Early Parenting Intervention - Biobehavioral Outcomes in infants with Neurodevelopmental Disabilities (EPI-BOND): study protocol for an Italian multicentre randomised controlled trial

Maternal sensitivity and child internalizing and externalizing behavior: a mediating role for glucocorticoid receptor gene (NR3C1) methylation?

The early caregiving environment can have lasting effects on child mental health. Animal models suggest that glucocorticoid receptor gene (NR3C1) DNA methylation plays a mediating role in linking more responsive caregiving to improved behavioral outcomes by its impact on the stress regulatory system. In this longitudinal study, we examined whether children's NR3C1 methylation levels mediate an effect of maternal sensitivity in infancy on levels of child internalizing and externalizing behavior in a community sample. Maternal sensitivity of 145 mothers was rated at infant age 5 weeks, 12 months, and 30 months by observing mother-infant interactions. Buccal DNA methylation was assessed in the same children at age 6 years and maternal-reported internalizing and externalizing behavior was assessed at age 6 and 10 years. Higher sensitivity at age 5 weeks significantly predicted lower DNA methylation levels at two NR3C1 CpG loci, although methylation levels at these loci did not mediate an effect of maternal sensitivity on levels of child internalizing and externalizing behavior. Overall, the study provides evidence that maternal sensitivity in early infancy is associated with DNA methylation levels at loci involved in stress regulation, but the significance of this finding for child mental health remains unclear.

Severity of developmental delay and parenting behavior in toddlers with neurodevelopmental disabilities

Introduction

The presence of a neurodevelopmental disability (ND) represents an adverse condition for child's development and parent-child relationship, and it is reasonable to assume that the severity of delay may influence parenting behavior. Previous research, however, did not specifically address this issue.

Methods

This cross-sectional study compared parental behaviors of mothers of toddlers with moderate/severe or mild/borderline developmental delay and mothers of toddlers with typical development, while considering maternal emotional states. A total of 88 dyads with children aged between 12 and 47 months participated in a 10-min video-recorded interaction then coded with the PICCOLO, a validated observation checklist that assesses four dimensions of parenting: affection, responsiveness, encouragement, and teaching. The mothers also fulfilled two standardized questionnaires assessing parental stress and presence of depressive symptoms. MANOVA and MANCOVA models were used to explore between-group differences in specific parenting dimensions, also considering parental stress.

Results

Mothers of toddlers with ND were less responsive than the comparison group, while the presence of a moderate/severe developmental delay specifically affected teaching behaviors. No differences emerged for affection and encouragement behaviors. Importantly, although mothers of toddlers with moderate/severe ND reported higher child-related dysfunctional interaction stress, this did not directly affect parenting behaviors.

Discussion

These findings highlight how the presence of a disability and the severity of developmental delay can affect specific dimensions of parenting (i.e., responsiveness, teaching) and might inform clinical practice and research on early parental interventions.

Improving the Treatment of Neonatal Sepsis in Resource-Limited Settings: Gaps and Recommendations

Neonatal sepsis causes significant global morbidity and mortality, with the highest burden in resource-limited settings where 99% of neonatal deaths occur. There are multiple challenges to achieving successful treatment of neonates in this setting. Firstly, reliable and low-cost strategies for risk identification are urgently needed to facilitate treatment as early as possible. Improved laboratory capacity to allow identification of causative organisms would support antimicrobial stewardship. Antibiotic treatment is still hampered by availability, but also increasingly by antimicrobial resistance - making surveillance of organisms and judicious antibiotic use a priority. Finally, supportive care is key in the management of the neonate with sepsis and has been underrecognized as a priority in resource-limited settings. This includes fluid balance and nutritional support in the acute phase, and follow-up care in order to mitigate complications and optimise long-term outcomes. There is much more work to be done in identifying the holistic needs of neonates and their families to provide effective family-integrated interventions and complete the package of neonatal sepsis management in resource-limited settings.

Positive Parenting and Sociodemographic Factors Related to the Development of Chilean Children Born to Adolescent Mothers

The lack of economic resources has a negative effect on the maternal role of younger mothers. In Chile, the majority of adolescent pregnancies occur in socially and economically vulnerable contexts. The current study aimed to examine the relationship between demographic variables within the family context and parenting behaviors among Chilean adolescent mothers (including affection, responsiveness, encouragement, and teaching). These factors were correlated with communication, problem-solving abilities, and personal-social development in typically developing infants. The study included a sample of 79 Chilean adolescent mother-child dyads with children aged 10 to 24 months. Communication, problem-solving, and personal-social development were assessed using the Ages and Stages Questionnaire-3, along with a demographic information questionnaire. The parenting behaviors mentioned above were observed using the Spanish version of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes. The findings indicated that mothers in employment and those who had not dropped out of school had children with better problem-solving skills. Additionally, children residing with their fathers and female children performed better in communication, problem-solving, and personal-social development. Maternal responsiveness was associated with communication and problem-solving, while maternal encouragement was linked to improved problem-solving skills. Maternal teaching was connected to communication, problem-solving, and personal-social development. The study emphasized the significance of parenting and sociodemographic factors among adolescent mothers and their influence on their children's development.

Ashamed or afraid? Traumatic symptom severity and emotional activations of Covid-19-related events

This study investigates the role of shame, guilt, and fear activations related to Covid-19 stressful experiences in predicting traumatic symptoms. We focused on 72 Italian adults recruited in Italy. The primary outcome was to explore the traumatic symptoms severity and negative emotions associated with COVID-19-related experiences. The presence of traumatic symptoms was met by a total of 36%. Shame and fear activations predicted traumatic scales. Qualitative content analysis identified Self-centered, and Externally-centered counterfactual thoughts and five relevant subcategories were also identified. The present findings suggest the importance of shame in the maintenance of traumatic symptoms related to COVID-19 experiences.

A contribution to the Italian validation of the Parenting Interaction with Children: Checklist of Observations Linked to Outcome (PICCOLO)

Introduction

PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes) is an observational instrument designed to assess four domains of parenting interactions that promote early child development (Affection, Responsiveness, Encouragement, and Teaching). Although PICCOLO has been validated in the United States for children as young as 4 months of age, the current focus is on parents with children aged between 10 and 47 months. This study contributes to the validation of the Italian translation of the PICCOLO by testing its psychometric properties and examining whether factors such as the child's age and child's sex are related to the four domains of parenting interactions.

Methods

To these aims, 152 mothers of children aged 10-47 months from three Italian regions participated in the study.

Results

Results indicate that the PICCOLO Italian version has acceptable inter-rater agreement, split-half reliability, and stability over time. Furthermore, the Italian version confirmed the robustness of the factor structure proposed in the original version. While there were no significant differences by child gender on the domains of parenting interactions, the Affection scores decreased with age.

Discussion

Overall, these results demonstrate that the Italian version of the PICCOLO is a reliable measure of maternal interactions with children. The psychometric properties of the instrument make it appropriate for general research purposes and for assessment of parenting before and after support interventions.

Relations between Positive Parenting Behavior during Play and Child Language Development at Early Ages

Parental behavior in interactions with children has been related to child language development. Our study contributes to the literature about relations between the characteristics of parent–child interactions during play and a child’s language development in typically developing children at early ages, with data from mothers and fathers from the same families in Spain. Our aim was to analyze the relation between positive parenting behaviors assessed with the Spanish version of the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) and child language development assessed with the Bayley-III scales. We controlled for some sociodemographic variables. The participants were 90 children aged 15–31 months and their mothers and fathers. Bivariate analysis showed significant positive relations between mothers’ responsive, encouraging and teaching behaviors and a child’s language scores. Relations were found between fathers’ encouraging and teaching behaviors and a child’s language. Regression models indicate that maternal and paternal encouraging behaviors predicted 18% of the variability in the child’s receptive language, and maternal responsive and teaching behaviors predicted 16% of the variability in the child’s expressive language and total language scores. The study provides new data that support the relevance of positive parental behaviors to improve a child’s linguistic development.

Supporting Parenting at Home-Empowering Rehabilitation through Engagement (SPHERE): study protocol for a randomised control trial

INTRODUCTION

Infants with neurodevelopmental disabilities (NDs) show emotional, cognitive and sociointeractive dysregulation dramatically impacting on caregiving behaviour. Early video-feedback interventions (VFIs) are effective in promoting sensitive parenting, which in turn supports infants' development, even in case of ND. In the light of limited resources of the healthcare systems, technological advances in telemedicine may facilitate the delivery of VFI to a greater number of families of infants with ND. To date, no study has implemented a telemedicine VFI (TVFI) for families of infants diagnosed with ND.

METHODS AND ANALYSIS

The Supporting Parenting at Home-Empowering Rehabilitation through Engagement project is a randomised controlled trial aimed at assessing the effectiveness of an early family-centred TVFI parenting support on dyads with infants diagnosed with ND. It includes two arms (TVFI vs Booklet Psychoeducational Intervention) and three assessment phases: T0, baseline; T1, immediate postintervention; T2, 6-month follow-up.

ETHICS AND DISSEMINATION

This study is funded by the Italian Ministry of Health and was approved by the Ethics Committee (Pavia). Results will be published in peer-reviewed journals and presented at national and international scientific conferences.

TRIAL REGISTRATION NUMBER

The study protocol has been also registered on NIH Clinical Trials (protocol code NCT04656483; Pre-results).

Early Intervention Services During the COVID-19 Pandemic in Spain: Toward a Model of Family-Centered Practices

Early intervention services (EIS) worked hard to continue serving children and their families during the COVID-19 lockdown, using online applications. This study aimed to determine families’ and professionals’ perceptions of the functioning of the early intervention (EI) model in Spain during the pandemic. The study sample comprised two subsamples: 81 families of children attended at an EIS (72 mothers and 9 fathers) and 213 professionals recruited from EIS. The survey was conducted online several weeks after the end of the strict lockdown in Spain. Descriptive statistics of the questionnaire answered by families and professionals were compiled, comparisons were made between the families’ and the professionals’ responses, and the relationships with several sociodemographic variables were analyzed. The results indicated that parents who cared for their children and were fully responsible for housework, parents who had used telematic tools before the lockdown, and younger professionals had a more positive perception of the EI model and the incorporation of family-centered practices (FCP) during the pandemic. The results also showed statistically significant differences in some items between parents and professionals: for example, professionals perceived more advantages than families during the lockdown, quoting the greater participation of families in the intervention and a greater focus on families’ needs. The data obtained from professionals suggested a more positive attitude toward FCP: however, the results show that they continued to adopt a directive role in the intervention, a position that is at odds with the tenets of FCP. There is a clear need for more training if a paradigm shift to FCP is to be achieved. Families’ and caregivers’ perceptions of telerehabilitation, and their adherence to telerehabilitation programs, are discussed. The implications of this study with regard to guiding future telematic interventions and family support are also considered.

The porridge-like framework: A multidimensional guidance to support parents of children with developmental disabilities

Parents of children with developmental disabilities face many daily challenges that can lead to emotional and affective problems, difficulties in caregiving, and partial mental representations about themselves and their children. The multi-faceted nature of these parents' needs requires a multi-component approach that should include the analysis of priority support goals and the planning of tailored therapeutic actions. Despite different types of validated interventions are available, the choice of the most appropriate strategy to pursue a family-centered approach to support parents of infants with developmental disabilities is not obvious. In this scenario, we propose a multi-dimensional model, the porridge-like framework of parenting. It considers three interrelated domains in parents' experience - affective (A), behavioral (B), and cognitive (C) aspects - that are intertwined with the specific degree of the child's impairment (D). This ABCD model may provide professionals with pragmatically valid guidance to plan and deliver family-centered healthcare interventions. By covering the multi-dimensional nature of parenting challenges, it provides clinicians with conceptual categories to recognize the specific needs and to choose the most suitable therapeutic action to address them. In addition, it aims to promote an ethical approach to family-centered rehabilitation for children with developmental disabilities, maximizing the potentials of a collaborative assessment approach.

Attachment-related dimensions in the epigenetic era: A systematic review of the human research

In recent years, an increasing number of studies documented potential links between parental care and epigenetic mechanisms. The present systematic review focuses on the potential association and interrelationship between attachment-related dimensions and DNA methylation in human studies. We performed a literature review using electronic databases such as PubMed, Scopus, Web of Science, and EBSCOhost. Thirteen papers were included in the review. Findings support significant associations between attachment-related dimensions and epigenetic status in studies which considered different populations, age ranges, attachment measures and peripheral tissues. Although research in this area is still under investigation, available results suggest that DNA methylation associated with attachment-related dimensions might affect the development of stress regulation system and social-emotional capacities, thus contributing to the emerging phenotypic outcomes. However, identifying mediator and moderator effects in the interrelationship between these parameters was problematic owing to heterogeneous methodologies. Finally, we discuss clinical implications, unanswered questions, and future directions for human development in epigenetics research.