Randomized control trial of an internet-based parenting intervention for mothers of infants.

Early parenting home-visiting interventions have been found to be highly effective in promoting child development. Yet, there are many obstacles in the implementation of home-visiting programs, including travel and access to trained providers. Internet-based interventions can reach many parents of infants to overcome these barriers. The objective of this randomized control trial was to evaluate the impact of the Internet-adaptation of the Play and Learning Strategies (PALS) program, a preventive intervention program to strengthen effective parenting practices that promote early language, cognitive, and social development. others in low-income environments (N = 164) of infants were randomized to either (a) an Internet-facilitated PALS parenting intervention or (b) an Internet-facilitated attention control condition. Measures included direct observations of maternal behavior with her infant, questionnaires about maternal functioning and parenting knowledge, and real-time program usage. Experimental participants demonstrated significantly greater increases in parenting knowledge and observed language-supportive parenting behaviors with a correlated positive change in infant language behaviors. Effects were pronounced when participants received a greater dosage of the intervention. Results suggest that the Internet-based translation of the PALS program is effective as a remotely delivered intervention for economically disadvantaged families to strengthen early parenting behaviors that promote infant social communication and child language development.

Nurturing the preterm infant brain: leveraging neuroplasticity to improve neurobehavioral outcomes.

An intrinsic feature of the developing brain is high susceptibility to environmental influence-known as plasticity. Research indicates cascading disruption to neurological development following preterm (PT) birth; yet, the interactive effects of PT birth and plasticity remain unclear. It is possible that, with regard to neuropsychological outcomes in the PT population, plasticity is a double-edged sword. On one side, high plasticity of rapidly developing neural tissue makes the PT brain more vulnerable to injury resulting from events, including inflammation, hypoxia, and ischemia. On the other side, plasticity may be a mechanism through which positive experience can normalize neurological development for PT children. Much of the available literature on PT neurological development is clinically weighted and focused on diagnostic utility for predicting long-term outcomes. Although diagnostic utility is valuable, research establishing neuroprotective factors is equally beneficial. This review will: (1) detail specific mechanisms through which plasticity is adaptive or maladaptive depending on the experience; (2) integrate research from neuroimaging, intervention, and clinical science fields in a summary of findings suggesting inherent plasticity of the PT brain as a mechanism to improve child outcomes; and (3) summarize how responsive caregiving experiences situate parents as agents of change in normalizing PT infant brain development.

Effects of a Responsiveness-Focused Intervention in Family Child Care Homes on Children's Executive Function.

Caregiver responsiveness has been theorized and found to support children's early executive function (EF) development. This study examined the effects of an intervention that targeted family child care provider responsiveness on children's EF. Family child care providers were randomly assigned to one of two intervention groups or a control group. An intervention group that received a responsiveness-focused online professional development course and another intervention group that received this online course plus weekly mentoring were collapsed into one group because they did not differ on any of the outcome variables. Children (N = 141) ranged in age from 2.5 to 5 years (mean age = 3.58 years; 52% female). At pretest and posttest, children completed delay inhibition tasks (gift delay-wrap, gift delay-bow) and conflict EF tasks (bear/dragon, dimensional change card sort), and parents reported on the children's level of attention problems. Although there were no main effects of the intervention on children's EF, there were significant interactions between intervention status and child age for delay inhibition and attention problems. The youngest children improved in delay inhibition and attention problems if they were in the intervention rather than the control group, whereas older children did not. These results suggest that improving family child care provider responsive behaviors may facilitate the development of certain EF skills in young preschool-age children.

Attention deficit hyperactivity disorder: parents' and professionals' perceptions.

Attention deficit hyperactivity disorder (ADHD) is a prevalent childhood psychiatric condition. This study was a qualitative investigation with parents and professionals conducted in two north London boroughs, using focus groups as well as semi-structured and narrative interviews. The aim was to explore parents' and professionals' beliefs regarding the causes of ADHD and their perceptions of service provision. The sample was drawn purposively from GP practices and voluntary support groups. Professionals were recruited via professional networks. Analysis was thematic. It was found that the views of parents and professionals differed. Professionals were more likely to see ADHD as a medical condition, while parents were more likely to see ADHD in association with socio-environmental causes. Delayed diagnosis, inadequate access to information and a lack of co-ordinated care are stated as some of the reasons for parental dissatisfaction with services. Professionals emphasised the need for multidisciplinary input into the management of ADHD. The implications of these findings were that parents often battled with professionals to encourage them to see their viewpoint, access to treatment was influenced by the views of parents and professionals, and noncompliance occurred when parents had different views from professionals.

A Randomized Controlled Trial Examination of a Remote Parenting Intervention: Engagement and Effects on Parenting Behavior and Child Abuse Potential.

Technology advances increasingly allow for access to remotely delivered interventions designed to promote early parenting practices that protect against child maltreatment. Among low-income families, at somewhat elevated risk for child maltreatment, there is some evidence that parents do engage in and benefit from remote-coaching interventions. However, little is known about the effectiveness of such programs to engage and benefit families at high risk for child maltreatment due to multiple stressors associated with poverty. To address this limitation, we examined engagement and outcomes among mothers at heightened risk for child abuse, who were enrolled in a randomized controlled, intent-to-treat trial of an Internet adaptation of an evidence-based infant parenting intervention. We found that engagement patterns were similar between higher and lower risk groups. Moreover, an intervention dose by condition effect was found for increased positive parent behavior and reduced child abuse potential.

Dynamic dose-feedback prostate brachytherapy in patients with large prostates and/or planned transurethral surgery before implantation.

OBJECTIVE: To compare the quality of permanent prostate brachytherapy (PPB) implants, dosimetric outcomes and urinary morbidity between patients with large (>50 mL) and those with smaller prostates, treated with a dynamic dose-feedback technique as monotherapy for localized prostate cancer. PATIENTS AND METHODS: The series included patients with pre-existing bladder outlet obstruction managed with planned transurethral resection or incision of the prostate; 155 consecutive men had PPB implants as monotherapy for localized prostate cancer using a dynamic dose-feedback approach. Dosimetric variables assessed included the implant volume, the minimum dose to 90% of the prostate (D90), and the volumes of prostate receiving 100% and 150% of the prescribed dose as a percentage of the total volume (V100 and V150), during and after implantation. Urinary morbidity was recorded in terms of acute urinary retention (AUR), the need for surgical intervention after implantation and the American Urologic Association (AUA) symptom score at baseline, 1.5, 3, 6, 9, 12 and 18 months. RESULTS: In all, 38 patients had prostate volumes of >or=50 mL; prostate volume had no influence on any dosimetric variable assessed. Two patients with large prostates (>or=50 mL) had AUR and required delayed surgery. Three patients with small prostates (<50 mL) had transient retention; the differences were not statistically significant (Fisher's exact test). AUA symptom scores peaked at 6 weeks and returned to baseline within a year; there were no statistically significant differences between the groups. Eight patients had planned transurethral surgery at >or=4 months before implantation; they all had D90s of >130 Gy and had no incontinence. CONCLUSION: Using the dynamic feedback technique, there was no adverse dosimetric and urinary morbidity in men having PPB and with prostates of >50 mL. Likewise, there were no impediments, e.g. pubic arch interference, which precluded a favourable dosimetric implant in men with a large prostate. Large prostates should not be a contraindication to PPB and require no hormonal cytoreduction. Patients with obstructive lower urinary tract symptoms can be managed with planned transurethral prostatic surgery before implantation, without compromising implant quality or morbidity.