Being an Infant in a Pandemic: Influences of the COVID-19 Pandemic on Infants, Toddlers and Their Mothers in a Clinical Population.

The COVID-19 pandemic and the ongoing lockdowns might have had a strong impact on mental health of mothers and their infants/toddlers. For example, families had to deal with health issues and social isolation, which might have affected mental health and parent-child interactions. The aim of this study is to evaluate differences in (1) infantile regulatory disorders, (2) maternal mental health, (3) the impact of maternal mental health on infantile regulatory disorders, and (4) alterations in the mother-child interaction for participants recruited before versus after the onset of the first German lockdown. For this reason, mother-child dyads have been divided into two groups and were compared by analyzing clinical interviews on psychopathology of mother and child (M.I.N.I. & DC:05) and mother-child-interactions (Emotional Availability Scales). Results showed that (1) differences in infantile sleeping disorders emerged (phi = 0.243; p = 0.016) compared to the pre-lockdown group, while (2) the occurrence of maternal panic and anxiety increased in the post-lockdown group (phi = 0.229; p = 0.022). Moreover, there was (3) an association for maternal panic and child's sleep disorder, and (4) specific associations with maternal non-hostility in the mother-child-interaction. In conclusion, the present study highlights the differences of maternal mental health occurrences and infants' regulatory problems, as well as the possible effects of the COVID-19 pandemic for infants. In the pre-lockdown group, maternal non-hostility might have acted as a promotive factor against regulatory disorders, while this mechanism was mitigated in the post-lockdown group.

Past attachment experiences, the potential link of mentalization and the transmission of behavior to the child by mothers with mental health problems: cross-sectional analysis of a clinical sample.

Maternal capacity to mentalize (= reflective functioning, RF), secure attachment and emotionally available parenting has an impact on the child's development. The transmission of mothers' past attachment experiences gained with both her caregivers in her own childhood and the impact on current mother-child interaction is part of the 'transmission gap.' This study explores the transgenerational transmission mechanisms and the potential moderating effect of RF in a clinical sample of 113 mother-child dyads suffering from mental health problems. In a cross-sectional study, the associations between maternal attachment experiences, RF (coded based on Adult Attachment Interviews) and current mother-child interaction (Emotional Availability Scales) were examined with univariate correlation, moderator analyses, and structural equation models. We found relationships between attachment experiences and mother-child interaction, but RF had no moderating effect. Past loving experiences and perceived neglection, particularly with the own father in childhood, were predictors for the present mother-child interaction. There seems to be an intergenerational transmission of attachment experiences to the ongoing generation. Particularly past adverse childhood experiences with the own father seem to explain currently disruptive interactions with the child.Trial registration: DRKS00017008 and DRKS00016353.

Efficacy of parent-infant psychotherapy compared to care as usual in children with regulatory disorders in clinical and outpatient settings: study protocol of a randomised controlled trial as part of the SKKIPPI project.

BACKGROUND: The first years of life are a significant period for child development, when children are particularly sensitive and prone to crises. This early phase lays the foundation for healthy growth. Clinical assessment of psychological symptoms in early infancy and adequate treatment are both important in improving the diagnostic outcome and preventing later long-term developmental consequences. The most common psychological problems in the first 3 years of life are regulatory disorders. The aim of this trial is to investigate the efficacy of Parent-Infant Psychotherapy (PIP) for infants and young children (aged 0-36 months, diagnosed with at least one regulatory disorder) and their mothers, compared to care as usual (CAU). METHODS: In this open multicentre randomised controlled trial, 160 mother-infant dyads are randomised to receive PIP or CAU for 6 weeks of intervention in clinical or outpatient (including home treatment) settings. The primary outcome is the maternal sensitivity (sensitivity scale of the Emotional Availability Scales (EAS)) after 6 weeks. Secondary outcomes include assessment of interaction, mental health problems, attachment, development, psychological factors, treatment adherence, health care system utilisation, and costs, after 6 weeks and 12 months. DISCUSSION: This study will evaluate whether a manualised focus-based short-term psychodynamic psychotherapeutic intervention in mother-child dyads improves the care situation for families of children diagnosed with regulatory disorders, and helps prevent long-term psychopathologies. Assessment of the intervention in different settings will support the development of more tailored interventions for affected infants and their mothers. TRIAL REGISTRATION: German Clinical Trial Register, ID: DRKS00017008 . Registered 03/20/2019.

[Postpartum mental health problems: healthcare service situation and effectiveness of parent-infant psychotherapy. Presentation of the SKKIPPI project funded by the German Innovationsfonds]. / Postpartale psychische Erkrankungen: Versorgungslage und Wirksamkeit der Eltern-Säugling-Kleinkind-Psychotherapie. Vorstellung des Innovationsfondprojektes SKKIPPI.

After the birth of a child, parents may experience episodes of stress and psychological strain. Some infants show psychological or somatic stress in the form of early regulatory disorders. While the close connection between parental psychological stress, early regulatory disorders, and the development of the parent-child relationship is well documented, current data on effective treatment options are lacking. Previous care services mostly operate on a preventive basis; evidence-based psychotherapeutic services with a special focus on the parent-child relationship are rare.SKKIPPI is a multicenter research project (Berlin, Flensburg, Hamburg, Leipzig) and consists of several study parts with a mixed methods approach: an epidemiological cohort study, two randomized controlled intervention studies (RCTs), and a qualitative study. A population-based cohort study records the occurrence and determinants of psychosocial stress and mental health disorders, as well as the use of health and social services by parents and their children within the first two years of life, using online questionnaires and telephone interviews. The aim of the two RCTs is to evaluate the efficacy of a focused, dyadic parent-infant psychotherapy (Eltern-Säugling-Kleinkind-Psychotherapie, ESKP) compared to routine treatment in inpatient and outpatient settings. The focus of these RCTs is on the improvement of maternal sensitivity and on mother-child attachment, as well as child development and the reduction of mother-child psychopathological symptoms. The qualitative study intends to reconstruct the perspectives of parents on the assistance system and to explore reasons for underuse. The results are expected to help develop preventive as well as therapeutic strategies in the German health system.

Kappa free light chains: diagnostic and prognostic relevance in MS and CIS.

BACKGROUND: Quantification of kappa free light chains (KFLC) in cerebrospinal fluid shows high diagnostic sensitivity in multiple sclerosis and clinically isolated syndrome patients. However, a clearly defined threshold value is still missing and a possible prognostic value of the KFLC levels in these patients remains undefined. METHODS: Results of KFLC quantification in 420 controls were used to set an upper limit of normal KFLC concentration in CSF under different blood-CSF-barrier conditions. Additionally, KFLC values of MS and CIS patients were assessed and results were evaluated with reference to the patients corresponding disease courses. RESULTS: The calculated upper limit of normal KFLC-concentration covers 98% of these control patients. Using this cut-off, plasma cell activity in CSF can be detected in 97% of MS patients and in 97% of CIS patients. However, there is no evidence that the extent of KFLC elevation provides prognostic value in MS and CIS patients in this study. CONCLUSION: KFLC determination should become a first line screen in the diagnostic algorithms of MS and CIS. The extent of elevation of intrathecal KFLC has no prognostic value on the disease course in MS and CIS patients.

["I do not worry about ...!" How the Berkeley Puppet Interview may reveal self-report of psychological symptoms of 4 to 8 years old children exposed to parental cancer]. / "Ich mach mir keine Sorgen ...!" Wie 4- bis 8-jährige Kinder krebskranker Eltern im Berkeley Puppet Interview psychische Symptome selbst einschätzen.

The Berkeley Puppet Interview (BPI) enables us to investigate psychological symptoms of children aged four to eight years under a multi-informant perspective by the means of self and parent report measures. 45 families with one parent suffering from cancer have been examined with regard to internalizing and externalizing symptoms of the children. Results have been compared to two different age-appropriate samples (Swiss preschool study of Basel and German KiGGS study). A small, highly selective sample of twelve children aged four to eight years could have been examined both from the self and parent perspective. Our results show, that four to eight year old children of cancer patients do not differ from other children of the same age in the way they express emotional symptoms in the BPI, but they are judged more emotionally burdened than other children by their parents (SDQ). Self and parent report do not significantly correlate. It seems as if parents in families struck by a cancer disease see their children's emotional symptoms more pronounced than the children themselves do express in the puppet interview. Implications for clinical and research practice will be discussed.

[Support for families with a parent diagnosed with cancer and children under the age of five--delineation of a counselling concept]. / Unterstützung von Familien mit einem an Krebs erkrankten Elternteil und Kindern unter fünf Jahren--Darstellung eines Beratungskonzeptes.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.

[Single-parenting and parental cancer--how does this affect the child? Children's mental health problems and their quality of life from their own and their mother's perspective]. / Alleinerziehend und krebskrank--was macht das mit dem Kind? Psychische Symptome und Lebensqualität von Kindern aus Kind- und Elternperspektive.

PURPOSE: Both, children of somatically ill parents and children of single-mothers are at risk to develop mental health problems and low QoL. This study investigates the effect on children when their single-mothers are exposed to cancer. METHODS: In a Cross-sectional design a sample of N=47 children of single-mothers exposed to parental cancer was compared to a sample of N=135 children of mothers (living in partnership) exposed to cancer (multi informant approach). RESULTS: SDQ and KIDSCREEN showed no differences between children of single-mothers and children of mothers in partnership. In the focused sample older children (11-17 years) showed more conduct problems than younger children (4-10 years). The differences between the types of assessment was significant for conduct problems. CONCLUSION: Single-parenting and parental cancer as a double burden don't increase the risk for mental health problems and low QoL of children. The results for conduct problems will be discussed.

[Parent-child-interaction based diagnostic in high risk families with infants and toddlers]. / Interaktionszentrierte Frühdiagnostik und bindungstheoretisch fundierte Frühintervention bei hoch belasteten Familien mit Säuglingen und Kleinkindern.

This article deals with methods and instruments used to identify high risk parents and early developing risks of infants and young children during the pre- and postnatal period in order to develop early intervention strategies based on early diagnosis in the context of parent-child-relationship. The specific experiences of our research approaches, funded by the German ministry of education and research (BMBF) from 2003 to 2007 at the University of Applied Sciences in Potsdam in cooperation with the parent counselling centre "Vom Säugling zum Kleinkind" are reflected. An interaction and communication focused strategy was developed to help to identify early development risks and resources in the parent-infant-relationship at the age of 0-3 years. After testing the diagnostical approach of this social-emotional development screening (SEE-0-3) in a current evaluation study on a high-risk-population, it was integrated as one module of early diagnosis into the early intervention program "STEEP--Steps toward effective and enjoyable parenting" which is based on the attachment theory. Using a concrete case it will first be discussed which kind of approaches to becoming parents with high risk factors can be developed on the basis of attachment reflecting acting and second which possibilities an interaction and video based concept could offer in the field of early diagnosis and intervention with families of infants and young children.