Proximal Processes and Contextual Factors Associated with Early Socio-emotional Competence Development.

There is growing interest in child socio-emotional competence from parents, educators, employers and policy makers, with emphasis on developing it as early as possible. The aim of the present study was to examine contextual and proximal factors that influence socio-emotional competence development across the first five years of a child's life. We used data from 3200 mothers and their children drawn mostly from four major data collection waves (antenatal, 9 months, 2 years and 4.5 years) of the population-based longitudinal study, Growing Up in New Zealand. Regression analyses were carried out to identify the predictors of socio-emotional competence after controlling for demographics and prior score(s) of socio-emotional competence. We found that specific maternal behaviours, such as playing games and playing with toys with children, singing songs or telling stories to them, reading books with them, having rules around viewing TV, DVDs and videos, and praising children have a positive effect on socio-emotional competence. Parental relationship warmth and less family stress at 9 months also made positive contributions to socio-emotional competence at 9 months and 2 years. In contrast, attending childcare and having more siblings at home negatively predicted socio-emotional competence at 9 months. Mother's unemployment, living in neighbourhoods perceived as negative and being in contact with family and social services were negatively associated with concurrent socio-emotional competence at 2 years. Overall, more and/or stronger contemporaneous effects were found suggesting that negative effects of contextual factors may not have lasting impact on socio-emotional competence. In addition, the results showed that maternal behaviours need to be practised regularly to have positive impact on child's socio-emotional development.

Do Patterns of Levels of Socio-emotional Competence During Early Childhood Predict Executive Function at 4.5 Years?

Socio-emotional competence and executive function both work together to meet the demands of the everyday environment. While many studies have focused on how various domains of socio-emotional competence are predicted by, or associated with executive function, the predictive influence of socio-emotional competence on executive function has largely been ignored despite strong theoretical links. In addition, contradictory information exists with regard to the divergent validity of two subtypes of executive function: cool and hot. Using data from 4839 children participating in three data collection waves (9 months, 2 years and 4.5 year) in the Growing Up in New Zealand longitudinal study, we examined how different patterns of socio-emotional competence development during the early preschool years (persistent lows, recent low, improved and no lows) related to cool and hot executive function measured at aged 4.5 using a hand clap task and a gift wrap task, respectively. Findings showed that children with persistent lows (with no improvement) in the levels of early socio-emotional competence had increased odds of having below average cool and hot executive function at 4.5 years. However, no difference was found in the influence of socio-emotional competence on cool and hot executive function. Possible explanations for these associations between socio-emotional competence and executive function are discussed.

The Association Between Persistence and Change in Behavioral Difficulties During Early to Middle Childhood and Cognitive Abilities at Age 8.

We investigated the association between persistence and change in behavioral difficulties during early to middle childhood and several cognitive outcomes. We observed 3904 8-year-olds enrolled in the longitudinal study Growing Up in New Zealand (50% male/female; 23% Maori, 9% Pacific Peoples, 13% Asian, 2% Middle Eastern/Latin American/African, 9% Other, 43% European). The NIH Toolbox Cognition Battery was used to assess cognitive functioning at 8 years and the Strengths and Difficulties Questionnaire for behavioral difficulties at 4.5 and 8 years. Multivariate logistic regression analyses were conducted, controlling for well-known sociodemographic confounders. Children with persistent or later onset of behavioral difficulties were at higher risk for poorer vocabulary, reading, inhibitory control/attention, episodic memory, working memory and processing speed at age 8 compared to children with no or improved difficulties. Our study supports the importance of addressing both cognitive and behavioral aspects when planning educational programmes and interventions in early and middle childhood.

Exploring the Factor Structure of the NIH Toolbox Cognition Battery in a Large Sample of 8-Year-Old Children in Aotearoa New Zealand.

OBJECTIVE: The objective of this study was to derive a factor structure of the measures of the National Institutes of Health (NIH) Toolbox Cognition Battery (CB) that is representative of cognitive abilities in a large ethnically diverse cohort of 8-year-old children in Aotearoa New Zealand. METHODS: Our sample comprised of 4298 8-year-old children from the Growing Up in New Zealand study. We conducted exploratory and confirmatory factor analysis for the NIH Toolbox CB measures to discover the best-fitting factor structure in our sample. Measurement invariance of the identified model was tested across child's gender, socio-economic status (SES), and ethnicity. RESULTS: A three-dimensional factor structure was identified, with one factor of Crystallised Cognition (Reading and Vocabulary), and two distinguished factors of fluid cognition: Fluid Cognition I (Attention/Inhibitory Control, Processing Speed, and Cognitive Flexibility) and Fluid Cognition II (Working Memory, Episodic Memory). The results demonstrate excellent model fit, but reliability of the factors was low. Measurement invariance was confirmed for child's gender. We found configural, but neither metric nor scalar, invariance across SES and the four major ethnic groups: European, Maori, Pacific Peoples, and Asian. CONCLUSION: Our findings show that, at the age of 8 years, fluid abilities are more strongly associated with one another than with crystallised abilities and that fluid abilities need to be further differentiated. This dimensional structure allows for comparisons across child's gender, but evaluations across SES and ethnicity within the Aotearoa New Zealand context must be conducted with caution. We recommend using raw scores of the individual NIH Toolbox CB measures in future research.

Patterns of risk exposure in first 1,000 days of life and health, behavior, and education-related problems at age 4.5: evidence from Growing Up in New Zealand, a longitudinal cohort study.

BACKGROUND: Children who are high priority candidates for early intervention need to be identified to reduce their risk for experiencing problems in development. Those exposed to multiple risk factors are more likely to exhibit problems in development than those exposed to a single or no risk factor. We examined the longitudinal associations between persistence and timing of exposure to cumulative risk (CR) on three occasions by age 2 and problems in development at age 4.5 in health, behavior, and education-related domains. METHODS: Data are from Growing Up in New Zealand (NZ), a prospective longitudinal study of a birth cohort first assessed during their last trimester in 2009-10 and followed at ages 9 months and 2 and 4.5 years. All women with an expected delivery date in a 12-month period who resided within a defined region were invited to participate, with no additional eligibility criteria. Exposure was measured for 12 sociodemographic and maternal health risk factors at third trimester and ages 9 months and 2 years, from which developmental trajectories were constructed capturing persistence and timing of CR exposure. Ten developmental outcomes were measured at age 4.5 to classify problems in overall health status, obesity, and injuries; internalizing and externalizing behavior problems; and letter naming, counting forward and backward, and expectations for starting school and completing education. RESULTS: Analyses of data from 6156 children (49% female, 33% Non-European ethnicity) who participated in the 4.5-age assessment uniformly showed associations between exposure to more than consistently zero CR across early development and higher prevalence of being classified with problems for 9 of 10 outcomes. Persistent exposure to a CR ≥ 4 was generally associated with a higher prevalence of problems for 7 of 10 outcomes, whereas the timing of first exposure to CR ≥ 4 showed a less consistent association with problem outcomes. CONCLUSIONS: These findings are concerning because over 50% of NZ children are exposed to at least one of these risk factors at some point in early development. Routine screening of most of these risk factors during pregnancy is feasible and can identify priority candidates for intervention.

The Association Between Persistence and Change in Early Childhood Behavioural Problems and Preschool Cognitive Outcomes.

The link between behavioural and cognitive difficulties is well established. However, research is limited on whether persistence and change in behavioural difficulties relates to cognitive outcomes, particularly during preschool. We used a large New Zealand birth cohort to investigate how persistence and change in serious behavioural problems from ages 2 to 4.5 years related to measures of cognitive delay at 4.5 years (n = 5885). Using the Strengths and Difficulties total problems score at each time point, children were categorised as showing no difficulties, improved behaviour, concurrent difficulties, and persistent difficulties. Cognitive measures assessed included receptive language, early literacy ability, and executive control. Our results showed that children with concurrent and persistent behavioural difficulties were at a greater risk of showing delays within specific cognitive domains relative to children with no difficulties and were also more likely to show comorbid delays across multiple cognitive domains.

Persistence and change in behavioural problems during early childhood.

BACKGROUND: Behavioural problems and psychopathology can present from as early as the preschool period. However there is evidence that behavioural difficulties may not be stable over this period. Therefore, the current study was interested in evaluating the persistence and change in clinically relevant behavioural problems during early childhood in a population-based New Zealand birth cohort. METHODS: Behaviour was assessed in 5896 children when they were aged 2 and 4.5 years using the Strengths and Difficulties Questionnaire (SDQ). Correlations and mean differences in subscale and total difficulties scores were examined. Scores were then dichotomised into normal/borderline and abnormal ranges to evaluate the persistence and change in significant behavioural problems. Chi-square analyses and ANOVAs were used to determine the association between sociodemographic and birth variables, and preschool behavioural stability. RESULTS: Raw scores at ages 2 and 4.5 years were moderately correlated, with most measures showing a small but significant decrease in mean scores over time. The majority of children who showed abnormal behaviour at 2 years improved at 4.5 years (57.9% for total difficulties). However, a notable proportion persisted in their difficulties from 2 to 4.5 years (42.1% for total difficulties). There was a small percentage of children who were categorised as abnormal only at 4.5 years. Children with difficulties at one or both time points had a greater proportion who were the result of an unplanned pregnancy, lived in highly deprived urban areas, and had mothers who were younger, of Maori and Pacific ethnicity and were less educated. CONCLUSIONS: Not all children who show early behavioural difficulties persist in these difficulties. Those whose difficulties persist were more likely to experience risk factors for vulnerability relative to children with no difficulties. Results suggest that repeated screening for early childhood behavioural difficulties is important.

Antenatal and Postnatal Determinants of Behavioural Difficulties in Early Childhood: Evidence from Growing Up in New Zealand.

Behavioural difficulties during early childhood have significant implications for multiple outcomes later in life. Child behavioural difficulties at 2 years of age (N = 6246) were assessed by mothers enrolled in a longitudinal, population-based New Zealand cohort study. 10.1% of children had total difficulties scores in the abnormal range on the preschool version of the Strengths and Difficulties Questionnaire. After controlling for maternal education, poverty, and child's birth age/weight, several antenatal and postnatal maternal health and family risk factors were significant for: (i) emotional problems (antenatal maternal perceived stress, lack of periconceptional folate, and moderate to severe maternal postnatal anxiety); (ii) hyperactivity-inattention (antenatal maternal perceived stress, mothers' antenatal exposure to secondhand smoke, moderate to severe maternal postnatal anxiety, and low maternal self-evaluation); (iii) conduct problems and total difficulties (antenatal maternal perceived stress, verbal inter-parental conflict and low maternal self-evaluation). The identification of risk and protective factors associated with early childhood difficulties are vital for guiding intervention and prevention efforts.

A Longitudinal Study of Pre-pregnancy and Pregnancy Risk Factors Associated with Antenatal and Postnatal Symptoms of Depression: Evidence from Growing Up in New Zealand.

Objectives Antenatal and postnatal depression can lead to poor outcomes for women and their children. The aim of this study was to explore whether risk factors differ for depression symptoms that are present during pregnancy and/or after childbirth. Methods An ethnically and socioeconomically diverse sample of 5301 women completed interviews during the third trimester of pregnancy and 9 months after childbirth. Depression symptoms were measured using the Edinburgh Postnatal Depression Scale (EPDS). Depression symptoms (defined as EPDS >12) among participants and associations with pre-pregnancy and pregnancy maternal characteristics were explored using logistic regression. Results The rate of antenatal depression symptoms (ADS) only was 8.5, 5% of women had depression symptoms at 9 months postpartum (PDS) only and 3% experienced depression symptoms at both time points. Perceived stress and Pacific or Asian ethnicity were risk factors for ADS and PDS. Anxiety during and before pregnancy was a risk factor for ADS only while having a pre-pregnancy diagnosis of depression was a risk factor for PDS only. Having ADS increased the odds ratio of PDS by 1.5 (95% CI 1.01-2.30). Conclusions The results supported evidence from previous longitudinal studies that depression symptoms appear to be higher during pregnancy than in the first year following childbirth. The study found that PDS may often be a continuation or recurrence of ADS.

Infant Behavior Questionnaire-Revised Very Short Form: A New Factor Structure's Associations With Parenting Perceptions and Child Language Outcomes.

The Infant Behavior Questionnaire Revised-Very Short Form (IBQ-R VSF; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014 ) is a new publicly available measure of infant temperament measuring positive affectivity/surgency (PAS), negative emotionality (NEG), and orienting and regulatory capacity (ORC). Although the initial psychometric properties of the 3-factor model appear promising, it has not been administered to a large and diverse sample and its predictive validity has not been established. This study administered the IBQ-R VSF to a diverse sample of 5,639 mothers of infants aged between 23 and 52 weeks. Confirmatory factor analysis found that the 3-factor solution did not meet the requirement for satisfactory model fit. Exploratory factor analysis found that a 5-factor solution (PAS, NEG, Orienting Capacity, Affiliation/Regulation, and Fear) was statistically and conceptually the most parsimonious. All 5 temperament dimensions were found to relate to both mother- and partner-reported infant closeness, parenting confidence, and parenting satisfaction, and four of the dimensions (PAS, Orienting Capacity, NEG, and Fear) related to the infants' communication development. Some parental differences were also found. Together these findings suggest that the 5-factor IBQ-R VSF is a promising measure of infant temperament and is related to parenting perceptions and child language development.

A Cross-Cultural Analysis of the Infant Behavior Questionnaire Very Short Form: An Item Response Theory Analysis of Infant Temperament in New Zealand.

The Infant Behavior Questionnaire-Revised Very Short Form (IBQ-R VSF; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014 ) is a newly published measure of infant temperament with a 3-factor structure. Recently Peterson et al. ( 2017 ) suggested that a 5-factor structure (Positive Affectivity/Surgency, Negative Emotionality, Orienting Capacity, Affiliation/Regulation, and Fear) was more parsimonious and showed promising reliability and predictive validity in a large, diverse sample. However, little is known about the 5-factor model's precision across the temperament dimensions range and whether it discriminates equally well across ethnicities. A total of 5,567 mothers responded to the IBQ-R VSF in relation to their infants (N = 5,639) between 23 and 52 weeks old. Using item response theory, we conducted a series of 2 parameter logistic item response models and found that 5 IBQ-R VSF temperament dimensions showed a good distribution of estimates across each latent trait range and these estimates centered close to the population mean. The IBQ-R VSF was also similarly precise across 4 ethnic groups (European, Maori, Pacific peoples, and Asians), suggesting that it can be used as comparable measure for infant temperament in a diversity of ethnic groups.

A review of longitudinal studies on antenatal and postnatal depression.

Antenatal depression is a known risk factor for postnatal depression; both are common disorders associated with negative impacts on child development. Few studies have followed up women from pregnancy and through the postnatal period to explore how rates of depression change. This review evaluates recent evidence on depression during pregnancy and after childbirth. A search of Embase, PsychINFO, MEDLINE and Cochrane Reviews was carried out to identify longitudinal studies on antenatal and postnatal depression. Studies that measured depression during pregnancy and up to 1 year after childbirth were evaluated against a set of criteria (e.g. less than 50 % attrition). Of the initial 523 studies identified, 16 studies met the final inclusion criteria with a total of 35,419 women. The average rate of antenatal depression across these studies was 17 and 13 % postnatal depression. The longitudinal nature of the studies revealed that on average 39 % of those who experienced antenatal depression went on to have postnatal depression. Similarly, on average, 47 % of those with postnatal depression had also experienced antenatal depression. On average, almost 7 % of women reported significant depressive symptoms in pregnancy that persisted after childbirth. The review provided evidence that rates of depression tend to be higher during pregnancy than in the first year following childbirth. Furthermore, the longitudinal data show that there is much movement between the groups categorised as depressed or not depressed. There is evidence that postnatal depression is often a continuation of existing antenatal depression.

How mothers talk to their children about failure, mistakes and setbacks is related to their children's fear of failure.

BACKGROUND: Many people fear failure and making mistakes. This fear can be transmitted from parents to children, suggesting that parental communication regarding failures and setbacks may play a critical role in shaping a child's perception of mistakes. AIMS: In this study, we investigated how everyday parent-child conversations about setbacks influence children's fear of making mistakes. SAMPLE: Drawing on the large pre-birth Growing Up in New Zealand cohort, we focused on a sub-sample of 231 mother-child dyads who engaged in a recorded conversations about a "recent disappointment or setback" when the children were 8 years old. METHOD: Conversations between mothers and children about the recent disappointments were coded to identify whether parents recognised or acknowledge their child's emotional response, if action plans were discussed, and the types of resources that the child could draw on. The children also completed a questionnaire about their global self-worth and their fear of making mistakes. RESULTS AND CONCLUSIONS: The discussion of clear action plans, in the absence of a discussion about collaborative resources, was found to be associated with an increased fear of making mistakes among children. Conversely, when mothers clearly acknowledged their child's emotions and discussed ways to work collaboratively with their child on future problems, there was a notable decrease in the child's fear of mistakes. However, it is noteworthy that many mothers in our study either minimally acknowledged or dismissed their child's emotions(40%), rarely discussed action plans (55%), or collaborative resources (79%)when discussing the recent setback.

Adolescents with diabetes: support from healthcare teams and families.

UNLABELLED: Adolescents with diabetes must learn to manage their own health plans. Support from family is typically associated with positive self-management outcomes, yet less is known about how healthcare teams can facilitate positive self-management. This study aims to investigate the associations between family and healthcare team support and adolescent emotional, behavioral and physical diabetes management. METHOD: A sample of 58 adolescents with type 1 diabetes completed self-report measures of their diabetes self-care management and their emotional distress or burden in relation to their diabetes. Adolescents' diabetes clinic attendance and glycated hemoglobin (HBA1c) levels were also secured. RESULTS: Perceived positive support from the healthcare team or family appeared to have little or negative effect on diabetes management. However, the study found that greater healthcare non-support was related to poorer self-care and poorer self-management of diabetes control (less clinic attendance, poorer dietary control, less glucose testing, and higher HBA1c levels), and greater feelings of being distressed or burdened by diabetes. CONCLUSIONS: These findings suggest that healthcare teams supporting adolescents should focus more on communicating and building relationships with adolescents in order to reduce perceived negative feelings of healthcare teams' support.

Behavioural outcomes of children exposed to antidepressants and unmedicated depression during pregnancy.

BACKGROUND: Antenatal exposure to both antidepressants and maternal depression has been associated with child behavioural difficulties. However, previous research has not adequately distinguished between the effects of the antidepressants and the underlying maternal depression. METHODS: Child behavioural difficulties were assessed using the Strengths and Difficulties Questionnaire at 2-, 4.5-, and 8-years of age by mothers in the Growing Up in New Zealand study (N = 6233 at 2-years; N = 6066 at 4.5-years; N = 4632 at 8-years). Mothers were classified as either on antidepressants, unmedicated depression, or neither based on self-reported antidepressant intake during pregnancy and the Edinburgh Postnatal Depression Scale. Hierarchical multiple logistic regressions were used to examine whether antenatal exposure to antidepressants and unmedicated depression had a differential association with child behavioural outcomes relative to no exposure. RESULTS: When later life depression in the mother and a range of birth and sociodemographic variables were accounted for, neither antenatal exposure to unmedicated depression or antidepressants remained associated with an increased risk of behavioural difficulties at the ages investigated. However, maternal later life depression was associated with behavioural difficulties in the fully adjusted analyses at all three ages investigated. LIMITATIONS: The current study relied on mother-report of child behaviour which may be susceptible to bias due to maternal mental health problems. CONCLUSIONS: Adjusted results did not show an adverse association between antenatal antidepressant exposure or unmedicated depression in relation to child behaviour. Findings also suggest that efforts to improve child behaviour need to include more family-based approaches that support maternal wellbeing.

Prenatal determinants of depressive symptoms in childhood: Evidence from Growing Up in New Zealand.

BACKGROUND: Young people who experience depression are at an increased risk of adverse psychosocial and developmental outcomes that can persist over the lifecourse. Identifying maternal prenatal risk factors that may contribute to childhood depressive symptoms can be useful when considering mental health intervention. METHODS: The current study included 3,925 children from the Growing Up in New Zealand (GUiNZ) study who had complete data for self-reported depressive symptoms and mothers' antenatal information. Depressive symptoms were measured at age 8 using the Centre for Epidemiological Studies Depression Scale for Children (CESD-10) short form questionnaire. Hierarchical linear regression was used to determine the relationship between prenatal factors and depressive symptoms at age 8. RESULTS: When controlling for sociodemographic characteristics, our hierarchical linear regression revealed that the most significant maternal prenatal predictors of high depressive symptoms at age 8 were maternal perceived stress, smoking during pregnancy, body mass index (BMI) in the overweight/obese range, and paracetamol intake. LIMITATIONS: One limitation with the current study was a reduction in the sample due to attrition. This may have affected our statistical power, reflected in our modest effect sizes. The sample remained both socioeconomically and ethnically diverse, however our results should be interpreted with respect to the sample and not the whole New Zealand population. CONCLUSIONS: A combination of maternal mental health and lifestyle factors contribute to depressive symptoms for children, possibly through foetal programming. Our results emphasise the importance of mental and physical health support for expectant mothers.

Associations between antenatal maternal diet and other health aspects with infant temperament in a large multiethnic cohort study: a path analysis approach.

OBJECTIVES: The aim of this study was to assess the association of antenatal maternal dietary patterns (DPs) and other health aspects with infant temperament in a large multiethnic cohort, taking maternal personality and prenatal stress into account. DESIGN AND METHODS: Using data from 3968 children born in 2009/2010 and their mothers from the Growing Up in New Zealand cohort, infant temperament was assessed at 9 months using the Infant Behavior Questionnaire-Revised Very Short Form. Maternal antenatal diet and other health aspects were assessed antenatally. Maternal DPs (n=4) were derived using principal components analysis based on food intake reported on a 44-item food frequency questionnaire. Path analyses investigated factors associated with infant temperament, namely maternal personality, prenatal maternal stress, DPs and other health aspects, including potential inter-relations and mediating effects. RESULTS: Women who scored higher in the fusion DP (standardised beta (ß)=0.05; 95% CI 0.02 to 0.09) and healthy DP (ß=0.05; 95% CI 0.02 to 0.09), who exercised more (ß=0.04; 95% CI 0.01 to 0.07), and who drank less alcohol (ß=-0.05; 95% CI -0.08 to -0.02) were more likely to have infants with an overall less difficult temperament. Sex-specific differences were found in the associations between maternal DP and infant temperament. Maternal personality and prenatal stress were significantly associated with all dimensions of infant temperament. The strongest predictors for a more difficult temperament were prenatal stress (ß=0.12; 95% CI 0.08 to 0.15) and the personality dimensions neuroticism (ß=0.10; 95% CI 0.07 to 0.14) and extraversion (ß=-0.09; 95% CI -0.12 to -0.06). CONCLUSIONS: Associations of antenatal maternal diet and health aspects with infant temperament were statistically significant but small. While they should not be overinterpreted as being deterministic, the findings of this study support the link between maternal modifiable health-related behaviours and infant temperament outcomes.

Associations between technoference, quality of parent-infant interactions, and infants' vocabulary development.

"Technoference" describes the distraction from interpersonal activities that can occur due to use of mobile screen devices. Focusing on parent-infant interactions, our study investigated the associations between potential sources of "technoference" and parental responsiveness, scaffolding and directiveness toward their infant, and coordinated joint attention (CJA). Previous research demonstrates that each of these dimensions is related to early language development. Potential sources of "technoference" employed in our study included the amount of time the parent spends on their mobile device per hour when with their infant; the number of audible notifications the parent receives per hour, the number of times per hour they check their device; and parents' score on the Distraction In Social Relations and Use of Parent Technology (DISRUPT) scale. We investigated associations between our measures of parental "technoference" and infants' language development, and whether parental responsiveness, scaffolding, directiveness or parent-infant CJA mediate associations between "technoference" and language. Frequency of audible notifications negatively predicted infant vocabulary, and this relationship was fully mediated by parental directiveness.

[Formula: see text] Cognitive and social/emotional influences on adaptive functioning in children with FASD: Clinical and cultural considerations.

Fetal Alcohol Spectrum Disorder (FASD) is one of the leading causes of intellectual disability and learning difficulties around the world. Children with FASD often have extremely low adaptive behavior due to the severity of brain impairment, however there is limited understanding as to the important predictors of adaptive behavior. In a study of 39 children with FASD and 29 comparison children, we found that social cognition (specifically recognizing emotions) was the only significant independent predictor of teacher-rated adaptive functioning even after including IQ, executive functioning, and adverse childhood experiences into the model. In this current study, Maori (Indigenous people of Aotearoa New Zealand) were overrepresented; therefore, the research was supported by a strong partnership with Te Wahanga Hauora Maori (Maori Health Service). Aotearoa New Zealand's colonized history is recognized and findings are discussed with regard to both the psychological literature and a Te Ao Maori worldview.

Siblings of Young People With Cancer in NZ: Experiences That Positively and Negatively Support Well-Being.

Siblings of young people with cancer experience significant distress and these effects often exist long after their sibling's treatment has successfully been completed. In New Zealand, many families must travel several hours to receive treatment, with some having to live away from home for extended periods which can create additional strains. We interviewed 10 siblings of pediatric cancer survivors drawn from a larger quantitative study, to investigate what made siblings' experiences more difficult and to find out what was helpful in supporting their adjustment. The selected participants came from across New Zealand, represented a mix of gender and age, and had a range of depression scores. Our thematic analysis found that experiences that were associated with the most distress included concurrent stressors, and feeling left out, rejected, or isolated. Experiences that were most helpful to their well-being were feeling involved, knowing that they were still important and a priority for their parents, connecting with people through their experiences, and focusing on positive experiences. Our findings suggest that professionals working with these families could help siblings of a child with cancer by promoting hope, acknowledging positive growth, drawing attention to positive events to promote benefit finding, and providing opportunities to have fun. Increasing parental awareness of the impact of differential treatment and improving the public understanding of sibling issues might also be helpful.