Moving into Parenthood: a program for new adolescent mothers combining parent education with creative physical activity

Parenting Stress Among Adolescent Mothers: An Integrative Literature Review

Adverse maternal and child outcomes are associated with parenting stress. Adolescent mothers may be particularly susceptible to parenting stress because of conflicting parenting and developmental demands. We performed an integrative literature review to identify risk and protective factors for parenting stress, measured by the Parenting Stress Index (PSI), among adolescent mothers. Guided by Belsky's Determinants of Parenting Model (1984) and using Whittemore and Knafl's (2005) five-stage review method, we searched CINAHL, EMBASE, PsycINFO, and MEDLINE databases to identify 786 research articles. After quality appraisal, 26 articles were included. Risk and protective factors were categorized into themes within the context of Belsky's framework, including maternal attributes (e.g. maternal self-efficacy), child characteristics (e.g. child temperament), and contextual influences (e.g. perceived social support). The new conceptual model maps risks, protective factors, and nuanced areas for parenting stress and can guide researchers and clinicians in approaches to prevent and reduce parenting stress among adolescent mothers.

How does adolescent motherhood affect mother-infant/toddler relationship and emotional availability

BACKGROUND

The present study examined the different aspects of infant-mother relationships in adolescent mothers and compared them in adult mothers.

METHODS

Children aged 18-40 months who were referred to our outpatient Infant Mental Health Department were analysed retrospectively. Sociodemographic data, Parent-Infant Relationship Global Assessment Scale (PIR-GAS) scores, and Emotional Availability (EA) Scales scores were analysed. Twenty-nine adolescent mothers being younger than 20 years at the beginning of pregnancy and thirty mothers who were aged at least 25 years were enrolled the same data as adult mother group.

RESULTS

In the adolescent mothers group, the education years of the mothers, the ratio of mothers having professions were significantly lower (p < 0.001); the spousal age gap was significantly higher than among the adult mothers (p < 0.001). It was also found that an underinvolved relationship pattern was seen more frequently among the mother-infant dyads in the adolescent mothers' group than in the adult mothers group (p = 0.002).

CONCLUSIONS

Although there were not found many problems in terms of the relationship of adolescent mothers with their infants/toddlers in the current study this may have been due to a small sample, we would like to emphasise that the problems should be detected and appropriate interventions should be made for adolescent mothers.Key pointsOur main aim for this study was assesment of the effect of adolescent motherhood in terms of infant\toddler-mother relationshipOur findings showed that lower education level and being unemployed were higher in adolescent mothers group.Higher age gap between spouses was found to be associated with adolescent motherhood. Underinvolved relationship was highly prevalent among adolescent mothersOur findings suggest that early motherhood is a risk factor for mother-infant\toddler-relationship and parenthood.Intervention and education programs during and after pregnancy for adolescent girls may help them to prepare for motherhood more consciously and form established relationships with their infants.

Parent Physical Activity: A Systematic Review of the Literature and Recommendations for Parents of Children With Autism Spectrum Disorder

BACKGROUND

The aims of this review were to describe exercise interventions, facilitators, and barriers to physical activity for parents of children with autism spectrum disorder.

METHODS

A systematic review of the literature, appraising the validity of each article with Melnyk and Fineout-Overholt's level of evidence, from different databases CINAHL, Cochrane, PsycINFO, PubMed, ProQuest, and Web of Science between 2000 and 2020 was conducted. As the initial search revealed no articles on exercise interventions and only 2 articles with children with autism spectrum disorder, the aim was widened to all parents of children.

RESULTS

Forty-five articles were identified on barriers to physical activity including being the primary caregiving parent, perception of guilt and selfishness, and adhering to exercise programs they do as part of research, once research ends. Facilitators for physical activity including parents being more likely to exercise if they can bring their child with them and parents preferring exercise that is a lifelong habit, such as walking.

CONCLUSIONS

Due to the lack of research on parents of children with autism spectrum disorder, recommendations include development and testing of interventions for parents of children with this condition including family-based exercise interventions where children and parents have a choice to exercise together.

Clinic-Based Programs to Prevent Repeat Teen Pregnancy: A Systematic Review

CONTEXT

The purpose of this paper is to synthesize and evaluate the evidence on the effectiveness of repeat teen pregnancy prevention programs offered in clinical settings.

EVIDENCE ACQUISITION

Multiple databases were searched for peer-reviewed articles published from January 1985 to April 2016 that included key terms related to adolescent reproductive health services. Analysis of these studies occurred in 2017. Studies were excluded if they focused solely on sexually transmitted disease/HIV prevention services, or occurred outside of a clinic setting or the U.S., Canada, Europe, Australia, or New Zealand. Inclusion and exclusion criteria further narrowed the studies to those that included information on at least one short-term (e.g., increased knowledge); medium-term (e.g., increased contraceptive use); or long-term (e.g., decreased repeat teen pregnancy) outcome, or identified contextual barriers or facilitators for providing adolescent-focused family planning services. Standardized abstraction methods and tools were used to synthesize the evidence and assess its quality. Only studies of clinic-based programs focused on repeat teen pregnancy prevention were included in this review.

EVIDENCE SYNTHESIS

The search strategy identified 27,104 citations, 940 underwent full-text review, and 120 met the adolescent-focused family planning services inclusion criteria. Only five papers described clinic-based programs focused on repeat teen pregnancy prevention. Four studies found positive (n=2) or null (n=2) effects on repeat teen pregnancy prevention; an additional study described facilitators for helping teen mothers remain linked to services.

CONCLUSIONS

This review identified clinic-based repeat teen pregnancy prevention programs and few positively affect factors that may reduce repeat teen pregnancy. Access to immediate postpartum contraception or home visiting programs may be opportunities to meet adolescents where they are and reduce repeat teen pregnancy.

THEME INFORMATION

This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.

Minding the Baby

Minding the Baby, an interdisciplinary, relationship based home visiting program, was initiated to help young, at-risk new mothers keep their babies (and themselves) "in mind" in a variety of ways. The intervention--delivered by a team that includes a nurse practitioner and clinical social worker--uses a mentalization based approach; that is, we work with mothers and babies in a variety of ways to develop mothers' reflective capacities. This approach--which is an adaptation of both nurse home visiting and infant-parent psychotherapy models--seems particularly well suited to highly traumatized mothers and their families, as it is aimed at addressing the particular relationship disruptions that stem from mothers' early trauma and derailed attachment history. We discuss the history of psychoanalytically oriented and attachment based mother-infant intervention, the theoretical assumptions of mentalization theory, and provide an overview of the Minding the Baby program. The treatments of two teenage mothers and their infants are described.

"Having a Baby Changes Everything" Reflective Functioning in Pregnant Adolescents

Reflective functioning (RF), the capacity to envision thoughts, feelings, needs and intentions within the self and others, is thought to be central to sensitive parenting, yet this capacity has been unexamined among pregnant adolescents. We explored how RF was related to the emotional experience of adolescent pregnancy.

DESIGN AND METHODS

This qualitative study was guided by interpretive description. Participants were 30 Latina and African-American adolescents (mean age 17.7+1.5years) residing in a low-income urban community. All adolescents were interviewed with the Pregnancy Interview (a 22 question semi-structured interview) in their third trimester of pregnancy. Interview transcripts had been previously coded for levels of RF (1-9 with higher levels denoting higher reflectiveness), and this secondary analysis focused on the teens' experience of pregnancy and their emerging reflective capacities. We used a priori and inductive coding with all interviews and developed patterns and themes.

RESULTS

These interviews provided an in-depth understanding of the complex adolescent emotional experiences of pregnancy. We identified five themes that create a picture of how the participants reflected upon their pregnancies, unborn babies, emerging parental roles, and complicated relationships with family and partners.

CONCLUSIONS AND PRACTICE IMPLICATIONS

Adolescent developmental issues and harsh family and neighborhood environments permeated the teens' experience of pregnancy and limited capacity for RF. Understanding distinctive features of RF in pregnant adolescents may contribute to developing conceptual models and tailored clinical approaches for enhancing parental reflectiveness and sensitivity in these vulnerable young women as they enter into the transition to parenthood.

Tailoring clinical services to address the unique needs of adolescents from the pregnancy test to parenthood

Clinicians across disciplines and practice settings are likely to encounter adolescents who are at risk for a pregnancy. In 2010, 34.2/1000 15-19-year-old teens had a live birth in the United States, many more will seek care for a pregnancy scare or options counseling. Teen mothers are also at risk for a second or higher-order pregnancy during adolescence. This paper provides clinicians with adolescent-friendly clinical and counseling strategies for pregnancy prevention, pre- and post-pregnancy test counseling, pregnancy-related care, and a review of the developmental challenges encountered by teens in the transition to parenthood. Clinicians are in a better position to approach the developmental, health and mental health needs of adolescents related to pregnancy if they understand and appreciate the obstacles adolescents may face negotiating the healthcare system. In addition, when clinical services are specially tailored to the needs of the adolescent, fewer opportunities will be lost to prevent unintended pregnancies, assist teens into timely prenatal services, and improve outcomes for their pregnancies and the transition to parenthood.

The school readiness of children born to low-income, adolescent Latinas in Miami

Although studies show teenage parenting and low socioeconomic status predict poor child academic performance, limited research has examined relations between teen parenting and children's school readiness within low-income Latina mothers. In the context of the Miami School Readiness Project, low-income preschoolers (N = 3,023) attending subsidized child-care programs were assessed on cognitive, language, and fine motor skills, and parents and teachers reported on children's social skills and behavior concerns. Maternal teenage status at time of birth, maternal education, child attachment, child immigrant generational status, language, and other demographic variables were explored, as they uniquely and interactively predicted children's school readiness. Teenage parenting among low-income Latinas in this sample was less frequent (15%) than national estimates and more common among mothers born in the United States. Teen parenting was negatively associated with child cognitive and language competence at age 4, controlling for background variables. Maternal receipt of a high school diploma contributed additively, rather than interactively, to child outcomes. Parent-reported strong child attachment served as a buffer against the negative effects of teen parent status on child outcomes. Implications for intervention are discussed.

The Role of Prenatal Stress and Maternal Emotional Support on the Postpartum Depressive Symptoms of African American Adolescent Fathers

This study sought to better understand the ways in which prenatal stress and support from their mother influences postpartum depressive symptoms among African American adolescent fathers. The study’s objectives were to (a) examine the relationship between prenatal stress and maternal support with postpartum depressive symptoms among African American adolescent fathers and (b) determine whether maternal support buffers the relationship between prenatal stress and postpartum depressive symptoms among adolescent fathers. A total of 59 first-time adolescent fathers participated in the study. Results revealed that more prenatal maternal support and lower prenatal stress were predictive of lower levels of postpartum depressive symptoms among fathers. Results did not support the buffering hypothesis for maternal support. This finding suggests that maternal support plays a positive role in the lives of adolescent fathers regardless of their prenatal stress levels. Study findings highlight the need to more broadly explore resources available to adolescent fathers. Future researchers must expand the discourse on adolescent parents to include the psychological risks and potential protective factors present in the lives of young African American fathers.

A review of attachment theory in the context of adolescent parenting

The purpose of this article is to review attachment theory and relate the attachment perspective to adolescent mothers and their children. Attachment theory explains positive maternal-infant attachment as a dyadic relationship between the infant and mother that provides the infant with a secure base from which to explore the world. With respect to cognitive, social, and behavioral domains, securely attached infants tend to have more favorable long-term outcomes, while insecurely attached infants are more likely to have adverse outcomes. Adolescent parenthood can disrupt normal adolescent development, and this disruption influences development of the emotional and cognitive capacities necessary for maternal behaviors that foster secure attachment. However, it appears that if specialized supports are in place to facilitate the process of developing attachment, infants of adolescent mothers can obtain higher rates of secure attachment than normative samples in this population.

Sources of Stress and Support and Maternal Resources of Homeless Teenage Mothers

PROBLEM

Homeless families headed by young mothers are increasing. This preliminary study describes the characteristics of 17 homeless teenage mothers (HTM).

METHODS

HTMs completed questionnaires researching depression, self-esteem, maternal competence, and sources of stress and support.

FINDINGS

HTMs had positive maternal competence and self-esteem scores. When compared to housed mothers, HTMs were younger, had more depressive symptoms and negative life events, and fewer social supports.

CONCLUSIONS

HTMs represent a high-risk group with fewer available supports and many complex life stressors. School-based programs can benefit HTMs by offering support, helping them continue their education, and assisting with on-site school-based childcare.

Promising outcomes in teen mothers enrolled in a school-based parent support program and child care center

BACKGROUND

This study described a cohort of teen mothers and their children attending an urban high school with a parent support program and school-based child care center. Specific aims of the study were to describe maternal characteristics and outcomes, and child developmental and health outcomes.

METHODS

A volunteer sample of 65 adolescent mothers enrolled in the parent support program and their children were interviewed, surveyed, and assessed. Fifty-three mothers had children enrolled in the school-based child care center and 12 mothers had their children cared for by family members. Maternal characteristics assessed included self-esteem and depressive symptoms, social stressors and support, self-perceived parental competence, parent-child teaching interactions, and subsequent childbearing and maternal educational outcomes. Child outcomes included child developmental assessments and health outcomes.

RESULTS

About 33% of teen mothers were mildly to moderately depressed and 39% of the sample had experienced transitional homelessness. Social support networks were small; in the past 12 months, mothers experienced a mean number of 13.2 +/- 11.9 negative life events. Maternal self-report measures and mother-child observation measures indicated positive levels of parental competence. Maternal educational outcomes were positive, and only 6% of mothers had subsequent childbirths within 2 years. The mean scores on developmental assessments of children fell within the normal range, although there were 7 children identified with developmental delays.

CONCLUSIONS

For at-risk teen mothers, this parent support program and school-based child care setting appears to offer promising opportunities to help young mothers with parenting, avoid rapid subsequent pregnancies, and stay engaged with school, while their children are cared for in a close and safe environment.

Prenatal and parenting stress on adolescent maternal adjustment: identifying a high-risk subgroup

OBJECTIVES

Identifying adolescents who are at increased risk for a particularly difficult pregnancy and adjustment into parenthood is important, as the physical and psychological development of their infants rest in the well-being of these new mothers. This study aims to examine the effects of prenatal stress and parenting stress and the association with: (1) adolescent maternal adjustment; and (2) postpartum emotional distress.

METHODS

In a prospective longitudinal cohort study, 154 pregnant adolescents (age 14-19) from 10 public clinics were interviewed four times from the third trimester of pregnancy to 16 months postpartum. Planned comparisons of four stress groups were used to compare mean scores for measures of feelings about motherhood, infant care, parenting competency, and emotional distress.

RESULTS

Adolescent mothers who experienced high prenatal stress and high parenting stress had lower maternal adjustment (i.e., fewer positive feelings about motherhood, less infant care, and low parenting competency) and high postpartum emotional distress. Even when compared to adolescent mothers who experienced prenatal or parenting stress only, these adolescents were still at a greater disadvantage.

CONCLUSIONS

Results suggest that adolescents who experience high stress during and after pregnancy are at increased risk for difficult maternal adjustment and high postpartum emotional distress. Findings support the need for health services targeting this subgroup of adolescent mothers, including both prenatal and parenting support. Early intervention to increase maternal adjustment and decrease emotional distress should remain a priority in facilitating the most optimal maternal and child health outcomes.