Mental health of outpatient pediatric patients.

The purpose of this study is to estimate the percentage of mental health problems in a pediatric outpatient Norwegian clinic. We used the Strengths and Difficulties Questionnaire to screen for mental health problems. Families of children aged 4-11 took part in the study, and 380 out of 982 possible families consented to take part, and 349 families contributed with questionnaire data. The main referral reasons for the patients were asthma, eneuresis and stomach pain. Mothers reported that 17.4% of boys and 17.8% of girls displayed mental clinical problems. The prevalence of problems did not differ significantly between somatic diagnostic groups. Although the study has low participation, it underlines the necessity of screening all pediatric patients for mental health problems. Future research in pediatric clinics should include factors of psychology because pediatric problems are not caused by somatics alone.

Early intervention influences positively quality of life as reported by prematurely born children at age nine and their parents; a randomized clinical trial.

BACKGROUND: The Tromsø Intervention Study on Preterms evaluates an early, sensitizing intervention given to parents of prematurely born children (birth-weight < 2000 g). The current study investigated the potential influence of the intervention on children's self-reported and parental proxy-reported quality of life (QoL) at children's age of nine. METHODS: Participants were randomized to either intervention (PI, n = 72) or preterm control (PC, n = 74) in the neonatal care unit, while healthy term-born infants were recruited to a term reference group (TR, n = 75). The intervention was a modified version of the Mother-Infant Transaction Program, and comprised eight one-hour sessions during the last week before discharge and four home visits at 1, 2, 4 and 12 weeks post-discharge. The two control groups received care in accordance with written guidelines drawn up at the hospital. Participants and parents reported QoL independently on the Kinder Lebensqualität Fragebogen (KINDL) questionnaire. Differences between groups were analyzed by SPSS; Linear Mixed Models and parent-child agreement were analyzed and compared by intra-class correlations within each group. RESULTS: On average, children in all groups reported high levels of well-being. The PI children reported better physical well-being than the PC children (p = 0.002). In all other aspects of QoL both the PI and the PC children reported at similar levels as the term reference group. PI parents reported better emotional wellbeing (p = 0.05) and a higher level of contentment in school (p = 0.003) compared with PC parents. Parent-child agreement was significantly weaker in the PI group than in the PC group on dimensions such as emotional well-being and relationships with friends (p < 0.05). PI parents reported QoL similar to parents of terms on all aspects except the subscale self-esteem, while PC parents generally reported moderately lower QoL than TR parents. CONCLUSIONS: This early intervention appears to have generated long-lasting positive effects, improving perceived physical well-being among prematurely born children and parent's perception of these children's QoL in middle childhood. TRIAL REGISTRATION: Clinical Trials Gov NCT00222456 .

Does An Early Intervention Influence Behavioral Development Until Age 9 in Children Born Prematurely?

This study examined whether the Mother-Infant Transaction Program prevents behavioral problems among preterm children (birth weight < 2000 g) until age 9. The program was administered to 72 preterms, while 74 preterms and 75 full-terms formed control groups (N = 221). Behavior was reported by parents (Child Behavior Checklist) and teachers (Teachers Report Form) and by all on selected Strengths and Difficulties Questionnaire (SDQ) questions. Long-term behavioral development appeared to be qualitatively unaffected by the intervention. At ages 7 and 9, fewer attention problems and better adaptation to school were reported from parents and teachers of the intervention group compared to preterm controls. At age 9, teachers reported fewer difficulties in the intervention group and better academic performance. In these areas they were reported as being at the statistically same level as term controls.

Do antenatal and postnatal parental psychological distress, and recognized need of help predict preadolescent's psychiatric symptoms? The Finnish Family Competence Cohort study.

In a prospective population-based study, mothers and fathers of 1,247 children reported their physical and mental health during pregnancy, after delivery, within the child's first 18 months of life, and at 12 years. Additionally, maternal health clinic nurses rated parents' well-being and perceived need for support. At age 12, child outcomes were also measured using CBCL and YSR externalizing and internalizing scales. Results indicate that both ante- and postnatal maternal distress predicted future externalizing problems in offspring. Conversely, fathers' postnatal distress predicted subsequent internalizing problems. Furthermore, mother's depressed mood in the first trimester best predicted the child's externalizing problems at age 12. Nurses's ratings of mother's antenatal and perinatal need for support, perinatal distress, and family's need for support were associated with both internalizing and externalizing problems at age 12. Maternal antenatal distress increases the risk of offspring's externalizing problems in preadolescense, and postnatal distress in either parent increases the risk of internalizing problems. Parental self-reports and indirect ratings from health care providers during pregnancy and infancy may therefore reliably recognize offspring at risk for subsequent psychiatric symptomatology.

What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide "From A Boy To A Man" birth cohort study.

OBJECTIVE: The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort. METHOD: The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old. RESULTS: One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes. CONCLUSIONS: Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.

Do adolescents exposed to peer aggression at school consider themselves to be victims of bullying? The influence of sex and age.

INTRODUCTION: Exposure to peer aggression (PA) and bullying victimization (BV) are both expressions of peer victimization. OBJECTIVES: In four age-sex groups, (1) Can exposure to PA and BV be considered distinct experiences? (2) To what extent do adolescents exposed to PA consider themselves bullying victims? and (3) What is the effect on BV of the number of PA events experienced? METHODS: This cross-sectional study evaluated a probabilistic community-based sample of 669 adolescents (11-15 years, 51.7% girls). A three-stage probabilistic sampling plan involved random selection of census units, eligible households, and one target child per household selected. A 15-item scale investigated exposure to PA events (physical aggression, verbal harassment, social manipulation) occurring more than once in the past six months. BV occurring more than once a week or most days in the past six months was investigated after presenting respondents with a BV definition that required them to feel harmed by their victimization experiences. RESULTS: Adolescents exposed to PA and/or BV reported PA only (76.2%), BV only (4.7%), and both (19.1%). Rates of BV among those exposed to PA were as follows: 11-to-12-year-old boys (22.7%), 13-to-15-year-old boys (9.7%), 11-to-12-year-old girls (46.5%), and 13-to-15-year-old girls (13.2%). Multiple logistic regression analysis (outcome = BV) found a significant interaction between PA, age, and sex. PA events had a significant effect on BV for all except older girls. CONCLUSION: Exposure to PA and BV are different constructs; few older boys exposed to PA consider themselves bullying victims; and older girls are less affected by PA when it comes to BV.

Bullying at age eight and criminality in adulthood: findings from the Finnish Nationwide 1981 Birth Cohort Study.

CONTEXT: There are no prospective population-based studies examining predictive associations between childhood bullying behavior and adult criminality. OBJECTIVE: To study predictive associations between bullying and victimization at age eight and adult criminal offenses. DESIGN: Nationwide birth cohort study from age 8 to 26 years. PARTICIPANTS: The sample consists of 5,351 Finnish children born in 1981 with information about bullying and victimization at age eight from parents, teachers, and the children themselves. MAIN OUTCOME MEASURES: National police register information about criminal offenses at age 23-26 years. RESULTS: When controlled for the parental education level and psychopathology score, bullying sometimes and frequently independently predicted violent (OR 3.9, 95% CI 1.9-7.9, p < 0.001; OR 2.5, 95% CI 1.6-4.1, p < 0.001, respectively), property (OR 2.3, 95% CI 1.2-4.7, p < 0.05; OR 1.7, 95% CI 1.1-2.7, p < 0.05), and traffic (OR 2.8, 95% CI 1.8-4.4, p < 0.001; OR 1.6, 95% CI 1.3-2.1, p < 0.001) offenses. The strongest predictive association was between bullying frequently and more than five crimes during the 4-year period (OR 6.6, 95% CI 2.8-15.3, p < 0.001) in adjusted analyses. When different informants were compared, teacher reports of bullying were the strongest predictor of adult criminality. In adjusted analyses, male victimization did not independently predict adult crime. Among girls, bullying or victimization at age eight were not associated with adult criminality. CONCLUSIONS: Bullying among boys signals an elevated risk of adult criminality.

Factors associated with reported childhood depressive symptoms at age 8 and later self-reported depressive symptoms among boys at age 18.

AIMS: This study aimed to study conditions associated with depressive symptoms at ages 8 and 18 in a representative birth cohort of Finnish males. METHODS: The participants in this community-based 10-year follow-up study consisted of 2,348 boys born in 1981. At age 8, three informant sources were used: parents, teachers, and the children themselves. Depressive symptoms were established using the Children's Depression Inventory (CDI). At age 18, self-report questionnaires were used to study the boys' family factors, life events, adaptive functioning, and substance use. Depressive symptoms at age 18 were established using Beck's Depression Inventory (BDI). RESULTS: Poor adaptive functioning at age 18 was independently associated with both child and late adolescent depressive symptoms. Use of illicit drugs and somatic health problems were independently associated with later depressive symptoms. Parental divorce in early childhood independently predicted depressive symptoms both in childhood and in late adolescence. Teacher reports of child's total problems at age 8 independently predicted depressive symptoms at age 18. CONCLUSIONS: Depression in males at ages 8 and 18 is particularly associated with stressful life events in childhood, whereas late depression is associated with somatic health problems and substance use. Further population-based studies comparing conditions associated with childhood and adolescent depression are needed.

A randomized study of the impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth weight preterm infants.

The background for this study was that nurturant child-rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child-rearing attitudes and early intervention (EI) in parents of LBW infants from 12-36 months corrected age. LBW infants (BW< 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in-hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child-rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child-rearing attitudes in mothers of preterms.

Childhood psychopathology and sense of coherence at age 18: findings from the Finnish from a boy to a man study.

OBJECTIVE: To examine associations between childhood psychopathology and family factors at age 8, and sense of coherence (SOC) at age 18. METHODS: The sample includes 2,314 Finnish boys born 1981 with information about psychopathology from parents and teachers using Rutter scales, and self-reports of depressive symptoms using Child Depression Inventory (CDI), and self-reports of SOC at age 18. RESULTS: Low parental education level and living in other than two biological parent family at age 8 were associated with low SOC 10 years later. Boys with internalizing symptoms based on parent/teacher reports, and depressive symptoms based on self-reports at age 8 were at risk for lower SOC at follow-up. Comorbidity of internalizing and conduct problems had the strongest association with low SOC. CONCLUSION: The study shows that internalizing symptoms, comorbid conduct and emotional problems, low parental education level and nonintact family at age 8 predict low SOC at age 18. Future research whether universal, selective or indicated early interventions targeted on risk factors of childhood mental health problems may result in promotion of well-being (including good SOC) in early adulthood is warranted.

Cross-informant correlations on social competence and behavioral problems in Sami and Norwegian preadolescents.

In a community-based birth cohort from Arctic Norway, correlations between parents and teachers on child competence and behavioral problems were determined for Sami and Norwegian 11-12 year-olds, using as instruments the child behavior checklist (CBCL), teacher report form (TRF), and the impact supplement of the extended strength and difficulties questionnaire (SDQ). Parent-teacher correlations on child behavioral problems were generally high in the Norwegian group, but low in the Sami group. Cross-cultural differences in cross-informant correlations were highest regarding externalizing and attention problems. Parent-teacher correlations on total impact of child difficulties also differed between the ethnic groups. Once again, a lower correlation was found for the Sami children. The discrepancy between parents' and teachers' perception of problems that needed attention was highest for the Sami, and lowest for the Norwegians. The Sami parents reported fewer perceived difficulties and less impact of problems than did the Norwegian parents. In contrast, no ethnic differences emerged for teachers' ratings. The paper discusses how cultural norms might influence the reports of child problems. It demonstrates the importance of combining parent and teacher reports of child behavior problems in minority and indigenous children, who often live under different cultural norms in home and school contexts.

Social competence and emotional/behavioral problems in a birth cohort of Sami and Norwegian preadolescents in Arctic Norway as reported by mothers and teachers.

In a 7-year follow-up birth cohort from the general population in the Sami core area in Finnmark, Arctic Norway, we examined mothers' and teachers' reports of social competence and emotional/behavioral problems among 71 indigenous Sami and 77 Norwegian 11-12-year-olds. The instruments used were the Child Behavior Checklist (CBCL) for parents and the Teacher Report Form (TRF). No ethnic differences were found on competence scales. Total Problems reported by Sami and Norwegian mothers were low in comparison with the overall mean found in multicultural meta-studies. Sami mothers reported lower Total Problems and Attention Problems than did Norwegian mothers. There were no ethnic differences on the TRF measures. Consistent with other international studies, mothers and teachers rated girls higher than boys on social competence and boys higher than girls on Externalizing and Attention Problems. Gender differences were larger on the TRF than on the CBCL. The very low problem ratings made by the Sami mothers indicate that there is a need for specific clinical cut-off points to distinguish between clinically referred and non-referred children in this indigenous Arctic population.

Does cyberbullying occur simultaneously with other types of violence exposure?

OBJECTIVE: Our study aimed to verify whether cyberbullying victimization among adolescents occurs concomitantly with other forms of violence exposure (at home, at school and in the community). METHODS: A collaborative longitudinal study by Norwegian and Brazilian researchers was conducted in Itaboraí, a low-income city in southeast Brazil. At baseline, trained interviewers applied a semi-structured questionnaire to a population-based sample of 669 in-school adolescents (11-15 years old). The investigated types of violence exposure included cyberbullying, traditional bullying, severe physical punishment by parents and community violence (victimization and eye-witnessed violent events outside the home and school). RESULTS: In the previous six months, 1.9% of the adolescents had been victims of cyberbullying, and 21.9% had been victims of physical aggression, verbal harassment and/or social manipulation by peers. However, only 5.5% of the adolescents considered themselves bullying victims. In the previous 12 months, 12.4% of adolescents had suffered severe physical punishment, 14.0% had been victims of community violence, and 20.9% eye-witnessed community violence. Multivariable regression analysis showed that victimization by multiple types of traditional bullying and self-perceived bullying victimization were correlates of cyberbullying victimization, while suffering violence at home and in the community were not. CONCLUSION: This study provides evidence of an association between cyberbullying, traditional bullying and self-perceived bullying among low-income Brazilian adolescents.

Stability and Change in Longitudinal Associations between Child Behavior Problems and Maternal Stress in Families with Preterm Born Children, Follow-Up after a RCT-Study.

The Tromsø Intervention Study on Preterms (TISP) randomized 146 preterm-born children either to the Mother-Infant Transaction Program (MITP) or to a preterm control group. Previously, significant reductions of child behavior problems and maternal stress have been reported in the intervention group. This follow-up study examines whether the MITP may have affected the longitudinal adaptation between mothers and their children from two until nine years, expressed as associations between different behavioral problems and parenting stress reported by mothers. Associations between internalizing, attentional, and social problems and different dimensions of parenting stress were analyzed in separate models that included effects of time and group status. The MITP did not influence the development of longitudinal associations as no significant three-way interaction (stress*group*time) was found. Significant stress by group interactions was only found in reports on children's attentional problems when analyzed with parent- or interaction-related stress. Mothers who had participated in the MITP reported weaker stress⁻behavior associations than control mothers. This effect was moderated by two independent variables, namely children's birthweight and years of maternal education for the parent⁻child difficult interaction stress.

A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years.

BACKGROUND: Preterm infants are at increased risk of cognitive, motor and behavioral problems. Different intervention programs have been designed in an attempt to improve outcome, but the results are conflicting. OBJECTIVE: To examine the effects of an early intervention program on cognitive, motor and behavioral problems and parenting stress among low birth weight children at 2 years corrected age. METHODS: A randomized controlled trial was conducted including infants with a birth weight <2000 g treated at the University Hospital of North Norway, to examine the effects of a modified version of the Mother-Infant Transaction Program on cognitive, motor and behavioral outcomes and parenting stress. The children were assessed with the Bayley Scales of Infant Development and the Child Behavior Checklist/2-3 (CBCL) and the Parenting Stress Index were administered to the parents at 2 years corrected age. RESULTS: Sixty-nine children in the intervention group and 67 in the control group were assessed at 2 years. There were no differences between the groups in cognitive or motor outcomes. The intervention group scored consistently lower on all CBCL syndrome scales, but no difference was significant. The mothers in the intervention group reported significantly lower parental stress in both child and parent domain, whereas the fathers reported lower stress in child domain compared to the control group. CONCLUSION: This early intervention program does not improve cognitive, motor or behavioral outcomes at 2 years. There was a significant reduction in parenting stress reported by both mothers and fathers in the intervention group.

Childhood bullies and victims and their risk of criminality in late adolescence: the Finnish From a Boy to a Man study.

OBJECTIVE: To study correlations of childhood bullying and victimization with juvenile criminality. DESIGN: Longitudinal birth cohort study from age 8 years to ages 16 to 20 years. SETTING: Population-based study from Finland. PARTICIPANTS: The sample comprised 2551 boys (86.6% of the original birth cohort) with complete information about bullying and victimization from parents, teachers, and children at age 8 years. MAIN OUTCOME MEASURE: Information about criminal offenses from the National Police Register at ages 16 to 20 years. RESULTS: Frequent bullies and those who frequently both bullied and were bullied (8.8% of the sample) were responsible for 33.0% of all juvenile crimes during the 4-year study period. Frequent bully-only status predicted both occasional and repeated offending, whereas bully-victim status predicted repeated offending. Bullying predicted most types of crime (violence, property, drunk driving, and traffic offenses) when controlled with parental education level. However, frequent bullies or victims without a high level of psychiatric symptoms were not at an elevated risk for later criminality. CONCLUSIONS: Boys who frequently bully are at risk for later criminality when this condition is accompanied by a high level of psychiatric symptoms. Frequent bullies should be actively screened for psychiatric problems.

Do adolescents exposed to peer aggression at school consider themselves to be victims of bullying? The influence of sex and age

Abstract Introduction Exposure to peer aggression (PA) and bullying victimization (BV) are both expressions of peer victimization. Objectives In four age-sex groups, (1) Can exposure to PA and BV be considered distinct experiences? (2) To what extent do adolescents exposed to PA consider themselves bullying victims? and (3) What is the effect on BV of the number of PA events experienced? Methods This cross-sectional study evaluated a probabilistic community-based sample of 669 adolescents (11-15 years, 51.7% girls). A three-stage probabilistic sampling plan involved random selection of census units, eligible households, and one target child per household selected. A 15-item scale investigated exposure to PA events (physical aggression, verbal harassment, social manipulation) occurring more than once in the past six months. BV occurring more than once a week or most days in the past six months was investigated after presenting respondents with a BV definition that required them to feel harmed by their victimization experiences. Results Adolescents exposed to PA and/or BV reported PA only (76.2%), BV only (4.7%), and both (19.1%). Rates of BV among those exposed to PA were as follows: 11-to-12-year-old boys (22.7%), 13-to-15-year-old boys (9.7%), 11-to-12-year-old girls (46.5%), and 13-to-15-year-old girls (13.2%). Multiple logistic regression analysis (outcome = BV) found a significant interaction between PA, age, and sex. PA events had a significant effect on BV for all except older girls. Conclusion Exposure to PA and BV are different constructs; few older boys exposed to PA consider themselves bullying victims; and older girls are less affected by PA when it comes to BV.

Cognitive outcome of early intervention in preterms at 7 and 9 years of age: a randomised controlled trial.

OBJECTIVE: Examine the effect of an early intervention programme on cognitive outcome at 7 and 9 years in children with birth weight (BW) <2000 g. DESIGN: A randomised controlled trial of a modified version of the Mother-Infant Transaction Program. SETTING: A single tertiary neonatal unit. PATIENTS: 146 infants were randomised into a preterm control group (74) or a preterm intervention group (72). INTERVENTIONS: The intervention consisted of eight sessions shortly before discharge and four home visits by specially trained nurses focusing on the infants' unique characteristics, temperament, developmental potential and the interaction between infants and parents. MAIN OUTCOME MEASURES: Outcomes were assessed with the Wechsler Intelligence Scale for Children (WISC-III). RESULTS: Mean BWs were 1396 (429) g in the intervention group and 1381(436) g in the control group. After adjusting for the possible clustering effects of twin pairs and maternal education, there were no significant differences in WISC-III scores at age 7 or 9. The mean difference was 4.1 points (95% CI -1.5 to 9.8 points) in favour of the intervention group at 7 years and 2.2 points (95% CI -3.4 to 7.6 points) at 9 years. At 7 years, a 6.8 points difference in the Verbal Comprehension Index (95% CI 0.5 to 13.0 points) was found in favour of the intervention group. Loss to follow-up at age 7 and 9 was 11% and 14%, respectively. CONCLUSIONS: This intervention programme did not have a sustained significant effect on overall cognitive outcomes in preterm children at age 7 and 9. TRIAL REGISTRATION NUMBER: The trial has been registered at http://www.clinicaltrials.gov (identifier NCT00222456).

Self-perceived peer harassment in a community sample of Norwegian school children.

OBJECTIVE: The experience of being harassed is associated with various forms of maladjustment. This study examined the prevalence of three domains of harassment, and their associations with emotional and behavioral problems. METHOD: A total of 4130 young people in 6th through 10th grade in 66 primary and secondary schools in Norway completed questionnaires on self-perceived harassment and emotional and behavioral problems. RESULTS: The structural psychometric properties of the scales of harassment showed an acceptable fit to the data. Boys reported more harassment on all items and domains than girls across grades. Strong associations between self-perceived harassment and psychiatric impact and behavioral and emotional problems, especially peer problems and conduct disorder, were revealed. DISCUSSION: The study adds to the understanding of the concept of harassment and its correlations with emotional and behavioral problems. The study underscores the importance of conducting routine screening in school as an important basis for the subsequent improvement in children's relationships.

Early intervention program reduces stress in parents of preterms during childhood, a randomized controlled trial.

BACKGROUND: It is well documented that heightened levels of parenting stress have a negative influence on children's socio-emotional and behavioral development. Parenting stress may therefore be regarded as an outcome variable in its own right. This study investigated whether a sensitizing intervention influences stress reported by parents of prematurely born children until the children were age nine. METHODS: Preterm infants (N = 146, birth weight <2,000 g) were randomized to intervention (N = 72) with the Mother-Infant Transaction Program (MITP) or a preterm control group (N = 74) that received standard hospital care. A term reference group comprised 75 healthy, full-term neonates. Parents reported on the Parenting Stress Index (PSI) when the children were 6 months, 1, 2, 3, 5, 7 years old and on the PSI-Short Form (PSI-SF) at age 9. Main outcomes were the mother's and father's reports of total, child and parent-related stress. Cross-sectional and longitudinal analyses were performed using linear mixed models (LMM), taking dependency in the data caused by twin pairs and repeated measures into account. Response rates were high across all follow-ups, and still reached 85% from mothers and 72% from fathers at 9 years. RESULTS: Mothers in the intervention group reported better longitudinal development of child-related stress than mothers of preterm controls, as they perceived their children as being more adaptable and less moody throughout childhood until the age of seven. Less stress in the intervention group was revealed by cross-sectional analysis of maternal reports at all ages, while fathers reported similar differences at ages three and five. Parents in the intervention group reported stronger agreement on several stress scores on several occasions. Fathers with high interventional participation (mean 54%) reported significantly less stress at age nine than those who participated less. Both parents in the intervention group reported levels of stress similar to those experienced by the term reference group at all follow-ups, while differences between the preterm control and term reference groups increased. CONCLUSIONS: This early intervention reduces stress among parents of prematurely born children to a level reported by parents of term-born children and enhances agreement between parents. TRIAL REGISTRATION: Clinical Trials Gov identifier NCT00222456, 05.09.2005.