Examining the Biological Impacts of Parent-Child Relationship Dynamics on Preschool-Aged Children who have Experienced Adversity.

Parent-child relationship dynamics have been shown to predict socioemotional and behavioral outcomes for children, but little is known about how they may affect biological development. The aim of this study was to test if observational assessments of parent-child relationship dynamics (cohesion, enmeshment, and disengagement) were associated with three biological indices of early life adversity and downstream health risk: (1) methylation of the glucocorticoid receptor gene (NR3C1), (2) telomere attrition, and (3) mitochondrial biogenesis, indexed by mitochondrial DNA copy number (mtDNAcn), all of which were measured in children's saliva. We tested hypotheses using a sample of 254 preschool-aged children (M age = 51.04 months) with and without child welfare-substantiated maltreatment (52% with documented case of moderate-severe maltreatment) who were racially and ethnically diverse (17% Black, 40% White, 23% biracial, and 20% other races; 45% Hispanic) and from primarily low-income backgrounds (91% qualified for public assistance). Results of path analyses revealed that: (1) higher parent-child cohesion was associated with lower levels of methylation of NR3C1 exon 1D and longer telomeres, and (2) higher parent-child disengagement was associated with higher levels of methylation of NR3C1 exon 1D and shorter telomeres. Results suggest that parent-child relationship dynamics may have distinct biological effects on children.

Child-focused infant and early childhood mental health consultation: Shifting adult attributions to reduce the risk for preschool expulsion.

Infant and early childhood mental health consultation (IECMHC) in early care and education (ECE) settings is a promising approach to support young children. Although research on the effects of IECMHC is encouraging, it is limited by the complexities of the systems in which IECMHC is implemented and the variability in IECMHC models. The current study aims to clearly articulate a statewide, child-focused, short-term IECMHC model, assess consultee satisfaction, examine the effects of consultation on children's functioning in the school and home settings, and evaluate changes in teacher perceptions associated with expulsion risk following consultation. In total, 268 children ages 1-5 (69% White, 75% male) and their family and school caregivers participated in consultation in a New England state, and 95 children and caregivers were included in an evaluation subsample. Of this subsample, teachers and ECE administrators, but not families, indicated significant improvement in children's functioning from referral to end of consultation. There was also a significant decrease in children's risk of expulsion, as measured by teachers' perceptions associated with expulsion decisions. This study contributes to the IECMHC literature by providing results specific to a child-focused model of consultation and highlighting the possible role of adult attributions for children in ECE.

La consulta de salud mental infantil y la temprana niñez (IECMHC) en los entornos de cuidados y educación tempranos (ECE) es un acercamiento prometedor para apoyar a los niños pequeños. A pesar de que la investigación sobre los efectos de IECMHC es alentadora, está limitada por las complejidades de los sistemas dentro de los cuales se implementa IECMHC y la variabilidad en los modelos de IECMHC. El presente estudio se propone articular claramente un modelo de IECMHC para todo el estado, con enfoque en el niño y a corto plazo, evaluar la satisfacción que quienes participan de la consulta, examinar los efectos de la consulta sobre el funcionamiento de los niños en la escuela y en el entorno del hogar, así como evaluar los cambios en las percepciones de los maestros asociadas con los riesgos de expulsión después de la consulta. En total, 268 niños de edad 1­5 (69% blancos, 75% varones) y sus familias y quienes les cuidaba en la escuela participaron en la consulta en un estado de Nueva Inglaterra, y se incluyó a 95 niños y sus cuidadores en una evaluación de un subgrupo muestra. De este subgrupo muestra, los maestros y los administradores de ECE, pero no las familias, indicaron significativas mejorías en el funcionamiento de los niños desde la referencia hasta el final de la consulta. Se dio también una significativa disminución en el riesgo de expulsión de los niños, tal como se midió por medio de las percepciones de los maestros asociadas con las decisiones de expulsión. Este estudio contribuye a la literatura informativa sobre IECMHC por medio de ofrecer resultados específicos al modelo de consulta enfocado en el niño y subrayar el posible papel de las atribuciones del adulto para los niños en ECE.

La consultation de santé mentale du nourrisson et de la petite enfance (Infant and early childhood mental health consultation abrégé en anglais IECMHC) dans des contextes éducatifs et de crèches (abrégé ici CEC selon le français) est une approche prometteuse pour le soutien aux jeunes enfants. Bien que les recherches sur les effets de l'IECMHC sont encourageantes, elles sont limitées par les complexités des systèmes dans lesquels l'IECMHC est mise en oeuvre et la variabilité des modèles de l'IECMHC. Cette étude s'est donné pour but de clairement articuler un modèle IECMHC au niveau de l'état, focalisé sur l'enfant et à court terme, d'évaluer la satisfaction de la personne consultée, d'examiner les effets de la consultation sur le fonctionnement des enfants à l'école et à la maison, et d'évaluer les changements dans les perceptions de l'enseignant liée au risque d'expulsion après la consultation. En tout 268 enfants âgés de 1­5 ans (69% blancs, 75% garçons) et leur famille et les personnes prenant soin d'eux à l'école ont participé à une consultation dans un état de nous Nouvelle Angleterre (aux Etats­Unis), et 95 enfants et personnes prenant soin d'eux ont été inclus dans un sous­échantillon d'évaluation. Dans ce sous­échantillon les enseignants et administrateurs CEC, mais pas les familles, ont fait état d'une amélioration important dans le fonctionnement des enfants du moment de la référence à la fin de la consultation. Il n'a pas de baisse importante du risque d'expulsion des enfants, mesurée par les perceptions des enseignants liées aux décisions d'expulsion. Cette étude contribue aux recherches sur l'IECMHC en offrant des résultats spécifiques à un modèle de consultation focalisé sur l'enfant et en mettant en lumière le rôle possible des attributions adultes pour les enfants dans les CEC.

Childhood stress, gender, and cognitive control: Midline theta power.

The emergence of psychiatric symptoms is a common consequence of childhood stress exposure. However, there are a dearth of reliable clinical hallmarks or physiological biomarkers to predict post-trauma symptom emergence. The objective of this study was to examine if childhood stressors and stress-related symptoms are associated with altered midline theta power (MTP) during cognitive control demands, and how these associations interact with gender and early adversity. N = 53 children (ages 9-13 years old) from a longitudinal study of children maltreated during early childhood and non-maltreated children participated in this study. EEG recorded neural activity during a Zoo-Themed Go/No-Go task. Stress-related symptoms, recent stressful events, and other adversity experiences were identified. MTP was analyzed with clinical variables in a series of follow-up analyses. The number of stressors in the past six months was negatively correlated with MTP in those with low preschool adversity, but not in those with high preschool adversity. MTP was higher in girls than in boys, and the associations of MTP with stressors and symptoms were moderated by gender. MTP was negatively associated with stressors in the past six months in girls, while in boys, MTP was associated with stress-related symptoms. Childhood stressful events were associated with reduced MTP during cognitive control demands, and this was finding was moderated by gender and early life adversity. These preliminary findings suggest that boys and girls may process stressful experiences in distinct ways, and preschool adversity may potentially blunt the interaction between current stress and neural dynamics. However, ongoing investigation is needed.

Maternal perinatal hypertensive disorders and parenting in infancy.

Maternal mental health strongly influences parenting during infancy. However, it is unclear whether maternal physical health conditions in the perinatal period may also impact parenting. Examining the association of hypertensive disorders - a common physical health problem in pregnancy - with subsequent parenting behaviors is an important first step in understanding the connection between maternal physical health and parenting during this critical developmental period. This study evaluated whether hypertensive disorders of pregnancy (HDP) and hypertensive disorders (HD) diagnosed after the birth of the infant were associated with parenting self-efficacy, parenting stress, and observed parental responsiveness during mother-infant interactions at 6 and 12 months postpartum among a sample of racially and ethnically diverse mothers and their infants (N = 295). Results showed that mothers with an HDP or HD diagnosis had lower levels of parenting self-efficacy, higher levels of parenting stress, and lower levels of observed parental responsiveness compared to mothers without an HDP or HD diagnosis. Given that women with childhood adversity are at higher risk for experiencing HDP/HD and may have more difficulties with parenting compared to women without childhood adversity, we utilized a sample of mothers wherein most had experienced at least one form of adversity in their childhoods. Exploratory analyses revealed that HDP/HD moderated the relation between early life experiences and parenting outcomes in all but one model. Associations between HDP/HD and parenting are discussed, with implications for how we understand maternal physical health as a determinant of parenting in the perinatal period.

Withdrawn Behavior in Preschool: Implications for Emotion Knowledge and Broader Emotional Competence.

The present study investigated the respective roles of withdrawal, language, and context-inappropriate (CI) anger in the development of emotion knowledge (EK) among a subsample of 4 and 5 year-old preschoolers (n = 74). Measures included parent-reported withdrawn behavior, externalizing behavior, and CI anger, as well as child assessments of receptive language and EK. Ultimately, findings demonstrated that receptive language mediated the relationship between withdrawn behavior and situational EK. However, CI anger significantly interacted with receptive language, and, when incorporated into a second-stage moderated mediation analysis, moderate levels of CI anger rendered the indirect effect of withdrawn behavior on situational EK via receptive language insignificant. Cumulatively, these findings demonstrate a mechanism by which withdrawal may impact EK. They also indicate that such an effect may be attenuated in children with moderate levels of CI anger. Implications of these findings are discussed.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health.

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Los síntomas de estrés materno postraumático (PTSS) se asocian con consecuencias adversas para niños de mayor edad, pero pocos estudios han examinado las conexiones entre PTSS materno perinatal y los resultados en el infante. El estar expuesta al trauma y la sicopatología de este, incluyendo PTSS, a menudo se intensifican más en el caso de mujeres durante el embarazo y hasta un año después del parto. Por tanto, el período perinatal pudiera ser un omento crítico para comprender el riesgo que el PTSS materno y otros factores de salud mental presentan para la salud socioemocional y física de los infantes. Este estudio exploró la relación entre el PTSS materno y los problemas de salud socioemocional y física del infante en un grupo muestra de díadas madre-infante racial y étnicamente diversas (N = 295), evaluadas prenatalmente y a los 12 meses después del parto. Este estudio también examinó si hay: (1) efectos moderadores de los síntomas depresivos maternos y el estrés de crianza sobre estas asociaciones y (2) efectos indirectos de PTSS sobre los resultados en el infante a través de la observada sensibilidad materna. Los resultados indican que los síntomas depresivos y el estrés de crianza, en vez de PTSS, estaban asociados con mayores problemas de salud socioemocional del infante. Sin embargo, el PTSS se asoció con mayores problemas de salud física en el infante cuando las madres también reportaron niveles clínicamente significativos de síntomas depresivos. No se corroboró el que la sensibilidad materna fuera un mecanismo intermediario de conexión entre PTSS y otros factores de salud mental materna y resultados en el infante.

Les symptômes des stress posttraumatique (SPT) maternel sont liés à des conséquences adverses pour les enfants plus âgés mais peu d'études ont examiné les liens entre le SPT périnatal maternel et les résultats sur les nourrissons. L'exposition au trauma et la psychopathologie, y compris le SPT, est souvent accrues pour les femmes durant la grossesse jusqu'à un an après la naissance. Par conséquent la période périnatale peut être un moment critique pour la compréhension du risque que posent le SPT maternel et d'autres facteurs de santé mentale à la santé socio-émotionnelle et physique des nourrissons. Cette étude a exploré la relation entre le SPT maternel et les problèmes socio-émotionnels et physiques des nourrissons chez un échantillon de dyades mère-nourrisson racialement et ethniquement diverses (N = 295) évaluées au stade prénatal et à 12 mois après la naissance. Cette étude a aussi examiné s'il existait : (1) des effets modérateurs de symptômes dépressifs maternels et du stress de parentage sur ces associations et (2) des effets indirects de SPT sur les résultats du nourrisson à travers une sensibilité maternelle observée. Les résultats ont indiqué que les symptômes dépressifs postpartum et le stress de parentage, plus que le SPT, étaient liés à des problèmes plus élevés de santé socio-émotionnels du nourrisson. Cependant le SPT prénatal était lié à de plus grands problèmes de santé physique du nourrisson quand les mères faisaient aussi état de niveaux cliniquement élevés de symptômes dépressifs postpartum. La sensibilité maternelle n'était pas liée au SPT maternel, aux symptômes dépressifs ou au stress de parentage, et n'était pas non plus liée à la santé socio-émotionnelle et physique du nourrisson. Donc la sensibilité maternelle n'a pas testée comme mécanisme intermédiaire liant la santé mentale maternelle aux résultats du nourrisson. Les implications pour la promotion de la santé mentale maternelle dans la période périnatale afin de soutenir la santé socio-émotionnelle et physique des nourrissons sont discutées.

The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care.

Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.

Testing the mid-range model: Attachment in a high risk sample.

Infant attachment is a key predictor of later socioemotional functioning, but it is not clear how parental responsivity to infant expressive behavior is associated with attachment outcomes. A mid-range model of responsivity holds that both unresponsive and highly reactive parental behaviors lead to insecure and disorganized attachment. We examined the relationship between maternal (and infant) contingent responsivity and attachment in a high-risk sample. Participants were 625 infant-mother pairs from a longitudinal study of children with and without prenatal drug exposure and variable levels of associated social risks. Infant-mother pairs participated in the Face-to-Face/Still-Face paradigm (FFSF) at 4-months and in the Strange Situation Procedure (SSP) at 18-months. A model incorporating both linear and quadratic responsivity effects indicated that mothers who were either very high (reactive) or very low (unresponsive) in responsivity were more likely to have infants with disorganized attachment outcomes. While maternal responsivity was associated with attachment disorganization, no associations between maternal responsivity, and attachment security/insecurity were detected. Infant responsivity to mother was not associated with attachment outcomes. The findings suggest the importance of mid-range levels of maternal responsivity in the development of organized attachment among infants facing high levels of prenatal and social risk.

Protocol for the Rhode Island CORD 3.0 Study: Adapting, Testing, and Packaging the JOIN for ME Family-Based Childhood Obesity Program in Low-Income Communities.

Background: Overweight and obesity in children is a public health crisis in the United States. Although evidence-based interventions have been developed, such programs are difficult to access. Dissemination of evidence-based pediatric weight management interventions (PWMIs) to families from diverse low-income communities is the primary objective of the CDC Childhood Obesity Research Demonstration (CORD) projects. Methods: The goal of the Rhode Island CORD 3.0 project is to adapt the evidence-based PWMI, JOIN for ME, for delivery among diverse families from low-income backgrounds and to test it in a hybrid effectiveness-implementation trial design in which the aims are to examine implementation and patient-centered outcomes. Children between the ages of 6 and 12 years with BMI ≥85th percentile and a caregiver will be recruited through two settings, a federally qualified health center, which serves as a patient-centered medical home, or low-income housing. Dyads will receive a remotely delivered group-based intervention that is 10 months in duration and includes 16 weekly sessions, followed by 4 biweekly and 4 monthly meetings. Assessments of child and caregiver weight status and child health-related quality of life will be conducted at baseline, and at 4 and 10 months after the start of intervention. Implementation outcomes assessing intervention acceptability, adoption, feasibility, fidelity, and penetration/reach will be collected to inform subsequent dissemination. Conclusions: If the adapted version of the JOIN for ME intervention can be successfully implemented and is shown to be effective, this project will provide a model for a scalable PWMI for families from low-income backgrounds. ClinicalTrials.gov no. NCT04647760.

Implementation of the JOIN for ME Program for Families from Low-Income Backgrounds: The Use of Theory-Driven Formative Evaluation: Rhode Island CORD 3.0.

Advances have been made in the development of effective interventions to address pediatric obesity; however, research findings often do not translate into clinical practice and a limited number of programs have been designed toward wide-spread dissemination and implementation. The Rhode Island (RI)-Childhood Obesity Research Demonstration (CORD) 3.0 Project involves adapting and testing an evidence-based pediatric weight management intervention (PWMI), JOIN for ME, for wide-scale dissemination and implementation in communities with a high proportion of families from low-income backgrounds. In this article, we describe the robust developmental formative evaluation (FE) process employed by RI-CORD as a model for the use of FE to drive dissemination of evidence-based PWMIs. The current project was guided by the Consolidated Framework for Implementation Research and Proctor Implementation Outcomes. This article also showcases examples of how the use of key informant interviews from engaged stakeholders in the community during a developmental FE process can drive selection of implementation strategies. The use of FE, driven by evidence-based theory, can help provide a roadmap to successful implementation of a pediatric weight management program, such as JOIN for ME.

Cascades of Risk Linking Intimate Partner Violence and Adverse Childhood Experiences to Less Sensitive Caregiving During Infancy.

This study evaluated if maternal intimate partner violence (IPV) had indirect effects on sensitive parenting in infancy through prenatal depressive symptoms and postpartum parenting stress and if maternal adverse childhood experiences (ACEs) moderated these indirect effects. We hypothesized that: (a) IPV would be associated with greater prenatal depressive symptoms, which would predict greater postpartum parenting stress, and ultimately less sensitive parenting and (b) the link between IPV and depressive symptoms would be strongest for mothers with high ACEs. Participants included 295 mothers and their infants who were assessed prenatally and at 12 months postpartum. Path analyses indicated that mothers with higher IPV endorsed greater prenatal depressive symptoms, which was in turn associated with postpartum parenting stress, and ultimately less sensitive parenting behavior. Moderation analyses revealed that these indirect effects varied as a function of maternal ACEs, with the link between IPV and depressive symptoms only present for mothers who reported high ACEs. Because less sensitive caregiving is often an early indicator of child maltreatment risk, understanding precursors to sensitivity is critical to increase precision in parenting interventions designed to reduce risk for maltreatment. Results may inform evidence-based preventive interventions for mothers and infants at high-risk for child abuse and neglect.

Patterns of Asthma Medication Use across the Transition to High School.

OBJECTIVE: Adherence to asthma controller medications is suboptimal among adolescents. We evaluated predictors of adherence and longitudinal patterns of medication use between 8th and 10th grade among a sample of youth of diverse race/ethnicity. METHODS: Eighth graders with asthma on controller medications (N = 62; 40.0% non-Latino white; 23.7% Black; 37.3% Latino; 37.3% female) completed measures of medication beliefs, responsibility for asthma management, and family cohesion. Objective methods tracked medication use longitudinally. RESULTS: Adherence declined during the high school transition, from 48.0% in eighth grade to 34.1% in tenth grade (F = 5.35, p < .01). Males had lower adherence (b = -10.11, SE = 5.37, p = .02, f2 = 0.11), as did Latino youth (b = -12.21, SE = 8.23, p = .03, f2 = 0.12). Family cohesion was associated with higher adherence (b = 4.38, SE = 1.98, p = .04, f2 = 0.06). Latent class models (LCMs) suggested a three-class model of longitudinal adherence patterns. This included low, declining adherence (Class 1 = 29%; higher proportion male, p = .02), high, sustained adherence (Class 2 = 26%, high family cohesion, p = .05, higher proportion female, p = .02), and low, sustained adherence (Class 3 = 45%; higher proportion Latino, p = .05, higher proportion male, p = .02). CONCLUSIONS: Asthma medication adherence declined between 8th and 10th grade. LCMs indicated some youth have stable patterns of adherence (high or low), whereas others demonstrate declines. Gender differences were observed, and family cohesion was associated with higher, sustained adherence. Interventions building on family resources and targeting the barriers adolescents face are necessary to improve asthma management during this vulnerable period.

Intergenerational Effects of Maternal Childhood Experiences on Maternal Parenting and Infant Developmental Progress.

OBJECTIVE: This study evaluated the intergenerational indirect effects of maternal childhood experiences on infant progress in reaching developmental milestones through maternal scaffolding behaviors. We hypothesized that mothers who perceived their own mothers as highly supportive in childhood, even in the context of adverse childhood experiences (ACEs), would be more likely to engage in scaffolding with their infants, which in turn would predict greater infant developmental progress (e.g., less risk for developmental delay). METHODS: Participants included 295 low-income mothers and their infants who were assessed prenatally and at 6 and 12 months postpartum. Mothers retrospectively reported on their childhood experiences, maternal parenting behaviors were observationally rated at 6 months postpartum, and infant developmental progress (communication, problem-solving, gross motor, fine motor, and personal-social) was assessed at 6 and 12 months postpartum using the Ages and Stages Questionnaire. RESULTS: The results of autoregressive structural equation models indicated that mothers who perceived their own mothers as highly supportive in childhood were more likely to engage in scaffolding behaviors with their infants, who in turn made greater progress (e.g., showed less risk for developmental delay) in reaching developmental milestones from 6 to 12 months postpartum. Follow-up analyses revealed that indirect effects were specific to infant problem-solving and communication skills. Maternal ACEs were not associated with parenting or infant developmental progress. CONCLUSION: Parenting behaviors in 1 generation influence parenting behaviors in the next, which has implications for infant developmental progress. The results may inform evidence-based preventive interventions for mothers and infants living in contexts of risk.

Household Chaos Moderates Indirect Pathways Involving Domestic Violence, Parenting Practices, and Behavior Problems among Preschool Children.

PURPOSE: This study examined the moderating role of household chaos in indirect pathways involving domestic violence (DV), parenting practices (punitive discipline and responsive), and preschool children's internalizing and externalizing symptoms. We hypothesized that high levels of household chaos would amplify links between domestic violence and parenting difficulties, and that parenting difficulties would in turn predict child behavior problems. METHOD: Participants in this multimethod (survey, semi-structured interview, child protection records) study included 274 preschool children (M age = 50.86 months) and their primary caregivers who were assessed in the home at two time-points spaced 6 months apart. Child welfare documentation of moderate-severe maltreatment within the last 6 months was present for 52% of children, 44% were in households characterized by DV, and most families qualified for public assistance. Hypotheses were tested using path analysis with manifest variables within a structural equation modeling framework. RESULTS: All models provided excellent fit to the data. DV was associated with punitive discipline practices only when household chaos was high. Punitive discipline practices in turn predicted greater child externalizing symptoms 6 months later. Follow-up analyses revealed that the moderating role of chaos was specific to DV, rather than general to other forms of adversity (child maltreatment, lifetime contextual stressors, traumatic events). This interaction between DV and chaos was salient even when controlling for exposure to other adversities and demographic covariates. CONCLUSIONS: Results point to multiple potential targets of intervention that may ultimately buffer children from the risk posed by experiencing DV in the home.

Sex Differences in Associations between Early Adversity, Child Temperament, and Behavior Problems.

Early adversity is associated with both internalizing and externalizing problems among children, and effects of adversity on dimensions of child temperament may underlie these links. However, very little is known about the role of child sex in these processes. The current study examined if there are indirect effects of early adversity on behavior problems through dimensions of child temperament and if these indirect effects vary across child sex. Participants in this multimethod (parent-report survey, semi-structured interview, child protection records) study included 274 preschool-aged children (M age = 50.86 months; 52% with documented case of moderate-severe maltreatment) and their primary caregivers assessed at two time-points spaced 6 months apart. Results of multi-group path analyses revealed that while anger mediated associations between lifetime stress and behavior problems for the full sample, inhibitory control and appropriate attentional allocation were significant intermediary mechanisms of lifetime stress for boys, but not for girls. Inhibitory control mediated associations between maltreatment and behavior problems for the full sample, but appropriate attentional allocation mediated these associations for boys only. Results suggest that early adversity influences child behavior problems through child temperament, particularly for boys. This work supports the perspective that temperament is influenced by characteristics of the early rearing environment, and the indirect effects of adversity on behavior problems through temperament vary across sex.

JOIN for ME: Testing a Scalable Weight Control Intervention for Adolescents.

Background: The goal of this randomized controlled trial was to compare the relative effectiveness of a comprehensive lifestyle intervention delivered through the YMCA, JOIN for ME, with an enhanced version of this program that included on-site supervised group physical activity and opportunities for peer support, in decreasing adolescent weight status. Methods: Sixty-six adolescents with BMI >85th percentile and absolute BMI <50 were randomly assigned to the JOIN for ME or the JOIN for ME enhanced program. Teens in both conditions attended 16 weekly, in-person group sessions, followed by four biweekly and four monthly maintenance sessions. The enhanced condition also included weekly, group-based physical activity sessions and challenges. Group sessions were led by YMCA coaches. Results: Groups did not differ at baseline by age (14.7 + 1.6 years), sex (60.6% female), racial/ethnic minority status (37.7%), or weight (53.0% with severe obesity). Retention was 91% at 16 weeks and 82% at 10 months. Controlling for minority status and sex, there were no significant group differences over time for BMI (p = 0.15), BMI z-scores for age and sex (BMIz, p = 0.07), or percent overweight (p = 0.15). Across all participants, on average, BMI decreased by 1.4 kg/m2, BMIz decreased by 0.12, and percent overweight decreased by 8.8% at four months. Conclusions: There were no significant differences observed in primary outcomes for adolescents randomized to the standard and enhanced versions of the JOIN for ME program. Although the absence of a control condition precludes attribution to the intervention, teens in both conditions demonstrated greater decreases in weight status than what was observed in an open trial of the original program.

Infant sleep moderates the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning.

Observed infant temperamental difficulty and infant sleep efficiency and sleep variability were examined as predictors of maternal depressive symptoms, maternal sensitivity, and family functioning. Eight observations at 8-months postpartum were used to assess infant temperament, and actigraphy was used to measure infant sleep for 1-week at the time of the 8-month assessment. Structured clinical interviews were used to assess maternal depressive symptoms between 5 and 12 months postpartum and at 15 months postpartum, and observational assessments were used to assess maternal sensitivity and family functioning at 15 months postpartum. Variability in infant sleep moderated the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning. Infant temperament was positively associated with maternal depressive symptoms when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Likewise, infant temperament was negatively associated with maternal sensitivity and family functioning when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Results underscore the importance of infant sleep for maternal and family health.

Childhood maltreatment, behavioral adjustment, and molecular markers of cellular aging in preschool-aged children: A cohort study.

OBJECTIVE: Childhood maltreatment is a major risk factor for the development of behavioral problems and poor physical and mental health. Accelerated cellular aging, through reduced telomere length and mitochondrial dysfunction, may be a mechanism underlying these associations. METHODS: Families with (n = 133) and without (n = 123) child welfare documentation of moderate-severe maltreatment in the past six months participated in this study. Children ranged in age from 3 to 5 years, were racially and ethnically diverse, and 91% qualified for public assistance. Structured record review and interviews were used to assess a history of maltreatment and other adversities. Telomere length and mitochondrial DNA copy number (mtDNAcn) were measured from saliva DNA using real-time PCR. Measures were repeated at a six-month follow-up assessment. Repeated measures general linear models were used to examine the effects of maltreatment and other adversities on telomere length and mtDNAcn over time. RESULTS: Maltreatment and other adverse experiences were significant positive predictors of both telomere length and mtDNAcn over time. Internalizing and externalizing behavior problems were also both significantly associated with telomere length, but only internalizing symptoms were associated with mtDNAcn. CONCLUSIONS: This is the first study to show that mtDNAcn is altered in children with stress and trauma, and the findings are consistent with recent studies of adults. Surprisingly, children who experienced moderate-severe levels of maltreatment in the prior six months had longer telomeres, possibly reflecting compensatory changes in response to recent trauma. Telomere length and mtDNAcn were also associated with behavioral problems, suggesting that these measures of cellular aging may be causally implicated in the pathophysiology of stress-related conditions.

Family Context Moderates the Association of Maternal Postpartum Depression and Stability of Infant Temperament.

Maternal postpartum depression, maternal sensitivity, and family functioning were examined as predictors of the stability of observed infant temperament over the first 30 months of life (N = 147 families). Eight observations at 8, 15, and 30 months postpartum were used to assess infant temperament. Structured clinical interviews were used to assess maternal depression, and observational assessments were used to assess family functioning and maternal sensitivity. Family context moderated the effect of maternal depression on change in infant temperament. Maternal depression was associated with change in infant temperament when maternal sensitivity was low but not when maternal sensitivity was high. Family functioning similarly moderated these links. Results underscore the centrality of the family context in shaping child behavior over time.