"Crippling and unfamiliar": Analysing the concept of perinatal anxiety; definition, recognition and implications for psychological care provision for women during pregnancy and early motherhood.

AIM: To clarify how perinatal anxiety is characterised within the current evidence base and discuss how a clearer definition and understanding of this condition may contribute to improving care provision by midwives and other healthcare professionals. BACKGROUND: Perinatal anxiety is common, occurs more frequently than depression and carries significant morbidity for mother and infant. The concept of perinatal anxiety is ill-defined; this can pose a barrier to understanding, identification and appropriate treatment of the condition. DESIGN: Concept Analysis paper. METHOD: Rodgers' Evolutionary Model of Concept Analysis, with review based on PRISMA principles (see Supplementary File-1). FINDINGS: While somatic presentation of perinatal anxiety shares characteristics with general anxiety, anxiety is a unique condition within the context of the perinatal period. The precursors to perinatal anxiety are grounded in biopsychosocial factors and the sequelae can be significant for mother, foetus, newborn and older child. Due to the unique nature of perinatal anxiety, questions arise about presentation and diagnosis within the context of adjustment to motherhood, whether services meet women's needs and how midwives and other health professionals contribute to this. Most current evidence explores screening tools with little examination of the lived experience of perinatal anxiety. CONCLUSION: Examination of the lived experience of perinatal anxiety is needed to address the gap in evidence and further understand this condition. Service provision should account for the unique nature of the perinatal period and be adapted to meet women's psychological needs at this time, even in cases of mild or moderate distress.

Enhancing Parent-Child Communication and Parental Self-Esteem With a Video-Feedback Intervention: Outcomes With Prelingual Deaf and Hard-of-Hearing Children.

Evidence on best practice for optimizing communication with prelingual deaf and hard-of-hearing (DHH) children is lacking. This study examined the effect of a family-focused psychosocial video intervention program on parent-child communication in the context of childhood hearing loss. Fourteen hearing parents with a prelingual DHH child (Mage = 2 years 8 months) completed three sessions of video interaction guidance intervention. Families were assessed in spontaneous free play interactions at pre and postintervention using the Emotional Availability (EA) Scales. The Rosenberg Self-esteem Scale was also used to assess parental report of self-esteem. Compared with nontreatment baselines, increases were shown in the EA subscales: parental sensitivity, parental structuring, parental nonhostility, child responsiveness, and child involvement, and in reported self-esteem at postintervention. Video-feedback enhances communication in families with prelingual DHH children and encourages more connected parent-child interaction. The results raise implications regarding the focus of early intervention strategies for prelingual DHH children.

Video feedback intervention: a case series in the context of childhood hearing impairment.

BACKGROUND: Recent research shows that parental sensitivity can explain a significant and unique amount of growth in speech and language outcomes in children with cochlear implants. In this intervention study we explored the impact of an intervention designed to support parental sensitivity on children's communication development. AIMS: This study tests the effect of a complex intervention in the context of childhood hearing impairment using a case study design of three families. Propositions for each case were made using parental report of the child's development in an attempt to identify change in outcome measurements that were not likely to be due to general development in the child or a halo effect from the intervention. METHODS AND RESULTS: Multiple pre- and post-intervention measures were taken. Outcome measures were mother-child contingencies to vocal utterances, emotional availability and an assessment of early communication in the child. Results for each case showed that improvements in some outcome measurements were found after the intervention and were maintained at follow-up. CONCLUSIONS & IMPLICATIONS: Taking account of developmental change in intervention studies with children is challenging. Single-subject intervention studies can be designed to allow research interventions to be tailored to meet families' specific needs. Video interaction guidance may support pre-linguistic communicative development in children with hearing impairment.

Communication Skills and Communicative Autonomy of Prelinguistic Deaf and Hard-of-Hearing Children: Application of a Video Feedback Intervention.

BACKGROUND AND AIM: Evidence on the efficacy of parenting interventions to support communication development in deaf and hard-of-hearing children is emerging. In previous research, we showed that parental participation in a video feedback-based intervention enhanced parental self-esteem and emotional availability to their deaf and hard-of-hearing children. This paper investigates the impact of the intervention on the development of the children's prelingual communication skills and autonomy. Evidence on the efficacy of parenting interventions to support communication development is warranted. METHODS: Sixteen hearing parents with a prelingual deaf and hard-of-hearing child (Mage = 2.05 years, SD = 1.77) were recruited by self-selection from pediatric audiological services and randomly stratified into intervention-first and waiting-list groups. Families completed three sessions of Video Interaction Guidance in their homes. Designed for maximal inclusion, the sample comprised children with complex developmental and social needs. The primary inclusion criterion was the child's prelingual status (<50 signed/spoken words), which was established using speech and language therapy reports. Child communicative autonomy was assessed from a 20 min free-play video recording using a gold standard measure for deaf and hard-of-hearing children (Tait) before and after the intervention. RESULTS: A Mann-Whitney U test indicated no significant difference between the two groups. The groups were collated, and a Wilcoxon signed-rank test with time (pre-/post-intervention) as a repeating variable was run. A significant increase in children's communicative autonomy (Z = -3.517, p < 0.0001, d = 0.62) and decrease in children's no-responses (Z = -3.111, p < 0.005, d = 0.55) were seen. There was no significant difference in the overall number of turn-taking between the parent and child, indicating differences in the quality of the parent-child interactions, not the quantity. CONCLUSION: This study adds to the emerging evidence for parenting interventions with deaf and hard-of-hearing children. We hypothesize that the video feedback intervention with its focus on emotional availability created space for the children to show increased communicative autonomy during parent-child interactions. Communicative autonomy is a long-term predictor of communication and linguistic development in deaf and hard-of-hearing children, and its conceptual underpinning makes it a good early measure of relational agency. Results can inform wider interventions that focus on the quantity of the parent-child communication.