Identifying infants at risk of sudden unexpected death with an automated predictive risk model.

BACKGROUND/OBJECTIVE: Sudden unexpected infant death (SUID) is a common cause of infant death. We evaluated whether a predictive risk model (PRM) - Hello Baby - which was developed to stratify children by risk of entry into foster care could also identify infants at highest risk of SUID and non-fatal unsafe sleep events. PARTICIPANTS AND SETTING: Cases: Infants with SUID or an unsafe sleep event over 5½ years in a single county. CONTROLS: All births in the same county. METHODS: Retrospective case-control study. Demographic and clinical data were collected and a Hello Baby PRM score was assigned. Descriptive statistics and the predictive value of a PRM score of 20 were calculated. RESULTS: Infants with SUID (n = 62) or an unsafe sleep event (n = 37) (cases) were compared with 23,366 births (controls). Cases and controls were similar for all demographic and clinical data except that infants with unsafe sleep events were older. Median PRM score for cases was higher than controls (17.5 vs. 10, p < 0.001); 50 % of cases had a PRM score 17-20 vs. 16 % of controls (p < 0.001). CONCLUSIONS: The Hello Baby PRM can identify newborns at high risk of SUID and non-fatal unsafe sleep events. The ability to identify high-risk newborns prior to a negative outcome allows for individualized evaluation of high-risk families for modifiable risk factors which are potentially amenable to intervention. This approach is limited by the fact that not all counties can calculate a PRM or similar score automatically.

Transactional Associations Among Maternal Depression, Parent-Child Coercion, and Child Conduct Problems During Early Childhood.

Maternal depression is among the most consistent and well-replicated risk factors for negative child outcomes, particularly in early childhood. Although children of depressed mothers are at an increased risk of adjustment problems, conversely, children with emotional or behavioral problems also have been found to adversely compromise maternal functioning, including increasing maternal depression. The purpose of this investigation was to examine transactional associations among maternal depression, parent-child coercive interaction, and children's conduct and emotional problems in early childhood using a cross-lagged panel model. Participants were 731 toddlers and families that were part of the Early Steps Multisite Study, a sample of diverse ethnic backgrounds and communities (i.e., rural, urban, suburban) recruited from Women, Infants, and Children Nutritional Supplement Centers. Analyses provided support for the existence of some modest transactional relations between parent-child coercion and maternal depression and between maternal depression and child conduct problems. Cross-lagged effects were somewhat stronger between children age 2-3 than age 3-4. Similar patterns were observed in the model with child emotional problems replacing conduct problems, but relations between coercion and maternal depression were attenuated in this model. In addition, the transactional hypothesis was more strongly supported when maternal versus secondary caregiver reports were used for child problem behavior. The findings have implications for the need to support caregivers and reinforce positive parenting practices within family-centered interventions in early childhood.

Early Childhood Predictors of Severe Youth Violence in Low-Income Male Adolescents.

Using a cohort of 310 low-income male adolescents living in an urban community and followed prospectively from 18 months through adolescence (ages 15-18 years), the current study examined whether individual, family, and community risk factors from ages 18 to 42 months were associated with adolescents' violent behavior, as indexed by juvenile petitions. Results of multivariate analyses indicated that although family income was the only factor to discriminate those with no arrest record from those with nonviolent arrests, rejecting parenting, child oppositional behavior, emotion regulation, and minority status during the toddler period contributed unique variance in distinguishing male adolescents arrested for violent behavior compared to those never arrested and those arrested for nonviolent behavior. Implications for prevention efforts are discussed.

Transactional effects among maternal depression, neighborhood deprivation, and child conduct problems from early childhood through adolescence: A tale of two low-income samples.

The current study sought to advance our understanding of transactional processes among maternal depression, neighborhood deprivation, and child conduct problems (CP) using two samples of low-income families assessed repeatedly from early childhood to early adolescence. After accounting for initial levels of negative parenting, independent and reciprocal effects between maternal depressive symptoms and child CP were evident across both samples, beginning in early childhood and continuing through middle childhood and adolescence. In addition, neighborhood effects were consistently found in both samples after children reached age 5, with earlier neighborhood effects on child CP and maternal depression found in the one exclusively urban sample of families with male children. The results confirm prior research on the independent contribution of maternal depression and child CP to the maintenance of both problem behaviors. The findings also have implications for designing preventative and clinical interventions to address child CP for families living in high-risk neighborhoods.

Warm Parenting and Effortful Control in Toddlerhood: Independent and Interactive Predictors of School-Age Externalizing Behavior.

Externalizing symptoms, such as aggression, impulsivity, and inattention, represent the most common forms of childhood maladjustment (Campbell et al. Development and Psychopathology, 12, 467-488, 2000). Several dimensions of parenting behavior, including overreactive and warm parenting, have been linked to children's conduct problems. However, the majority of these studies involve biologically-related family members, thereby limiting understanding of the role of genetic and/or environmental underpinnings of parenting on child psychopathology. This study extends previous research by exploring associations between overreactive and warm parenting during toddlerhood and school-age externalizing problems, as well as the potential moderating effects of child effortful control (EC) on such associations using a longitudinal adoption design. The sample consisted of 225 adoption-linked families (adoptive parents, adopted child [124 male and 101 female] and birth parent[s]), thereby allowing for a more precise estimate of environmental influences on the association between parenting and child externalizing problems. Adoptive mothers' warm parenting at 27 months predicted lower levels of child externalizing problems at ages 6 and 7. Child EC moderated this association in relation to teacher reports of school-age externalizing problems. Findings corroborate prior research with biological families that was not designed to unpack genetic and environmental influences on associations between parenting and child externalizing problems during childhood, highlighting the important role of parental warmth as an environmental influence.

Resilience in the Offspring of Depressed Mothers: Variation Across Risk, Domains, and Time.

Considerable research has demonstrated that maternal depression is a significant risk factor for emotional and behavioral problems in children and adolescents (Goodman and Gotlib in Psychol Rev 106:458-490, 1999). It is important to note, however, that most children of depressed parents do not develop problems. This review will examine studies of resilience as they relate to the degree to which positive adjustment occurs across different levels of risk (i.e., severity and chronicity of depression as well as in context of multiple risk factors), domains of adjustment, and time. Understanding the phenomenon of resilience to depression is of critical importance to prevention and intervention experts because it may provide insight into processes that can be enhanced and targeted in prevention approaches among high-risk populations.

A family-based intervention for improving children's emotional problems through effects on maternal depressive symptoms.

OBJECTIVE: This study focused on whether a brief family-based intervention for toddlers, the Family Check-Up (FCU), designed to address parent management skills and prevent early conduct problems, would have collateral effects on maternal depressive symptoms and subsequent child emotional problems. METHOD: Parents with toddlers were recruited from the Women, Infants, and Children Nutritional Supplement Program based on the presence of socioeconomic, family, and child risk (N = 731). Families were randomly assigned to the FCU intervention or control group with yearly assessments beginning at child age 2. Maternal depressive symptoms were measured using the Center for Epidemiological Studies Depression Scale at child ages 2 and 3. Child internalizing problems were collected from primary caregivers, alternative caregivers, and teachers using the Child Behavior Checklist at ages 7.5 and 8.5. RESULTS: Structural equation models revealed that mothers in families randomly assigned to the FCU showed lower levels of depressive symptoms at child age 3, which in turn were related to lower levels of child depressed/withdrawal symptoms as reported by primary caregivers, alternative caregivers, and teacher at ages 7.5-8.5. CONCLUSIONS: Findings suggest that a brief, preventive intervention improving maternal depressive symptoms can have enduring effects on child emotional problems that are generalizable across contexts. As there is a growing emphasis for the use of evidence-based and cost-efficient interventions that can be delivered in multiple delivery settings serving low-income families and their children, clinicians and researchers welcome evidence that interventions can promote change in multiple problem areas. The FCU appears to hold such promise.