A Systematic Review of Neurodevelopmental Assessments in Infancy and Early Childhood: Developing a Conceptual Framework, Repository of Measures, and Clinical Recommendations.

The first 6 years of life are when 90% of brain development occurs, setting the foundation for lifelong neurodevelopment. The field of infant and early childhood neurodevelopment has made marginal advancements since introduced in 1988. There remains a gap in knowledge around early neurodevelopmental domains and trajectories given that there are few established assessment procedures for infants and young children and controversies around reserving assessments until school age. Throughout this systematic review, we (1) identified neurodevelopmental assessment measures employed in the literature by domain and age of assessment, (2) compiled a repository of 608 domain-specific neurodevelopmental assessment measures, and (3) established a preliminary conceptual framework for cross-domain neurodevelopmental assessments across infancy and early childhood. This review adhered to PRISMA guidelines and spanned three databases (PsycINFO, MEDLINE, PubMed). Articles were reviewed for (1) infancy and early childhood (0-6 years), (2) neurodevelopmental measures, and (3) English language. This systematic review spanned 795 articles from 1978 to 2020 with international representation. Advancements in assessment methods (e.g. measures, domains, frameworks) are essential for the evaluation of early neurodevelopmental profiles to inform early interventions, thus harnessing the neuroplasticity and dynamic development notable during early childhood. We hope this work catalyzes future research and clinical guidelines around early assessments methods.

A systematic review of callous-unemotional traits and attachment in children and adolescents.

METHODS: The systematic review and meta-analysis included 17 research articles from 1994 to 2022. Results were summarized by developmental periods. RESULTS: Attachment insecurity was associated with CU traits across development (r = .17). This association was marginally stronger for high-risk samples (e.g., clinical, justice) and for continuous attachment measures versus coding schemes. From early to middle childhood, attachment disorganization was associated with CU traits (r = .17). IMPLICATIONS: Research on attachment and CU traits in childhood is still in its infancy. Changes in attachment measures from childhood to adolescence make developmental comparisons difficult. Results suggest attachment as a potential developmental mechanism for youth with CU traits, however, the area requires more research.

A dyadic perspective on aggressive behavior between friends.

Youth are sometimes victimized by their friends, but we know little about the nature of these relationships. Taking a dyadic approach, we studied relationships characterized by both friendship and aggression. Participants (952 middle schoolers; 50% female; 44% Latinx) nominated friends and aggressive perpetrators and victims. Using two analytic samples of friend dyads (N = 6971) and aggressive dyads (N = 4662), results indicated that aggression by a friend was somewhat common. Compared with friend dyads without aggression, aggressive friend dyads were stronger (i.e., reciprocal) and longer lasting, though victimized youth were less satisfied with the friendship. Aggressive dyads who were friends more often had reciprocal aggression than aggressive dyads who were not friends. Results provide insight into the dynamics of aggression in close peer relationships.

The Mediational Effect of Affect Dysregulation on the Association Between Attachment to Parents and Oppositional Defiant Disorder Symptoms in Adolescents.

Oppositional defiant disorder (ODD) is a childhood disorder, commonly occurring in early school aged children with some symptoms becoming normative in adolescence (e.g., irritability, disagreeing). Affect dysregulation is a risk factor in the development of ODD. Affect regulation is nurtured within parent-child relationships, thus disruptions to attachment may derail children's capacity to develop adaptive affect regulation, increasing the risk for ODD. Using a high-risk sample of adolescents, we investigated the association between attachment anxiety and attachment avoidance with ODD through affect dysregulation. Attachment anxiety, but not avoidance, was associated with affect dysregulation and ODD. Affect dysregulation was found to fully mediate the relationship between attachment anxiety and ODD concurrently and prospectively. Similar findings have been demonstrated among children; results show that attachment anxiety, and its effects on affect dysregulation, are associated with ODD symptoms well into adolescence.

ADHD and Exposure to Maltreatment in Children and Youth: a Systematic Review of the Past 10 Years.

PURPOSE OF THE REVIEW: The purpose of the current paper was to review and summarize the literature on ADHD and maltreatment over the past 10 years. RECENT FINDINGS: The majority of research on ADHD and exposure to maltreatment focuses on the high rates of comorbidity, including international studies from Asia, South America, North America, and Europe. Longitudinal studies showed that early exposure to maltreatment is a risk factor for ADHD symptoms later in development; however, this finding was not consistent. There were some preliminary studies on the neurological and genetic mechanisms underlying the link between ADHD and exposure to maltreatment. Finally, ADHD and exposure to maltreatment were found to have an additive effect on clinically salient outcomes (e.g., aggression, suicide attempts). Results from the review have direct clinical and future implications, including the need to understand the effect of comorbid ADHD and exposure to maltreatment in treatment studies.

Trauma-informed and relational approaches to service provision: building community-based project capacity to respond to interpersonal violence through a national initiative.

BACKGROUND: Community services that engage and service marginalized families can act as an important entry point for mothers and children experiencing interpersonal violence. The purpose of this study was to use an initiative that included training, implementation, and evaluation of an interpersonal violence intervention to understand changes in the capacity of service providers in community-based organizations to use trauma-informed and relational approaches to support mothers and children experiencing violence in relationships. METHODS: Participants (N = 27) were service providers from 14 community-based organizations across Canada, who had been trained to implement an interpersonal violence intervention with mothers in their communities. Using a phenomenological approach, participants engaged in an open-ended interview in which they were encouraged to reflect on their experiences in the intervention initiative, with prompts relating to the ways in which their work and their organization may have changed as a result of their participation. RESULTS: Findings indicated that participants were able to identify changes in four key areas related to trauma-informed practice: awareness (e.g., attitudes toward interpersonal violence), competency (e.g., application of trauma-informed knowledge), collaboration (e.g., working with other organizations to provide services to children and families), and safety (e.g., organizational policies to ensure safe, welcoming spaces). Further, participants identified these areas of change at the level of themselves as facilitators of the interpersonal violence intervention, their organizations, and their communities. CONCLUSIONS: Results indicate that, through training, implementation, and evaluation of an interpersonal violence intervention, service providers in community-based projects were able to extend trauma-informed and relational principles not only to the intervention itself, but also to their own work, as well as that of their organizations and communities. With some additional support, leveraging the existing capacities within community-based projects may be an effective means to support mothers and children experiencing interpersonal violence and other challenges.

Peer victimization through a trauma lens: Identifying who is at risk for negative outcomes.

Peer victimization is a chronic stressor that occurs within the context of peer interactions and has been robustly associated with numerous negative psychological and social adjustment problems. Although increased frequency of peer victimization has been linked to psychosocial problems, few researchers have studied the role of duration and pervasiveness of victimization (i.e., number of places it occurs). The objective of this study was to examine how frequency, duration, and pervasiveness of peer victimization are associated with youth adjustment. Canadian adolescents (N = 879), ages 12-18 completed an online survey about experiences with peer victimization. Youth also answered questions about internalizing problems, distress, relationship quality with family, friends, and adults in their school and community, as well as academic functioning. Data were analyzed using multinomial logistic regression modeling. Both duration and pervasiveness of peer victimization were predictive of increased internalizing problems, distress, relationship problems, and academic difficulties. Duration and pervasiveness of peer victimization were identified as important factors to consider when predicting youth psychosocial adjustment. By asking questions about these situational factors, parents, teachers, and healthcare providers may more effectively identify youth who are at risk for experiencing mental health problems associated with peer victimization.

Developing and testing a readiness tool for interpersonal violence prevention partnerships with community-based projects.

Community-based projects that serve vulnerable families have the opportunity to identify and respond to interpersonal violence (IPV). We developed a readiness assessment tool to support selection of projects to participate in an initiative that involved implementing a community-based IPV intervention for mothers. The overarching aim of the current study was to describe the development of this tool and examine the reliability of coding, validity, and utility of the tool. After developing and refining the tool, 41 community-based projects completed the tool. Responses were coded and scored; scores were used to select projects for the initiative. Preliminary validation for the tool included (a) expert opinion, (b) uptake/implementation of the intervention, and (c) feedback and responses from service providers in terms of the usefulness and importance of the tool. This tool can be used by both researchers and service providers to assess community project readiness and capacity to provide trauma-informed services for vulnerable families.

Internalizing symptoms and dating violence perpetration in adolescence.

BACKGROUND: Increasing evidence suggests an association between internalizing symptoms and violence against others. It remains unknown whether this link exists in the context of romantic relationships. In the current study, we tested whether anxiety and depression were associated over time with adolescent dating violence perpetration. METHODS: The sample included 238 Canadian adolescents (42% boys). Using a longitudinal design, their anxiety, depressive symptoms, and dating violence perpetration were annually assessed from age 14 to 15 years. RESULTS: Cross-lagged analyses revealed effects from anxiety and depressive symptoms to dating violence one year later (ß = 0.27, p < .001; and ß = 0.14, p = .04, respectively). No reversed cross-lagged paths were found from dating violence to subsequent anxiety or depression. CONCLUSIONS: Our findings underscore the predictive value of internalizing symptoms on dating violence perpetration. Reducing internalizing symptoms and improving coping strategies are important targets for the prevention of dating violence.

Adherence to and Motivations for Complying With Public Health Measures Among Adolescents During the Coronavirus Disease (COVID-19) Pandemic in Canada.

Background: Public health measures (e.g., minimizing social interactions, social distancing, and mask wearing) have been implemented in Canada to reduce the transmission of COVID-19. Given that adolescents may be a high-risk demographic for spreading COVID-19, this study investigated adherence to and motivations for complying with public health measures among Canadian youth at two points of the COVID-19 pandemic. Methods: Adolescents (N = 1,484, 53% girls, Mage = 15.73 [SD = 1.41]) completed an online survey in either Summer 2020 (Cohort 1 [C1]; n = 809, 56% girls) or Winter 2020/2021 (Cohort 2 [C2]; n = 675, 50% girls). We investigated differences in adherence across cohorts using independent sample t-tests and predictors of adherence using a path analysis. Results: Youth engaged in similar levels of social interaction in C1 and C2. Relative to adolescents in C1, adolescents in C2 reported more mask wearing, but less social distancing. Social responsibility was associated with adherence to almost all public health measures across both cohorts, with one exception: it did not predict minimizing social interactions in C2. Not wanting to get sick predicted minimizing social interactions and mask wearing. Concern with population health predicted adherence to all public health measures in C1 and all but mask wearing in C2. Maintaining social ties was negatively associated with minimizing social interactions in both cohorts, and with social distancing in C1. Conclusions: Youth engaged in more mask wearing but less social distancing as the pandemic progressed. Social responsibility and not wanting to get sick were consistent predictors of adherence to most public health measures throughout the pandemic. Youth shifted away from adhering to mask wearing measures due to concern with population health over the course of the pandemic. These results can inform targeted campaigns to bolster compliance with public health measures among adolescents.

Why Worry about Bullying?

In this article, the authors review research to identify bullying as a critical public health issue for Canada. Drawing from recent World Health Organization surveys, they examine the prevalence of Canadian children and youth involved in bullying others or being victimized. There is a strong association between involvement in bullying and health problems for children who bully, those who are victimized and those involved in both bullying and being victimized. Health problems can manifest as physical complaints (e.g., headaches), mental health concerns (e.g., depression, anxiety) and psychosocial problems (e.g., substance use, crime). In Canada, there has recently been a disturbing incidence of Canadian children who have committed suicide as a result of prolonged victimization by peers. Healthcare professionals play a major role in protecting and promoting the health and well-being of Canadian children and youth. Given the significant mental and physical health problems associated with involvement in bullying, it is important that clinicians, especially primary care healthcare professionals, be able to identify signs and symptoms of such involvement. Healthcare professionals can play an essential role supporting children and their parents and advocating for the safety and protection for those at risk. By understanding bullying as a destructive relationship problem that significantly impacts physical and mental health, healthcare professionals can play a major role in promoting healthy relationships and healthy development for all Canadian children and youth. This review provides an overview of the nature of bullying and the physical and psychological health problems associated with involvement in bullying. The review is followed by a discussion of the implications for health professionals and a protocol for assessing the potential link between bullying and a child's physical and psychological symptoms.

A national implementation of a community-based intervention for mothers experiencing violence in relationships.

Interpersonal violence is a significant concern for families; thus interventions to support vulnerable mothers and children experiencing violence are essential. The purpose of this study was to present preliminary evaluation results from the national dissemination of an interpersonal violence intervention for mothers delivered in community-based programs across Canada. In 18 communities, 184 mothers participated in the intervention. Mothers reported on measures related to the self, relationships, parenting, and knowledge of community services, both before and after the intervention. Mothers comprised a high-risk, vulnerable population. Results indicated feasibility and acceptability, based on a high proportion of intervention completers and high levels of satisfaction. Women reported improvements in self-esteem, self-efficacy, relationship capacity, parenting stress, knowledge of community services, and understanding of relevant concepts compared to before the intervention (with small to medium effects). Additional analyses supported some of these findings as particularly robust. We discuss the importance of community-based projects in reaching diverse families, sustaining engagement with high levels of satisfaction, and supporting mothers in making changes relating to themselves, their relationships, and their parenting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cumulative Risk, Protection, and Early Intervention: Neurodevelopment in Sibling Groups Exposed Prenatally to Substances.

Mothercraft's Breaking the Cycle is an early intervention program for substance-exposed children with neurodevelopmental vulnerabilities. Within three substance-exposed sibling groups (N = 8; 0-6 years), we 1) described longitudinal neurodevelopmental trajectories, 2) explored the balance of cross-domain cumulative risk and protection on neurodevelopment, and 3) generated hypotheses on how cumulative risk, protection, and early intervention impact neurodevelopment. Neurodevelopment is potentially shaped by the balance of risk and protection. Postnatal risk (birth/postnatal, child, parent-child interaction) and relational protection (family, parent-child interaction) appear to have the most salient impact on neurodevelopment. Early intervention is thought to be important as soon as possible and before age 3 years.

Establishing clinically and theoretically grounded cross-domain cumulative risk and protection scores in sibling groups exposed prenatally to substances.

BACKGROUND: Prenatal substance exposure is associated with neurodevelopmental deficits. Deficits are exacerbated by cumulative risks yet attenuated by cumulative protective factors. Cross-domain relative to intra-domain risk exposure presents more neurodevelopmental challenges. Cumulative risk and protection scores must be clinically and theoretically grounded, with cross-domain considerations. OBJECTIVES: 1) Create clinically and theoretically grounded, cross-domain cumulative risk and protection scores; 2) Describe the benefits of our methodological approach. PARTICIPANTS & SETTING: This study included three sibling groups (N = 8) at Mothercraft's Breaking the Cycle, a child maltreatment prevention and early intervention program for substance using mothers and their children. METHOD: We outlined the process of establishing clinically and theoretically grounded, cross-domain cumulative risk and protection scores. Total and cross-domain cumulative risk and protection percentages, and the balance between domains of risk and protection, were explored. RESULTS: Clinically and theoretically grounded, cross-domain cumulative risk and protection scores were established. Total percentages were reported. Cross-domain profiles of cumulative risk and protection, and the number of significant domains of risk relative to protection, were reported. The cross-domain profiles facilitated consideration of intra- and inter-domain risk and protection within and between sibling groups. CONCLUSIONS: Emerging patterns indicate the importance of establishing cumulative risk and protection scores that are: 1) clinically and theoretically grounded, 2) cross-domain, and 3) encompass cumulative protection and risk. In understanding profiles of risk and protection, we can inform evidence-based early interventions that address: 1) high-risk children, 2) the full range of risks, 3) vulnerable domains, and 4) protective factors.

Cumulative risk and protection measures data.

These data include clinically and theoretically grounded, cross-domain cumulative risk and protection measures. These measures were established for use with three sibling groups at Mothercraft's Breaking the Cycle (BTC), a child maltreatment prevention and early intervention program for substance using mothers and their children. These measures were established using archival data obtained from clients' charts. The cumulative risk factor measure encompasses: 1) items from a cumulative risk measure utilized in prior BTC research, 2) clinical measures assessing maternal mental health, addiction, and parenting capacity, 3) a measure utilized in studies on adverse childhood experiences, and 4) the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (Axis IV: Psychosocial Stressors) [1-3]. The cumulative protection factor measure encompasses: 1) existing early intervention components of services at BTC, 2) clinical measures assessing maternal mental health, addiction, and parenting capacity, and 3) known protective factors outlined in the literature. Both measures were theoretically grounded using the Developmental Model of Transgenerational Transmission of Psychopathology [4], which enabled salient domains of risk and protection to be delineated for children exposed prenatally to substances and accessing child maltreatment prevention and early intervention services. For a description of the process of establishing these measures, the total and cross-domain cumulative risk and protection percentages for the sample, as well as a qualitative interpretation of the balance between domains of risk and protection, see [5]. These measures can contribute to improved future understanding around cumulative risk and cumulative protection in vulnerable populations, salient domains of risk and protection, and the unique interaction that occurs between risk and protective processes in the context of child maltreatment prevention and early intervention.

Approach to bullying and victimization.

OBJECTIVE: To review the epidemiology, identification, and management of bullying and victimization among children in the primary care setting. SOURCES OF INFORMATION: Information was obtained from PsycINFO and MEDLINE databases, as well as the authors' own clinical and research experience. Information is based on levels II and III evidence. MAIN MESSAGE: Involvement in bullying is a destructive relationship problem, with important health implications. Physicians need to be aware of the physical and psychosocial symptoms commonly associated with involvement in bullying so that they can screen and identify those children involved. This article presents a review of bullying and associated symptoms, a tool for assessing bullying involvement, and an overview of intervention and management. CONCLUSION: Bullying is a substantial problem affecting Canadian children. With an increased awareness and understanding of bullying as a health problem, physicians can play an instrumental role in identifying children involved in bullying and providing them with the support needed to develop healthy relationships.

Using a Developmental-Relational Approach to Understand the Impact of Interpersonal Violence in Women Who Struggle with Substance Use.

Substance use among women is a major public health concern. This review article takes a developmental-relational approach to examine processes through which early relational trauma and violence in relationships may lead to substance use. We examine how early exposure to violence in relationships can impact neurological development, specifically through interference with physiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis), brain structure and functioning (e.g., the hippocampus and prefrontal cortex), and neuropsychological development (e.g., executive functioning and emotion regulation) across the lifespan. Further, we discuss the impact of exposure to violence on the development of relational capacity, including attachment, internal working models, and subsequent interpersonal relationships across the lifespan, and how these developmental pathways can lead to continued problematic substance use in women.

Addressing the Impact of Interpersonal Violence in Women Who Struggle with Substance Use Through Developmental-Relational Strategies in a Community Program.

From a developmental-relational framework, substance use in women can be understood as relating to early experiences of violence in relationships and across development. This article uses a developmental-relational approach to outline specific strategies that can be used by service providers and to guide interventions for women with substance use issues. By reviewing research and clinical work with women attending a community-based prevention and early intervention program, we describe how specific components of programming can target the developmental and intergenerational pathway between experiences of violence in relationships and substance use. We include the voices of women who attended the program to support the strategies discussed. Specifically, these strategies address the impact of interpersonal violence on substance use by promoting the process of repair and reintegration for women whose neurological development, sense of self, and capacity to form relationships have been significantly impacted by experiences of violence in relationships.

Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study.

BACKGROUND: Substance use during pregnancy is a major public health concern, stemming from potential physical and psychosocial harms to both the mother and child. PURPOSE: To understand women's experiences using substances during pregnancy and the reasons that women continue and/or discontinue using substances. METHODS: Focus groups were conducted with women who attended an early intervention program for pregnant or parenting women with substance use issues. RESULTS: Women identified that external and internal stressors, feelings of guilt and low-self efficacy, and a lack of understanding of the scientific and medical consequences of substance use contributed to their continued substance use. Conversely, women highlighted the importance of high self-efficacy and the quality of relationships when trying to make positive changes to their substance use during pregnancy. CONCLUSIONS: Recommendations are proposed for easier access to and more comprehensive services. Healthcare professionals and service providers should offer non-judgmental care by building high-quality relationships with pregnant women with substance use issues, to increase these women's self-efficacy and empower them to discontinue substance use.

Engaging mothers with substance use issues and their children in early intervention: Understanding use of service and outcomes.

Mothers who use substances need integrated, multi-sectoral intervention services to support substance use discontinuation. We explored mothers' service use at Breaking the Cycle, an early intervention and prevention program for pregnant and parenting women and their young children in Toronto, Canada. We conducted retrospective analyses of families' service records and client charts (N = 160). Aims were to 1) describe women's use of service, 2) examine how early engagement of pregnant women related to postnatal service use, and 3) examine the circumstances in which women ended their service relationship with Breaking the Cycle. Specifically, we examined circumstances at service ending relating to women's service goals; custody status with children; and global substance-use, parent-child relationship, and child development outcomes. We found that these vulnerable women were actively engaged in many services and for a long duration, early engagement was associated with greater service use, and greater service use was associated with more positive circumstances upon ending service. Results provide support for a relational approach to service that promotes not only the relationship between mother and child, and mother and service provider, but also highlights relationships among staff, between staff and management, and between community partners as integral to effective service delivery. Integrating positive relationships at all levels is critical to support vulnerable families with complex needs.