[Prevention for children with parents with depression or anxiety : National and international approaches and their age specificity]. / Prävention bei Kindern mit depressiven oder angsterkrankten Eltern : Nationale und internationale Ansätze und deren Altersspezifizität.

BACKGROUND: Children of mentally ill parents are exposed to a multitude of burdens due to the diseases of their parents. Age-related preventive measures and interventions are needed to minimize the risk for the development of psychiatric disorders by the children themselves. OBJECTIVE: The aim of the study was the documentation of preventive options on a national and international level for children of different age groups between 3 and 14 years with parents with depressive or anxiety disorders. MATERIAL AND METHODS: A systematic literature search was conducted to identify current evidence-based preventive interventions measures for these target groups and analyzed with respect to age-specific aspects and evidence. RESULTS: From screening 107,573 publications 43 interventions could be found. After examining the evidence of the interventions 25 projects could be included in the analysis For each of the different age groups the intervention with the best evidence is presented in this article. CONCLUSION: Many interventions were found but most of them were not sufficiently evaluated or psychometrically defined; however, the few well-evaluated evidence-based projects for children mostly addressed the age-specific needs. Projects for preschool age children mostly worked with the parents and referred to elements of parental training. For schoolchildren there were various preventive projects that especially worked with increasing the self-esteem and the development of coping strategies. Projects for adolescents worked with psychoeducation and increasing social connectedness. Across all age groups there was no comprehensive and cross-system networking between the interventions.

Alterations of hair cortisol and dehydroepiandrosterone in mother-infant-dyads with maternal childhood maltreatment.

BACKGROUND: Child maltreatment (CM) has severe effects on psychological and physical health. The hypothalamic-pituitary-adrenal (HPA) axis, the major stress system of the body, is dysregulated after CM. The analysis of cortisol and dehydroepiandrosterone (DHEA) in scalp hair presents a new and promising methodological approach to assess chronic HPA axis activity. This study investigated the effects of CM on HPA axis activity in the last trimester of pregnancy by measuring the two important signaling molecules, cortisol and DHEA in hair, shortly after parturition. In addition, we explored potential effects of maternal CM on her offspring's endocrine milieu during pregnancy by measuring cortisol and DHEA in newborns' hair. METHODS: CM was assessed with the Childhood Trauma Questionnaire (CTQ). Cortisol and DHEA were measured in hair samples of 94 mothers and 30 newborns, collected within six days after delivery. Associations of maternal CM on her own and her newborn's cortisol as well as DHEA concentrations in hair were analyzed with heteroscedastic regression models. RESULTS: Higher CM was associated with significantly higher DHEA levels, but not cortisol concentrations in maternal hair. Moreover, maternal CM was positively, but only as a non-significant trend, associated with higher DHEA levels in the newborns' hair. CONCLUSIONS: Results suggest that the steroid milieu of the mother, at least on the level of DHEA, is altered after CM, possibly leading to non-genomic transgenerational effects on the developing fetus in utero. Indeed, we observed on an explorative level first hints that the endocrine milieu for the developing child might be altered in CM mothers. These results need extension and replication in future studies. The measurement of hair steroids in mothers and their newborns is promising, but more research is needed to better understand the effects of a maternal history of CM on the developing fetus.

Childhood maltreatment, postnatal distress and the protective role of social support.

The postpartum period is a vulnerable period for women with a history of childhood maltreatment. This study investigated the association between childhood maltreatment and postnatal distress three months postpartum and examined the role of social support provided by different sources (intimate partner, parents, parents-in-law, and friends). Analyses are based on N=66 women, who were screened for maltreatment experiences shortly after parturition with the Childhood Trauma Questionnaire. Their levels of postnatal distress (symptoms of depression, anxiety, and stress; assessed with the Hospital Anxiety and Depression Scale and the 4-Item version of the Perceived Stress Scale) and postpartum social support (measured with the Postpartum Social Support Questionnaire) were assessed three months postpartum. Adjusting for educational level and the experience of a recent stressful event, childhood maltreatment was directly associated with higher levels of postnatal distress. Social support provided by friends moderated this association in a heteroscedastic regression analysis. No moderating effect was observed for support provided by the own parents, the intimate partner, or parents-in-law. The association between childhood maltreatment and postnatal distress was not mediated by social support. Additional analyses revealed no main, moderating, or mediating effects of satisfaction with support. Results suggest that support provided by friends may promote resilience during the postpartum period in women with a history of childhood maltreatment. Efforts to better understand the role of postpartum support and mechanisms that may enhance a mother's ability to develop and maintain supportive friendships may be promising for guiding preventive interventions.

Psychosocial Risk Factors for Child Welfare among Postpartum Mothers with a History of Childhood Maltreatment and Neglect.

Background: Childhood maltreatment (CM) can increase the risk of psychosocial risk factors in adulthood (e. g. intimate partner violence, financial problems, substance abuse or medical problems). The transition to parenthood presents those affected by CM with particular challenges, in addition to usual birth-related stressors. Methods: In this cross-sectional study a total of 240 women were interviewed in the puerperium with respect to CM experiences, using the German version of the Childhood Trauma Questionnaire (CTQ). Current psychosocial risk factors (e. g. financial concerns, maternal mental illness, single parent) were assessed using the Constance Index (KINDEX) for early childhood risk factors. Associations between CM experience and psychosocial risk factors were calculated using simple correlation. Results: The average age of participants was 33 years. On the CTQ 13.8 % of participants reported emotional abuse, 6.7 % physical abuse and 12.5 % sexual abuse, while 32.1 % reported emotional neglect and 7.5 % physical neglect during childhood. With rising severity of CM, more psychosocial risk factors (KINDEX) were present. Conclusions: This study shows a clear association between experiences of maltreatment during childhood and the presence of psychosocial stressors among women in the puerperium. Regular screening for a history of CM and parental psychosocial stressors should be conducted early, i.e. during pregnancy, to avoid negative consequences for the child.

Child Abuse and Neglect: Screening for Risks During the Perinatal Period.

Purpose: Currently, there is a claim for earlier interventions for families in order to prevent child maltreatment. Here, a screening instrument to assess risk indicators for child abuse and neglect already in the context of maternity clinics is introduced. The present study is the first report on the psychometric properties of this instrument, the "short questionnaire for risk indices around birth" (RIAB). Material and Methods: Data were collected in the context of three different studies conducted at Ulm University Hospital. To examine interrater reliability eight case vignettes were rated by n = 90 study participants (50 students and 40 experts working at a maternity clinic). Criterion validity was examined in two studies applying the German version of the child abuse potential inventory CAPI (n = 96 families at risk and n = 160 additional families). Results: Both laymen and experts were able to understand and use the screening instrument correctly, leading to a high agreement with the sample solutions given. A high concordance was found between parents' and experts' ratings: In case of no reported risk factors applying the screening instrument RIAB, parents themselves reported significantly less stressors and burdens, compared to those parents with an indication for a thorough examination as pointed out in the RIAB. Conclusion: In the context of maternity clinics the RIAB is a useful, broadly applicable instrument, screening for existing risk factors at the earliest and thus allowing for the initiation of specific interventions when needed.

[Social network analysis of interdisciplinary cooperation and networking in early prevention and intervention. A pilot study]. / Soziale Netzwerkanalyse interdisziplinärer Kooperation und Vernetzung in den Frühen Hilfen. Eine Pilotuntersuchung.

Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.

[Prevention of risks to children on the basis of early intervention and interdisciplinary cooperation in the example of the model project "a good start to life"]. / Prävention von Kindeswohlgefährdung auf der Basis früher Hilfen und interdisziplinärer Kooperation am Beispiel des Modellprojekts "Guter Start ins Kinderleben"

Infants and toddlers are at high risk of neglect and maltreatment, as they are especially dependent on the care and the safeguard of their parents. Child protection can only succeed if early and preventive support for families at risk and their infants is provided. The project "A good start to life" helps to promote parental sensitive behaviour and care giving competence of parents in precarious life settings and in high risk situations and is aimed to prevent child neglect and abuse at an early age. A relevant prerequisite for child protection is interdisciplinary networking between the involved systems. The main focus of the project is the establishment of collaboration and network structures between the infant and youth welfare system and the health-care system and their services in eight communities in four states in Germany by using so-called round tables as communication platforms. Preliminary results of the round tables are reported in this article together with the results of the evaluation process.

Maternal expressed emotion related to attachment disorganization in early childhood: a preliminary report.

Using a longitudinal sample of children, this study examined the relation between maternal Expressed Emotion (EE) and mother-child attachment disorganization at age 6 years. A nonclinical sample of 33 children (at ages 12 months and 18 months) from Berlin, Germany participated with their mothers in Ainsworth's Strange Situation. Thirty-two children were again observed with their mothers at age 6 years in a standard laboratory attachment observation. At the time of the 6-year assessment, maternal EE was assessed based on a Five-Minute Speech Sample. Mothers also completed the Life Events Questionnaire, a measure of family stress, and the Present State Examination, a measure of maternal depression. Maternal Expressed Emotion was significantly linked to mother-child attachment security at age 6 years. Further analyses revealed that High EE was most closely linked to the disorganized attachment pattern at age 6 years, an at-risk attachment pattern that has been associated with intrusive and hostile maternal behavior. The relationship was upheld when other relevant variables, including infant attachment disorganization and a measure of perceived family stress, were simultaneously considered. The study provides independent validation of Expressed Emotion as a measure of relationship quality in early childhood. It also provides a basis for the further investigation of the nature of the relation between maternal Expressed Emotion and attachment disorganization.

[Contribution of maternal sensitivity in transgenerational promotion of binding quality]. / Die Stellung von mütterlicher Sensitivität bei der transgenerationalen Ubermittlung von Bindungsqualität.

Attachment research revealed evidence for a relationship between the quality of parental attachment representations as assessed with the Adult Attachment Interview and quality of infant's attachment representations using the Ainsworth Strange Situation. Current research indicates that parental sensitivity is one of the main variables connecting the parent's internal attachment representations with the quality of their infants' attachment. Sensitivity is not only operationalized on the behavioral as well as on the representational level, but is particularly operationalized as perspective-taking behavior and reflection. In order to illustrate this position, individual differences of 3 mothers with different attachment representations in the Adult Attachment Interview and their behavior during the Strange Situation are presented.

Assessing children's representational attachment models: links to mother-child attachment quality in infancy and childhood.

The authors examined whether the finding of a correspondence between specific behavioral patterns of attachment in infancy and childhood and specific representational patterns in childhood could be replicated using children's responses to a story depicting an imagined parent-child separation experience. The participants were 33 German mothers and their children (16 girls, 17 boys). Attachment quality was assessed via standard and exploratory attachment observations at ages 12 months, 18 months, and 6 years. Chi-square analyses indicated that there was a good level of concordance between the behavioral and representation attachment patterns in infancy and childhood.

Children's ability to delay gratification: longitudinal relations to mother-child attachment.

Concurrent and longitudinal mother-child attachment qualities were studied in relation to children's ability to postpone gratification at age 6 years. A sample of 32 children (at ages 12 months and 18 months) and their mothers participated in the strange situation procedure. At age 6 years, they were observed in an attachment situation and administered a standard delay of gratification task. The length of time that children were able to delay gratification at age 6 was predicted both by concurrent attachment quality and by a longitudinal attachment measure. Children with secure attachment were able to wait the longest periods of time, whereas those with insecure-disorganized attachment had the most difficulties in waiting. The effects of longitudinal, but not concurrent, attachment quality on children's total waiting time remained significant when other important variables were considered, including gender and children's cognitive functioning. An interactive effect was found between attachment quality and cognitive functioning. Insecure-avoidantly attached children with high cognitive functioning did not differ in their overall waiting times from securely attached children, but insecure-avoidantly attached children with average or low cognitive functioning did have shorter waiting times. The study provides a basis for the further investigation of mother-child attachment quality as a factor that is linked to children's delay behavior.

[Early attachment experiences and behavioral problems in young children in a social and cognitive test situation]. / Frühe Bindungserfahrungen und Verhaltensauffälligkeiten bei Kleinkindern in einer sozialen und kognitiven Anforderungssituation.

In this article, the influence of quality of attachment (Ainsworth Strange Situation at 21 months) and of the intensity of attachment insecurity on test performance and emotional state in the test situation (Bayley-test at 20 months) are analyzed. The quality of attachment of 75 infants was classified according to Crittenden's PAA (Preschool Assessment of Attachment) as: secure (B), insecure defended (A) and insecure-coercive (C). Alternately, the infants were classified according to their intensity of insecurity of attachment across subtypes of qualities (secure, insecure, highly insecure). Securely attached (B) infants had the best Bayley Mental scores, were socially open and bodily relaxed. The insecure-defended (A) infants had moderate test results, were moderately open and tense, whereas the insecure-coercive (C) infants showed not only the worst test-results but were often withdrawn, fearful, tense, and poorly coordinated. Additional clinical signs of disorganization were spread unspecifically over all attachment groups particularly those of the insecure children. In the classification of children according to intensity of insecurity, these signs of disorganization accumulated particularly in the group of highly insecure infants. Children with highly insecure attachment who also exhibited unusual test situation behavior also had the lowest Bayley-test scores in the Mental Scale. These results are interpreted in the sense of balance between test engagement and emotional cost.