IMPACT OF JOINT ATTENTION ON SOCIAL‐COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long‐term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months’ postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow‐up session 6 months’ postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age‐at‐adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at‐risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.     

MEDIATING ROLE OF MATERNAL SENSITIVITY: ENHANCING LANGUAGE DEVELOPMENT IN AT‐RISK FAMILIES

Home‐visiting programs have gained increasing importance in family‐centered prevention and intervention. However, few studies have examined the mechanisms underlying early intervention treatment effects. The goal of this study is to analyze the mediating role of maternal sensitivity in enhancing language development with the home‐visiting program Parents as Teachers (PAT). Data were collected and analyzed within the ongoing, long‐term ZEPPELIN study, a randomized controlled trial with 251 participating at‐risk families. Via longitudinal mediation analysis, we examined whether effects of the PAT on receptive and expressive language outcomes at 24 and 36 months were mediated by maternal sensitivity at 12 months. Within a moderated mediation framework, we investigated whether the level of family psychosocial stress affects this mediation. Results showed that intervention effects on language outcomes are mediated by maternal sensitivity—weakly and through specific pathways. Moderation and moderated mediation analyses indicated that effects of the PAT and also specific mediation effects increase with the level of psychosocial stress. Implications of the results for practice are discussed.     

EARLY HEAD START FAMILIES’ EXPERIENCES WITH STRESS: UNDERSTANDING VARIATIONS WITHIN A HIGH‐RISK,LOW‐INCOME SAMPLE

The federal Early Head Start program provides a relevant context to examine families’ experiences with stress since participants qualify on the basis of poverty and risk. Building on previous research that has shown variations in demographic and economic risks even among qualifying families, we examined possible variations in families’ perceptions of stress. Family, parent, and child data were collected to measure stressors and risk across a variety of domains in families’ everyday lives, primarily from self‐report measures, but also including assay results from child cortisol samples. A cluster analysis was employed to examine potential differences among groups of Early Head Start families. Results showed that there were three distinct subgroups of families, with some families perceiving that they experienced very high levels of stress while others perceived much lower levels of stress despite also experiencing poverty and heightened risk. These findings have important implications in that they provide an initial step toward distinguishing differences in low‐income families’ experiences with stress, thereby informing interventions focused on promoting responsive caregiving as a possible mechanism to buffer the effects of family and social stressors on young children.     

A LONGITUDINAL,PERSON‐CENTERED ANALYSIS OF EARLY HEAD START MOTHERS’ PARENTING

This study used a person‐centered approach to examine stability and change in parenting typologies across early childhood. Profiles were associated within and across time with contextual covariates, including demographic characteristics, risk factors, and Early Head Start participation. Participants were drawn from the Early Head Start Research and Evaluation Project (N = 2, 876). Parenting profiles were identified based on observed parenting dimensions at 14, 24, and 36 months, and pre‐Kindergarten (pre‐K). Results suggested a four‐profile solution at each time point: Supportive, Lukewarm (14 & 24 months)/Sufficient (36 months and pre‐K), Harsh, and Detached. Supportive was the largest, most stable, and most likely transitioned into profile while Harsh and Detached represented rare profiles with moderate to low membership stability across time. Depression and family conflict emerged as important correlates of unsupportive parenting profiles both within and across time. Findings are discussed in terms of their relevance for both policy and implementation practices for low‐income mothers with young children.     

The associations between insecure attachment,rooming‐in,and postpartum depression: A 2 months’ longitudinal study

Postpartum depression (PPD) is the most common complication of childbearing, and recent studies have attempted to examine risk factors associated with it. The main study hypothesis was that a protective situational factor at a sensitive time period (full rooming‐in postpartum) would moderate the associations between insecure attachment dimensions and PPD. Three hundred twelve women, in either full or partial rooming‐in, participated in a longitudinal study at the maternity ward of a tertiary healthcare center. A Demographic questionnaire and the Experiences in Close Relationships Scale were administered at 1–4 days postpartum, and the Edinburgh Postnatal Depression scale at 2 months postpartum. PPD was significantly associated with both anxious and avoidant attachment dimensions, but not with rooming‐in conditions. In addition, women in partial rooming‐in showed a positive correlation between insecure attachment dimensions and PPD, whereas no such correlation was found for full rooming‐in women. A situational factor such as full rooming‐in, which occurs at a critical time point for the mother–infant relationship, can moderate the association between maternal avoidant or anxious attachment dimensions and the mother's PPD levels. Postpartum practices, such as rooming‐in, can be personalized and thus beneficial in moderating personal risk factors for PPD.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.     

POSTPARTUM BONDING DIFFICULTIES AND ADULT ATTACHMENT STYLES: THE MEDIATING ROLE OF POSTPARTUM DEPRESSION AND CHILDBIRTH‐RELATED PTSD

Despite decades of research demonstrating the role of adult attachment styles and early mother–infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth‐related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant‐focused anxiety, mediated by postpartum depression but not childbirth‐related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth‐related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth‐related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.     

EARLY PARENTING SUPPORT AND INFORMATION: A CONSUMER PERSPECTIVE

The transition to parenthood is a period of both joy and challenge for most parents. There is a recognized need to support parents during this period, yet existing interventions have shown limited evidence of efficacy. This study takes a consumer‐focused approach to examine the needs and preferences of parents both prenatally (n = 77) and postnatally (n = 123) for parenting support. The study used a cross‐sectional design with a purpose‐built online survey. Parents were recruited via online forums, Facebook and parenting blogs, childcare centers, and playgroups. In general, all parents were satisfied with their current levels of both formal and informal support, and about one fourth of parents had accessed a parenting intervention. Parents expressed a moderate level of interest in additional parenting information, and parents expecting their first baby indicated preferences for information about basic baby care needs whereas postnatally, parents expressed more interest in topics around self‐care and behavior management. The implications for developing interventions and engaging families are discussed.     

IMPACT OF REFLECTIVE SUPERVISION ON EARLY CHILDHOOD INTERVENTIONISTS’ PERCEPTIONS OF SELF‐EFFICACY,JOB SATISFACTION,AND JOB STRESS

Despite widespread recognition of the importance of reflective practice in the field of infant mental health, little quantitative research exists regarding the impact of reflective supervision on professionals’ self‐efficacy, job satisfaction, and work‐related stress. Thirty‐three early childhood interventionists received approximately 9 months of reflective supervision and completed pre‐ and post‐assessments of their job‐related stress and self‐efficacy using a modified version of the Reflective Supervision Self‐Efficacy Scales for Supervisees (S. Shea, S. Goldberg, & D.J. Weatherston, 2012). At the post‐assessment, participants also rated their overall experience of reflective supervision. Reported self‐efficacy increased significantly from pre‐ to post‐assessment, and participants reported a positive overall impact of reflective supervision with respect to a variety of indices, such as job satisfaction, professional development, and the ability to cope with job‐related stress. These results provide necessary quantitative data demonstrating a positive impact of reflective supervision on early childhood professionals and suggest the value of reflective supervision for supporting workforce development.     

EARLY REGULATION IN CHILDREN WHO ARE LATER DIAGNOSED WITH AUTISM SPECTRUM DISORDER. A LONGITUDINAL STUDY WITHIN THE DANISH NATIONAL BIRTH COHORT

Studies have shown that children later diagnosed with autism spectrum disorders (ASD) in their first years of life might show symptoms in main developmental areas and that these signs might be sensed by the parents. The present study investigated in a large birth cohort if children later diagnosed with ASD had deviations at 6 and 18 months in areas such as the ability to self‐regulate emotions, feeding, and sleeping. The study was based on prospective information collected from 76,322 mothers who participated in the Danish National Birth Cohort. When the children reached an average age of 11 years, 973 children with ASD and a control group of 300 children with intellectual disability (IDnoASD) were identified via Danish health registries. Associations were found between short periods of breast‐feeding and the children later diagnosed with ASD and IDnoASD as well as associations at 18 months to deviations in regulation of emotions and activity. The similarities in these associations emphasize how difficult it is to distinguish between diagnoses early in life.     

The Crying Clinic: Increasing accessibility to Infant Mental Health services for immigrant parents at risk for peripartum depression

Peripartum depression (PPD) is considered a major public health concern due to its profound impact on families, including infants. In this paper, we report on a pilot initiative designed to reduce barriers and stigma related to the use of traditional infant mental health services for immigrant parents deemed at high risk of PPD. The Crying Clinic (CC) is an innovative walk‐in service offered in a culturally diverse Canadian community to support maternal well‐being and healthy parent–infant relationships. The CC was designed to be a gateway to existing infant mental health services, through its emphasis on accessibility and cultural sensitivity. Support for concrete concerns, such as anxiety about normative infant behaviors like crying, is underscored in this approach to attract vulnerable families who would otherwise not access mental health support. A review of 44 users, utilization, plans for the use of additional services, and client evaluations suggests that the CC accomplished most of its goals. We conclude that gateway service models such as the CC have the potential to enhance traditional infant mental health programs by creatively addressing the challenge of engaging highly vulnerable parents from culturally diverse backgrounds.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.     

IMPACT OF PARENTAL BINGE EATING DISORDER: EXPLORING CHILDREN'S EMOTIONAL/BEHAVIORAL PROBLEMS AND THE QUALITY OF PARENT–CHILD FEEDING INTERACTIONS

This study examines psychopathological problems in children of parents with binge eating disorder (BED), particularly the effect of parental diagnosis on their offspring's psychopathology and the mediating power of the quality of parent–infant feeding interactions. Two hundred parents and their offspring were administered a questionnaire for the assessment of their children's psychopathology at 18 (T1) and 36 (T2) months of age. An observational measure to evaluate feeding interactions was administered at T1. Children with both parents with BED showed the highest affective, anxiety, oppositional/defiant, and autism spectrum problems, but no influence of paternal diagnosis was found on the offspring's psychopathology. Maternal BED had an influence on children's affective and autism spectrum problems, and diagnosis of BED in both parents had an effect on infants’ affective problems. Paternal BED had an effect on oppositional/defiant problems through the quality of father–infant interactions, and maternal BED had an effect on the offspring's affective and anxiety problems through the mediation of mother–infant interactions. These results suggest the importance of intervention programs focusing both on parental psychopathology and on mother–child and father–child feeding interactions in families with parents with BED.     

Short‐term psychodynamic infant–parent interventions at Child health centers: Outcomes on parental depression and infant social–emotional functioning

Randomized controlled trials (RCTs) demonstrate efficacy of parent–infant psychotherapy, but its applicability and effectiveness in public health care are less known. The method followed is Naturalistic study evaluating Short‐term Psychodynamic Infant–Parent Interventions at Child Health Centers (SPIPIC) in Stockholm, Sweden. One hundred distressed mothers with infants were recruited by supervised nurses. Six therapists provided 4.3 therapy sessions on average (SD = 3.3). Sessions typically included the mothers, often with the baby present, while fathers rarely attended sessions. The Edinburgh Postnatal Depression Scale (EPDS) and the Ages and Stages Questionnaire: Social–Emotional (ASQ: SE) were distributed at baseline and at 3 and 9 months later. Data from a nonclinical group were collected simultaneously to provide norm data. Multilevel growth models on the mothers’ questionnaire scores showed significant decreases over time on both measures. Nine months after baseline, 50% achieved a reliable change on the EPDS and 14% on the ASQ: SE. Prepost effect‐sizes (d) were 0.70 and 0.40 for EPDS and ASQ: SE, figures that are comparable to results of other controlled studies. Psychotherapists integrated with public health care seem to achieve good results when supporting distressed mothers with brief interventions in the postnatal period. SPIPIC needs to be compared with other modalities and organizational frameworks.     

SOCIOEMOTIONAL AND BEHAVIORAL PROBLEMS IN TODDLERS WITH LANGUAGE DELAY

Toddlers with language delay are at risk for persistent developmental and behavioral difficulties; however, the association between socioemotional/behavior problems and language in young children is not well understood. This study explored socioemotional/behavior problems in a unique sample of toddlers with language delays using a measure developed explicitly for this age group. Toddlers identified by 18 months with receptive and expressive language delay (LD; n = 30) or typical development (TD; n = 61) were evaluated at 18 and 24 months of age using the Infant‐Toddler Social and Emotional Assessment (ITSEA) and the Mullen Scales of Early Learning. Compared to toddlers who had TD, toddlers with LD had significantly more concerning scores at 18 and 24 months on all ITSEA domains. The rate of “clinical concern” on most domains was not high in either group, except that >60% of LD toddlers were in the clinical concern range on the Competence domain. Socioemotional/behavioral problems were dimensionally related to receptive and expressive language, with greater language delay associated with more concerning ITSEA scores. Socioemotional and behavioral problems are related to receptive and expressive language abilities in 18‐ and 24‐month‐olds, indicating the need for screening of both types of concerns in toddlers identified with potential language delays.     

TEMPERAMENTAL ADAPTABILITY,PERSISTENCE, AND REGULARITY: PARENTAL RATINGS OF NORWEGIAN INFANTS AGED 6 TO 12 MONTHS,WITH SOME IMPLICATIONS FOR PREVENTIVE PRACTICE

There is a need for standardized measures of infant temperament to strengthen current practices in prevention and early intervention. The present study provides Norwegian data on the Cameron‐Rice Infant Temperament Questionnaire (CRITQ; J.R. Cameron & D.C. Rice, 1986a), which comprises 46 items and is used within a U.S. health maintenance organization. The CRITQ was filled out by mothers and fathers at 6 and again at 12 months as part of a longitudinal study of mental health during the first years of life (the “Little in Norway” study, N = 1,041 families enrolled; V. Moe & L. Smith, 2010). Results showed that internal consistencies were comparable with U.S. data. The temperament dimensions of persistence, adaptability, and regularity had acceptable or close‐to‐acceptable reliabilities in the U.S. study as well as in this study, and also were unifactorial in confirmatory factor analysis. These dimensions are the focus in this article. Findings concerning parents’ differential ratings of their infants on the three dimensions are reported, as is the stability of parents’ ratings of temperament from 6 to 12 months. In addition, results on the relation between temperament and parenting stress are presented. The study suggests that temperamental adaptability, persistence, and regularity may be relevant when assessing infant behavior, and may be applied in systematic prevention trials for families with infants. The inclusion of concepts related to individual differences in response tendencies and regulatory efforts may broaden the understanding of parent—infant transactions, and thus enrich prevention and sensitizing interventions with the aim of assisting infants’ development.     

CAREGIVER'S DEPRESSIVE SYMPTOMS AND YOUNG CHILDREN'S SOCIOEMOTIONAL DEVELOPMENT DELAYS: A CROSS‐SECTIONAL STUDY IN POOR RURAL AREAS OF CHINA

Poverty and its associated factors put people at risk for depression. The aims of this study were to describe the prevalence of depressive symptoms (DS) of primary caregivers and socioemotional development (SED) delays of young children in poor rural areas of China, and to explore the association between them. Cross‐sectional data of 2,664 children aged 3 to 35 months and their primary caregivers were used for analysis. Characteristics of the child, caregiver, and family were collected through face‐to‐face caregiver interviews. DS were assessed by the Zung Self‐Rating Depression Scale (W.W. Zung, 1965, as cited in World Health Organization, 2016b ), and SED was evaluated by the Ages and Stage Questionnaires: Social‐Emotional (J. Squires, D. Bricker, & L. Potter, 1997). The χ² test, stratification analysis, and logistic regression analyses were used to explore the association. Among the caregivers, 40.3% (95% confidence interval [CI] [38.4, 42.1]), reported DS. Caregivers who were male, older and ethnic minorities as well as had a low level of education, a low family income, or more children were more likely to have DS. Of the children, 24.4% (95% CI [22.8, 26.0]) were recognized with SED delays. Older children displayed more delays than did younger children, but no significant differences between males and females were found. SED delays were significantly associated with mother outmigrating, male caregivers, older age, ethnic minorities, and low education or families with a single parent, low‐income, and having more children. Caregivers having DS, odds ratio (OR) = 2.40, 95% CI [1.99, 2.88], was a significant predictor of increased odds of SED delays; other factors were single‐parent family, OR = 1.99, 95% CI [1.37, 2.89], inadequate care, OR = 1.69, 95% CI [1.30, 2.21], physical punishment, OR = 1.61, 95% CI [1.33, 1.95], ethnic minorities, OR = 1.41, 95% CI [1.17, 1.71], and child age in months, OR = 1.03, 95% CI [1.02, 1.04], according to the logistic regression analysis. DS are prevalent among caregivers with young children in poor rural areas. Interventions to improve the mental health of caregivers and their parenting behaviors are needed to improve children's SED.     

Translation and preliminary validation of a Korean version of the parental reflective functioning questionnaire

This study aimed to explore the factor structure, reliability, and validity of a Korean translation of the Parental Reflective Functioning Questionnaire (PRFQ). The PRFQ consists of three subscales: prementalizing modes, certainty about mental states, and interest and curiosity in mental states. A convenience sample of 163 Korean parents completed the K‐PRFQ. Exploratory factor analysis showed three factors mapped on to the original PRFQ factors, but items from the original prementalizing modes subscale clustered into two additional factors. Data from a subsample (n = 67) showed that the certainty about mental states and interest and curiosity in mental states subscales correlated positively with more optimal self‐reported parenting. We discuss the validity of using the PRFQ in collectivistic cultures.