Evaluating the use of the AMBIANCE-Brief measure in clinical settings: Assessing acceptability, feasibility, and utility of the AMBIANCE-Brief.

Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceived acceptability, feasibility, utility, relevance, fidelity, and sustainability of the Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) among practitioners who had taken a training. Practitioners (N = 59) who attended a virtual AMBIANCE-Brief training originating from Canada between June 2020 and November 2021 completed an online follow-up survey. Practitioners reported that they primarily used the AMBIANCE-Brief for case conceptualization (68%). Additionally, 95% agreed that the AMBIANCE-Brief was relevant to their clinical practice, 98% agreed it was useful for their clinical work, 76% agreed that it was feasible to implement into their clinical work, and 59% found it easy to incorporate into their treatment planning with clients. Findings suggest that the AMBIANCE-Brief may be acceptable, feasible, and useful for practitioners. Avenues for continuing to evaluate the AMBIANCE-Brief include cross-cultural validity, coder drift, and booster sessions. Additional work clarifying how practitioners integrate the measure into practice would be valuable.

Agencias comunitarias y profesionales de la práctica alrededor del mundo buscan oportunidades para aprender sobre varias herramientas de evaluación e intervenciones basadas en la teoría de la afectividad. Sin embargo, la información acerca de la posibilidad de implementación y sostenibilidad de estas herramientas, una vez que los participantes han sido entrenados para usarlas, es limitada. Este estudio investigó la percepción sobre la aceptabilidad, posibilidad, utilidad, relevancia, fidelidad y sostenibilidad del Instrumento de Comportamiento Materno Atípico para la Evaluación y Clasificación, versión abreviada (AMBIANCE­Abreviado) entre los profesionales de la práctica que habían recibido un entrenamiento. Los profesionales de la práctica (N = 59) que asistieron a un entrenamiento virtual de AMBIANCE­Abreviado que se originó en Canadá entre junio de 2020 y noviembre 2021, completaron en línea una encuesta de seguimiento. Los profesionales de la práctica reportaron que ellos primariamente usaban el AMBIANCE­Abreviado para el caso de conceptualización (68%). Adicionalmente, el 95% estuvo de acuerdo en que el AMBIANCE­Abreviado era relevante para su práctica clínica, 98% estuvo de acuerdo con que era útil para su trabajo clínico, 76% estuvo de acuerdo que era posible implementarlo en su trabajo clínico, y 59% lo encontraba fácil de incorporar en su plan de tratamiento con clientes. Los resultados sugieren que el AMBIANCE­Abreviado pudiera ser aceptable, posible y útil para los profesionales de la práctica. Entre las maneras para continuar evaluando el AMBIANCE­Abreviado se incluyen la validez intercultural, la variación del codificador y las sesiones de refuerzo. El trabajo adicional que clarifique cómo los profesionales integran la medida dentro de su práctica sería valioso.

Parental sensitivity and child behavioral problems: A meta-analytic review.

Meta-analytic associations between observed parental sensitivity and child behavioral problems were examined (children aged 0-17 years). Studies (k = 108, N = 28,114) contained sociodemographically diverse samples, primarily from North America and Europe, reporting on parent-child dyads (95% mothers; 54% boys). Sensitivity significantly related to internalizing (k = 69 studies; N = 14,729; r = -.08, 95% CI [-.12, -.05]) and externalizing (k = 94; N = 25,418; r = -.14, 95% CI [-.17, -.11]) problems, with stronger associations found for externalizing. For internalizing problems, associations were significantly stronger among samples with low socioeconomic status (SES) versus mid-high SES, in peer-reviewed versus unpublished dissertations, and in studies using composite versus single scale sensitivity measures. No other moderators emerged as significant.

When the Bough Breaks: A systematic review and meta-analysis of mental health symptoms in mothers of young children during the COVID-19 pandemic.

Parents have experienced considerable challenges and stress during the COVID-19 pandemic, which may impact their well-being. This meta-analysis sought to identify: (1) the prevalence of depression and anxiety in parents of young children (

Los padres han experimentado retos considerables y estrés durante la pandemia del COVID-19, lo cual puede tener un impacto en su bienestar. Este metaanálisis busca identificar: 1) la prevalencia de la depresión y ansiedad en los padres de niños pequeños (

Les parents ont fait l'expérience de défis considérables et d'un stress considérable durant la pandémie du COVID-19, ce qui peut impacter leur bien-être. Cette méta-analyse s'est donné pour but d'identifier: 1) la prévalence de la dépression et de l'anxiété chez les parents de jeunes enfants (<âge 5) durant la pandémie du COVID-18, et 2) les facteurs de modération sociodémographique (par exemple, l'âge du parent, le fait d'être d'une minorité raciale) et méthodologique (par exemple, la qualité de l'étude) qui expliquent l'hétérogénéité dans les étudies. Une recherche systématique a été faite au travers de quatre banques de données du premier janvier 2020 au 3 mars 2021. Un total de 18 études ne se recoupant pas (8981 participants), toutes focalisées sur la santé mentale maternelle, ont rempli les critères d'inclusion. Des méta-analyses à effet aléatoire approprié ont été faites. Les estimations de prévalences regroupées pour une dépression cliniquement importante et des symptômes d'anxiété pour les mères de jeunes enfants durant la pandémie de COVID-19 étaient respectivement de 26,9% (95% CI: 21,3-33,4) et de 41,9% (95% CI: 26,7-58,8). La prévalence d'une dépression cliniquement élevée et de symptômes d'anxiété était plus élevée en Europe et en Amérique du Nord et chez les mères plus âgées. Les symptômes dépressifs cliniquement élevés étaient plus bas dans les études avec un pourcentage plus élevé d'individus de minorités raciales. Par comparaison les symptômes d'anxiété cliniquement élevés étaient plus haut dans les études de moindre qualité d'étude et dans les échantillons avec des mères très éduquées. Les politiques et les ressources visant des améliorations dans la santé mentale maternelle sont essentielles.

Bidirectional associations between screen time and children's externalizing and internalizing behaviors.

BACKGROUND: While it has been purported that excessive screen time can lead to behavioral problems, it has also been suggested that children with behavioral dysregulation receive more access to screens to manage problematic behavior. In this study, both temporally stable and longitudinal associations between screen time and externalizing and internalizing behaviors across childhood are examined to directly address this issue of directionality. METHODS: Data are from a prospective cohort of 10,172 Irish children, collected between 2010 and 2018 when children were ages 3, 5, 7, and 9. Children's screen time (hours/day) and externalizing and internalizing behaviors (Strengths and Difficulties Questionnaire) were assessed via caregiver report. Random-intercepts cross-lagged panel models were used to estimate longitudinal bidirectional associations while controlling for temporally stable (i.e., 'time-invariant' or 'trait-like') differences between children. RESULTS: Temporally stable differences between children were observed for both screen time and behavior problems. Longitudinal trajectories for screen time lacked stability; however, and externalizing and internalizing behaviors stabilized increasingly during later childhood. Greater externalizing and internalizing behaviors at age 3 were directionally associated with increased screen time at age 5. Greater screen time at ages 3 and 5 was directionally associated with increased internalizing behaviors at ages 5 and 7, respectively. More screen time at age 7 was directionally associated with fewer internalizing behaviors at age 9. Screen time was not associated with later externalizing behaviors. CONCLUSIONS: Bidirectional associations between screen time and internalizing behaviors were observed for preschoolers. Directional associations between screen time and internalizing difficulties were observed across childhood. These findings can inform screen use guidelines and family media planning at different ages and stages of development.

Adverse childhood experiences and maternal anxiety and depression: a meta-analysis.

BACKGROUND: It has been proposed that adverse childhood experiences (ACEs) can put women at risk for mental illness in the pregnancy and postpartum periods. While some studies have found strong support for this proposition, others have found weak or no support. This study is a meta-analysis of the association between ACEs and maternal mental health to resolve between-study discrepancies, and to examine potential moderators of associations. METHODS: Three electronic databases (i.e., MEDLINE, Embase, and PsycINFO) were searched up to November 2018 by a health sciences librarian. A hand search was conducted in January 2020 and relevant studies were added. Included studies reported on associations between ACEs and maternal depression and/or anxiety in the perinatal period (pregnancy to 1-year postpartum). Pregnancy and postpartum outcomes were examined separately for both depression and anxiety. Random-effect meta-analyses were conducted. Moderator analyses were conducted using meta-regression. Study quality was evaluated using a 15-point scale. RESULTS: The initial search yielded 4646 non-duplicate records and full text review occurred for 196 articles. A total of 15 studies (N = 7788) were included in the meta-analyses, of which 2 were also described narratively. Publication year ranged from 1998 to 2019. Mothers were approximately 28.93 years of age when they retrospectively reported on their ACEs. All studies had maternal self-report questionnaires for the mental health outcomes. Study quality ranged from 7 to 12. The pooled effect sizes between ACEs and prenatal (N = 12; r = .19; 95% CI= .13, .24) and postpartum (N = 7; r = .23; 95% CI = .06 to .39) depressive symptoms were significant. The pooled effect size between ACEs and prenatal anxiety was also significant (N = 5; r = .14; 95% CI= .07, .21). Moderator analyses indicated that timing of depressive and anxiety symptoms may be important for understanding associations. CONCLUSIONS: ACEs confer risk to maternal mental health, albeit effect sizes are small to moderate in magnitude. Trauma-informed approaches, as well as increased mental health support during and after pregnancy, may help to offset the relative risk of ACEs on maternal mental health.

Feasibility of training service providers on the AMBIANCE-Brief measure for use in community settings.

The Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) was developed to provide a clinically useful and psychometrically sound assessment of disrupted parenting behavior for community practitioners. With prior evidence of this tool's reliability and validity in laboratory settings, this study aimed to determine whether providers from family service agencies could become reliable in the use of the level of disrupted communication following a brief training. Providers (N = 46) from three agency sites participated in a 2-day AMBIANCE-Brief training and, at the end of the training, coded eight videotaped mother-child interactions. Novice participant coding was compared to expert consensus ratings using intraclass correlations. On average, participants' interrater agreement was good (ICCmean  = .84, SD = 0.10), with 89% meeting the reliability standards of ICC ≥ .70. In response to queries, 100% of participants indicated that they would recommend the AMBIANCE-Brief training to their colleagues, 85% reported that the AMBIANCE-Brief measure would be useful or very useful for their clinical practice, and 56% of participant clinicians believed that parents would find the measure acceptable or very acceptable for integration into intervention or support planning. Altogether, these findings speak to the feasibility of using the AMBIANCE-Brief in community settings. Future studies are needed in diverse clinical and community contexts to evaluate whether use of this assessment tool can inform more targeted interventions tailored to the specific needs of families.

El Instrumento Abreviado para Evaluación y Clasificación de la Conducta Materna Atípica (AMBIANCE-Abreviado; Madigan, Bronfman, Haltigan y Lyons-Ruth, 2018) se desarrolló para ofrecer a quienes practican en la comunidad una evaluación clínicamente útil y sicométricamente acertada de la conducta de crianza trastornada. Con la anterior evidencia de la confiabilidad y validez de esta herramienta en el marco de los laboratorios (Cooke, Eirich, Racine, Lyons-Ruth y Madigan, 2020), este estudio se propuso determinar si se podría confiar en quienes proveen el servicio como parte de las agencias de servicio a las familias después de un breve entrenamiento. Los proveedores (N = 46) de tres lugares de agencias participaron en un entrenamiento de dos días sobre AMBAIANCE-Abreviado y, al final del entrenamiento, codificaron ocho interacciones madre-niño grabadas en video. Se comparó la forma de codificar de los novatos con el puntaje consenso de los expertos usando correlaciones dentro de clases. El acuerdo entre los evaluadores fue bueno (ICC media = .84, SD = 0.10), con un 89% de los participantes que lograron el estándar de confiabilidad de ICC > .70. En respuesta a preguntas, el 100% de los participantes indicó que ellos recomendarían el entrenamiento de AMBIANCE-Abreviado a sus colegas, 85% reportó que la medida AMBIANCE-Abreviado sería útil o muy útil en su práctica clínica, y 56% creían que los progenitores encontrarían la medida aceptable o muy aceptable para ser integrada en la intervención o el planeamiento de apoyo. En conjunto, estos resultados hablan de la factibilidad de usar AMBIANCE-Abreviado en el marco comunitario.

L'Instrument d'Evaluation et de Classification-Brève du Comportement Maternel Atypique (AMBIANCE-Bref; Madigan, Bronfman, Haltigan, & Lyons-Ruth, 2018) a été développé afin d'offrir une évaluation du comportement de parentage perturbé, cliniquement utile et saine du point de vue psychométrique, pour les acteurs communautaires. Avec des preuves préalables de la fiabilité et de la validité de cet outil en laboratoire (Cooke, Eirich, Racine, Lyons-Ruth, & Madigan, 2020), cette étude s'est donné pour but de déterminer si les prestataires des agences de service à la famille pouvaient devenir fiables pour son utilisation après une formation courte. Des prestataires (N = 46) de trois sites d'agence ont participé à une formation AMBIANCE-Bref de deux jours et à la fin de la formation ont codé huit interactions mère-enfant filmées. Le codage du participant débutant a été comparé aux évaluations par consensus d'expertes en utilisant des corrélations intraclasses. Le coefficient d'objectivité était bon (moyenne des coefficient de corrélation intraclasse [ICC] = 84, SD = 0,10), avec 89% des participants remplissant les standards de fiabilité d'ICC ICC ³,70. En répondant aux questions, 100% des participants ont indiqué qu'ils ou elles recommanderaient la formation AMBIANCE-bref à leurs collègues, 85% ont indiqué que la mesure AMBIANCE-bref serait utile ou très utile pour leur pratique clinique, et 56% ont déclaré qu'ils ou elles croyaient que les parents trouveraient cette mesure acceptable ou très acceptable pour une intégration à une intervention ou le plan de soutien. Au total, ces résultats parlent de la viabilité de l'utilisation de l'AMBIANCE-bref dans des contextes communautaires.

Validation of the AMBIANCE-brief: An observational screening instrument for disrupted caregiving.

Resulting from a community-identified need for a well-validated indicator of caregiving difficulties for use in practice settings, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination, this study aimed to assess the feasibility, reliability, and validity of the AMBIANCE-Brief. Adolescent mother-infant dyads (N = 69) participated in the Strange Situation Procedure, as well as play sessions with and without toys. Maternal disrupted caregiving was coded from the play sessions using the AMBIANCE and AMBIANCE-Brief. The AMBIANCE-Brief demonstrated convergent validity with the AMBIANCE in the play session with toys (r = .65, p < .001) and without toys (r = .61, p < .001). Concurrent validity of the AMBIANCE-Brief was also demonstrated in relation to infant attachment disorganization in the play session with toys (r = .36, p < .05) and without toys (r = .32, p < .01). These findings suggest a shorter protocol for assessing disrupted caregiving may be feasible and valid for use in community settings. Future studies are in progress to train community practitioners in the use of the AMBIANCE-Brief and to evaluate their reliability.

Como resultado de una necesidad identificada por la comunidad para un indicador bien validado de dificultades en la prestación de cuidado para uso en escenarios prácticos, se desarrolló una forma breve del Sistema del Instrumento de Conducta Materna Atípica para la Evaluación y Clasificación (AMBIANCE) para ser usado como instrumento de detección. Antes de ser diseminado, la meta de este estudio fue de evaluar la posibilidad, confiabilidad y validez de AMBIANCE-Abreviado. Las díadas de madres adolescentes e infantes (N = 69) participaron en el Procedimiento de la Situación Extraña, así como en sesiones de juego con y sin juguetes. La interrumpida prestación de cuidado materna fue codificada a partir de las sesiones de juego usando AMBIANCE y AMBIANCE-Abreviado. El AMBIANCE-Abreviado demostró una validez convergente con AMBIANCE en la sesión de juego con juguetes (r = .65, p < .001) y sin juguetes (r = .61, p < .001). También se demostró la validez concurrente de AMBIANCE-Abreviado en relación con la desorganización de la afectividad del infante en la sesión de juegos con juguetes (r = .36, p < .05) y sin juguetes (r = .32, p <.01). Estos resultados sugieren que un protocolo más corto para evaluar la interrumpida prestación de cuidado pudiera ser posible y válido para uso en escenarios comunitarios. Hay estudios futuros en progreso para entrenar al personal de la práctica comunitaria en el uso de AMBIANCE-Abreviado y para evaluar su confiabilidad.

Résultat d'un besoin identifié au niveau communautaire d'un indicateur bien validé de difficultés dans les soins pour une utilisation dans des contextes de pratique, une forme écourtée ("brève", ci-dessous) de l'Instrument d'Evaluation et du Système de Classification du Comportement Maternel Atypique (abrégé AMBIANCE en anglais, nous gardons ici l'abréviation anglaise) a été développée pour une utilisation à des fins d'outil de dépistage. Avant sa dissémination, cette étude s'était donnée pour but d'évaluer la faisabilité, la fiabilité et la validité de l'AMBIANCE-Brève. Des dyades adolescentes mères-nourrissons (N = 69) ont participé à la Procédure de Situation Etrange, ainsi qu'à des séances de jeu avec et sans jouets. Les soins maternels perturbés ont été codés à partir des séances de jeu en utilisant l'AMBIANCE et l'AMBIANCE-Brève. L'AMBIENCE-Brève a fait preuve de validité de convergence avec l'AMBIENCE dans les séances de jeu avec des jouets (r = ,65, p <,001) et sans jouets (r = ,61, p <,001). La validité concurrente de l'AMBIENCE-Brève a aussi été démontrée pour ce qui concerne la désorganisation de l'attachement du bébé dans la séance avec les jouets (r = ,36, p <,05) et sans jouets (r = ,32, p <,01). Ces résultats suggèrent qu'un protocole écourté pour l'évaluation de soin perturbé peut s'avérer plus fiable et valide pour l'utilisation en contexte communautaire. Des études supplémentaires sont en cours afin de former les praticiens communautaires à l'utilisation de l'AMBIENCE-Brève et afin d'évaluer leur fiabilité.

Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment.

It has long been claimed that "maltreatment begets maltreatment," that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.

Perceived Parental Distraction by Technology and Mental Health Among Emerging Adolescents.

Importance: The digital phenomenon termed technoference refers to interruptions in routine social interactions due to technology use. Technoference may negatively affect parents' attention to cues necessary for supporting children's mental health. Objective: To explore whether there are directional prospective associations between perceived parental technoference and emerging adolescents' mental health symptoms (anxiety, depression, inattention, and hyperactivity). Design, Setting, and Participants: This cohort study assessed a general population of mothers and emerging adolescents in Calgary, Alberta, Canada. Women were recruited during pregnancy between May 3, 2008, and December 13, 2010, with convenience sampling and repeated follow-up; eligible women were 18 years or older, spoke English, had a gestational age of at least 24 weeks, and received local prenatal care. Data collection for the present study took place when emerging adolescents were aged 9 (May 20 to July 15, 2020), 10 (March 4 to April 30, 2021), and 11 (November 22, 2021, to January 17, 2022) years. Mothers provided consent for their child to participate, and emerging adolescents provided assent. Data were analyzed from December 1 to 31, 2023, using random-intercept cross-lagged panel models. Exposure: Perceived parental technoference. Main Outcomes and Measures: Emerging adolescents completed questionnaires about their perception of parental technoference and their mental health symptoms (depression, anxiety, hyperactivity, and inattention) at the 3 study times. This study did not rely on statistical significance, but instead on the magnitude of effect sizes to determine meaningful effects. Results: Participants included 1303 emerging adolescents (mean [SD] age, 9.7 [0.8] years at time 1; of the 1028 reporting information, 529 [51.5%] were girls). Cross-sectional associations indicated correlations between perceptions of parental technoference and emerging adolescents' mental health (r range, 0.17-0.19). Higher levels of anxiety at 9 and 10 years of age were prospectively associated with higher parental technoference scores at 10 (ß = 0.11 [95% CI, -0.05 to 0.26]) and 11 (ß = 0.12 [95% CI, 0.001-0.24]) years of age, with small magnitudes of effect size. Higher parental technoference scores at 9 and 10 years of age were prospectively associated with higher hyperactivity at 10 (ß = 0.07 [95% CI, -0.07 to 0.22]) and 11 (ß = 0.11 [95% CI, -0.02 to 0.24]) years of age and inattention at 11 years of age (ß = 0.12 [95% CI, 0.001-0.24]), with small magnitudes of effect size. No gender differences were identified. Conclusions and Relevance: In this 3-wave longitudinal birth cohort study, perceived parental technoference was associated with emerging adolescents' mental health. The findings speak to the need to discuss digital technology use and mental health with parents and emerging adolescents as a part of routine care.

Maternal and paternal sensitivity: Key determinants of child attachment security examined through meta-analysis.

Sensitive caregiving behavior, which involves the ability to notice, interpret, and quickly respond to a child's signals of need and/or interest, is a central determinant of secure child-caregiver attachment. Yet, significant heterogeneity in effect sizes exists across the literature, and sources of heterogeneity have yet to be explained. For all child-caregiver dyads, there was a significant and positive pooled association between caregiver sensitivity and parent-child attachment (r = .25, 95% CI [.22, .28], k = 174, 230 effect sizes, N = 22,914). We also found a positive association between maternal sensitivity and child attachment security (r = .26, 95% CI [.22, .29], k = 159, 202 effect sizes, N = 21,483), which was equivalent in magnitude to paternal sensitivity and child attachment security (r = .21, 95% CI [.14, 27], k = 22, 23 effect sizes, N = 1,626). Maternal sensitivity was also negatively associated with all three classifications of insecure attachment (avoidant: k = 43, r = -.24 [-.34, -.13]; resistant: k = 43, r = -.12 [-.19, -.06]; disorganized: k = 24, r = -.19 [-.27, -.11]). For maternal sensitivity, associations were larger in studies that used the Attachment Q-Sort (vs. the Strange Situation), used the Maternal Behavior Q-Sort (vs. Ainsworth or Emotional Availability Scales), had strong (vs. poor) interrater measurement reliability, had a longer observation of sensitivity, and had less time elapse between assessments. For paternal sensitivity, associations were larger in older (vs. younger) fathers and children. These findings confirm the importance of both maternal and paternal sensitivity for the development of child attachment security and add understanding of the methodological and substantive factors that allow this effect to be observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of Preadolescent Children's Recreational Screen Time Duration During the COVID-19 Pandemic.

OBJECTIVE: Research suggests that children's screen use during the COVID-19 pandemic has doubled. There is a need to understand factors associated with increased use to more adequately inform COVID-19 pandemic recovery efforts aimed at promoting healthy device habits. The objective of this multi-informant study of children aged 9 to 11 years was to examine whether duration of screen use during the COVID-19 pandemic was predicted by sociodemographic factors (e.g., child age and sex), COVID-19 pandemic family stressors, daily routines (e.g., sleep and physical activity), and device use factors (e.g., parent management strategies and content and context of use). METHODS: Participants included 846 children (M = 9.85, SD = 0.78) and their mothers from the All Our Families cohort, Calgary, Canada. Mothers reported (May-July 2020) on child screen use and COVID-19 pandemic impacts (e.g., job/income loss and stress), and children self-reported (July-August 2020) on their screen use and daily routines (e.g., sleep, physical activity, and device-free activities). RESULTS: Screen use during the COVID-19 pandemic was highest among male and minoritized children and families reporting high levels of stress. Children had lower durations of screen time when device limits were set by mothers. Children also had lower durations of screen time when they used screens to connect with others and when they engaged in higher levels of physical activity or device-free recreational activities. CONCLUSION: This study sheds light on children's screen use during the COVID-19 pandemic and supports the current screen use guidelines for school-aged children, suggesting that parents monitor use and foster high-quality screen use (e.g., coviewing or used for connection) and device-free recreational activities when possible.

Assessment of Changes in Child and Adolescent Screen Time During the COVID-19 Pandemic: A Systematic Review and Meta-analysis.

Importance: To limit the spread of COVID-19, numerous restrictions were imposed on youths, including school closures, isolation requirements, social distancing, and cancelation of extracurricular activities, which independently or collectively may have shifted screen time patterns. Objective: To estimate changes in the duration, content, and context of screen time of children and adolescents by comparing estimates taken before the pandemic with those taken during the pandemic and to determine when and for whom screen time has increased the most. Data Sources: Electronic databases were searched between January 1, 2020, and March 5, 2022, including MEDLINE, Embase, PsycINFO, and the Cochrane Central Register of Controlled Trials. A total of 2474 nonduplicate records were retrieved. Study Selection: Study inclusion criteria were reported changes in the duration (minutes per day) of screen time before and during the pandemic; children, adolescents, and young adults (≤18 years); longitudinal or retrospective estimates; peer reviewed; and published in English. Data Extraction and Synthesis: A total of 136 articles underwent full-text review. Data were analyzed from April 6, 2022, to May 5, 2022, with a random-effects meta-analysis. Main Outcomes and Measures: Change in daily screen time comparing estimates taken before vs during the COVID-19 pandemic. Results: The meta-analysis included 46 studies (146 effect sizes; 29 017 children; 57% male; and mean [SD] age, 9 [4.1] years) revealed that, from a baseline prepandemic value of 162 min/d (2.7 h/d), during the pandemic there was an increase in screen time of 84 min/d (1.4 h/d), representing a 52% increase. Increases were particularly marked for individuals aged 12 to 18 years (k [number of sample estimates] = 26; 110 min/d) and for device type (handheld devices [k = 20; 44 min/d] and personal computers [k = 13; 46 min/d]). Moderator analyses showed that increases were possibly larger in retrospective (k = 36; 116 min/d) vs longitudinal (k = 51; 65 min/d) studies. Mean increases were observed in samples examining both recreational screen time alone (k = 54; 84 min/d) and total daily screen time combining recreational and educational use (k = 33; 68 min/d). Conclusions and Relevance: The COVID-19 pandemic has led to considerable disruptions in the lives and routines of children, adolescents, and families, which is likely associated with increased levels of screen time. Findings suggest that when interacting with children and caregivers, practitioners should place a critical focus on promoting healthy device habits, which can include moderating daily use; choosing age-appropriate programs; promoting device-free time, sleep, and physical activity; and encouraging children to use screens as a creative outlet or a means to meaningfully connect with others.

Association of Screen Time With Internalizing and Externalizing Behavior Problems in Children 12 Years or Younger: A Systematic Review and Meta-analysis.

Importance: Currently, there is a lack of consensus in the literature on the association between screen time (eg, television, video games) and children's behavior problems. Objective: To assess the association between the duration of screen time and externalizing and internalizing behavior problems among children 12 years or younger. Data Sources: For this systematic review and meta-analysis, MEDLINE, Embase, and PsycINFO databases were searched for articles published from January 1960 to May 2021. Reference lists were manually searched for additional studies. Study Selection: Included studies measured screen time (ie, duration) and externalizing or internalizing behavior problems in children 12 years or younger, were observational or experimental (with baseline data), were available in English, and had data that could be transformed into an effect size. Studies conducted during the COVID-19 pandemic were excluded. Of 25 196 nonduplicate articles identified and screened for inclusion, 595 met the selection criteria. Data Extraction and Synthesis: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Extracted variables were child age, sex, and socioeconomic status; informants and measurement type for screen time and behavior problems; study publication year; and study design and quality. Data were extracted by 2 independent coders and were pooled using a random-effects model. Main Outcomes and Measures: The primary outcome was the association of screen time duration with externalizing (eg, aggression, attention deficit/hyperactivity disorder symptoms) and internalizing (eg, depression, anxiety) behaviors or diagnoses. Results: Of the 595 full-text articles assessed for eligibility, 87 studies met all inclusion criteria, comprising 98 independent samples and 159 425 participants (mean [SD] age, 6.07 [2.89] years; 83 246 [51.30%] male). Increased duration of screen time had a small but significant correlation with more externalizing problems (90 samples; r, 0.11; 95% CI, 0.10-0.12) and internalizing problems (43 samples; r, 0.07; 95% CI, 0.05-0.08) in children. Several methodological moderators explained between-study heterogeneity. There was evidence of significant between study heterogeneity (I2 = 87.80). Conclusions and Relevance: This systematic review and meta-analysis found small but significant correlations between screen time and children's behavior problems. Methodological differences across studies likely contributed to the mixed findings in the literature.

Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis.

Importance: Emerging research suggests that the global prevalence of child and adolescent mental illness has increased considerably during COVID-19. However, substantial variability in prevalence rates have been reported across the literature. Objective: To ascertain more precise estimates of the global prevalence of child and adolescent clinically elevated depression and anxiety symptoms during COVID-19; to compare these rates with prepandemic estimates; and to examine whether demographic (eg, age, sex), geographical (ie, global region), or methodological (eg, pandemic data collection time point, informant of mental illness, study quality) factors explained variation in prevalence rates across studies. Data Sources: Four databases were searched (PsycInfo, Embase, MEDLINE, and Cochrane Central Register of Controlled Trials) from January 1, 2020, to February 16, 2021, and unpublished studies were searched in PsycArXiv on March 8, 2021, for studies reporting on child/adolescent depression and anxiety symptoms. The search strategy combined search terms from 3 themes: (1) mental illness (including depression and anxiety), (2) COVID-19, and (3) children and adolescents (age ≤18 years). For PsycArXiv, the key terms COVID-19, mental health, and child/adolescent were used. Study Selection: Studies were included if they were published in English, had quantitative data, and reported prevalence of clinically elevated depression or anxiety in youth (age ≤18 years). Data Extraction and Synthesis: A total of 3094 nonduplicate titles/abstracts were retrieved, and 136 full-text articles were reviewed. Data were analyzed from March 8 to 22, 2021. Main Outcomes and Measures: Prevalence rates of clinically elevated depression and anxiety symptoms in youth. Results: Random-effect meta-analyses were conducted. Twenty-nine studies including 80 879 participants met full inclusion criteria. Pooled prevalence estimates of clinically elevated depression and anxiety symptoms were 25.2% (95% CI, 21.2%-29.7%) and 20.5% (95% CI, 17.2%-24.4%), respectively. Moderator analyses revealed that the prevalence of clinically elevated depression and anxiety symptoms were higher in studies collected later in the pandemic and in girls. Depression symptoms were higher in older children. Conclusions and Relevance: Pooled estimates obtained in the first year of the COVID-19 pandemic suggest that 1 in 4 youth globally are experiencing clinically elevated depression symptoms, while 1 in 5 youth are experiencing clinically elevated anxiety symptoms. These pooled estimates, which increased over time, are double of prepandemic estimates. An influx of mental health care utilization is expected, and allocation of resources to address child and adolescent mental health concerns are essential.

Characteristics and Service Needs of Maltreated Children Referred for Mental Health Services at a Child Advocacy Centre in Canada.

OBJECTIVE: There is a dearth of Canadian-based literature on children referred to treatment services following maltreatment exposure. In order to inform assessment, intervention, and program development to improve outcomes, insight into the demographics and mental health needs of this population is required. METHODS: A retrospective file review of 176 children and youth who were referred for assessment and treatment at a mental health partner agency within a Canadian Child Advocacy Centre was conducted from January 2016 to June 2017. A standardized protocol was developed to extract data on family and child demographic characteristics, type of maltreatment, other adversity exposure, presenting concerns of the child, and mental health service utilization. RESULTS: The majority of children were female (66.5%), 4.5% were 0 to <5 years, 66.5% were 5 to <13 years, and 29.0% were 13 to <18 years of age. More than half of the children (53.4%) had multiple forms of maltreatment, with 67% exposed to sexual abuse. Exposure to other forms of adversity was also common, including domestic violence (53.4%) and parental mental health difficulties (52.3%). Most children had more than five presenting concerns at the time of referral, and most went on to receive intervention services. Sixty-nine percent of families had not previously received child mental health treatment, although 41.5% had prior child welfare involvement. Thirty percent of families ended treatment prematurely. CONCLUSIONS: The current study illustrates the complex profile and mental health needs of children referred for treatment following maltreatment exposure. Results may have implications for clinical care improvement that support maltreated children.

OBJECTIF: Il y a un manque de littérature canadienne sur les enfants adressés à des services de traitement par suite d'une exposition à la maltraitance. Afin d'éclairer l'évaluation, l'intervention et l'élaboration de programmes pour améliorer les résultats, il faut discerner les données démographiques et les besoins de santé mentale de cette population. MÉTHODES: Une revue rétrospective des dossiers de 176 enfants et jeunes qui ont été adressés pour une évaluation et un traitement à un organisme partenaire de santé mentale dans un Centre canadien d'appui aux enfants a été menée de janvier 2016 à juin 2017. Un protocole normalisé a été élaboré afin d'extraire les données sur les caractéristiques démographiques de la famille et de l'enfant, le type de maltraitance, une autre forme d'exposition à l'adversité, les préoccupations présentées par l'enfant, et l'utilisation des services de santé mentale. RÉSULTATS: La majorité des enfants étaient de sexe féminin (66,5 %), 4,5 % avaient de 0 à 5 ans, 66,5 % avaient de 6 à 12 ans, et 29,0 % avaient de 13 à 18 ans. Plus de la moitié des enfants (53,4 %) souffraient de multiples formes de maltraitance, et 67 % étaient exposés à l'abus sexuel. L'exposition à d'autres formes d'adversité était aussi commune, notamment la violence familiale (53,4 %) et les difficultés de santé mentale parentales (52,3 %). La plupart des enfants avaient plus de 5 préoccupations actuelles au moment d'être adressés, et la plupart a poursuivi et reçu des services d'intervention. Soixante-neuf pour cent des familles n'avaient pas précédemment reçu de traitement pour la santé mentale des enfants, même si 41,5 % avaient auparavant été impliquées dans les services d'aide à l'enfance. Trente pour cent des familles ont mis fin au traitement prématurément. CONCLUSIONS: La présente étude illustre le profil et les besoins de santé mentale complexes des enfants adressés à un traitement par suite d'une exposition à la maltraitance. Les résultats peuvent avoir des implications sur l'amélioration des soins cliniques qui soutiennent les enfants maltraités.

Post-secondary Student Mental Health During COVID-19: A Meta-Analysis.

The COVID-19 pandemic has posed notable challenges to post-secondary students, causing concern for their psychological well-being. In the face of school closures, academic disruptions, and constraints on social gatherings, it is crucial to understand the extent to which mental health among post-secondary students has been impacted in order to inform support implementation for this population. The present meta-analysis examines the global prevalence of clinically significant depression and anxiety among post-secondary students during the COVID-19 pandemic. Several moderator analyses were also performed to examine sources of variability in depression and anxiety prevalence rates. A systematic search was conducted across six databases on May 3, 2021, yielding a total of 176 studies (1,732,456 participants) which met inclusion criteria. Random-effects meta-analyses of 126 studies assessing depression symptoms and 144 studies assessing anxiety symptoms were conducted. The pooled prevalence estimates of clinically elevated depressive and anxiety symptoms for post-secondary students during the COVID-19 pandemic was 30.6% (95% CI: 0.274, 0.340) and 28.2% (CI: 0.246, 0.321), respectively. The month of data collection and geographical region were determined to be significant moderators. However, student age, sex, type (i.e., healthcare student vs. non-healthcare student), and level of training (i.e., undergraduate, university or college generally; graduate, medical, post-doctorate, fellow, trainee), were not sources of variability in pooled rates of depression and anxiety symptoms during the pandemic. The current study indicates a call for continued access to mental health services to ensure post-secondary students receive adequate support during and after the COVID-19 pandemic. Systematic Review Registration: PROSPERO website: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021253547.

Prevalence of posttraumatic and general psychological stress during COVID-19: A rapid review and meta-analysis.

Emerging evidence suggests rates of posttraumatic stress and psychological stress in the general population are elevated due to COVID-19. However, a meta-analysis is needed to attain more precise prevalence estimates due to between-study variability. Thus, we performed a rapid review and meta-analysis of posttraumatic stress and general psychological stress symptoms during COVID-19. Electronic searches were conducted up to May 26th, 2020 using key terms: mental illness and COVID-19. A total of k = 14 non-overlapping studies were identified for inclusion. Random effects meta-analyses indicated that the pooled prevalence of posttraumatic stress symptoms and psychological stress in the general population was 23.88% and 24.84%, respectively. In both meta-analyses, the prevalence of stress symptoms was higher in unpublished compared to peer-reviewed studies. Overall, nearly one-in-four adults experienced significant stress due to the COVID-19 pandemic. Psychological resources and services must be allocated to help address the mental health burden of COVID-19. High quality, longitudinal research on the long-term mental health effects of the pandemic is greatly needed.

Development of trauma symptoms following adversity in childhood: The moderating role of protective factors.

BACKGROUND: Although the buffering effect of protective factors on children's outcomes following exposure to adverse childhood experiences has been well documented, research gaps remain as to whether this buffering effect differs based on the type of adversity experienced (i.e., maltreatment versus household dysfunction). OBJECTIVE: To examine whether protective factors moderate the association between cumulative adversity, as well as adversity subtypes (i.e., maltreatment and household dysfunction) and child trauma-related distress in a clinical sample referred for treatment following exposure to adversity. PARTICIPANTS AND SETTING: One-hundred and seventy-six children (aged 3-18) referred to a child abuse treatment clinic and who's files were opened between January 2016 and June 2017 were included. METHODS: Data were collected, extracted, and coded from clinical files using a standardized data extraction protocol. Protective factors included: using individual coping strategies, peer support, individual social skills, caregiver physical caregiving, caregiver psychological caregiving, and educational involvement. RESULTS: Cumulative childhood adversity (b = .16, p = .04) positively predicted child trauma-related distress. The link between exposure to cumulative adversity and child trauma-related distress varied as a function of protective factors: there was a positive association between adversity and child trauma-related distress for children who had low levels of protective factors, but not for those with high levels of protective factors (b=-0.56, p=<.001). Similar findings were observed when data was stratified by maltreatment and household dysfunction. CONCLUSIONS: Bolstering children's protective factors prior to, and during child abuse treatment, may reduce trauma-related distress following exposure to adversity.

Associations Between Screen Use and Child Language Skills: A Systematic Review and Meta-analysis.

Importance: There is considerable public and scientific debate as to whether screen use helps or hinders early child development, particularly the development of language skills. Objective: To examine via meta-analyses the associations between quantity (duration of screen time and background television), quality (educational programming and co-viewing), and onset of screen use and children's language skills. Data Sources: Searches were conducted in MEDLINE, Embase, and PsycINFO in March 2019. The search strategy included a publication date limit from 1960 through March 2019. Study Selection: Inclusion criteria were a measure of screen use; a measure of language skills; and statistical data that could be transformed into an effect size. Exclusion criteria were qualitative studies; child age older than 12 years; and language assessment preverbal. Data Extraction and Synthesis: The following variables were extracted: effect size, child age and sex, screen measure type, study publication year, and study design. All studies were independently coded by 2 coders and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Main Outcomes and Measures: Based on a priori study criteria, quantity of screen use included duration of screen time and background television, quality of screen use included co-viewing and exposure to educational programs, and onset of screen use was defined as the age children first began viewing screens. The child language outcome included assessments of receptive and/or expressive language. Results: Participants totaled 18 905 from 42 studies included. Effect sizes were measured as correlations (r). Greater quantity of screen use (hours per use) was associated with lower language skills (screen time [n = 38; r = -0.14; 95% CI, -0.18 to -0.10]; background television [n = 5; r = -0.19; 95% CI, -0.33 to -0.05]), while better-quality screen use (educational programs [n = 13; r = 0.13; 95% CI, 0.02-0.24]; co-viewing [n = 12; r = 0.16; 95% CI, 0.07-.24]) were associated with stronger child language skills. Later age at screen use onset was also associated with stronger child language skills [n = 4; r = 0.17; 95% CI, 0.07-0.27]. Conclusions and Relevance: The findings of this meta-analysis support pediatric recommendations to limit children's duration of screen exposure, to select high-quality programming, and to co-view when possible.