[Smartphone Use in the Presence of Infants and Young Children: A Systematic Review]. / Smartphone-Nutzung in Gegenwart von Babys und Kleinkindern: Ein systematisches Review.

In previous years, concerns have been repeatedly raised regarding the impact of parental use of smartphones and other portable digital devices (PDD) in the presence of infants and young children on children's development. Recently, this topic gainedmore attention by researchers. Therefore, this review aimed at answering the following questions based on the current state of research: How does parental use of PDD in the presence of their 0-3-year-old child affect the quality of the parent-child interaction and relationship, their child's affective and physiological regulation as well as social-emotional and cognitive development? The literature search of six databases based on previously established criteria resulted in 22 articles. The results suggest that parents are less sensitive and responsive towards their children while using PDD. Furthermore, negative effects on children's affect and physiological regulation during parental device use were reported, which appear not to persist beyond the period of use. Moreover, parental technoference in everyday life might affect the parent-child relationship, although respective findings are inconsistent. Furthermore, parental technoference appears to be associated with impaired child learning. Further research is needed to determine the extent of parental use and specific patterns of use leading to lasting negative consequences for child development.

Exclusion Expected? Cardiac Slowing Upon Peer Exclusion Links Preschool Parent Representations to School-Age Peer Relationships.

Attachment theory proposes that children's representations of interactions with caregivers guide information-processing about others, bridging interpersonal domains. In a longitudinal study (N = 165), preschoolers (Mage  = 5.19 years) completed the MacArthur Story Stem Battery to assess parent representations. At school-age (Mage  = 8.42 years), children played a virtual ballgame with peers who eventually excluded them to track event-related cardiac slowing, a physiological correlate of rejection, especially when unexpected. At both ages, parents and teachers reported on peer and emotional problems. During exclusion versus inclusion-related events, cardiac slowing was associated with greater positive parent representations and fewer emerging peer problems. Cardiac slowing served as a mediator between positive parent representations and peer problems, supporting a potential psychophysiological mechanism underlying the generalization of attachment-related representations to peer relationships.

[Evaluation of Short-term Psychoanalytic Child Therapy (PaCT) for Young Children with Depressive Disorders: Results from a Pilot Study]. / Evaluation der Psychoanalytischen Kurzzeittherapie (PaKT) für junge Kinder mit depressiven Störungen: Ergebnisse der Pilotstudie.

Depressive disorders in early childhood are associated with high psychosocial impairment and tend to remain stable over time without adequate treatment. Short-term psychoanalytic therapy is a common form of child psychotherapy, yet there is a lack of empirical evaluation of this approach for young children with depressive disorders. Therefore, this secondary evaluation of a study on the treatment of anxiety disorders used an uncontrolled pre-post design in a clinical setting to investigate whether children with depressive comorbidity would evidence significant diagnostic and symptomatic remission after treatment with manualized short-term Psychoanalytic Child Therapy (PaCT). Nineteen children who had an anxiety disorder and a (subclinical) depressive disorder (assessed with the Preschool Age Psychiatric Assessment using DSM-IV criteria) were treated with PaCT. After treatment, 15 of 19 children (78.94 %) were remitted and 15 of 17 children (88.24 %; 2 were lost to follow-up) were free of depressive disorders at the 6-month follow-up. Further analyses revealed significant effects for pre- to post and pre- to follow-up comparisons regarding internalizing symptoms and overall problems using parent- and (nursery-)teacher-ratings. These results suggest that short-term PaCT shows promise as a treatment for childhood depressive disorders.

Quality of life and psychological co-morbidities in children and adolescents with cardiac pacemakers and implanted defibrillators: a cohort study in Eastern Germany.

INTRODUCTION: The implantation of a pacemaker or an implantable cardioverter-defibrillator during childhood may reduce quality of life and lead to mental health problems. This study aimed to evaluate potential mental health problems (i.e., depressive and anxiety symptoms) and quality of life in children with cardiac active devices in comparison to healthy peers. METHODS: We analysed data of children with pacemakers or implantable cardioverter-defibrillators aged 6-18 years. Quality of life, depressive and anxiety symptoms were assessed by standardised questionnaires. The results were compared to age-matched reference groups. RESULTS: Children with implantable cardioverter-defibrillator showed significant lower quality of life in comparison to reference group (p = 0.03), but there was no difference in quality of life between children with pacemaker and reference group. There was no significant difference in depressive symptoms between children with a cardiac rhythm device compared to reference group (self-report: p = 0.67; proxy report: p = 0.49). There was no significant difference in anxiety (p = 0.53) and depressive symptoms (p = 0.86) between children with pacemaker and children with implantable cardioverter-defibrillator. CONCLUSIONS: Living with an implantable cardioverter-defibrillator in childhood seems to decrease the patients' quality of life. Although children with pacemaker and implantable cardioverter-defibrillator don't seem to show more depressive and anxiety symptoms in comparison to their healthy peers, there still can be an increased risk for those children to develop mental health problems. Therefore, treating physicians should be aware of potential mental health problems and provide the patients and their families with appropriate therapeutic offers.

Getting less than their fair share: Maltreated youth are hyper-cooperative yet vulnerable to exploitation in a public goods game.

Human cooperative behavior has long been thought to decline under adversity. However, studies have primarily examined perceived patterns of cooperation, with little eye to actual cooperative behavior embedded within social interaction. Game-theoretical paradigms can help close this gap by unpacking subtle differences in how cooperation unfolds during initial encounters. This study is the first to use a child-appropriate, virtual, public goods game to study actual cooperative behavior in 329 participants aged 9-16 years with histories of maltreatment (n = 99) and no maltreatment (n = 230) while controlling for psychiatric symptoms. Unlike work on perceived patterns of cooperation, we found that maltreated participants actually contribute more resources to a public good during peer interaction than their nonmaltreated counterparts. This effect was robust when controlling for psychiatric symptoms and peer problems as well as demographic variables. We conclude that maltreatment may engender a hyper-cooperative strategy to minimize the odds of hostility and preserve positive interaction during initial encounters. This, however, comes at the cost of potential exploitation by others.

Latent trajectories of internalizing symptoms from preschool to school age: A multi-informant study in a high-risk sample.

Recent proposals suggest early adversity sets in motion particularly chronic and neurobiologically distinct trajectories of internalizing symptoms. However, few prospective studies in high-risk samples delineate distinct trajectories of internalizing symptoms from preschool age onward. We examined trajectories in a high-risk cohort, oversampled for internalizing symptoms, several preschool risk/maintenance factors, and school-age outcomes. Parents of 325 children completed the Strengths and Difficulties Questionnaire on up to four waves of data collection from preschool (3-5 years) to school age (8-9 years) and Preschool Age Psychiatric Assessment interviews at both ages. Multi-informant data were collected on risk factors and symptoms. Growth mixture modelling identified four trajectory classes of internalizing symptoms with stable low, rising low-to-moderate, stable moderate, and stable high symptoms. Children in the stable high symptom trajectory manifested clinically relevant internalizing symptoms, mainly diagnosed with anxiety disorders/depression at preschool and school age. Trajectories differed regarding loss/separation experience, maltreatment, maternal psychopathology, temperament, and stress-hormone regulation with loss/separation, temperament, maternal psychopathology, and stress-hormone regulation (trend) significantly contributing to explained variance. At school age, trajectories continued to differ on symptoms, disorders, and impairment. Our study is among the first to show that severe early adversity may trigger a chronic and neurobiologically distinct internalizing trajectory from preschool age onward.

Like mother like daughter, like father like son? Intergenerational transmission of internalizing symptoms at early school age: a longitudinal study.

Despite the well-established link between parental depressive symptoms and children's internalizing symptoms, studies that divide transmission into gender-specific components remain scarce. Therefore, the present study focused on gender-specific associations between internalizing symptoms of parents and children over the course of early school age, a key stage where gender-specific roles are increasingly adopted. Participants were 272 children (49.6% girls) oversampled for internalizing symptoms. Parents completed questionnaires twice during early school age (mean age time 1 = 7.4 years; SD = 0.24; mean age time 2 = 8.5 years; SD = 0.28). Mothers and fathers separately reported on their own depressive symptoms and their child's internalizing symptoms. Latent multiple group analyses indicated gender-independent stability as well as gender-specific relations between parental and child outcomes. Maternal depressive symptoms were concurrently associated with symptoms of girls and boys, while paternal symptoms were concurrently associated only with symptoms of boys, but not of girls. Moreover, the associations between children and the parent of the same gender became more relevant over time, suggesting a growing identification with the same-gender model, particularly for fathers and boys. In regard to prospective effects, girls' internalizing symptoms at age 7 predicted paternal depressive symptoms 1 year later. In a rigorous longitudinal design, this study underscores the importance of gender specificity in the associations of internalizing symptoms between children and their mothers and fathers after controlling for symptom stability over time. The study also raises the interesting possibility that girls' internalizing symptoms elicit similar symptoms in their fathers.

[Factors Influencing Theory of Mind Development in Preschoolers within the Context of Early Interventions]. / Einflussfaktoren auf die Theory of Mind-Entwicklung im Vorschulalter im Rahmen Früher Hilfen.

Factors Influencing Theory of Mind Development in Preschoolers within the Context of Early Interventions The Theory of Mind (ToM) competency is closely related to the child's cognitive, language, and socio-emotional development. In early interventions, skills and developmental processes associated with ToM development are often primary intervention targets, but empirical support for direct or indirect influences of early interventions on ToM development is missing so far. Within the home visiting program "Pro Kind" N = 755 families were accompanied by professionals from the last trimester of pregnancy until the child's second birthday. In the present follow-up study we investigated influences of treatment, pre- and postnatal family environment, parental competencies and child competencies on the ToM ability in a sample of n = 39 five-year-old children using Ctree analyses. Prenatal and current parental stress as well as an enriched family learning environment, and children's language competencies in interaction with temperament significantly predicted ToM competency. The treatment had no direct influence on ToM development. Thus, the results argue for the urgent need to address maternal stress regulation and mentalizing competencies in early interventions during pregnancy, as well as to focus on promoting positive stimulating learning environments and language development after the child's birth.

Commentary: The dynamic panel model: a promising approach to clarify sources of influence in developmental psychopathology - a commentary on Wichstrøm et al. (2017).

In their study, Wichstrøm et al. (2017) have proposed a novel groundbreaking approach for developmental psychopathology that undoubtedly will inspire other research. Applying the dynamic panel model (DPM), the authors were able to show that within-disorder (homotypic) and between-disorder (heterotypic) continuities of psychiatric symptoms are mostly due to unmeasured time-invariant factors while only few effects of earlier symptoms on later symptoms remained significant after accounting for these factors. The DPM calls for future applications of this approach to samples across different countries, diverse developmental phases, and in various settings - community samples and clinical samples alike.

Commentary: The importance of exploring dose-dependent, subtype-specific, and age-related effects of maltreatment on the HPA axis and the mediating link to psychopathology. A response to Fisher (2017).

We greatly appreciate Dr. Fisher's commentary that provides an excellent backdrop and well-considered perspective on our findings. We agree that our results mesh well with previous work documenting hypocortisolism among youth who experienced early adversity, especially neglect. Moreover, as also perceptively noted by Dr. Fisher, our cross-sectional data provide support for the notion that hypocortisolism is not simply a transient phenomenon, but, rather, a persistent pattern characterizing maltreated youth. Specifically, the consistency of the between group effect (from age 9.69 onwards) on a multimonth index of cumulative cortisol and the dose-dependent gradient of cortisol secretion within the maltreated group, which was related to the number of subtypes and the length of exposure to maltreatment, lend weight to this view.

Reduced hair cortisol after maltreatment mediates externalizing symptoms in middle childhood and adolescence.

BACKGROUND: The enduring impact of childhood maltreatment on biological systems and ensuing psychopathology remains incompletely understood. Long-term effects of stress may be reflected in cumulative cortisol secretion over several months, which is now quantifiable via hair cortisol concentrations (HCC). We conducted a first comprehensive investigation utilizing the potential of hair cortisol analysis in a large sample of maltreated and nonmaltreated children and adolescents. METHOD: Participants included 537 children and adolescents (3-16 years; 272 females) with maltreatment (n = 245) or without maltreatment histories (n = 292). Maltreated subjects were recruited from child protection services (CPS; n = 95), youth psychiatric services (n = 56), and the community (n = 94). Maltreatment was coded using the Maltreatment Classification System drawing on caregiver interviews and complemented with CPS records. Caregivers and teachers reported on child mental health. HCC were assessed in the first 3 cm hair segment. RESULTS: Analyses uniformly supported that maltreatment coincides with a gradual and dose-dependent reduction in HCC from 9 to 10 years onwards relative to nonmaltreated controls. This pattern emerged consistently from both group comparisons between maltreated and nonmaltreated subjects (27.6% HCC reduction in maltreated 9-16-year-olds) and dimensional analyses within maltreated subjects, with lower HCC related to greater maltreatment chronicity and number of subtypes. Moreover, both group comparisons and dimensional analyses within maltreated youth revealed that relative HCC reduction mediates the effect of maltreatment on externalizing symptoms. CONCLUSIONS: From middle childhood onwards, maltreatment coincides with a relative reduction in cortisol secretion, which, in turn, may predispose to externalizing symptoms.

Cause or consequence? Investigating attention bias and self-regulation skills in children at risk for obesity.

Impaired self-regulation, especially in food-specific situations, has been linked to childhood obesity. These deficits may be acquired during the development of obesity rather than being a prerequisite thereof. The current study, hence, focused on an at-risk population versus controls. Normal-weight children of obese and normal-weight parents were tested regarding attentional flexibility, emotion regulation, and inhibitory control. A sample of 50 preschoolers of obese parents (n=25) or normal-weight parents (n=25) participated in this study. Through eye-tracking, attentional bias for food cues was measured during a visual probe task using food and toy images. Emotion regulation was assessed during a distress-evoking task, and inhibitory control was examined through a delay-of-gratification task. Both tasks are standardized and were conducted in non-food contexts. Results showed no significant group differences in overall attentional bias to food images over toy images. However, children of normal-weight parents showed a preference for toy images. Regarding emotion regulation, children in the risk group expressed significantly less overall emotional distress. In addition, less gaze aversion and bodily sadness could be observed in this group. No differences were found for inhibitory control. Findings suggest that general deficits in self-regulation are not yet present in normal-weight children at risk for obesity. Instead, they might develop as a by-product of unhealthy weight gain. Results indicate, however, that children of obese parents are less emotionally expressive compared with children of normal-weight parents. Furthermore, children of normal-weight parents appeared to be more interested in toy images than in food images.

Recruitment strategies in a prospective longitudinal family study on parents with obesity and their toddlers.

BACKGROUND: Recruitment of participants with obesity is a real challenge. To reduce time and costs in similar projects, we investigated various recruiting strategies used in a longitudinal family study with respect to their enrolment yield and cost effectiveness. Results may help other research groups to optimize their recruitment strategies. METHODS: We applied different recruitment strategies to acquire families with children aged 6 to 47 months and at least one parent with obesity (risk group) or two parents of normal weight (control group) for a longitudinal non-interventional study. Based on four main strategies-via media, kindergartens, health professionals and focusing on the community-we examined 15 different subcategories of strategies. Based on enrolment yield and relative costs (e.g., material expenses, staff time) we analyzed the effectiveness of each recruitment strategy. RESULTS: Following different recruitment approaches, 685 families contacted us; 26% (n = 178) of these met the inclusion criteria. Of the four main strategies, the community-focused strategy was the most successful one (accounting for 36.5% of the sample) followed by contacts with kindergartens (accounting for 28.1% of the sample). Of the subcategories, two strategies were outstanding: Posters (community-focused strategies), and recruitment via kindergartens using phone contacts rather than emailing. Only a small number of participants were recruited via announcements in newspapers (lower cost strategy), advertisements on public transport or face-to-face recruitment at various places (higher cost strategies). CONCLUSIONS: Results revealed that only a combination of different active and passive methods and approaches led to a sufficient sample size. In this study, recruitment via posters and contacting kindergartens on the phone produced the highest numbers of participants (high enrolment yield) at moderate costs.

The Pizzagame: A virtual public goods game to assess cooperative behavior in children and adolescents.

Social dilemmas are characterized by conflicts between immediate self-interest and long-term collective goals. Although such conflicts lie at the heart of various challenging social interactions, we know little about how cooperation in these situations develops. To extend work on social dilemmas to child and adolescent samples, we developed an age-appropriate computer task (the Pizzagame) with the structural features of a public goods game (PGG). We administered the Pizzagame to a sample of 191 children 9 to 16 years of age. Subjects were led to believe they were playing the game over the Internet with three sets of two same-aged, same-sex co-players. In fact, the co-players were computer-generated and programmed to expose children to three consecutive conditions: (1) a cooperative strategy, (2) a selfish strategy, and (3) divergent cooperative-selfish strategies. Supporting the validity of the Pizzagame, our results revealed that children and adolescents displayed conditional cooperation, such that their contributions rose with the increasing cooperativeness of their co-players. Age and gender did not influence children and adolescents' cooperative behavior within each condition. However, older children adapted their behavior more flexibly between conditions to parallel the strategies of their co-players. These results support the utility of the Pizzagame as a feasible, reliable, and valid instrument for assessing and quantifying child and adolescent cooperative behavior. Moreover, these findings extend previous work showing that age influences cooperative behavior in the PGG.

Maternal mentalization affects mothers' - but not children's - weight via emotional eating.

Previous research on childhood obesity has shown that maternal obesity is an important risk factor for this malady. Because biological and environmental factors are able to explain the transgenerational transmission of obesity only in part, psychological risk factors (e.g., emotional eating) have become more important in recent research. As maternal mentalization - which lays the foundation for the child's ability to regulate his/her emotions - has not yet been investigated, we examined the effects of mentalization on maternal and childhood obesity. By investigating groups of obese (n = 30) and normal-weight (n = 30) mothers and their children aged 18 to 55 months, we found, contrary to our expectations, that obese mothers' mentalization (Reflective Functioning Scale) was similar to that of mothers with normal weight and that mentalization showed no direct effect on the child's weight. However, we found hints of an indirect influence of mentalization via emotional eating on mothers' but not on children's weight and via mother-child attachment (Attachment Q-Set) on children's weight. Possible reasons for these inconclusive effects are discussed.

Analyzing pathways from childhood maltreatment to internalizing symptoms and disorders in children and adolescents (AMIS): a study protocol.

BACKGROUND: Effective interventions for maltreated children are impeded by gaps in our knowledge of the etiopathogenic mechanisms leading from maltreatment to mental disorders. Although some studies have already identified individual risk factors, there is a lack of large-scale multilevel research on how psychosocial, neurobiological, and genetic factors act in concert to modulate risk of internalizing psychopathology in childhood following maltreatment. To help close this gap, we aim to delineate gender-specific pathways from maltreatment to psychological disorder/resilience. To this end, we examine the interplay of specific maltreatment characteristics and psychological, endocrine, metabolomic, and (epi-)genomic stress response patterns as well as cognitive-emotional/social processes as determinants of developmental outcome. Specifically, we will explore endocrine, metabolomic, and epigenetic mechanisms leading from maltreatment to a higher risk of depression and anxiety disorders. METHODS/DESIGN: Four large samples amounting to a total of N = 920 children aged 4-16 years will be assessed: Two cohorts with prior internalizing psychopathology and controls will be checked for maltreatment and two cohorts with substantiated maltreatment will be checked for internalizing (and externalizing) psychopathology. We will apply a multi-source (interview, questionnaires, official records), multi-informant strategy (parents, children, teachers) to assess maltreatment characteristics (e.g., subtypes, developmental timing, chronicity) and psychopathological symptoms, supplemented with multiple measurements of risk and protective factors and cutting-edge laboratory analyses of endocrine, steroid metabolomic and epigenetic factors. As previous assessments in the two largest samples are already available, longitudinal data will be generated within the three year study period. DISCUSSION: Our results will lay the empirical foundation for (a) detection of early biopsychosocial markers, (b) development of screening measures, and

A prospective study of behavioral and emotional symptoms in preschoolers.

A substantial number of preschool children exhibit psychological symptoms that have an impact on their own and their families' lives. The aim of the current study was to investigate the prevalence, stability and increase/decrease in emotional and behavioral symptoms and the resultant impairment at two assessment points at preschool age. The sample consisted of 1,034 children drawn from the general population with a mean age of 51 months at t1 and 72 months at t2. Parents completed the Strengths and Difficulties Questionnaire extended version (Goodman, J Child Psychol Psychiatry 38(5):581-586, 1997; Goodman, J Child Psychol Psychiatry 40(5):791-799, 1999). At t1, 6.9 % of the preschoolers had a total difficulties and 6.8 % a total impact score within the abnormal range. At t2, these scores were 5.7 and 6.2 %, respectively. We found moderate stability of symptoms. From t1 to t2, emotional symptoms and prosocial behavior significantly increased, while hyperactivity, conduct problems, peer problems and total difficulties decreased. The mean total impact score did not change. Boys showed higher levels of symptoms (except emotional symptoms) and impact, and lower prosocial behavior, than girls. Moreover, there was a significant time × gender interaction, with girls showing a larger decrease in hyperactivity/inattention and in total difficulties than boys. The stepwise multiple regression analysis revealed that the total impact score at baseline, male gender, conduct problems, hyperactivity and peer problems significantly contributed to the explained variance of the total impact score at follow-up. This is one of very few studies to examine the stability and change of psychological symptoms in a large community sample of preschoolers, assessed twice during preschool age.

Insatiable insecurity: maternal obesity as a risk factor for mother-child attachment and child weight.

Childhood obesity has become a rising health problem, and because parental obesity is a basic risk factor for childhood obesity, biological factors have been especially considered in the complex etiology. Aspects of the family interaction, e.g., mother-child attachment, have not been the main focus. Our study tried to fill this gap by investigating whether there is a difference between children of obese and normal weight mothers in terms of mother-child attachment, and whether mother-child attachment predicts child's weight, in a sample of 31 obese and 31 normal weight mothers with children aged 19 to 58 months. Mother-child attachment was measured with the Attachment Q-Set. We found that (1) children of obese mothers showed a lower quality of mother-child attachment than children of normal weight mothers, which indicates that they are less likely to use their mothers as a secure base; (2) the attachment quality predicted child`s BMI percentile; and (3) the mother-child attachment adds incremental validity to the prediction of child's BMI beyond biological parameters (child's BMI birth percentile, BMI of the parents) and mother's relationship status. Implications of our findings are discussed.