The relationship between responsive caregiving and child outcomes: evidence from direct observations of mother-child dyads in Pakistan

Social Support and Spousal Relationship Quality Improves Responsiveness among Anxious Mothers

Maternal responsiveness, a mother's ability to consistently identify infant cues and then act on them, is critical for healthy child development. A woman's social support and spousal relationship may affect responsiveness to an infant, especially among mothers with anxiety. We assessed how social support and spousal relationship quality is associated with responsiveness among anxious mothers, and if postpartum depression (PPD) moderated these associations. Cross-sectional data were collected from 2019 to 2022 in a public hospital in Pakistan from 701 women at six-weeks postpartum. Eligible women had at least mild anxiety in early- to mid- pregnancy. Linear regression analyses assessed if spousal relationship quality and social support from family and friends were associated with maternal responsiveness, measured using the Maternal Infant Responsiveness Instrument. Interaction terms were used to examine if PPD moderated these associations. Spousal relationship quality (B = 2.49, 95% CI: 1.48, 3.50) and social support (B = 1.07, 95% CI: 0.31, 1.83) were positively related to maternal responsiveness to the infant. Emotional support from a spouse was positively associated with responsiveness (B = 1.08, 95% CI: 0.12, 2.03 depressed; B = 2.96, 95% CI: 1.34, 4.58 non-depressed), and conflict with the spouse was negatively associated with responsiveness (B=-1.02, 95% CI: -1.94, -0.09 depressed; B=-2.87, 95% CI: -4.36, -1.37 non-depressed). However, social support was related to responsiveness only in non-depressed women (B = 2.61, 95% CI: 1.14, 4.07). While spousal relationships and social support enhance maternal responsiveness, for depressed women, spousal relationships were particularly critical. In considering maternal-infant interventions to improve child development outcomes, our study indicates the importance of supportive relationships that foster effective responsiveness.

Depressive symptoms, parenting attitude, and violent discipline among caregivers of left-behind children in rural China: a cross-sectional study

BACKGROUND

The situation of mental health and discipline behaviors of left-behind children's caregivers were not optimistic in rural China. Caregivers' depression might increase the risk of using violent discipline. However, the specific ways in which depressive symptoms impact violent discipline have rarely been explored in rural areas. This study aims to assess the prevalence of violent discipline among left-behind children under 6 years of age in rural China and explore the potential mechanisms of how caregivers' depressive symptoms affect violent discipline.

METHODS

We enrolled a total of 396 pairs of left-behind children and their caregivers in our study, which was conducted in 5 counties of Hebei, Henan, Jiangxi, Guizhou, and Sichuan provinces in China. The depressive symptoms of caregivers were measured by using Zung Self-rating Depression Scale (ZSDS) and violent discipline was assessed by the Child Discipline Module of Multiple Indicator Cluster Surveys (MICS). A self-designed questionnaire was utilized to measure caregiver's parenting attitude. Based on the cross-sectional data, controlling for potential confounders, structural equation modeling (SEM) was used to assess the direct and indirect effects of the mediation models by applying the weighted least squares with mean and variance adjusted (WLSMV) estimate.

RESULTS

The prevalence of violent discipline, psychological aggression, and physical punishment was 72.7%, 59.3%, and 60.4% respectively of left-behind children under 6 years of age. According to the results of SEM, parenting attitude acted as a suppressor, suppressing the association between caregivers' depressive symptoms and physical punishment/psychological aggression/violent discipline. The caregivers' depressive symptoms positively influenced all the outcome variables by affecting parenting attitudes (p = 0.002, p = 0.013, p = 0.002).

CONCLUSIONS

The presence of depressive symptoms in caregivers increases the use of violent discipline through negative parenting attitudes. The mental health status of primary caregivers of left-behind children in rural China needed emphasis and improvement.

Practices and outcomes of responsive caregiving on child neurodevelopment and mental health across diverse global populations: a scoping review protocol

INTRODUCTION

Responsive caregiving (RC) leads to positive outcomes in children, including secure attachment with caregivers, emotional regulation, positive social interactions and cognitive development. Through our scoping review, we aim to summarise the practices and outcomes of RC in diverse caregiver and child populations from 0 to 8 years.

METHODS AND ANALYSIS

We will use the Arksey and O'Malley framework and the Joanna Briggs Institute methodology for scoping reviews. We shall present our findings as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping review. Only peer-reviewed, English-language articles from 1982 to 2022 will be included from PubMed, Web of Science, APA PsychInfo, APA PsycArticles, SocINDEX and Google Scholar databases. Reference lists of included articles will also be screened. The search strategy will be developed for each database, and search results will be imported into Rayyan. Screening will be done in two phases: (1) titles and abstracts will be screened by two authors and conflicts will be resolved by mutual discussion between both or by consulting with a senior author; and (2) full-texts of shortlisted studies from the first phase will then be screened using the same inclusion/exclusion criteria. A data extraction form will be developed to collate relevant information from the final list of included articles. This form will be pilot tested on the first 10 papers and iteratively refined prior to data extraction from the remaining articles. Results will be presented in figures, tables and a narrative summary.

ETHICS AND DISSEMINATION

No ethics approval needed as the review shall only use already published data. We shall publish the review in an open-access, peer-reviewed journal and disseminate through newsletters, social media pages, and presentations to relevant audiences.

Maternal childhood trauma and observed maternal care behaviors with 4-month-old infants

OBJECTIVE

To examine the relationship between maternal childhood trauma and early maternal caregiving behaviors (MCB).

METHOD

Participants included 74 mother-infant dyads (maternal age 20-45 years; ethnicity 64.9% Latina) from a longitudinal pregnancy cohort study. Maternal childhood trauma was assessed during pregnancy with the childhood trauma questionnaire (CTQ). Observed mother-infant interactions at infant age 4 months were coded utilizing modified Ainsworth's MCB rating scales that assessed a range of behaviors (e.g., acceptance, soothing, and delight) which we analyze grouped together and will summarize using the term "maternal sensitivity." Linear regressions tested the associations between maternal childhood trauma and MCB. Primary analyses examined the relationships of MCB with (a) any maternal childhood trauma (moderate or greater exposure to physical abuse, sexual abuse, emotional abuse, physical neglect, and/or emotional neglect) and (b) cumulative childhood trauma. Secondary analyses examined the relationships between each type of childhood trauma and MCB.

RESULTS

Exposure to childhood trauma was not associated with MCB (p = .88). Cumulative childhood trauma score was associated with lower scores on MCB (β = -1.88, p < .05). Emotional abuse and emotional neglect were individually associated with lower scores on MCB (β = -1.78, p = .04; β = -1.55, p = .04, respectively). Physical abuse, sexual abuse, and physical neglect were not associated with MCB.

CONCLUSIONS

Many mothers exposed to childhood trauma may be resilient to negative effects on parenting behaviors, while specific experiences of childhood trauma (emotional abuse, emotional neglect, and cumulative childhood trauma) may predict less sensitive early parenting behaviors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Evaluating caregiver-child interactions in low- and middle-income countries: a systematic review of tools and methods

AIMS/BACKGROUND

The United Nations Sustainable Development Goals (SDGs) has placed emphasis on improving early child development globally. This is supported through the Nurturing Care Framework which includes responsive caregiving. To evaluate responsive caregiving, tools to assess quality of caregiver-child interactions are used, however there is little information on how they are currently employed and/or adapted particularly in low- and middle-income countries (LMICs) where children have a greater risk of adverse outcomes. The aim of this review is to provide a comprehensive guide on methodologies used to evaluate caregiver-child interaction - including their feasibility and cultural adaptation.

DESIGN/METHODS

We conducted a systematic review of studies over 20years in LMICs which assessed caregiver-child interactions. Characteristics of each tool, their validity (assessed with COSMIN Risk of Bias checklist), and the quality of the study (Mixed Methods Appraisal Tool) are reported.

RESULTS

We identified 59 studies using 34 tools across 20 different LMICs. Most tools (86.5%) employed video-recorded observations of caregiver-child interactions at home (e.g. Ainsworth's Sensitivity Scale, OMI) or in the laboratory (e.g. PICCOLO) with a few conducting direct observations in the field (e.g. OMCI, HOME); 13.5% were self-reported. Tools varied in methodology with limited or no mention of validity and reliability. Most tools are developed in Western countries and have not been culturally validated for use in LMIC settings.

CONCLUSION

There are limited caregiver-child interaction measures used in LMIC settings, with only some locally validated locally. Future studies should aim to ensure better validity, applicability and feasibility of caregiver-child interaction tools for global settings.

Maternal stimulation and early child development in sub-saharan Africa: evidence from Kenya and Zambia

BACKGROUND

Despite major improvements in child survival over the past decade, many children in low and middle-income countries (LMICs) remain at risk of not reaching their developmental potential due to malnutrition, poor health, and a lack of stimulation. Maternal engagement and stimulation have been identified as some of the most critical inputs for healthy development of children. However, relatively little evidence exists on the links between maternal stimulation and child development exists in sub-Saharan Africa (SSA). This current paper aims to identify the associations between maternal stimulation and child development in Kenya and Zambia, as well as the activities that are most predictive of developmental outcomes in these settings.

METHODS

We conducted a descriptive study using data from a prospective study in Kenya and Zambia. The study included three rounds of data collection. Children were on average 10 months old in round one, 25 months old in round two, and 36 months old in round three. The primary exposure variable of interest was maternal stimulation activities, which we grouped into cognitive, language, motor, and socio-emotional activities. The outcome of interest was child development measured through the Third Edition of the Ages and Stages Questionnaire (ASQ-3). Linear regression models were used to estimate the associations between overall maternal stimulation and domain-specific maternal stimulation and child development across the three rounds of the survey.

RESULTS

Higher maternal stimulation scores were associated with higher ASQ scores (effect size = 0.25; 95% CI: 0.19, 0.31) after adjusting for other confounders. For domain specific and child development (ASQ scores), the largest effect size (ES) was found for language stimulation (ES = 0.15) while weakest associations were found for socio-emotional domain activities (ES= -0.05). Overall maternal stimulation was most strongly associated with gross motor development (ES = 0.21) and the least associated with problem-solving (ES = 0.16).

CONCLUSION

Our study findings suggest a strong positive link between maternal stimulation activities and children's developmental outcomes among communities in poor rural settings.

TRIAL REGISTRATION

NA (not a clinical trial).

Are adolescent diet quality and emotional eating predicted by history of maternal caregiving quality and concurrent inhibitory control?

The risk for unhealthy eating behaviour, including poor diet quality and emotional eating, is heightened in adolescence and could result in profound and long-lasting psychological and physical implications. Caregiving quality and adolescents' regulatory skills, such as inhibitory control, may play an essential role in the development of adolescent eating behaviour. This preregistered study investigated whether maternal caregiving throughout the first 14 years of life predicts adolescent diet quality and emotional eating and whether potential associations are mediated by adolescents' inhibitory control. In this low-risk community cohort, maternal caregiving quality was observed at child ages five weeks, 12 months, 2.5, 10, and 14 years. At age 14, diet quality and emotional eating were assessed through self-report. Adolescent inhibitory control was assessed with three behavioural tasks and a maternal report. Mediation analyses were performed with structural equation modelling in R. No evidence was found for links between maternal caregiving quality and adolescent diet quality and emotional eating. Higher levels of adolescent inhibitory control predicted better adolescent diet quality. Longitudinal and experimental studies are needed to investigate directionality, and replication studies are needed in more representative samples (e.g. including high-risk families). Such studies will shed further light on potential links between the history of caregiving behaviour and adolescent regulatory and eating behaviour.

Parental Anxiety, Practices, and Parent-Child Relationships among Families with Young Children in China: A Cross-Sectional Study

This study explored the ambiguous characteristics and influencing factors of parental anxiety, practices, and parent-child relationships among families with young children during a sudden COVID-19 lockdown in Shanghai, China. An online survey was conducted from 1 June to 10 November 2022, with 477 valid responses. Parental anxiety, practices, and parent-child relationships were evaluated. During this lockdown, 72.6% caregivers felt anxious about parenting to different degrees, with only a small proportion experiencing extreme anxiety. Parental anxiety was mainly influenced by whether the caregivers faced parenting issues and external parenting difficulties. The frequency of two-parent-child activities of reading books or looking at picture books with their children and telling stories to them significantly increased. Caregivers' occupations of either professional or technical personnel and working from home were the most significant influencing factors. Mother-child relationships were relatively good. In conclusion, parental anxiety, practices, and parent-child relationships were relatively good and stable among families with young children during this lockdown. In the context of public health emergencies like COVID-19, more parenting support and knowledge should be provided to caregivers from professionals in CHCs or hospitals to decrease parental anxiety and improve parent-child relationships. Full advantage should be taken of working from home to promote parent-child activities.

The Day-in-the-Life method for assessing infant caregiving in rural Pakistan

Objective

This manuscript describes the Day-in-the-Life (DIL) method for assessing child caregiving activities, its implementation, and findings regarding family members' roles and associations with maternal depression symptoms.

Background

Infant caregiving activities are most commonly performed by the mother, although there is increasing acknowledgement of others' contribution. Few methods exist to measure the diverse caregiving activities that mothers and others perform.

Method

Method development occurred within the Bachpan Cohort Study in rural Pakistan (N = 1,154 maternal-child dyads) when the child was 3 months old. The DIL was designed as a semi-structured interview in which the mother describes her child's day from their perspective. Regression analyses were then used to explore the correlation between the DIL and depression symptoms, using the Patient Health Questionnaire-9 (PHQ-9) measure.

Results

The DIL method was easy to administer and displayed excellent interrater agreement. The findings indicated that instrumental caregiving was mostly provided by the mother alone, others in the household tended to contribute more to infant social interactions, and there was more support from others when the mother was less able to provide care (e.g., when ill). Depression symptoms were higher among women who experienced less contribution from family members when the mother was less able to provide care.

Conclusions

The DIL can be deployed to measure infant caregiving activities and associations with maternal mental health.

Implications

This method is promising for researchers interested in disentangling the contribution of multiple family members toward child caregiving and its impacts on maternal and child health.

Strengthening mother-child interactions among mothers and children with behavior problems at early development

The present study examined the effectiveness of a personalized remote video feedback parenting program to improve mother-child interactions and child behavior outcomes among mothers of children with behavior problems in comparison to counterparts with no behavior problems. The sample comprised 60 mothers and their 2-to-6-year-old children, including children with behavior problems (BP = 19) and children without behavior problems (NoBP = 41). The Strengthening Bonds program included one in-person group session and remote personalized video feedback about their mother-child interactions in a play situation via smartphone for six weeks. Mother-child interactions were the primary outcome, and children's behaviors were the secondary outcome. Pre- and post-intervention assessments were performed. The mother-child interactions were recorded during free- and structured-play situations and were then analyzed by the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) and the Dynamics of the dyad activity coding system. Additionally, the mothers answered the Strengths and Difficulties Questionnaire. The results showed that, in the post-intervention, the mother-child interaction pattern improved in the BP group, especially in the teaching dimension of the PICCOLO. Also, after the program, more children with normal classification were in the BP group.

Bonding and Infants' Development and Quality of Life: A Study Among Mothers with Severe Mental Illnesses in Remission

Background

Maternal mental health has specific implications for bonding and infants' mental health. However, most of the evidence comes from mothers who are either symptomatic or did not have adequate mental health support. In this context, our objective was to explore if symptom status in mothers and bonding share any significant association with the infants' development and quality of life (QOL), in case of mothers with severe mental illnesses in remission.

Methods

The study included 41 mother-infant dyads from the outpatient perinatal psychiatry services and the mother-baby unit of the current study center. Symptom status, self-reported bonding, mother-infant interactions, and infants' development and QOL were assessed with Clinical Global Impressions, Postpartum Bonding Questionnaire, Pediatric Infant-Parent Exam, Developmental Assessment Scales for Indian Infants, and Pediatric Quality of Life Scale, respectively.

Results

Most mothers had a complete recovery or minimal symptoms. Nine (22%) infants had a significant developmental delay. Atypical play-based interactions were observed in nine (22%) mothers. Self-reported bonding and bonding as evinced over play-based interactions did not significantly correlate with the QOL or development of the infants. Mothers who have recovered and are functioning well reported good bonding with their infants, though objective assessment revealed specific difficulties. Symptom severity correlated with poor physical QOL in infants.

Conclusion

The association between mothers' bonding and infants' mental health is domain-specific and differential than linear and robust. Infants of mothers with severe mental illnesses postpartum should be routinely monitored for mother-infant bonding, development, and quality of life.

Effects of short-term quarantine on growth and development of children aged 1-36 months during the Omicron outbreak

Consequences of epidemic quarantine on children's well-being are not clear and there are scarce data about the short-term impact of epidemic quarantine on children's growth and development. The study aimed to explore and analyze the potential impacts of the Omicron outbreak on children's growth and development during the lockdown in Shanghai, China. Totally, 4565 children aged 1-36 months who had a routine physical examination in the child health departments of hospitals before (June 1, 2021, to July 6, 2021) and after (June 1, 2022, to July 6, 2022) Shanghai's lockdown were included in this study. A population-based cross-sectional study was conducted by using the Infant Toddler Growth Development Screening Test (ITGDST). The children's growth and development in these two periods were compared with a propensity score matching (PSM) approach. After 1:1 matching, a total of 2462 children aged 1-36 months were analyzed. After PSM, there was no significant difference in terms of overall development, gross motor, fine motor, and language development for children before and after the Omicron lockdown. However, statistically significant decrease of wasting was observed for children after the lockdown (p < 0.05). Further interaction analysis indicated older age group (OR = 0.26, 95% CI 0.11-0.59) and the group of second parity (OR = 0.30, 95% CI 0.11-0.83) were favorable to language development during the lockdown.  Conclusion: Short-term quarantine had no significant adverse, but rather beneficial, effects on growth and development of children aged 1-36 months during the Omicron epidemic in Shanghai, China. What is Known: • Consequences of epidemic quarantine on children's well-being are not clear. Long-term psychological effects of coronavirus disease 2019 pandemic on children have been reported. However, there are scarce data about the short-term impact of epidemic quarantine on children's growth and development. What is New: • Short-term quarantine had no significant adverse, but rather beneficial, effects on growth and development of children aged 1-36 months during the Omicron epidemic in Shanghai, China.

The relationship between home environment and early childhood development of left-behind children under 3 years in rural China

BACKGROUND

Home environment provides stimulation and learning opportunities required for children's early development. However, few studies have focused on the effects of home environment on left-behind children's development in rural China. The study aimed to investigate the relationship between home environment and early childhood development of left-behind children under 3 years old in rural China.

METHODS

Information about sociodemographic characteristics, caregivers' mental health, home environment and children's development was collected. Infant/Toddler Home Observation for Measurement of the Environment Inventory (IT-HOME) was used to assess home environment. Child's development was evaluated with the Chinese version of the Ages & Stages Questionnaire - third edition.

RESULTS

Elevated caregivers' depressive symptoms were associated with a higher risk of total suspected development delay. An increase of one score in the IT-HOME resulted in a 7% decrease in total suspected development delay. Higher scores in the dimensions of involvement and variety were associated with a lower risk of suspected development delay adjusting for covariates.

CONCLUSIONS

Our results have implications for home-based intervention aiming at promoting nurturing care as well as caregivers' mental health, which is required for early development of young left-behind children in rural areas of China.

Intergenerational Transmission of Depression during Adolescence: The Mediating Roles of Hostile Attribution Bias, Empathic Concern, and Social Self-Concept

Few studies have empirically examined the role of peer microsystem in the intergenerational transmission of depression, and more importantly, little is known about the mechanisms underlying this potential pathway of intergenerational transmission. The purpose of the current study was to examine the sequential mediation effects of adolescent hostile attribution bias, empathic concern, and social self-concept on the association between maternal depression and adolescent depression. An urban Chinese sample of 761 mother-child dyads was investigated when the adolescents were in secondary school (M = 14.36 years, range =12.33-16.92 years, 52.3% female). The results provided evidence of cross-generational continuity in depression during adolescence, and the hypothesized sequential mediation model was supported. The findings highlight the importance of peer-related factors during the intergenerational transmission of depression and have important implications for interpersonal interventions that aim to prevent depression during adolescence. The limitations of the study and suggestions for future research are briefly discussed.

Fleur J, Hilaire J, Evans A, Long J, Wing D, Carpenter C, Wilson K, Palfrey J, Stulac S. Associations Between Parental Depression, Self-efficacy, and Early Childhood Development in Malnourished Haitian Children

Background. Haiti lacks early childhood development data and guidelines in malnourished populations. Literature shows that developmental interventions are crucial for improving developmental outcomes malnourished children. This study examines the prevalence of early childhood development delays in a cohort of malnourished Haitian children and their associations with parental depression and self-efficacy. Methods. We used cross-sectional data from 42 patients 6 months to 2 years old in Saint-Marc, Haiti. We assessed their developmental status using the Ages and Stages Questionnaire. Parents were surveyed on depression symptoms and self-efficacy using validated surveys developed for low-resource settings. Demographic and socio-economic data were included. Prevalence of early childhood development delays and high parental depression risk were calculated. Multivariable logistic regression analyses were used to test whether parental depression risk and low self-efficacy were associated with a higher risk for childhood developmental delays. Results. Among participants, 45.2% (SD = 7.7%) of children with a recorded ASQ met age-specific cutoffs for developmental delay in one or more domains. 64.3% (SD = 7.4%) of parents were at high risk for depression. 47.6% (SD = 7.7%) of parents reported relatively low self-efficacy. Multivariable analysis showed that low parental self-efficacy was strongly associated with developmental delays (OR 17.5, CI 1.1-270.0) after adjusting for socioeconomic factors. Parental risk for depression was associated with higher odds (OR 4.6, CI 0.4-50.6) of children having developmental delays but did not reach statistical significance in this study. Conclusion. Parental self-efficacy was protectively associated with early childhood developmental delays in malnourished Haitian children. More research is needed to design contextually appropriate interventions.

Maternal self-efficacy and emotional well-being in Chilean adolescent mothers: the relationship with their children's social-emotional development

Background

Low maternal self-efficacy and high levels of anxiety, depression, and stress can be triggered in adolescent mothers due to an incomplete development process that makes them physically or psychologically unprepared for the responsibilities of motherhood and parenting. These factors may be linked to difficulties with their children's social-emotional development. The present study aims to: (a) analyze the relationship between maternal self-efficacy and stress, depression, and anxiety levels in low-income adolescent mothers; (b) examine the relationship between maternal self-efficacy and well-being with children's social-emotional development; and (c) describe the effects of maternal self-efficacy on children's social-emotional development, mediated by maternal well-being.

Methods

A sample of 79 dyads comprising low-income Chilean adolescent mothers aged from 15 to 21 years old (M = 19.1, SD = 1.66) and their children aged 10 to 24 months (M = 15.5, SD = 4.2) participated in this research. A set of psychometric scales was used to measure maternal self-efficacy (Parental Evaluation Scale, EEP), the mothers' anxiety and depression (Hospital Anxiety and Depression Scale, HADS), maternal stress (Parental Stress Scale, PSS), and the children's social-emotional development (Ages and Stages Questionnaire Socio-emotional, ASQ-SE). Bivariate analyses and mediation models were employed to estimate and test the relevant relationships.

Results

A bivariate analysis showed that maternal self-efficacy was negatively related to the mother's anxiety, depression, and stress. Moreover, there was a significant relationship between maternal self-efficacy and maternal stress, and children's self-regulation and social-emotional development. Maternal self-efficacy, mediated by maternal anxiety, depression, and stress scores, had a significant effect on the development of children's self-regulation.

Conclusions

The results confirm the importance of adolescent mothers' emotional well-being and maternal self- efficacy with respect to their children's social-emotional development. This makes it necessary to have detailed information about how emotional and self-perception status influences a mother's role in the development of her children.

Longitudinal association between maternal psychological stress during pregnancy and infant neurodevelopment: The moderating effects of responsive caregiving

BACKGROUND

Little is known regarding the role of responsive caregiving in the association between maternal psychological stress and child neurodevelopment. We, therefore, herein investigated the relationship between maternal psychological stress during pregnancy and children's neurodevelopment with modifications in responsive caregiving.

METHODS

A total of 3,603 mother-child pairs were recruited from the Shanghai Maternal-Child Pairs Cohort, and we assessed maternal psychological stress using the Life Events Scale for Pregnant Women (LESPW) during early and late pregnancy. Early neurodevelopment of infants at 6 and 12 months of age was also evaluated using the Age and Stage Questionnaire, Third Edition (ASQ-3). The 2-month-old infant nursing-care questionnaire was designed based on the Five Elements of Parenting Care Framework released by the World Health Organization (WHO) and used to evaluate the levels of early responsive caregiving for infants. Multivariate logistic regression analysis was then applied to determine the association between maternal psychological stress during pregnancy and child development.

RESULTS

The suspected developmental delay rate of infants aged 6 and 12 months ranged between 13.3% and 24.5%. After adjusting for confounders, we noted that high maternal subjective events stress during early pregnancy was associated with an increased risk of suspected developmental delay in problem-solving domains at 12 months of age [adjusted OR (aOR) = 1.51; 95% confidence interval (CI), 1.09-2.20]. High general negative objective events' stress during late pregnancy also constituted a risk factor for development in the personal-social domain at 12 months of age (aOR = 1.57; 95% CI, 1.13-2.19). Remarkably, we noted in infants with insufficient responsive caregiving that there were greater associations between the risk of general maternal negative objective events during late pregnancy and personal-social domain at 12 months of age (aOR = 2.06; 95% CI, 1.15-3.68). Similarly, there was a greater association between the risk for maternal subjective events during early pregnancy and problem-solving at 12 months of age (aOR = 1.55; 95% CI, 1.11-2.34).

CONCLUSIONS

Maternal psychological stress during pregnancy was predominantly associated with suspected developmental delay in infants at 6 and 12 months of age, and these associations were modified by early responsive caregiving.

Responsive Caregiving and Opportunities for Early Learning Associated With Infant Development: Results From a Prospective Birth Cohort in China

BACKGROUND

Infant development shapes children's health into adulthood. Although providing responsive caregiving and opportunities regarding early learning for infants have received increasing attention from the international community, few studies have been published on these topics thus far. The purpose of the present study, then, was to explore the influences of responsive caregiving and the opportunities for early learning on infant development.

METHODS

Mother-child dyads (3,714 pairs) were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) for the present study, and the development of infants, responsive caregiving and opportunities for early learning were collected from three waves of follow-up (2-, 6-, and 12-month old) We used the cross-lagged model to analyze the longitudinal correlation between responsive caregiving or opportunities for early learning and development of infants. We used the generalized estimation equation (GEE) to evaluate the effect of responsive caregiving and opportunities for early learning on suspected developmental delay; we also conducted a hierarchical analysis to investigate the interaction between responsive caregiving or opportunities for early learning and annual family income.

RESULTS

There was a mutual prediction between responsive caregiving or opportunities for early learning and some developmental domains of the Ages and Stages Questionnaires, third edition (ASQ-3). Sustained high-exposure to responsive caregiving or opportunities for early learning significantly decreased the risk of suspected developmental delay in most domains of the ASQ-3. And For infants whose annual family income was < ¥200,000, sustained high-exposure (Adjusted Odds Ratio = 0.456, 95% CI, 0.325-0.638) and fluctuating-exposure (Adjusted Odds Ratio = 0.510, 95% CI, 0.414-0.627) to responsive caregiving significantly reduced the risk for suspected developmental delay.

CONCLUSION

Responsive caregiving or opportunities for early learning interacted with infant development. Infants' early access to adequate responsive caregiving and opportunities for early learning exerted a sustained and positive impact on infant development, and this effect is more pronounced in relative low-income families.

A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

Maternal depression is the predominant persistent risk for child cognitive and social-emotional problems from early childhood to pre-adolescence: A longitudinal cohort study

RATIONALE

Brain development occurs rapidly during early childhood and continues throughout middle childhood. Early and later windows of opportunity exist to alter developmental trajectories. Few studies in low- and middle-income countries have examined the importance of the timing of exposure to risks for poor pre-adolescent cognitive and social-emotional outcomes.

METHODS

We assessed 359 children who participated in two follow-up studies of the Supplementation with Multiple Micronutrients Intervention Trial conducted in Indonesia in 2001-2004: at 3.5 years in 2006 and 9-12 years in 2012-2014. Using structural equation models, we examined indicators of early childhood (3.5 y) and pre-adolescent (9-12 y) exposure to risks (child height-for-age z-score [HAZ], hemoglobin [Hb], maternal depressive symptoms [MDS], home environment [HOME]), with two developmental outcomes: cognitive ability and social-emotional problems. We characterized patterns of change by calculating residuals of indicators measured earlier (3.5 y) predicting the same indicators measured later (9-12 y), for example, the residual of 3.5 y MDS predicting 9-12 y MDS (rMDS).

RESULTS

Three early risk indicators (HOME, Hb, and MDS) were indirectly associated with pre-adolescent cognitive scores through early cognitive scores (HOME: 0.15, [95% CI 0.09, 0.21]; Hb: 0.08 [0.04, 0.12], MDS: -0.07 [-0.12, -0.02]). Pre-adolescent cognitive scores were also associated with change in MDS (rMDS: -0.13 [-0.23, -0.02]) and Hb (rHb: 0.10 [0.00, 0.20]) during middle childhood. For pre-adolescent social-emotional problems, both early childhood MDS (0.31 [0.19, 0.44]) and change in MDS during middle childhood (rMDS: 0.48 [0.37, 0.60]) showed strong direct associations with this outcome.

CONCLUSIONS

Our findings confirm those of previous studies that prevention of risk exposures during early childhood is likely to support long-term child development. It also adds evidence to a previously scarce literature for the middle childhood period. Prevention of maternal depressive symptoms and child anemia during middle childhood should be assessed for effectiveness to support child development.

Impact of parent-child separation on children's social-emotional development: a cross-sectional study of left-behind children in poor rural areas of China

BACKGROUND

Parent-child separation is a considerable adversity for left-behind children (LBC), but there is little evidence on the association between detailed characteristics of parent-child separation and social-emotional development among LBC. This study examined the characteristics of parent-child separation and its impacts on developmental delay among under-3 LBC in poor rural China.

METHODS

We used data from 811 LBC surveyed in five poor counties in rural China in 2018. Detailed characteristics of their parental migration were recalled by their primary caregivers in face-to-face interviews. The children's social-emotional development was measured by using the Ages and Stages Questionnaire: Social-Emotional. Logistic regression was employed to examine the association of detailed characteristics of parent-child separation with early social-emotional problems after adjusting for the children's and primary caregivers' sociodemographic characteristics.

RESULTS

287 (35.4%) children were left behind by fathers and cared for by mothers (FM-MC), while 524 (64.6%) were left behind by both parents and cared for by grandparents (PM-GC). The rate of social-emotional problems among LBC was 36.8% (PM-GC vs FM-MC: 40.6% vs 29.5%; aOR 1.51, 95% CI: 1.06 to 2.16). For paternal migration, the medians of the child's age at the first migration and average duration per migration were 3 months (IQR: 1 to 9 months) and 4.48 months (IQR: 2.38 to 7.54 months), respectively. For maternal migration, the corresponding values were 9 months (IQR: 6 to 13 months) and 4.65 months (IQR: 2.71 to 7.62 months), respectively. On average, LBC had been separated from fathers for 72% of their life due to paternal migration and from mothers for 52% of their life due to maternal migration. No significant association was found between the detailed characteristics of paternal migration and social-emotional development among LBC, while social-emotional problems among LBC were significantly associated with the proportion of cumulative duration of maternal migration in the child's lifetime (aOR 2.83; 95% CI: 1.13 to 7.10).

CONCLUSIONS

LBC under 3 years had a high risk of social-emotional problems in poor rural China. Cumulative exposure to maternal migration may be detrimental to LBC's early social-emotional development. Programs are necessary to support these children as well as their families.

What Does Social Support Sound Like? Challenges and Opportunities for Using Passive Episodic Audio Collection to Assess the Social Environment

Background: The social environment, comprised of social support, social burden, and quality of interactions, influences a range of health outcomes, including mental health. Passive audio data collection on mobile phones (e.g., episodic recording of the auditory environment without requiring any active input from the phone user) enables new opportunities to understand the social environment. We evaluated the use of passive audio collection on mobile phones as a window into the social environment while conducting a study of mental health among adolescent and young mothers in Nepal.

Methods: We enrolled 23 adolescent and young mothers who first participated in qualitative interviews to describe their social support and identify sounds potentially associated with that support. Then, episodic recordings were collected for 2 weeks from the mothers using an app to record 30 s of audio every 15 min from 4 A.M. to 9 P.M. Audio data were processed and classified using a pretrained model. Each classification category was accompanied by an estimated accuracy score. Manual validation of the machine-predicted speech and non-speech categories was done for accuracy.

Results: In qualitative interviews, mothers described a range of positive and negative social interactions and the sounds that accompanied these. Potential positive sounds included adult speech and laughter, infant babbling and laughter, and sounds from baby toys. Sounds characterizing negative stimuli included yelling, crying, screaming by adults and crying by infants. Sounds associated with social isolation included silence and TV or radio noises. Speech comprised 43% of all passively recorded audio clips (n = 7,725). Manual validation showed a 23% false positive rate and 62% false-negative rate for speech, demonstrating potential underestimation of speech exposure. Other common sounds were music and vehicular noises.

Conclusions: Passively capturing audio has the potential to improve understanding of the social environment. However, a pre-trained model had the limited accuracy for identifying speech and lacked categories allowing distinction between positive and negative social interactions. To improve the contribution of passive audio collection to understanding the social environment, future work should improve the accuracy of audio categorization, code for constellations of sounds, and combine audio with other smartphone data collection such as location and activity.

Protocol for the Adaptation of a Direct Observational Measure of Parent-Child Interaction for Use With 7-8-Year-Old Children

Objective

Parenting sensitivity and mutual parent-child attunement are key features of environments that support children’s learning and development. To-date, observational measures of these constructs have focused on children aged 2–6 years and are less relevant to the more sophisticated developmental skills of children aged 7–8 years, despite parenting being equally important at these ages. We undertook a rigorous process to adapt an existing observational measure for 7–8-year-old children and their parents. This paper aimed to: (i) describe a protocol for adapting an existing framework for rating parent-child interactions, (ii) determine variations in parents’ sensitive responding and parent-child mutual attunement (‘positive mutuality’) by family demographics, and (iii) evaluate the psychometric properties of the newly developed measure (i.e., inter-rater reliability, construct validity).

Method

Parent-child dyads completed one home visit, including a free-play observation and parent questionnaire. Dyads were provided with three toy sets: LEGO^® Classic Box, Classic Jenga^®, and animal cards. The Coding of Attachment-Related Parenting (CARP) was adapted for use with 7–8-year-old children, and rating procedures were streamlined for reliable use by non-clinician/student raters, producing the SCARP:7–8 Years. Trained staff rated video-recorded observations on 11 behaviors across two domains (five for parents’ sensitive responding, six for parent-child positive mutuality).

Results

Data were available for 596 dyads. Consistently strong inter-rater agreement on the 11 observed behaviors was achieved across the 10-week rating period (average: 87.6%, range: 71.7% to 96.7%). Average ICCs were 0.77 for sensitive responding and 0.84 for positive mutuality. These domains were found to be related but distinct constructs (r = 0.49, p < 0.001). For both domains, average ratings were strongly associated with the main toy used during the observation (p < 0.001, highest: cards, lowest: LEGO^®). Adjusted multivariate linear regression models (accounting for toy choice) revealed that less sensitive responding was associated with younger parent (p = 0.04), male parent (p = 0.03), non-English speaking background (p = 0.04), and greater neighborhood disadvantage (p = 0.02). Construct validity was demonstrated using six parent-reported psychosocial and parenting measures.

Conclusion

The SCARP: 7–8 Years shows promise as a reliable and valid measure of parent-child interaction in the early school years. Toy selection for direct observation should be considered carefully in research and practice settings.

Cross-Cultural Adaptation and Validation of the Brazilian Portuguese Version of an Observational Measure for Parent-Child Responsive Caregiving

Responsive caregiving is the dimension of parenting most consistently related to later child functioning in both developing and developed countries. There is a growing need for efficient, psychometrically sound and culturally appropriate measurement of this construct. This study describes the cross-cultural validation in Brazil of the Responsive Interactions for Learning (RIFL-P) measure, requiring only eight minutes for assessment and coding. The cross-cultural adaptation used a recognized seven-step procedure. The adapted version was applied to a stratified sample of 153 Brazilian mother-child (18 months) dyads. Videos of mother-child interaction were coded using the RIFL-P and a longer gold standard parenting assessment. Mothers completed a survey on child stimulation (18 months) and child outcomes were measured at 24 months. Internal consistency (α = 0.94), inter-rater reliability (r = 0.83), and intra-rater reliability (r = 0.94) were all satisfactory to high. RIFL-P scores were significantly correlated with another measurement of parenting (r's ranged from 0.32 to 0.47, p < 0.001), stimulation markers (r = 0.34, p < 0.01), and children's cognition (r = 0.29, p < 0.001), language (r = 0.28, p < 0.001), and positive behavior (r = 0.17, p < 0.05). The Brazilian Portuguese version is a valid and reliable instrument for a brief assessment of responsive caregiving.

The Effect of Parenting Quality on Child Development at 36-48 Months in China's Urban Area: Evidence from a Birth Cohort Study

Environmental exposures, especially parenting quality, are critical for later child development. This study aimed to determine the status of parenting quality and suspected development delay of preschool children in China's urban area and explore the associations between these two factors. The research was based on a birth cohort study conducted in Changsha, Hunan province, China. We used the Parenting Assessment Tool and Ages and Stages Questionnaires, Third Edition (ASQ-3), to measure parenting quality and child development status, respectively. Other data were collected from maternal health manuals and self-administered questionnaires during the follow-up period. The generalized estimating equation was used to examine whether parenting quality was significantly associated with child development outcomes. In the study, good parenting quality was 33.6% measured at 18 months, and suspected development delay was below 10% at 36-48 months among urban China; we observed negative associations between parenting quality scores and child development scores; poor parenting quality had a negative association with suspected development delay [OR and 95% CI: 2.74 (1.17, 6.40)], girls [OR and 95% CI: 0.33 (0.16, 0.69)] and maternal education years (>12 years) [OR and 95% CI: 0.27 (0.12, 0.64)] were protective factors for suspected development delay. Our findings highlighted the importance of good parenting quality among children in urban areas of China through a birth cohort study and may be used to reduce the children at high risk of developmental delay as a future intervention program.

Reorienting Nurturing Care for Early Childhood Development during the COVID-19 Pandemic in Kenya: A Review

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children's ecology to provide nurturing care is needed, as is further testing of new ideas.

Burden of caring for children living with human immunodeficiency virus in a semi-rural South African community

Background

Methods

Results

Conclusion

Agreement between Fathers' and Mothers' Reported Stimulation and Associations with Observed Responsive Parenting in Pakistan

Parental stimulation and responsiveness are associated with improved early child development outcomes. However, the majority of studies have relied on maternal-reported measures of only mothers’ parenting practices. The purpose of this study was to assess the agreement between fathers’ and mothers’ reports of their own and their partner’s engagement in stimulation and assess the degree to which parents’ reported stimulation correlated with their observed responsive caregiving behaviors. Data were collected from 33 couples (33 fathers and 32 mothers) who had a child under 5 years of age in rural Pakistan. Paternal and maternal stimulation were measured based on reports of their own and their partner’s practices in play and learning activities with the child. Paternal and maternal responsiveness were observed in a subsample of 18 families. Moderate agreement was found between paternal and maternal reports of their own and their partner’s practices. Moderate associations were also found between self-reported measures of stimulation and observed responsive caregiving for both fathers and mothers. The strengths of agreement and associations were greater among couples who had higher quality coparenting relationships. Findings highlight the feasibility, reliability, and promise of assessing fathers’ parenting in a low-resource setting, using similar methods as for mothers’ parenting, to triangulate measures between reported and observed parenting and gain a deeper understanding of fathers’ and mothers’ unique caregiving contributions.

Wearable Digital Sensors to Identify Risks of Postpartum Depression and Personalize Psychological Treatment for Adolescent Mothers: Protocol for a Mixed Methods Exploratory Study in Rural Nepal

BACKGROUND

There is a high prevalence of untreated postpartum depression among adolescent mothers with the greatest gap in services in low- and middle-income countries. Recent studies have demonstrated the potential of nonspecialists to provide mental health services for postpartum depression in these low-resource settings. However, there is inconsistency in short-term and long-term benefits from the interventions. Passive sensing data generated from wearable digital devices can be used to more accurately distinguish which mothers will benefit from psychological services. In addition, wearable digital sensors can be used to passively collect data to personalize care for mothers. Therefore, wearable passive sensing technology has the potential to improve outcomes from psychological treatments for postpartum depression.

OBJECTIVE

This study will explore the use of wearable digital sensors for two objectives: First, we will pilot test using wearable sensors to generate passive sensing data that distinguish adolescent mothers with depression from those without depression. Second, we will explore how nonspecialists can integrate data from passive sensing technologies to better personalize psychological treatment.

METHODS

This study will be conducted in rural Nepal with participatory involvement of adolescent mothers and health care stakeholders through a community advisory board. The first study objective will be addressed by comparing behavioral patterns of adolescent mothers without depression (n=20) and with depression (n=20). The behavioral patterns will be generated by wearable digital devices collecting data in 4 domains: (1) the physical activity of mothers using accelerometer data on mobile phones, (2) the geographic range and routine of mothers using GPS (Global Positioning System) data collected from mobile phones, (3) the time and routine of adolescent mothers with their infants using proximity data collected from Bluetooth beacons, and (4) the verbal stimulation and auditory environment for mothers and infants using episodic audio recordings on mobile phones. For the second objective, the same 4 domains of data will be collected and shared with nonspecialists who are delivering an evidence-based behavioral activation intervention to the depressed adolescent mothers. Over 5 weeks of the intervention, we will document how passive sensing data are used by nonspecialists to personalize the intervention. In addition, qualitative data on feasibility and acceptability of passive data collection will be collected for both objectives.

RESULTS

To date, a community advisory board comprising young women and health workers engaged with adolescent mothers has been established. The study is open for recruitment, and data collection is anticipated to be completed in November 2019.

CONCLUSIONS

Integration of passive sensing data in public health and clinical programs for mothers at risk of perinatal mental health problems has the potential to more accurately identify who will benefit from services and increase the effectiveness by personalizing psychological interventions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/14734.