DEVELOPMENT OF THE PARENT‐CHILD PLAY SCALE FOR USE IN CHILDREN WITH FEEDING DISORDERS

The Parent‐Child Play Scale was developed as a scale that complements the Parent‐Child Feeding Scale, created by I. Chatoor et al. (1997), to evaluate mother–infant/toddler interactions in two different caregiving contexts of a young child's everyday life, specifically play and feeding. This Play Scale can be used with infants and toddlers ranging in age from 1 month to 3 years and provides reliable global ratings of mother–child interactions during 10 min of videotaped free‐play in a laboratory setting. The scale consists of 32 mother and infant/toddler interactive behaviors which are rated by trained observers from videotaped observations. Four subscales are derived: Dyadic Reciprocity, Maternal Unresponsiveness to Infant's/Toddler's Cues, Dyadic Conflict, and Maternal Intrusiveness. Construct validity and interrater and test‐retest reliability of the Play Scale have been demonstrated. This Play Scale discriminates between children with and without feeding disorders as well as between children with different subtypes of feeding disorders as defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, Revised (DC:0–3R) (Feeding Disorder of State Regulation, Feeding Disorder of Caregiver‐Infant Reciprocity, and Infantile Anorexia). It can be used for research or clinical practice in the diagnosis and treatment of early feeding problems, to assess the pervasiveness of mother–infant/toddler difficulties and to monitor changes following therapy.     

Therapeutic Assessment With Children: A Pilot Study of Treatment Acceptability and Outcome

Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome–postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.     

A translational evaluation of renewal of inappropriate mealtime behavior

The term renewal describes the recurrence of previously extinguished behavior that occurs when the intervention context changes. Renewal has important clinical relevance as a paradigm for studying treatment relapse because context changes are necessary for generalization and maintenance of most intervention outcomes. The effects of context changes are particularly important during intervention for pediatric feeding disorders because children eat in a variety of contexts, and extinction is an empirically supported and often necessary intervention. Therefore, we used an ABA arrangement to test for renewal during intervention with 3 children diagnosed with a feeding disorder. The A phase was functional reinforcement of inappropriate mealtime behavior in a simulated home setting with the child's caregiver as feeder, B was function‐based extinction in a standard clinic setting with a therapist as feeder, and the return to the A phase was function‐based extinction in a simulated home setting with caregiver as feeder. Returning to Context A resulted in renewal of inappropriate mealtime behavior across children, despite the caregivers' continued implementation of function‐based extinction with high levels of integrity.     

A postpartum telephone program of reassurance,information, and early intervention in a family practice

This paper presents a program developed in a family practice office to provide reassurance, guidance, and early detection and intervention for mothers and their new infants in the first month of the infant's life. Telephone calls from an office nurse at 2 weeks of age followed by a written questionnaire demonstrated a dichotomy between the mothers' expressions of their physical and emotional problems. Feeding was the most prominently expressed concern, but we also found that complaints or worries about feeding were also an acceptable way to initiate intervention for more serious problems.     

Mothers who were severely abused during childhood and their children talk about emotions: Co‐construction of narratives in light of maternal trauma

The article focuses on detailed examination of the co‐construction of emotion dialogues between mothers and their 6‐year‐old children in light of mothers' experiences of being sexually, physically, and emotionally abused during childhood. We present examples from dialogues between 3 mothers and their children about emotional events experienced by the children and illustrate emotionally mismatched co‐construction processes. To better understand these difficulties, the article also provides vignettes from interviews with mothers about children's inner worlds and show how examining the interviews may help explain the unfolding of the dialogues and particularly points of difficulty. The dialogues between the mothers and their children were assessed using the Autobiographical Emotional Events Dialogue procedure (Koren‐Karie, Oppenheim, Chaimovich, & Etzion‐Carasso, 2000). The maternal interviews were obtained using the Insightfulness Assessment procedure (Oppenheim & Koren‐Karie, 2002). The discussion focuses on the significance of mother–child dialogues in shaping children's inner world, and points to the importance of providing intervention for adults who experienced childhood traumas that address not only their own personal issues but also their functioning as parents.     

The relationship between Turkish children's perceptions of marital conflict and their internalizing and externalizing problems

The present study investigated the relationship between children's perceptions of marital conflict and children's internalizing and externalizing problems. Additionally, investigating gender and age differences in children's perceptions and the type of problems they exhibited were the other purposes of the study. The sample consisted of 9‐ to 12‐year‐old, nonclinical children from intact families (N = 232), one of their parents, and teachers. The data were gathered by administering the Child Behavior Checklist for Ages 4–18 and the Teacher's Report Form to adult participants and the Children's Perception of Interparental Conflict Scale and the Children's Depression Inventory to the child participants. Findings indicated that there was a significant relationship between children's perceptions of marital conflict and their internalizing and externalizing problems. More specifically, children's perceptions of conflict properties were associated with their internalizing problems in parents', teachers', and children's reports. Children's perceptions of threat were associated with child‐reported depression. Children's perceptions of self‐blame were associated with child‐reported depression, parent‐reported internalizing and externalizing problems, and teacher‐reported externalizing problems. Furthermore, it was found that there were gender and age differences in children's perceptions of marital conflict and their internalizing and externalizing problems. Findings indicated that boys have higher self‐blame scores and teacher‐reported externalizing problems than girls and that girls have more parent‐ and teacher‐reported internalizing problems than boys. Additionally, it was found that 9‐year‐old children have more teacher‐reported internalizing and externalizing problems than 12‐year‐old children. Also, 9‐year‐old boys have higher parent‐reported externalizing problems than 9‐year‐old girls and 9‐year‐old boys have higher parent‐reported externalizing problems than 12‐year‐old boys.     

A model for predicting behavioural sleep problems in a random sample of Australian pre‐schoolers

Behavioural sleep problems (childhood insomnias) can cause distress for both parents and children. This paper reports a model describing predictors of high sleep problem scores in a representative population‐based random sample survey of non‐Aboriginal singleton children born in 1995 and 1996 (1085 girls and 1129 boys) in Western Australia. Longitudinal repeated data were collected up to age 4 years by caregiver report. Children's sleep rhythmicity levels in their first year, as well as conflicted and lax parenting in their second year, predicted higher scores on the sleep problem scale from the Child Behaviour Checklist/2–3 in the children's third year. Higher scores on the sleep problem scale in the children's third year predicted higher scores on the aggressive behaviour subscale of the Child Behaviour Checklist/4–16. The results support a model in which sleep problems mediated the relationship between parental conflict and aggressive behaviour, even when controlling for maternal depression, which has been associated with children's aggressive behaviour. Copyright © 2007 John Wiley & Sons, Ltd.     

Home‐based intervention after discharge for Latino families of low‐birth‐weight infants

A home‐based intervention designed for impoverished Latino families of low‐birth‐weight infants was implemented, and the efficacy assessed for infants and mothers. Specially trained public health nurses visited the participants' homes for 4 months for the “short” and 12 months for the “extended” intervention groups. Mothers received support and training in infant care. A third group did not receive the intervention. Assessments were at 4‐ to 6‐month intervals from 1 to 24 months. Although the extended visitation group showed no benefits from the intervention, the short visitation group had higher scores on maternal confidence at one month, and on the Bayley Mental Scores at four months than the group receiving no intervention and extended intervention. The nonvisitation group scored significantly higher than both intervention groups on the HOME scores and on the Mother–Infant Interaction and Feeding scores at three different assessment periods. These data suggest that for poor Latino families home intervention is not beneficial across the board. Instead, efforts should be made to identify families that could benefit from intervention and to tailor the program to the specific needs of Latino families. © 2000 Michigan Association for Infant Mental Health.     

Atypical maternal behavior toward feeding‐disordered infants before and after intervention

The display of atypical behaviors and disrupted communication during parent–infant interactions, as assessed by the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), has been linked to disorganized infant attachment, which, in turn, has been linked to psychopathology. The present study examined the usefulness of the AMBIANCE as an indicator of the efficacy of two brief interventions in reducing atypical behaviors and disrupted communication during play interactions. Twenty‐eight mother–infant dyads participated (14 per intervention). All infants had feeding problems. One intervention, Interaction Guidance, focused on training caregivers to respond sensitively to their infants (play‐focused intervention). The other intervention focused on training mothers to use new feeding techniques (feeding‐focused intervention). Results showed a significant decrease in AMBIANCE scores in the play‐focused group from pre‐ to postintervention, but not in the feeding‐focused group. There was a significant decrease in the level of disrupted communication from pre‐ to postintervention sessions in the play‐focused group but not in the feeding‐focused group. 73% of mothers from the play‐focused group and 17% of mothers from the feeding‐focused group initially classified as “disrupted” attained a classification of “nondisrupted” at the postintervention session. Some limitations of the study include small sample size, differences in timing of assessment for each intervention, and use of samples of convenience. Nonetheless, these findings provide preliminary evidence both of the usefulness of AMBIANCE as an instrument for assessing clinical efficacy and the efficacy of Interaction Guidance. ©2001 Michigan Association for Infant Mental Health.     

Preventing preschool externalizing behavior problems through video‐feedback intervention in infancy

In the present study (1) intervention effects on children's preschool behavior problems were evaluated in a high risk sample with an overrepresentation of insecure adult attachment representations in 77 first‐time mothers, and (2) predictors and correlates of child problem behavior were examined. Early short‐term video‐feedback intervention to promote positive parenting (VIPP) focusing on maternal sensitivity and implemented in the baby's first year of life significantly protected children from developing clinical Total Problems at preschool age. Also, compared with the control group, fewer VIPP children scored in the clinical range for Externalizing Problems. No intervention effects on Internalizing clinical problem behavior were found. The VIPP effects on Externalizing and Total clinical Problems were not mediated by VIPP effects on sensitivity and infant attachment or moderated by mother or child variables. Maternal satisfaction with perceived support appeared to be associated with less children's Internalizing, Externalizing, and Total Problems. More research is needed to find the mechanisms triggered by VIPP, but the outcomes could be considered as promising first steps in the prevention of disturbing, externalizing behavior problems in young children.     

A socioemotional intervention in a Latin American orphanage

A pilot intervention that emphasized training and technical assistance to promote warm, sensitive, and responsive one‐on‐one caregiver–child interactions primarily during feeding and bathing/changing was implemented using regular staff in a depressed orphanage for children birth to approximately 8 years of age in Latin America. Despite a variety of unanticipated irregularities in the implementation of the intervention, many beyond the researchers' control, ward environments improved; caregivers displayed more warm, sensitive, and responsive interactions with children; and children improved an average of 13.5 developmental quotient (DQ) points after 4+ months' exposure to the completed intervention. Furthermore, 82% of the children had DQs greater than 70 before the intervention, but only 27.8% did so afterward. Although the training for all caregivers was aimed at children birth to 3 years, the number of different caregivers was reduced, and technical assistance was provided only to caregivers serving children less than 3 years, younger and older children (3–8 years) improved approximately the same amount. However, children who were transitioned from a younger to an older ward during the intervention improved less than did children who remained in either a younger or an older ward, the first evidence suggesting that the common orphanage practice of periodically graduating children from one homogeneous age group to another may impede their development. The study is consistent with others that have shown that orphanages can be changed, and increases primarily in warm, sensitive, responsive caregiver–child interactions can produce improvements in children's development.     

Stability and prediction of parenting stress

The study focused on stability and prediction of parenting stress experiences over a 6‐year period. Mothers (N=93) who had received a clinical intervention for feeding or sleeping problems during infancy (Time 1; T 1) were followed‐up when the children were 5–10 years old (Time 2; T 2). An age‐ and sex‐of‐child matched normal group was used for comparison of stress levels at T 2. Parenting stress was measured by the Swedish Parenthood Stress Questionnaire, which consists of a general parenting stress scale and sub‐scales tapping different aspects of parenting stress experiences. T 1 predictors were clinical assessments of child problem load, maternal unresponsiveness, and family psychosocial problems. T 2 predictors were mother‐reported concurrent child problem load and psychosocial problems. The individual stability in stress experiences was moderate. Effect sizes indicated that mothers with early clinical contacts had reduced their stress to levels close to those in the normal sample. Parenting stress at T 2 could be predicted from early and from concurrent child and family problems. The results point to the relevance of early clinical assessments and to the importance of a sub‐area approach in parenting stress research, as there were differences between stress sub‐areas regarding both prediction and stability. Copyright © 2007 John Wiley & Sons, Ltd.     

Findings for a CBT Support Group for Latina Migrant Farmworkers in Western Colorado

Despite previous research findings that suggested that migrant farmworkers are at great risk for mental health problems, no published research has evaluated mental health interventions in migrant farmworkers. The purpose of the present study was to evaluate a culturally-responsive cognitive-behavioral support group for migrant farmworker women of Mexican descent. Six participants with elevated depression and migrant farmworker stress underwent a 6-session intervention conducted in Spanish by a licensed clinical psychologist and a lay health worker (promotora). Participants completed baseline, posttreatment and 6-month followup assessments. Baseline and outcome measures included the Center for Epidemiologic Studies Depression Scale, Migrant Farmworker Stress Inventory, Personality Assessment Inventory Anxiety Scale, Beck Hopelessness Scale, and Rosenburg Self-Esteem Inventory. Wilcoxon Signed Ranks Tests indicated significant reductions in depression, anxiety, migrant farmworker stress, and hopelessness and increased self-esteem scores at posttreatment and followup. Eighty-three percent of participants achieved clinically significant pretreatment-posttreatment change and 100 % achieved clinically significant pretreatment-followup change. Our overall findings provide support for the usage of culturally-responsive support groups as an effective short-term intervention for migrant farmworkers. Our use of a promotora appeared especially helpful in decreasing stigma and promoting trust. Although our intervention shows promise, future research should evaluate the intervention in a more controlled manner.     

The additive and interactive effects of parenting and children's personality on externalizing behaviour

Parenting practices have been previously linked to childhood externalizing behaviour. However, little attention has been given to the potential effect of individual personality differences among children on this relation. The current study assesses the additive effects of children's personality characteristics and explores the moderating effects of children's personality on relations between parenting practices and childhood externalizing behaviour using a proportional stratified sample of 599 nonclinical elementary‐school‐aged children. Multiple regression analyses reveal that in the mother data as well as in the father data, dysfunctional parenting and the children's personality characteristics Benevolence, Conscientiousness, and Extraversion were directly related to outcomes consistent with an additive model of their effects. Significant interactions indicate that children with low scores on Benevolence who were exposed to overreactive discipline practices exhibited higher levels of externalizing behaviour. Children characterized by low scores on Conscientiousness who were exposed to coercive parenting behaviour showed elevated levels of externalizing behaviour. These results suggest that integrating children's personality characteristics within parenting models can improve the understanding of the aetiology of childhood externalizing problem behaviour. The implications of such integrations for intervention are discussed. Copyright © 2002 John Wiley & Sons, Ltd.     

Does dose of early intervention matter for preschoolers with externalizing behavior problems? A pilot randomized trial comparing intensive summer programming to school consultation

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model to a more standard approach in school settings (i.e., behavioral school consultation). Forty-five preschool children (82% boys; Mage = 5.16 years; 93% Hispanic/Latino background) were randomized to one of three intervention conditions: 1) 8-week STP-PreK (8W); 2) 4-week STP-PreK (4W); or 3) school year behavioral consultation (SC). Both STP-PreK groups included an 8-week parent training component. Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness and kindergarten success outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral, academic, social-emotional, and self-regulation functioning significantly improved across groups. Few significant differences were found between children receiving the 4W and 8W programs, suggesting that both programs have the potential to prepare preschool children with EBP for the transition to school. Both 4W and 8W groups experienced greater initial growth across time in most domains compared to children in the SC group. However, by the end of the kindergarten year, children in the SC group caught up to children in both 4W and 8W groups on most domains. Overall, these findings suggest that all three intervention doses are effective in improving kindergarten year functioning, with some important considerations for intervention timing in preparation for the transition to elementary school. Clinical implications for school personnel are discussed.     

Eyberg Child Behavior Inventory (ECBI): Normative data,psychometric properties,and associations with socioeconomic status in Finnish children

Assessment of behavioral disorders is one of the most commonly encountered tasks in child psychiatry. The Eyberg Child Behavior Inventory (ECBI) is a widespread measurement tool used for assessing conduct problems, though the psychometric properties of the tool have varied in different samples. In this study, the ECBI was evaluated in a Finnish population based sample of children aged 4 to 12 years (n = 1,715). Factor structure and internal consistency of the ECBI and associates of behavioral problems in Finnish children were evaluated. The results showed that a unidimensional one‐factor solution for the ECBI intensity scale was the best fit for the data. The ECBI mean scores were considerably higher in our sample compared to other Nordic countries. Boys scored higher than girls on both ECBI scales, and the mean scores decreased with child's age. Socioeconomic status (SES) was weakly connected to the ECBI scores. Our results highlight the need for country specific reference norms in order to improve the clinical utility of evidence‐based measures for assessing conduct problems.     

The Better Beginnings,Better Futures Project: Long‐term Parent,Family, and Community Outcomes of a Universal,Comprehensive, Community‐Based Prevention Approach for Primary School Children and their Families

Better Beginnings, Better Futures is a large‐scale, multi‐year, longitudinal research‐demonstration project designed to reduce children's problems, promote healthy child development, and enhance family and community environments in three economically disadvantaged communities in the province of Ontario, Canada. The initial intervention was implemented from 1993 to 1997 and focused on families with children from 4 to 8 years of age in their first 4 years of schooling (from Junior Kindergarten to Grade 2). This study examined the long‐term parent, family and community programme outcomes, 15 years after the start of the intervention, when the young people who had participated in the intervention as young children were 18 to 19 years of age. Comparison of intervention communities with matched non‐intervention communities showed a mix of outcomes. Although few significant differences between intervention and comparison communities were found with regard to parents' health and family outcomes, there was evidence that parents in the intervention communities were engaging in fewer risk behaviours, had lower levels of depression and had more community involvement than parents in the comparison communities. These results suggest that the intervention did have some positive long‐term effects on youths' parents and on their community environments. Results are discussed with respect to the importance of considering family and neighbourhood contexts in the development and evaluation of prevention programmes. Copyright © 2012 John Wiley & Sons, Ltd.     

Understanding teachers' perceptions of the motor difficulties of children with developmental coordination disorder (DCD)

Background. Children with developmental coordination disorder (DCD) are often identified by classroom teachers and the identification process relies heavily on teachers' perceptions. The literature would suggest that teachers' perceptions may be influenced by a child's gender, behaviour and the type of motor problem they demonstrate. To date, the influence of these factors on teachers' perceptions of children with DCD has not been empirically tested. Aim. This study investigated whether child gender, behaviour and type of motor problem influenced teachers' ratings of concern and importance of intervening for children with motor difficulties. Sample. One hundred and forty‐seven teachers of children from 6 to 9 years of age participated in this study. Method. Hypothetical case scenarios were developed that experimentally manipulated the factors of child gender (male/female), behaviour (disruptive/non‐disruptive) and type of motor problem (fine motor/gross motor). Teachers were given two case scenarios of the same gender (that varied by behaviour) and rated: (a) their degree of concern about children's motor problems and (b) how important they thought it was for the child to receive intervention for that problem. Results. The effect of child gender on teachers' perceptions depends upon the type of motor problem. While child behaviour had a marginal influence on teachers' perceptions, interestingly, teachers appeared to recognize motor problems only in the absence of disruptive behaviour. The type of motor problem demonstrated also influenced teachers' perceptions. Conclusion. This study provides preliminary insight into factors that influence teachers' perceptions of children with DCD with clear implications for the classroom identification of children with DCD.     

Effects of a Danish Student‐Centered Prosocial Intervention Program Among Japanese Children

Japan and Denmark represent two different educational cultures. Where Danish students in general report high scores on self‐esteem, Japanese children report low. A student‐centered and interaction‐based prosocial intervention program that was designed according to Danish educational culture was administered to children aged 11–12 years in Japan. Questionnaires measuring the children's quality of life (QoL) and metacognitive awareness were applied. Overall, the results showed that the student‐centered intervention improved the emotional well‐being aspect of QoL among Japanese boys. In contrast, Japanese boys’ scores on the declarative knowledge of metacognitive regulation declined. The teachers’ attitudes towards the intervention program were analyzed by use of interviews. The effect of the student‐centered intervention program is discussed with respect to the educational cultures in Japan.     

Child's behaviour in mother–child interaction predicts later emotional and behavioural problems

The aims were to examine the association of maternal or child interactive behaviour with emotional and behavioural problems of the child simultaneously and 3 years later, and to assess whether there is continuity in children's emotional and behavioural symptoms from 2 to 5 years. Sixty‐five 2‐year‐old children with their mothers were videotaped during a feeding situation. Their mothers completed the CBCL at 2 years and when the children were 5. Simultaneously, there were no strong correlations between child's emotional and behavioural problems and maternal or child interactive behaviour. Subsequently, mothers' higher sensitivity and more optimal structuring, as well as child's higher involvement of the mother, were associated with lower levels of child externalizing and total problem scores. Also, less responsive children showed more externalizing symptoms 3 years later. There was continuity of emotional and behavioural problems from 2 to 5 years. Problems in mother–child interaction may predict behavioural problems in the child subsequently. Besides maternal behaviour, it is important to consider the interactive behaviour of the child. Children who are less responsive and who show less involvement of the mother are more likely to subsequently present more externalizing symptoms, and these children should be recognized and treated early. Copyright © 2009 John Wiley & Sons, Ltd.