Parental Self-Efficacy and Personal Time Help Explain Impact of Parent-Staff Interactions on Parental Distress and Bonding in the NICU.

OBJECTIVES: To identify factors that help explain associations between parent-staff interactions and: (1) parental depression, anxiety, and posttraumatic stress; and (2) parent-child bonding in the neonatal intensive care unit (NICU). STUDY DESIGN: Our cross-sectional mixed methods survey investigated the ways in which parental-staff interactions relate to parental distress and parent-child bonding. Parents with babies in the NICU (N = 165) completed validated measures and open-ended questions about their experiences with staff. Using a sequential explanatory approach, we examined: (1) whether and how parental self-efficacy and personal time mediated parent-staff interactions on distress and bonding; and (2) parental written accounts of experiences with staff. RESULTS: Multiple mediation analyses revealed that parent-staff interactions exhibited an: (1) indirect effect on parental depression (b = -.05, SE = .02, CI [-.10, -.01]), anxiety (b = -.08, SE = .04, CI [-.16, -.02]), and parent-child bonding (b = -.26, SE = .08, CI [-.43, -.11]) through parental self-efficacy; and (2) indirect effect on parental posttraumatic stress (b = -.08, SE = .04, CI [-.17, -.00], CSIE= -.06) through parental personal time. Thematic analyses revealed that emotional and instructional support from staff helped build parental self-efficacy. Trust with staff helped parents feel comfortable leaving the bedside and engage in basic needs (eg, eat, sleep). CONCLUSIONS: Family-staff dynamics are the foundation for high quality family-centered care. Staff who empower parents to participate in care, engage in parenting tasks, and take care of themselves may reduce their distress and improve relationships among staff, parents, and babies.

Availability of psychological resources for parents receiving communication of positivity at newborn screening for metabolic diseases in Italy.

Receiving information in the case of a positive or false-positive expanded newborn screening (ENBS) result for metabolic diseases is a stressful event. The availability of psychological support to families is crucial across the different communication steps and is recommended by different guidelines and position papers. However, more information is needed about the availability of psychological resources in the ENBS process. This national survey aimed to provide an overview of the availability of psychological resources for parents who received communication of positivity at the ENBS in the 23 Italian centers and how the support is provided to parents. An online survey was sent to the Heads of the ENBS centers asking about the availability of a clinical psychologist, their involvement in the ENBS process, and an estimation of parents receiving psychological support. More than 60% of the centers report having a clinical psychologist in the ENBS team; however, in more than 50% of cases, the psychologist does not participate in the consultation with parents (nor for the first consultation post-positivity or at confirmation of diagnosis). Furthermore, nearly 60% of the centers reported the experience of parental rejection of psychological sessions.  Conclusion: There is a need for harmonization among the Italian ENBS centers concerning the availability of psychological resources and how these resources are provided to families. Parents' needs remained only partially fulfilled. What is Known: • Receiving communication of positivity at the ENBS can be highly stressful for parents and requires adequate psychological support. • The guidelines recommend psychological support for parents during the ENBS process. What is New: • Only 14/23 (60.9%) of Italian ENBS centers have a clinical psychologist within the team. • In half of the consultations with parents receiving communication of positivity, the clinical psychologist is never involved.

The course of health-related quality of life after the diagnosis of childhood cancer: a national cohort study.

BACKGROUND: Comprehensive insight in the longitudinal development of health-related quality of life (HRQOL) after childhood cancer diagnosis could improve quality of care. Thus, we aimed to study the course and biopsychosocial determinants of HRQOL in a unique national cohort of children with cancer. METHODS: HRQOL of 2154 children with cancer was longitudinally reported (median: 3 reports) between diagnosis and 5 years after, using the pediatric quality of life inventory generic core scales (PedsQL). HRQOL was modelled over time since diagnosis using mixed model analysis for children 2-7 years (caregiver-reports) and ≥ 8 years (self-reports). Differences in the course between hematological, solid and central nervous system malignancies were studied. Additional associations of demographics, disease characteristics (age at diagnosis, relapse, diagnosis after the national centralization of childhood cancer care and treatment components) and caregiver distress (Distress thermometer) were studied. RESULTS: Overall, HRQOL improved with time since diagnosis, mostly in the first years. The course of HRQOL differed between diagnostic groups. In children aged 2-7 years, children with a solid tumor had most favorable HRQOL. In children aged ≥ 8 years, those with a hematological malignancy had lower HRQOL around diagnosis, but stronger improvement over time than the other diagnostic groups. In both age-groups, the course of HRQOL of children with a CNS tumor showed little or no improvement. Small to moderate associations (ß: 0.18 to 0.67, p < 0.05) with disease characteristics were found. Centralized care related to better HRQOL (ß: 0.25 to 0.44, p < 0.05). Caregiver distress was most consistently associated with worse HRQOL (ß: - 0.13 to - 0.48, p < 0.01). CONCLUSIONS: The HRQOL course presented can aid in identifying children who have not fully recovered their HRQOL following cancer diagnosis, enabling early recognition of the issue. Future research should focus on ways to support children, especially those with a CNS tumor, for example by decreasing distress in their caregivers.

Long-term parental distress after pediatric hematopoietic stem cell transplantation for nonmalignant diseases.

BACKGROUND: Survival rates have continued to increase for pediatric hematopoietic stem cell transplantation (HSCT) for nonmalignant diseases. Despite the crucial role of caregivers in this high-intensity treatment, knowledge about long-term parental impact is lacking. PROCEDURE: This cross-sectional study assessed parental distress and everyday problems in parents of patients 2 years and older after pediatric HSCT for a nonmalignant disease using Distress Thermometer for Parents (DT-P), and compared outcomes to matched Dutch parents of healthy children and Dutch parents of children with a chronic condition (CC). RESULTS: Median follow-up was 5.3 years (interquartile range [IQR]: 2.9-8.6). Underlying diseases were inborn errors of immunity (N = 30), hemoglobinopathies (N = 13), and bone marrow failure (N = 27). Mothers of pediatric HSCT recipients (N = 70) reported comparable overall distress levels to mothers of healthy children, but experienced more distress related to parenting problems, specifically managing their child's emotions, discussing disease consequences, and fostering independence. Fathers of HSCT recipients (N = 45) reported higher overall distress levels and had more emotional distress compared to fathers of healthy children. CONCLUSIONS: Overall, parental distress and everyday problems of parents of HSCT recipients are comparable to those of parents of children with CC. However, there is ongoing parental burden, both emotional and in parenting, long-term after HSCT compared to parents of healthy children, and the type of burden differs between mothers and fathers. These results indicate that individualized parental supportive care should not remain restricted to the acute hospitalization phase, but also be actively offered during long-term follow-up after pediatric HSCT.

Distress in parents of children with first-onset steroid-sensitive nephrotic syndrome.

BACKGROUND: Steroid-sensitive nephrotic syndrome (SSNS) is associated with a relapsing-remitting course that can be stressful for parents. As little is known of parental distress at the first onset of SSNS, this study aims to describe parental distress and everyday problems in mothers and fathers of a child with newly diagnosed SSNS participating in a randomized controlled trial of levamisole added to corticosteroids. METHODS: To assess distress, the Distress Thermometer for Parents (DT-P) was used, which includes questions on distress (thermometer score 0-10, ≥ 4 "clinical distress") and presence of everyday problems in six domains: practical, social, emotional, physical, cognitive, and parenting. The DT-P was completed 4 weeks after the onset of SSNS. Total sum and individual items of everyday problems were compared with reference data from mothers and fathers of the Dutch general population. RESULTS: There was no difference in clinically elevated parental distress between SSNS mothers (n = 37) and fathers (n = 25) and reference parents. Compared to reference fathers, fathers of a child with SSNS scored significantly higher on emotional problems (P = 0.030), while mothers experienced more parenting problems (P = 0.002). Regression analyses showed that lower parental age and having a girl with SSNS were significantly associated with more practical problems and higher distress thermometer scores, respectively. CONCLUSIONS: Four weeks after onset, SSNS mothers and fathers experience equal distress as reference parents. However, both parents endorsed significantly more everyday problems. Therefore, monitoring parental distress, even in the first weeks of the disease, could contribute to timely interventions and prevent worsening of problems. CLINICAL TRIAL REGISTRY: Dutch Trial Register ( https://onderzoekmetmensen.nl/en/trial/27331 ). A higher resolution version of the Graphical abstract is available as Supplementary information.

Course of child social-emotional and sleep symptoms, parental distress and pandemic-related stressors during COVID-19.

Research on the longitudinal courses of child social-emotional symptoms and sleep during the COVID-19 pandemic within societies would be of key value for promoting child well-being in global crises. We characterized the course of children's social-emotional and sleep symptoms before and throughout the pandemic in a Finnish longitudinal cohort of 1825 5- to 9-year-old children (46% girls) with four follow-up points during the pandemic from up to 695 participants (spring 2020-summer 2021). Second, we examined the role of parental distress and COVID-related stressful events in child symptoms. Child total and behavioral symptoms increased in spring 2020 but decreased thereafter and remained stable throughout the rest of the follow-up. Sleep symptoms decreased in spring 2020 and remained stable thereafter. Parental distress was linked with higher child social-emotional and sleep symptoms. The cross-sectional associations between COVID-related stressors and child symptoms were partially mediated by parental distress. The findings propose that children can be protected from the long-term adverse influences of the pandemic, and parental well-being likely plays a mediating role between pandemic-related stressors and child well-being. Further research focusing on the societal and resilience factors underlying family and child responses to the pandemic is warranted.

The role of parental health and distress in assessing children's health status.

PURPOSE: The purpose of the study was to examine the contributions of parents' health and distress to parent's and children's assessments of children's health. METHODS: We used baseline data from a longitudinal study of 364 children (ages 4-12) about to undergo surgery and their parents in a Southern California pediatric hospital. We used the 20-item child self-reported CHRIS 2.0 general health and the parallel parent-reported measure of the child's health, along with a measure of parental distress about the child's health were administered in the perioperative period. Other measures included parents' physical and mental health, quality of life, distress over their child's health, and number and extent of other health problems of the child and siblings. RESULTS: On average, parents' reports about the child were consistently and statistically significantly higher than children's self-reports across all sub-dimensions of the CHRIS 2.0 measure. Parents' personal health was positively associated with their reports of the child's health. More distressed parents were closer to the child's self-reports, but reported poorer personal health. CONCLUSION: Parent-child differences in this study of young children's health were related to parental distress. Exploring the nature of the gap between parents and children in assessments of children's health could improve effective clinical management for the child and enhance family-centered pediatric care. Future studies are needed to assess the generalizability of CHRIS 2.0 to other health settings and conditions and to other racial/ethnic groups.

Impacts of COVID-19 on caregivers of childhood cancer survivors.

PURPOSE: We sought to assess the impact of disruptions due to coronavirus disease 2019 (COVID-19) on caregivers of childhood cancer survivors. METHODS: A 13-question survey containing multiple-choice, Likert-type, and free-text questions on experiences, behaviors, and attitudes during the COVID-19 outbreak was sent to childhood cancer caregivers and completed between April 13 and May 17, 2020. Ordered logistic regression was used to investigate relationships between demographics, COVID-related experiences, and caregiver well-being. RESULTS: Caregivers from 321 unique families completed the survey, including 175 with children under active surveillance/follow-up care and 146 with children no longer receiving oncology care. Overall, caregivers expressed exceptional resiliency, highlighting commonalities between caring for a child with cancer and adopting COVID-19 prophylactic measures. However, respondents reported delayed/canceled appointments (50%) and delayed/canceled imaging (19%). Eleven percent of caregivers reported struggling to pay for basic needs, which was associated with greater disruption to daily life, greater feelings of anxiety, poorer sleep, and less access to social support (p < .05). Caregivers who were self-isolating reported greater feelings of anxiety and poorer sleep (p < .05). Respondents who expressed confidence in the government response to COVID-19 reported less disruption to their daily life, decreased feelings of depression and anxiety, better sleep, and greater hopefulness (p < .001) CONCLUSIONS: Caregivers are experiencing changes to medical care, financial disruptions, and emotional distress due to COVID-19. To better serve caregivers and medically at-risk children, clinicians must evaluate financial toxicity and feelings of isolation in families affected by childhood cancer, and work to provide reliable information on how COVID-19 may differentially impact their children.

Parental experiences of adolescent cancer-related distress: A qualitative study.

OBJECTIVE: Adolescents' cancer-related distress is more complex, severe, and long-lasting than that of children and adults. Parents adopt an active role in supporting their adolescent, reporting that adolescent cancer-related distress is the most problematic symptom parents experience. Research has predominantly focused on exploring adolescents' experiences of cancer-related distress, with little attention to how their parents experience their adolescent's cancer-related distress. Therefore, we aimed to explore parents' experiences of distress within the context of parenting an adolescent with cancer-related distress during or immediately subsequent to active treatment. METHODS: A total of 21 semi-structured interviews were conducted face-to-face or via telephone, with parents of adolescents aged 12-18 years from south-west England. Inductive reflexive thematic analysis was used to analyse the data. RESULTS: Three themes were generated: "The contagion of distress", "Navigating breaking point" and "Developmental disruption". Parental distress transcended from adolescent cancer-related distress, eliciting uncertainty and challenging parenting limits. Parental distress was perpetuated by feelings that their adolescent had missed out on "normal" adolescence during and just after active treatment. CONCLUSION: Parental distress reflected the multi-faceted nature of their adolescent's cancer-related distress. Findings advocate the importance of providing a parental voice within adolescent oncology populations. Developing tailored interventions to address parental distress are suggested.

Dental pain, parental SARS-CoV-2 fear and distress on quality of life of 2 to 6 year-old children during COVID-19.

BACKGROUND: Coronavirus disease (COVID-19) has crippled life, families and oral healthcare delivery in India due to nationwide lockdown. AIM: Through cross-sectional design, we investigated the impact of child's dental pain, caregiver's fear of SARS-CoV-2 and parental distress on oral health-related quality of life (OHRQOL) of preschoolers during the nationwide COVID-19 pandemic lockdown. DESIGN: Preschool children self-reported their pain using Pieces of Hurt scale; caregiver SARS-CoV-2 fear was assessed using Fear of COVID-19 scale and parental distress evaluated using 4-item scale. Child's oral health was assessed using the dmft index and OHRQOL evaluated using early childhood oral health impact scale. Bivariate, multivariate regression analysis was conducted to identify predictors; statistical significance was set at 5%. RESULTS: Sample mean age was 4.58 years, and about 69% were boys. Children reporting higher pain scores (OR = 1.9) due to decayed teeth and having dmft > 5 (OR = 4.25), followed by greater parental distress (OR = 4.13) and fear of SARS-CoV-2 (OR = 3.84), were significantly associated with poor OHRQOL during the COVID-19 pandemic. CONCLUSIONS: Greater parental distress and fear of COVID-19 among caregivers, higher self-perceived dental pain among children and caries experience are associated with poor OHRQOL of preschool children during the COVID-19 pandemic.

[Burn-out of parents of a child with atypical development]. / Le burn-out des parents ayant un enfant au développement atypique.

The parents of a child with a neurodevelopmental disorder have a higher level of distress than those of a typical child. The consequences of their child's atypical development have a considerable impact on their parenting. Having an special child would therefore be a particular stressor, specific to this form of parenting. As a result, they are more likely to suffer from parental burnout.

Parental deployment and distress, and adolescent disordered eating in prevention-seeking military dependents.

OBJECTIVE: Parental military deployment can lead to stress in the family system due to concerns about the deployed service-member's safety and increased responsibilities for those not deployed. Parent-related stress can impact adolescent disordered eating. Given the important role that stress plays in disordered eating and obesity, it is crucial to understand the impacts of unique stressors to which vulnerable populations are exposed. METHOD: We studied 126 adolescent (14.3 ± 1.6 years; 59.5% girls; 44.4% non-Hispanic White; BMI-z, 1.91 ± .39) military dependents prior to entering an obesity and binge-eating disorder prevention trial. The Eating Disorder Examination was used to assess adolescent disordered eating. Parents self-reported their own distress and family deployment history that occurred during the adolescent's lifetime. RESULTS: Parental distress interacted with frequency of parental deployments such that for those with high parental distress, more frequent deployment was associated with greater adolescent shape and weight concerns (ß = .21, p = .012) and global eating pathology (ß = .18, p = .024). DISCUSSION: In this hypothesis-generating study, the combination of number of deployments and parental distress may be associated with disordered eating among adolescent military dependents seeking prevention of binge-eating disorder and adult obesity. If these preliminary findings are supported longitudinally, interventions to reduce parental stress related to deployment may be warranted to reduce disordered eating in adolescent dependents.

Conditions of Poverty, Parent-Child Interactions, and Toddlers' Early Language Skills in Low-Income Families.

Objectives The study examined the relations between parent-child interaction in the first year of life to toddlers' language skills at age 2 years for a sample of children reared in poverty; of specific interest was testing the Family Stress Model, which proposes that the conditions of poverty influence children's language skills through caregiver well-being (e.g., distress, depression) and interaction dysregulation. Methods Participants were from the Kids in Columbus Study, a birth-cohort study of children born to urban families experiencing material hardship. Caregiver questionnaires were collected when the child was 4-7 months to document poverty conditions (maternal hardship, institutional resources), caregiver well-being (depression, distress), and dysregulation in parent-child interactions. The Bayley-III assessed receptive and expressive language skills when the children were 2 years. Results On average, receptive language skills were nearly 1 SD below the normative mean. Path models showed a significant effect of caregiver-child dysregulated interactions on toddlers' language skills, and an indirect effect of maternal distress on parent-child interactions and, in turn, toddlers' language skills. Conclusions for Practice This study confirmed the theoretical Family Stress Model as a viable representation of the effects of poverty on the language skills of toddlers reared in homes experiencing socioeconomic disadvantage.

Internal and External Resources and the Adjustment of Parents of Premature Infants.

Studies have shown premature birth and infant hospitalization to be associated with increased levels of parental distress. Internal and external psychological resources have been found to mitigate distress among persons coping with stressful medical events. The current study evaluated psychological resources and distress in 87 parents (57 mothers and 30 fathers) to whom an infant was born prematurely and hospitalized in the NICU of a large tertiary medical center. Parents were administered standardized measures of internal (problem-solving skills) and external (total spousal support, adequacy of spousal support) psychological resources and of psychological distress (depression, posttraumatic symptoms, and mood). Findings indicated that higher levels of problem-solving skills and more adequate spousal support, but not total spousal support, were related to lower levels of parental distress. Adequacy of spousal support and parents' problem-solving skills accounted for 18% of the variance in overall mood and 13.8% of the variance in posttraumatic stress symptoms. A significant two-way interaction was found between adequacy of spousal support and problem-solving skills such that individuals with better problem-solving skills reported better overall mood independent of the adequacy of spousal support they receive. However, for individuals with poor problem-solving skills, the adequacy of the spousal support they receive was a significant factor in determining their overall mood. The theoretical and clinical implications of these findings are discussed in terms of the accessibility of these resources to assessment and their potential for change via existing intervention approaches.

Child symptoms, parent behaviors, and family strain in long-term survivors of childhood acute lymphoblastic leukemia.

OBJECTIVE: How family environment and parental factors affect health status and symptoms in childhood cancer survivors is understudied. We examined the influence of family cohesion, parent distress, and overprotection on child symptom burden and health-related quality of life (HRQOL) and family strain in survivors of childhood acute lymphoblastic leukemia. METHODS: Parents of 213 children treated with chemotherapy only completed a survey when survivors were at least 5-year postdiagnosis. Family Environment Scale, Brief Symptom Inventory-18, Parent Protection Scale, Pediatric Quality of Life Inventory, and Impact on Family were used to assess family cohesion, parental distress, overprotection, child symptom burden and HRQOL, and family strain, respectively. Path analysis was conducted to quantify effects of family cohesion on family strain through parental distress, overprotection, child symptoms, and HRQOL. RESULTS: Lower family cohesion (ß = 0.06, 95% CI, 0.01-0.13), higher parental distress (ß = 0.35, 95% CI, 0.20-0.45), and overprotection (ß = 0.17, 95% CI, 0.01-0.32) were associated with more child symptom burden. More symptom burden were associated with poorer child HRQOL (ß = 0.66, 95% CI, 0.57-0.75), which in turn was associated with more family strain (ß = 0.11, 95% CI, 0.01-0.22). Lower maternal education was associated with overprotection (ß = -0.23, 95% CI, -0.33 to -0.12), more child symptoms (ß = -0.30, 95% CI, -0.41 to -0.16), poorer child HRQOL (ß = -0.36, 95% CI, -0.46 to -0.21), and more family strain (ß = -0.15, 95% CI, -0.23 to -0.08). CONCLUSIONS: Family and parental factors contributed to health outcomes of childhood acute lymphoblastic leukemia survivors. Interventions to enhance family cohesion, decrease parental distress and overprotection, and ameliorate child symptoms may improve family functioning.

Predicting parental distress among children newly diagnosed with craniopharyngioma.

BACKGROUND: Childhood brain tumor diagnoses are stressful for families. Children diagnosed with craniopharyngioma (Cp) present with particularly challenging medical and cognitive problems due to tumor location and associated biophysiologic comorbidities. This study examined parental distress in a sample of families of patients with Cp treated with proton beam therapy to identify factors for targeting psychological intervention. PROCEDURE: Prior to (n = 96) and 1 year after (n = 73) proton therapy, parents of children diagnosed with Cp (9.81 ± 4.42 years at baseline; 49% male) completed a self-report measure of distress, the Brief Symptom Inventory (BSI). Children completed cognitive assessment measures at baseline; medical variables were extracted from the study database. RESULTS: At baseline, t-tests revealed parents reported higher levels of distress than normative expectations on Anxiety, Depression, Global Severity, and Positive Symptom Distress BSI scales (P < 0.05). Linear mixed effects models revealed parent report measures of child executive dysfunction and behavioral issues were more predictive of parental distress than patients' cognitive performance or medical status (P < 0.05). Models also revealed a significant reduction only in Anxiety over time (t = -2.19, P < 0.05). Extensive hypothalamic involvement at baseline predicted this reduction (P < 0.05). CONCLUSION: Parents experience significant distress before their child begins adjuvant therapy for Cp, though parental distress appears largely unrelated to medical complications and more related to parent perceptions of child cognitive difficulties (vs. child performance). Importantly, this may be explained by a negative parent reporting style among distressed parents. Knowledge of socio-emotional functioning in parents related to patient characteristics is important for optimization of psychological intervention.

Interaction between healthcare professionals and parents is a key determinant of parental distress during childhood hospitalisation for respiratory syncytial virus infection (European RSV Outcomes Study [EROS]).

AIM: We characterised the distress that parents experienced when their child was hospitalised for respiratory syncytial virus (RSV) infection. METHODS: This survey-based, observational study was conducted during 2014-2015. Meetings were held in Spain and Italy, with 24 parents of RSV hospitalised infants and 11 healthcare professionals experienced in RSV, which identified 110 factors related to parental distress. The resulting questionnaire was completed by another 105 Spanish and Italian parents and 56 healthcare professionals, to assess the impact these factors had on parental distress, using a scale from 0 to 10 (very unimportant to very important). RESULTS: The five most important factors for parents were: healthcare professionals' awareness of the latest developments, readmission, reinfections, painful procedures and positive experiences with healthcare professionals. Healthcare professionals associated only medical factors with a meaningful impact on parents. Half of the six medical factors were given similar importance by both groups and the overall scoring for the 110 factors was comparable, with a correlation coefficient of 0.80. A primary concern on discharge was ongoing support. CONCLUSION: The relationship between parents and healthcare professionals was a significant factor in determining parental distress. Healthcare professionals appeared to have a good understanding of the overall impact on parents, particularly the key medical factors.

Maternal distress in the context of their child's type 1 diabetes: exploring the role of adaptive maternal emotion regulation on child outcomes.

Parents of children with Type 1 diabetes (T1D) experience high levels of distress, which may negatively impact child functioning. However, little is known about mechanisms that may buffer the adverse impact of parental distress. The current study explored the possible buffering role of maternal adaptive cognitive emotion regulation (CER) for the relationship between maternal distress and child psychological functioning. Forty-three children with T1D (8-15 years) completed measures assessing trait anxiety and depressive symptoms. Their mothers reported on general distress, illness-related parenting stress, and adaptive CER. Maternal illness-related parenting stress (but not general distress) was significantly associated with child psychological functioning. No buffering role for maternal adaptive CER was observed. As the current study is rather preliminary, future research using other methods to examine maternal adaptive CER, and examining other parental variables that may buffer against the negative impact of parental distress is warranted.

Children's Early Disruptive Behavior Predicts Later Coercive Behavior and Binge Drinking by Mothers.

PURPOSE: We examined the prospective influence of early child problematic behavior on later coercive interactions and binge drinking by mothers. DESIGN AND METHODS: Canadian participants are from the Quebec Longitudinal Study of Child Development, born between spring 1997 and 1998, which allowed a longitudinal birth cohort design. At the 41months, 628 parents reported on children's oppositional, aggressive, turbulent, and inattentive/hyperactive behavior. Mothers then reported on their own coercive and binge drinking behavior at the 60month follow-up. RESULTS: We estimated a series of ordinary least-squares regressions to examine the relationship between early child behavior problems and later parental coercion and binge drinking, above and beyond many key pre-existing/concurrent confounding factors including prior parenting stress and binge alcohol use. Oppositional, aggressive, and turbulent child behaviors at 41months predicted harsh, negative parenting at 60months. Early inattentive/hyperactive child behavior also forecasted later binge alcohol use by mothers within the same time frame. CONCLUSION: Negative preschool behavior predicted harsh, negative maternal behavior kindergarten entry. Early inattentive/hyperactive behavior also forecasted later binge alcohol use by mothers. Coercive parenting and alcohol use are clinically signs of adult distress. Such parents might use alcohol excessively because of its perceived stress-dampening effects and mental evasion from their life difficulties and frustration experiences. PRACTICE IMPLICATIONS: Problematic preschool behavior can lead to less effective child-rearing and unhealthy parental behavior. Such at-risk mothers would benefit from professional caring practices. Practitioners can inspire change, especially using interaction interventions which encourage positive parent-child relations that, in turn, diminish parental distress.

[The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry]. / Die Behandlung von Säuglingen und Kleinkindern mit ihren Eltern in einer kinderpsychiatrischen Spezialsprechstunde.

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry This article presents an integrative treatment model for infants and toddlers between zero to three years and their parents by integrating different complementary psychotherapeutic perspectives. Between 2012 and 2014 a total of 214 children between zero and three years have been treated, the diagnostic and process data of 53 % (N = 113) of the children were evaluable. The parents have been consulted in the beginning, at the end and six months post-treatment with different questionnaires concerning distress of the children and of the parents as well as regarding the social and the emotional behavior of the toddlers. The psychotherapists filled in different instruments at the beginning and at the end of the treatment. Our research demonstrates that a clearly conceptualized intervention has a measurable and persistent positive effect on the symptoms of the children, on the parent-child-relationship and on the wellbeing of the parents.