Predicting externalizing behaviors in typically developing toddlers at 24 months: Insights from parenting at 12 months.

Early observational assessment of parent and child behaviors may identify risk factors associated with the development of early child externalizing behaviors. This study aimed to examine factors associated with child externalizing behaviors at 24-months of age, including early maternal depression, family social risk and the parent-child relationship. Using a longitudinal design in 89 mother-child dyads (n = 43 female), maternal depressive symptoms and social risk were measured post-birth, and 12-months later parent-child interaction was assessed using the Emotional Availability Scales. To assess child externalizing behaviors, a parent-report questionnaire was administered when children were 24-months old. Increased early maternal depressive symptoms (p = .03), but not higher social risk (p = 0.17), were associated with higher child externalizing behaviors in children at age 24-months. After adjusting for early maternal depressive symptoms and familial social risk, lower levels of observed maternal structuring (ß = -2.60, 95 %CI = -4.56, -0.64, p = .01) and lower levels of non-hostility (ß = -3.39, 95 %CI -6.64, -0.14, p = .04) when the child was 12-months old were associated with higher parent-report of externalizing behaviors. However, the child's observed interaction behavior was not associated with the mother's report of child externalizing behavior. Interventions targeting specific post-natal maternal mental health and early parenting behaviors may reduce the risk for the development of later child externalizing problems.

Associations between physical activity and development in preschool-aged children born <30 weeks' gestation: a cohort study.

OBJECTIVE: To investigate the effect of physical activity (PA) on development (motor, cognitive, social-emotional) in children 4-5 years old born <30 weeks' gestation, and to describe subgroups of children at risk of low PA in this cohort. DESIGN: Longitudinal cohort study. PATIENTS: 123 children born <30 weeks were recruited at birth and assessed between 4 and 5 years' corrected age. MAIN OUTCOME MEASURES: Development was assessed using the Movement Assessment Battery for Children, Second Edition (MABC-2), Little Developmental Coordination Disorder Questionnaire (L-DCDQ), Wechsler Preschool and Primary Scale of Intelligence (Fourth Edition; WPPSI-IV), and Strengths and Difficulties Questionnaire (SDQ). To measure PA, children wore an accelerometer and parents completed a diary for 7 days. Effects of PA on developmental outcomes, and associations between perinatal risk factors and PA, were estimated using linear regression. RESULTS: More accelerometer-measured PA was associated with better MABC-2 aiming and catching scores (average standard score increase per hour increase in PA: 0.54, 95% CI 0.11, 0.96; p=0.013), and lower WPPSI-IV processing speed index scores (average composite score decrease per hour increase in PA: -2.36, 95% CI -4.19 to -0.53; p=0.012). Higher accelerometer-measured PA was associated with better SDQ prosocial scores. Major brain injury in the neonatal period was associated with less moderate-vigorous and less unstructured PA at 4-5 years. CONCLUSIONS: Higher levels of PA are associated with aspects of motor, cognitive and social-emotional skill development in children 4-5 years old born <30 weeks. Those with major brain injury in the neonatal period may be more vulnerable to low PA at preschool age.

360-degree phenomenology: A qualitative approach to exploring the infant experience of hospitalisation in neonatal intensive care.

This paper describes the development and justification of a qualitative methodology aimed at exploring the infant's personal experience of hospitalisation in the neonatal intensive care unit (NICU). We begin by briefly reviewing existing methods for documenting and recording infant experiences. These methods focus on the clinical needs of the infant predominantly through quantifiable medical outcome data. Research understanding their experience of receiving clinical care is lacking. By exploring newborn infant behaviour, cues, and communication strategies we assert the infant as a capable participant in neonatal research. We then describe the methodology and methods which we have named 360-degree phenomenology that draws directly from the capabilities and knowledge of the infants themselves. We propose this methodology will address the gap in the literature by enabling a rich and comprehensive overview of the early life experiences of infants hospitalised in NICU.

Prospective Association of Parenting Stress with Later Child Behavior Problems in Early Childhood Autism.

PURPOSE: Autistic children are reported to display higher levels of externalizing and internalizing behaviors than neurotypical children, and their parents report more stress than parents of neurotypical children. It is unclear whether child behavior difficulties contribute to increased parenting stress, whether parenting stress contributes to child behavior difficulties, or whether the relationship may be bidirectional. METHODS: We investigated prospective bidirectional associations between parenting stress and child externalizing and internalizing behaviors when autistic children were aged on average 3.5, 4.5, and 5.5 years. Data collected at these three timepoints were examined across two panels: Time 1 to Time 2 (n = 38 parent-child dyads) and Time 2 to Time 3 (n = 27 dyads). RESULTS: Across Time 1 to Time 2, early parenting stress was significantly associated with later child externalizing behavior, and cross-lagged panel analysis supported a uni- rather than a bidirectional association between these factors. There was some evidence of a bidirectional association between parenting stress and child internalizing behavior, though this was non-significant when the strong stability of child internalizing behavior was statistically controlled. In contrast, across Time 2 to Time 3, there were no significant prospective associations found between variables, highlighting the importance of considering the impact of parenting stress early in the course of childhood autism. CONCLUSION: Our results add to research indicating that support targeting parent characteristics, especially parenting stress, could ameliorate subsequent outcomes for both parents and children.

Relationship Between Parental Postnatal Distress and 5-Year Mental Health Outcomes of Children Born at <30 Weeks and at Term.

OBJECTIVE: The purpose of this study was to compare mental health symptoms and diagnoses at age 5 years between children born <30 weeks' gestation and their term-born peers and associations with postnatal symptoms of depression and anxiety in their mothers and fathers. METHODS: Parents of children born <30 weeks' gestation (n = 106) and at term (n = 105) completed measures of anxiety and depression symptoms within 4 weeks of birth and questionnaires assessing child socioemotional symptoms and mental health/neurodevelopmental diagnostic criteria at age 5 years. RESULTS: At age 5 years, children born <30 weeks' gestation were more likely to show clinically concerning levels of total difficulties (odds ratio [OR] = 3.97, 95% confidence interval [CI], 1.21-13.05), emotional problems (OR = 3.71, 95% CI, 1.14-12.15), and inattention/hyperactivity problems (OR = 4.34, 95% CI, 1.51-12.47) than term-born peers. They also showed higher rates of mental health/neurodevelopmental diagnoses than their term-born peers (18% vs 9%), although evidence for the group difference was weak ( p = 0.08). Maternal postnatal anxiety and depression symptoms were related to poorer child mental health outcomes in many domains. There was little evidence that paternal postnatal anxiety/depression symptoms were related to child outcomes or that any associations varied by birth group. CONCLUSION: Children born <30 weeks' gestation showed more mental health symptoms than their term-born peers at age 5 years. Maternal postnatal distress was associated with poorer child mental health across both groups, reinforcing the need for early identification and support of mental health distress in the postnatal period to improve longer-term child well-being.

Parental Mental Health and Parenting Behaviors Following Very Preterm Birth: Associations in Mothers and Fathers and Implications for Child Cognitive Outcome.

OBJECTIVES: To investigate the longitudinal associations between parental mental health symptoms within 4 weeks of birth, parenting behaviors at 1 year, and child general cognitive ability at 4.5-5 years in a sample of children born very preterm (VP). This study also examined whether these associations differed based on level of family social risk. METHODS: Participants were 143 children born <30 weeks' gestation and their parents. Within 4 weeks of birth, mothers' and fathers' depressive and anxiety symptoms were assessed using the Center for Epidemiologic Studies Depression Scale and Hospital Anxiety Depression Scale-Anxiety Subscale. Parents' sensitive and structuring parenting behaviors were assessed at 1 year using the Emotional Availability Scales. Child general cognitive ability was assessed at 4.5-5 years using the Wechsler Preschool & Primary Scale of Intelligence-Fourth Edition. RESULTS: Higher maternal depressive symptoms were associated with lower levels of sensitive and structuring parenting behavior, while higher maternal anxiety symptoms were associated with higher levels of structuring parenting behavior. There was weak evidence for positive associations between mothers' sensitive parenting behavior and fathers' structuring parenting behavior and child general cognitive ability. There was also weak evidence for stronger associations between mothers' mental health symptoms, parenting behaviors, and child general cognitive ability, in families of higher compared with lower social risk. CONCLUSIONS: Depressive and anxiety symptoms experienced by mothers in the initial weeks following VP birth can have long-term effects on their parenting behaviors. Enquiring about parents' mental health during their child's hospitalization in the neonatal intensive care unit is crucial.

Growth of prefrontal and limbic brain regions and anxiety disorders in children born very preterm.

BACKGROUND: Children born very preterm (VP) display altered growth in corticolimbic structures compared with full-term peers. Given the association between the cortiocolimbic system and anxiety, this study aimed to compare developmental trajectories of corticolimbic regions in VP children with and without anxiety diagnosis at 13 years. METHODS: MRI data from 124 VP children were used to calculate whole brain and corticolimbic region volumes at term-equivalent age (TEA), 7 and 13 years. The presence of an anxiety disorder was assessed at 13 years using a structured clinical interview. RESULTS: VP children who met criteria for an anxiety disorder at 13 years (n = 16) displayed altered trajectories for intracranial volume (ICV, p < 0.0001), total brain volume (TBV, p = 0.029), the right amygdala (p = 0.0009) and left hippocampus (p = 0.029) compared with VP children without anxiety (n = 108), with trends in the right hippocampus (p = 0.062) and left medial orbitofrontal cortex (p = 0.079). Altered trajectories predominantly reflected slower growth in early childhood (0-7 years) for ICV (ß = -0.461, p = 0.020), TBV (ß = -0.503, p = 0.021), left (ß = -0.518, p = 0.020) and right hippocampi (ß = -0.469, p = 0.020) and left medial orbitofrontal cortex (ß = -0.761, p = 0.020) and did not persist after adjusting for TBV and social risk. CONCLUSIONS: Region- and time-specific alterations in the development of the corticolimbic system in children born VP may help to explain an increase in anxiety disorders observed in this population.

Early parenting behaviour is associated with complex attention outcomes in middle to late childhood in children born very preterm.

Attention deficits are common in children born very preterm (VP), especially for children with higher social risk. The aim of this study was to examine the association between parenting behavior and attention in children born VP, and whether this association is influenced by familial social risk. Two hundred and twenty-four children born <30 weeks' gestation and/or with a birth weight <1250 g were recruited at birth. At 2 years, social risk was calculated and parenting behaviors were observed during a parent-child interaction task, with children's attention skills assessed at 7 and 13 years using standardized assessments. Higher levels of sensitive parenting at 2 years were positively associated with divided attention at age 7 years, and higher levels of intrusive parenting were negatively associated with divided attention at 13 years. Children born VP with higher social risk were more positively influenced by sensitive parenting behavior for sustained attention at 7 years, selective attention at 13 years, and divided attention at 7 and 13 years than children born VP with lower social risk. Additionally, children born VP with higher social risk were more negatively influenced by intrusive parenting for sustained attention outcomes at 7 years than those with lower social risk. In summary, the evidence for a contribution of early parenting to attention outcomes in children born VP was stronger for more complex attention (divided attention) compared with basic attention domains. Our findings also suggest that early parenting behavior has a particular influence on children born VP from socially disadvantaged environments for attention outcomes.

Fiber-Specific Measures of White Matter Microstructure and Macrostructure Are Associated With Internalizing and Externalizing Symptoms in Children Born Very Preterm and Full-term.

BACKGROUND: Tensor-based investigations suggest that delayed or disrupted white matter development may relate to adverse behavioral outcomes in individuals born very preterm (VP); however, metrics derived from such models lack specificity. Here, we applied a fixel-based analysis framework to examine white matter microstructural and macrostructural correlates of concurrent internalizing and externalizing problems in VP and full-term (FT) children at 7 and 13 years. METHODS: Diffusion imaging data were collected in a longitudinal cohort of VP and FT individuals (130 VP and 29 FT at 7 years, 125 VP and 44 FT at 13 years). Fixel-based measures of fiber density, fiber-bundle cross-section, and fiber density and cross-section were extracted from 21 white matter tracts previously implicated in psychopathology. Internalizing and externalizing symptoms were assessed using the Strengths and Difficulties Questionnaire parent report at 7 and 13 years. RESULTS: At age 7 years, widespread reductions in fiber-bundle cross-section and fiber density and cross-section and tract-specific reductions in fiber density were related to more internalizing and externalizing symptoms irrespective of birth group. At age 13 years, fixel-based measures were not related to internalizing symptoms, while tract-specific reductions in fiber density, fiber-bundle cross-section, and fiber density and cross-section measures were related to more externalizing symptoms in the FT group only. CONCLUSIONS: Age-specific neurobiological markers of internalizing and externalizing problems identified in this study extend previous tensor-based findings to inform pathophysiological models of behavior problems and provide the foundation for investigations into novel preventative and therapeutic interventions to mitigate risk in VP and other high-risk infant populations.

Preterm Infant Outcomes at 24 Months After Clinician-Supported Web-Based Intervention.

The authors of this study evaluated infant and parent outcomes at 12 and 24 months after a clinician-supported, web-based early intervention for preterm infants. OBJECTIVE: To examine the efficacy of a clinician-supported, web-based intervention delivered over the first year after birth compared with standard care in children born after <34 weeks' gestation, on child development at 24 months corrected age (CA), parental mental health, and the parent-child relationship at 24 months. METHODS: We randomly allocated 103 preterm infants to clinician-supported, web-based intervention (n = 50) or standard care control (n = 53) groups. At 24 months CA, child cognitive, language, motor, social-emotional development, and the parent-child relationship were assessed. Parental mental health and quality of life were assessed at 12 and 24 months CA. RESULTS: At 24 months, child development, maternal mental health, and maternal quality of life were similar for the intervention and control groups. There was some evidence that mothers in the intervention group had lower odds of being in the elevated category for depression at 12 months (odds ratio: 0.19; 95% confidence interval [CI]: 0.04-0.90; P = .04). Scores were higher in the intervention group for child responsiveness (mean difference: 0.57; 95% CI: 0.03-1.11; P = .04), child involvement (mean difference: 0.61; 95% CI: 0.09-1.13; P = .02), and maternal structuring (mean difference: 0.72; 95% CI: 0.22-1.21; P = .01) during the parent-infant interaction at 24 months. CONCLUSIONS: This study provides preliminary evidence that a clinician-supported, web-based early intervention program for preterm infants had a positive effect on the parent-child relationship and maternal mental health immediately after the intervention but potentially little effect on child development.

Thirteen-Year Outcomes of a Randomized Clinical Trial of Early Preventive Care for Very Preterm Infants and Their Parents.

OBJECTIVE: To evaluate 13-year outcomes of a randomized controlled trial of preventive care (VIBeS Plus) for infants born very preterm and their parents and examine whether possible effects of intervention varied by family social risk. STUDY DESIGN: Families were randomized to an intervention arm (n = 61) or a standard care arm (n = 59). The intervention was delivered at home by psychologists and physiotherapists over the infants' first year, focusing on infant development and parental mental health. At 13 years corrected age, cognitive, motor, and behavioral outcomes, and parental mental health were assessed. Primary estimands were between-group mean differences, estimated using multiple imputed regression models. RESULTS: Follow-up included 81 surviving children (69%). There was little evidence of benefits of the intervention for IQ, attention, executive functioning, working memory, and academic skills regardless of level of social risk. Specifically, mean differences in adolescent cognitive outcomes ranged from -2.0 units (95% CI, -9.9 to 5.9) in favor of standard treatment to 5.1 units (95% CI, -2.3 to 12.5) favoring the intervention. A group-by-social risk interaction was observed only for adolescent motor outcomes, with mean differences favoring the intervention for those at higher social risk (balance, 4.9; 95% CI, 1.3-8.5; total motor, 3.2; 95% CI, 0.3-6.2), but not those at lower social risk (balance, -0.3; 95% CI, -2.4 to 1.9; total motor, 0.03; 95% CI, -1.9 to 2.0). Mean differences in adolescent behavior and parental mental health ranged from -6.6 (95% CI -13.8, 0.5) to -0.2 (95% CI, -1.9 to 1.4) and -1.8 (95% CI, -4.1 to 0.6) to -1.7 (95% CI, -4.3 to 1.0), respectively, indicating a pattern of fewer symptoms in the intervention group. CONCLUSIONS: Benefits of the intervention persisted for adolescent behavior, with better motor outcomes observed in those from socially disadvantaged families. Replication with larger samples, multiple informant reports, and assessment of quality of life-related outcomes is warranted. TRIAL REGISTRATION: http://www.anzctr.org.au/: ACTRN12605000492651.

Working out dads (WOD): a study protocol for a randomised controlled trial of a group-based peer support intervention for men experiencing mental health difficulties in early fatherhood.

BACKGROUND: Approximately one in ten men experience mental health difficulties during the early years of fatherhood, and these can have negative impacts on children and families. However, few evidence-based interventions targeting fathers' mental health are available. The aim of the trial is to evaluate the effectiveness and cost-effectiveness of Working Out Dads (WOD) - a facilitated peer support group intervention for fathers of young children, in reducing psychological distress and other mental health symptoms. METHODS: This trial will employ a parallel-arm randomised controlled trial (RCT) to evaluate the effectiveness and cost effectiveness of WOD peer support group intervention compared to usual care (a 30-min mental health and service focused phone consultation with a health professional). A total of 280 fathers of young children (aged 0-4 years) who are experiencing mental health difficulties and/or are at risk of poor mental health will be recruited. Randomisation and analyses will be at the level of the individual participant. The primary outcome is psychological distress symptoms, measured by the Kessler Psychological Distress Scale (K10) from baseline to 24 weeks post randomisation. A range of secondary outcomes will be assessed including suicidal ideation; mental health disorders, specific symptoms of depression, anxiety, and stress; social support, quality of life, health service use, and health care costs. Data will be collected at baseline, 10- and 24 weeks post-randomisation. DISCUSSION: This trial will examine the effectiveness of a novel group-based peer support intervention in reducing the psychological distress and other mental health symptoms of fathers compared to usual care. The economic and process evaluation will guide policy decision making along with informing the future implementation of WOD on a larger scale if effectiveness is demonstrated. TRIAL REGISTRATION: The current trial has been registered with ClinicalTrials.gov (Registration ID - NCT04813042 ). Date of Registration: March 22nd, 2021.

Facilitators to Engagement in a Mother-Child Therapeutic Intervention Following Intimate Partner Violence.

Intimate partner violence (IPV) affects more than one in four children worldwide. Despite the growing evidence base for interventions addressing children's IPV exposure, little is known about what assists families to engage with services. The current study sought to explore women's perceptions of barriers and facilitators to accessing an intervention for their children following IPV. A total of 16 mothers who had engaged in a community-based, dyadic intervention for children exposed to IPV participated in the study. The Brief Relational Intervention and Screening (BRISC) is an evidenced informed program designed by Berry Street (Australia). A pilot of the intervention was implemented across one metropolitan and one regional site. In-depth semi-structured interviews were conducted with 16 mothers who had completed BRISC. Transcripts were analyzed in NVivo using thematic analysis. Key facilitators to initial engagement included strong referral pathways, clear information about the program, and initial phone contact from the service. Difficulty trusting services were identified as a key barrier to initial engagement. Facilitators of continued engagement included flexibility in service delivery, consistent and direct communication between sessions, and the therapeutic approach. Key barriers to sustained intervention engagement included children's continued contact with their father, mothers' experiences of guilt and blame, and the need for additional support for mothers' own mental health. These findings highlight how service and clinician factors such as flexibility, therapeutic approaches, and communication can facilitate engagement for families affected by IPV. In addition, the study highlights the importance of including the voices of women in research to improve the acceptability of services for consumers.

Maternal Mental Health Disorders Following Very Preterm Birth at 5 Years Post-Birth.

OBJECTIVE: Mothers of children born very preterm (VP) are at increased risk of developing postnatal depression, anxiety, and post-traumatic stress symptoms. However, mental health disorder rates are rarely assessed in this population compared with full-term peers, and it is unclear if postnatal distress symptoms precede higher rates of maternal mental health disorders at 5 years post-birth in both birth groups. METHODS: Mothers of children born VP (n = 65; mean [SD] age at birth, 33.9 [5.0]; 72.1% tertiary educated) and full-term (n = 90; mean [SD] age at birth, 33.4 [4.0]; 88.2% tertiary educated) completed questionnaires assessing symptoms of depression, anxiety, and trauma within 4 weeks of birth. At 5 years post-birth, they participated in a structured diagnostic interview assessing mood, anxiety, and trauma-related mental health disorders, both current and over the lifetime. RESULTS: There was little evidence for differences between mothers in the VP and full-term groups in rates of any mental health disorder at 5 years (VP = 14%, full-term = 14%) or lifetime (VP = 41%, full-term = 37%). In mothers of children born VP, elevated postnatal post-traumatic stress symptoms were associated with higher rates of mental health disorders at 5 years (odds ratio = 21.5, 95% confidence interval = 1.35-342). CONCLUSIONS: Findings suggest that preterm birth may not lead to increased odds of later developing maternal mental health disorders, despite known risks of elevated postnatal distress following a VP birth. However, those with post-traumatic stress symptoms following a VP birth could be more vulnerable, and assessment and monitoring is recommended.

Capturing the experiences of clinicians implementing a new brief intervention for parents and children who have experienced family violence in Australia.

Family violence (FV) affects one in four families. While the evidence regarding therapeutic interventions for children and families who experience FV is expanding, little research has been conducted about clinicians' experiences of implementation. The current study aimed to capture the voices of clinicians delivering a brief dyadic intervention for women and their children after FV exposure. The Brief Relational Intervention and Screening (BRISC) is an evidence-informed intervention designed by Berry Street (Australia) for mothers and children with recent experiences of FV. Consisting of four sessions, BRISC was implemented across one regional and one metropolitan site. Thirteen BRISC clinicians participated in semi-structured interviews individually or in a focus group. Thematic analysis of transcripts was conducted using NVivo. Clinicians considered key strengths of BRISC to be related to the intervention principles, including the hopeful and relationship-focused approach, the intervention implementation such as the timing, structure and flexibility, as well as the systems and processes in place, such as intake and triage, supervision structure and their team environment. Challenges described by clinicians included aspects of delivery such as limited referral options and safety concerns, the nature of the program including the mechanics of delivery and specific role challenges such as vicarious trauma. Clinicians also shared suggestions for improvements for delivery, supervision and training. This study emphasises the importance of clinician perspectives when identifying factors that can promote the successful implementation of innovative interventions in real-world community settings.

School Readiness in Children Born <30 Weeks' Gestation at Risk for Developmental Coordination Disorder: A Prospective Cohort Study.

OBJECTIVE: The objective of this study was to determine whether school readiness differs between children born <30 weeks' gestation who are classified as at risk for developmental coordination disorder (DCD) and those who are not. METHODS: This study was a prospective cohort study of children born <30 weeks' gestation. Children were classified as at risk for DCD at a corrected age of 4 to 5 years if they scored <16th centile on the Movement Assessment Battery for Children-Second Edition (MABC-2), had a full scale IQ score of ≥80 on the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition (WPPSI-IV), and had no cerebral palsy. Children were assessed on 4 school readiness domains: (1) health/physical development [Physical Health domain of Pediatric Quality of Life Inventory (PedsQL), Pediatric Evaluation of Disability Inventory Computer Adaptive Test, and Little Developmental Coordination Disorder Questionnaire], (2) social-emotional development (Strengths and Difficulties Questionnaire and PedsQL psychosocial domains), (3) cognitive skills/general knowledge (WPPSI-IV), and (4) language skills (WPPSI-IV). RESULTS: Of 123 children assessed, 16 were ineligible (IQ < 80 or cerebral palsy: n = 15; incomplete MABC-2: n = 1); 28 of 107 (26%) eligible children were at risk for DCD. Children at risk for DCD had poorer performance on all school readiness domains, with group differences of more than 0.4 SD in health/physical development, social-emotional development, and language skills and up to 0.8 SD for cognitive skills/general knowledge compared with those not at risk of DCD. CONCLUSION: Being at risk for DCD in children born <30 weeks' gestation is associated with challenges in multiple school readiness domains, not only the health/physical domain.

Prevalence and risk factors associated with perinatal depression in sexual minority women.

Perinatal depression is associated with wide-ranging negative outcomes for women and their families, though little research has examined perinatal depression in sexual minority women. We examined depression in sexual minority women in the perinatal period, and whether there were unique minority stress-related risk and protective factors that predicted perinatal depression. One hundred ninety-four perinatal sexual minority women aged 18 years and older were recruited from the US and Australia. Participants completed an online questionnaire incorporating the Edinburgh Postnatal Depression Scale (EPDS) and measures of minority stress and social support. Over one third (35.6%) of the sample scored in the clinical range on the EPDS. Experiences of discrimination were associated with greater depression symptoms via poor social support from family. Higher concealment motivation was associated with greater depression symptoms via poor family and partner support. There were no direct or indirect effects of internalized stigma on depression. Rates of clinically elevated perinatal depression symptoms among sexual minority women are high, extending previous research demonstrating mental health disparities between sexual minorities and their heterosexual counterparts to the perinatal period. The role of social support in mediating the relationships between minority stress and depression suggests that increasing partner and family support might be effective targets for therapeutic interventions during the perinatal period.

Parenting and Neurobehavioral Outcomes in Children Born Moderate-to-Late Preterm and at Term.

OBJECTIVES: To compare the parenting environment and the relationships between parenting behaviors and concurrent child neurobehavioral outcomes at 2 years of corrected age between children born moderate-to-late preterm (MLP; 32-36 weeks of gestation) and at term (≥37 weeks of gestation). STUDY DESIGN: Participants were 129 children born MLP and 110 children born at term and their mothers. Mothers' parenting behaviors (sensitivity, structuring, nonintrusiveness, nonhostility) were assessed at 2 years of corrected age using the Emotional Availability Scales. Child cognitive and language development were assessed using the Bayley Scales of Infant and Toddler Development, and social-emotional competence using the Infant Toddler Social and Emotional Assessment. RESULTS: Mothers of children born MLP and at term displayed similar parenting behaviors overall, with slightly lower nonintrusiveness in mothers of children born MLP (adjusted mean difference -0.32 [-0.60, -0.04]; P = .03). In both groups of children, greater maternal sensitivity was associated with better cognitive development (P < .001 MLP; P = .02 term), increased maternal structuring was associated with better social-emotional competence (P = .02 MLP; P = .03 term), and higher maternal nonintrusiveness was associated with better cognitive, language, and social-emotional outcomes (all P < .04). Greater maternal sensitivity and structuring were associated with better language development in children born MLP but not in children born at term. CONCLUSIONS: Parenting behaviors are important for neurobehavioral outcomes in children born MLP and at term. Language development may be more strongly influenced by select parenting behaviors in children born MLP compared with children born at term.

The Structural Connectome and Internalizing and Externalizing Symptoms at 7 and 13 Years in Individuals Born Very Preterm and Full Term.

BACKGROUND: Children born very preterm (VP) are at higher risk of emotional and behavioral problems compared with full-term (FT) children. We investigated the neurobiological basis of internalizing and externalizing symptoms in individuals born VP and FT by applying a graph theory approach. METHODS: Structural and diffusion magnetic resonance imaging data were combined to generate structural connectomes and calculate measures of network integration and segregation at 7 (VP: 72; FT: 17) and 13 (VP: 125; FT: 44) years. Internalizing and externalizing symptoms were assessed at 7 and 13 years using the Strengths and Difficulties Questionnaire. Linear regression models were used to relate network measures and internalizing and externalizing symptoms concurrently at 7 and 13 years. RESULTS: Lower network integration (characteristic path length and global efficiency) was associated with higher internalizing symptoms in VP and FT children at 7 years, but not at 13 years. The association between network integration (characteristic path length) and externalizing symptoms at 7 years was weaker, but there was some evidence for differential associations between groups, with lower integration in the VP group and higher integration in the FT group associated with higher externalizing symptoms. At 13 years, there was some evidence that associations between network segregation (average clustering coefficient, transitivity, local efficiency) and externalizing symptoms differed between the VP and FT groups, with stronger positive associations in the VP group. CONCLUSIONS: This study provides insights into the neurobiological basis of emotional and behavioral problems after preterm birth, highlighting the role of the structural connectome in internalizing and externalizing symptoms in childhood and adolescence.