Immediate Caregiving Environment of Young Children with Autism: Findings from the U.S. National Survey of Children's Health

Autism spectrum disorder (ASD) is a complex neurodevelopmental disability that negatively affects children's learning, motor behavior, social communication, and interaction. It was estimated that, in 2020, 1 in 36 children aged 8 years in the United States had ASD. Caring for children with ASD might exert significant psychological and emotional distress on parents. Receiving parental emotional support and fostering positive parent-child interactions at home have been identified as beneficial for the immediate caregiving environment for children with ASD. The current secondary analysis of the 2019-2020 National Survey of Children's Health examined parent-child interactions and accessible sources of emotional support for parents caring for 3-5-year-old children diagnosed with ASD (N = 243). Children with the following characteristics had higher odds of having ASD: male gender; having no private insurance or uninsured; and having less than excellent general health. Among parents, higher odds of caring for children with ASD were associated with accessing emotional support from various sources, especially from healthcare professionals and peers, and spending more time telling stories and/or singing to their children. Given these significant health disparities, educational interventions and strategies are needed to foster a positive home caregiving environment for young children with ASD, including equitable access to parent resources.

Teaching or learning from baby: Inducing explicit parenting goals influences caregiver intrusiveness

Caregivers' goals influence their interactions with their children. In this preregistered study, we examined whether directing parents to teach their baby versus learn from their baby influenced the extent to which they engaged in intrusive (e.g., controlling, adult-centered rather than child-centered), sensitive, warm, or cognitively stimulating caregiving behaviors. Mothers and their 6-month-old infants (N = 66; 32 female infants) from the San Francisco Bay Area participated in a 10-min "free-play" interaction, coded in 2-min epochs for degree of parental intrusiveness. Prior to the final epoch, mothers were randomly assigned to receive instructions to focus on (a) teaching something to their infant or (b) learning something from their infant. A control group of mothers received no instructions. Analyses of within-person changes in intrusive behavior from before to after receiving these instructions indicated that mothers assigned to teach their infant increased in intrusiveness whereas mothers assigned to learn from their infant and mothers in the control group did not significantly change in intrusiveness. The study provides experimental evidence that caregivers' explicit goals to teach infants result, on average, in more controlling and adult-centered caregiving behavior. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The BEM Program: An innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil

Objective

To describe the BEM Program, an innovative online parenting program for socioeconomically disadvantaged caregiver-child dyads in Brazil.

Methods

The Template for Intervention Description and Replication checklist was used to describe the BEM Program in detail.

Results

The BEM Program (an acronym for Brincar Ensina Mudar in Portuguese, "Play Teaches Change" in English) refers to the change in adult, child, and dyad outcomes that can be observed through incorporating playful interactions between the caregiver and their child into their daily household chores. Content consisting of 8 videos and 40 text and audio messages was sent entirely online through WhatsApp®. Thus, the Program could be accessed wherever caregivers wanted, if they had their smartphone and Internet access.

Conclusions

The detailed description of an innovative online parenting program focused on caregiver-child interaction and child development contributes to the scarce evidence on this type of programs. Adherence to the program continues to represent one of the main challenges to overcome.

Promoting caregiver involvement at the public library: An evaluation of a math and science storytime program for young children

Introduction

Public libraries are asset institutions that provide important spaces for families to engage in meaningful, authentic STEM learning. However, limited budgets and a model centered on open-access and broad inclusion makes conducting rigorous evaluations in these spaces, such as randomized control trials, challenging. There is a need to consider evaluation designs that consider both rigor and feasibility. The aims of the present study were to: (1) describe an innovative interactive parent-child interactive storytime program, Fun with Math and Science (FMS); and (2) conduct a preliminary evaluation of FMS in a large, urban public library setting, using a quasi-experimental static group comparison design.

Methods and Results

Post-test scores for caregivers who completed the program in the fall or winter (n = 80) were compared to pre-test scores for caregivers who completed the program the following spring (n = 35); Fall/winter caregivers scored higher on program items related to concrete behaviors to support math and science learning, but significant differences were not found on items related to caregiving beliefs or general caregiving practices. Demographic differences were also found related to program outcomes.

Discussion

Results are discussed both in terms of implications for the development and implementation of caregiver-child interactive programming, as well as the use of innovative analytic approaches to program evaluation in community settings.

Adapting to Adversity: Effects of COVID-19 on Parenting in Chile

The pandemic outbreak in March 2020 and its associated sanitary regulations and restrictions triggered an abrupt and significant change for society in general and for families' organization in particular. In Chile, the Santiago Metropolitan District was under a strict lockdown that involved the closure of the entire educational system. From a systemic-family stress perspective, the impact of these changes might have consequences not only for each individual family member, but for the parental dynamic and, consequently, for children's well-being. This paper presents the results of a follow-up study showing changes in self-reported parental depression and the perceived home organization of mothers and fathers assessed at three different moments: before the pandemic, at the initial outbreak, and after 1 month of strict lockdown. Relevant moderators were explored using linear mixed models to understand the within-subject changes in mothers' and fathers' self-reports across the different assessment times. Financial strain, personality traits of self-criticism and dependency, previous parent-child quality interaction, recent major stressful events, and number of children are highlighted as relevant factors that moderate changes in home chaos and parental mental health perception. Significant risks and protective factors are described for fathers and mothers. The use of pre-pandemic measures as baseline levels enabled the identification of personal and family characteristics that were related to better outcomes. The results help increase our understanding of the sanitary regulations' impacts on the family system and identify vulnerability indicators that should be considered.

Parent book choices: How do parents select books to share with infants and toddlers with language impairment?

Book-sharing with young children is an established vehicle for promoting early language development and pre-literacy skills. Although parents are widely encouraged to read to their child and existing interventions provide instruction on book-sharing strategies, there is a prominent lack of guidance for parents on how to choose the book itself. Importantly, there is a foundational lack of knowledge on the factors that parents take into consideration when choosing books to share with their young child. While understanding that parent book-choice is important for all children, it may be particularly important for those with language-impairment (LI), since book-sharing is an evidence-based intervention approach and widely recommended to promote language for LI populations. This qualitative study examines parents' book selection choices, and the elements they consider, when choosing books to share with their infants and toddlers with LI. Participants included 13 parents of young children aged 19-29 months (9 males, 4 females; mean age 25 months) receiving Part C services. Parent responses indicated that the most common themes considered included physical aesthetics, text difficulty, physical properties, educational considerations and content; the relative importance of these themes varied depending on context. Results are framed in the context of research on parent-child book-sharing interactions. Recommendations for practitioners working with parents and young children with LI during book-sharing are also highlighted.

The Emergence of 5-Year-Olds' Behavioral Difficulties: Analyzing Risk and Protective Pathways in the United Kingdom and Germany

This study aimed to advance our understanding of 5-year-olds' behavioral difficulties by modeling and testing both mediational protective and risk pathways simultaneously. Drawing on two national samples from different Western European countries-the United Kingdom (13,053) and Germany (2,022), the proposed model considered observed sensitive parental interactive behaviors and tested child vocabulary as protective pathways connecting parental education with children's behavioral outcomes; the risk pathways focused on negative parental disciplinary practices linking (low) parental education, parental distress, and children's difficult temperament to children's behavioral difficulties. Further, the tested model controlled for families' income as well as children's sex and formal child care attendance. Children with comparatively higher educated parents experienced more sensitive interactive behavior, had more advanced vocabulary, and exhibited fewer behavioral difficulties. Children with a comparatively higher level of difficult temperament or with parents who suffered from distress tended to experience more negative disciplinary behavior and exhibited more behavioral difficulties. Additionally, children's vocabulary skills served as a mechanism mediating the association between parental education and children's behavioral difficulties. Overall, we found similar patterns of results across the United Kingdom and Germany with both protective and risk pathways contributing simultaneously to children's behavioral development. The findings suggest that promoting parents' sensitive interactive behaviors, favorable disciplinary practices, and child's vocabulary skills have potential for preventing early behavioral difficulties.

Naturalistic parent-child reading frequency and language development in toddlers with and without autism

BACKGROUND AND AIMS

The efficacy of parent-child reading for supporting language development has been well-established in the neurotypical (NT) literature. For children with autism spectrum disorder, (ASD) who may be at risk for delays in language development, prior research has shown promise for shared book-reading interventions. Yet there has been limited research on naturalistic parent-child reading with autistic children to date. The present study aimed to fill this missing link in the current literature.

METHODS

Fifty-seven autistic toddlers participated at two developmental time points: Time 1 (Mage = 30.4 months) and Time 2 (Mage = 43.8 months). An NT control group (N = 31) was matched on age to a subset of the ASD group (N = 33). We assessed group differences in parent-child reading frequency between age-matched NT and autistic groups. Using a one-year follow-up design, we evaluated the relationship between parent-child reading and autistic children's language development.

RESULTS

Cross-group comparisons revealed that parents of age-matched NT children reported significantly more frequent weekly parent-child reading than parents of autistic toddlers. After a one-year follow-up with the autistic group, within-group analyses revealed that greater frequency of parent-child reading (controlling for maternal education, books in the home, and autism symptom severity) was associated with larger growth in autistic toddlers' receptive and expressive language skills.

CONCLUSIONS AND IMPLICATIONS

These findings have important clinical implications as they emphasize the potential of parent-child reading for supporting autistic children's language development. Findings demonstrate that frequency of parent-child reading is associated with language development over one year. Findings also demonstrate that parents of autistic children engage in less frequent parent-child reading than parents of age-matched NT peers, suggesting these parents may face more barriers to implementing parent-child reading than parents of NT children.

COVID-19 and Mental Health of Young Adult Children in China: Economic Impact, Family Dynamics, and Resilience

OBJECTIVE

The current study aimed to examine the economic impact of COVID-19 virus on family dynamics and college-age children's mental health in China and to identity personal and social or relational resilience factors that could buffer the negative consequences of COVID-19.

BACKGROUND

Since an outbreak of COVID-19 was first reported in China in December 2019, it has profoundly changed the lives of families and children of all ages. In particular, it has created challenges among families with college-age young adult children.

METHOD

Using a sample of 484 college students from 21 universities in China, an online survey design was utilized to obtain information from these students on their family demographics and economic situation, parent-child interactions, and individual well-being during COVID-19.

RESULTS

Results from structural equation modeling suggested that family income loss due to COVID-19 was related to economic pressure. Economic pressure was associated with negative interactions between parents and young adult children, which were associated with problems in young adult children's mental health (i.e., anxiety and depressive symptoms). Further, self-control was found to buffer the association between family income loss and economic pressure, and respect for family was found to weaken the association between economic pressure and negative parent-child interactions.

CONCLUSION

Findings supported the hypotheses of the negative impacts of COVID-19 on young adult children's mental health and the resilience factors that buffered the negative impacts.

IMPLICATIONS

Implications to family researchers, family life educators, practitioners, and policymakers were discussed.

Spatial Thinking in Term and Preterm-Born Preschoolers: Relations to Parent-Child Speech and Gesture

Spatial skills predict important life outcomes, such as mathematical achievement or entrance into Science, Technology, Engineering, and Mathematics (STEM) disciplines. Children significantly vary in their spatial performance even before they enter formal schooling. One correlate of children's spatial performance is the spatial language they produce and hear from others, such as their parents. Because the emphasis has been on spatial language, less is known about the role of hand gestures in children's spatial development. Some children are more likely to fall behind in their spatial skills than others. Children born premature (gestational age <37 weeks) constitute such a risk group. Here, we compared performance of term and preterm-born children on two non-verbal spatial tasks-mental transformation and block design. We also examined relations of children's performance on these tasks to parental spatial language and gesture input and their own production of spatial language and gesture during an independent puzzle play interaction. We found that while term and preterm-born children (n = 40) as a group did not differ in the mental transformation or block design performance, children varied widely in their performance within each group. The variability in mental transformation scores was predicted by both a subset of spatial words (what aspects of spatial information) and all spatial gestures children produced. Children's spatial language and gesture were in turn related to their parents' spatial language and gesture. Parental spatial language and gesture had an indirect relation on children's mental transformation, but not block design, scores via children's spatial language, and gesture use. Overall, results highlight the unique contributions of speech and gesture in communicating spatial information and predicting children's spatial performance.

Predictive and Incremental Validity of Parental Representations During Pregnancy on Child Attachment

Parental pre-natal representations predict the interactive patterns that parents will put in place after childbirth. Early interactions defined by high parental emotional availability (EA) influence the development of security in children. To date, research on the predictive role of parental pre-natal representations on child attachment is still poor. Moreover, investigations on pre-natal representations have mainly focused on mothers. This study aimed at: investigating the criterion validity of the Interview of Maternal Representations During Pregnancy-Revised (IRMAG-R) and of the Interview of Paternal Representations During Pregnancy (IRPAG), using EA, parental attachment, and child attachment toward both parents, as criteria; testing the incremental validity of the IRMAG-R and IRPAG in the prediction of child attachment, controlling for other covariates, such as depressive and anxious levels during pregnancy, EA, and parental attachment; evaluating the possible mediation role of EA on the relationship between parental representations during pregnancy and child attachment. Fifty couples of primiparous parents were recruited during pregnancy, when the IRMAG-R and IRPAG were administered to mothers and fathers. At 6–9 months after childbirth, the mother–child and father–child interactions were coded by means of the EA Scales (EAS). At 14–18 after childbirth, the Adult Attachment Interview (AAI) was administered to parents, and the Strange Situation Procedure (SSP) was carried out to assess children's attachment toward mothers and fathers, respectively. The results showed significant correlations between parental pre-natal representations and EA, parental attachment and child attachment. As regards the prediction of child attachment, the IRMAG-R/IRPAG categories showed: a significant and large unique contribution for maternal representations; a close to be significant contribution for paternal representations (with a higher effect size for mothers than fathers). Moreover, while the indirect effect of pre-natal representations in the prediction of child attachment was not significant for mothers, it was instead significant for fathers. The results of this study confirmed the criterion validity of the IRMAG-R and IRPAG, and supported the incremental validity of the IRMAG-R and IRPAG in the prediction of children's attachment categories. Finally, the mediation models revealed that EA did not mediate the relationship between maternal pre-natal representations and child attachment, while it totally mediated the relationship between paternal pre-natal representations and child attachment.

Examining the Factor Structure of the Home Mathematics Environment to Delineate Its Role in Predicting Preschool Numeracy, Mathematical Language, and Spatial Skills

A growing body of evidence suggests that the ways in which parents and preschool children interact in terms of home-based mathematics activities (i.e., the home mathematics environment; HME) is related to children's mathematics development (e.g., primarily numeracy skills and spatial skills); however, this body of evidence is mixed with some research supporting the relation and others finding null effects. Importantly, few studies have explicitly examined the factor structure of the HME and contrasted multiple hypothesized models. To develop more precise models of how the HME supports children's mathematics development, the structure of the HME needs to be examined and linked to mathematics performance. The purpose of this study was to extend prior work by replicating the factor structure of the HME (as one general HME factor and three specific factors of direct numeracy, indirect numeracy, and spatial) and using those factors to predict direct assessments of children's numeracy, mathematical language, and spatial skills. It was hypothesized that the general HME factor would be related to each direct assessment, the direct numeracy factor would be related to both numeracy and mathematical language, and the spatial factor would be related to spatial skills. Using a sample of 129 preschool children (M age = 4.71 years, SD = 0.55; 46.5% female), a series of confirmatory factor analyses were conducted. Results diverged somewhat from prior work as the best fitting model was a bifactor model with a general HME factor and two specific factors (one that combined direct and indirect numeracy activities and another of spatial activities) rather than three specific factors as had previously been found. Further, structural equation modeling analyses suggested that, in contrast to expectations, only the direct + indirect numeracy factor was a significant predictor of direct child assessments when accounting for age, sex, and parental education. These findings provide evidence that a bifactor model is important in understanding the structure of the HME, but only one specific factor is related to children's outcomes. Delineating the structure of the HME, and how specific facets of the HME relate to children's mathematics skills, provides a strong foundation for understanding and enhancing the mechanisms that support mathematics development.

Are Parents Less Responsive to Young Children When They Are on Their Phones? A Systematic Naturalistic Observation Study

This study examined whether parents are less responsive to their young children (0-5) when they use a phone. We systematically observed 53 parent-child dyads in consultation bureau waiting rooms and playgrounds. Twenty-three parents used their phone at least once during the observation. Across the dyads, we observed parent and child behavior during a total of 1,038 ten-second intervals. Of these intervals, 641 contained a bid for attention from the child. Accounting for the nested nature of the data, we found that the odds of parents responding to their child's bid for attention were five times lower when using a phone than when not using one. Moreover, parents' responses were less timely, weaker, showed less affect, and were less likely to prioritize the child over other activities. While being fully absorbed in one's phone significantly decreased the odds of responding compared to when not using a phone, occasionally glancing at the phone did not, suggesting that parents may have developed a "mode" of phone use for managing dual attention over the phone and the child. In addition, while a higher intensity of phone use does seem to matter, it did not differ from intense engagement in other nonchild directed activities. The incidence of fully absorbed phone use, however, is greater. Finally, the results show that asking for consent for the observation beforehand leads to a decrease in the odds of phone use, suggesting a social desirability bias. Overall, the findings support concerns over the impact of parental phone use on child development.

An investigation into maternal use of telegraphic input to children with Down syndrome

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Quantity and Quality of Parental Utterances and Responses to Children With Hearing Loss Prior to Cochlear Implant

This study investigated the extent to which parental language input to children with hearing loss (HL) prior to cochlear implant (CI) differs from input to children with typical hearing (TH). A 20-min parent-child interaction sample was collected for 13 parent-child dyads in the HL group and 17 dyads in the TH group during free play. Ten minutes were transcribed and were coded for four variables: (a) overall utterances, (b) high-quality utterances, (c) utterances in response to child communicative acts (i.e., overall responses), and (d) high-quality utterances in response to child communicative acts (i.e., high-quality responses). Differences were detected for both quantity and quality of parental language input across the two groups. Early language skills correlated with three out of the four parental variables in both groups. Post hoc analyses suggested that the lower rate of high-quality responses in parents of children with HL could be attributed to lower intelligibility of child communication.

Efficacy of a Home-Based Parent Training-Focused Weight Management Intervention for Preschool Children: The DRIVE Randomized Controlled Pilot Trial

OBJECTIVES

To pilot-test a home-based parent training intervention aimed at maintaining body weight among children at risk for obesity (> the 75th body mass index percentile).

METHODS

Sixteen parent-child dyads were randomized to a health education or Developing Relationships that Include Values of Eating and Exercise (DRIVE) intervention arm. The DRIVE curriculum was a structured parenting program to promote healthy weight in children by relying on behavioral principles to promote skill acquisition in the family's natural setting. Body weight and waist circumference were measured at baseline and weeks 9 and 19.

RESULTS

Body mass index z-score, body weight, and percent body weight increased in children in the health education arm vs DRIVE at weeks 9 and 19. Body weight, percent body weight, and waist circumference decreased in parents in DRIVE vs the health education arm at week 19, whereas no differences were shown at week 9.

CONCLUSIONS AND IMPLICATIONS

The DRIVE program mitigated weight gain in a small sample of at-risk children and showed promising results in reducing weight in parents. Home-based interventions emphasizing parent-child interactions are indicated as a practical model to deliver weight management in children.

Testing the Similarity Fit/Misfit Hypothesis in Adolescents and Parents With ADHD

OBJECTIVE

Higher rates of conflict are observed between adolescents with ADHD and their parents due to cognitive, academic, social, and behavioral difficulties. Conflict should be even more pronounced when parents have ADHD themselves; however, some research suggests that parents with ADHD may have increased tolerance toward children who share similar challenges (i.e., similarity-fit hypothesis).

METHOD

We tested the similarity-fit model and its converse, the similarity-misfit model, in a sample of 93 ADHD adolescents, 63 comparison adolescents, and their parents with varying levels of ADHD. Quantity and intensity of conflict were examined in mothers and fathers separately.

RESULTS

We found evidence for the similarity-fit process in fathers, and similarity misfit in mothers, particularly regarding quantity of conflict between parent and adolescent.

CONCLUSION

Results indicate the importance of differential parental roles in mothers and fathers, and have implications for involving parents in treatment for ADHD in adolescents.

Exploratory Factor Analysis of Observational Parent-Child Interaction Data

The majority of studies using observational coding systems for family interaction data derive scales describing family members' behaviors based on rational/theoretical approaches. This study explored an empirical approach to identifying the component structure of parent-child observational data that incorporated the affective context of the interaction. Dyads of 155 typically developing 8-year-olds and their mothers completed questionnaires and two interaction tasks, one each designed to illicit positive and negative interactions. Behaviors were coded based on a modified version of the Family Interaction Macro-coding System. Multiple factor analysis identified four-component solutions for the maternal and child data. For both, two of the components included negative behaviors, one positive behavior, and one communicative behavior. Evidence for the validity of the maternal and child components was demonstrated by associations with child depression and anxiety symptoms and behavioral problems. Preliminary evidence supports an empirical approach to identify context-specific components in parent-child observational data.

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention

BACKGROUND

One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent-infant interactions and their infant's sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep?

METHOD AND ANALYSIS

An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results.

DISCUSSION

Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent-infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.

Parent Cardiac Response in the Context of Their Child's Completion of the Cold Pressor Task: A Pilot Study

Parents’ ability to regulate their emotions is essential to providing supportive caregiving behaviours when their child is in pain. Extant research focuses on parent self-reported experience or observable behavioural responses. Physiological responding, such as heart rate (HR) and heart rate variability (HRV), is critical to the experience and regulation of emotions and provides a complementary perspective on parent experience; yet, it is scarcely assessed. This pilot study examined parent (n = 25) cardiac response (HR, HRV) at rest (neutral film clip), immediately before the cold pressor task (pre-CPT), and following the CPT (post-CPT). Further, variables that may influence changes in HR and HRV in the context of pediatric pain were investigated, including (1) initial HRV, and (2) parent perception of their child’s typical response to needle procedures. Time-domain (root mean square of successive differences; RMSSD) and frequency-domain (high-frequency heart rate variability; HF-HRV) parameters of HRV were computed. HR and HF-HRV varied as a function of time block. Typical negative responses to needle pain related to higher parental HR and lower HRV at rest. Parents with higher HRV at baseline experienced the greatest decreases in HRV after the CPT. Consequently, considering previous experience with pain and resting HRV levels are relevant to understanding parent physiological responses before and after child pain.

Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit

OBJECTIVE

To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting.

STUDY DESIGN

This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors.

RESULTS

Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories.

CONCLUSIONS

Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children.

Child-mother attachments in the face of grandparent HIV

Child-mother attachment, as observed in the Strange Situation (SSP), was assessed in 61 families affected by HIV and 18 neighborhood comparison families not affected by HIV, but of similar ethnicity and socioeconomic status. Children were aged one to three years at the assessment. Secure attachment was significantly less likely among children in the HIV-affected group than among comparison group children (36% versus 67%). The most common pattern of attachment in the HIV-affected group was disorganized/disoriented, observed in 41% of children (versus 22% of comparison children). Children from families that included a surviving grandparent with HIV showed disorganized attachments more often than children whose grandparents died (53% versus 36%). Child attachment classifications were not associated with families' participation in a family-based, cognitive-behavioral HIV intervention. These results document the inter-generational impact of young mothers' who were growing up with an HIV-infected parent. These findings suggest that families affected by HIV may benefit from interventions that address attachment issues.

Parent Scaffolding of Young Children When Engaged with Mobile Technology

Shared parent-child experiences while engaged with an iPad(TM) were examined to determine if and then how parents interact with their children when using mobile digital devices. In total, 104 parent-child dyads participated in an observation session where parent-child interactions using the touchscreen tablet device were video recorded in order to observe first-hand the supports and exchanges between parent and child (age range 46.21-75.9 months). Results indicate that parents provide a great deal of support to their children while interacting with the touchscreen tablet device including verbal, emotional-verbal, physical and emotional-physical supports. The types of support offered did not differ as a function of parent gender or experience with mobile devices (users versus non-users). Overall, parents rated their own experience engaging with the touchscreen tablet and that of their child's positively. Additional survey measures assessed parents' perceptions of their child's technology use and attitudes regarding optimal ages and conditions for introducing and using technology. Most parents indicated a preference for very early introduction to mobile technologies. Implications of these findings are discussed.

Ties of silence--Family lived experience of selective mutism in identical twins

This article is based on an in-depth interview with a pair of twins diagnosed with selective mutism and their parents 2 years after recovery. Selective mutism (SM) is a rare disorder, and identical twins sharing the condition are extremely rare. The twins developed SM simultaneously during their first year of school. The treatment and follow-up they received for several years are briefly described in this article. The interview explored the children's and their parents' narratives about the origin of the condition, the challenges it entailed in their daily lives, and what they found helpful in the treatment they were offered. In the interview, the children conveyed experiences that even the parents were unaware of and revealed examples of daily life-traumas for which they were unable to obtain support and help. The whole family was trapped in the silence. The twins and their parents emphasized different aspects in terms of what they believed were helpful. The implications of these findings for our understanding and treatment of children with SM are discussed, as well as the potential of service user involvement in child and adolescent mental health research.

Maternal responsivity in mothers of young children with Down syndrome

OBJECTIVE

The purpose of this study was to examine maternal responsivity and directive behaviors in mothers of children with Down syndrome (DS).

METHODS

Participants included 22 mothers with a young child with DS compared to 22 mothers of chronologically age-matched typically developing (TD) children using a cross-sectional design. The dyads participated in videotaped structured activities that were coded for responsive and directive behaviors.

RESULTS

RESULTS indicated that the mothers of children with DS used a more facilitative style with the older children while these behaviors decreased with older children with TD; one directive behavior, request for behavioral comply, increased with the older children with DS.

CONCLUSION

The mothers of children with DS adapted their parenting style to be facilitative of their children's linguistic development.

Cognitive deconstruction of parenting in schizophrenia: the role of theory of mind

OBJECTIVE

Schizophrenia patients experience impairments across various functional roles. Emotional unresponsiveness and an inability to foster intimacy and display affection may lead to impairments in parenting. A comprehensive cognitive understanding of parenting abilities in schizophrenia has the potential to guide newer treatment strategies. As part of a larger study on functional ability in schizophrenia patients, we attempted a cognitive deconstruction of their parenting ability.

METHODS

Sixty-nine of the 170 patients who participated in a study on social cognition in remitted schizophrenia were parents (mean age of their children: 11.8 ± 6.2 years). They underwent comprehensive assessments for neurocognition, social cognition (theory of mind, emotion processing, social perception and attributional bias), motivation and insight. A rater blind to their cognitive status assessed their social functioning using the Groningen Social Disabilities Schedule. We examined the association of their functional ability (active involvement and affective relationship) in the parental role with their cognitive performance as well as with their level of insight and motivation.

RESULTS

Deficits in first- and second-order theory of mind (t = 2.57, p = 0.01; t = 3.2, p = 0.002, respectively), speed of processing (t = 2.37, p = 0.02), cognitive flexibility (t = 2.26, p = 0.02) and motivation (t = 2.64, p = 0.01) had significant association with parental role dysfunction. On logistic regression, second-order theory of mind emerged as a specific predictor of parental role, even after controlling for overall functioning scores sans parental role.

CONCLUSIONS

Second-order theory of mind deficits are specifically associated with parental role dysfunction of patients with schizophrenia. Novel treatment strategies targeting theory of mind may improve parenting abilities in individuals with schizophrenia.

Activation During Observed Parent-Child Interactions with Anxious Youths: A Pilot Study

Parent-child interaction paradigms are often used to observe dysfunctional family processes; however, the influence of such tasks on a participant's level of activation remain unclear. The aim of this pilot project is to explore the stimulus value of interaction paradigms that have been commonly used in child anxiety research. Twenty-nine parent-child dyads with clinically anxious (n = 16) and non-anxious (n = 13) youths engaged in a series of tasks (threat and non-threat) used in previous studies of parenting and youth anxiety. Heart rate (HR) data, as an indicator of physiological activation, were collected across tasks, and participants rated the perceived representativeness of their interactions in the laboratory to their usual behavior at home. Significant HR changes were observed for both parent and child. Change in child HR from baseline to non-threat task was smaller than change in HR from baseline to threat tasks. Change in parent HR from baseline to ambiguous situations tasks was smaller than changes from baseline to other threat tasks. Differences in HR change between anxious and non-anxious children were explored. Participants rated laboratory interactions as similar to those experienced in the home. Results suggest that presumably emotionally-charged discussion tasks may produce increased activation compared to tasks that were designed to be more neutral. Implications for future research and limitations are discussed.