Exploring Perinatal Indicators of Infant Social-Emotional Development: A Review of the Replicated Evidence.

The importance of infant social-emotional development for outcomes across the lifecourse has been amply demonstrated. Despite this, most screening measures of social-emotional development are designed for children 18 months of age and over, with a clear gap in earlier infancy. No systematic review has yet harvested the evidence for candidate indicators in the perinatal window. This paper examines modifiable risk and protective factors for two seminal early markers of social-emotional development: attachment security and behavioral regulation mid-infancy. We searched meta-analytic and longitudinal studies of developmental relationships between modifiable exposures in the perinatal window (pregnancy to 10 months postpartum) and attachment and behavioral regulation status measured between 12 and 18 months. Six electronic databases were used: ERIC, PsycINFO, Medline Complete, Informit, Embase, and Scopus. Twelve meta-analytic reviews and 38 original studies found replicated evidence for 12 indicators across infant, caregiving, and contextual domains predictive of infant behavioral regulation and attachment status between 12 and 18 months. Key among these were caregiving responsiveness, maternal mental health, couple relationship, and SES as a contextual factor. Perinatal factors most proximal to the infant had the strongest associations with social-emotional status. Beyond very low birthweight and medical risk, evidence for infant-specific factors was weaker. Risk and protective relationships were related but not always inverse. Findings from this review have the potential to inform the development of reliable tools for early screening of infant social-emotional development for application in primary care and population health contexts.

Exploring the Efficacy of Telehealth for Family Therapy Through Systematic, Meta-analytic, and Qualitative Evidence.

There is a current escalating need for telehealth (TH) options in family mental health services. In the absence of replicated evidence, TH guidelines from peak bodies are largely based on assumptions of the effectiveness of TH methods. New investments in TH would optimally be based in evidence of clinical efficacy. To this end, we conducted three studies in which we (1) systematically reviewed eight professional guidelines for TH family therapy, (2) examined replicated evidence for the efficacy of TH family therapy through systematic review of 20 studies and meta-analyses of 13 effects, and (3) synthesised clinical accommodations to TH methodology from a study of 12 experienced TH family therapists. The studies found (1) a predominant focus in existing TH guidelines on operational matters pertaining to TH and relative neglect of therapeutic process; (2) meta-analyses of efficacy for child behavioural problems (k = 8) and parental depression (k = 5) showed equivalent outcomes in TH and face-to-face therapy and enhanced outcomes in TH relative to treatment as usual, resource provision (i.e. written materials), or wait-list control. Narrative review of 20 studies for a range of relational and mental health outcomes aligned with these findings; and (3) therapists defined clear conditions for enhanced engagement and therapeutic process via TH and reflected on cautions and accommodations for purposes of rapport building and mitigating risk. Given moderate-strong evidence for the efficacy of TH methods of family therapy for a range of conditions, we offer recommendations for future implementation of TH for family therapy.

Preconception and perinatal predictors of offspring attachment disorganization: Advancing the replicated evidence.

Attachment disorganization in early childhood is an influential yet modifiable risk factor for later mental health problems. Beyond established transmission through parents' unresolved attachment representations and caregiving sensitivity, little replicated evidence exists for wider determinants of offspring attachment disorganization. This study examined the replicated evidence for psychosocial risk factors in the preconception, prenatal, and postnatal periods. We identified all relevant longitudinal studies, and examined all risk relationships for which evidence existed in two or more cohorts (48 effects, 17 studies, N = 6,099). Study-specific and pooled risk associations were estimated and a range of moderators evaluated. Mothers' low socioeconomic status (r = .28, k = 2), perinatal loss of a child (r = .26, k = 2), caregiving intrusiveness (r = .31, k = 2), and infant male sex (r = .26, k = 4) predicted offspring attachment disorganization. Maternal sensitivity (r = -.25, k = 6) and higher metacognition during pregnancy (r = -.23, k = 3) predicted lower risk of offspring attachment disorganization. Findings suggest the origins of offspring disorganized attachment include but extend beyond maternal unresolved attachment representations and caregiving. We discuss implications for theory and for identification of modifiable risk pathways in the perinatal window.

An Initial Examination of Post-Traumatic Stress Disorder in Mothers of Children with Autism Spectrum Disorder: Challenging Child Behaviors as Criterion A Traumatic Stressors.

Parenting a child with autism spectrum disorder (ASD) is associated with high levels of stress. Several studies have conceptualized this as a traumatic stress response to challenging child behaviors such as self-harm, suicidal ideation, and physical aggression toward caregivers. In the present study, we explored the relevance of a trauma-based diagnostic framework to a sample of 30 mothers (M age = 42.97, SD = 5.82) of children with ASD (M age = 12.43, SD = 3.15). Participants were interviewed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) for post-traumatic stress disorder (PTSD) and an abbreviated Mini International Neuropsychiatric Interview to assess for comorbidity. Three participants were excluded as they met criteria for PTSD from a traumatic event unrelated to their parenting experience. Of the remaining 27 participants, 6 (22.2%) met criteria for PTSD in the context of traumatic parenting experiences. Descriptions of traumatic events experienced are summarized. Results suggest that, for some parents, challenging child behaviors such as physical violence toward the caregiver from the child, self-injurious behaviors, and suicidal behaviors function as traumatic stressors as per Criterion A of PTSD (American Psychiatric Association [2013]. Diagnostic and statistical manual of mental disorders [DSM-5]. Arlington, VA). This has implications for health professionals engaged with parents of children with ASD, who should consider the possibility of PTSD when challenging behaviors of a potentially traumatic nature are present. Autism Res 2020. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study found that some challenging behaviors exhibited by children with autism spectrum disorder can be traumatic for parents and lead to the development of post-traumatic stress disorder. Some of these behaviors included self-harming behaviors like head banging, expressing suicidal urges, and becoming physically aggressive toward parents during meltdowns. Autism Res 2020, 13: 1527-1536. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Psychopathology in parents of children with autism spectrum disorder: A systematic review and meta-analysis of prevalence.

Parents of children with autism spectrum disorder appear to experience high levels of psychological distress, yet little is known about the prevalence of psychological disorders in this population. The aim of this systematic review and meta-analysis was to estimate the proportion of these parents who experience clinically significant psychopathology. Articles reporting proportions of psychological disorders in a sample of parents of children with autism spectrum disorder were located. The initial search returned 25,988 articles. Thirty-one studies with a total sample of 9208 parents were included in the final review. The median meta-analytic proportions were 31% (95% confidence interval = [24%, 38%]) for depressive disorders, 33% (95% confidence interval = [20%, 48%]) for anxiety disorders, 10% (95% confidence interval = [1%, 41%]) for obsessive-compulsive disorder, 4% (95% confidence interval = [0%, 22%]) for personality disorders, 2% (95% confidence interval = [1%, 4%]) for alcohol and substance use disorders and 1% (95% confidence interval = [0%, 5%]) for schizophrenia spectrum disorders. Significant heterogeneity was detected in these categories. Further research is needed to gain more insight into variables that may moderate parental psychopathology. This review and meta-analysis is the first to provide prevalence estimates of psychological disorders in parents of children with autism spectrum disorder.