[Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality]. / Einfluss der sozioökonomischen Risikobelastung auf mütterliche Feinfühligkeit, Stressbelastung und Familienfunktionalität.

Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality Parental stress exposure can influence the parent-child relationship, child development and child wellbeing in negative ways. The aim of this study was to investigate the impact of socio-economic risk exposure on the quality of the mother-child-interaction and family functionality. A sample of 294 mother-infant dyads at psychosocial risk was compared with a lower-risk, middle-class sample of 125 mother-infant-dyads in regard to maternal sensitivity/child's cooperation (CARE-Index), maternal stress (PSI-SF) and family functionality (FB-K). Lower levels of maternal sensitivity/child's cooperation and by trend also of the family functionality were found among the mothers from the at-risk sample in comparison to the low-risk sample. The level of maternal stress was similar in both samples. The results underpin the negative effects of a socio-economic risk exposure on the mother-child relationship. An early, sensitivity-focused family support could be encouraged to counteract the negative effects of early socioeconomic stress.

[Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders]. / Elterliche Mentalisierungsfähigkeit und der Zusammenhang mit elterlicher Belastung bei frühkindlichen Regulationsstörungen.

Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders Parents' capacity to reflect on their child as a mental agent, is defined as an important competence for the early parent-infant relationship. One way to operationalize this is parental reflective functioning (PRF) that distinguishes between mentalizing and non-mentalizing modes of reflection. Until today PRF has not been investigated in samples of infants/toddlers with early regulatory disorders. Goal of the present study is to investigate PRF by comparing a clinical group with parents of infants/toddlers with early regulatory disorders (N = 98) with a healthy control group (N = 27) and testing if PRF is related to parenting stress, past mental illness of the mother, and stress factors related to pregnancy and birth. A semi-structured clinical interview, the Parenting Stress Index, the Symptom-Check-List-90R-S, the Parental Reflective Functioning Questionnaire, and an anamnestic questionnaire were used. Compared to the control group, mothers of infants/toddlers with early regulatory disorders reported significant more prementalizing. Prementalizing in the total sample was significantly predicted by parenting stress, accounting for 16.3 % of the variance. None of the other independent variables significantly predicted prementalizing. Results are discussed in relation to early regulatory disorders and implications for clinical practice.

[Health-related long-term effects of adverse childhood experiences - an update]. / Gesundheitliche Langzeitfolgen psychosozialer Belastungen in der Kindheit - ein Update.

In the last decade strong empirical evidence from several long-term studies supports the conclusion that physical and sexual abuse as well as emotional deprivation in childhood make people significantly more vulnerable to mental and functional disorders across their lifetime. Additionally, an increased vulnerability to several somatic disorders (cardiovascular disorders, type-2-diabetes, hepatitis, chronic obstructive pulmonary disease (COPD), immunological and pain disorders, pharynx and lung cancer) was demonstrated - most of them with a reduced life expectancy. A review of the current research will be presented that outlines the underlying developmental neurobiological and psychological mechanisms mediating these long-term effects. There is now sufficient evidence about familial risk constellations that demonstrates the well-documented impact of specific prevention strategies by several model projects. Only by establishing these strategies, future enormous health-related burdens and high economic costs (unfitness to work, early retirement) can presumably be limited.

[The Family Questionnaire (FB-K) - A Short Version of the General Family Questionnaire and its Reliability and Validity]. / Der Familienbogen (FB-K) - eine Kurzversion des Allgemeinen Familienbogens, seine Reliabilität und Validität.

UNLABELLED: A standardized assessment of a family system plays a crucial role in family therapy research and diagnostic, as well as in a family therapy itself. A 14-item short version of the General Family Questionnaire (FB-K) was designed to get a tool for assessing family functionality that is low time-consuming. METHOD: The short version was developed by factor analysis from the long version FA-A. The quality criteria of the family questionnaire were verified in a control sample of 208 high-risk families four months after the birth of their child. The new family questionnaire demonstrates a very good reliability and a satisfactory 8-months-stability. The concurrent validity with the FACES scale "cohesion" is assured. Regarding the construct validity a positive correlation to the feeling of coherence was found. The family questionnaire shows a negative correlation to the maternal postnatal depressive symptoms, the degree of maternal stress burden, the dysfunctionality of the mother-child-relationship and impaired bonding. The values taken from a norm sample with infants are higher by trend and in the sample with children under 18 do not deviate from the values of the risk sample. FB-K covers two aspects of family functioning, the bond between family members and their willingness to communicate. The internal consistency of FB-K is excellent, the criterion and the construct validity are good.

Assessing DSM-5 level of personality functioning from videotaped clinical interviews: a pilot study with untrained and clinically inexperienced students.

Several authors have raised the concern that the DSM-5 Level of Personality Functioning Scale (LPFS) is relatively complex and theory laden, and thus might put high requirements on raters. We addressed this concern by having 22 untrained and clinically inexperienced students assess the personality functioning of 10 female psychotherapy inpatients from videotaped clinical interviews, using a multi-item version of the LPFS. Individual raters' LPFS total scores showed acceptable interrater reliability, and were significantly associated with 2 distinct expert-rated measures of the severity of personality pathology. These findings suggest that, contrary to the previously mentioned concerns, successfully applying the LPFS to clinical cases might require neither extensive clinical experience nor training.

[Empirical basis of the Questionnaire for Crying, Feeding and Sleeping]. / Empirische Grundlagen des Fragebogens zum Schreien, Füttern und Schlafen (SFS).

The Questionnaire for Crying, Feeding and Sleeping of an infant, constructed based on theory and factor analysis, is assessed for internal consistency, inter-correlations, and its relation to a behaviour diary. A clinical and a non-clinical sample are compared. The sample of in total 704 infants younger than one year consists of different subsamples. To test the differences between a clinical and a non-clinical sample assessed with the questionnaire, data of 134 infants brought to the outpatient unit for parents with their infants and toddlers and a matched sample are used. The principal components analysis results in three well-interpretable scales correlating with each other, which all show a high internal consistency. The connections to the diary records and the differences between the means of the clinical and the non-clinical sample are found in the expected directions. The results of the Questionnaire for Crying, Feeding and Sleeping, including the criterion of Wessel, are consistent with the behaviour diary as well as the clinical diagnostics. The Questionnaire for Crying, Feeding and Sleeping shows validity according to these criteria and can therefore be used in research and clinical practise for the assessment of problems concerning crying, feeding and sleeping in the first year of life.

Assessing the level of structural integration using operationalized psychodynamic diagnosis (OPD): implications for DSM-5.

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.

[Persistent, excessive crying in 5-month-old infants and the pre-, peri- and postnatal adversities of their mothers in a high-risk sample]. / Das exzessive Schreien bei 5 Monate alten Säuglingen und prä-, peri- und postnatale Belastungen ihrer Mütter in einer Hoch-Risiko-Stichprobe.

OBJECTIVE: To investigate the relationship between persistent, excessive crying in 5-month-old infants and the pre- and perinatal adversities as well as postpartal mood of their mothers. METHOD: A sample of 300 mother-child dyads was examined at infants' age of 18.5 weeks. All mothers exhibited psychosocial risks such as poverty, lack of social support, being underage, drug abuse or mental disorders. Excessive crying was assessed by the Wessel's «rule of threes¼. Pre-, peri- and postnatal problems were measured by self-report questionnaires. RESULTS: Multivariate data analysis revealed an increased risk for social adversities during pregnancy (OR = 17.66) and unwanted pregnancy (OR = 13.77). For the postnatal period persistent crying was associated with a higher rate of maternal postpartum depressive symptoms, maternal stress, dysfunctional mother-child interactions, perception of the infant as being «difficult¼ as well as bonding problems. CONCLUSIONS: The results point to the influence of prenatal stress in mothers and a primarily unwanted pregnancy on infants' persistent crying. An increased need for support is suggested in cases of considerably reduced well-being of the mother or bonding problems. The combined effect of prenatal variables and relationship variables influences the occurrence and perpetuation of early regulation problems.

[Maternal affect regulation of mothers with a history of abuse in mother-infant-interaction]. / Mütterliche Affektabstimmung von Müttern mit Missbrauchserfahrungen in der Mutter-kind-Interaktion.

Maternal intuitive skills can be threatened as a result of severe deprivation or unresolved trauma in the own childhood and can even be inaccessible to the mother. A mother's own childhood experience of abuse maybe a risk factor for repeated child abuse. As a follow-up study to assess the emotional availability of abused mothers it was investigated how a physical or sexual abuse appears in the mother-child interaction and communication in the context of "cycle of abuse" and whether it could give effect to it. Interactions of mothers with abuse experience were compared with those of mothers without an abuse experience and evaluated five months postpartum with the Munich clinical communication scale (MKK). The results suggest that maltreatment experienced mothers show less emotion tuning to their child in a standardized interaction sequence.

[Assessing risk exposure in families within the scope of early intervention: the Heidelberg Stress scale (HBS) and its quality criteria]. / Einschätzung der Risikobelastung in Familien im Rahmen von Frühen Hilfen: Die Heidelberger Belastungsskala (HBS) und ihre Gütekriterien.

The aim of the study presented is to introduce the newly developed instrument to assess stress, the Heidelberg Stress Scale (Heidelberger Belastungsskala--HBS), and to examine its psychometric characteristics. The HBS was developed for a low-threshold and multi-professional assessment of a family's stresses and resources after the birth of a child. The HBS can be used in the outreach work of family midwives, for instance, as well as in research. The validity of the HBS was tested in a sample of 284 psychosocially stressed families after the birth of their child; the inter-rater reliability was tested in a sample of 41 families that were also in stress. The HBS exhibits an excellent inter-rater reliability within a homogeneous professional group (psychology students). As relates to the construct validity, a strong positive connection between the HBS and Kindler's screening sheet was found; the HBS exhibits a negative correlation with maternal sensitivity and a positive correlation with maternal stress level. With a high level of stress in the HBS, the risk of taking the child into care is increased by 4.5 times; the sensitivity amounts to 63.6%. The quality criteria are satisfactory.

[Differentiated structures of early prevention measures for families at risk using the example of the project "nobody slips through the net"]. / Differenzielle Angebotsstrukturen in der Betreuung belasteter Familien am Beispiel des Frühe-Hilfen-Projektes "Keiner fällt durchs Netz".

Against the background of practical experiences from the Early Prevention model project "Nobody slips through the net" (in three counties of Germany) the necessity of differentiated structures of preventive measures for different groups of families will be discussed. Therefore a distribution in three types of families the visiting qualified person could be confronted with during their work in the families' homes is proposed, especially with respect to the degree of risk and available resources. We conclude by illustrating the implications of this approach by means of a case vignette.

Maternal Parenting Stress in the Face of Early Regulatory Disorders in Infancy: A Machine Learning Approach to Identify What Matters Most.

Objective: Early regulatory disorders (ERD) in infancy are typically associated with high parenting stress (PS). Theoretical and empirical literature suggests a wide range of factors that may contribute to PS related to ERD. The aim of this study was to identify key predictors of maternal PS within a large predictor data set in a sample of N = 135 mothers of infants diagnosed with ERD. Methods: We used machine learning to identify relevant predictors. Maternal PS was assessed with the Parenting Stress Index. The multivariate dataset assessed cross-sectionally consisted of 464 self-reported and clinically rated variables covering mother-reported psychological distress, maternal self-efficacy, parental reflective functioning, socio-demographics, each parent's history of illness, recent significant life events, former miscarriage/abortion, pregnancy, obstetric history, infants' medical history, development, and social environment. Variables were drawn from behavioral diaries on regulatory symptoms and parental co-regulative behavior as well as a clinical interview which was utilized to diagnose ERD and to assess clinically rated regulatory symptoms, quality of parent-infant relationship, organic/biological and psychosocial risks, and social-emotional functioning. Results: The final prediction model identified 11 important variables summing up to the areas maternal self-efficacy, psychological distress (particularly depression and anger-hostility), infant regulatory symptoms (particularly duration of fussing/crying), and age-appropriate physical development. The RMSE (i.e., prediction accuracy) of the final model applied to the test set was 21.72 (R 2 = 0.58). Conclusions: This study suggests that among behavioral, environmental, developmental, parent-infant relationship, and mental health variables, a mother's higher self-efficacy, psychological distress symptoms particularly depression and anger symptoms, symptoms in the child particularly fussing/crying symptoms, and age-inappropriate physical development are associated with higher maternal PS. With these factors identified, clinicians may more efficiently assess a mother's PS related to ERD in a low-risk help-seeking sample.

The Efficacy of Brief Parent-Infant Psychotherapy for Treating Early Regulatory Disorders: A Randomized Controlled Trial.

OBJECTIVE: Early regulatory disorders (ERD) place considerable strain on the parent-infant relationship and are associated with high parental distress. Brief (4-session) psychodynamic-based focused parent-infant psychotherapy (fPIP) treats ERD by strengthening the quality of the parent-infant relationship. This randomized controlled trial investigates the efficacy of fPIP for treating ERD compared to standard pediatric care (treatment as usual [TAU]). METHOD: Participants were 154 mothers and infants from 4 to 15 months who met criteria for persistent excessive crying, sleeping disorders, feeding disorders, or regulation disorders of sensory processing and were randomly assigned to fPIP (n = 81) or TAU (n = 73). Assessments took place at baseline and at the end of treatment after 12 weeks. Primary outcomes were the infants' regulatory symptoms and remission rate. Secondary outcomes were parents' psychological distress, depression, parenting stress, maternal self-efficacy, parental reflective functioning, and observer-rated emotional availability. RESULTS: fPIP was superior to TAU in reducing infants' overall symptoms (p = .004, η2 = 0.05, CI = 0.01-0.12), night-waking disorders (p = .030, odds ratio = 3.12, CI = 1.21-9.22), and mothers' psychological distress (p = .000, η2 = 0.08, CI = 0.03-0.16) and depression (p = .002, η2 = 0.06, CI = 0.02-0.13). There was a trend suggesting that fPIP led to increased maternal self-efficacy and parental reflective functioning. CONCLUSION: Results underscore the efficacy of brief fPIP in significantly reducing symptoms in infants with ERD and their mothers. Generalizability is restricted to low psychosocial risk samples with highly distressed mothers and comorbid ERD with a predominance of night-waking disorders. CLINICAL TRIAL REGISTRATION INFORMATION: The Efficacy of a Brief Parent-Infant Psychotherapy for the Treatment of Early Regulatory Disorders: A Randomized Controlled Trial; https://www.drks.de/drks_web/; DRKS00005739.

Symptom presentation, interventions, and outcome of emotionally-distressed patients in primary care.

BACKGROUND: Patients with psychosocial problems often present somatic symptoms in primary care. OBJECTIVE: The authors compare interventions and outcomes of emotionally-distressed patients by presenting physical disease, somatoform symptoms, or psychological symptoms. METHOD: General practitioners (N=191) documented data from 1,286 patients with psychosocial problems. Experts rated the presented reasons for encounter. RESULTS: Somatoform symptoms, as well as physical disease, result in patients' receiving physical treatments. Psychologically-oriented treatment is more likely with psychological presentation, but not significantly related to somatoform symptoms. CONCLUSION: These findings underline the importance of a specific treatment approach for patients with somatoform symptoms, so as to avoid inappropriate treatment.

[Paternal presence--a four-level model]. / Väterliche präsenz - ein rahmenmodell mit vier ebenen.

A framework model for paternal presence is introduced, which is meant to assist the integration of the often times confusing magnitude of theoretical findings of contemporary father research. The presented model includes a biological, an intrapersonal, an interpersonal as well as a family level. The levels are based on and contain one another. Each level discusses facets of how is fatherhood represented in fathers as well as actual quantitative and qualitative engagement.

[Violence prevention in secondary schools: the Faustlos-curriculum for middle school]. / Gewaltprävention in weiterführenden Schulen: Das Faustlos-Curriculum für die Sekundarstufe.

Schools and kindergartens are particularly suitable for the implementation of violence prevention programs. Many German schools and kindergartens have securely established the violence prevention curriculum Faustlos. The Faustlos programs for kindergartens and elementary schools are now complemented with the version for middle schools. As the kindergarten- and elementary school versions the middle school program too focuses on the theoretically profound, age group-tailored promotion of empathy, impulse control and anger management. These dimensions are subdivided into the five themes "understanding the problem" "training for empathy"; "anger management", "problem solving" and "applying skills" and taught stepwise, highly structured and based on several video sequences in 31 lessons. US-American evaluation studies proof the effectiveness and the violence prevention potential of the program. With the curriculum for middle schools a comprehensive Faustlos program package is now made available to sustainably promote core violence prevention competences of children and adolescents on a developmentally appropriate level and with a consistent didactic approach.

[Differences in doll play of four-year old children of different ethnic groups]. / Unterschiede im Spielverhalten von Vierjährigen aus unterschiedlichen ethnischen Gruppen.

In its psychological development, the child learns social-emotional competences in order to be able to cope with conflicts. Since ethnic diversity increases due to globalization, the influence of the ethnic background on the social competence children development must be investigated furthermore. The present study examines the differences of the social-emotional competences of children of various ethnic groups. To track the social-emotional competence in play, 84 Asian-American, Latin-American and African-American kindergarteners (age = 4) were tested with the Mac Arthur Story Stem Battery and the attachment representation using the Attachment Doll Play manual. There were significant differences in the avoidance of conflict, empathic and moral themes in problem-solving among the ethnic groups. Furthermore, according to ethnic background the children significantly differed in the dimensions of attachment representation, freezing/blocking, constriction and controlling. Since ethnically specific social competence, attachment dimensions and their inter-correlation were found, the children started Kindergarten with differing qualifications. There are indications that the differences in attachment accentuations in children call for ethnic differences in social competence and interpretations of social situations in adults and children.

[Behavior problems and identification of mental states in preschoolers]. / Verhaltensprobleme und das Erkennen mentaler Zustände im Vorschulalter.

Aim of the study is to present a method to map the ability of children to identify emotions and intentions in emotionally relevant situations (intentional and emotional reflectiveness). Moreover we analyze interrelation between this ability and behavior problems. Therefore we administered Story Stem Interviews with 70 children and added demand questions focusing emotions and intentions of diverse characters within the child constructed stories. All the given answers we displayed on a six-ary scale. To review the clinical relevance we correlated this measure with questionnaire-based behavior screenings by educators in kindergarten. We found correlations between behavior problems and especially answers to emotion questions (emotional reflectiveness). We regard this as evidence that the ability to identify emotions and intentions in others has an important protective function even in childhood.

[The use of OPD-based focused interventions in inpatient psychotherapy: effects on outcome and course of treatment]. / Fokusorientierte Interventionen mit der OPD in der stationären Psychotherapie: Effekte auf Ergebnis und Verlauf der Behandlung.

OBJECTIVES: The study explores the course and outcome of inpatient psychodynamic psychotherapy (N=200) with particular regard to interpersonal experiences and behaviour. Based on the implementation of a focus conference, the multi-professional team members formulated an interpersonal treatment focus and individualised helpful interpersonal attitude towards the patient (so-called therapeutic tuning). This focus formulation follows the systematic procedure provided by the Operationalised Psychodynamic Diagnostics System (OPD-2). METHODS: The study was initiated to evaluate the effectiveness of the so-called "tuning-treatment" compared to inpatient "treatment as usual". RESULTS: Compared to "treatment as usual", the tuning condition showed greater improvement (p>.001) in interpersonal functioning (GARF). Interpersonal problems (IIP) and symptoms (SCL-90-R) were slightly more improved than in the "treatment as usual" cases (p=.13 and. p=.09). CONCLUSIONS: An interpersonal treatment focus followed by focus-oriented interventions is a promising approach for inpatient psychodynamic psychotherapy. Generalisation of the empirical results is, however, limited due to problems of internal validity.