Reward Responsivity in Parenting: Development of a Novel Measure in Mothers of Young Children.

The purpose of the current study was to develop and evaluate a measure of maternal reward responsivity in parenting. Deficits in reward responsivity, a common feature of depression, may contribute to maladaptive parenting behaviors. Reward responsivity is an individual difference in reactivity to pleasurable stimuli and represents a key motivational component that could contribute to the frequency and quality of mothers' interactions with their infants. However, there is currently no measure of reward responsivity in parenting, which would be necessary to evaluate the link between mother reward responsivity, behaviors towards their infant, and infant behavior. Therefore, the current study reports on the development and initial evaluation of a self-report measure of reward responsivity in parenting, the Mother Inventory of Reward Experience (MIRE). We evaluated the MIRE among 200 mothers (M =28.45, SD = 5.50) recruited from a pediatric primary care center. After item analysis, 22 items were retained and displayed high internal consistency reliability and test re-test reliability. Convergent validity was established via a significant correlation with global reward responsivity. Concurrent validity was established via significant correlations with depressive symptoms, parenting stress, and child behavior problems. Incremental validity of the MIRE over a measure of global reward responsivity was supported. These results support the reliability and validity of the MIRE as a measure of reward responsivity in parenting.

Behavioral Parent Training in Infancy: A Window of Opportunity for High-Risk Families.

To meet the mental health needs of infants from high-risk families, we examined the effect of a brief home-based adaptation of Parent-child Interaction Therapy (PCIT) on improvements in infant and parent behaviors and reductions in parenting stress. Participants included 60 infants (55 % male; average age of 13.5 ± 1.31 months) who were recruited at a large urban primary care clinic and were included if their scores exceeded the 75th percentile on a brief screener of early behavior problems. Most infants were from an ethnic or racial minority background (98 %) and lived below the poverty line (60 %). Families were randomly assigned to receive the home-based parenting intervention or standard pediatric primary care. Observational and parent-report measures of infant and parenting behaviors were examined at pre- and post-intervention and at 3- and 6-month follow-ups. Infants receiving the intervention were more compliant with maternal commands at the 6-month follow-up and displayed lower levels of externalizing and internalizing behavior problems across post and follow-up assessments compared to infants in standard care. Mothers receiving the intervention displayed a significantly higher proportion of positive and lower proportion of negative behaviors with their infant during play compared to mothers in the standard care group. There were no significant group differences for parenting stress. Results provide initial evidence for the efficacy of this brief and home-based adaptation of PCIT for infants. These findings highlight the benefit of identification and intervention as early as possible to promote mental health for infants from high-risk families.

Otitis Media: To Treat, To Refer, To Do Nothing: A Review for the Practitioner.

.On the basis of research evidence, a recommended strategy for improving the care of middle ear infections is to identify the subset of patients least likely to benefit from antibiotic therapy. They include children ages 6 months to 23 months with unilateral disease without severe signs and symptoms (moderate or severe otalgia, otalgia lasting more than 48 hours,or temperature of 39°C [102.2°F]), and those older than 2 years ofage with unilateral or bilateral disease who have mild signs andsymptoms.(9) On the basis of research evidence, the initial treatment of otitis media with effusion is watchful observation. There is little harm in observing a child who is not at risk for speech, language, or learning difficulties compared to medical or surgical intervention.(4) On the basis of research evidence, administration of the annual influenza vaccine and the conjugated pneumococcal vaccination has been shown to have a small but statistically significant impact on the frequency of middle ear disease. (7)(8) On the basis of expert opinion, optimal outcomes depend oncommunication between clinicians and parents. At a minimum , primary care clinicians should state their reasons for their own clinical judgment about appropriate management and for referral to otolaryngology if necessary.

Home-Based Preventive Parenting Intervention for at-Risk Infants and Their Families: An Open Trial.

The purpose of this study was to examine the feasibility, acceptability, and initial outcome of a home-based adaptation of Parent-Child Interaction Therapy for at-risk infants with externalizing behavior problems. Seven 12- to 15-month-old infants and their families were recruited at a large pediatric primary care clinic to participate in a home-based parenting intervention to prevent subsequent externalizing behavior problems. Home-based assessments were conducted at baseline, postintervention, and a 4- to 6-month follow-up. Six of the 7 (86%) families completed the intervention, and all completers reported high satisfaction with the intervention. All of the mothers demonstrated significant improvements and statistically reliable changes in their interactions with their infant, and most reported clinically significant and statistically reliable changes in infant behavior problems. The current study provides preliminary support for the use of this brief, home-based parenting intervention in addressing behavior problems as early as possible to improve access to an intervention for at-risk infants and their families. Successes and challenges with the development and implementation of this intervention are discussed along with directions for future research and clinical practice.