Change in toddlers' cortisol activity during a year in childcare. Associations with childcare quality, child temperament, well-being and maternal education.

Elevated levels of the stress hormone cortisol have been found in toddlers in childcare. Measuring cortisol may provide an indication of children's experiences in childcare and help to adjust practices better to their needs. To the best of our knowledge, toddlers' cortisol levels in childcare have not yet been investigated longitudinally. Furthermore, it is unclear which child and childcare factors contribute to cortisol elevation in toddlers. Using linear mixed model analyses, we investigated the full-day cortisol activity (10.00 h, 15.00 h, 18.00 h) of 156 toddlers (81 female, 56 male) during a year in childcare (September, January, June). We also investigated child cortisol levels at home in January. In addition, we tested the relation between cortisol activity and changes in cortisol activity across the year and childcare quality, temperament, well-being in childcare, and maternal education. We found increasing evening cortisol levels through the year while controlling for age. Afternoon cortisol levels were stable, but above morning cortisol levels in September and January and only slightly below morning cortisol levels in June. At home in January, afternoon levels were significantly below morning levels. Higher well-being in childcare was associated with lower overall cortisol levels and less increase in evening cortisol levels through the year in childcare. Further, less active toddlers seemed to accumulate some stress during the childcare day, indicated by higher evening cortisol levels. Rising evening cortisol levels may indicate accumulating stress across the year. Results point toward childcare being demanding for toddlers and their need for consideration from caregivers and parents, also after a longer period of childcare attendance. The findings underline the importance of observing, promoting, and further researching children's well-being in childcare.

Does the Incredible Years Teacher Classroom Management programme improve child-teacher relationships in childcare centres? A 1-year universal intervention in a Norwegian community sample.

The Incredible Years Teacher Classroom Management (IY TCM) programme has shown promise in reducing behaviour problems among high-risk children in childcare. However, at present, we do not know whether the IY TCM successfully improves the child-teacher relationship in childcare and whether the effects manifest in both the population and in high-risk groups. Hence, we conducted a quasi-experimental pre-post study with a matched control condition to examine the changes in child-teacher relationships in a sample of 1085 children aged 3-6 years after implementing the IY TCM programme. Linear mixed models revealed favourable group-by-time differences benefitting the intervention compared to the control condition. Subgroup analyses of children scoring at or above the 90th percentile on either internalising or externalising behaviour problems showed that the preventive effects persisted in both high-risk subsamples. In sum, the findings indicate that the IY TCM programme does improve child-teacher relationships and that the effect is present for the entire study population as well as children scoring in the clinical range on behaviour problems. This suggests that the application of the IY TCM programme in childcare settings has important preventive effects. Implications and limitations are further discussed.

Screening for mental health problems in a Norwegian preschool population. A validation of the ages and stages questionnaire: Social-emotional (ASQ:SE).

BACKGROUND: Early detection of mental health problems in childhood is important. However, studies on screening instruments for preschool children are rare. The aim of this study was to validate the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) with teacher reports and examine its screening accuracy in a preschool population. METHODS: A total of 1428 children, aged 18 months - 5 years, attending child-care centers were recruited in Norway. Their teachers completed a survey including the ASQ:SE and the Caregiver-Teacher Report Form (C-TRF). The Spearman's correlation was calculated for the convergence between the ASQ:SE and the C-TRF and the screening accuracy of the ASQ:SE was assessed using receiver operating characteristic (ROC) analysis with the criterion of a score at or above the 90th percentile for the C-TRF total problem score. RESULTS: The Spearman's correlation between the total scores for the ASQ:SE and the C-TRF were from .49 to .72. The ROC analyses demonstrated that the ASQ:SE had a promising ability to classify children at risk based on the C-TRF criterion with AUC ranging from .87 to .96 for the different forms. The ASQ:SE generally demonstrated high specificity across all forms and some forms (from age 30 months upwards) produced both high sensitivity and high specificity using the selected cutoff values. CONCLUSIONS: The ASQ:SE could serve as a good starting point for screening for social-emotional problems among children in child-care centers. The 30- to 60-month ASQ:SE forms exhibit promising psychometric properties and may prove useful for early detection. The 18- to 24-month ASQ:SE forms demonstrate more limited efficacy in detecting children at risk.

Does the Incredible Years Teacher Classroom Management Training programme have positive effects for young children exhibiting severe externalizing problems in school?: a quasi-experimental pre-post study.

BACKGROUND: Young children exhibiting severe externalizing problems in school are at risk of developing several poor outcomes. School-based intervention programs have been found to be effective for students with different problems, including those with behavioral problems, emotional distress, or social problems. The present study investigated whether the IY-TCM programme, as a universal stand-alone school intervention programme, reduced severe child externalizing problems as reported by the teacher, and evaluated if these children improved their social competence, internalizing problems, academic performances and student- teacher relationship as a result of the IY TCM training. METHODS: A quasi-experimental pre-post study was conducted, including 21 intervention schools and 22 control schools. Children in 1st - 3rd grade (age 6-8 years) assessed by their teacher as having severe externalizing problems on the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R) total Intensity score, were included in the study, N = 83 (65 boys and 18 girls). Treatment effects were evaluated using 3- level linear mixed models analysis. RESULTS: In our study we found no differences in change between the two conditions from baseline to follow-up in externalizing problems, social skills, internalizing problems and closeness with teacher. The intervention condition did however show advantageous development in terms of student-teacher conflicts and increased academic performances. CONCLUSION: The IY Teacher Classroom Management program is not sufficient being a stand-alone universal program in a Norwegian primary school setting, for students with severe externalizing problems. However; some important secondary findings were found. Still, young school children with severe externalizing problems are in need of more comprehensive and tailored interventions.

Symptom changes of oppositional defiant disorder after treatment with the Incredible Years Program.

OBJECTIVE: To examine changes in symptoms of oppositional defiant disorder (ODD) after treatment with the Incredible Years Program. The frequency of symptoms was also calculated. METHOD: The participants were 84 children (aged 4.1-8.9 years) diagnosed with ODD before treatment. The data were collected with KIDDIE-SADS interviews before treatment and at a 1-year follow-up. RESULTS: At the 1-year follow-up, descriptive analyses showed that 68% of the children no longer had an ODD diagnosis. Even though all the ODD symptoms had been significantly reduced after treatment, most symptoms still occurred "sometimes". CONCLUSIONS: The Incredible Years Program has a positive effect on children with ODD. However, many children still have symptoms of ODD at the 1-year follow-up, although the frequency of symptoms is significantly reduced. Future studies should explore further these changes in ODD symptoms and evaluate whether some parents and children need support in addition to the Incredible Years Program. It would also be valuable to determine whether patterns of childhood ODD symptoms are related to later development of depression and conduct disorder.

Associations between high levels of conduct problems and co-occurring problems among the youngest boys and girls in schools: a cross-sectional study.

BACKGROUND: Few studies have focused on conduct problems and co-occurring problems among the youngest children in schools, such as social, internalizing and attention problems. In particular, there is a lack of studies that differentiate between boys and girls in terms of such problems. AIM: The aim of the current study was to test associations between conduct problems and social, internalizing and attention problems, as well as adaptive school functioning, which was rated by the teachers of boys and girls in grades 1-3. METHODS: In a cross-sectional study, 103 boys and 108 girls in grades 1-3 at six schools participated in a national Norwegian study of child conduct problems in the normal population. Linear regression analysis was used to test the associations between conduct problems, social skills, problems of internalization, attention problems and adaptation to school among boys and girls. RESULTS: There were significant associations between high levels of conduct problems and social skills problems, attention problems and low adaptive school functioning scores among boys and girls. Attention problems had the most powerful associations with conduct problems for both genders. CONCLUSIONS: Young schoolchildren with high levels of conduct problems also had co-occurring problems. Schools and teachers need to adopt a comprehensive approach to help these children during their first years in school.

Do toddlers' levels of cortisol and the perceptions of parents and professional caregivers tell the same story about transition from home to childcare? A mixed method study.

Introduction: Enrolling in childcare represents the first transition in toddlers' lives and lays the foundation for their well-being in childcare centers going forward. Child cortisol levels may be an indicator of how toddlers themselves experience their introduction to childcare. In the present study, we explored changes in toddler cortisol levels during their first month in childcare and at a 3-month follow-up, as well as the perceptions of parents and professional caregivers regarding the toddlers' settling-in process during the same period. Method: This study used a mixed-method design. Saliva samples were collected from 113 toddlers and their cortisol levels analyzed. Qualitative notes were collected from parents (n = 87) and professional caregivers (n = 101). The data were analyzed using linear mixed model and thematic analyses, respectively. Results: Changes in toddler cortisol levels and their parents' and professional caregivers' perceptions of the transition process fit well. Both data sources indicated an easy start in childcare when parents were present, while the first weeks separated from parents seemed quite demanding. After 3 months, the cortisol levels returned to a low level, while child well-being was perceived as high. Discussion: Toddlers need time to adapt to childcare settings. Even if they are well taken care of by their keyworkers during the day, many toddlers are tired and exhausted in the evenings at home, particularly in the first weeks of separation from their parents. Both professional caregivers and parents should be aware of toddlers' need for emotional support during their transition to childcare.

School competence and emotional/behavioral problems among Norwegian school children as rated by teachers on the Teacher Report Form.

Of 1,409 eligible children aged 6-13 years in grades 1 to 7 who were randomly selected from a national sample of Norwegian schools, 858 participated in the present study (60.9%). The sample was stratified by school centrality, region and size of grade cohort. The teachers assessed their children's academic performance, adaptive school functioning, and levels of emotional/behavioral problems using the 2001 version of the Teacher Report Form (TRF). Only one child was randomly selected from each grade cohort. Girls had significantly higher scores than boys in the Working Hard, Appropriate Behavior, Learning, and Total Adaptive Functioning domains. For girls, only the Working Hard domain was of medium effect size. While boys had significantly higher scores than girls on Attention, Thought Problems, Rule-Breaking, Aggression, Externalizing Problems and Total problems, only Attention Problems showed a medium effect size. Significant sex by age interaction effects were also found for Rule-Breaking, Externalizing, Internalizing, Anxious-Depressed and Total Problems. In all these comparisons, 10-13-year-old boys had significantly higher scores than 6-9-year olds, while girls had similar problem levels across age groups. Our mean Total Problems score (17.2) was lower than the grand mean (21.6) reported in a multi-country comparison but higher than in another Norwegian large-scale survey. Overall, our findings indicate that teachers in Scandinavia report, just as do parents, relatively low levels of emotional/behavioral problems among school-aged children.

Promoting the Quality of Teacher-Toddler Interactions: A Randomized Controlled Trial of "Thrive by Three" In-Service Professional Development in 187 Norwegian Toddler Classrooms.

The effectiveness of the Thrive by Three intervention, a 10-month, multicomponent, in-service professional development model to promote the quality of caregiver-toddler interactions (i.e., process quality), was tested utilizing a clustered randomized controlled design. Eighty childcare centers with 187 toddler classrooms in Norway were randomly assigned to either the Thrive by Three intervention group (n=87) or a usual-activity wait list control group (n=100). Interactional quality was assessed with the Toddler version of the Classroom Assessment Scoring System (CLASS-Toddler) at three timepoints: pre-, mid-, and post-intervention. There were significant group differences in change in quality during the intervention period in both CLASS domains, Emotional and Behavioral Support (EBS), and Engaged Support for Learning (ESL), with greater overall differences in the ESL domain. Quality increased in the intervention groups, but quality decreased in the control group from baseline to post-intervention. There were significant group differences in quality at baseline. The Thrive by Three intervention had a positive effect on teacher-toddler interactions in both the EBS and ESL domains. Results need to be replicated preferably in more diverse samples. Clinical Trial Registration: ClinicalTrials.gov #NCT03879733.

Validation of the Leiden Inventory for the Child's Well-Being in Daycare (LICW-D) Questionnaire in Norwegian Early Childhood Education and Care Centers.

The promotion of children's development and well-being is a core concept in Early Childhood Education and Care (ECEC) quality frameworks. Yet, few validated instruments measuring young children's well-being exist. This study examined the validity of The Leiden Inventory for the Child's Well-being in Daycare (LICW-D) (De Schipper et al., 2004b) in a sample of toddlers (n = 1,472) attending ECEC centers in Norway, using confirmatory factor analysis. Factorial invariance across gender and concurrent validity were also investigated. Indicators of concurrent validity were problem behaviors and difficult temperament, as rated by professional caregivers. Results showed a marginally acceptable fit for the hypothesized one-factor model, when allowing the measurement error of four item pairs to be correlated. This slightly modified model showed satisfactory concurrent validity, and factorial invariance across gender was confirmed.

The Association Between Toddlers' Temperament and Well-Being in Norwegian Early Childhood Education and Care, and the Moderating Effect of Center-Based Daycare Process Quality.

Children who experience well-being are engaging more confidently and positively with their caregiver(s) and peers, which helps them to profit more from available learning opportunities and support current and later life outcomes. The goodness-of-fit theory suggests that children's well-being might be a result of the interplay between their temperament and the environment. However, there is a lack of studies that examined the association between children's temperament and well-being in early childhood education and care (ECEC), and whether this association is affected by ECEC process quality. Using a multilevel random coefficient approach, this study examines the association between toddlers' (N = 1,561) temperament (shyness, emotionality, sociability, and activity) and well-being in Norwegian ECEC and investigates whether process quality moderates this association. Results reveal an association between temperament and well-being. Staff-child conflict moderates the association between shyness and well-being, and between activity and well-being. Moreover, high emotional behavioral support moderates the association between activity and well-being. Extra attention should be paid by the staff to these children's needs.

Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training.

BACKGROUND: While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. METHOD: In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5-6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5-6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview. RESULTS: While all children qualified for a diagnosis of ODD/CD before treatment, 5-6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5-6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems. CONCLUSION: The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.

Characteristics of young children with persistent conduct problems 1 year after treatment with the Incredible Years program.

In the present study, predictors of persistent conduct problems among children aged 4-8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program (PT), or combined parent training and child treatment (PT + CT). Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.

A Model of Intervention and Implementation of Quality Building and Quality Control in Childcare Centers to Strengthen the Mental Health and Development of 1-3-Year Olds: Protocol for a Randomized Controlled Trial of Thrive by Three.

BACKGROUND: Universal, high-quality childcare offers a unique opportunity to prevent developmental trajectories leading to mental health problems. Yet, growing evidence has shown that the process quality of Norwegian childcare centers varies considerably, and that research-based models for quality building are significantly lacking. OBJECTIVE: To examine whether a model for quality building in childcare centers, Thrive by Three, increases the quality of child-caregiver interactions, and promotes child development, well-being, and mental health. METHODS: The Thrive by Three study is a clustered randomized controlled trial involving 187 toddler groups in childcare centers across 7 municipalities within southern and central Norway. Each center is randomly allocated to the intervention or wait-list control group. Data are collected at 4 points: preintervention (T1), midway (T2), postintervention (T3), and 1-year postintervention (T4). Primary outcomes are changes in childcare quality measured by the Classroom Assessment Scoring System toddler version (CLASS), Student-Teacher Relationship Scale, Short Form (STRS-SF), and Life in Early Childhood Programs (LECP), as well as child development and mental health measured by The Brief Infant Toddler Social and Emotional Assessment (BITSEA, parent and teacher report), the Caregiver-Teacher Report Form (C-TRF), and Child Behavior Checklist (parent report) from the Achenbach System of Empirically Based Assessment (ASEBA) from 1.5 to 5 years, and child well-being measured by the Leiden Inventory for Child's Well-Being in Day Care (LICW-D). Secondary outcomes are child cortisol levels, assessed in a subsample of 372 children. RESULTS: As of August 2020, a total of 1531 children and 769 staff from 187 toddler groups were recruited. Because of turnover, the recruitment of staff will be ongoing until August 2020. As of January 2020, the intervention group has been working with Thrive by Three for 1.5 years. Data at T1, T2, and T3 from both the intervention and control groups have been completed and T4 will be completed in August 2020. CONCLUSIONS: This study makes an important contribution to the field of quality building in childcare centers. The results will provide greater insight into how high quality can be obtained and the effects of high-quality early childcare on child mental health. This in turn will be significant for policymakers and to the Norwegian society at large. TRIAL REGISTRATION: ClinicalTrials.gov NCT03879733; https://clinicaltrials.gov/ct2/show/NCT03879733 and Norwegian Research Council 260624/H10; https://prosjektbanken.forskningsradet.no/#/project/NFR/260624/Sprak=en. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17726.

Mediating Mechanisms of the Incredible Years Teacher Classroom Management Program.

This study examined whether, and the extent to which, the Incredible Years Teacher Classroom Management program predicted positive development of children's emotional, behavioral, and social adjustment through changes in the child-teacher relationship. Using data from a longitudinal quasi-experimental intervention trial with a matched control condition, including 1,085 children (49.7% girls, meanage = 4.22 years; SDage = 0.88 years), the potential associations were tested by means of multilevel path modeling. The mediation model demonstrated that (1) children in the intervention condition achieved more favorable changes in the child-teacher relationship than the control condition; (2) changes in the child-teacher relationship were associated with changes in the target outcomes; and (3) the intervention effects were mediated via changes in the child-teacher relationship.

Treatment of oppositional defiant and conduct problems in young Norwegian children : results of a randomized controlled trial.

The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4-8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries.

Video feedback compared to treatment as usual in families with parent-child interactions problems: a randomized controlled trial.

BACKGROUND: For the first time to our knowledge, short- and long-term effects of a multi-site randomized-controlled trial (RCT) of video feedback of infant-parent interaction (VIPI) intervention in naturalistic settings are published. The intervention targets families with children younger than 2 years old and parent-child interactions problems. Outcome variables were 1) observed parent-child interactions and 2) parent-reported child social and emotional development. Between-group differences of the moderating effects of parental symptoms of depression, personality disorders traits, and demographic variables were investigated. METHOD: The study had a parallel-group, consecutively randomized, single-blinded design; participants were recruited by health- and social workers. Seventy-five families received VIPI, and 57 families received treatment as usual (TAU). Videotapes of each parent-child interactions were obtained before treatment, right after treatment, and at a 6-month follow-up and coded according to Biringen's Emotional Availability Scales. Parental symptoms of depression and personality disorder traits were included as possible moderators. RESULTS: Evidence of a short-term effect of VIPI treatment on parent-child interactions was established, especially among depressed parents and parents with problematic interactions-and, to some extent, among parents with dependent and paranoid personality disorder traits. A long-term positive effect of VIPI compared with TAU on child social/emotional development was also evident. In a secondary analysis, VIPI had a direct positive effect on the depressive symptoms of parents compared with TAU. CONCLUSION: The findings of the study support the use of VIPI as an intervention in families with interaction difficulties. TRIAL REGISTRATION: Current Controlled Trials ISRCTN99793905.

International epidemiology of child and adolescent psychopathology ii: integration and applications of dimensional findings from 44 societies.

OBJECTIVE: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c) testing effects of society, gender, and age in 44 societies by integrating new and previous data; (d) testing cross-society correlations between mean item ratings; (e) describing the construction of multisociety norms; (f) illustrating clinical applications. METHOD: Confirmatory factor analyses (CFAs) of parent, teacher, and self-ratings, performed separately for each society; tests of societal, gender, and age effects on dimensional syndrome scales, DSM-oriented scales, Internalizing, Externalizing, and Total Problems scales; tests of agreement between low, medium, and high ratings of problem items across societies. RESULTS: CFAs supported the tested syndrome models in all societies according to the primary fit index (Root Mean Square Error of Approximation [RMSEA]), but less consistently according to other indices; effect sizes were small-to-medium for societal differences in scale scores, but very small for gender, age, and interactions with society; items received similarly low, medium, or high ratings in different societies; problem scores from 44 societies fit three sets of multisociety norms. CONCLUSIONS: Statistically derived syndrome models fit parent, teacher, and self-ratings when tested individually in all 44 societies according to RMSEAs (but less consistently according to other indices). Small to medium differences in scale scores among societies supported the use of low-, medium-, and high-scoring norms in clinical assessment of individual children.

Changes in social competence in young children treated because of conduct problems as viewed by multiple informants.

In the present study changes in social competence were examined in a clinic sample of 127 children aged 4-8. The children were recruited to a controlled treatment study because of conduct problems at home and were randomised to the Incredible Years parent training (PT), combined PT and child therapy (CT) or a waiting-list control-group. Assessments were conducted pre- and post-treatment and at a one-year follow-up by multiple informants (mother, father, teacher and child). Parent training combined with child treatment showed most improvement in child social competence based on mother, father and child reports, however, father reports showed positive results for children treated with PT only. Treated mothers and fathers showed a decrease in correlations in their reports of social competence in the child after treatment as compared to parents in the waiting-list condition. No generalisation effects to peer-relationships in day-care/school were found, neither on teacher or child reports. A broad perspective using multiple informants from different settings is needed when effects of treatment of young children with conduct problems are evaluated and should include various aspects of social competence.

Childhood disruptive behaviors and family functioning in clinically referred children: are girls different from boys?

Baseline assessments of 4 to 8-year-old children, 26 girls and 101 boys, referred to outpatient treatment for disruptive behaviors, were examined, focusing on possible differences between the functioning of boys and girls and their families. Child variables included diagnostic information, measures of disruptive behaviors, social competence, and independent observations of child behaviors. A variety of family variables, such as information regarding parenting practices, parental stress, and depression were included. Teacher reports of disruptive behaviors and social competence at school were included. Teacher ratings of child functioning indicated that boys displayed significantly more externalizing behaviors and they were less socially competent than girls. Parents perceived both girls and boys as highly oppositional and aggressive, and generally speaking, differences were few. Nevertheless, the level of stress was higher in girls' than in boys' families, and mothers of girls reported of higher levels of depressive symptoms. Girls and boys did not differ regarding diagnostic status.