Pleasure in parenting and father-child attachment security.

This study examined relations between father-child attachment security and both paternal sensitivity and fathers' pleasure in parenting. At 12 months of age sensitivity was coded from father-infant interactions and pleasure in parenting was coded from fathers' interviews assessing attitudes toward the parenting role. Father-child dyads participated in the Strange Situation Procedure assessing attachment relationship quality. Sensitivity was related to more pleasure in parenting, but neither variable alone predicted attachment security. However, pleasure in parenting moderated the association between sensitivity and attachment. Moreover, the concordance between sensitivity and pleasure in parenting differed markedly across attachment classifications. In secure relationships fathers showed strong concordance between sensitivity and pleasure in parenting. Fathers in avoidant relationships demonstrated high sensitivity coupled with low pleasure in parenting, whereas fathers in disorganized relationships showed low sensitivity coupled with high pleasure in parenting. Results speak to the importance of integrating cognitive, affective, and behavioral aspects of parenting in father-child attachment research.

Mothers' Physiological and Affective Responding to Infant Distress: Unique Antecedents of Avoidant and Resistant Attachments.

In a sample of 127 mother-infant dyads, this study examined the predictive significance of mothers' physiological and observed emotional responding within distressing and nondistressing caregiving contexts at 6 months for infant attachment assessed with Fraley and Spieker's (2003) dimensional approach and the categorical approach at 12 months. Findings revealed that a lesser degree of maternal respiratory sinus arrhythmia withdrawal and higher levels of maternal neutral (vs. positive) affect within distressing (vs. nondistressing) caregiving contexts were distinctive antecedents of avoidance versus resistance assessed dimensionally (but not categorically), independent of maternal sensitivity. Discussion focuses on the usefulness of examining mothers' physiological and affective responding, considering the caregiving context, and employing the dimensional approach to attachment in identifying unique antecedents of patterns of attachment insecurity.

Parenting and Cortisol in Infancy Interactively Predict Conduct Problems and Callous-Unemotional Behaviors in Childhood.

This study examines observed maternal sensitivity, harsh-intrusion, and mental-state talk in infancy as predictors of conduct problems (CP) and callous-unemotional (CU) behaviors in middle childhood, as well as the extent to which infants' resting cortisol and cortisol reactivity moderate these associations. Using data from the Family Life Project (n = 1,292), results indicate that maternal sensitivity at 6 months predicts fewer CP at first grade, but only for infants who demonstrate high levels of cortisol reactivity. Maternal harsh intrusion predicts fewer empathic-prosocial behaviors, a component of CU behaviors, but only for infants who demonstrate high resting cortisol. Findings are discussed in the context of diathesis-stress and differential susceptibility models.

Vagal Regulation in Breastfeeding Infants and Their Mothers.

Consistent with the gustatory-vagal hypothesis, vagal stimulation during breastfeeding may contribute to infants' physiological regulatory development independent of caregiving effects. This study examined whether breastfeeding predicted 6-month-old infants' (N = 151) and their mothers' vagal regulation during the face-to-face still-face (FFSF). Although breastfed and nonbreastfed infants showed expected vagal withdrawal during the Still-Face episode, only breastfed infants showed continued withdrawal during the reunion episode, suggesting greater physiological mobilization to repair the interaction. Breastfeeding mothers showed higher vagal tone than nonbreastfeeding mothers at baseline, suggesting greater capacity for regulation, and throughout the FFSF, suggesting calmer states. Breastfeeding effects were independent of maternal sensitivity. Findings suggest that infants' and mothers' physiological regulation may be shaped by breastfeeding independently of associated social factors.

The Interaction Between Child Respiratory Sinus Arrhythmia and Early Sensitive Parenting in the Prediction of Children's Executive Functions.

This study investigated the interaction between children's parasympathetic functioning and maternal sensitive parenting behaviors during infancy and toddlerhood in the prediction of children's executive functions (EF) at the age of 5 years. Participants included 137 children and their mothers who were followed from the age of 3 months to 5 years. Children's cardiac activity was recorded at rest at multiple times from ages 3 to 36 months, and estimates of respiratory sinus arrhythmia (RSA; a measure of parasympathetic functioning) were calculated. Sensitive parenting was assessed during a mother-child play task at ages 6, 12, 24, and 36 months, and 5 years. Children completed age appropriate EF tasks at the age of 5 years. The link between sensitive parenting during toddlerhood (ages 24 and 36 months) and children's later EF was moderated by children's RSA such that this positive link was evident only among children who had low levels of baseline RSA, and not among those who had high levels of baseline RSA. These findings were obtained while controlling for concurrent sensitive parenting and maternal and child verbal abilities. Results from this study provide evidence for the significant role of biopsychosocial processes in early childhood in the development of EF.

Associations between early caregiving and rural, low-SES, African-American children's representations of attachment relationships.

Little research has examined the legacy of early maternal care for later attachment representations among low-income and ethnic minority school-aged children. Using data from a sample of 276 rural, low-income, African-American families, this study examined associations between maternal care in infancy and children's representations of attachment figures in middle childhood. Maternal care was coded from 10-min home-based observations at 6, 15, and 24 months of age. Representations of attachment figures were assessed using the Manchester Child Attachment Story Task at 6 years of age. Sensitive maternal care in infancy was not significantly related to attachment security or episodic disorganized behaviors in children's representations. However, children exposed to more harsh-intrusive parenting during infancy displayed less secure representations of attachment figures in middle childhood and more episodic disorganized behaviors, even after controlling for numerous child and family contextual covariates. Findings inform conceptualizations of attachment formation among rural, low-income, African-American parent-child dyads.

Infant attachment disorganization and moderation pathways to level and change in externalizing behavior during preschool ages.

This research examined the child, parent, and family conditions under which attachment disorganization was related to both level and change in externalizing behavior during preschool among a community sample. Using the ordinary least squares regression, we found that attachment disorganization at 12 months significantly predicted children's externalizing behavior at 36 months and this prediction was not contingent on any other factors tested. For predicting changes in externalizing behavior from 36 to 60 months, we found a significant main effect of family cumulative risk and an interaction effect between attachment disorganization at 12 months and maternal sensitivity at 24 months. Specifically, high disorganization was related to a significant decrease in externalizing behavior from 36 to 60 months when maternal sensitivity at 24 months was high. Our main-effect findings replicated the significant effect of attachment disorganization and cumulative risk on externalizing behavior with preschool-aged children. Our interaction finding provided support for understanding the parenting conditions under which infant attachment disorganization may be related to change in externalizing behavior during preschool ages. Implications of the findings were discussed.

Mothers' and Fathers' Sensitivity and Children's Cognitive Development in Low-Income, Rural Families.

This study examines associations between maternal and paternal sensitive parenting and child cognitive development across the first 3 years of life using longitudinal data from 630 families with co-residing biological mothers and fathers. Sensitive parenting was measured by observational coding of parent-child interactions and child cognitive development was assessed with the Bayley Scales of Infant Development and the Wechsler Preschool and Primary Scales of Intelligence. There were multiple direct and indirect associations between parenting and cognitive development across mothers and fathers, suggesting primary effects, carry-forward effects, spillover effects across parents, and transactional effects across parents and children. Associations between parenting and cognitive development were statistically consistent across mothers and fathers, and the cumulative effects of early parenting on later cognitive development were comparable to the effects of later parenting on later cognitive development. As interpreted through a family systems framework, findings suggest additive and interdependent effects across parents and children.

The Interdependence of Adult Relationship Quality and Parenting Behaviours among African American and European Couples in Rural, Low-Income Communities.

The present study extends the spillover and crossover hypotheses to more carefully model the potential interdependence between parent-parent interaction quality and parent-child interaction quality in family systems. Using propensity score matching, the present study attempted to isolate family processes that are unique across African American and European American couples that are independent of other socio-demographic factors to further clarify how interparental relationships may be related to parenting in a rural, low-income sample. The Actor-Partner Interdependence Model (APIM), a statistical analysis technique that accounts for the interdependence of relationship data, was used with a sample of married and non-married cohabiting African American and European American couples (n = 82 dyads) to evaluate whether mothers' and fathers' observed parenting behaviours are related to their behaviours and their partner's behaviours observed in a couple problem-solving interaction. Findings revealed that interparental withdrawal behaviour, but not conflict behaviour, was associated with less optimal parenting for fathers but not mothers, and specifically so for African American fathers. Our findings support the notion of interdependence across subsystems within the family and suggest that African American fathers may be specifically responsive to variations in interparental relationship quality.

The Family Life Project: an epidemiological and developmental study of young children living in poor rural communities.

About 20% of children in the United States have been reported to live in rural communities, with child poverty rates higher and geographic isolation from resources greater than in urban communities. There have been surprisingly few studies of children living in rural communities, especially poor rural communities. The Family Life Project helped fill this gap by using an epidemiological design to recruit and study a representative sample of every baby born to a mother who resided in one of six poor rural counties over a 1-year period, oversampling for poverty and African American. 1,292 children were followed from birth to 36 months of age. This monograph described these children and used a cumulative risk model to examine the relation between social risk and children's executive functioning, language development, and behavioral competence at 36 months. Using both the Family Process Model of development and the Family Investment Model of development, observed parenting was examined over time in relation to child functioning at 36 months. Different aspects of observed parenting were examined as mediators/moderators of risk in predicting child outcomes. Results suggested that cumulative risk was important in predicting all three major domains of child outcomes and that positive and negative parenting and maternal language complexity were mediators of these relations. Maternal positive parenting was found to be a buffer for the most risky families in predicting behavioral competence. In a final model using both family process and investment measures, there was evidence of mediation but with little evidence of the specificity of parenting for particular outcomes. Discussion focused on the importance of cumulative risk and parenting in understanding child competence in rural poverty and the implications for possible intervention strategies that might be effective in maximizing the early development of these children.

Association between Maternal sensitivity and Externalizing Behavior from Preschool to Preadolescence.

Using data from the longitudinal NICHD Study of Early Child Care and Youth Development (N=1364), this study examined the association between mothers' sensitivity and children's externalizing behavior from preschool to preadolescence. Externalizing behavior declined on average across this period with a slowing of this decline around middle childhood. Maternal sensitivity remained relatively stable on average, and there was significant variation across mothers. A decrease in maternal sensitivity from ages 3 to 11 was related to an increase in externalizing behavior from ages 4 to 12. A model-based test of the direction of the effect suggested that the association between changes in maternal sensitivity and externalizing behavior from ages 4 to 11 was driven by child effects on mothers and not vice-versa. Between late preschool age and preadolescence, the behavior problems of children appear to strongly influence the sensitive support of mothers. Practical implications were discussed in light of these findings.

The effect of study design on the reporting of mortality due to colorectal cancer in adults with mental illness in Nova Scotia.

OBJECTIVE: Some studies suggest a higher case fatality from colorectal cancer (CRC) in psychiatric patients even though the incidence is no greater than in the general population. However, this finding is not universal and may be confounded by study design (for example, inception, compared with historical, cohort), mean cohort age, or delays in presentation with more advanced staging at diagnosis. We assessed how study design and cancer stage at presentation affected outcomes in psychiatric patients. METHODS: A retrospective historical cohort of CRC presentations was used comparing psychiatric patients with control subjects. Psychiatric status was defined by either health service use or psychotropic prescription, and outcomes by logistic or Cox proportional hazards regression. RESULTS: There were 3501 new presentations of CRC from 2001 to 2005. Psychiatric cases, as defined by in- or outpatient contacts, made up 15.9% (n = 558) of patients with CRC. There was no association between psychiatric status and stage at presentation, surgical intervention, or mortality after adjusting for confounders. There was a reduced likelihood of resection, an indicator of curative treatment, when on a selective serotonin reuptake inhibitor or serotonin noradrenergic reuptake inhibitor (n = 194; AOR 0.54; 95% CI 0.30 to 0.97) or antipsychotics (n = 28; AOR 0.27; 95% CI 0.08 to 0.92). CONCLUSIONS: The association between psychiatric status and CRC may vary by study design and how psychiatric status is defined. These factors should be considered when interpreting any association between mental illness and cancer. As in studies of all-cause and cardiac mortality, historical cohorts of prevalent psychiatric cases may be less sensitive than inception cohorts of new patients, possibly because the excess of deaths is greatest within 7 years of initial presentation for a psychiatric disorder.

Bidirectional Associations Among Sensitive Parenting, Language Development, and Social Competence.

Rapid changes in language skills and social competence, both of which are linked to sensitive parenting, characterize early childhood. The present study examines bidirectional associations among mothers' sensitive parenting and children's language skills and social competence from 24 to 36 months in a community sample of 174 families. In addition, this study examines how these developmental pathways vary by child sex. Findings indicate stability across time in sensitive parenting, expressive language skills, and social competence, as well as positive main effects of sensitive parenting on expressive and receptive language skills for girls and boys. We find mixed evidence over time of reciprocal links between social competence and sensitive parenting. Further, boys' receptive language skills at 24 months uniquely contribute to increases in mothers' observed sensitive parenting from 24 to 36 months. These findings highlight the utility of applying transactional frameworks to the study of sex-based differences in early developmental processes.

Salivary cortisol mediates effects of poverty and parenting on executive functions in early childhood.

In a predominantly low-income population-based longitudinal sample of 1,292 children followed from birth, higher level of salivary cortisol assessed at ages 7, 15, and 24 months was uniquely associated with lower executive function ability and to a lesser extent IQ at age 3 years. Measures of positive and negative aspects of parenting and household risk were also uniquely related to both executive functions and IQ. The effect of positive parenting on executive functions was partially mediated through cortisol. Typical or resting level of cortisol was increased in African American relative to White participants. In combination with positive and negative parenting and household risk, cortisol mediated effects of income-to-need, maternal education, and African American ethnicity on child cognitive ability.

Maternal sensitivity buffers the adrenocortical implications of intimate partner violence exposure during early childhood.

This study prospectively examined the effect of intimate partner violence (IPV) on adrenocortical reactivity and recovery during early childhood. The sample (n = 1102 mother-infant dyads; 49.2% male) was racially diverse and from predominantly low-income, rural communities. To measure IPV exposure mothers completed the Conflicts Tactics Scale, and her caretaking behaviors were observed when her child was approximately 7, 15, and 24 months of age. Children's saliva samples, later assayed for cortisol, were collected around challenge tasks designed to elicit emotional reactivity. IPV was related to a trajectory of increased cortisol reactivity from infancy to toddlerhood. By contrast, the trajectory for non-IPV-exposed children decreased in cortisol reactivity across 7 to 24 months of age. At the 24-month assessment, on average, toddlers did not exhibit a cortisol reaction; however, those exposed to high levels of violence continued to have reactivity. Accumulative levels of IPV across the first 2 years of life predicted cortisol reactivity at 24 months of age. Early (7-month) sensitive maternal behavior moderated this relationship, so that only children exposed to both early insensitivity and high accumulated IPV exhibited increased reactivity at the 24-month assessment. Findings are discussed in relation to the risky family framework.

Interparental aggression, attention skills, and early childhood behavior problems.

The current study explored longitudinal associations between interparental aggression, the development of child attention skills, and early childhood behavior problems in a diverse sample of 636 families living in predominately low-income, nonmetropolitan communities. The results of latent-variable, cross-lagged longitudinal models revealed that maternal-reported interparental aggression in infancy predicted reduced observed attention skills in toddlerhood; no association was observed, however, between attention in infancy and interparental aggression during the toddler years. Further, reduced toddler attention and high interparental aggression were both associated with increased risk for attention-deficit/hyperactivity disorder symptoms and conduct problems at 3 years of age. Processes largely operated in similar ways regardless of child gender or low-income status, although a few differences were observed. Overall, the results suggest that interparental aggression undermines attention development, putting children's early behavioral adjustment at risk.

Adult Attachment Style and Stress as Risk Factors for Early Maternal Sensitivity and Negativity.

The current study examined the individual and joint effects of self-reported adult attachment style, psychological distress, and parenting stress on maternal caregiving behaviors at 6 and 12 months of child age. We proposed a diathesis-stress model to examine the potential deleterious effects of stress for mothers with insecure adult attachment styles. Data from 137 mothers were gathered by the longitudinal Durham Child Health and Development Study. Mothers provided self-reports using Hazan and Shaver's (1987) Adult Attachment Style measure, the Brief Symptom Inventory, and the Parent Stress Inventory; observations of parenting data were made from 10-minute free play interactions. Consistently avoidant mothers were less sensitive with their infants than consistently secure mothers; however, this effect was limited to avoidant mothers who experienced elevated levels of psychological distress. Results suggest that the association between insecure adult attachment style and insensitive parenting behavior is moderated by concurrent psychosocial stress. Clinical implications for these findings are discussed.

Systems theory and cascades in developmental psychopathology.

In the wake of prominent theoreticians in developmental science, whose contributions we review in this article, many developmental psychologists came to endorse a systems approach to understanding how the individual, as it develops, establishes functional relationships to social ecological contexts that from birth to school entry rapidly increase in complexity. The concept of developmental cascade has been introduced in this context to describe lawful processes by which antecedent conditions may be related with varying probabilities to specified outcomes. These are understood as processes by which function at one level or in one domain of behavior affect the organization of competency in later developing domains of general adaptation. Here we propose a developmental sequence by which the developing child acquires regulative capacities that are key to adjustment to a society that demands considerable control of emotional and cognitive functions early in life. We report empirical evidence showing that the acquisition of regulative capacities may be understood as a cascade of shifts in control parameters induced by the progressive integration of biological, transactional, and socioaffective systems over development. We conclude by suggesting how the developmental process may be accessed for effective intervention in populations deemed "at risk" for later problems of psychosocial adjustment.

Do the Health of the Nation Outcome Scales measure outcome?

OBJECTIVE: Among mental health outcome measures that have been developed for routine use, most of the information concerns the Health of the Nation Outcome Scales (HoNOS). This instrument is widely used in Europe, Australia, and New Zealand, but not in Canada. We tested its sensitivity and predictive validity under conditions that would resemble, as closely as possible, routine use. METHOD: Treating clinicians were asked to assess patients of all ages referred to outpatient mental health facilities of 2 district health authorities in Nova Scotia using either the HoNOS for adults or the HoNOS for Children and Adolescents (HoNOSCA). Data were entered using the existing routine administrative data system. RESULTS: We obtained at least 1 rating on 4620 patients, giving a completion rate of 82%. On follow-up, ratings for the global score and most of the individual items were sensitive to change (n = 808). After adjusting for confounders, a baseline HoNOS score was significantly associated with subsequent in and outpatient service use including admissions, bed days, and psychiatric contacts (n = 1359). CONCLUSIONS: HoNOS has satisfactory sensitivity and predictive validity for routine use. We could introduce the adult version and HoNOSCA simultaneously and collect data using routine databases. Given the widespread routine use of HoNOS internationally, using the same outcome measure in Canada would enable comparisons of illness severity and outcomes between jurisdictions.

Mother-infant vagal regulation in the face-to-face still-face paradigm is moderated by maternal sensitivity.

Parents' physiological regulation may support infants' regulation. Mothers (N= 152) and 6-month-old male and female infants were observed in normal and disrupted social interaction. Affect was coded at 1-s intervals and vagal tone measured as respiratory sinus arrhythmia (RSA). Maternal sensitivity was assessed in free play. Mothers and infants showed opposite patterns of RSA change. During disrupted interaction, mothers' RSA increased and infants' decreased, suggesting self-regulation of distress. During reunion, although the typical pattern was for infants to return to baseline levels, infants of sensitive mothers and sensitive mothers both showed a significant decrease in RSA from baseline. Mothers' and infants' physiological responses may be a function of mutual responsiveness.