Prenatal maternal infections and early childhood developmental outcomes: analysis of linked administrative health data for Greater Glasgow & Clyde, Scotland.

BACKGROUND: Previous research has linked prenatal maternal infections to later childhood developmental outcomes and socioemotional difficulties. However, existing studies have relied on retrospectively self-reported survey data, or data on hospital-recorded infections only, resulting in gaps in data collection. METHODS: This study used a large linked administrative health dataset, bringing together data from birth records, hospital records, prescriptions and routine child health reviews for 55,856 children born in Greater Glasgow & Clyde, Scotland, 2011-2015, and their mothers. Logistic regression models examined associations between prenatal infections, measured as both hospital-diagnosed prenatal infections and receipt of infection-related prescription(s) during pregnancy, and childhood developmental concern(s) identified by health visitors during 6-8 week or 27-30 month health reviews. Secondary analyses examined whether results varied by (a) specific developmental outcome types (gross-motor-skills, hearing-communication, vision-social-awareness, personal-social, emotional-behavioural-attention and speech-language-communication) and (b) the trimester(s) in which infections occurred. RESULTS: After confounder/covariate adjustment, hospital-diagnosed infections were associated with increased odds of having at least one developmental concern (OR: 1.30; 95% CI: 1.19-1.42). This was broadly consistent across all developmental outcome types and appeared to be specifically linked to infections occurring in pregnancy trimesters 2 (OR: 1.34; 95% CI: 1.07-1.67) and 3 (OR: 1.33; 95% CI: 1.21-1.47), that is the trimesters in which foetal brain myelination occurs. Infection-related prescriptions were not associated with any clear increase in odds of having at least one developmental concern after confounder/covariate adjustment (OR: 1.03; 95% CI: 0.98-1.08), but were associated with slightly increased odds of concerns specifically related to personal-social (OR: 1.12; 95% CI: 1.03-1.22) and emotional-behavioural-attention (OR: 1.15; 95% CI: 1.08-1.22) development. CONCLUSIONS: Prenatal infections, particularly those which are hospital-diagnosed (and likely more severe), are associated with early childhood developmental outcomes. Prevention of prenatal infections, and monitoring of support needs of affected children, may improve childhood development, but causality remains to be established.

Investigating low birth weight and preterm birth as potential mediators in the relationship between prenatal infections and early child development: a linked administrative health data analysis.

BACKGROUND: Prenatal infections are associated with childhood developmental outcomes such as reduced cognitive abilities, emotional problems and other developmental vulnerabilities. However, there is currently a lack of research examining whether this arises due to potential intermediary variables like low birth weight or preterm birth, or due to some other mechanisms of maternal immune activation arising from prenatal infections. METHODS: Administrative data from the National Health Service health board of Greater Glasgow & Clyde, Scotland, were used, linking birth records to hospital records and universal child health review records for 55 534 children born from 2011 to 2015, and their mothers. Causal mediation analysis was conducted to examine the extent to which low birth weight and preterm birth mediate the relationship between hospital-diagnosed prenatal infections and having developmental concern(s) identified by a health visitor during 6-8 weeks or 27-30 months child health reviews. RESULTS: Model estimates suggest that 5.18% (95% CI 3.77% to 7.65%) of the positive association observed between hospital-diagnosed prenatal infections and developmental concern(s) was mediated by low birth weight, while 7.37% (95% CI 5.36 to 10.88%) was mediated by preterm birth. CONCLUSION: Low birth weight and preterm birth appear to mediate the relationship between prenatal infections and childhood development, but only to a small extent. Maternal immune activation mechanisms unrelated to low birth weight and preterm birth remain the most likely explanation for associations observed between prenatal infections and child developmental outcomes, although other factors (for example, genetic factors) may also be involved.

The use and potential of artificial intelligence for supporting clinical observation of child behaviour.

BACKGROUND: Observation of child behaviour provides valuable clinical information but often requires rigorous, tedious, repetitive and time expensive protocols. For this reason, tests requiring significant time for administration and rating are rarely used in clinical practice, however useful and effective they are. This article shows that Artificial Intelligence (AI), designed to capture and store the human ability to perform standardised tasks consistently, can alleviate this problem. CASE STUDY: We demonstrate how an AI-powered version of the Manchester Child Attachment Story Task can identify, with over 80% concordance, children with insecure attachment aged between 5 and 9 years. DISCUSSION: We discuss ethical issues to be considered if AI technology is to become a useful part of child mental health assessment and recommend practical next steps for the field.

Online therapy with families - what can families tell us about how to do this well? A qualitative study assessing families' experience of remote Dyadic Developmental Psychotherapy compared to face-to-face therapy.

Dyadic Developmental Psychotherapy (DDP) is a family-based therapy for adopted children aiming to achieve secure attachment between the child and parent. Due to restrictions under the COVID-19 pandemic, delivery of DDP transitioned from face-to-face to online methods. This study aimed to explore families experience of online DDP compared to face-to-face DDP, looking at the advantages and disadvantages of remote delivery methods and the implications this has on future service delivery for clinicians. Semi-structured interviews with 6 families were conducted online. Analysis of transcripts using Interpretative Phenomenological Analysis (IPA) revealed four superordinate themes: environment and child engagement, non-verbal communication, travel and familiarity with remote interactions. Parents recognised the influence the physical and online environment had on their child's engagement levels, however, varied in their experience and hence preference of delivery method. All families emphasised the importance of non-verbal communication within DDP sessions and majority highlighted this may be lost online. For families who travelled to face-to-face DDP, car journeys provided a unique opportunity to decompress and reflect after sessions. For families where travel is unfeasible, online DDP was a lifeline, demonstrating the ability of remote therapy to widen access to specialist healthcare. Familiarity with online work emerged as a strong indicator of positive attitudes towards remote DDP, especially if the previous experience is positive and the child is confident using technology. Overall, families differed greatly in their experience of remote and face-to-face DDP indicating a new approach must be undertaken with each family beginning therapy, ensuring it is unique and individual to their needs.

Editorial perspective: protective factors following cumulative childhood adversity.

Adverse childhood experiences can have a significant impact on adult psychosocial outcomes. However, negative outcomes are not inevitable, and protective factors can interrupt the realisation of negative developmental trajectories and result in positive adaptation in spite of childhood adversity. Interventions that promote social support, encourage education and academic achievement, and address specific personality and dispositional factors are likely to beneficial for those with experience of childhood adversity. Holistic assessment that considers both neurodevelopmental conditions and trauma symptoms is also important for promoting resilience and avoiding assumptions that mental and behavioural problems in children with cumulative adversity are purely 'social'.

Towards system redesign: An exploratory analysis of neurodivergent traits in a childhood population referred for autism assessment.

BACKGROUND: Children's health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated. METHODS: We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence. RESULTS: 114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment. CONCLUSIONS: Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.

Reactive attachment disorder, disinhibited social engagement disorder, adverse childhood experiences, and mental health in an imprisoned young offender population.

BACKGROUND: A high proportion of young people in prison have a history of abuse and neglect, and/or of neurodevelopmental or psychiatric conditions.  Despite this, the only two conditions specifically associated with abuse and neglect, Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED), have never been included as part of a comprehensive prevalence study. METHODS: A cross sectional study, in 110 male inmates aged 16 to 23, examined the prevalence of, and associations between, adverse childhood experiences (ACEs), neurodevelopmental and mental health conditions, including RAD and DSED. OUTCOMES: Virtually all of the young men (96 %) had one or more lifetime neurodevelopmental or mental health conditions, 85.5 % had a current condition, yet less than 3 % reported having received a mental health assessment in prison. High rates of RAD and/or DSED symptoms were found (53.6 %) and 74.5 % had experienced some form of abuse or neglect. INTERPRETATION: There is a high prevalence of ACEs, RAD/DSED, neurodevelopmental and other mental health conditions within this population. Comprehensive clinical assessments are required to ensure appropriate support and staff training is needed to ensure that the full implications of the high prevalence of neurodevelopmental and mental health conditions are understood as part of trauma informed care.

Is there evidence of a causal link between childhood maltreatment and attention deficit/hyperactivity disorder? A systematic review of prospective longitudinal studies using the Bradford-Hill criteria.

Background: Studies report an elevated risk of maltreatment in children with attention deficit/hyperactivity disorder (ADHD), and elevated levels of ADHD in people who suffered childhood maltreatment (CM). However, the direction(s) of causality between CM and ADHD remain unclear-does ADHD create a context for CM, does CM cause ADHD, or both? Objective: This study systematically reviews and qualitatively synthesizes the research evidence relating to this question using Bradford-Hill criteria for establishing causality-strength, temporality, dose-response and plausibility. Methods: We conducted a systematic review, following PRISMA guidelines, of prospective longitudinal studies examining both CM and ADHD. We then used Bradford-Hill criteria to assess the quality of evidence for a causal link between CM and ADHD. Results: All 11 included studies demonstrated an association between CM and ADHD. Seven included evidence for temporality: five suggesting that CM precedes ADHD in the lifespan; two suggesting ADHD precedes CM. Four studies demonstrated a dose response relationship in which greater CM exposure was associated with elevated risk of ADHD. Studies presented a range of plausible mechanisms, including CM causing ADHD through biological programming, versus ADHD causing CM through parental stress. Conclusions: The high quality prospective longitudinal studies reviewed confirm the association between ADHD and CM, but present conflicting evidence about the direction of causality and mechanisms underpinning this association. To better understand the complex interplay between CM and ADHD, more studies using new research designs will be required that can partition effects by type of CM and account for bidirectional effects and other complexities.

Correction: The hallmarks of childhood abuse and neglect: A systematic review.

[This corrects the article DOI: 10.1371/journal.pone.0243639.].

Abuse, neglect and neurodevelopment across the life course: what can paediatricians and child psychiatrists do about this together? The Illingworth-Rees keynote lecture 2023.

Paediatricians and child psychiatrists share complex cases, often associated with abuse, neglect and other 'Adverse Childhood Experiences (ACEs)'. ACEs are associated in a dose-response relationship with both mental and physical health problems across the life span. We found that 9-year-old children who had been abused and neglected were much more likely to also have symptoms of heritable neurodevelopmental conditions (NDCs) such as ADHD, autism and intellectual disabilities. To our surprise, these were not caused by the abuse and neglect. Instead, both the NDCs and the abuse and neglect were being caused by additional genetic factors. We also found that children who have experienced abuse and neglect, and who also have NDCs, are at twice the risk of developing symptoms of severe mental illness in adolescence. This has caused us to develop our 'Double Jeopardy' hypothesis-that experiencing both abuse and neglect and NDCs in childhood might double the risk of a range of physical and mental health problems across the life span.Both paediatricians and child psychiatrists will be faced with children who have complex problems, and they will sometimes need to work together to solve these-whether or not abuse or neglect is in the mix.Dr Corinne Rees's words were prescient: 'The truth that psychological issues and behaviour are integral to all illness indicates the necessity for every doctor to feel competent in considering their relevance'. As paediatricians and child psychiatrists, let's move forward together to overcome the mind-body dichotomy for the benefit of our patients.

Using the candidacy framework to conceptualize systems and gaps when developing infant mental health (IMH) services: A qualitative study.

The development of infant mental health (IMH) services globally is still in its early stages. This qualitative study aims to understand the challenges of setting up IMH services and explores the views and experiences of 14 multi-disciplinary stakeholders who are part of the IMH implementation group in a large Scottish health board. Six major themes were identified through thematic analysis. This paper examines the most prominent theme "Systems" alongside the theme "Gaps in Current Service". The theoretical framework of "candidacy" is found to be a valuable way to conceptualize the complex systemic layers of micro, meso, and macro factors that contribute to the challenges of setting up services. At the micro level, key themes included the view that services must be accessible, individualized, and involve families. At the meso level, in line with the aims of the service, multiagency integration, aspects of early intervention, and clear operating conditions were all seen as important. Finally, at the macro level, perhaps the biggest challenge perceived by stakeholders is delivering a service that is entirely infant-focused. These findings will help inform policy makers about factors considered by professionals to be vital in the establishment of IMH services in Scotland and across the globe.

El desarrollo de los servicios de salud mental infantil (IMH) globalmente está aún en sus niveles básicos. Este estudio cualitativo se propone comprender los retos de establecer los servicios IMH y explora los puntos de vista y experiencias de 14 personas interesadas de múltiples disciplinas que son parte de un grupo de implementación de IMH dentro de una extensa junta de salud escocesa. A través de análisis temáticos se identificaron seis temas de mayor importancia. Este estudio examina el tema más prominente según la mayor percepción, "Sistemas," junto con el tema "Vacíos en la Actual Prestación de Servicio." Se estima que el marco teorético de trabajo de "candidatura," es una manera valiosa de conceptualizar los complejos niveles sistémicos de micro, medio y macro factores que contribuyen a los retos de establecer los servicios. Al nivel micro, los temas claves incluyen el punto de vista de que los servicios deben ser accesibles, individualizados y deben involucrar a las familias. Al nivel medio, alineados con las metas del servicio, la integración de agencias múltiples, aspectos de temprana intervención y claras condiciones operativas fueron todas estimadas como importantes. Finalmente, al nivel macro, quizás el mayor reto percibido por las personas interesadas es cumplir con el ofrecimiento de un servicio que esté enteramente enfocado en el infante. Estos resultados ayudarán a informar a quienes determinan las políticas a seguir acerca de los factores que los profesionales consideran vitales en el establecimiento de servicios IMH en Escocia y alrededor del globo.

Au niveau global, le développement de service de santé mentale du nourrisson et de la petite enfance en est encore à ses débuts. Cette étude qualitative s'est donnée pour but de comprendre les défis que pose l'installation de services IMH. Elle explore les vues et les perspectives de 14 parties prenantes de diverses disciplines qui font partie d'un groupe de mise en place IMH dans un grand conseil de santé en Ecosse. Six thèmes principaux ont été identifiés au travers une analyse thématique. Cet article examine le thème ayant été perçu comme le plus grand et proéminent, Systèmes, ainsi que le thème « Brèches dans les services actuels ¼. La structure théorique de la 'candidature' a été utilisée pour trouver une manière utile de conceptualiser les couches systémiques complexes de facteurs micro, méso, et macro qui contribuent aux défis qu'il y a dans l'installation de services. Au niveau micro, les thèmes clés ont inclus l'idée que les services doivent être accessibles, individualisés et engager les familles. Au niveau méso, s'alignant avec les buts du service, l'intégration de plusieurs agences, les aspects d'une intervention précoce et des conditions d'opération claires ont tous été estimé être importants. Enfin, au niveau macro, le défi étant peut-être le plus grand selon les parties prenantes est d'offrir un service qui est entièrement focalisé sur le nourrisson. Ces résultats aideront les décideurs pour ce qui s'agit des facteurs considérés comme étant vitaux par les professionnels pour ce qui concerne l'établissement de services IMH en Ecosse et au travers du globe.

'Breaking the cycle': a qualitative study exploring general practitioners' views of infant mental health.

BACKGROUND: Infants living in areas of socioeconomic deprivation are more likely to have adverse childhood experiences (ACEs), which are associated with infant mental health (IMH) problems and poor physical and mental health outcomes throughout the life course. As part of the development of IMH services in Scotland, studies are being conducted to explore various stakeholders' perspectives. AIM: To understand the views and experiences of GPs working in socioeconomically deprived areas in relation to IMH. DESIGN & SETTING: Qualitative study with GPs working in deprived urban communities in Scotland, UK. METHOD: Semi-structured interviews were conducted with 12 GPs from 11 practices. Transcribed interviews were thematically analysed, following the Braun and Clarke framework, using NVivo (version 12) software. RESULTS: The following three overarching themes are presented: (1) Deep End GPs' inherent understanding of IMH, owing to their placement in deprived communities and their under-recognised role in current IMH provision; (2) Factors influencing how communities might perceive IMH, including the potential associations of IMH with parental blame or judgement in areas of socioeconomic deprivation; and (3) Using previous experience to visualise future IMH service delivery, particularly improving on current shortcomings of connectivity and accessibility of services, to develop successful new services. CONCLUSION: GPs in areas of socioeconomic deprivation have a deep understanding of the issues affecting IMH, although do not necessarily relate to the term 'IMH'. New community-based IMH services are much needed, particularly in deprived areas. However, the pre-existing role of primary care must be recognised, supported, and integrated into new services, alongside training to increase IMH awareness among GPs and other primary healthcare professionals (HCPs).

Child maltreatment and telomere length in middle and older age: retrospective cohort study of 141 748 UK Biobank participants.

BACKGROUND: There is evidence that child maltreatment is associated with shorter telomere length in early life. AIMS: This study aims to examine if child maltreatment is associated with telomere length in middle- and older-age adults. METHOD: This was a retrospective cohort study of 141 748 UK Biobank participants aged 37-73 years at recruitment. Leukocyte telomere length was measured with quantitative polymerase chain reaction, and log-transformed and scaled to have unit standard deviation. Child maltreatment was recalled by participants. Linear regression was used to analyse the association. RESULTS: After adjusting for sociodemographic characteristics, participants with three or more types of maltreatment presented with the shortest telomere lengths (ß = -0.05, 95% CI -0.07 to -0.03; P < 0.0001), followed by those with two types of maltreatment (ß = -0.02, 95% CI -0.04 to 0.00; P = 0.02), referent to those who had none. When adjusted for depression and post-traumatic stress disorder, the telomere lengths of participants with three or more types of maltreatment were still shorter (ß = -0.04, 95% CI -0.07 to -0.02; P = 0.0008). The telomere lengths of those with one type of maltreatment were not significantly different from those who had none. When mutually adjusted, physical abuse (ß = -0.05, 95% CI -0.07 to -0.03; P < 0.0001) and sexual abuse (ß = -0.02, 95% CI -0.04 to 0.00; P = 0.02) were independently associated with shorter telomere length. CONCLUSIONS: Our findings showed that child maltreatment is associated with shorter telomere length in middle- and older-aged adults, independent of sociodemographic and mental health factors.

Routinely used interventions to improve attachment in infants and young children: a national survey and two systematic reviews.

BACKGROUND: Attachment refers to an infant's innate tendency to seek comfort from their caregiver. Research shows that attachment is important in promoting healthy social and emotional development. Many parenting interventions have been developed to improve attachment outcomes for children. However, numerous interventions used in routine practice have a limited evidence base, meaning that we cannot be sure if they are helpful or harmful. OBJECTIVES: This research aimed to conduct a large-scale survey to identify what interventions are being used in UK services to improve child attachment; conduct a systematic review to evaluate the evidence for parenting attachment interventions; and develop recommendations for future research and practice. DESIGN AND METHODS: We worked closely with our Expert Reference Group to plan a large-scale survey focused on relevant UK services. We then conducted two systematic reviews. One searched for all randomised controlled trial evidence for any attachment parenting intervention. The second searched for all research for the top 10 routinely used interventions identified from the survey. RESULTS: The survey collected 625 responses covering 734 UK services. The results identified the 10 most commonly used interventions. The responses showed a limited use of validated measures and a wide variety of definitions of attachment. For the first review, seven studies were included from 2516 identified records. These were combined with results from previous reviews conducted by the team. Meta-analyses showed that, overall, parenting interventions are effective in reducing disorganised attachment (pooled odds ratio 0.54, 95% confidence interval 0.39 to 0.77) and increasing secure attachment (pooled odds ratio 1.85, 95% confidence interval 1.36 to 2.52). The second review searched the literature for the top 10 routinely used interventions identified by the survey; 61 studies were included from 1198 identified records. The results showed that many of the most commonly used interventions in UK services have a weak evidence base and those with the strongest evidence base are not as widely used. CONCLUSIONS: There is a need for better links between research and practice to ensure that interventions offered to families are safe and effective. Possible reasons for the disparity include the cost and accessibility of training. There is also a need for improved understanding by professionals regarding the meaning of attachment. LIMITATIONS: Although the survey had good geographical spread, most respondents were based in England. For review 2 we were unable to access a large number of papers; however, we conducted extensive reference checking to account for this. FUTURE WORK: There is a need for robust research to test the efficacy of routinely used attachment interventions. Research could also explore why routinely used interventions are not consistently subject to thorough evaluation; how to embed dissemination, cost-effectiveness, fidelity and sustainability into research; and how to keep clinical practice up to date with research developments. STUDY REGISTRATION: This study is registered as PROSPERO CRD42019137362. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 2. See the NIHR Journals Library website for further project information.

Attachment refers to an infant's natural instinct to seek comfort from their main carers. There are four ways in which infants show attachment ('attachment patterns'). These are known as secure, insecure-avoidant, insecure-resistant and disorganised. Secure attachment usually occurs with consistent and responsive parenting/caregiving and is linked with positive social and emotional child development. Inconsistent, neglectful or abusive parenting/caregiving can lead to problems with attachment, including disorganised attachment, and is linked to poorer outcomes. Parenting support, education and therapies help parents improve infant attachment and their child's outcomes. We surveyed UK services to see what they offered families with attachment problems. A total of 734 UK services responded. This identified 10 therapies or support packages most commonly offered to parents. We checked what research had been done on these. We found very little. We found 61 studies of support packages with quite good evidence, but these were generally not ones offered by UK services. We also looked in detail at research for all types of support/therapies to improve attachment. We looked for the best research (called 'randomised controlled trials'); 26 studies had tested therapies to see if they improved secure attachment and 20 had tested whether or not they improved (i.e. reduced) disorganised attachment. We found that these therapies or support packages are good at increasing secure attachment and improving disorganised attachment. Mostly they did this by helping parents/caregivers improve caregiving and particularly how sensitive and responsive they are to their child and their needs. Currently, practice is not following research, and research is not being done to properly evaluate current practice. We need to improve the evidence and the way it links to practice, including how those organising and paying for services are made aware of up-to-date research to make sure that the best treatments are available. High-quality training for staff is also important.

Using the live assessment to discriminate between Autism Spectrum Disorder and Disinhibited Social Engagement Disorder.

BACKGROUND: Children with Autism Spectrum Disorder (ASD) and children with Disinhibited Social Engagement Disorder (DSED) may present with similar social problems, despite differing aetiologies, resulting in diagnostic conundrums. METHODS: Thirty children: 10 with ASD, no maltreatment history, 10 with DSED and 10 typically developing children were assessed via 'gold standard' ASD assessments, including the Autism Diagnostic Observational Schedule (ADOS) and a unique unstructured observation known as the Live assessment. Live utilises a triadic interaction (2 assessors and child), playful teasing and social 'stress' scenarios to increase the social challenge. RESULTS: The ADOS supported discrimination of DSED from ASD to a degree. Where additional neurodevelopmental problems created ambiguity, the Live assessment was more supportive than the ADOS for unpicking the underlying nature of the social problems. CONCLUSION: Live supported differentiation between ASD, DSED and other neurodevelopmental problems. The greater social challenge presented by Live exacerbated core problems of ASD and, in DSED, core social skills stood out.

"I will commit to this child as much as I can for the time that they are with me:" A qualitative examination of how foster carer commitment relates to short-term foster care for young children following abuse and neglect.

BACKGROUND: Foster carer commitment to the child has been shown to be of paramount importance in young children's recovery and development following abuse and neglect. In Dozier's definition of commitment in the US, there is a focus on both emotional investment in the child and committing to an enduring relationship with the child. How this relates to the routine practice of short-term, temporary, foster care has not been studied. OBJECTIVE: This is the first qualitative study to explore the drivers of, and barriers to, commitment in short-term foster care within the broader aim of examining whether short-term care is meeting the needs of maltreated young children. PARTICIPANTS & SETTING: Fourteen foster carers took part in research interviews and five focus groups were conducted with infant mental health professionals. METHODS: Interviews and focus group data were subject to qualitative thematic analysis in order to identify patterns of commonality in relation to our research questions. RESULTS: Three broad themes pertain to commitment and the meeting of young children's needs in short-term foster care: Influence, Timescales and Choice in the fostering role. These themes were found to house both drivers of, and barriers to, commitment in short-term care, which are influenced by systemic normalisations of fostering practices. CONCLUSIONS: The emotional investment facet of commitment is more alive in the 'psyche' of short-term foster care than commitment to an enduring relationship. A long-term outlook for the child may be an undefined facet of commitment that is more akin with short-term placements.