Impact of parent child interaction therapy on child eating behaviors.

BACKGROUND: Picky eating commonly co-occurs with disruptive behaviors in young children. While feeding interventions exist, it remains unknown whether unmodified behavioral parent training (BPT) improves maladaptive child eating. As coercive feeding practices may exacerbate picky eating, BPT could ameliorate associated behaviors by increasing authoritative parenting. METHODS: Caregiver-child dyads (N = 194, ages 2-8) received 18 weeks of Parent-Child Interaction Therapy (PCIT). Caregivers completed the Behavioral Pediatrics Feeding Assessment Scale (BPFAS) at pre-, mid-, and post-treatment. The BPFAS overall picky eating frequency and number of problems was examined, as well as the subscale of mealtime misbehaviors, and overall caregiver feeding practices. RESULTS: From pre-to post-treatment, reductions occurred in frequency/problems scales across overall BPFAS child behaviors. Mealtime misbehaviors significantly declined at all checkpoints - early skill acquisition may drive this early change, whereas changes in frequency/problem scales occurred after mid-treatment, suggesting later skill acquisition may be driving these changes. On the coercive caregiver feeding subscale, multivariate regression identified a significant race by time interaction (p = .02) - multiracial caregivers improved while others showed no difference. CONCLUSION: Standard PCIT, not adapted for feeding concerns, decreased maladaptive child eating behaviors across all caregivers and coercive feeding practices in multiracial caregivers. Authoritative parenting principles may generalize to eating contexts for certain cultural groups. PCIT shows promise as an early upstream intervention potentially changing trajectories without needed feeding content modifications. Assessment of long-term maintenance is warranted. Coupling with nutrition education could optimize impact.

Virtual robotic telepresence early childhood mental health consultation to childcare centers in the aftermath of COVID-19: training approaches and perceived acceptability and usefulness.

Introduction: Childcare center closures during COVID-19 impacted education for approximately 40 million children nationwide. Unfortunately, COVID-19 restrictions significantly limited the extent that outside personnel could provide in-person support to educators, resulting in the need for innovative approaches to meet childcare centers' needs. A virtual robotic telepresence approach was applied to early childhood consultation models to promote child resilience while mitigating COVID-19 risks. The goal of this study was to examine how training influenced consultants' and childcare staff uptake of the virtual robotic telepresence consultation approach and their acceptance of this technology. Methods: Ten early childhood consultants received multimedia/simulation training and weekly communities of practice related to virtual telepresence robotic consultation. Telepresence robotic consultation equipment was deployed to 16 childcare centers in a diverse multilingual metropolitan area as a part of a larger randomized controlled trial. Consultants trained childcare staff (14 center directors and 58 teachers) on how to receive virtual telepresence robotic consultation. Demographic information and measures of technology acceptability and uptake were collected from childcare staff and consultants. A mixed methods approach was used including multilevel modeling and focus groups to examine consultation uptake, acceptability, barriers, and facilitators of virtual telepresence robotic consultation implementation. Results: Consultants and childcare staff generally perceived the virtual telepresence consultation approach to be useful and easy to use. Consultant perceptions of the acceptability of technology did not change over time. Childcare staff, center, and consultant factors impacted the uptake of the virtual robotic telepresence consultation approach and childcare staff acceptance of the technology. Focus groups revealed that consultants believed that additional hands-on training with childcare staff would have benefited implementation and expressed a desire for a hybrid approach for consultation. Discussion: Perceptions of telepresence robotic consultation acceptability are discussed, including future recommendations for training.

Longitudinal effects of prenatal cocaine use on mother-child interactions at ages 3 and 5 years.

OBJECTIVE: To assess the effect of maternal prenatal and past-year cocaine use on mother-child interactions across preschool years. METHODS: The sample is drawn from the Miami Prenatal Cocaine Study, a longitudinal follow-up of prenatal cocaine exposure (PCE) in a large cohort of African-American infants prospectively enrolled at birth. Analyses are based on the 366 children (168 PCE and 198 non-cocaine-exposed) in the care of their biological mothers and with completed mother-child interaction measures at the 3- and/or 5-year assessments. Videotaped interactions were coded using a modified Egeland Teaching Task scheme. Generalized linear models with a generalized estimating equations approach were used to evaluate the effect of PCE on the overall quality of maternal-child interaction, measured by the Egeland total score at both study visits, and on the individual Egeland subscales at the 5-year visit, while adjusting for other suspected influences on interactions. RESULTS: PCE dyads demonstrated less optimal overall mother-child interactions compared with non-cocaine-exposed dyads. The estimated PCE-associated difference did not shift appreciably with statistical adjustment for child sex, child age at examination, or other birth covariates. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared with children with neither exposure. In subscale analyses, PCE was most strongly associated with greater maternal intrusiveness and boundary dissolution at the 5-year visit. CONCLUSIONS: Prenatal and past-year maternal cocaine use seems to be associated with poorer quality in mother-child interaction during early childhood. These dynamics should be considered when examining the association between PCE and child cognitive, behavioral, and academic outcomes.

Estimated effects of in utero cocaine exposure on language development through early adolescence.

The potential longitudinal effects of prenatal cocaine exposure (PCE) on language functioning were estimated from early childhood through early adolescence in a large, well-retained urban sample of 451 full-term children (242 cocaine-exposed, 209 non-cocaine-exposed) participating in the Miami Prenatal Cocaine Study (MPCS). The sample was enrolled prospectively at birth, with documentation of prenatal drug exposure status through maternal interview, and toxicology assays of maternal and infant urine, and infant meconium. Age-appropriate versions of the Clinical Evaluation of Language Fundamentals (CELF) were used to measure total, expressive, and receptive language at ages 3, 5, and 12years. Longitudinal latent growth curve (LLGC) modeling of the data revealed an association between PCE (measured dichotomously as yes/no) and lower functioning in expressive and total language scores, after considering other sources of variation including child's age at testing, sex, prenatal exposure to alcohol, marijuana, and tobacco, and additional medical and social-demographic covariates. Analyses of level of PCE showed a gradient, i.e. dose-dependent, relationship between PCE level and expressive, receptive, and total language scores in the models controlling for age, child's sex, and other prenatal drug exposures. With additional covariate control these findings were most stable for the total language score. The evidence supports an inference about an enduring stable cocaine-specific effect on children's language abilities, with no effect on language growth over time in the longitudinal trajectory of language development.

Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7 years.

UNLABELLED: Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others. OBJECTIVE: The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior. METHODS: 407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure status. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software. RESULTS: Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope ß=-0.25; 95% CI=-0.48, -0.02; p=0.04) but not Sociability (estimated slope ß=-0.03; 95% CI=-0.26, 0.20; p=0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10). CONCLUSIONS: Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.

Prenatal drug exposure: infant and toddler outcomes.

This manuscript provides an overview of the current scientific literature on the impact of maternal drug use, specifically opioids and cocaine, during pregnancy on the acute and long-term outcomes of infants and toddlers from birth through age 3 years. Emphasis with regard to opioids is placed on heroin and opioid substitutes used to treat opioid addiction, including methadone, which has long been regarded as the standard of care in pregnancy, and buprenorphine, which is increasingly being investigated and prescribed as an alternative to methadone. Controlled studies comparing methadone at high and low doses, as well as those comparing methadone with buprenorphine, are highlighted and the diagnosis and management of neonatal abstinence syndrome is discussed. Over the past two decades, attention of the scientific and lay communities has also been focused on the potential adverse effects of cocaine and crack cocaine, especially during the height of the cocaine epidemic in the United States. Herein, the findings are summarized from prospective studies comparing cocaine-exposed with non-cocaine-exposed infants and toddlers with respect to anthropometric growth, infant neurobehavior, visual and auditory function, and cognitive, motor, and language development. The potentially stigmatizing label of the so-called "crack baby" preceded the evidence now accumulating from well-designed prospective investigations that have revealed less severe sequelae in the majority of prenatally exposed infants than originally anticipated. In contrast to opioids, which may produce neonatal abstinence syndrome and infant neurobehavioral deficits, prenatal cocaine exposure appears to be associated with what has been described as statistically significant but subtle decrements in neurobehavioral, cognitive, and language function, especially when viewed in the context of other exposures and the caregiving environment which may mediate or moderate the effects. Whether these early findings may herald more significant learning and behavioral problems during school-age and adolescence when the child is inevitably confronted with increasing social and academic challenges is the subject of ongoing longitudinal research.