Navigating their child's attachment-related difficulties: Parents' journey from shame into awareness.

Attachment-related difficulties frequently present in child and adolescent clinical services. Yet how parents engage with being informed of their child's attachment-related difficulties is little understood. In this qualitative study, ten parents with a birth child with attachment-related difficulties, as informed by a relevant service, and six healthcare professionals, were interviewed. The aim was to explore both perspectives on how parents experienced and engaged with this process, of their understanding of the child's difficulties and the supports they engaged with. Using grounded theory, the parental journey from shame to awareness is described, based around four main themes: failing as a parent, the process of making sense, a call to action, and awareness of attachment and interrelated difficulties. The intensity of shame and defensive processes felt by parents came through strongly in narratives, forming a key barrier to sense-making and action, while specific clinical, personal and support/resource characteristics facilitated progress. The findings highlight how parents can be better supported into a space of attachment-related awareness and understanding, which may in turn facilitate more positive outcomes for the child. The study also raises wide ranging implications relevant to all involved in the investment, planning and delivery of care for this client group.

A Group Parenting Intervention for Depressed Fathers (LTP + Dads): A Feasibility Study from Pakistan.

BACKGROUND: Globally, paternal depression is a neglected and under-researched area. AIMS: To feasibility test Learning Through Play Plus Dads (LTP+ Dads), a group parenting psychoeducation program adapted for depressed Pakistani fathers of children under 3 years of age. METHODS: Fathers with depression were recruited in Karachi, Pakistan, for a pre-post feasibility study. Ten sessions of group LTP+ Dads were offered over three months. Clinical assessments were administered at baseline, three (end of intervention), and six (follow-up) months and included the Edinburgh Postnatal Depression Scale, 17-item Hamilton Depression Rating Scale, Brief Disability Questionnaire, Multidimensional Scale of Perceived Social Support, Euro-Qol-5 Dimensions, Rosenberg Self-esteem Scale, Parenting Stress Index, and Knowledge, Attitude and Practices questionnaire. RESULTS: Of the 78 fathers approached, 34 consented to screening and 18 were eligible to participate. Participants had a mean age of 33 years, with a mean of 3.61 children. Most were unemployed and were from low-income households with low education backgrounds. The intervention was feasible and acceptable based on a recruitment rate of 100% of eligible participants and a 100% attendance rate for five of the 10 sessions. Fathers showed, on average, a reduction in depressive symptoms, an increase in most areas of knowledge, and positive attitudes about child development. Perceived social support, self-esteem, and functioning scores also increased. CONCLUSIONS: A low-cost, culturally adapted group intervention was found to be feasible and acceptable. Changes in depression, parenting-related, and other outcomes are promising and inform a future larger trial. TRIAL REGISTRATION: The trial was registered on Clinicaltrials.gov on 9 December 2020 (identifier: NCT04660253).

Prevalence and predictors of parenting outcomes in a cohort of mothers with schizophrenia admitted for joint mother and baby psychiatric care in England.

OBJECTIVES: Most women with schizophrenia have children. Schizophrenia has been identified as an independent predictor of poor parenting outcome following joint mother and baby psychiatric admission. We aimed to describe the characteristics of these women postnatally and to estimate the prevalence of, and identify independent predictors of, parenting outcomes. METHOD: Clinical and psychosocial data from consecutive joint psychiatric admissions of mothers and infants between September 1996 and September 2002 were collected. Diagnoses were based on ICD-10 criteria (N = 239 schizophrenia; N = 693 affective disorders). The prevalence of each parenting outcome at discharge, assessed according to social services intervention and staff-rated measures of parenting ability, was estimated. Factors associated with poor parenting outcomes and independent predictors were identified using "modified" Poisson regression, and prevalence of these parenting outcomes was estimated in subgroups of mothers stratified by combinations of protective/risk factors. RESULTS: Mothers with schizophrenia were characterized as having more complex clinical and psychosocial problems and were considerably more likely to experience all types of poor parenting outcomes, compared to mothers with affective disorders. Mothers with schizophrenia reporting supportive marital and other relationships, those whose partners were well, and those of higher social class showed the best parenting outcomes. CONCLUSIONS: Mothers with schizophrenia who experience better parenting outcomes may be protected by certain factors. Successful parenting is related, partly, to stability within the family and access to financial and social resources. The nature of the relationship between identified predictors and parenting outcomes in this group is unclear but may suggest that parenting outcome varies with clinical outcome in schizophrenia. Future research and service development should focus on potential protective factors that may encourage successful parenting outcomes in this vulnerable group.

Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial.

BACKGROUND: Risk markers for later autism identified in the first year of life present plausible intervention targets during early development. We aimed to assess the effect of a parent-mediated intervention for infants at high risk of autism on these markers. METHODS: We did a two-site, two-arm assessor-blinded randomised controlled trial of families with an infant at familial high risk of autism aged 7-10 months, testing the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) versus no intervention. Families were randomly assigned to intervention or no intervention groups using a permuted block approach stratified by centre. Assessors, but not families or therapists, were masked to group assignment. The primary outcome was infant attentiveness to parent. Regression analysis was done on an intention-to-treat basis. This trial is registered with ISCRTN Registry, number ISRCTN87373263. FINDINGS: We randomly assigned 54 families between April 11, 2011, and Dec 4, 2012 (28 to intervention, 26 to no intervention). Although CIs sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0.29, 95% CI -0.26 to 0.86, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect). For secondary outcomes, the intervention reduced autism-risk behaviours (0.50, CI -0.15 to 1.08), increased parental non-directiveness (0.81, 0.28 to 1.52), improved attention disengagement (0.48, -0.01 to 1.02), and improved parent-rated infant adaptive function (χ(2)[2] 15.39, p=0.0005). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES-0.62, CI -2.42 to 0.31; P2: -0.29, -1.55 to 0.71). INTERPRETATION: With the exception of the response to vowel change, our study showed positive estimates across a wide range of behavioural and brain function risk-markers and developmental outcomes that are consistent with a moderate intervention effect to reduce the risk for later autism. However, the estimates have wide CIs that include possible nil or small negative effects. The results are encouraging for development and prevention science, but need larger-scale replication to improve precision. FUNDING: Autistica, Waterloo Foundation, Autism Speaks, and the UK Medical Research Council.