Promoting reflective practice in an infant and early childhood training program.

Reflective practices provide a supportive base through which preservice infant and early childhood teachers and allied professionals can achieve knowledge, skills, and professional dispositions to support young children and their families. This paper is a program description that describes the rationale for infusing reflective practices into the learning goals for preservice early childhood training, highlighting the specific reflection skills from the Infant and Early Childhood Mental Health Competency Guidelines. We describe how one university early childhood training program promotes student reflection skills referencing three distinct perspectives: (1) why reflection is essential to developing knowledge and skills; (2) the role group reflection plays in sustaining deep knowledge and skill development for students and faculty; (3) how faculty promote students' awareness of the connection between personal experience and professional dispositions through reflection during practicum experiences. The benefits and challenges of embedding reflective practices in preservice early childhood training are also discussed.

Las prácticas de reflexionar proveen una base de apoyo a través de la cual los maestros y profesionales aliados en el pre-servicio de infantes y la temprana niñez pueden lograr conocimientos, habilidades y disposiciones profesionales para apoyar a los pequeños niños y sus familias. Este ensayo es la descripción de un programa que describe la razón fundamental para incluir las prácticas de reflexionar dentro de los objetivos de aprendizaje para el entrenamiento del pre-servicio en la temprana niñez, subrayando las habilidades de reflexionar específicas que parten de los Preceptos Guías para la Competencia en la Salud Mental de la Infancia y la Temprana Niñez. Describimos cómo el programa de entrenamiento en la temprana niñez en una universidad promueve las habilidades de reflexionar en el estudiante, haciendo referencia a tres perspectivas distintas: 1. Por qué el reflexionar es esencial para desarrollar el conocimiento y las habilidades; 2. El papel que juega el grupo de reflexión para sostener el profundo desarrollo del conocimiento y las habilidades para estudiantes y profesores; 3. Cómo el profesorado promueve la concienciación de los estudiantes sobre la conexión entre la experiencia personal y las disposiciones profesionales a través de la reflexión durante las experiencias de práctica. También se discuten los beneficios y retos de incluir prácticas de reflexión en el entrenamiento del pre-servicio en la temprana niñez.

Les pratiques de réflexion offrent une base de soutien au travers de laquelle les enseignants et professionnels allies de la petite enfance et des services aux nourrissons peuvent développer et acquérir des connaissances, des compétences et des dispositions professionnelles afin de soutenir les jeunes enfants et leurs familles. Cet article est une description qu'un programme qui décrit la rationnelle pour l'infusion de compétences de réflexions dans les objectifs d'apprentissage pour la formation pré-service de la petite enfance, mettant en évidence les compétences de réflexion spécifiques qui se trouvent dans les Grandes Lignes de Compétence en Santé Mentale de la Petite Enfance. Nous décrivons la manière dont le programme de formation pour la petite enfance d'une université promeut des compétences de réflexion des étudiants en faisant référence à trois perspectives distinctes: 1. Pourquoi la réflexion est essentielle au développement des connaissances et des compétences; 2. Le rôle que joue la réflexion de groupe pour le maintien de connaissances profondes et le développement des compétences pour les étudiants et les professeurs; 3. La manière dont les professeurs promeuvent la prise de conscience de la part des étudiants du lien entre l'expérience personnelle et les dispositions professionnelles au travers de la réflexion durant les expériences en stages. Les bénéfices et les défis qu'il y a à intégrer des pratiques de réflexion dans la formation pré-service de la petite enfance sont aussi discutés.

On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age.

BACKGROUND: Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS: This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS: Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS: sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.

Improving Child Health and Healthcare Use Outcomes: How Risk and Resilience Intersect in Pediatric Care.

More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children's health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018-2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need-income assistance, health insurance, housing, and food assistance-at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

Professional quality of life in home visitors: Core components of the reflective supervisory relationship and IMH-E® Endorsement® engagement.

Infant and early childhood home visiting models are gaining prominence as effective programs for families. Most U.S. state infant mental health associations (IMHAs) recommend reflective supervision (RS) and Infant Mental Health (IMH-E® ) Endorsement® as components of home visitor professional development. These efforts may promote workforce professional quality of life. It is unknown whether a workplace policy to provide RS improves the likelihood that best practice guidelines, especially core components of a reflective supervisory relationship, are experienced by the workforce. We sought to investigate associations between home visitor well-being indicated by professional quality of life (i.e., burnout, secondary traumatic stress, compassion satisfaction) and a workplace policy providing RS, consistent experience of core components of a reflective supervisory relationship, and engagement in endorsement. We also examined differences in consistently experiencing core components of the reflective supervisory relationship in home visitors who reported having a workplace policy for providing RS and those who did not, and for home visitors engaged or not engaged in the endorsement process. A Workplace Supports Survey was designed to investigate these associations; we report findings from a sample of home visitor respondents (N = 139).  A policy to provide RS was not associated with professional quality of life. However, analyses suggest an association between a policy to provide RS and consistently experiencing core components of a reflective supervisory relationship. Unanticipated positive associations between engagement in endorsement and burnout and secondary traumatic stress were also found. Finally, engagement in endorsement was associated with less consistent experience of these core components. Implications for future inquiry about the purposes of RS and IECMH Endorsement® as strategies to promote workforce development and well-being are discussed.

Los modelos de visitas a casa en el campo de la infancia y la temprana niñez han adquirido importancia como programas eficaces para familias. La mayoría de las asociaciones estatales de salud mental infantil en Estados Unidos promueven la supervisión con reflexión (RS) y en Endoso® de Salud Mental Infantil (IMH-E®) como recursos de desarrollo profesional. RS y el Endoso® IMH-E® pudieran también promover la calidad de vida de la fuerza laboral profesional. Se desconoce si una política laboral de proveer RS se asocia con la experiencia de la fuerza laboral y las mejores directrices en la práctica, incluyendo los componentes centrales de una relación de supervisión con reflexión (CCRSR). Investigamos las asociaciones entre la calidad de vida profesional del visitante a casa (v.g. cansancio, estrés traumático secundario, satisfacción en la compasión) y una política laboral para RS, la experiencia consistente de CCRSR y la participación en el endoso. Una Encuesta sobre los Apoyos Laborales se diseñó para investigar estas asociaciones; nosotros reportamos los resultados de un grupo muestra de visitadores a casa (N = 139). Una política para ofrecer RS no se asoció con la calidad de vida profesional. Sin embargo, los análisis indican una asociación entre una política para ofrecer RS y experimentar consistentemente CCRSR. Se observaron asociaciones positivas no anticipadas entre la participación en el endoso y el cansancio y estrés traumático secundario. Finalmente, la participación en el endoso se asoció con una menos consistente experiencia de CCRSR. Se discuten las implicaciones para consulta futura acerca de los propósitos de RS y el Endoso® IECHM como estrategias para promover el desarrollo y bienestar de la fuerza laboral.

Les modèles de visite à domicile du nourrisson/de la petite enfance ont gagné en importance en tant que programmes efficaces pour les familles. La plupart des associations de santé mentale du nourrisson au niveau des états aux USA font la promotion de la supervision réflective (RS) et de l'adoption Infant Mental Health (IMH-Eâ) en tant que ressources de développement professionnel. La RS et l'adoption IMH-Eâ peuvent aussi promouvoir la qualité de vie professionnelle des effectifs. On ne sait pas si le fait d'offrir la RS au travail est lié à l'expérience des effectifs des lignes directrices des pratiques exemplaires y compris les composants essentiels d'une relation de supervision réflective (CCRSR). Nous avons étudié les liens entre la qualité de vie professionnelle d'un visiteur à domicile (i.e. burnout, stress traumatique secondaire, satisfaction de compassion) et le fait d'avoir la RS au travail, l'expérience constante de la CCRSR et l'engagement dans l'adoption. Un Questionnaire de Soutien du Lieu de Travail a été conçu pour étudier ces liens. Nous faisons état des résultats à partir d'un échantillon de visiteurs à domicile (N = 139). Le fait d'offrir la RS n'était pas lié à la qualité de vie professionnelle. Cependant les analyses suggèrent un lien entre le fait d'offrir la RS et le fait de faire l'expérience de la CCRSR avec constance. Des liens positifs inattendus entre l'engagement d'adoption et le burnout et le stress traumatique secondaires ont été observés. Enfin, l'engagement d'adoption était lié à une expérience moins constante de la CCRSR. Les implications pour des recherches futures sur les objectifs de la RS et de l'adoption IECMH en tant que stratégies de promotion du développement et du bien-être au travail sont discutées.

Sparking collaboration and instilling core competencies through training a statewide workforce in Infant Mental Health: Report from the field.

Fostering collaboration and instilling core competencies across the diverse Infant Mental Health systems and understanding their training needs are crucial endeavors to support the delivery of evidence-based care and treatment continuity for infants and their families. This paper details the Connecticut Association for Infant Mental Health's use of a comprehensive infant mental health training series as a vehicle to achieve these aims. The training series, and the steps taken to execute and evaluate it are described to provide a framework for future collaborative training initiatives. Evaluation efforts were designed to address knowledge sought and gained and included pre and posttraining tests, participant reports of their training goals and needs, and interviews with trainers regarding the series' strengths and limitations. Findings suggest significant improvements in participants' knowledge of training content across trainings. Participants indicated a desire for trainings on working with the whole family and their plan to integrate skills from the training into their work. Recommendations from trainers and evaluators are provided to spark future trainings and collaborative efforts.

Fomentar la colaboración e inculcar las competencias centrales entre los diversos sistemas de Salud Mental Infantil, así como comprender las necesidades de entrenamiento son iniciativas cruciales para apoyar la continuidad del ofrecimiento del cuidado y el tratamiento con base en la evidencia para infantes y sus familias. Este ensayo detalla el uso de una serie de entrenamientos de salud mental infantil comprensiva de la Asociación de Connecticut para la Salud Mental Infantil como un vehículo para lograr las metas mencionadas. La serie de entrenamientos y los pasos que se toman para ejecutarlo y evaluarlo se describen para aportar un marco de trabajo para futuras iniciativas colaborativas de entrenamiento. Los esfuerzos de evaluación se diseñaron para tomar en cuenta el conocimiento que se busca y se recibe e incluyeron exámenes previos y posteriores al entrenamiento, el reporte de los participantes sobre sus metas y necesidades en el entrenamiento, así como entrevistas con entrenadores acerca de los puntos fuertes y limitaciones de la serie. Los resultados sugieren mejoras significativas en cuanto al conocimiento de los participantes acerca del contenido del entrenamiento a lo largo de las sesiones de entrenamiento. Los participantes manifestaron su deseo de ser entrenados en trabajar con la familia entera y su plan de integrar habilidades aprendidas en el entrenamiento en su trabajo. Se incluyen las recomendaciones de los entrenadores y evaluadores con el fin de motivar futuros entrenamientos y esfuerzos colaborativos.

Le fait de cultiver des collaborations et le fait d'instiller des compétences fondamentales au travers des divers systèmes de Santé Mentale du Nourrisson, tout comme le fait de comprendre leurs besoins en formation sont des tentatives cruciales de soutenir la prestation de soins factuels et la continuité de traitement pour les nourrissons et leurs familles. Cet article détaille l'utilisation qu'a faite l'Association de Santé Mentale du Nourrisson de l'état du Connecticut aux Etats-Unis d'une série de formation complète en santé mentale du nourrisson en tant que véhicule afin d'achever ces buts. La série de formation et les mesures prises pour la mettre en place et l'évaluer sont ici décrites afin d'offrir une structure d'initiatives collaboratives de formation. Les efforts d'évaluation ont été conçus afin d'aborder les connaissances désirées et acquises et ont inclus des tests pré- et post-formation, des rapports des participants sur leurs buts et leurs besoins de formation, et des entretiens avec les formateurs concernant les points forts et les limitations de la série. Les résultats suggèrent des améliorations importantes dans les connaissances sur le contenu de la formation de la part des participants au travers des formation. Les participants ont indiqué le désir de formation sur le travail avec toute la famille et les intentions qu'ils avaient d'intégrer les compétences acquises durant la formation dans leur travail. Des recommandations pour les formateurs et les évaluateurs sont présentées afin de faire naître dans le future d'autres formations et efforts collaboratifs.

The association between toddlerhood empathy deficits and antisocial personality disorder symptoms and psychopathy in adulthood.

The present study examined empathy deficits in toddlerhood (age 14 to 36 months) as predictors of antisocial personality disorder (ASPD) symptoms and psychopathy measured by the Levenson Self-Report Psychopathy scale (Levenson, Kiehl, & Fitzpatrick, 1995) in adulthood (age 23 years) in 956 individuals from the Colorado Longitudinal Twin Study. Consistent with the hypothesis that antisocial behavior is associated with "active" rather than "passive" empathy deficits, early disregard for others, not lack of concern for others, predicted later ASPD symptoms. Early disregard for others was also significantly associated with factor 1 of the Levenson Self-Report Psychopathy Scale, which includes items assessing interpersonal and affective deficits, but not with factor 2, which includes items assessing impulsivity and poor behavioral control. The association between early disregard for others and psychopathy factor 2 was near zero after controlling for the shared variance between psychopathy factors 1 and 2. These results suggest that there is a propensity toward adulthood ASPD symptoms and psychopathy factor 1 that can be assessed early in development, which may help identify individuals most at risk for stable antisocial outcomes.

A Longitudinal and Multidimensional Examination of the Associations Between Temperament and Self-Restraint During Toddlerhood.

Developing self-restraint, or the inhibition of behavior in response to a prohibition, is an important process during toddlerhood. The objective of this study was to gain a better understanding of individual differences in the development of self-restraint during toddlerhood by examining stable elements and growth of temperament (i.e., attentional control, behavioral inhibition, negative emotionality), general intelligence, and self-restraint. Participants were 412 same-sex twin pairs (approximately 90% European American) from predominately middle-class households in Colorado. Data were collected at 14, 20, 24, and 36 months. Results indicated that higher behavioral inhibition, attentional control, and intelligence were independently associated with better self-restraint, whereas higher negative emotionality was an independent predictor of lower self-restraint. The associations between temperament and self-restraint generally appeared to be stable from 14 to 36 months.

IS REFLECTIVE SUPERVISION ENOUGH? AN EXPLORATION OF WORKFORCE PERSPECTIVES.

Infant mental health practice requires the performance of intense emotional labor. Professionals comprising the infant mental health (IMH) field are largely women at seminal points in adult life-span development. The purpose of this article is to explore the day-to-day challenges faced by clinical infant mental health professionals and their perspectives on the supports available for effective job performance. We review reflective supervision as a long-cherished professional support in the IMH field designed to hold the practitioner's fears, worries, and ambivalence, so that she may return to the work fortified to remain in therapeutic alliance with families despite unsolvable problems and an unknowable future (Weatherston, D., 2009). Yet, we propose that reflective supervision alone may not be an adequate protective measure for a workforce performing intensive emotional labor for extended periods and therefore at potentially increased risk for burnout and high turnover (Hochschild, A.R. ; C. Maslach, , C.M. Brotheridge & A.A. Grandey, 2009; A.S. Wharton, ). We suggest that structural factors concerning organizational culture, flexibility in scheduling, and professional growth and versatility bear deeper examination for their merits in supporting the IMH workforce. Finally, we contend that the overrepresentation of women in practitioner positions in IMH leaves an empirical gap where little is known about the experience of male IMH practitioners and the ramifications of their performance of emotional labor.

Correlates of Positive Parenting Behaviors.

The present study examined the influence of maternal and child characteristics on parenting behaviors in a genetically informative study. The participants were 976 twins and their mothers from the Colorado Longitudinal Twin Study and the Twin Infant Project. Indicators of positive parenting were coded during parent-child interactions when twins were 7-36 months old. Child cognitive abilities and affection were independent correlates of positive parenting. There were significant gender differences in the magnitude of genetic and environmental influences on positive parenting, with shared environmental influences on parenting of girls and additive genetic influences on parenting of boys. Girls received significantly more positive parenting than boys. Differences in etiology of positive parenting may be explained by developmental gender differences in child cognitive abilities and affection, such that girls may have more rewarding interactions with parents, evoking more positive parenting.

The Association Between Toddlerhood Self-Control and Later Externalizing Problems.

Lower self-control is a significant correlate or predictor of a wide range of adult outcomes, and this association may be due to more general tendencies toward childhood externalizing problems. The present study examined the association between toddlerhood self-control expressed within a "don't" compliance task (at 14-36 months) and later externalizing problems (parent-reported externalizing problems from age 4 to 12 years, teacher-reported externalizing problems from age 7 to 12 years, and self-reported conduct disorder symptoms at age 17 years) in a longitudinal, genetically informative study. The slope of self-control, but not its intercept, predicted later teacher-reported, but not parent- or self-reported, externalizing problems. That is, increase in self-control during toddlerhood was associated with lower levels of later teacher-reported externalizing problems. The slope of self-control was no longer a significant predictor of teacher-reported externalizing problems after controlling for observed disregard for others, a robust predictor of externalizing problems. Thus, the hypothesis that self-control is the primary predictor of externalizing problems was not supported. Results from genetic analyses suggested that the covariance between the slope of self-control and teacher-reported externalizing problems is due to both genetic and shared environmental influences.

Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship.

OBJECTIVE: To examine changes that occur in infant and parent salivary oxytocin (OT) and salivary cortisol (SC) levels during skin-to-skin contact (SSC) and whether SSC alleviates parental stress and anxiety while also supporting mother-father-infant relationships. METHODS: This randomized crossover study was conducted in the neonatal intensive care unit (NICU) with a sample of 28 stable preterm infants and their parents. Saliva samples were collected from infants, mothers, and fathers on Days 1 and 2 (1/parent) for OT and cortisol measurement pre-SSC, during a 60-min SSC session, and a 45-min post-SSC. Parental anxiety was measured at the same time points. Parent-infant interaction was examined prior to discharge on Day 3 via video for synchrony and responsiveness using Dyadic Mutuality Coding. RESULTS: Salivary OT levels increased significantly during SSC for mothers ( p < .001), fathers ( p < .002), and infants ( p < .002). Infant SC levels decreased significantly ( p < .001) during SSC as compared to before and after SSC. Parent anxiety scores were significantly related to parent OT and SC levels. Parents with higher OT levels exhibited more synchrony and responsiveness ( p < .001) in their infant interactions. CONCLUSION: This study addresses a gap in understanding the mechanisms linking parent-infant contact to biobehavioral responses. SSC activated OT release and decreased infant SC levels. Facilitation of SSC may be an effective intervention to reduce parent and infant stress in the NICU. Findings advance the exploration of OT as a potential moderator for improving responsiveness and synchrony in parent-infant interactions.

Longitudinal pathways from early maternal depression to children's dysregulated representations: a moderated mediation analysis of harsh parenting and gender.

There is some evidence linking maternal depression, harsh parenting, and children's internal representations of attachment, yet, longitudinal examinations of these relationships and differences in the developmental pathways between boys and girls are lacking. Moderated mediation growth curves were employed to examine harsh parenting as a mechanism underlying the link between maternal depression and children's dysregulated representations using a nationally-representative, economically-vulnerable sample of mothers and their children (n = 575; 49% boys, 51% girls). Dysregulation representations were measured using the MacArthur Story Stem Battery at five years of age (M = 5.14, SD = 0.29). Harsh parenting mediated the association between early maternal depression and dysregulated representations for girls. Though initial harsh parenting was a significant mediator for boys, a stronger direct effect of maternal depression to dysregulated representations emerged over time. Results are discussed in terms of their implications for intervention efforts aimed at promoting early supportive parenting.

An examination of the developmental propensity model of conduct problems.

The present study tested specific hypotheses advanced by the developmental propensity model of the etiology of conduct problems in the Colorado Longitudinal Twin Study, a prospective, longitudinal, genetically informative sample. High negative emotionality, low behavioral inhibition, low concern and high disregard for others, and low cognitive ability assessed during toddlerhood (age 14 to 36 months) were examined as predictors of conduct problems in later childhood and adolescence (age 4 to 17 years). Each hypothesized antisocial propensity dimension predicted conduct problems, but some predictions may be context specific or due to method covariance. The most robust predictors were observed disregard for others (i.e., responding to others' distress with active, negative responses such as anger and hostility), general cognitive ability, and language ability, which were associated with conduct problems reported by parents, teachers, and adolescents, and change in observed negative emotionality (i.e., frustration tolerance), which was associated with conduct problems reported by teachers and adolescents. Furthermore, associations between the most robust early predictors and later conduct problems were influenced by the shared environment rather than genes. We conclude that shared environmental influences that promote disregard for others and detract from cognitive and language development during toddlerhood also predispose individuals to conduct problems in later childhood and adolescence. The identification of those shared environmental influences common to early antisocial propensity and later conduct problems is an important future direction, and additional developmental behavior genetic studies examining the interaction between children's characteristics and socializing influences on conduct problems are needed. (PsycINFO Database Record

Longitudinal Influence of Paternal Distress on Children's Representations of Fathers, Family Cohesion, and Family Conflict.

A parent's distress is known to color children's experiences of their families. Studies, however, have rarely focused on the levels of distress experienced by fathers, and in particular, as they affect the emotional experiences of their children. We examine the impact that fathers' experience of distress throughout their children's early years has on children's emerging narrative representations of father-child relationships and of family conflict and cohesion. In this longitudinal investigation, fathers of young children reported their distress on two occasions in relation to self, the marital relationship, and the family climate. Fathers also concurrently reported on their children's temperament, specifically negative emotionality. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for dysregulated negative-disciplinary and positive parental behaviors of fathers, family conflict themes, and family harmony themes. It was hypothesized that children of more distressed fathers would represent greater dysregulated fathering and higher levels of family conflict, and lower levels of positive fathering and family harmony than children of less distressed fathers. Further, the study examined whether this effect was mediated through the fathers' reports of their children's negative emotionality. Results partially supported the hypothesized direct and indirect effects. Children's narratives of negative-disciplinary fathering and family conflict were more common in boys when fathers reported greater distress, and temperament ratings fully mediated this effect. However, their narratives of positive fathering and family harmony were not significantly affected. That positive family features were preserved in children's narratives even in the face of greater father distress suggests that families may be able to build resilience to internalized distress through these positive narrative features.

Effect of holding on co-regulation in preterm infants: a randomized controlled trial.

OBJECTIVE: To determine whether kangaroo holding of healthy preterm infants over the first eight weeks of an infant's life facilitates co-regulation of salivary cortisol between mother and infant. STUDY DESIGN: Randomized control trial. Infants were assigned to receive 1h of daily kangaroo (skin-to-skin contact on the chest of mother) or blanket holding (dressed and held in mother's arms). A registered nurse visited mothers weekly for eight weeks to encourage holding and provide information about infant development. A control group had no holding restrictions and received weekly brief social visits. SUBJECTS: The study included 79 preterm infants, born between 32 and 35weeks gestational age and were a mean of 15days (±5.7) at enrollment. OUTCOME MEASURES: Co-regulation was conceptualized as progressive reduction in the absolute difference between mother and infant cortisol levels across 60min of holding at each holding session. Mother and infant cortisol levels were measured before holding and at 30 and 60min after holding began during three holding sessions (baseline and at two and eight weeks after study initiation). Primary analyses were conducted using hierarchical linear models. RESULTS: There was much variability in cortisol levels. Levels of mother and infant cortisol decreased during holding. No significant co-regulation occurred in any group at any holding session or over time. CONCLUSIONS: Decreasing level of cortisol in both mothers and infants suggests that holding promoted the expected decline in stress hormone levels. However, supported holding methods did not differentially affect co-regulation compared to controls. Holding is pleasurable and stress may need to be present in order for mothers and infants to demonstrate co-regulation in cortisol levels.

Testing alternative hypotheses regarding the association between behavioral inhibition and language development in toddlerhood.

Studies have reported an inverse association between language development and behavioral inhibition or shyness across childhood, but the direction of this association remains unclear. This study tested alternative hypotheses regarding this association in a large sample of toddlers. Data on behavioral inhibition and expressive and receptive language abilities were collected from 816 twins at ages 14, 20, and 24 months. Growth and regression models were fit to the data to assess the longitudinal associations between behavioral inhibition and language development from 14 to 24 months. Overall, there were significant associations between behavioral inhibition and expressive language, and minimal associations with receptive language, indicating that the association is better explained by reticence to respond rather than deficient language development.

Effects of home visits by paraprofessionals and by nurses on children: follow-up of a randomized trial at ages 6 and 9 years.

IMPORTANCE: The Nurse-Family Partnership delivered by nurses has been found to produce long-term effects on maternal and child health in replicated randomized trials. A persistent question is whether paraprofessional home visitors might produce comparable effects. OBJECTIVE: To examine the impact of prenatal and infancy/toddler home visits by paraprofessionals and by nurses on child development at child ages 6 and 9 years. DESIGN, SETTING, AND PARTICIPANTS: Randomized trial in public and private care settings in Denver, Colorado, of 735 low-income women and their first-born children (85% of the mothers were unmarried; 47% were Hispanic, 35% were non-Hispanic white, 15% were African American, and 3% were American Indian/Asian). INTERVENTIONS: Home visits provided from pregnancy through child age 2 years delivered in one group by paraprofessionals and in the other by nurses. MAIN OUTCOMES AND MEASURES: Reports of children's internalizing, externalizing, and total emotional/behavioral problems, and tests of children's language, intelligence, attention, attention dysfunction, visual attention/task switching, working memory, and academic achievement. We hypothesized that program effects on cognitive-related outcomes would be more pronounced among children born to mothers with low psychological resources. We report paraprofessional-control and nurse-control differences with P < .10 given similar effects in a previous trial, earlier effects in this trial, and limited statistical power. RESULTS: There were no significant paraprofessional effects on emotional/behavioral problems, but paraprofessional-visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years (effect size = -0.30, P = .08). There were no statistically significant paraprofessional effects on other primary outcomes. Nurse-visited children were less likely to be classified as having total emotional/behavioral problems at age 6 years (relative risk [RR] = 0.45, P = .08), internalizing problems at age 9 years (RR = 0.44, P = .08), and dysfunctional attention at age 9 years (RR = 0.34, P = .07). Nurse-visited children born to low-resource mothers compared with control-group counterparts had better receptive language averaged over ages 2, 4, and 6 years (effect size = 0.30, P = .01) and sustained attention averaged over ages 4, 6, and 9 years (effect size = 0.36, P = .006). There were no significant nurse effects on externalizing problems, intellectual functioning, and academic achievement. CONCLUSIONS AND RELEVANCE: Children born to low-resource mothers visited by paraprofessionals exhibited improvement in visual attention/task switching. Nurse-visited children showed improved behavioral functioning, and those born to low-resource mothers benefited in language and attention but did not improve in intellectual functioning and academic achievement. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00438282 and NCT00438594.

Parent adaptation and family functioning in relation to narratives of children with chronic illness.

BACKGROUND: This study assessed the experience of parents who have a child diagnosed with chronic illness and whether children's narratives mirror these experiences. METHOD: A total of 66 parents completed assessments about adaptation and family functioning. Children with type 1 diabetes or asthma participated in a story-stem narrative task. RESULTS: Forty-one percent of parents were unresolved about their child's diagnosis, regardless of time since diagnosis. Unresolved parents reported lower family functioning, and children in these families had more family conflict themes. CONCLUSIONS: Parental/Child narratives may provide unique insights into family adjustment. Future work may consider interventions related to family communication and expression of emotion.

Maternal distress influences young children's family representations through maternal view of child behavior and parent-child interactions.

Distress of a parent is a key influence on the quality of the child's experience in the family. We hypothesized that maternal distress would spill over into more negative views of their children's behaviors and less emotional availability in their relationships. Further, we investigated whether these cumulative experiences contributed to children's emerging narratives about mothers and family life. In this longitudinal study, mothers of young twin children reported their distress on three occasions in relation to: self, the marital relationship, and the family climate. Mothers also reported on their children's externalizing behavior problems. Mother-child interaction was observed focusing on maternal sensitivity and child responsivity. Children responded to story stem beginnings about challenging situations in the family and their narratives were scored for family conflict and cohesion themes. Actor-partner interdependence model methods of dyadic data analysis accounted for the inclusion of both twins in the analysis. Results from structural equation models supported the hypothesized cumulative experience of maternal distress on children's family life representations for both family conflict and family cohesion. A family environment in which children are exposed to persistent maternal distress early in life may have cumulative effects, influencing how mothers interact with and view their children's behavior at later developmental stages. Moreover, exposure to repeated distress for longer periods of time may contribute to an intergenerational continuity of distress for the child that may become rooted in negative affective bias in their own view of family relationships.