intrusive caregiving, or a control intervention. Caregiver type moderated the effects of ABC on young children's observed anger dysregulation during a frustrating task at age 2 to 3 years. Among children remaining with their birth parents, children whose caregivers received ABC showed lower anger dysregulation than children whose caregivers received the control intervention. Children placed in foster care showed lower anger dysregulation than children with birth parents regardless of parenting intervention, and additionally showed higher adaptive regulation than children remaining with their birth parents. Adaptive regulation was not significantly associated with parenting intervention or the caregiver by intervention interaction. Results suggest that foster care placement may be protective for emerging emotion regulation skills among young children referred to CPS, and an attachment-based parenting intervention buffers risks of remaining in the home for young children's emotion dysregulation.
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Affiliation(s)
- Madelyn H Labella
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.
| | - Teresa Lind
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.,Child and Adolescent Services Research Center (CASRC), 3665 Kearny Villa Road, Suite 200N, San Diego, CA, 92123, USA
| | - Tabitha Sellers
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
| | - Caroline K P Roben
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
| | - Mary Dozier
- Department of Psychological & Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
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Zajac L, Prendergast S, Feder KA, Cho B, Kuhns C, Dozier M. Trajectories of sleep in Child Protective Services (CPS)-referred children predict externalizing and internalizing symptoms in early childhood. CHILD ABUSE & NEGLECT 2020; 103:104433. [PMID: 32126399 PMCID: PMC7716882 DOI: 10.1016/j.chiabu.2020.104433] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Previous studies have established links between poor sleep and negative developmental outcomes. However, it remains unclear whether young maltreated children demonstrate atypical sleep patterns and whether sleep duration is associated with emotional and behavioral problems. OBJECTIVE Explore trajectories of sleep among Child Protective Services (CPS)-referred children and examine whether sleep duration is significantly associated with externalizing and internalizing symptoms, even when controlling for the home environment. PARTICIPANTS Participants included 197 children (Mage at first assessment = 10.24 months, SD = 6.39) whose parents were referred to CPS due to allegations of maltreatment. METHODS Parents completed sleep diaries for their children at up to five time-points and the preschool version of the Child Behavior Checklist (CBCL) when children were approximately 2 years of age (Mage = 26.40 months, SD = 3.36). The Home Observation for Measurement of the Environment Scale (HOME) assessed the quality of the early home environment. RESULTS Results from latent growth curve modeling demonstrated that CPS-referred children significantly varied (B = 3.28, SE = 0.90, p < .001) in the amount they slept in a 24-hour period at baseline (i.e., 4.1 months of age), and the amount of total sleep in a 24-hour period significantly decreased across time (B1 = -0.03, SE = 0.01, p < .001). When controlling for characteristics of the home environment, total sleep in a 24-hour period at baseline significantly inversely predicted externalizing (B = -1.03, SE = 0.06, p < .001) and internalizing symptoms (B = -0.19, SE = 0.03, p < .001) in early childhood. CONCLUSIONS This study is an important first step in exploring trajectories of sleep among CPS-referred children. Findings underscore sleep as a promising target for interventions aimed at promoting regulation and highlight the need for future research to examine sleep in maltreated children as a predictor of later developmental outcomes.
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Affiliation(s)
| | | | - Kenneth A Feder
- Johns Hopkins Bloomberg School of Public Health, United States
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Zajac L, Raby L, Dozier M. Sustained effects on attachment security in middle childhood: results from a randomized clinical trial of the Attachment and Biobehavioral Catch-up (ABC) intervention. J Child Psychol Psychiatry 2020; 61:417-424. [PMID: 31677152 PMCID: PMC7135967 DOI: 10.1111/jcpp.13146] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Interventions have been developed to promote the development of secure and organized attachments during early childhood among children who have experienced early adversity, yet little is known about whether the effects of these early interventions are sustained beyond 12 months postintervention. The current study examined whether receiving the Attachment and Biobehavioral Catch-Up (ABC) intervention during infancy led to improvements in perceived attachment security in middle childhood among 100 Child Protective Services (CPS)-referred children. METHODS Children and parents were randomized to receive ABC or a control intervention during infancy. Children completed the Kerns Security Scale at age nine (Mage = 9.46, SD = 0.36). (Trial Registry Name: Intervening Early with Neglected Children; Registry ID: NCT02093052; URL for registry: https://clinicaltrials.gov/ct2/show/NCT02093052?term=dozier&rank=1). RESULTS Children whose parents received ABC reported higher levels of attachment security on the Kerns Security Scale at age nine than children whose parents had received the control intervention, t(98) = 2.31, p = .023, d = 0.49. CONCLUSIONS Findings underscore the long-term benefits of intervening early to promote caregiving quality among at-risk families and demonstrate the efficacy of a brief 10-session intervention in promoting attachment security over the span of eight years in a sample of CPS-referred children.
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Affiliation(s)
- Lindsay Zajac
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Lee Raby
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
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Miller TR, Waehrer GM, Oh DL, Purewal Boparai S, Ohlsson Walker S, Silverio Marques S, Burke Harris N. Adult health burden and costs in California during 2013 associated with prior adverse childhood experiences. PLoS One 2020; 15:e0228019. [PMID: 31990957 PMCID: PMC6986705 DOI: 10.1371/journal.pone.0228019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/06/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To estimate the adult health burden and costs in California during 2013 associated with adults' prior Adverse Childhood Experiences (ACEs). METHODS We analyzed five ACEs-linked conditions (asthma, arthritis, COPD, depression, and cardiovascular disease) and three health risk factors (lifetime smoking, heavy drinking, and obesity). We estimated ACEs-associated fractions of disease risk for people aged 18+ for these conditions by ACEs exposure using inputs from a companion study of California Behavioral Risk Factor Surveillance System data for 2008-2009, 2011, and 2013. We combined these estimates with published estimates of personal healthcare spending and Disability-Adjusted-Life-Years (DALYs) in the United States by condition during 2013. DALYs captured both the years of healthy life lost to disability and the years of life lost to deaths during 2013. We applied a published estimate of cost per DALY. RESULTS Among adults in California, 61% reported ACEs. Those ACEs were associated with $10.5 billion in excess personal healthcare spending during 2013, and 434,000 DALYs valued at approximately $102 billion dollars. During 2013, the estimated health burden per exposed adult included $589 in personal healthcare expenses and 0.0224 DALYs valued at $5,769. CONCLUSIONS Estimates of the costs of childhood adversity are far greater than previously understood and provide a fiscal rationale for prevention efforts.
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Affiliation(s)
- Ted R. Miller
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States of America
- School of Public Health, Curtin University, Perth, Australia
| | - Geetha M. Waehrer
- Pacific Institute for Research and Evaluation, Calverton, Maryland, United States of America
| | - Debora L. Oh
- University of California, San Francisco, California, United States of America
| | | | - Sheila Ohlsson Walker
- Children’s National Medical Center, George Washington University, Washington, DC, United States of America
| | | | - Nadine Burke Harris
- Center for Youth Wellness, San Francisco, California, United States of America
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Ryan KR, Jones MB, Allen KY, Marino BS, Casey F, Wernovsky G, Lisanti AJ. Neurodevelopmental Outcomes Among Children With Congenital Heart Disease: At-Risk Populations and Modifiable Risk Factors. World J Pediatr Congenit Heart Surg 2019; 10:750-758. [PMID: 31658880 DOI: 10.1177/2150135119878702] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As survivable outcomes among patients with complex congenital heart disease (cCHD) have continued to improve over the last several decades, more attention is being dedicated to interventions that impact not just survival but quality of life among patients with cCHD. In particular, patients with cCHD are at risk for impaired neurodevelopmental outcomes. In this review summarizing select presentations given at the 14th Annual Pediatric Cardiac Intensive Care Society's Annual Meeting in 2019, we discuss the neurodevelopmental phenotype of patients with cCHD, patients at greatest risk of impaired development, and three specific modifiable risk factors impacting development.
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Affiliation(s)
- Kathleen R Ryan
- Division of Cardiology, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA
| | - Melissa B Jones
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Kiona Y Allen
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Bradley S Marino
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA.,Division of Critical Care Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, IL, USA
| | - Frank Casey
- Department of Cardiology, Belfast Health and Social Care Trust, Belfast, Ireland
| | - Gil Wernovsky
- Division of Cardiac Critical Care, Children's National Health System, Washington, DC, USA.,Division of Pediatric Cardiology, Children's National Health System, Washington, DC, USA
| | - Amy Jo Lisanti
- Department of Cardiac Nursing and the Center for Pediatric Nursing Research and Evidence-based Practice, Children's Hospital of Philadelphia, PA, USA
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Abstract
Foster and adoptive parents often face challenges while taking care of children who, due to their adverse early life experiences, are at risk of developing insecure attachment relationships, behavior problems, and stress dysregulation. Several intervention programs have been developed to help foster and adoptive parents to overcome these challenges. In the current study, a series of eight meta-analyses were performed to examine the effectiveness of these intervention programs on four parent outcomes (sensitive parenting, k = 11, N = 684; dysfunctional discipline, k = 4, N = 239; parenting knowledge and attitudes, k = 7, N = 535; parenting stress, k = 18, N = 1,306), three child outcomes (attachment security, k = 6, N = 395; behavior problems, k = 33, N = 2,661; diurnal cortisol levels, k = 3, N = 261), and placement disruption (k = 7, N = 1,100). Results show positive effects for the four parent outcomes and child behavior problems, but not for attachment security, child diurnal cortisol levels, or placement disruption. Indirect effects on child outcomes may be delayed, and therefore long-term follow-up studies are needed to examine the effects of parenting interventions on children.
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Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal. Dev Psychopathol 2019; 32:1139-1148. [PMID: 31366415 DOI: 10.1017/s0954579419000786] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.
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Callaghan BL, Gee DG, Gabard-Durnam L, Telzer EH, Humphreys KL, Goff B, Shapiro M, Flannery J, Lumian DS, Fareri DS, Caldera C, Tottenham N. Decreased Amygdala Reactivity to Parent Cues Protects Against Anxiety Following Early Adversity: An Examination Across 3 Years. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:664-671. [PMID: 30952600 PMCID: PMC6612442 DOI: 10.1016/j.bpsc.2019.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 01/16/2023]
Abstract
BACKGROUND The human brain remains highly plastic for a protracted developmental period. Thus, although early caregiving adversities that alter amygdala development can result in enduring emotion regulation difficulties, these trajectories should respond to subsequent enriched caregiving. Exposure to high-quality parenting can regulate (i.e., decrease) children's amygdala reactivity, a process that, over the long term, is hypothesized to enhance emotion regulation. We tested the hypothesis that even following adversity, the parent-child relationship would be associated with decreases in amygdala reactivity to parent cues, which would in turn predict lower future anxiety. METHODS Participants were 102 children (6-10 years of age) and adolescents (11-17 years of age), for whom data were collected at one or two time points and who either had experienced institutional care before adoption (n = 45) or had lived always with their biological parents (comparison; n = 57). We examined how amygdala reactivity to visual cues of the parent at time 1 predicted longitudinal change (from time 1 to time 2) in parent-reported child anxiety across 3 years. RESULTS At time 1, on average, amygdala reactivity decrements to parent cues were not seen in children who had received institutional care but were seen in children in the comparison group. However, some children who previously experienced institutional care did show decreased amygdala reactivity to parent cues (∼40%), which was associated with greater child-reported feelings of security with their parent. Amygdala decreases at time 1 were followed by steeper anxiety reductions from time 1 to time 2 (i.e., 3 years). CONCLUSIONS These data provide a neurobiological mechanism by which the parent-child relationship can increase resilience, even in children at significant risk for anxiety symptoms.
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Affiliation(s)
- Bridget L Callaghan
- Department of Psychology, Columbia University, New York, New York; Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut
| | | | - Eva H Telzer
- Department of Psychology, University of Illinois at Urbana-Champaign, Champaign, Illinois
| | - Kathryn L Humphreys
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee
| | - Bonnie Goff
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Mor Shapiro
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California
| | - Jessica Flannery
- Department of Psychology, University of Oregon, Eugene, Eugene, Oregon
| | - Daniel S Lumian
- Department of Psychology, University of Denver, Denver, Colorado
| | - Dominic S Fareri
- Department of Psychology, Adelphi University, Garden City, New York
| | - Christina Caldera
- Department of Psychology, University of California-Los Angeles, Los Angeles, California
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
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