Contextual stress and maternal sensitivity: A meta-analytic review of stress associations with the Maternal Behavior Q-Sort in observational studies

Development of temperamental regulation of infants at 6 and 24 months: Associations with maternal soothing and distress

Background and Aims

In the neurobiological theory of attention, the orienting network mainly supports the temperamental regulatory function in infancy, with soothing methods such as visual attention distraction influencing its development. The attention distraction method chosen for soothing is thought to be influenced by maternal sensitivity, which has been found to decrease with poor maternal mental health. We hypothesize that the degree of maternal distress may affect the choice of attention distraction soothing method. Further, individual differences in being soothed by attention distraction will be associated with the temperamental regulation function in infancy/toddlerhood.

Method

Structural equation modeling (SEM) was conducted on longitudinal data at 6 and 24 months on a sample (N = 1892) drawn from the sub-cohort of the Japan Environment and Children's Study (JECS). Temperament was examined through the short Infant Behavior Questionnaire-Revised (Japanese version) and the Early Childhood Behavior Questionnaire (Japanese version). Distress in caregivers was measured through the Kessler Psychological Distress Scale (Japanese version) at prenatal and 1-year-postnatal stages. Individual differences in using visual distraction soothing methods were also measured using tailor-made items.

Results

Postnatal maternal distress at 12 months was negatively related to the tendency to use visual attention distraction as a soothing method (β = -0.06, p = 0.006) at 24 months. When we applied the subscale of the temperamental regulatory factor in SEM, the more the mothers chose the distraction method for soothing, i.e., the more the toddlers experienced it, the higher their attention shifting scores (β = 0.07, p = 0.002).

Conclusion

The findings support the view that caregivers' choice of method for distracting offspring's attention from distress may be associated with the development of self-regulation during infancy and toddlerhood.

Maternal Stress Mediates Association of Infant Socioemotional Development with Perinatal Mental Health in Socioeconomically Vulnerable Peruvian Settings

Increased maternal mental health during the perinatal period has been widely associated with a variety of positive outcomes for both mothers and infants. However, no studies in Peru have yet focused on studying maternal mental health and related psychological variables during this stage. Thus, the aim of this study was to test a model to associate a mother's parental stress with infant socioemotional difficulties and maternal mental health. The sample included 988 mothers of infants aged 6 to 18 months from Peru, all from socioeconomically vulnerable settings. The findings showed that infant socioemotional difficulties were associated with poorer maternal mental health through the mother's parental stress (χ2(7) = 28.89, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.03). These results provide a better understanding of the key elements associated with maternal mental health during the perinatal period in Peru and offer valuable insights for developing interventions and support strategies for socioeconomically vulnerable mothers and their young children.

Mother-Infant Dyadic Synchrony and Interaction Patterns After Infant Cardiac Surgery

OBJECTIVE

Parents and their infants with complex congenital heart disease (CHD) face relational challenges, including marked distress, early separations, and infant hospitalizations and medical procedures, yet the prevalence of parent-infant interaction difficulties remains unclear. Using a standardized observational paradigm, this study investigated mother-infant dyadic synchrony, interactional patterns, and associated predictors in mother-infant pairs affected by CHD, compared with typically-developing pairs.

METHODS

In this prospective, longitudinal cohort study, mothers and their infants requiring cardiac surgery before age 6-months (n=110 pairs) and an age- and sex-matched Australian community sample (n=85 pairs) participated in a filmed, free-play interaction at 6.9±1.0 months. Mother-infant dyadic synchrony, maternal and infant interactional patterns, and relational risk were assessed using the Child-Adult Relationship Experimental (CARE) Index. Maternal and infant predictors were assessed at 32 weeks gestation, 3- and 6-months postpartum.

RESULTS

Most mother-infant interactions were classified as "high risk" or "inept" (cardiac: 94%, control: 81%; p=.007). Dyadic synchrony (p<.001), maternal sensitivity (p=.001), and infant cooperativeness (p=.001) were lower for cardiac than control pairs. Higher maternal traumatic stress at 6-months postpartum predicted lower dyadic synchrony for mother-infant pairs affected by CHD (B=-.04, p=.03). Dyadic synchrony was higher among older infants in the total (B=.40, p=.003) but not cardiac sample (B=.24, p=.06).

CONCLUSIONS

Relational difficulties were almost universal among mother-infant pairs affected by CHD and were also high in the Australian community sample. Widespread education initiatives are recommended to increase awareness of heightened mother-infant relational risk in congenital heart care and well-child settings, alongside relationally-focused prevention and early intervention programs.

Infant and preschool attachment, continuity and relationship to caregiving sensitivity: findings from a new population-based Australian cohort

BACKGROUND

Here, we report new prevalence and temporal stability data for child attachment and parental caregiving behaviour, from infancy (1 year) to preschool (4 years).

METHODS

Attachment (SSP) and caregiving data (MBQS) were from observations of parents and their infants and preschoolers, who represent the third generation of participants within an Australian longitudinal cohort.

RESULTS

At 1 year (n = 314 dyads) and at 4 years (n = 368 dyads), proportions assessed secure were 59% and 71%, respectively. Proportions assessed avoidant were 15% and 11%; ambivalent 9% and 6%, and disorganised 17% and 12%, at 1 and 4 years. Continuity of attachment pattern was highest for the infant secure group. Of dyads initially classified disorganised in infancy, 36% remained so at the preschool assessment. Attachment and caregiving continuities across the infancy-preschool period were highest for the stable secure attachment group and lowest for the stable insecure attachment group. Loss of secure attachment to mother by age 4 years correlated with decreased maternal caregiving sensitivity, and acquisition of secure status by age 4 was associated with increased maternal sensitivity. We found no difference in caregiving sensitivity scores for mothers and fathers for female and male preschool children.

CONCLUSIONS

The contemporary infant and preschool attachment proportions we report here closely mirror the patterns of those reported in prior decades, with an inclination towards secure base relationships. Our findings alert practitioners anew to the responsiveness of early attachment status to change in caregiving responsiveness and support ongoing investment in early identification of disorganised attachment.

The polygenic and reactive nature of observed parenting

In Wertz et al. (2019), parents' polygenic scores of educational attainment (PGS-EA) predicted parental sensitive responses to the child's needs for support, as observed in a dyadic task (i.e., observed sensitivity). We aimed to replicate and expand these findings by combining longitudinal data, child genotype data and several polygenic scores in the Generation R Study. Mother-child dyads participated in two developmental periods, toddlerhood (14 months old; n = 648) and early childhood (3-4 years old, n = 613). Higher maternal PGS-EA scores predicted higher observed sensitivity in toddlerhood (b = 0.12, 95% CI 0.03, 0.20) and early childhood (b = 0.16, 95% CI 0.08, 0.24). Child PGS-EA was significantly associated with maternal sensitivity in early childhood (b = 0.11, 95% CI 0.02, 0.21), and the effect of maternal PGS-EA was no longer significant when correcting for child PGS-EA. A latent factor of PGSs based on educational attainment, intelligence (IQ) and income showed similar results. These polygenic scores might be associated with maternal cognitive and behavioral skills that help shape parenting. Maternal PGSs predicted observed sensitivity over and above the maternal phenotypes, showing an additional role for PGSs in parenting research. In conclusion, we replicated the central finding of Wertz et al. (2019) that parental PGS-EA partially explains parental sensitivity. Our findings may be consistent with evocative gene-environment correlation (rGE), emphasizing the dynamic nature of parenting behavior across time, although further research using family trios is needed to adequately test this hypothesis.

Mentalizing in first-time fathers: reflective functioning as a mediator between attachment representation and sensitivity

Sensitivity in parent-child interaction is essential for child development. Since fathers are increasingly involved in childrearing, identifying factors leading to paternal sensitivity is crucial. We examined the relation between attachment representation and reflective functioning (RF) as factors influencing paternal sensitivity in a longitudinal study including N = 40 first-time fathers (Mage = 33) and their 6-month-old children. We used the Adult Attachment Interview during pregnancy to assess paternal attachment representation and general RF, the Parental Development Interview to assess fathers' parental RF, and the Emotional Availability Scale to measure sensitivity at child's age of 6 month. Data show that secure paternal attachment representation, high general and parental RF are associated with higher levels of paternal sensitivity. Further, parental RF mediates the association between attachment representation and paternal sensitivity. These findings contribute to the identification of a causal interplay in that they suggest an explanatory effect of RF on the association between fathers' attachment representation, and sensitivity.

Changes in children's attachment security to mother and father after the birth of a sibling: Risk and resilience in the family

Changes in children's attachment security to mother and father were examined for 230 firstborn children (M = 31.17 months), their mothers and fathers participating in a longitudinal investigation starting in the last trimester of the mothers' pregnancy and 1, 4, 8, and 12 months after the birth of an infant sibling. Both parents completed the Attachment Q-set at prenatal, 4, and 12 months. Growth mixture models revealed four latent classes in which children's attachments were (a) both secure with a modest decline to both parents (68.3%); (b) more secure with father than mother with a steep decline for both (12.6%); (c) both insecure with no change (10%); and (d) more secure with mother than father with a modest increase for both (9.1%). Multi-group latent growth curve analyses revealed that parenting and coparenting differed across families. Children had lower externalizing behavior problems in families with two secure attachments than in families with one secure attachment, either to mother or to father, who, in turn, had fewer problems than children with two insecure attachments. Findings underscore the strengths of a family systems framework to understand attachment relationships with multiple caregivers and the family risks and protective factors that covary with children's behavioral adjustment after the birth of a sibling.

The effects and process of the intervention "Individual Shantala Infant Massage" in preventive child healthcare to improve parent-child interaction: study protocol for a quasi-experimental study

BACKGROUND

Individual Shantala Infant Massage is an intervention that is offered by several Dutch Preventive Child Healthcare (PCH) organizations as optional preventive support, in addition to basic care as offered to all children. It targets vulnerable families and aims to enhance sensitive parenting and to reduce (effects of) parental stress. The intervention is carried out by a certified nurse. It consists of three structured home visits. Parents learn to massage their infant and receive parenting support. This study aims to investigate the effectiveness and the process of the intervention. The main hypothesis is that Individual Shantala Infant Massage leads to increased parental sensitive responsiveness, lower perceived and physiological parental stress, and improved child growth and development in the intervention group, compared to a control group where this intervention is not offered by PCH. Secondary research questions address effects on parenting confidence and parental concerns regarding the infant, the influence of background characteristics and the intervention process.

METHODS

The study is a quasi-experimental non-randomized trial. The aim is to include 150 infant-parent dyads in both the intervention and the control group. This takes into account possible attrition and missing data as 105 dyads with complete data per group are sufficient for analysis. All participants complete questionnaires at T0 (pre-test, child age between six-sixteen weeks), T1 (post-intervention, or ± four weeks after T0), and T2 (follow-up at five months). At T2, a hair tuft is cut from the parents' head to measure hair cortisol levels. Data on infant growth and development is obtained from PCH files. In the intervention group, additional data is collected to evaluate the intervention process: parents complete an evaluation questionnaire at T1, nurses keep semi-structured logbooks of intervention sessions and interviews are conducted with parents and professionals.

DISCUSSION

Study results can contribute to the evidence base of infant massage as applied in Dutch PCH, and can inform parents, PCH practitioners, policy makers and researchers both inside and outside the Netherlands on feasibility and effectiveness of the infant massage intervention as applied in this format and setting.

TRIAL REGISTRATION

ISRCTN registry: ISRCTN16929184. Date (retrospectively) registered: 29/03/2022.

Maternal distress and parenting during COVID-19: differential effects related to pre-pandemic distress?

BACKGROUND

Distinguishing whether and how pre-existing characteristics impact maternal responses to adversity is difficult: Does prior well-being decrease the likelihood of encountering stressful experiences? Does it protect against adversity's negative effects? We examine whether the interaction between relatively uniformly experienced adversity (due to COVID-19 experience) and individual variation in pre-existing (i.e., pre-pandemic onset) distress predicted mothers' pandemic levels of distress and insensitive caregiving within a country reporting low COVID-19 death rates, and strict nationwide regulations.

METHOD

Fifty-one Singaporean mothers and their preschool-aged children provided data across two waves. Pre- pandemic onset maternal distress (i.e., psychological distress, anxiety, and parenting stress) was captured via self-reports and maternal sensitivity was coded from videos. Measures were repeated after the pandemic's onset along with questionnaires concerning perceived COVID-19 adversity (e.g., COVID-19's impact upon stress caring for children, housework, job demands, etc.) and pandemic-related objective experiences (e.g., income, COVID-19 diagnoses, etc.). Regression analyses (SPSS v28) considered pre-pandemic onset maternal distress, COVID-19 stress, and their interaction upon post-pandemic onset maternal distress. Models were re-run with appropriate covariates (e.g., objective experience) when significant findings were observed. To rule out alternative models, follow up analyses (PROCESS Model) considered whether COVID-19 stress mediated pre- and post-pandemic onset associations. Models involving maternal sensitivity followed a similar data analytic plan.

RESULTS

Pre-pandemic maternal distress moderated the association between COVID-19 perceived stress and pandemic levels of maternal distress (β = 0.22, p < 0.01) but not pandemic assessed maternal sensitivity. Perceived COVID-19 stress significantly contributed to post-pandemic onset maternal distress for mothers with pre-pandemic onset distress scores above (β = 0.30, p = 0.05), but not below (β = 0.25, p = 0.24), the median. Objective COVID-19 adversity did not account for findings. Post-hoc analyses did not suggest mediation via COVID-19 stress from pre-pandemic to pandemic maternal distress.

CONCLUSIONS

Pre-existing risk may interact with subsequent perceptions of adversity to impact well-being. In combination with existing research, this small study suggests prevention programs should focus upon managing concurrent mental health and may highlight the importance of enhanced screening and proactive coping programs for people entering high stress fields and/or phases of life.

History of "Serve and Return" and a Synthesis of the Literature on its Impacts on Children's Health and Development

Parent/caregiver sensitivity and responsiveness are important for children's health and development. The "serve and return" metaphor was created to help providers and caregivers understand the importance of sensitive and responsive early caregiving. In this review, we explain the concept of "serve and return", outline historical and theoretical principles that culminated in this metaphor, highlight parent and child constructs associated with "serve and return" interactions, and synthesize literature on sensitive and responsive caregiving and children's health and developmental outcomes. Nurses and other healthcare professionals in public policy, clinical, community, education, and research roles need knowledge of "serve and return" interactions.

Factor structure of the Mini-Maternal Behavior Q-Sort and associations with infant attachment: Informing precision in research and intervention

We examined the factor structure of parental sensitivity to infants as assessed by the Mini-Maternal Behavior Q-Sort (Mini-MBQS), a 25-item short-form of the original 90-item MBQS. We aimed to: (1) identify latent factors of the Mini-MBQS; and (2) validate each factor by testing associations with infant attachment classifications. Data on parent-infant dyads (n = 313; 222 mothers with 281 children, 29 fathers with 32 children) were drawn from a three-generation Australian cohort study. Exploratory Factor Analysis and Exploratory Structural Equation Modelling examined the structure of the Mini-MBQS. Two latent Mini-MBQS factors were identified, requiring 8 of 25 original items: (1) Attention and Responsiveness and (2) Contingency in Interactions. Infants with insecure attachment classifications had parents with lower sensitivity across both factors relative to infants classified secure. In particular, infants with resistant attachment classifications had parents with notably low Contingency in Interactions scores. Infants with disorganised attachment classifications had parents with the lowest relative sensitivity across both factors, and in these dyads Attention and Responsiveness scores were especially low. Results provide an empirically derived factor structure for the Mini-MBQS. Two subscales, each with significant infant attachment associations, may improve precision in clinical intervention and research translation.

Parental personality and early life ecology: a prospective cohort study from preconception to postpartum

Personality reliably predicts life outcomes ranging from social and material resources to mental health and interpersonal capacities. However, little is known about the potential intergenerational impact of parent personality prior to offspring conception on family resources and child development across the first thousand days of life. We analysed data from the Victorian Intergenerational Health Cohort Study (665 parents, 1030 infants; est. 1992), a two-generation study with prospective assessment of preconception background factors in parental adolescence, preconception personality traits in young adulthood (agreeableness, conscientiousness, emotional stability, extraversion, and openness), and multiple parental resources and infant characteristics in pregnancy and after the birth of their child. After adjusting for pre-exposure confounders, both maternal and paternal preconception personality traits were associated with numerous parental resources and attributes in pregnancy and postpartum, as well as with infant biobehavioural characteristics. Effect sizes ranged from small to moderate when considering parent personality traits as continuous exposures, and from small to large when considering personality traits as binary exposures. Young adult personality, well before offspring conception, is associated with the perinatal household social and financial context, parental mental health, parenting style and self-efficacy, and temperamental characteristics of offspring. These are pivotal aspects of early life development that ultimately predict a child's long-term health and development.

Impact of the COVID-19 pandemic on expectant and new parents' experience of pregnancy, childbirth, breast feeding, parental responsiveness and sensitivity, and bonding and attunement in high-income countries: a systematic review of the evidence

OBJECTIVES

To review the evidence on how pregnancy, birth experience, breast feeding, parental responsiveness and sensitivity, and bonding and attunement were impacted by COVID-19.

METHODS

We searched eight literature databases and websites of relevant UK-based organisations. The review focused on evidence during pregnancy and the early years (0-5 years). Studies of any study design published in English from 1 March 2020 to 15 March 2021 and conducted in high-income countries were included. Screening and data extraction were undertaken in duplicate. Evidence was synthesised using a narrative approach. Study quality of included studies was assessed using the Mixed Methods Appraisal Tool.

RESULTS

The search yielded 9776 publications, of which 26 met our inclusion criteria. Significant knowledge gaps on how COVID-19 affected pregnancy and breast feeding limited healthcare providers' ability to provide consistent evidence-based information and care at the start of the pandemic. There was an enduring sense of loss about loved ones being restricted from taking part in key moments. Parents were concerned about the limitations of virtual healthcare provision. Some parents reported more opportunities for responsive breast feeding and improved parent-infant bonding due to reduced social and work pressures. Women from minoritised ethnic groups were less likely to continue breast feeding and attributed this to a lack of face-to-face support.

CONCLUSIONS

The evidence suggests that new and expectant families have been both negatively and positively impacted by the COVID-19 pandemic and the resulting restrictions. The impacts on parents' opportunities to bond with their young children and to be attuned to their needs were felt unequally. It is important that emergency response policies consider the mother and the partner as a family unit when making changes to the delivery of maternal and child health and care services, so as to mitigate the impact on the family and existing health inequalities.

PROSPERO REGISTRATION NUMBER

CRD42021236769.

Young children's traumatic stress reactions to the COVID-19 pandemic: The long reach of mothers' adverse childhood experiences

BACKGROUND

The COVID-19 pandemic has negatively impacted parental and child mental health; however, it is critical to examine this impact in the context of parental histories of adversity. We hypothesized that maternal adverse childhood experiences (ACEs) and pandemic-related negative life events would predict child traumatic stress symptoms (TSS) and tested potential mediating pathways through maternal pandemic-related TSS and/or poorer maternal sensitivity during the pandemic.

METHODS

Data were collected from a longitudinal sample of low-income, racially/ethnically diverse mothers and their children. Between May and November 2020, mothers (n = 111) of young children (M age = 7.42 years, SD = 0.45) completed questionnaires to assess their own and their child's pandemic-related TSS, exposure to pandemic-related negative events, and parent-child relationship quality. Maternal ACEs, maternal depression, parent-child relationship quality, and child internalizing symptoms had been assessed approximately 1-3 years prior.

RESULTS

Structural equation analyses revealed that pandemic negative life events were indirectly associated with child TSS via greater maternal TSS. For mothers, recent pandemic-related negative events were associated with their own TSS, whereas maternal ACEs were not. Maternal ACEs directly predicted greater child TSS, with no evidence of mediation by either maternal TSS or maternal sensitivity.

LIMITATIONS

All measures were parent report, and pandemic-related measures were collected at the same time point.

CONCLUSIONS

Findings underscore the long reach of mothers' own adverse childhood experiences, highlighting the negative consequences of these prior traumatic exposures alongside current pandemic-related maternal trauma symptoms for children's adjustment during the pandemic.

Maternal sensitivity moderates the association between maternal history of childhood maltreatment and child executive function

BACKGROUND

Experiences of childhood maltreatment are associated with a variety of negative outcomes throughout individuals' lives as well as disadvantaged cognitive and socioemotional development among their offspring. The mechanisms through which some children show resilience against the intergenerational transmission of risk, however, are less well understood.

OBJECTIVE

The current study focuses on a proximal parental factor that plays a central role in children's early cognitive development - maternal sensitivity - and examines whether it moderates the association between maternal history of childhood maltreatment and child executive function (EF).

PARTICIPANTS AND SETTING

Data were collected from a community sample of 139 mothers and their infants (51 % female) recruited from urban areas in Ontario, Canada.

METHODS

Maternal maltreatment history was assessed via self-report at child age 3 months. Maternal sensitivity was assessed observationally at child age 8 months, and child executive function was assessed using performance-based measures at child age 3 years. Hypotheses were tested through multiple regression models.

RESULTS

In the current sample, maternal maltreatment history was not associated with child EF on average. However, results were consistent with a moderation model, indicating that maternal maltreatment history was associated with lower levels of child EF only when mothers were relatively insensitive.

CONCLUSIONS

The findings indicate the importance of considering sensitive parenting practices as a protective factor for children's cognitive development in the context of more distal risk factors such as mothers' history of childhood maltreatment.

A Web-Based, Mindful, and Compassionate Parenting Training for Mothers Experiencing Parenting Stress: Results from a Pilot Randomized Controlled Trial of the Mindful Moment Program

Objectives

Mindful Moment is a self-guided, web-based, mindful, and compassionate parenting training for postpartum mothers who experience parenting stress. We aimed to assess Mindful Moment’s feasibility, acceptability, and usability, and to gather preliminary evidence of its effectiveness in reducing parenting stress and outcomes such as mindful parenting, self-compassion, depressive symptoms, anxious symptoms, dispositional mindfulness, mother’s perception of infant temperament, and mother-infant bonding.

Methods

This pilot randomized controlled trial (RCT) was a two-arm trial and followed the CONSORT 2010, CONSORT-EHEALTH, and CONSORT-SPI 2018 extension guidelines. A total of 292 Portuguese mothers were randomly assigned to the intervention group (n = 146) or to the waiting list control group (n = 146) and completed baseline (T1) and postintervention (T2) self-reported assessments.

Results

A total of 31 mothers (21.23%) completed the Mindful Moment intervention. Most mothers evaluated the program as good or excellent (90%), considered that Mindful Moment provided them the kind of help they expected or wanted (61%), were satisfied with the help provided by the program (74.6%), would recommend it to a friend in a similar situation (86.4%), and would use it again if needed (81.4%). Regarding the program’s preliminary effectiveness, mothers in the intervention group presented a greater decrease in parenting stress, a greater increase in dispositional mindfulness, and a greater decrease in their perception of the difficult temperament of their infants from T1 to T2.

Conclusions

This study provides preliminary evidence of the Mindful Moment’s effectiveness and suggests that it is a feasible and acceptable program for postpartum mothers experiencing parenting stress. Further research is needed to confirm these results in a larger RCT.

Trial Registration

ClinicalTrials.gov (NCT04892082).

The predictive significance of fluctuations in early maternal sensitivity for secure base script knowledge and relationship effectiveness in adulthood

Attachment theory suggests that both the quality and consistency of early sensitive care should shape an individual's attachment working models and relationship outcomes across the lifespan. To date, most research has focused on the quality of early sensitive caregiving, finding that receiving higher quality care predicts more secure working models and better long-term relationship outcomes than receiving lower quality care. However, it remains unclear whether or how the consistency of early sensitive care impacts attachment working models and adult relationship functioning. In this research, we utilized data from the Minnesota Longitudinal Study of Risk and Adaptation to examine to what extent the quality (i.e., mean levels) and consistency (i.e., within-person fluctuations) in behaviorally coded maternal sensitive care assessed 7 times from 3 months to 13 years prospectively predicts secure base script knowledge and relationship effectiveness (i.e., interpersonal competence in close relationships) in adulthood. We found that larger fluctuations and lower mean levels of early maternal sensitivity jointly predict lower relationship effectiveness in adulthood via lower secure base script knowledge. These findings reveal that nonlinear models of early caregiving experiences more completely account for relationship outcomes across the lifespan, beyond what traditional linear models have documented. Implications for attachment theory and longitudinal methods are discussed.

Presence at a distance: Video chat supports intergenerational sensitivity and positive infant affect during COVID-19

COVID-19 disrupted infant contact with people beyond the immediate family. Because grandparents faced higher COVID-19 risks due to age, many used video chat instead of interacting with their infant grandchildren in person. We conducted a semi-naturalistic, longitudinal study with 48 families, each of whom submitted a series of video chats and surveys, and most (n = 40) also submitted a video of an in-person interaction. Families were mostly highly-educated, White/Caucasian, and lived between 1 and 2700 miles apart. We used multilevel models to examine grandparents' and parents' sensitivity during video chat across time (centered at February 1, 2021, the approximate date of vaccine availability). Grandparent video chat sensitivity changed as a function of date and parent sensitivity. Parent sensitivity changed as a function of date, grandparent sensitivity, and geographic distance. We then modeled infants' affective valence during video chat and in-person interactions with their grandparents, which was only predicted by grandparent sensitivity, not modality or other factors. This study demonstrates that caregivers were sensitive toward infants during video chat interactions despite fluctuations in family stress and reduced in-person contact during COVID-19 and that grandparent sensitivity predicted positive infant affect during both video chat and in-person interactions.

Trust me! Parental embodied mentalizing predicts infant cognitive and language development in longitudinal follow-up

Children's cognitive and language development is a central aspect of human development and has wide and long-standing impact. The parent-infant relationship is the chief arena for the infant to learn about the world. Studies reveal associations between quality of parental care and children's cognitive and language development when the former is measured as maternal sensitivity. Nonetheless, the extent to which parental mentalizing - a parent's understanding of the thoughts, feelings, and attitudes of a child, and presumed to underlie sensitivity - contributes to children's cognitive development and functioning, has yet to be thoroughly investigated. According to the epistemic trust theory, high mentalizing parents often use ostensive cues, which signal to the infant that they are perceived and treated as unique subjective beings. By doing so, parents foster epistemic trust in their infants, allowing the infant to use the parents a reliable source of knowledge to learn from. Until recently, parental mentalizing has been limited to verbal approaches and measurement. This is a substantial limitation of the construct as we know that understanding of intentionality is both non-verbal and verbal. In this investigation we employed both verbal and non-verbal, body-based, approaches to parental mentalizing, to examine whether parental mentalizing in a clinical sample predicts children's cognitive and language development 12 months later. Findings from a longitudinal intervention study of 39 mothers and their infants revealed that parental embodied mentalizing in infancy significantly predicted language development 12 months later and marginally predicted child cognitive development. Importantly, PEM explained unique variance in the child's cognitive and linguistic capacities over and above maternal emotional availability, child interactive behavior, parental reflective functioning, depression, ethnicity, education, marital status, and number of other children. The theoretical, empirical, and clinical implications of these findings are discussed.

The Influence of Socioeconomic Status (SES) and Processing Speed on the Psychological Adjustment and Wellbeing of Pediatric Brain Tumor Survivors

Simple Summary

Processing speed (PS) is one of the most impaired functions in pediatric brain tumor survivors (PBTSs) and it has been linked to difficulties in their psychological functioning, together with other non-insult-related risk factors, such as socio-economic status (SES). Given the psychological adjustment difficulties observed in PBTS, the aim of the current study was to explore the relationship between SES and psychological functioning, measured with the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire, and considering the contribution of PS as a mediator. The results demonstrated that the influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the SES–internalizing problems relationship but not on the SES–externalizing problems relationship. These findings suggest that PS may be a rehabilitation target to prevent psychological distress and should be addressed, especially for PBTSs who live in a disadvantaged situation.

Abstract

(1) Background: The relationship between processing speed (PS) and psychological adjustment in the healthy population is well established, as is that between low socio-economic status (SES) and psychological distress. While PS is one of the most impaired functions in pediatric brain tumor survivors (PBTSs), previous research has demonstrated that low SES may be a predictor of increased psychosocial risk in PBTSs. Given the psychological adjustment difficulties observed in PBTS, in the current study we aimed to explore the relationship between SES and psychological functioning, considering the contribution of PS as a mediator. (2) Methods: demographic and clinical data of 80 children (age range: 4–17 y.o.) were retrospectively collected. Psychological measures were the parent-compiled versions of the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Mediation analysis models were performed on psychological measures with and without the inclusion of covariates. (3) Results: The influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the relationship between SES and internalizing problems but not on the relationship between SES and externalizing problems. (4) Conclusions: The results suggest that PS may be a rehabilitation target for the prevention of psychological distress and should be addressed especially for PBTSs who live in a disadvantaged situation.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

From adolescence to parenthood: a multi-decade study of preconception mental health problems and postpartum parent-infant bonds

PURPOSE

To examine associations between anxiety and depressive symptoms across adolescence and young adulthood with subsequent maternal- and paternal-infant bonding at 1 year postpartum.

METHODS

The data were from a prospective, intergenerational cohort study. Participants (381 mothers of 648 infants; 277 fathers of 421 infants) self-reported depression and anxiety at three adolescent waves (ages 13, 15 and 17 years) and three young adult waves (ages 19, 23 and 27 years). Subsequent parent-infant bonds with infants were reported at 1 year postpartum (parent age 29-35 years). Generalised estimating equations (GEE) separately assessed associations for mothers and fathers.

RESULTS

Mean postpartum bonding scores were approximately half a standard deviation lower in parents with a history of persistent adolescent and young adult depressive symptoms (maternal β_adj = - 0.45, 95% CI - 0.69, - 0.21; paternal β_adj = - 0.55, 95% CI - 0.90, 0.20) or anxiety (maternal β_adj = - 0.42, 95% CI - 0.66, - 0.18; paternal β_adj = - 0.49, 95% CI - 0.95, 0.03). Associations were still mostly evident, but attenuated after further adjustment for postpartum mental health concurrent with measurement of bonding.

CONCLUSIONS

Persistent symptoms of depression or anxiety spanning adolescence and young adulthood predict poorer emotional bonding with infants 1-year postbirth for both mothers and fathers.

Household clutter and crowding constrain associations between maternal sensitivity and child theory of mind

Social interactions between parents and children are important for developing theory of mind, but these may be disrupted by aspects of the proximal home environment. The current study observed maternal sensitivity and its associations with child theory of mind and the housing environment (index by clutter and crowding) in a sample of mothers and their 3.5-year-old twins (N = 250 children). Maternal sensitivity and housing environment were measured from experimenter report and child theory of mind was measured through behavioural tasks. Results show that the association between maternal sensitivity and child theory of mind was moderated by the housing environment, where the positive associations between maternal sensitivity and child theory of mind were only observed at lower levels of clutter and crowding in the housing environment. Additional contextual variables and processes are discussed.

The impact of childhood adversity on parenting stress is mediated by adult attachment and depressive symptoms

Adverse childhood experiences can have far-reaching implications for later mental health, including in parenthood. Research suggests that childhood adversity is a risk factor for later parenting stress, yet the underlying mechanisms are only just being uncovered. Uncovering these mechanisms is important to diminish heightened levels of parenting stress and thereby reduce adverse effects of elevated parenting stress on child and parent outcomes. In a cross-sectional study using a sample of mothers of 2-10 month-old infants (N = 367) we first examined depressive symptoms as a mediator, and then, the indirect effect of adult attachment through depressive symptoms between childhood adversity and parenting stress. Results showed that the effect of childhood adversity on parenting stress was mediated by an indirect pathway through depressive symptoms alone, and an indirect pathway of adult attachment through depressive symptoms. The indirect effect of adult attachment through depressive symptoms was found to be stronger than the indirect effect of depressive symptoms alone, supporting the hypothesis that adult attachment insecurity together with depressive symptoms are particularly important risk factors to be considered in this relationship. Results suggest that childhood adversity is a risk factor for parenting stress, and not a determinant of later parenting stress per se. Instead, mediators in this association, adult attachment, and depressive symptoms, were identified as potential targets of intervention to prevent negative effects of childhood adversity on parenting stress. A limitation of the study lies in its cross-sectional design. Future studies should examine these associations longitudinally to allow for interpretation of causality.

Attachment and stress regulation in socioeconomically disadvantaged children: Can public childcare compensate?

Children growing up in families experiencing socioeconomic disadvantage (SED) are at greater risk for deficits in attachment and stress regulation as compared to peers in families with more socioeconomic resources. The present study hypothesized that care providers in out-of-home care might help these children to compensate. We therefore investigated 60 children (n = 30 from SED, n = 30 matched counterparts from middle class) and assessed children's Attachment Q-Sort (AQS) toward the mother and the primary care provider in childcare centers. Moreover, children's diurnal cortisol rhythm was measured based on 12 saliva samples taken across three days a week. The disadvantaged children showed lower AQS scores with their mothers than their care providers. Compared to their counterparts, disadvantaged children also displayed heightened cortisol release and flatter cortisol profiles reflecting overall high hypothalamic-pituitary-adrenocortical activities and lower capacities to regulate stress. Most notably however, multilevel path modeling linked higher care provider AQS scores to decreasing cortisol release throughout the week.

Parental Psychological Control: Maternal, Adolescent, and Contextual Predictors

Parental psychological control (PC) hinders the development of autonomy, identity formation, and the attainment of self-determination and individuation of adolescents. The aim of this study was to deepen the understanding of which conditions increase the risk of the use of maternal PC by simultaneously considering the contribution of adolescent temperament, maternal separation anxiety, and adolescents’ perception of interparental conflict. A correlational study involving a sample of 106 Chilean adolescent-mother dyads was done. Adolescents were, on average, 15.42 years old (SD = 1.09) and 77% male. Mothers were, on average, 45.46 years old (SD = 6.39). We administered self-report questionnaires to the adolescent measuring effortful control and frustration as temperamental dimensions, along with the perception of interparental conflict. Mothers reported on their separation anxiety. Both the adolescents and their mothers reported on the use of maternal PC. Adolescents reported higher levels of maternal PC than their mothers did. All predictors were associated with PC reports. Higher levels of maternal anxiety about adolescent distancing, inter-parental conflict, and adolescent frustration were associated with higher reported levels of PC. In contrast, higher levels of adolescent effortful control were associated with lower levels of maternal PC. Finally, when maternal separation anxiety and inter-parental conflict were high there was a higher use of maternal PC. The present findings inform on how adolescent’s self-regulatory skills could reduce the risk of being exposed to maternal PC. And highlight the importance of using a systemic and interactional conceptualization when trying to understand their use.

Maternal perinatal anxiety and neural responding to infant affective signals: Insights, challenges, and a road map for neuroimaging research

Anxiety symptoms are common among women during pregnancy and the postpartum period, potentially having detrimental effects on both mother and child's well-being. Perinatal maternal anxiety interferes with a core facet of adaptive caregiving: mothers' sensitive responsiveness to infant affective communicative 'cues.' This review summarizes the current research on the neural correlates of maternal processing of infant cues in the presence of perinatal anxiety, outlines its limitations, and offers next steps to advance future research. Functional neuroimaging studies examining the neural circuitry involved in, and electrophysiological studies examining the temporal dynamics of, processing infant cues during pregnancy and postpartum are reviewed. Studies have generally indicated mixed findings, although emerging themes suggest that anxiety may be implicated in several stages of processing infant cues- detection, interpretation, and reaction- contingent upon cue valence. Limitations include inconsistent designs, lack of differentiation between anxiety and depression symptoms, and limited consideration of parenting-specific (versus domain-general) anxiety. Future studies should incorporate longitudinal investigation of multiple levels of analysis spanning neural, cognitive, and observed aspects of sensitive caregiving.

Associations between Turkish incarcerated mothers' sensitivity and their co-residing children's attachment: The moderating role of children's temperament

This study investigated the associations between incarcerated mothers' sensitivity and their co-residing children's attachment security. Furthermore, the moderating role of children's temperament on the associations between maternal sensitivity and children's attachment security was examined. The study sample consisted of 84 incarcerated mothers (M_age = 29.9, SD = 5.6) and their 12- to 43-month-old (M = 25.3, SD = 8.3) children who co-resided with them in prison facilities. Maternal sensitivity and child's attachment were assessed by observation of mother-child interaction using the Maternal Sensitivity Scale and the Turkish Toddler Attachment Sort-60, respectively. Mothers reported their children's temperamental features (i.e. negative emotionality and effortful control) using the Early Childhood Behavior Questionnaire. Results showed that maternal sensitivity was related positively to children's secure attachment and negatively to children's disorganized attachment. Furthermore, children's negative emotionality and effortful control moderated the associations between maternal sensitivity and children's attachment. Specifically, maternal sensitivity negatively predicted children's avoidant attachment only for children with low negative emotionality and with high effortful control. Additionally, maternal sensitivity negatively predicted children's anxious attachment only for children with low effortful control. Results are discussed in terms of sample-specific experiences, contextual factors, and the differential susceptibility hypothesis.

Enhancing maternal sensitivity in contexts of urban extreme poverty in Sierra Leone: A pilot study

This pilot study presents preliminary data on the efficacy of Strong Bonds, Strong Pikin (SBSP), a brief intervention program that aims to enhance sensitivity among mothers who care for their preschool children in a slum settlement in Freetown (Sierra Leone). SBSP adapts principles of attachment theory to intervention within a non-Western cultural setting, where families suffer from extreme poverty. A combination of psychoeducation, group work, video-feedback, and storytelling defines the methodology of the program. Maternal sensitivity, parenting stress, and the use of violent discipline practices were measured before (pretest) and after the intervention (posttest) in a sample of 43 mothers who participated in the program. Analyses showed a significant increase in observed maternal sensitivity, as well as a decrease in mother-reported parenting stress, child problems, and use of violent discipline practices from pretest to posttest. These results are discussed in terms of the potential value of culturally sensitive, attachment-centered interventions with caregivers who raise their children in non-Western settings affected by economic vulnerability.

A Preliminary Investigation of Psychoneurological Symptoms in Low-Income Mothers

BACKGROUND

Exposure to chronic stressors may contribute to the development of psychoneurological symptoms (i.e., fatigue, cognitive dysfunction, sleep disturbance, depressed mood, and pain) that can compromise maternal function.

OBJECTIVES

In two studies of low-income mothers, we investigated the presence of psychoneurological symptoms and explored associations between mothers' stressors and psychoneurological symptoms as well as between symptoms and function. We also considered the possible mediating role of the symptoms between stressors and function.

METHODS

We conducted secondary analyses of psychoneurological symptoms in two studies of low-income mothers of infants and toddlers in the United States. Study 1 sampled Latina women with limited English proficiency, whereas Study 2 was conducted with English-speaking women from diverse backgrounds. In both studies, symptoms were measured using items from the Center for Epidemiological Studies Depression Scale and the Medical Outcomes Study Short-Form Health Survey. Maternal function was measured through self-report and researcher observation. In Study 2, stressors were measured using the Everyday Stressors Index. Multiple linear regressions were used to investigate associations while controlling for relevant covariates.

RESULTS

In both studies, mothers endorsed a wide range of psychoneurological symptoms. In Study 1, psychoneurological symptoms had significant negative associations with role function, social function, and developmental stimulation. In Study 2, psychoneurological symptoms had significant negative associations with role function, social function, and physical function. Using Aroian test for mediation, we found that psychoneurological symptoms mediated all significant relationships between stressors and maternal functions in Study 2.

DISCUSSION

In two samples of low-income mothers, psychoneurological symptoms were prevalent and associated with chronic stressors and with maternal function and may mediate the association between those two factors. These findings extend prior research on depressive symptoms in mothers by investigating pain as an additional key symptom. The studies advance symptom science by highlighting psychoneurological symptoms in a heterogeneous sample without known health conditions.

Non-verbal and verbal parental mentalization as predictors of infant attachment security: Contributions of parental embodied mentalizing and mind-mindedness and the mediating role of maternal sensitivity

Interest in studying the relative contributions of verbal (e.g., maternal mind-mindedness [MM]) and non-verbal dimensions (i.e., parental embodied mentalizing [PEM]) of parental mentalization to child socio-emotional development is relatively recent. To date, only one study has addressed this issue in relation to child attachment security, suggesting a complementary and unique contribution of each one. The purpose of the present study was to further examine the specific contribution of PEM to infant attachment security by considering MM. In addition, this study aimed to explore the mediating role of maternal sensitivity linking PEM, MM to infant attachment security within 110 mother-infant dyads at moderate psychosocial risk. The two dimensions of parental mentalization (PEM and MM) were assessed on the basis of observations made during a videorecorded sequence of mother-child interactions in a context of free play with and without toys when the infants were 8 months old. The Maternal Behavior Q-Sort was used to measure the mothers' sensitivity in a natural setting based on observations of daily mother-child interactions, also when the infants were about 8 months old. Attachment security was measured using The Strange Situation Procedure at infant age 16 months. The results showed positive correlations between maternal sensitivity and both verbal and non-verbal measures of parental mentalization. The mediation analyses first revealed that PEM had a significant indirect effect on attachment security, with sensitivity being identified as a mediator in this association. No indirect effect linking MM and attachment security via sensitivity was observed. These results highlight the contribution of PEM to maternal sensitivity and show maternal sensitivity to be a factor that partly explains the influence of PEM on attachment security in children.

Postpartum Stress and Neural Regulation of Emotion among First-Time Mothers

Early parenting relies on emotion regulation capabilities, as mothers are responsible for regulating both their own emotional state and that of their infant during a time of new parenting-related neural plasticity and potentially increased stress. Previous research highlights the importance of frontal cortical regions in facilitating effective emotion regulation, but few studies have investigated the neural regulation of emotion among postpartum women. The current study employed a functional neuroimaging (fMRI) approach to explore the association between perceived stress, depressive symptoms, and the neural regulation of emotion in first-time mothers. Among 59 postpartum mothers, higher perceived stress during the postpartum period was associated with less self-reported use of cognitive reappraisal in everyday life, and greater use of emotion suppression. While viewing standardized aversive images during the Emotion Regulation Task (ERT), mothers were instructed to experience their natural emotional state (Maintain) or to decrease the intensity of their negative emotion by using cognitive reappraisal (Reappraise). Whole-brain analysis revealed a two-way interaction of perceived stress x condition in the right dorsolateral prefrontal cortex (DLPFC) at p < .05 cluster-wise corrected, controlling for postpartum months and scanner type. Higher levels of perceived stress were associated with heightened right DLPFC activity while engaging in cognitive reappraisal versus naturally responding to negative stimuli. Higher right DLPFC activity during Reappraise versus Maintain was further associated with elevated parenting stress. Findings suggest that stress and everyday reappraisal use is reflected in mothers' neural regulation of emotion and may have important implications for their adaptation to parenthood.

Parent-child bonding and attachment during pregnancy and early childhood following congenital heart disease diagnosis

Diagnosis and treatment of congenital heart disease (CHD) can present challenges to the developing parent-child relationship due to periods of infant hospitalization and intensive medical care, parent-infant separations, child neurodevelopmental delay and feeding problems, and significant parent and child distress and trauma. Yet, the ways in which CHD may affect the parent-child relationship are not well-understood. We systematically reviewed the evidence on parental bonding, parent-child interaction, and child attachment following CHD diagnosis, according to a pre-registered protocol (CRD42019135687). Six electronic databases were searched for English-language studies comparing a cardiac sample (i.e., expectant parents or parents and their child aged 0-5 years with CHD) with a healthy comparison group on relational outcomes. Of 22 unique studies, most used parent-report measures (73%) and yielded mixed results for parental bonding and parent-child interaction quality. Observational results also varied, although most studies (4 of 6) found difficulties in parent-child interaction on one or more affective or behavioural domains (e.g., lower maternal sensitivity, lower infant responsiveness). Research on parental-fetal bonding, father-child relationships, and child attachment behaviour was lacking. Stronger evidence is needed to determine the nature, prevalence, and predictors of relational disruptions following CHD diagnosis, and to inform targeted screening, prevention, and early intervention programs for at-risk dyads.

The association of infant temperament and maternal sensitivity in preterm and full-term infants

Infants who experience sensitive caregiving are at lower risk for numerous adverse outcomes. This is especially true for infants born preterm, leading them to be more susceptible to risks associated with poorer quality caregiving. Some research suggests that preterm and full-term infants differ on temperament, which may contribute to these findings. This study aimed to investigate associations between infant temperament (negative emotionality, positive affectivity/surgency, and orienting/regulatory capacity) and maternal sensitivity among infants born preterm (M = 30.2 weeks) and full term. It was hypothesized that mothers of infants born preterm and mothers of infants with more difficult temperaments would display lower sensitivity, indicated by lower responsiveness to nondistress, lower positive regard, and higher intrusiveness. Videotaped play interactions and a measure of temperament (Infant Behavior Questionnaire) were coded for 18 preterm and 44 full-term infants at 9 months (corrected) age. Results suggest that mothers of preterm and full-term infants differed significantly in responding to their infants, but these results cannot be explained by infant temperament. Preterm status and sociodemographic risk emerged as correlates of maternal behavior, such that mothers of infants born preterm and mothers with greater sociodemographic risk displayed lower levels of maternal sensitivity.

Determinants of Maternal Emotion Socialization: Based on Belsky's Process of Parenting Model

The purpose of the current study was to investigate how the potential multifactors influence mothers’ emotion socialization. This study involved 300 Japanese-speaking married mothers with 2–5-year-old children, who answered a series of measures of emotion socialization (coaching, dismissing, dysfunction, and non-involvement), emotion regulation strategy (reappraisal and expressive suppression), psychopathology (anxiety and depression), and perceived parenting alliance with their partners. (a) Hierarchical multiple regression analyses demonstrated different effects between maternal anxiety and depression, such that higher levels of depression were associated with less coaching and higher levels of anxiety were associated with more dismissing and dysfunction. (b) Moreover, maternal emotion regulation was significant even when controlling for psychopathology, in which reappraisal had significant positive association with coaching and, conversely, expressive suppression had significant negative association with coaching and positive associations with non-involvement, dismissing, and dysfunction. (c) Additionally, moderation analysis revealed that a greater use of reappraisal was associated with more coaching, and this relation was strongest in lower levels of parenting alliance. Similarly, a greater use of reappraisal was associated with less dysfunction only when parenting alliance was low. Reappraisal may be effective in promoting supportive emotion socialization and buffering the negative effect of lower parenting alliance on unsupportive emotion socialization. Based on Belsky’s process of parenting model, we incorporate maternal psychopathology, emotion regulation, and perceived parenting alliance into one model of influencing maternal emotion socialization and highlight the unique role of emotion regulation.

Preconception and perinatal predictors of offspring attachment disorganization: Advancing the replicated evidence

Attachment disorganization in early childhood is an influential yet modifiable risk factor for later mental health problems. Beyond established transmission through parents' unresolved attachment representations and caregiving sensitivity, little replicated evidence exists for wider determinants of offspring attachment disorganization. This study examined the replicated evidence for psychosocial risk factors in the preconception, prenatal, and postnatal periods. We identified all relevant longitudinal studies, and examined all risk relationships for which evidence existed in two or more cohorts (48 effects, 17 studies, N = 6,099). Study-specific and pooled risk associations were estimated and a range of moderators evaluated. Mothers' low socioeconomic status (r = .28, k = 2), perinatal loss of a child (r = .26, k = 2), caregiving intrusiveness (r = .31, k = 2), and infant male sex (r = .26, k = 4) predicted offspring attachment disorganization. Maternal sensitivity (r = -.25, k = 6) and higher metacognition during pregnancy (r = -.23, k = 3) predicted lower risk of offspring attachment disorganization. Findings suggest the origins of offspring disorganized attachment include but extend beyond maternal unresolved attachment representations and caregiving. We discuss implications for theory and for identification of modifiable risk pathways in the perinatal window.

Maternal care in infancy and the course of limbic development

Maternal care may predict limbic development, though relations may vary by age and type of assessment. Here, we examined maternal behavior during early infancy (i.e., six months postpartum) in relation to offspring hippocampal and amygdala volume and microstructure development between 4.5 (n = 99) and 6 (n = 111) years. In interaction with offspring sex, maternal sensitivity predicted left amygdala volume at 6.0 years (β=-0.214, p = 0.032, df = 89) and independently predicted predominately left lateralized aspects of amygdala and hippocampal microstructure at both time points (hippocampus: left FA at 4.5 years [β=-0.241, p = 0.043, df = 68], and, in interaction with sex, left [(β = 0.349, p = 0.022, df = 86) and right FA at 6 years (β = 0.357, p = 0.016, df = 86] and left MD growth [β = -0.517, p = 0.021, df = 37]; amygdala: left MD at 4.5 years [β = -0.319, p = 0.007, df = 69] and, in interaction with offspring sex, left MD growth [β = -0.546, p = 0.019, df = 37]). Results suggest exposure to non-extreme, early insensitive care impacts neuroanatomy important to learning and stress regulation, perhaps by accelerating development. This underscores the need to promote sensitive caregiving during early infancy within community samples.

Mothers' postpartum sleep disturbance is associated with the ability to sustain sensitivity toward infants

BACKGROUND/OBJECTIVE

Infancy is a period of rapid development when the quality of caregiving behavior may be particularly consequential for children's long-term functioning. During this critical period for caregiving behavior, parents experience changes in their sleep that may affect their ability to provide sensitive care. The current study investigated the association of mothers' sleep disturbance with both levels and trajectories of maternal sensitivity during interactions with their infants.

METHODS

At 18 weeks postpartum, mothers and their infants were observed during a home-based 10-minute "free play" interaction. Mothers' nighttime sleep was objectively measured using actigraphy and subjectively measured using sleep diaries. Maternal sensitivity was coded in two-minute intervals in order to characterize changes in sensitivity across the free play interaction. We used exploratory factor analysis to reduce the dimensionality of the objective and subjective measures of mothers' sleep, identifying a subjective sleep disturbance and an objective sleep continuity factor.

RESULTS

Using multi-level modeling, we found that mothers with poorer objective sleep continuity evidenced decreasing sensitivity toward their infants across the interaction. Mothers' self-reports of sleep disturbance were not associated with maternal sensitivity.

CONCLUSIONS

Although future research is necessary to identify the mechanisms that may explain the observed association between poor sleep continuity and the inability to sustain sensitivity toward infants, mothers' postpartum sleep continuity may be one factor to consider when designing interventions to improve the quality of caregiving.

CLINICAL TRIAL REGISTRATION

Clinicaltrials.gov, NCT01846585.

Emotion Regulation and Parent Distress: Getting at the Heart of Sensitive Parenting among Parents of Preschool Children Experiencing High Sociodemographic Risk

OBJECTIVES

Sensitive parenting requires modulation of emotions in order to effectively organize and orient behavioral responses. There is considerable evidence that psychological distress can impair sensitive parenting practices, and also that psychological distress is associated with deficits in emotion regulation capacities. The negative effect that psychological distress has on parents' emotion regulation capacities may be a mechanistic pathway through which psychological distress impacts parenting, as dysregulated emotions may be more proximal to parenting behaviors than distress itself; however, this specific link between psychological distress, emotion regulation, and parenting is not often examined in parenting models.

METHODS

The current study tested these relations in a high sociodemographic risk community-sample, oversampled for violence exposure, of caregivers of preschoolers. Caregivers self-reported on their psychological distress and emotion regulation difficulties. Parent sensitivity was assessed via observations of parent-child interactions.

RESULTS

Results indicated that difficulties in emotion regulation were a mediator for the relation between parents' psychological distress and sensitive parenting behaviors. Difficulties in emotion regulation predicted decreased sensitivity above and beyond the effect of psychological distress.

CONCLUSIONS

These findings emphasize the importance of regulation of emotional reactions in order to orient and engage in sensitive parenting behaviors. Additionally, they suggest clinically that supporting parents' emotion regulation capacities specifically may promote more sensitive parenting in contexts of parental psychological distress.