Protocol for evaluation of effects of a psychoeducational trauma-informed intervention directed at schools.

Background: Adverse childhood experiences (ACE) can have negative effects on cognitive, social and emotion regulation abilities, which can threaten the child's school integration and capacity to learn. While steady relations to sensitive, understanding adults may moderate these negative outcomes, the difficulties of children with ACEs pose a major challenge for teachers, whose insufficient preparation may lead to career attrition.Objective: Psychoeducational trauma-informed care (TIC) interventions targeting teachers may strengthen teacher preparation and buffer the deleterious outcomes of ACEs, yet the evidence-base for these interventions is limited. Importantly, while minority groups are overrepresented among those with ACEs and additionally risk exposure to ethno-racial trauma, TIC interventions lack a social disadvantage/discrimination perspective. The Present trial addresses these issues.Method: The study protocol employs a quasi-experimental design for assessing effects of a psychoeducational TIC intervention carried out in Swedish schools by Save the Children, Sweden (SCS). We compare, for the first time, an intervention group (N = 160) and a control group (N = 160) over time (pre-intervention, immediately after, 6 and 12 months post-intervention), assessing teacher stress, compassion fatigue, self-efficacy and trauma-informed knowledge. We monitor teacher attitudes and attributions of students' academic weaknesses and behavioural and mental difficulties. The trial is preregistered (DOI:10.17605/OSF.IO/V7SH8).Results: We hope that the mitigating effects of the SCS-TIC school intervention may be independent of social category, and that the trial will additionally generate knowledge of how providers and recipients of TIC may respond to it differently depending on their social and cultural identities. As school-based TIC practices and interventions are expansively relied on as means of preventing teacher burnout and career attrition, and buffering negative consequences of ACEs for children, establishing their effects with methodological robustness is important and timely.Conclusion: Such knowledge may be used to tailor and target interventions to specific populations, while ensuring maximum effectiveness.

Psychoeducational trauma-informed care interventions targeting teachers may strengthen teacher preparation and buffer the negative outcomes of adverse childhood experiences.The evidence based for these interventions is insufficient, while potential interactions with the teachers' and children's social identities are unexplored.Our quasi-experimental, longitudinal, preregistered trial will address these knowledge gaps and increase the knowledge for targeted intervention.

Coparent exclusion, prenatal experiences, and mental health during COVID-19 in Sweden.

Pregnant women were classified as a risk group during the COVID-19 pandemic, and restrictions resulted in nonbirthing parents being excluded from antenatal care and in uncertain or brief involvement in the birth of the child. Sweden presents a unique context for examining parents' experiences during the pandemic because of the country's policy to not enforce lockdown and its commitment to gender equality in parenting. This study aimed to explore the experiences and mental health of expecting parents in Sweden by combining qualitative content analysis of parents' own narratives (n = 212) and quantitative analysis of established measures of perinatal depression, anxiety, and self-efficacy (N = 378). Content analysis indicated that parents reported feeling isolated and missing social support. Regarding the medical context, nonbirthing parents reported feeling excluded, and birthing parents reported increased worry about a potential birth with their partner absent. However, parents with a partner also reported feeling closer with their coparent and appreciating the increased time and nearness. Quantitative results indicated that symptoms of depression and anxiety significantly predicted mentions of feeling isolated and absence of mentions of positives. Concerns of exclusion were significantly linked to lower self-efficacy. Together, the findings highlight the risks of reducing social support and excluding nonbirthing parents in health care during the pandemic, as well as the potential for more positive perinatal experiences if parents' time together is enabled in the prenatal period. Implications for health care and workplaces are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Variation in coparenting quality in relation to child age: Links to coparents' relationship satisfaction and education.

Coparenting, denoting shared responsibilities in caring for a child, is a core component of parenthood for most parents. Research has linked quality in the coparenting relationship to several child outcomes as well as parent relationship satisfaction and mental health, yet whether and how these links may differ depending on child age is unclear. Here, we investigated links between coparenting quality, relationship satisfaction, parents' education, and child age, after assessing the psychometric properties of a Swedish version of the 35-item Coparenting Relationship Scale (CRS) in a sample of 206 parents in Sweden. Participants completed the full 35-item CRS, alongside the Parenting Alliance Measure (PAM) and a relationship satisfaction measure. Our findings reveal good psychometric qualities and construct validity for both the CRS and PAM used with Swedish parents. Consistent with other adaptations of the CRS, we found four composite factors for the CRS, all demonstrating high reliability and convergence with the PAM. In relation to child age, parents of older children reported poorer coparenting quality than parents of younger children. The link between relationship satisfaction and coparenting quality was stronger for highly educated parents. Education also predicted partner endorsement in parents of children in early and middle childhood, but not parents of infants. Together, our findings expand the empirical base for understanding coparenting and its links to relationship satisfaction in parents with children of different ages, and they highlight a moderating role of parental education in these links.

Transition to Preschool: Paving the Way for Preschool Teacher and Family Relationship-Building.

Background: Previous research suggests that interactions between preschool teachers and children in early care and educational contexts can contribute to the child's positive attachment development and socioemotional adjustment. Objective: Investigate how the transition process to preschool is organized and whether various ways of organizing it may differently influence family-teacher relationship-building and child adjustment. Methods: Conducted a mixed methods study of quantitative and qualitative survey data from Swedish preschool professionals (N = 535). Results: Preschool introduction varied across preschools in several structural aspects such as introduction length and intensity, timing for first child-parent separation, and number of children and teachers involved in the introduction process. Results moreover suggested that different introduction models were associated with different ways of engaging the parent, where the "parent-active" model was characterized by a high level of parental participation during the introductory activities. This was perceived by preschool professionals as positively influencing the family-teacher relational formation. Conclusion: Findings suggest that inviting parents to participate actively in preschool transition may help better engage them in the introduction process, which in turn may positively influence family-teacher relationship-building. Future research should focus in more detail on how child-teacher and parent-teacher interactions, respectively, influence family-teacher relationship-building and child adjustment during, and after, the introduction period.

The Role of Family Function and Triadic Interaction on Preterm Child Development-A Systematic Review.

Preterm infants are at high risk of developmental disability/delay and are more dependent on their caregiving environment for regulation due to their neurological immaturity. A premature birth is also a major stressor to the family system that constitutes the infant's caregiving environment. The following systematic review investigates whether families with preterm children differ from families with full-term children in their interactions, and what impact the quality of family interaction has on child development. Using the Cochrane model, we conducted a systematic review of quantitative studies published in psycINFO, socINDEX, and PubMed, concerning family quality in triadic interactions in families with premature infants and children, and at least one child development outcome variable. The quality of these studies was assessed using the Newcastle-Ottawa scale assessment form for cohort studies (NOS). Eleven studies were included in the review. Quality of family interactions is either equal to or poorer in families with preterm children, compared with families with full-term children. Importantly, the link between quality of family interactions and child development outcome is stronger in preterm children compared with full-term children, regarding both positive and negative influence. Our results highlight the importance of strengthening family interactions in order to promote development in preterm children. Notably, this review provides the first systematic overview of family function and the quality of triadic interactions in preterm families. The limited number of studies with a family-system focus makes it difficult for us to draw any definitive conclusions, while underscoring the need for more observational studies, particularly post-infancy, to be able to identify specific aspects of family interactions that may be critical for preterm child development.

Solo mothers' by choice experiences during pregnancy and early parenthood: Thoughts and feelings related to maternal health-services.

The present study examined the thoughts and feelings of solo mothers by choice (SMC) regarding their experiences during pregnancy and early parenthood, with special focus on their contact with maternal health-services (MCHS). Semi-structured interviews were carried out with solo mothers (N = 10) who had undergone assisted fertilization in Sweden. Thematic analysis revealed two main themes. The first theme, "Strong individual, vulnerable group", illustrated a perception among participants that, although SMC as a group are vulnerable, they themselves are strong and do not identify with this vulnerability. It is thus conceivable that staff in MCHS may not detect the vulnerability and needs of these women who have strong incentives to present themselves as strong and competent. The second theme, "Same but different", reflected the participants' conflicting needs to be treated like everyone else within the MCHS while at the same time wishing for adaptations of the healthcare services' praxis so that it better suits their needs as solo mothers. These themes illustrate what may be considered as paradoxical expectations and unreasonable needs in the participants' contacts with the MCHS, but they also highlight how social attitudes can have an impact on these parents' individual experiences of healthcare. Because contact with MCHS takes place during a vulnerable period, particular sensitivity and compassionate attention may be needed in order to encourage these women to bring their needs forward.

Attachment goes to court: child protection and custody issues.

Attachment theory and research are drawn upon in many applied settings, including family courts, but misunderstandings are widespread and sometimes result in misapplications. The aim of this consensus statement is, therefore, to enhance understanding, counter misinformation, and steer family-court utilisation of attachment theory in a supportive, evidence-based direction, especially with regard to child protection and child custody decision-making. The article is divided into two parts. In the first, we address problems related to the use of attachment theory and research in family courts, and discuss reasons for these problems. To this end, we examine family court applications of attachment theory in the current context of the best-interest-of-the-child standard, discuss misunderstandings regarding attachment theory, and identify factors that have hindered accurate implementation. In the second part, we provide recommendations for the application of attachment theory and research. To this end, we set out three attachment principles: the child's need for familiar, non-abusive caregivers; the value of continuity of good-enough care; and the benefits of networks of attachment relationships. We also discuss the suitability of assessments of attachment quality and caregiving behaviour to inform family court decision-making. We conclude that assessments of caregiver behaviour should take center stage. Although there is dissensus among us regarding the use of assessments of attachment quality to inform child custody and child-protection decisions, such assessments are currently most suitable for targeting and directing supportive interventions. Finally, we provide directions to guide future interdisciplinary research collaboration.

The Study of Security Priming on Avoidant Attentional Biases: Combining Microsaccadic Eye-Movement Measurement With a Dot-Probe Task.

Microsaccades are small fixational eye movements that have shown to index covert attentional shifts. The present experiment combined microsaccades with performance measures from a dot-probe task to study influences of attachment security priming on the attentional biases of individuals high in attachment avoidance. Security priming is an experimental manipulation aimed at boosting felt security. Using a randomized, mixed design, we measured differences in attentional vigilance toward angry and neutral faces as a function of priming (neutral vs. secure) and attachment avoidance. Individuals high in avoidance habitually tend to withdraw from, or otherwise dismiss, emotionally salient stimuli. Here, we operationalized attentional withdrawal based on both task performance in the dot-probe task and microsaccadic movements. In addition, unlike previous studies where priming salience for the individual participant has been unclear, we used a standardized narrative method for attachment script assessment, securing an indication of how strongly each participant was primed. Dot-probe data significantly captured the link between avoidance and attentional disengagement, though from all facial stimuli (angry and neutral). Although microsaccadic movements did not capture avoidant attentional disengagement, they positively correlated to dot-probe data suggesting measurement convergence. Avoidance was associated with weaker security priming and no overall effect of priming on attention was found, indicating a need for further exploration of suitable priming methods to bypass avoidant deactivation. Our results provide a first indication that, as an implicit looking measure, microsaccadic movements can potentially reveal where early attention is directed at the exact moment of stimulus presentation.

Validation of the Swedish version of the Beliefs about Medicines Questionnaire, based on people with epilepsy.

TITLE: Validation of the Swedish version of the Beliefs about Medicines Questionnaire, based on people with epilepsy. PURPOSE: The aims of the study were to explore the latent structure of the Swedish Beliefs about Medicines Questionnaire (BMQ), to investigate its reliability and to identify the extent to which individual factors among people with epilepsy (PWE), as well as their general beliefs about medication, predict their beliefs about their specific anti-seizure drugs (ASDs). METHODS: One-hundred and fifty six included study participants diagnosed with epilepsy and with a well-established neurological follow-up completed an array of rating scales. Included were the Swedish BMQ, which captures beliefs about medicines, scales for symptoms of anxiety and depression and sense of self-efficacy, as well as a general questionnaire regarding their social situation in general. Statistical analysis included Principal Component Analyses (PCA) and hierarchical multiple regression analysis. RESULTS: The PCA revealed a two-factor structure for each of the BMQ-subscales with acceptable (BMQ-G) to high (BMQ-S) internal consistency. The only individual factor that predicted variance in beliefs about medication was patient gender, where levels of both anxiety and depression were elevated in women. CONCLUSION: The Swedish BMQ exhibits psychometric features indicating its reliable use in adult PWE. Our results suggest that the BMQ provides information about the patients' view of their medication regardless of their general mood and that women hold stronger beliefs of concern beyond influence from their levels of depression and anxiety.

Flexibility in Problem Solving: Analogical Transfer of Tool Use in Toddlers Is Immune to Delay.

Solving problems that are perceptually dissimilar but require similar solutions is a key skill in everyday life. In adults, this ability, termed analogical transfer, draws on memories of relevant past experiences that partially overlap with the present task at hand. Thanks to this support from long-term memory, analogical transfer allows remarkable behavioral flexibility beyond immediate situations. However, little is known about the interaction between long-term memory and analogical transfer in development as, to date, they have been studied separately. Here, for the first time, effects of age and memory on analogical transfer were investigated in 2-4.5-olds in a simple tool-use setup. Children attempted to solve a puzzle box after training the correct solution on a different looking box, either right before the test or 24 h earlier. We found that children (N = 105) could transfer the solution regardless of the delay and a perceptual conflict introduced in the tool set. For children who failed to transfer (N = 54) and repeated the test without a perceptual conflict, the odds of success did not improve. Our findings suggest that training promoted the detection of functional similarities between boxes and, thereby, flexible transfer both in the short and the long term.

Insecure Attachment and Other Help-Seeking Barriers among Women Depressed Postpartum.

When untreated, postpartum depression (PPD) can severely, negatively affect maternal health, child development, and the wellbeing and functioning of the entire family. Yet, despite screening and treatment programs for PPD, many women who experience depression with onset in the postpartum year do not communicate their symptoms. Negative relational experiences early in life, such as not receiving sensitive help and support when needed, often result in so-called insecure attachment styles, and there is evidence that these may contribute to the development and maintenance of PPD. However, the role of insecure attachment styles in non-help-seeking is unknown for this group. Using mixed quantitative and qualitative methodology, we identified help-seeking barriers of women who experienced depression with onset in the postpartum year but who had not sought help for their depression (N = 37), and explored links to their attachment orientations as assessed through both self-reported attachment style and narrative based attachment script assessment. The sample was non-normative regarding attachment, with an over-representation of avoidant attachment styles. Help-seeking barriers varied systematically with the mother's adult attachment style. Specifically, convictions of a strong self and lack of trust in healthcare professionals constituted a common barrier among women with avoidant attachment styles, while unrealistic expectations about motherhood constituted a barrier for women with secure attachment styles. This new knowledge on how barriers to communicating symptoms and seeking help when suffering from PPD vary systematically with attachment orientation can help formulate individualized, and therefore more efficient, approaches to addressing non-help-seeking behavior in women who suffer in silence.

The Role of Physical Activity on Parental Rejection and Body Image Perceptions.

The present study investigated the potential moderating role of physical activity on the relationship between parental rejection and poor body image perceptions. Late adolescents and young adults from Turkey (N = 373; 256 females/117 males) reported their memories of upbringing (Egna Minnen Beträffande Uppfostran/EMBU) related to both their mother and father, respectively, levels of physical activity (International Physical Activity Questionnaires/IPAQ), and body image perception (Body Cathexis Scale/body dissatisfaction and Social Physique Anxiety Scale/SPAS). EMBU mother and father rejection scores were combined and dichotomized, placing participants into high and low rejection groups. Multiple analysis of covariance, controlling for gender and body mass index, showed that high parental rejection was associated with poorer overall body image perception (η2 = 0.09; η2Body Dissatisfaction = 0.09; η2SPAS = 0.04), whereas higher physical activity was linked to better body image perception η2 = 0.02; η2Body Dissatisfaction = 0.04; η2SPAS = 0.03). While level of physical activity did not mediate the negative relationship between parental rejection on body image perceptions, very physically active individuals recalling high parental rejection displayed body image perceptions similar to participants with low parental rejection. Thus, although higher parental rejection is related to poorer body image perception, interventions targeting regular physical activity may help buffer against these negative effects.

A Comparison of Attachment representations to Mother and Father using the MCAST.

The aim of the current study was to examine the factorial structure of the Manchester Child Attachment Story Task (MCAST), using a father doll to address the child's attachment representation to father. While the MCAST, a doll story completion task measuring attachment representations in early childhood, has been validated for use with a mother doll, its use for assessing attachment to father is relatively unexplored. Thus, an additional aim was to compare the factorial structure of the child's attachment representation to father and mother, respectively. We analyzed data from 118 first-grade children who underwent counterbalanced administration of the MCAST with a mother and father doll, respectively, within a period of three months. Exploratory factorial analysis revealed similar, three-factor solutions for attachment to father and mother, with a first factor capturing the child's (scripted) knowledge of secure base/safe haven and a second factor reflecting intrusive and conflict behavior. The third factor was different in the father and mother representations, capturing self-care and role-reversal in attachment to father and disorganization in attachment to mother. Findings support the potential usefulness of the MCAST for exploring the father-child relationship and highlight a need for further research on early attachment representations to father.

Factor structure of the Friends and Family interview.

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi-structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7-12 years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three-component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child's narrative style, along with scales regarding reflective functioning, self-perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter-relations among the components were consistent with attachment theory, and respondents' scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co-occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self-perception, and positive peer relations were less in evidence. The multi-dimensional FFI coding system appears to measure successfully these diverse features of the child's narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence.

The influence of attachment representations and co-parents' scripted knowledge of attachment on fathers' and mothers' caregiving representations.

Despite increased engagement of men in parenting, paternal caregiving representations have not been investigated, and potential gender differences in the links between parents' attachment representations and their caregiving representations are unexplored. The present study investigated fathers' and mothers' (N = 77) representations of caregiving, and links to their own and their co-parents' current mental representations of attachment. Parents were interviewed with the Adult Attachment Interview (AAI) and the Parental-Caregiving Attachment Interview (P-CAI), and co-parents' attachment scripts were measured with the Attachment Script Assessment (ASA). Our results demonstrate several similarities between mothers' and fathers' caregiving representations, but gender differences emerged in probable rejecting and neglecting parental behaviors. For both fathers and mothers, we found systematic differences in caregiving-specific state of mind dimensions on the P-CAI, depending on the parent's attachment classification on the AAI. Importantly, co-parent attachment security, but not parent gender was associated with the likelihood of being classified as autonomous with respect to caregiving.

Together I Can! Joint Attention Boosts 3- to 4-Year-Olds' Performance in a Verbal False-Belief Test.

Effects of joint attention were addressed on 3- to 4-year-olds' performance in a verbal false-Belief Test (FBT), featuring the experimenter as co-watcher rather than narrator. In two experiments, children (N = 183) watched a filmed-FBT jointly with a test leader, disjointed from a test leader, or alone. Children attending jointly with a test leader were more likely to pass the FBT compared with normative data and to spontaneously recall information indicating false-belief understanding, suggesting that joint attention strengthens the plausibility of the FBT and renders plot-critical information more salient. In a third experiment (N = 59), results were replicated using a typical, image-based FBT. Overall findings highlight the profound impact of experimenter as social context in verbal FBTs, and link recall of specific story features to false-belief understanding.

"Partner in Prime"? Effects of repeated mobile security priming on attachment security and perceived stress in daily life.

Lacking secure attachment representations is associated with vulnerability to mental and physical health problems, perhaps mediated by increased susceptibility to stress and impaired emotion regulation. Even though cognitive representations of self and others tend to favor confirmation over information, research has shown that adult attachment security can be positively influenced. In a randomized control trial using a mixed between- and within-subjects design, participants (N = 112) were mobile primed with attachment security stimulating visualization tasks, over a 7-day period. Self-reported attachment security was unchanged; however, reduced attachment avoidance and perceived stress and increased resilience and self-compassion scores were obtained up to one week after the last prime. Participants who reported less effort and more pleasure in carrying out the visualization tasks experienced the highest gains. Results highlight the potential of mobile attachment security priming for intervention, but also the differential potential of such intervention for people with different attachment orientations.

Test-specific differences in verbal memory assessments used prior to surgery in temporal lobe epilepsy.

OBJECTIVE: To study the relationship between two commonly used verbal memory tests in presurgical evaluation for temporal lobe epilepsy (TLE) in Sweden, the Claeson-Dahl Test for verbal learning and retention (CDT) and the Swedish version of the Rey Auditory Verbal Learning Test (RAVLT). METHODS: Fifty-nine patients with TLE (male: 41%, mean: age 41.7 ±â€¯12.3 years; epilepsy onset at mean age: 18.3 ±â€¯13.1 years) previously tested with the CDT, the RAVLT, and three nonverbal memory tests on the same occasion were included. We performed (1) a principal component analysis (PCA) on test performances in the CDT and the RAVLT as well as in nonverbal memory tests; (2) a Pearson's correlation analysis for memory components, biological age, education, age at epilepsy onset, and self-rating scores for depression and anxiety; and (3) an estimation of clinically significant verbal memory impairment in patients with left TLE and left-sided hippocampal sclerosis. RESULTS: The PCAs showed coherence between the learning variables of the CDT and the RAVLT and divergence between the recall variables of the two tests. The RAVLT delayed recall variable was correlated to four out of five nonverbal memory measures. Both tests showed 70-80% clinically significant impairment of verbal memory in patients with left TLE, with or without hippocampal sclerosis, similar to other cohorts with resistant TLE. CONCLUSIONS: The construct structure of the two verbal memory differs. It was shown that the RAVLT correlated with visuospatial memory, whereas the CDT did not. The study highlights that there are important nonoverlapping features regarding verbal recall of the two tests, indicating that these tests cannot fully replace one another.

Natural frequencies improved diagnostic inference among medical students i Sweden / Naturliga antal förbättrar förmågan att tolka testresultat.

The ability to draw statistical inferences from test results may be generally limited among physicians. A new way of presenting statistics, called natural frequencies, has been shown to improve this ability. The current study is the first to investigate this effect in Sweden, involving senior medical students. An intra-individual cross-over design was used in which participants answered a statistical inference task presented with natural frequencies and another with percentages, which has been the customary format. A total of 74% made a correct inference on the natural frequencies task, as compared to 54% on the percentages task, with an odds ratio of 3.2, p = 0.002, 95% CI 1.52-6.81. The findings indicate that the effect of using natural frequencies arises also in a Swedish context.

Psychotropic drug use as indicator of mental health in adolescents affected by a plexus injury at birth: A large population-based study in Sweden.

Chronic handicap in early life may have a long-term impact on children's psychosocial well-being. Here, we investigated whether Brachialis Plexus Birth Injury (BPBI)-an unpredictable injury at birth-is associated with worse mental health later on, as indicated by prescription and use of psychotropic drugs in adolescence. We explored further whether this association is different depending on socioeconomic characteristics of the child's family, as well as sex. Of the 641 151 children born to native parents in Sweden 1987-1993 (alive and still living in Sweden at the end of 2008), identified in the Swedish Medical Birth Registry, 1587 had suffered a BPBI. Logistic regression analysis was performed to assess the impact of socioeconomic characteristics and associations with later psychosocial health. Results show that beyond the known increased risks for females as compared to males, BPBI, but also lower family income, further increased the risk of burdened mental health requiring psychotropic drug use in adolescence. The effects were additive. Thus, compared to unaffected peers, teenagers who suffered a BPBI at birth are at higher risk of suffering poor mental health during adolescence, independently of surgical intervention and its outcome. Girls growing up in families with lower socioeconomic status have this risk added to their already increased risk of poor mental health during adolescence.