Ethical dilemmas in infant mental health: Examples from child protection, home visiting, and medical contexts.

Infant mental health is explicitly relational and strengths based as a field. Ethical dilemmas in infant mental health have received insufficient attention at the level of infant mental health professionals (IMHP) and other professionals caring for infants who must grapple with questions of when caregivers and infants have conflicting interests. We present composite cases drawn from North American and Australian contexts, using three systems in which such conflicts may commonly manifest: child protection, home visiting, and medical settings. The field of infant and early childhood mental health (IECMH) should begin to discuss such dilemmas and how best to balance the needs of caregivers and infants when they are not well aligned.

Como campo profesional, la salud mental infantil se basa explícitamente en relaciones y puntos fuertes. Los dilemas éticos en el campo de la salud mental infantil no han recibido suficiente atención al nivel de los practicantes profesionales que luchan con preguntas de cuando quienes prestan el cuidado y los infantes tienen intereses que entran en conflicto. Presentamos casos compuestos tomados de contextos en Norteamérica y Australia, usando tres sistemas en los cuales tales conflictos pudieran comúnmente manifestar: protección infantil, visitas a casa y escenarios médicos. El campo de la salud mental infantil y la temprana niñez debe comenzar a hablar de tales dilemas y cómo equilibrar mejor las necesidades de quienes prestan el cuidado y de los infantes cuando ambos no se encuentran bien emparejados.

La santé mentale du nourrisson et de la petite enfance est explicitement relationnelle ainsi que basée sur les forces qui existent, en tant que domaine. Les dilemmes éthiques en santé mentale du nourrisson et de la petite enfance n'ont pas assez reçu d'attention au niveau des praticiens aux prises avec des questions ayant trait aux moments et situations où les personnes prenant soin des enfants et les nourrissons ont des intérêts qui sont en conflit. Nous présentons des cas complexes issus de contextes nord-américains et australiens, en utilisant trois systèmes au sein desquels de tels conflits peuvent se manifester : la protection de l'enfant, la visite à domicile, et le cadre médical. Le domaine de la santé mentale du nourrisson et de la petite enfance devrait commencer à discuter de tels dilemmes et de la meilleure manière d'équilibrer les besoins des personnes prenant soin des bébés et des bébés lorsqu'ils ne sont pas bien alignés.

[Innovative Integrative Approach in the Trauma Treatment in the First Years of Life: Integrative Attachment-Based TraumaTherapy for Infants and Toddlers]. / Innovativer integrativer Ansatz in der Trauma-Behandlung in den ersten Lebensjahren: Integrative Bindungsorientierte Traumatherapie bei Säuglingen und Kleinkindern.

Untreated trauma in the first years of life has profound consequences for the further psychological, neurobiological and physical development of those affected.The earlier psychotherapeutic treatment takes place, the sooner the consequences can bemitigated or even prevented. Integrative Attachment-Based TraumaTherapy for Infants and Toddlers (I.B.T.®) describes an innovative approach that incorporates treatment aspects of proven trauma integrativemethods such as EMDR and trauma narrative, as well as elements of systemic, attachment-oriented and stressorbased psychotherapy. Treatment includes work with attachment figures, improving the quality of attachment between caregivers and child, as well as direct trauma integrative work on the infant and toddler themselves. Experience to date shows a rapid, complete remission of symptoms, as well as an improvement in the quality of attachment between caregivers and child.

Validation of parental stress scale in a Greek sample of mothers with infants from 0 to 12 months.

Parenting an offspring is a rewarding, albeit challenging task, often accompanied by high levels of stress. It is important to accurately assess the stress associated with parenting, as severe forms of stress may affect the parent-child dyad and lead to poor child outcomes. The aim of this study was to translate and validate the Parental Stress Scale (PSS) in the Greek population. We implemented forward and back translation and conducted a pilot test. A total of 735 mothers (Mage  = 34.6) with infants aged 0-12 months completed the PSS, the Edinburgh Postnatal Depression Scale, and the Hospital Anxiety and Depression Scale. The Greek PSS-18 showed good internal consistency (Cronbach's α = .83) and adequate convergent validity. Results of exploratory and confirmatory factor analysis revealed two underlying factors: positive aspects of parenting and negative aspects of parenting. Our data confirm the validity of the Greek version of the PSS-18 in mothers with infants aged 0-12 months. The Greek version of the PSS-18 could be a useful tool for professionals and researchers who are interested in perinatal period and the aspects of parenthood.

Criar a un hijo es una tarea gratificante, aunque desafiante, a menudo acompañada por altos niveles de estrés. Es importante evaluar con certeza el estrés asociado con la crianza, ya que formas severas de estrés pudieran afectar la díada progenitor-niño y llevar a pobres resultados en el niño. El propósito de este estudio fue traducir y validar la Escala de Estrés del Progenitor (PSS) en la población griega. Implementamos la traducción hacia adelante y hacia atrás y llevamos a cabo una examinación experimental. Un total de 735 madres (Edad promedio = 34.6) con infantes de edad 0-12 meses completaron la PSS, la Escala de Edimburgo de Depresión Posnatal y la Escala de Ansiedad de Hospital y Depresión. La PSS griega-18 mostró una buena consistencia interna (de Cronbach α = .83) y una validez de convergencia adecuada. Los resultados de los análisis de factores exploratorios y confirmatorios revelaron dos factores subyacentes: aspectos positivos de crianza y aspectos negativos de crianza. Nuestros datos confirman la validez de la versión griega de PSS-18 en madres con infantes de edad 0-12 meses. La versión griega de PSS-18 pudiera ser una herramienta útil para profesionales e investigadores que están interesados en el período perinatal y los aspectos de la maternidad/paternidad.

Le parentage d'un enfant est une tâche gratifiante mais également un défi, souvent accompagnée de niveaux de stress élevés. Il est important d'évaluer avec précision le stress lié au parentage puisque les formes sévères de stress affectent la dyade parent-enfant et mènent à de piètres résultats pour l'enfant. Le but de cette étude était de traduire et de valider l'Echelle de Stress Parental (abrégé en anglais et ici par PSS) chez la population grecque. Nous avons procédé à la traduction et fait un test pilote. Un total de 735 mères (Mâge = 34,6) avec des bébés âgés de 0 à 12 mois ont rempli la PSS, l'Echelle de Dépression Postnatale d'Edinbourg, et l'Echelle d'Anxiété de l'Hôpital et de Dépression. La PSS-18 grecque a fait preuve de bonne cohérence interne (Cronbach's α = .83) et d'une validité convergente adéquate. Les résultats de l'analyse de facteur exploratoire et confirmative ont révélé deux facteurs sous-jacents: les aspects positifs du parentage et les aspects négatifs du parentage. Nos données confirment la validité de la version grecque de la PSS-19 chez des mères avec des bébés âgés de 0 à 12 mois. La version grecque de la PSS-18 pourrait être un outil utile pour les professionnels et les chercheurs qui s'intéressent à la période périnatale et aux aspects du parentage.

Cognitively-Based Compassion Training for parents reduces cortisol in infants and young children.

This study tests a group-based secular contemplative practice intervention, Cognitively-Based Compassion Training (CBCT), with parents of young children. We report on a randomized controlled preliminary efficacy study. Certified teachers administered CBCT for 20 hr across 8 to 10 weeks in two cohorts of parents with infants and young children. The intervention group was compared to a waitlist control group. Thirty-nine parents and their children, who ranged in age from 4 months to 5 years, were evaluated at pre- and postintervention (n = 25 intervention, n = 14 waitlist control) on hair cortisol concentration. Parents also completed self-administered questionnaires at both time points regarding demographics, physical symptoms of stress, parenting stress, self-compassion, and mindfulness. Children of parents in the CBCT group experienced significant decreases in cortisol at the postintervention assessment, as compared with the control group. However, parent cortisol and self-report measures did not significantly change other than a small effect on clinical levels of parenting stress. CBCT may be a positive new way to intervene with parents to lower infants' and young children's cumulative physiological stress.

Este estudio puso a prueba una práctica de intervención contemplativa secular con base en un grupo, el Entrenamiento Compasivo con Base Cognitiva (CBCT), con padres de niños pequeños. Nosotros reportamos sobre un estudio de efectividad preliminar controlado al azar. Maestros titulados administraron el CBCT por 20 horas a lo largo de 8-10 semanas en dos grupos de padres con infantes y niños pequeños. El grupo de intervención fue comparado con un grupo de control en lista de espera. Treinta y nueve padres y sus niños, que oscilaban en edad de 4 meses a 5 años, fueron evaluados antes y después de la intervención (n=25 grupo de intervención, n=14 grupo de control en lista de espera) en cuanto a la concentración de cortisol en el cabello. Los padres también completaron cuestionarios auto-administrados en ambos momentos temporales con respecto a información demográfica, síntomas físicos de estrés, estrés de crianza, auto-compasión, así como plena conciencia. Los niños de padres en el grupo CBCT experimentaron una significativa disminución de cortisol al momento de la evaluación posterior a la intervención, tal como se les comparó con el grupo de control. Sin embargo, el cortisol de los padres y las medidas de auto-reporte no cambiaron significativamente. El CBCT pudiera ser una nueva manera positiva de intervenir con padres para reducir el estrés fisiológico cumulativo de infantes y niños pequeños.

Cette étude a testé une intervention de pratique contemplative séculaire et basée sur un groupe, la Formation de Compassion Cognitive (abrégé ici selon l'anglais CBCT), avec des parents de jeunes enfants. Cet article porte sur une étude d'efficacité préliminaire randomisée et contrôlée. Des formateurs certifiés ont procédé à une CBCT de 20 heures réparties sur 8-10 semaines chez deux cohortes de parents avec des nourrissons et des jeunes enfants. Le groupe d'intervention a été comparé à un groupe de contrôle en liste d'attente. Trente-neuf parents et leurs enfants, allant de 4 mois à 5 ans d'âge, ont été évalués avant et après l'intervention (n=25 intervention, n=14 contrôle de liste d'attente) sur la concentration de cortisol capillaire. Les parents ont également rempli des questionnaires auto-administrés aux deux temps d'évaluation, concernant des données démographiques, les symptômes physiques de stress, le stress de parentage, l'auto-compassion et la pleine conscience. Les enfants de parents du groupe CBCT ont fait preuve de baisses de niveau de cortisol importantes à l'évaluation post-intervention en comparaison au groupe de contrôle. Cependant le cortisol parental et les mesures auto-rapportées n'ont pas changé de manière importante. La CBCT peut être une nouvelle manière positive d'intervenir avec les parents afin de faire baisser le stress physiologique cumulatif des nourrissons et des jeunes enfants.

Sex differences in the development of physical aggression: An intergenerational perspective and implications for preventive interventions.

This article reviews the state of knowledge on the development of chronic physical aggression (CPA), with the aim of identifying the most effective prevention strategies. We specifically focus on the early development of physical aggression, on sex differences in the use of physical aggression, and on the transmission of behavior problems from one generation to the other. The body of research on the development of CPA from the past three decades that we review shows increasing evidence that its prevention requires a long-term biopsychosocial developmental approach which also must include an intergenerational perspective. Recent genetic and epigenetic research has indicated that there are both important genetic and environmental effects on gene expression which start at conception. We conclude that one of the most effective strategies to break the intergenerational transmission of CPA involves giving long-term support to pregnant women with a history of behavior problems, their spouse, and their offspring.

DOES A PERINATAL PARENTING INTERVENTION WORK FOR FATHERS? A RANDOMIZED CONTROLLED TRIAL.

Fathers are increasingly expected to contribute to their parenting role at the transition to parenthood; however, many fathers experience mental health problems during this time. Parenting support for new fathers is limited, and research often only includes the mothers in intervention studies. Clear evidence for parenting programs for fathers has not yet been established. This study evaluated the effects of a parenting intervention (Baby Triple P) on fathers who were expecting their first baby. The design was a randomized controlled trial comparing Baby Triple P with care as usual over three time points (pregnancy, 10 weeks' postbirth, and 6 months' postbirth) for 112 fathers living in Brisbane, Australia. The primary outcomes included paternal psychological distress such as depression, anxiety, and stress and several secondary measures. No significant intervention effects for Baby Triple P were found at either post- or follow-up assessments. Fathers in both groups reported significant increases in their parenting confidence and self-efficacy. The results indicate no conclusive evidence for the effectiveness of Baby Triple P for new fathers. Future research using a sample with greater likelihood of experiencing problems at the transition to parenthood is needed as is offering more tailored need-based support to obtain substantial evidence for this preventative parenting program.

TEMPERAMENTAL ADAPTABILITY, PERSISTENCE, AND REGULARITY: PARENTAL RATINGS OF NORWEGIAN INFANTS AGED 6 TO 12 MONTHS, WITH SOME IMPLICATIONS FOR PREVENTIVE PRACTICE.

There is a need for standardized measures of infant temperament to strengthen current practices in prevention and early intervention. The present study provides Norwegian data on the Cameron-Rice Infant Temperament Questionnaire (CRITQ; J.R. Cameron & D.C. Rice, 1986a), which comprises 46 items and is used within a U.S. health maintenance organization. The CRITQ was filled out by mothers and fathers at 6 and again at 12 months as part of a longitudinal study of mental health during the first years of life (the "Little in Norway" study, N = 1,041 families enrolled; V. Moe & L. Smith, 2010). Results showed that internal consistencies were comparable with U.S. DATA: The temperament dimensions of persistence, adaptability, and regularity had acceptable or close-to-acceptable reliabilities in the U.S. study as well as in this study, and also were unifactorial in confirmatory factor analysis. These dimensions are the focus in this article. Findings concerning parents' differential ratings of their infants on the three dimensions are reported, as is the stability of parents' ratings of temperament from 6 to 12 months. In addition, results on the relation between temperament and parenting stress are presented. The study suggests that temperamental adaptability, persistence, and regularity may be relevant when assessing infant behavior, and may be applied in systematic prevention trials for families with infants. The inclusion of concepts related to individual differences in response tendencies and regulatory efforts may broaden the understanding of parent-infant transactions, and thus enrich prevention and sensitizing interventions with the aim of assisting infants' development.

CAREGIVER'S DEPRESSIVE SYMPTOMS AND YOUNG CHILDREN'S SOCIOEMOTIONAL DEVELOPMENT DELAYS: A CROSS-SECTIONAL STUDY IN POOR RURAL AREAS OF CHINA.

Poverty and its associated factors put people at risk for depression. The aims of this study were to describe the prevalence of depressive symptoms (DS) of primary caregivers and socioemotional development (SED) delays of young children in poor rural areas of China, and to explore the association between them. Cross-sectional data of 2,664 children aged 3 to 35 months and their primary caregivers were used for analysis. Characteristics of the child, caregiver, and family were collected through face-to-face caregiver interviews. DS were assessed by the Zung Self-Rating Depression Scale (W.W. Zung, 1965, as cited in World Health Organization, ), and SED was evaluated by the Ages and Stage Questionnaires: Social-Emotional (J. Squires, D. Bricker, & L. Potter, 1997). The χ2 test, stratification analysis, and logistic regression analyses were used to explore the association. Among the caregivers, 40.3% (95% confidence interval [CI] [38.4, 42.1]), reported DS. Caregivers who were male, older and ethnic minorities as well as had a low level of education, a low family income, or more children were more likely to have DS. Of the children, 24.4% (95% CI [22.8, 26.0]) were recognized with SED delays. Older children displayed more delays than did younger children, but no significant differences between males and females were found. SED delays were significantly associated with mother outmigrating, male caregivers, older age, ethnic minorities, and low education or families with a single parent, low-income, and having more children. Caregivers having DS, odds ratio (OR) = 2.40, 95% CI [1.99, 2.88], was a significant predictor of increased odds of SED delays; other factors were single-parent family, OR = 1.99, 95% CI [1.37, 2.89], inadequate care, OR = 1.69, 95% CI [1.30, 2.21], physical punishment, OR = 1.61, 95% CI [1.33, 1.95], ethnic minorities, OR = 1.41, 95% CI [1.17, 1.71], and child age in months, OR = 1.03, 95% CI [1.02, 1.04], according to the logistic regression analysis. DS are prevalent among caregivers with young children in poor rural areas. Interventions to improve the mental health of caregivers and their parenting behaviors are needed to improve children's SED.

EARLY PARENTING SUPPORT AND INFORMATION: A CONSUMER PERSPECTIVE.

The transition to parenthood is a period of both joy and challenge for most parents. There is a recognized need to support parents during this period, yet existing interventions have shown limited evidence of efficacy. This study takes a consumer-focused approach to examine the needs and preferences of parents both prenatally (n = 77) and postnatally (n = 123) for parenting support. The study used a cross-sectional design with a purpose-built online survey. Parents were recruited via online forums, Facebook and parenting blogs, childcare centers, and playgroups. In general, all parents were satisfied with their current levels of both formal and informal support, and about one fourth of parents had accessed a parenting intervention. Parents expressed a moderate level of interest in additional parenting information, and parents expecting their first baby indicated preferences for information about basic baby care needs whereas postnatally, parents expressed more interest in topics around self-care and behavior management. The implications for developing interventions and engaging families are discussed.

A PRELIMINARY EVALUATION OF THE MANAGING YOUTH TRAUMA EFFECTIVELY PROGRAM FOR SUBSTANCE-ABUSING WOMEN AND THEIR CHILDREN.

This article provides a description of the development, implementation, and preliminary evaluation of feasibility and acceptability of the Managing Youth Trauma Effectively (MYTE) program and highlights perceptions of changes in mothers' trauma-informed parenting practices. The program consists of a training and consultation program for staff of the U.S. State of Arkansas' Specialized Women's Programs (SWS), and an 8-week, group psychoeducational program designed to help mothers with substance-abuse problems learn how traumatic experiences may affect their children and how they may help support their children by creating a safe and nurturing environment. A posttraining evaluation with leadership and staff at SWS centers, feedback provided on consultation calls with MYTE facilitators, and a retrospective pre/post survey were used to examine feasibility, acceptability, and perceptions of changes in mothers' trauma-informed parenting practices. Preliminary results suggest that the MYTE program is feasible to implement and is acceptable to training participants, facilitators, and mothers participating in the program. Mothers reported significant growth in their perceptions of use of trauma-informed parenting practices. Future research is necessary to confirm these results and examine the effectiveness of the program using a randomized clinical trial.

PREDICTORS OF INFANT AND TODDLER BLACK BOYS' EARLY LEARNING: SEIZING OPPORTUNITIES AND MINIMIZING RISKS.

Using the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) data set (U.S. Department of Education Institute of Education Sciences, National Center for Education Statistics, 2001), this study examined child, family, and community factors in the early years (infant and toddler years) to predict the cognitive and language outcomes for preschool-age Black boys in relation to Black girls and White boys. Findings indicate that Black children face many challenges, with Black boys experiencing less sensitive parenting as compared to their peers. We live in a highly complex, racialized environment. While there are universal indicators that predict children's preschool outcomes such as strong social positioning and positive parenting, there are, in addition, some indicators that are more beneficial for Black boys' early development, including a stable, less urban home environment with parents engaging in "tough love."

REFLECTING ON THE PRACTICE OF INFANT MENTAL HEALTH AND THE REDUCTION OF RISK IN INFANCY AND EARLY PARENTHOOD: AN ESSAY.

This essay discusses infant mental health (IMH) as well as its origins and relational framework. The author then reflects, professionally and personally, on the meaning of psychological vulnerability of boys under 5 years of age, the importance of early caregiving relationships to the reduction of risk, and implications for education and training in the IMH field.

DOES TRAINING IN THE CIRCLE OF SECURITY FRAMEWORK INCREASE RELATIONAL UNDERSTANDING IN INFANT/CHILD AND FAMILY WORKERS?

This article evaluated whether attendance at Circle of Security training workshops resulted in attendees showing greater empathy and attachment-related knowledge and understanding, and fewer judgmental responses to viewing a stressful parent-child interaction. Participants were 202 practitioners who attended and completed a 2-day (n = 70), 4-day (n = 105), or 10-day (n = 27) COS training workshop in Australia or New Zealand in 2015. In a pre/post design, participant reactions to a video clip of a challenging parent-child interaction were coded for empathic, judgmental, or attachment-focused language. Attachment understanding was coded in response to questions about the greatest challenge that the dyad faced. In all training conditions, participants provided significantly more attachment-focused descriptors and showed significantly greater attachment understanding after training, but significantly fewer empathic descriptors. While participants at the longer workshops provided significantly fewer judgmental/critical descriptors, there was no change for those attending the 2-day workshop. Irrespective of workshop duration or professional background, participants took a more relational perspective on the vignette after the training workshops. More detailed research is required to establish the extent to which this increased knowledge and understanding is retained and integrated into infant mental health practice with parents and young children.

THE WORKING MODEL OF THE CHILD INTERVIEW: STABILITY OF THE DISRUPTED CLASSIFICATION IN A COMMUNITY INTERVENTION SAMPLE.

The Working Model of the Child Interview (WMCI; C.H. Zeanah, D. Benoit, & M.L.Barton, 1986) assesses caregiver internal representation of his or her child and the relationship with the child, with a relatively new coding system for representations associated with disorganized attachment-WMCI-Disrupted (WMCI-D; A. Crawford & D. Benoit, 2009). In the present study, we investigated the stability of the WMCI-D classification using a sample of 62 mothers who completed the WMCI twice as part of their involvement in a randomized trial comparing an attachment-focused parent group to home visiting. Demographic information and measures of maternal sensitivity, parenting stress, and infant attachment also were obtained in the randomized trial. There was significant concordance between WMCI-D classifications over 8 months (from pretest to follow-up) (90% agreement; κ = .79), with 61% of mothers remaining disrupted, 29% remaining not-disrupted, 8% becoming disrupted, and 2% becoming not-disrupted. Compared to mothers with not-disrupted representations, mothers classified as disrupted had lower socioeconomic status, more parenting stress, and infants with less attachment security, ps < .05. These results suggest that the WMCI-D classification is stable over 8 months during infancy. The findings are consistent with research demonstrating stability for disorganized/unresolved/disrupted classifications, the validity of the WMCI-D classification, and the lack of intervention impact on disorganized attachment.