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Tesson S, Swinsburg D, Nielson-Jones C, Costa DSJ, Winlaw DS, Badawi N, Sholler GF, Butow PN, Kasparian NA. Mother-Infant Dyadic Synchrony and Interaction Patterns After Infant Cardiac Surgery. J Pediatr Psychol 2024; 49:13-26. [PMID: 37873696 DOI: 10.1093/jpepsy/jsad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/19/2023] [Accepted: 09/19/2023] [Indexed: 10/25/2023] Open
Abstract
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.
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Affiliation(s)
- Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- School of Psychology, The University of Sydney, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Dianne Swinsburg
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Claudia Nielson-Jones
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Faculty of Medicine and Health, The University of New South Wales, Australia
| | - Daniel S J Costa
- School of Psychology, The University of Sydney, Australia
- Pain Management Research Institute, Royal North Shore Hospital, Australia
| | - David S Winlaw
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Nadia Badawi
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Australia
| | - Gary F Sholler
- Heart Centre for Children, The Sydney Children's Hospitals Network, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Australia
| | - Phyllis N Butow
- School of Psychology, The University of Sydney, Australia
- Psycho-Oncology Co-operative Research Group, The University of Sydney, Australia
| | - Nadine A Kasparian
- Heart Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
- Heart and Mind Wellbeing Center, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, USA
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Anis L, Letourneau N, Ross KM, Hart M, Graham I, Lalonde S, Varro S, Baldwin A, Soulsby A, Majnemer A, Donnelly C, Piotrowski C, Collier C, Lindeman C, Goldowitz D, Isaac D, Thomson D, Serré D, Citro E, Zimmermann G, Pliszka H, Mann J, Baumann J, Piekarski J, Dalton JA, Johnson-Green J, Wood K, Bruce M, Santana M, Mayer M, Gould M, Kobor M, Flowers M, Haywood M, Koerner M, Parker N, Muhajarine N, Fairie P, Chrishti R, Perry R, Merrill S, Pociuk S, StephanieTaylor, Cole S, Murphy T, Marchment T, Xavier V, Shajani Z, West Z. Study protocol for Attachment & Child Health (ATTACHTM) program: promoting vulnerable Children’s health at scale. BMC Pediatr 2022; 22:491. [PMID: 35986306 PMCID: PMC9388995 DOI: 10.1186/s12887-022-03439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022] Open
Abstract
Background Children’s exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents’ capacity for insight into their child’s and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHTM) program has been implemented and tested in seven rapid-cycling pilot studies (n = 64) and found to significantly improve parents’ RF in the domains of attachment, parenting quality, immune function, and children’s cognitive and motor development. The purpose of the study is to conduct an effectiveness-implementation hybrid (EIH) Type II study of ATTACHTM to assess its impacts in naturalistic, real-world settings delivered by community agencies rather than researchers under more controlled conditions. Methods The study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHTM program, and a qualitative examination of implementation feasibility using thematic analysis via Normalization Process Theory (NPT). We will work with 100 families and their children (birth to 36-months-old). Study outcomes include: the Parent Child Interaction Teaching Scale to assess parent-child interaction; the Parental Reflective Function and Reflective Function Questionnaires to assess RF; and the Ages and Stages Questionnaire – 3rd edition to examine child development, all administered pre-, post-, and 3-month-delayed post-assessment. Blood samples will be collected pre- and post- assessment to assess immune biomarkers. Further, we will conduct one-on-one interviews with study participants, health and social service providers, and administrators (total n = 60) from each collaborating agency, using NPT to explore perceptions and experiences of intervention uptake, the fidelity assessment tool and e-learning training as well as the benefits, barriers, and challenges to ATTACHTM implementation. Discussion The proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHTM in community agencies. Trial registration Name of registry: https://clinicaltrials.gov/. Registration number: NCT04853888. Date of registration: April 22, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03439-3.
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Kaminski JW, Robinson LR, Hutchins HJ, Newsome KB, Barry CM. Evidence base review of couple- and family-based psychosocial interventions to promote infant and early childhood mental health, 2010-2019. JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:23-55. [PMID: 34783041 PMCID: PMC10995740 DOI: 10.1111/jmft.12570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/23/2021] [Indexed: 06/13/2023]
Abstract
Infant and early childhood mental health (IECMH) has been defined as the capacity of infants and young children to regulate their emotions, form secure relationships, and explore their environments. For this special issue, we conducted a review of IECMH outcomes from evaluations of couple- and family-based psychosocial interventions not explicitly designed for trauma exposure published from 2010 through 2019, following Evidence Base Update criteria and the current convention of classifying general categories of intervention approaches rather than the former practice of evaluating specific brand-name packaged programs. Full-text review of 695 articles resulted in 39 articles eligible for categorization into intervention approaches, taking into consideration the theoretical orientation of the treatment, the population served, the intervention participants, the target outcomes, the treatment theory of change, and the degree to which the intervention was standardized across participants. Four intervention approaches were identified in this review as Probably Efficacious: Behavioral Interventions to Support Parents of Toddlers, Interventions to Support Adolescent Mothers, Tiered Interventions to Provide Support Based on Assessed Risk, and Home Visiting Interventions to Provide Individualized Support to Parents. Other intervention approaches were classified as Possibly Efficacious, Experimental, or did not have sufficient evidence in this time period to classify under these criteria. Further research could explore how to ensure that all families who need support can receive it, such as by increasing the reach of effective programs and by decreasing the number of families needing additional support.
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Affiliation(s)
- Jennifer W. Kaminski
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
| | - Lara R. Robinson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
| | - Helena J. Hutchins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Centers for Disease Control and Prevention Research Participation Programs, Oak Ridge, Tennessee, USA
| | - Kimberly B. Newsome
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control & Prevention, Atlanta, Georgia, USA
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Lemoigne S, Bouvard M, Sutter-Dallay AL. [Early mother-infant care, definition and effectiveness: A review of the literature]. Encephale 2021; 47:470-483. [PMID: 33994160 DOI: 10.1016/j.encep.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/16/2021] [Accepted: 02/01/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Professionals agree on the need for early joint mother-baby care, but its effectiveness remains poorly studied. The aim of our work is to propose a review of the literature on this subject. METHODS We included randomized or non-randomized controlled clinical trials of interventions targeting the mother-baby dyad which can begin during pregnancy or during the first three years of life. RESULTS Forty-one studies met the inclusion criteria and focused on mother-baby psychotherapy, educational or guidance programs, care for premature infants, infant massage, and home visits. The results show an improvement of the quality of the interactions whatever the type of approach, but according to different indications or modalities. The heterogeneity of intervention methods and indications make the comparison of results almost impossible. CONCLUSION This work highlights the lack of consensus on mother-child care methods, both for their indications and their effectiveness. The isolated evaluation of interactions is an insufficient criterion for judging the effectiveness of care. Finally, whatever the theoretical models, the interventions must take into account the environment of the child.
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Affiliation(s)
- S Lemoigne
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux, France.
| | - M Bouvard
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux, France
| | - A-L Sutter-Dallay
- Inserm 1219, Réseau de psychiatrie perinatale, pole universitaire de psychiatrie de l'enfant et de l'adolescent, centre hospitalier Charles-Perrens, Bordeaux et Bordeaux Population Health Research Center, Bordeaux University, Bordeaux, France
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Cañas M, Ibabe I, De Paúl J. Promising observational instruments of parent-child (0-12 years) interaction within the child protection system: A systematic review. CHILD ABUSE & NEGLECT 2020; 109:104713. [PMID: 32971348 DOI: 10.1016/j.chiabu.2020.104713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/27/2020] [Accepted: 08/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Parent-child interaction (PCI) is considered a critical environmental factor that affects child development. In the field of child and family intervention, assessment of caregiver-child interaction has great relevance for decision-making. OBJECTIVE The aim of this study is to report the results of a systematic review of the best observational instruments to assess the quality of PCI, taking into account the most advanced protocols. METHODS Firstly, one search was conducted to identify eligible observational instruments, and a second search was conducted to identify studies reporting on the psychometric properties of the instruments previously identified. To assess and rate the quality of the psychometric properties of the tools, the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) checklist was applied. RESULTS The nine PCI observational tools selected (with category B - promising) are widely used by researchers and clinicians across different stages of childhood. The Keys to Interactive Parenting Scale (2-71 months) obtained the highest rating. CONCLUSIONS The most reported and robust psychometric property was inter-rater reliability, but validity evidence is understudied. This systematic review can help clinicians keep up-to-date, provide evidence for policymakers to judge risks and benefits of health care behaviors, as well as assess the evaluation programs in child abuse and neglect context.
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Affiliation(s)
- María Cañas
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Avda. Tolosa 70, 20018, Donostia-San Sebastián, Spain..
| | - Izaskun Ibabe
- Department of Clinical and Health Psychology and Research Methodology, University of the Basque Country UPV/EHU, Avda. Tolosa 70, 20018, Donostia-San Sebastián, Spain..
| | - Joaquín De Paúl
- Department of Social Psychology, University of the Basque Country, Avda. Tolosa 70, 20018, Donostia-San Sebastián, Spain..
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Crittenden PM. CCPP's contribution to the maturing of the DMM. Clin Child Psychol Psychiatry 2020; 25:734-739. [PMID: 32985245 DOI: 10.1177/1359104520952814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over a decade, CCPP published many articles, a special issue and two special sections that enabled the DMM to become established as an alternative to both attachment disorganization and psychiatric diagnoses. New clinical authors from many countries contributed to an empirical set of assessment validity studies and findings regarding troubled and highrisk children and families. The outcome was a validated life-span series of assessments of attachment, a coherent body of important clinical findings, especially regarding school-aged children, and family functional formulations as laying the basis for DMM Integrative Treatment.
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Wright T, Stevens S, Reed PW, Wouldes TA. Post-discharge outcomes for mothers and the mother-infant relationship following admission to a psychiatric Mother-Baby Unit. Infant Ment Health J 2020; 41:770-782. [PMID: 32573014 DOI: 10.1002/imhj.21870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mother-Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother-infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as "completely recovered," one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother-infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.
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Affiliation(s)
- Tanya Wright
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Suzanne Stevens
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Peter W Reed
- Starship Child Health, Auckland District Health Board, Auckland, New Zealand
| | - Trecia A Wouldes
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Letourneau N, Anis L, Ntanda H, Novick J, Steele M, Steele H, Hart M. Attachment & Child Health (ATTACH) pilot trials: Effect of parental reflective function intervention for families affected by toxic stress. Infant Ment Health J 2020; 41:445-462. [PMID: 32533796 DOI: 10.1002/imhj.21833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function-parents' capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child-may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children <36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.
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Affiliation(s)
- Nicole Letourneau
- Faculty of Nursing and Cumming School of Medicine, Departments of Pediatrics, Psychiatry, & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, T2N 1N4.,Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Lubna Anis
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada, T2N 1N4.,Faculty of Nursing and Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Henry Ntanda
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada, T2N 1N4.,Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Jason Novick
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada, T2N 1N4.,Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
| | - Miriam Steele
- Department of Psychology, The New School, New York City, NY, 1011
| | - Howard Steele
- Department of Psychology, The New School, New York City, NY, 1011
| | - Martha Hart
- Owerko Centre at the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada, T2N 1N4.,Faculty of Nursing and Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada, T2N 1N4
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Nath S, Pearson RM, Moran P, Pawlby S, Molyneaux E, Howard LM. Maternal personality traits, antenatal depressive symptoms and the postpartum mother-infant relationship: a prospective observational study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:621-634. [PMID: 31642966 DOI: 10.1007/s00127-019-01790-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Maternal depression has been associated with bonding difficulties and lower maternal sensitivity in observed mother-infant interactions. However, little research has examined the impact of disordered personality traits in mothers on these outcomes. We investigated the association between disordered personality traits in mothers measured during pregnancy and postnatal (a) self-reported bonding with infant; (b) observational mother-infant interactions. METHODS Five hundred fifty-six women were recruited during early pregnancy and subsequently followed up at mid-pregnancy (approximately 28 weeks' gestation) and when infants were aged approximately 3 months (n = 459). During early pregnancy, data were collected on disordered personality traits (using the Standardised Assessment of Personality Abbreviated Scale) and depressive symptoms (using the Edinburgh Postnatal Depression Scale). At 3 months postpartum, self-reported perceived bonding (using the Postpartum Bonding Questionnaire) were collected. A sub-sample of women additionally provided observational mother-infant interaction data (n = 206) (coded using the Child-Adult Relationship Experimental Index). RESULTS Higher disordered personality traits was not associated with maternal perceptions of bonding impairment, but was associated with reduced maternal sensitivity during observational mother-infant interactions [adjusted for age, education, having older children, substance misuse prior to pregnancy, infant sex and gestational age: coefficient = - 0.28, 95% CI = - 0.56 to - 0.00, p < 0.05]. After adjusting for depressive symptoms, the association was attenuated [coefficient = - 0.19, 95% CI = - 0.48 to 0.11, p = 0.217]. CONCLUSIONS Mothers with disordered personality traits did not perceive themselves as having bonding impairments with their infants but were less sensitive during observed interactions, though depressive symptoms attenuated this relationship. Both depression and disordered personality traits need to be addressed to optimize mother-infant interactions.
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Affiliation(s)
- Selina Nath
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS8 2BN, UK
| | - Susan Pawlby
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Emma Molyneaux
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Louise M Howard
- Section of Women's Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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El desarrollo de la comunicación preverbal y verbal temprana. La importancia del juego. REVISTA IBEROAMERICANA DE PSICOLOGÍA 2020. [DOI: 10.33881/2027-1786.rip.13103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
En el presente artículo se propone reflexionar acerca de la heterogeneidad de investigaciones vinculada con los estudios del desarrollo de la comunicación. Se trata de un campo amplio y hasta difuso, en donde los límites no resultan ser muy claros, por esto uno de los objetivos del presente trabajo es definir los constructos teóricos a los que han arribado los investigadores del desarrollo, desde una organización que parte desde las tradiciones de investigación que han dado lugar a la génesis de la comunicación en los primeros años de vida del niño. En este sentido, el segundo objetivo es realizar una reflexión, a partir del análisis del cuerpo o “mapa” teórico construido sobre de las diferentes funciones psicológicas implicadas en el desarrollo de la comunicación, las competencias sociales, y respuesta social de los niños, analizando el juego como principal vehiculizador de los actos comunicativos en los infantes. A través del material analizado se podría inferir que la evidencia empírica apoya que la génesis del desarrollo comunicativo se da a través de los gestos no verbales que refuerzan y construyen el desarrollo comunicativo, siendo también la base para el desarrollo del lenguaje verbal, ya que estos cumplen el rol de facilitador. La expresión tangible del desarrollo del mismo, encuadrada dentro de la respuesta social, sucedería a través del juego, que cumpliría una función vehiculizadora del desarrollo del acto y acción comunicativa, siendo esta última la expresión exteriorizada de las necesidades emocionales internas o producto de la interacción hasta las necesidades biológicas más básicas para su supervivencia.
No obstante a pesar de que los estudio sobre el desarrollo de la comunicación, respuesta social y juego durante los primeros años de vida del niño han avanzado en los últimos años, aún se verifica una escasez de estudios empíricos que propongan abordar en forma asociada el desarrollo de la comunicación, la respuesta social y el juego, como vehiculizador del desarrollo y lo que esto elicita en el niño. Estos estudios nos podrían brindar un análisis más integral acerca del impacto que tienen los vehiculizadores de la expresión gestual y visual, su accionar en el medio, sus modalidades de exploración, así como la identificación de los mecanismos subyacentes producto de tales asociaciones, que aportarían la generación de nueva evidencia científica que podría promover la creación de una nueva diversidad de intervenciones terapéuticas, preventivas, prácticas de crianza, orientadas a optimizar las competencias de comunicación en las fases tempranas del desarrollo.
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Abstract
Se presentan los resultados obtenidos de una investigación desarrollada con 20 tríadas madre-padre-hijo/hija de primer año de vida, residentes en el municipio Plaza de la Revolución, La Habana, Cuba. Se analizaron las características que adquiere el cuidado parental a partir de la aplicación de cuestionarios, entrevistas y la observación durante varias visitas al hogar de la familia. Como resultado se encontró que las madres son las principales encargadas del cuidado de la descendencia y que los padres manifiestan diferentes niveles de participación en este. Las madres son más sensibles, disponibles y cooperadoras ante las necesidades del/la infante. Asimismo, se constató la importancia de algunas representaciones mentales parentales en las manifestaciones de cuidado que ofrecen las madres y los padres a su hijo/hija de primer año de vida.
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Tryphonopoulos PD, Letourneau N. Promising Results From a Video-Feedback Interaction Guidance Intervention for Improving Maternal-Infant Interaction Quality of Depressed Mothers: A Feasibility Pilot Study. Can J Nurs Res 2020; 52:74-87. [PMID: 31910674 DOI: 10.1177/0844562119892769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mothers and infants affected by postpartum depression are known to have (1) reduced quality interactions and (2) elevated cortisol levels, both of which are linked to negative developmental outcomes in children. Parent training promoting sensitive and responsive maternal-infant interactions may help optimize development in children of mothers with postpartum depression. OBJECTIVES This pilot study tested a video-feedback interaction guidance intervention designed to improve maternal-infant interaction, depressive symptoms, and cortisol patterns of depressed mothers and their infants. METHOD An experimental, pre-test, post-test design was employed to randomly assign mothers with postpartum depression to intervention (n = 6) and control (n = 6) conditions. Intervention mothers received three video-feedback sessions during home visits, provided at three-week intervals. Control participants received three home visits on the same schedule. RESULTS Significant differences favoring the intervention group were observed in maternal-infant interaction quality, especially maternal sensitivity and cognitive growth fostering activities, and in reduced infant diurnal cortisol. CONCLUSION Professionally guided video-feedback intervention appears to support improvements in interactions between depressed mothers and their infants and optimizes infants' diurnal cortisol patterns. The findings from this feasibility pilot study have been used to support a large-scale follow-up exploration.
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Affiliation(s)
- Panagiota D Tryphonopoulos
- Arthur Labatt Family School of Nursing, Western University, FIMS and Nursing Building, London, Ontario, Canada
| | - Nicole Letourneau
- Faculty of Nursing, Cumming School of Medicine (Pediatrics, Psychiatry & Community Health Sciences), University of Calgary, Calgary, Alberta, Canada
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O'Hara L, Smith ER, Barlow J, Livingstone N, Herath NINS, Wei Y, Spreckelsen TF, Macdonald G. Video feedback for parental sensitivity and attachment security in children under five years. Cochrane Database Syst Rev 2019; 11:CD012348. [PMID: 31782528 PMCID: PMC6883766 DOI: 10.1002/14651858.cd012348.pub2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children who are securely attached to at least one parent are able to be comforted by that parent when they are distressed and explore the world confidently by using that parent as a 'secure base'. Research suggests that a secure attachment enables children to function better across all aspects of their development. Promoting secure attachment, therefore, is a goal of many early interventions. Attachment is mediated through parental sensitivity to signals of distress from the child. One means of improving parental sensitivity is through video feedback, which involves showing a parent brief moments of their interaction with their child, to strengthen their sensitivity and responsiveness to their child's signals. OBJECTIVES To assess the effects of video feedback on parental sensitivity and attachment security in children aged under five years who are at risk for poor attachment outcomes. SEARCH METHODS In November 2018 we searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, nine other databases and two trials registers. We also handsearched the reference lists of included studies, relevant systematic reviews, and several relevant websites SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs that assessed the effects of video feedback versus no treatment, inactive alternative intervention, or treatment as usual for parental sensitivity, parental reflective functioning, attachment security and adverse effects in children aged from birth to four years 11 months. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 22 studies from seven countries in Europe and two countries in North America, with a total of 1889 randomised parent-child dyads or family units. Interventions targeted parents of children aged under five years, experiencing a wide range of difficulties (such as deafness or prematurity), or facing challenges that put them at risk of attachment issues (for example, parental depression). Nearly all studies reported some form of external funding, from a charitable organisation (n = 7) or public body, or both (n = 18). We considered most studies as being at low or unclear risk of bias across the majority of domains, with the exception of blinding of participants and personnel, where we assessed all studies as being at high risk of performance bias. For outcomes where self-report measures were used, such as parental stress and anxiety, we rated all studies at high risk of bias for blinding of outcome assessors. Parental sensitivity. A meta-analysis of 20 studies (1757 parent-child dyads) reported evidence of that video feedback improved parental sensitivity compared with a control or no intervention from postintervention to six months' follow-up (standardised mean difference (SMD) 0.34, 95% confidence interval (CI) 0.20 to 0.49, moderate-certainty evidence). The size of the observed impact compares favourably to other, similar interventions. Parental reflective functioning. No studies reported this outcome. Attachment security. A meta-analysis of two studies (166 parent-child dyads) indicated that video feedback increased the odds of being securely attached, measured using the Strange Situation Procedure, at postintervention (odds ratio 3.04, 95% CI 1.39 to 6.67, very low-certainty evidence). A second meta-analysis of two studies (131 parent-child dyads) that assessed attachment security using a different measure (Attachment Q-sort) found no effect of video feedback compared with the comparator groups (SMD 0.02, 95% CI -0.33 to 0.38, very low-certainty evidence). Adverse events. Eight studies (537 parent-child dyads) contributed data at postintervention or short-term follow-up to a meta-analysis of parental stress, and two studies (311 parent-child dyads) contributed short-term follow-up data to a meta-analysis of parental anxiety. There was no difference between intervention and comparator groups for either outcome. For parental stress the SMD between video feedback and control was -0.09 (95% CI -0.26 to 0.09, low-certainty evidence), while for parental anxiety the SMD was -0.28 (95% CI -0.87 to 0.31, very low-certainty evidence). Child behaviour. A meta-analysis of two studies (119 parent-child dyads) at long-term follow-up found no evidence of the effectiveness of video feedback on child behaviour (SMD 0.04, 95% CI -0.33 to 0.42, very low-certainty evidence). A moderator analysis found no evidence of an effect for the three prespecified variables (intervention type, number of feedback sessions and participating carer) when jointly tested. However, parent gender (both parents versus only mothers or only fathers) potentially has a statistically significant negative moderation effect, though only at α (alpha) = 0.1 AUTHORS' CONCLUSIONS: There is moderate-certainty evidence that video feedback may improve sensitivity in parents of children who are at risk for poor attachment outcomes due to a range of difficulties. There is currently only little, very low-certainty evidence regarding the impact of video feedback on attachment security, compared with control: results differed based on the type of measure used, and follow-up was limited in duration. There is no evidence that video feedback has an impact on parental stress or anxiety (low- and very low-certainty evidence, respectively). Further evidence is needed regarding the longer-term impact of video feedback on attachment and more distal outcomes such as children's behaviour (very low-certainty evidence). Further research is needed on the impact of video-feedback on paternal sensitivity and parental reflective functioning, as no study measured these outcomes. This review is limited by the fact that the majority of included parents were mothers.
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Affiliation(s)
- Leeanne O'Hara
- Queen's University BelfastSchool of Social Sciences, Education and Social Work6 College ParkBelfastNorthern IrelandUKBT7 1LP
| | - Emily R Smith
- University of WarwickWarwick Medical SchoolCoventryUKUKCV4 7AL
| | - Jane Barlow
- University of OxfordDepartment of Social Policy and InterventionBarnett House32 Wellington SquareOxfordUKOX1 2ER
| | - Nuala Livingstone
- CochraneEditorial & Methods DepartmentSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | | | - Yinghui Wei
- University of PlymouthCentre for Mathematical Sciences, School of Engineering, Computing and MathematicsPlymouthUK
| | - Thees Frerich Spreckelsen
- University of GlasgowSchool of Social and Political Sciences, Department of SociologyAdam Smith Building, Room 513Bute GardenGlasgowUKG12 8RT
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Elmer JRS, O'Shaughnessy R, Bramwell R, Dickson JM. Exploring health visiting professionals' evaluations of early parent-infant interactions. J Reprod Infant Psychol 2019; 37:554-565. [PMID: 31280629 DOI: 10.1080/02646838.2019.1637831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To examine the accuracy of Health Visitors (HVs) evaluations of the quality of parent-infant interactions. Background: HVs have been identified as key professionals in the early identification of difficulties in parent-infant interactions. Method: A sample of 56 HVs, 4 Family Health Nurses (FHNs) and 14 Community Nursery Nurses (CNNs) recruited from two National Health Service (NHS) Trusts, viewed video footage of six early parent-infant interactions which had been categorised as 'sensitive', 'mixed', and 'problematic' using the CARE-Index. Participants evaluated the quality of the parent-infant interactions shown in these videos using the Parent-Infant Interaction Rating Questionnaire (PIIRQ). Results: On average, participants correctly rated the problematic videos as lowest in quality, the mixed as higher in quality than the problematic videos, and the sensitive videos as highest in quality. Interestingly, within the problematic category participants rated the 'unresponsive' pattern of interaction as significantly lower in quality than the 'controlling' interaction. Conclusions: Findings suggest participants were relatively accurate in their evaluations of parent-infant interactions. However, they indicate that participants were more likely to be concerned about unresponsive, as opposed to controlling, interactive behaviours. Recommendations for further research include exploration of potential differences in how health-visiting professionals evaluate particular patterns of parent-infant interactions.
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Affiliation(s)
- Jessica R S Elmer
- IEYS CAMHS, The Tavistock & Portman NHS Foundation Trust , London , UK
| | - Ruth O'Shaughnessy
- Specialist CAMHS, Alder Hey Children's NHS Foundation Trust , Liverpool , UK
| | - Ros Bramwell
- Department of Psychology, University of Chester , Chester , UK
| | - Joanne M Dickson
- School of Arts and Humanities, Edith Cowan University , Perth , Western Australia
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Syrjänen M, Hautamäki A, Pleshkova N, Maliniemi S. Attachment and sensitivity among parents with ADHD – a multiple-case study. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2019. [DOI: 10.1080/13632752.2019.1602985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Milla Syrjänen
- Faculty of Educational Sciences, University of Helsinki, Helsinki, Finland
| | - Airi Hautamäki
- Swedish School of Social Science, University of Helsinki, Helsinki, Finland
| | - Natalia Pleshkova
- Division of Child and Parent Mental Health and Early Intervention, St. Petersburg State University, St. Petersburg, Russian Federation
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Spieker SJ, Crittenden PM. CAN ATTACHMENT INFORM DECISION-MAKING IN CHILD PROTECTION AND FORENSIC SETTINGS? Infant Ment Health J 2018; 39:625-641. [DOI: 10.1002/imhj.21746] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Dawson NK. From Uganda to Baltimore to Alexandra Township: How far can Ainsworth's theory stretch? S Afr J Psychiatr 2018; 24:1137. [PMID: 30263216 PMCID: PMC6138127 DOI: 10.4102/sajpsychiatry.v24i0.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 02/05/2018] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION After extensive observation of mother-infant dyads in two diverse contexts, Ainsworth developed the construct of maternal sensitivity to explain the nature of mother-infant interactions that lead to infant attachment security. She believed this construct to be universally applicable. Since Ainsworth's publications, her theory has been adapted and extended, particularly by theorists working in North American and Western European countries. These developments have been largely uninterrogated in relation to their universal cultural relevance, despite the fact that parenting practices differ greatly across cultural groups. Those who have begun to interrogate the cultural universality of current conceptualisation of maternal sensitivity highlight important areas of cultural disagreement. METHOD This article provides a critical theoretical argument regarding the cultural universality of maternal sensitivity, extending comment to the cultural and contextual relevance of developments in its operationalisation. RESULTS Particular aspects of current theoretical and operational use of the construct of maternal sensitivity that are potentially culturally specific (as opposed to culturally universal) are noted, namely the inclusion of positive affect, the centrality of parent-infant play, verbal responsiveness, the inclusion of learning in parent-infant interactions and the shift towards a more proactive (rather than reactive) role for the parent in parent-infant interactions. CONCLUSION This article suggests that the evolution of the concept of maternal sensitivity has failed to account for cultural differences.
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Affiliation(s)
- Nicola K Dawson
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, South Africa
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Kristensen IH, Simonsen M, Trillingsgaard T, Kronborg H. Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study. BMC Pregnancy Childbirth 2017; 17:379. [PMID: 29141587 PMCID: PMC5688723 DOI: 10.1186/s12884-017-1568-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 11/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Supporting early mother-infant relationships to ensure infants’ future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities. Methods This quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis. Results The levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93–10.09) compared with 7.62 (95%CI;7.03–8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96–10.14) compared with 7.83 (95%CI;7.19–8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88–9.99) in the intervention group compared with 7.73 (95%CI;7.13–8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13–33.94) compared with 35.29 (95%CI;34.07–36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22–41.98) compared with 40.10 (95%CI;39.65–40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE. Conclusion The findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method. Trial registration This study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447. Electronic supplementary material The online version of this article (10.1186/s12884-017-1568-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingeborg Hedegaard Kristensen
- Department of Public Health, Section for Nursing, Aarhus University, Høegh-Guldbergs Gade 6A, 8000, Aarhus C, Denmark.
| | - Marianne Simonsen
- Department of Economics and Business Economies, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V, Denmark
| | - Tea Trillingsgaard
- Department of Psychology and Behavioural Sciences, Aarhus University, Bartolins Allé 9, 8000, Aarhus C, Denmark
| | - Hanne Kronborg
- Department of Public Health, Section for Nursing, Aarhus University, Høegh-Guldbergs Gade 6A, 8000, Aarhus C, Denmark
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Bressem K, Ziegenhain U, Doelitzsch C, Hofer A, Besier T, Fegert JM, Kuenster AK. A German e-learning-training in the context of early preventive intervention and child protection: preliminary findings of a pre-post evaluation. Child Adolesc Psychiatry Ment Health 2016; 10:25. [PMID: 27499806 PMCID: PMC4975889 DOI: 10.1186/s13034-016-0113-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 07/13/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In recent years, a number of government-sponsored initiatives have been implemented in Germany that are focused on early preventive intervention in child protection. In response to the need for interdisciplinary training in this area, the internet-based e-learning program "Early Preventive Intervention and Child Protection" was developed for professionals in the child welfare and health care systems working with families with infants and toddlers. The program is currently undergoing evaluation for effectiveness and user satisfaction. METHODS In a pre-post design, users are requested to complete questionnaires that assess three measures of expertise: theoretical knowledge of relevant fields, the ability to correctly identify subtle signals of infant communication, and the ability to assess maternal sensitivity. This article presents the contents of the program and the pre-training results (N = 1.294 participants). Descriptive analyses as well as Pearson correlations and Bonferroni corrections of error were conducted using the statistical program SPSS v. 21.0. RESULTS The findings show that a wide range of professionals are making use of the program, and that their existing theoretical knowledge about early preventive intervention, as well as their ability to identify subtle signals of infant communication, is relatively good. However, their ability to assess maternal sensitivity, which is considered a crucial indicator for the risk of child abuse, was low. CONCLUSIONS The outcome of the pre-training results indicates that professionals working in the area of child protection need to develop more capability in recognizing maternal sensitivity, in order to ensure early detection of families who are at risk and thus in need of support. Finally, the number of years of professional experience did not correlate with the scores on any of the three measures, which emphasizes the importance of providing interdisciplinary training in this area for all those working in child and family services, regardless of background.
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Affiliation(s)
- Kristina Bressem
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Ute Ziegenhain
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Claudia Doelitzsch
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Alexandra Hofer
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Tanja Besier
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Joerg M. Fegert
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
| | - Anne K. Kuenster
- Department for Child and Adolescent Psychiatry/Psychotherapy, Ulm University Hospital, Ulm, Germany
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Szaniecki E, Barnes J. Measurement Issues: Measures of infant mental health. Child Adolesc Ment Health 2016; 21:64-74. [PMID: 32680360 DOI: 10.1111/camh.12105] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Emotional and behavioural problems emerging in very young children can represent a challenge to the child and family and warrant early identification and appropriate support or intervention. Diagnostic systems are being developed that allow for specific difficulties to be identified and this review summarizes them. SCOPE This evidenced based review describes the psychometric properties and potential for use in clinical practice of a range of instruments and methods that are available to identify infant mental health difficulties, and which may be suitable for use in primary care settings, including observations, questionnaires and checklists. FINDINGS AND CONCLUSION While debate continues about whether infant mental health problems can or should be identified, the use of standardized tools may help clinicians to compare observations of infants so that those emerging as atypical can receive additional attention, reflecting a more targeted approach to primary care services.
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Affiliation(s)
| | - Jacqueline Barnes
- Institute for the Study of Children, Families and Social Issues, Birkbeck, University of London, London, UK
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Intervención grupal para reducir la sintomatología depresiva y promover la sensibilidad materna en embarazadas chilenas. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.sumpsi.2015.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Letourneau N, Tryphonopoulos P, Giesbrecht G, Dennis CL, Bhogal S, Watson B. NARRATIVE AND META-ANALYTIC REVIEW OF INTERVENTIONS AIMING TO IMPROVE MATERNAL-CHILD ATTACHMENT SECURITY. Infant Ment Health J 2015; 36:366-87. [DOI: 10.1002/imhj.21525] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nicole Letourneau
- Alberta Children's Hospital Research Institute for Child and Maternal Health; University of Calgary
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Barlow J, Bennett C, Midgley N, Larkin SK, Wei Y. Parent-infant psychotherapy for improving parental and infant mental health. Cochrane Database Syst Rev 2015; 1:CD010534. [PMID: 25569177 PMCID: PMC8685508 DOI: 10.1002/14651858.cd010534.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Parent-infant psychotherapy (PIP) is a dyadic intervention that works with parent and infant together, with the aim of improving the parent-infant relationship and promoting infant attachment and optimal infant development. PIP aims to achieve this by targeting the mother's view of her infant, which may be affected by her own experiences, and linking them to her current relationship to her child, in order to improve the parent-infant relationship directly. OBJECTIVES 1. To assess the effectiveness of PIP in improving parental and infant mental health and the parent-infant relationship.2. To identify the programme components that appear to be associated with more effective outcomes and factors that modify intervention effectiveness (e.g. programme duration, programme focus). SEARCH METHODS We searched the following electronic databases on 13 January 2014: Cochrane Central Register of Controlled Trials (CENTRAL, 2014, Issue 1), Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, BIOSIS Citation Index, Science Citation Index, ERIC, and Sociological Abstracts. We also searched the metaRegister of Controlled Trials, checked reference lists, and contacted study authors and other experts. SELECTION CRITERIA Two review authors assessed study eligibility independently. We included randomised controlled trials (RCT) and quasi-randomised controlled trials (quasi-RCT) that compared a PIP programme directed at parents with infants aged 24 months or less at study entry, with a control condition (i.e. waiting-list, no treatment or treatment-as-usual), and used at least one standardised measure of parental or infant functioning. We also included studies that only used a second treatment group. DATA COLLECTION AND ANALYSIS We adhered to the standard methodological procedures of The Cochrane Collaboration. We standardised the treatment effect for each outcome in each study by dividing the mean difference (MD) in post-intervention scores between the intervention and control groups by the pooled standard deviation. We presented standardised mean differences (SMDs) and 95% confidence intervals (CI) for continuous data, and risk ratios (RR) for dichotomous data. We undertook meta-analysis using a random-effects model. MAIN RESULTS We included eight studies comprising 846 randomised participants, of which four studies involved comparisons of PIP with control groups only. Four studies involved comparisons with another treatment group (i.e. another PIP, video-interaction guidance, psychoeducation, counselling or cognitive behavioural therapy (CBT)), two of these studies included a control group in addition to an alternative treatment group. Samples included women with postpartum depression, anxious or insecure attachment, maltreated, and prison populations. We assessed potential bias (random sequence generation, allocation concealment, incomplete outcome data, selective reporting, blinding of participants and personnel, blinding of outcome assessment, and other bias). Four studies were at low risk of bias in four or more domains. Four studies were at high risk of bias for allocation concealment, and no study blinded participants or personnel to the intervention. Five studies did not provide adequate information for assessment of risk of bias in at least one domain (rated as unclear).Six studies contributed data to the PIP versus control comparisons producing 19 meta-analyses of outcomes measured at post-intervention or follow-up, or both, for the primary outcomes of parental depression (both dichotomous and continuous data); measures of parent-child interaction (i.e. maternal sensitivity, child involvement and parent engagement; infant attachment category (secure, avoidant, disorganised, resistant); attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and secondary outcomes (e.g. infant cognitive development). The results favoured neither PIP nor control for incidence of parental depression (RR 0.74, 95% CI 0.52 to 1.04, 3 studies, 278 participants, low quality evidence) or parent-reported levels of depression (SMD -0.22, 95% CI -0.46 to 0.02, 4 studies, 356 participants, low quality evidence). There were improvements favouring PIP in the proportion of infants securely attached at post-intervention (RR 8.93, 95% CI 1.25 to 63.70, 2 studies, 168 participants, very low quality evidence); a reduction in the number of infants with an avoidant attachment style at post-intervention (RR 0.48, 95% CI 0.24 to 0.95, 2 studies, 168 participants, low quality evidence); fewer infants with disorganised attachment at post-intervention (RR 0.32, 95% CI 0.17 to 0.58, 2 studies, 168 participants, low quality evidence); and an increase in the proportion of infants moving from insecure to secure attachment at post-intervention (RR 11.45, 95% CI 3.11 to 42.08, 2 studies, 168 participants, low quality evidence). There were no differences between PIP and control in any of the meta-analyses for the remaining primary outcomes (i.e. adverse effects), or secondary outcomes.Four studies contributed data at post-intervention or follow-up to the PIP versus alternative treatment analyses producing 15 meta-analyses measuring parent mental health (depression); parent-infant interaction (maternal sensitivity); infant attachment category (secure, avoidant, resistant, disorganised) and attachment change (insecure to secure, stable secure, secure to insecure, stable insecure); infant behaviour and infant cognitive development. None of the remaining meta-analyses of PIP versus alternative treatment for primary outcomes (i.e. adverse effects), or secondary outcomes showed differences in outcome or any adverse changes.We used the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach to rate the overall quality of the evidence. For all comparisons, we rated the evidence as low or very low quality for parental depression and secure or disorganised infant attachment. Where we downgraded the evidence, it was because there was risk of bias in the study design or execution of the trial. The included studies also involved relatively few participants and wide CI values (imprecision), and, in some cases, we detected clinical and statistical heterogeneity (inconsistency). Lower quality evidence resulted in lower confidence in the estimate of effect for those outcomes. AUTHORS' CONCLUSIONS Although the findings of the current review suggest that PIP is a promising model in terms of improving infant attachment security in high-risk families, there were no significant differences compared with no treatment or treatment-as-usual for other parent-based or relationship-based outcomes, and no evidence that PIP is more effective than other methods of working with parents and infants. Further rigorous research is needed to establish the impact of PIP on potentially important mediating factors such as parental mental health, reflective functioning, and parent-infant interaction.
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Affiliation(s)
- Jane Barlow
- Warwick Medical SchoolDivision of Mental Health and WellbeingUniversity of WarwickGibbett Hill RoadCoventryUKCV4 7LF
| | - Cathy Bennett
- Coventry UniversityCentre for Technology Enabled Health Research (CTEHR)Priory StreetCoventryUKCV1 5FB
| | - Nick Midgley
- University College LondonResearch Department of Clinical, Educational and Health PsychologyGower StreetLondonUKWC1E 6BT
| | - Soili K Larkin
- University of WarwickDivision of Health SciencesGibbets Hill RoadCoventryUKCV4 7AL
| | - Yinghui Wei
- University of PlymouthSchool of Computing and MathematicsPlymouthUK
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Olhaberry M, Zapata J, Escobar M, Mena C, Farkas C, Santelices MP, Krause M. Antenatal depression and its relationship with problem-solving strategies, childhood abuse, social support, and attachment styles in a low-income Chilean sample. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.mhp.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tryphonopoulos PD, Letourneau N, Ditommaso E. Attachment and caregiver-infant interaction: a review of observational-assessment tools. Infant Ment Health J 2014; 35:642-56. [PMID: 25798513 DOI: 10.1002/imhj.21461] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The relationship between maternal-infant interaction and attachment quality to infant developmental outcomes has long been established. As children mature, problems stemming from troubled caregiver-infant relations may result in referral to mental health or child protection services. The accurate and appropriate assessment of attachment is critical for early recognition of problematic relations and for informing suitable treatment modalities. Evaluating the quality of attachment poses a challenge for researchers and clinicians seeking to explore the association between infant development and the quality of early caregiving experiences. Although providing a definitive answer to the question of which of these assessment procedures is the single universal standard for measuring attachment quantity is beyond the scope of this article, readers will be provided with a description and comparison of strengths and limitations of the most commonly used measures of attachment, including the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978), Attachment Q-Sort (E. Waters & K.E. Deane, 1985), Toddler Attachment Sort (TAS-45; J. Kirkland, D. Bimler, A. Drawneek, M. McKim, & A. Scholmerich, 2004), CARE-Index (P. Crittenden, 1985), Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; E. Bronfman, E. Parsons, & K. Lyons-Ruth, 1999), Massie-Campbell Scale of Mother-Infant Attachment Indicators During Stress Scale (Attachment During Stress Scale; H.N. Massie & B.K. Campbell, 1983), and the Risky Situation Procedure (D. Paquette & M. Bigras, 2010).
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Mortensen JA, Mastergeorge AM. A META-ANALYTIC REVIEW OF RELATIONSHIP-BASED INTERVENTIONS FOR LOW-INCOME FAMILIES WITH INFANTS AND TODDLERS: FACILITATING SUPPORTIVE PARENT-CHILD INTERACTIONS. Infant Ment Health J 2014; 35:336-53. [DOI: 10.1002/imhj.21451] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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27
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Dollberg D, Feldman R, Tyano S, Keren M. Maternal Representations and Mother-Infant Relational Behavior Following Parent-Infant Psychotherapy. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/15289168.2013.821884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Power TG, Sleddens EFC, Berge J, Connell L, Govig B, Hennessy E, Liggett L, Mallan K, Santa Maria D, Odoms-Young A, St. George SM. Contemporary research on parenting: conceptual, methodological, and translational issues. Child Obes 2013; 9 Suppl:S87-94. [PMID: 23944927 PMCID: PMC3746214 DOI: 10.1089/chi.2013.0038] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Researchers over the last decade have documented the association between general parenting style and numerous factors related to childhood obesity (e.g., children's eating behaviors, physical activity, and weight status). Many recent childhood obesity prevention programs are family focused and designed to modify parenting behaviors thought to contribute to childhood obesity risk. This article presents a brief consideration of conceptual, methodological, and translational issues that can inform future research on the role of parenting in childhood obesity. They include: (1) General versus domain specific parenting styles and practices; (2) the role of ethnicity and culture; (3) assessing bidirectional influences; (4) broadening assessments beyond the immediate family; (5) novel approaches to parenting measurement; and (6) designing effective interventions. Numerous directions for future research are offered.
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Affiliation(s)
- Thomas G. Power
- Department of Human Development, Washington State University, Pullman, WA
| | - Ester F. C. Sleddens
- Department of Health Promotion, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerica Berge
- Department of Family and Community Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Lauren Connell
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA
| | - Bert Govig
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Erin Hennessy
- Cancer Prevention Fellowship Program, National Cancer Institute, Rockville, MD
| | - Leanne Liggett
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Kimberley Mallan
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Kelvin Grove, Australia
| | | | - Angela Odoms-Young
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
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Svanberg P, Barlow J, Tigbe W. The Parent–Infant Interaction Observation Scale: reliability and validity of a screening tool. J Reprod Infant Psychol 2013. [DOI: 10.1080/02646838.2012.751586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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30
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Sweet Mother: evaluation of a pilot mental health service for asylum‐seeking mothers and babies. JOURNAL OF PUBLIC MENTAL HEALTH 2012. [DOI: 10.1108/17465721211289392] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Pleshkova NL, Muhamedrahimov RJ. Quality of attachment in St Petersburg (Russian Federation): A sample of family-reared infants. Clin Child Psychol Psychiatry 2010; 15:355-62. [PMID: 20603423 DOI: 10.1177/1359104510365453] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The study aimed to describe the quality of attachment in the sample of children living in St Petersburg (Russian Federation). Up to the present there were no studies on quality of attachment relationship among infants living in families in the Russian Federation (RF), including families living in St Petersburg. The study results have an important value for understanding of development of attachment patterns in a changing society with a previous history of being a totalitarian state. The St Petersburg sample consisted of 130 children, living in families, aged 11-16 months old (mean = 13.3 months). Children were living in largely normative low-risk families. The Strange Situation Procedure was used (Ainsworth Blehar, Waters, & Wall, 1978). The attachment categories were classified according to the criteria of the DMM model (Crittenden, 2002). Results presented show that 50% of children showed the complex strategies (pre-A3-4 compulsive caregiving and compliant, pre-C3-4 aggressive and feigned helpless, A/C). It was found that among a St Petersburg sample of families there was small number of children with secure attachment pattern and many children with complex attachment strategies.
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Farnfield S, Hautamäki A, Nørbech P, Sahhar N. DMM assessments of attachment and adaptation: Procedures, validity and utility. Clin Child Psychol Psychiatry 2010; 15:313-28. [PMID: 20603420 DOI: 10.1177/1359104510364315] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article gives a brief over view of the Dynamic-Maturational Model of attachment and adaptation (DMM; Crittenden, 2008) together with the various DMM assessments of attachment that have been developed for specific stages of development. Each assessment is discussed in terms of procedure, outcomes, validity, advantages and limitations, comparable procedures and areas for further research and validation. The aims are twofold: to provide an introduction to DMM theory and its application that underlie the articles in this issue of CCPP; and to provide researchers and clinicians with a guide to DMM assessments.
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Affiliation(s)
- Steve Farnfield
- School Human and Life Sciences, Whitelands College, University of Roehampton, London, UK.
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Künster AK, Fegert JM, Ziegenhain U. Assessing parent--child interaction in the preschool years: A pilot study on the psychometric properties of the toddler CARE-Index. Clin Child Psychol Psychiatry 2010; 15:379-89. [PMID: 20603425 DOI: 10.1177/1359104510367585] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to test the utility of the Toddler CARE-Index, an assessment tool for parent-child interaction among preschool-aged children, for screening of parental sensitivity. The CARE-Index was initially developed for infants and had been adapted for toddlers up to 3 years of age. This study tests its utility for children up to 5.8 years old. Sixty-four children (2.3 to 5.8 years) and their mothers took part in the study and were examined with both the Toddler CARE-Index and the Preschool Assessment of Attachment. The sample comprised two groups, a sample that had come to professional attention (n = 21) and a normative sample (n = 43). Analysis of coder agreement showed adequate correspondence among three coders. Test-retest reliability was less robust. Testing validity, there was a significant relation between sensitivity of the mother and attachment security of the child in the total sample as well as in both subsamples. These results are a first step for using the Toddler CARE-Index as an economical and promising instrument for the assessment of parental sensitivity with children beyond toddlerhood in both normative and clinical settings.
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Affiliation(s)
- Anne Katrin Künster
- Ulm University Hospital for Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany.
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