Parents Research Articles

Cognitive and affective control for adolescents in care versus their peers: implications for mental health

BackgroundMany adolescents who have been removed from the care of their biological parent(s) and placed in State or Local Authority care have experienced significant adversity, including high rates of maltreatment and other trauma(s). As a group, these young people experience far higher rates of mental health difficulties compared to their peers. While their mental health outcomes are well-documented, little is known about mechanisms that may drive this. One potential mechanism, linked to both trauma and adversity exposure and mental health, is affective control (the application of cognitive control in affective contexts).MethodsWe compared cognitive and affective control in 71 adolescents (65% girls) in care aged 11–18 (M = 14.82, SD = 2.10) and 71 age and gender-matched peers aged 11–19 years (M = 14.75, SD = 1.95). We measured cognitive and affective control using standard experimental tasks, and for those in care, we also examined associations with self-reported emotion regulation, mental health, and school well-being.ResultsAfter controlling for IQ, there was a significant group difference in affective control performance, with those in care on average performing worse across all tasks. However, further analyses showed this was driven by deficits in overall cognitive control ability, and was not specific to, or worsened by, affective stimuli. Further, we found no evidence that either cognitive or affective control was associated with emotion regulation abilities or the mental health and well-being of young people in care.ConclusionsResults suggest that cognitive and affective control may not underlie mental health for young people in care, though limitations should be considered. We discuss implications for theory and intervention development, and avenues for further research.Trial registration: https://doi.org/10.17605/OSF.IO/QJVDA

Acceptability, feasibility and perceived effectiveness of online and remote mental health and wellbeing interventions during the COVID-19 pandemic: A qualitative study with care-experienced young people, carers and professionals

The COVID-19 pandemic, and associated lockdowns, saw numerous services move to online and remote delivery. This included mental health and wellbeing interventions for care-experienced young people. To date there has been limited consideration of how different stakeholders experienced the receipt or delivery of remote provision during this period. We conducted online one-to-one and small group interviews with: young people with experience of care (n = 3); a young person whose biological parents were foster carers (n = 1); foster and kinship carers (n = 10); and social care and affiliated professionals (n = 9). We further engaged with relevant stakeholder consultation groups to refine and confirm study findings. Five central themes were generated, that reflected participants’ experience of a range of services, while also serving as recommendations for the future development and optimisation of provision: 1) Awareness: there is a lack of general awareness of mental health provision and understanding of what is available to support care-experienced young people, and a specific lack of knowledge regarding online support; 2) Choice and tailoring: young people need choice and flexibility in identifying provision that best suits their needs, and this includes the decision to receive online, blended or in-person services; 3) Training: carers and professionals need training on how to foster relationships with young people online and how to ensure safety and child protection; 4) Safety, protection and risk: young people need to have safe and private spaces when accessing online services; and 5) Access and resources: care-experienced young people don’t always have access to online support, and need appropriate technological devices that don’t have prohibitive restrictions. Taken together, the study findings offer insight into how interventions and services may be developed and optimised moving forward to ensure that they are meeting the needs of young people in care, and maximize likely effectiveness.

Legal Protection for Exploitation of Children as Beggars in the Market by Parents in Gorontalo Regency

The phenomenon of exploitation of child buskers is one of the social problems that must be resolved by all groups, both the government and society. This exploitation of children is even carried out by their own parents. The focus of this research study is how the form of legal protection from child exploitation should children get education but only in the market. This study aims to determine the forms of child labor exploitation, the factors that influence working children, and to determine the negative impacts arising from child exploitation. In this study, normative research on written law was examined from various aspects such as aspects of theory, philosophy, comparison, structure/composition, consistency, general explanation. This method is considered suitable by researchers to be used in describing the problem of child exploitation in the Gorontalo district market. Based on the results of this study, biological parents are involved in the form of exploitation of children in the market. Factors that influence children to work in the market are economic factors, family factors, and environmental factors. And the negative impact arising from the exploitation of children in the market is the disruption of children's health, loss of desire to go to school, the emergence of psychological traumas in children. and the emergence of unrest in the community around the red light as well as the community around where the child workers themselves live.

Influence of Kinship Caregiver and Family Characteristics on Kinship Care Experiences

Kinship care is the increasingly preferred child placement with a relative when the biological parents are unable to provide care. Program and resource supports must understand how to best meet these caregivers’ needs. Through thematic analysis of existing literature, this study aims to understand how kin caregiver characteristics affect kinship care outcomes. A total of 28 peer-reviewed articles were included in this analysis. Findings indicate that caregiver characteristics, including racial differences, family roles, economic burden, structural supports, and caregiver health, have potentially differential impacts on kinship care and outcomes. Identifying influential caregiver characteristics highlights the importance of adapting policy, programming, and research to support diverse kinship families, rather than viewing them as homogeneous. Incorporation of these characteristic considerations may lead to more effective and impactful supports and improved well-being for all kinship families.

Addressing Reproductive Education Among Young Adults with Sickle Cell Disease (SCD): Sickle Cell Reproductive Outreach and Education (ROE) Project

Background: As children with sickle cell disease (SCD) survive into adulthood, it is important to address emerging reproductive health concerns. This population faces unique fertility challenges, including balancing the desire for biological parenthood, risk of pregnancy-associated complications, unintended pregnancy, and fertility concerns with the use of SCD modifying therapies (DMTs) (Smith-Whitley, Blood, 2014, Pecker, Br J Haematol, 2021) . Recent research identified knowledge gaps that impact reproductive care for adults with SCD (Carrithers, Frontiers, 2023). To overcome these gaps, we need to evaluate the baseline knowledge of young adults with SCD regarding reproduction to understand the complex implications of reproductive decision-making. This study was done to gauge young adults' knowledge of reproduction, understanding of fertility, and current reproductive behaviors in order to develop educational material to support young adults' with SCD reproductive decisions. Methods: This IRB-approved, cross-sectional study included young adults living with SCD (ages 18-35) from University of Alabama-Birmingham's Lifespan Comprehensive SCD Center. Patients were recruited during routine clinic visits to complete an electronic 33-question survey to evaluate reproductive health topics adapted from the Sisters Informing Sisters About AIDS (SISTA) questionnaire (CDC, 2008), including demographics (age separated into younger age (18-25) and older age (26-35), sexual health behaviors (contraception, sexually transmitted infection (STI) prevention), family planning, patient advocacy, and attitudes towards reproductive education. Responses were recorded as “Yes, No, Don't Know”, unless questions specifically asked for participants to choose an option. Attitudes toward reproductive education were graded on 5-point Likert scale (1= strongly disagree to 5=strongly agree). Data analysis includes averages to evaluate subgroup comparisons and independent student's t-test to compare subgroups with statistical significance set at p<0.05. Results: We enrolled 47 participants (55% women and 51% were of older age). In this cohort, 87% completed high school and 60% were sexually active. Among those who were sexually active, 86% had previously undergone STI testing and 36% had prior history of STI (22% men vs. 77% women, 22% younger age vs. 77% older age, p<0.05). Thirty-eight percent identified personal or partner contraceptive use. Regarding children, 19% had birthed/fathered a child(ren) (55% men vs. 45% women, 22% younger age vs. 77% older age, p>0.005) among whom 11% knew their child had SCD, 55% knew their child had sickle cell trait (SCT), and 33% did not know if their child had SCD/SCT. Only 26% were aware of contraceptive options for people with SCD (17% men vs. 83% women, p<0.05). Importantly, 89% recognized high risk sexual activity as a risk factor for STIs but no one in the cohort recognized the risk of infertility due to STIs. When asking about their partners, 32% knew if their partner had SCD/SCT (20% men vs. 80% women, p<0.05). Notably, 79% desired biologic children. Among those who desired children, 41% felt that their SCD changed their decision to have children and 26% were previously told they could not have children due to SCD (12% men vs. 88% women, 25% younger age vs. 75% older age, p<0.05). Notably, 57% were interested in conceiving if pregnancy was planned (41% men vs. 59% women, 37% younger age vs. 63% older age, p<0.05). When asked if patients wanted to discuss their reproductive health, 87% wanted to discuss this with their hematologist but only 51% would discuss this with PCPs. Conclusion: In this study, we identified evaluated 4 tenets of reproductive health knowledge: contraceptive use, STI prevention, family planning, and patient advocacy. We identified gaps in knowledge in these areas that can be addressed to improve reproductive education in young adults with SCD. Young adults with SCD in our cohort have low contraceptive use and were often not aware of contraceptive options for people with SCD or their partner's SCD/SCT status. Our cohort also reported a significant history of STI but was unaware of the associated increasing risk for infertility. Importantly. young adults are especially interested in discussing reproductive health with their hematologists, which provides an opportunity to improve reproductive education within this unique population.

56 Investigating the Moderating Effect of Family Psychiatric History on the Association Between Concussion History and Elevated Symptom Endorsement

Objective:Prior research has found that a greater history of concussion is associated with subtle increases in symptom endorsement. Recent work indicates that a family history of psychiatric disorder is a potential risk factor for prolonged recovery following a single injury. While greater symptom endorsement is observed among those with a personal psychiatric history, the potential role of family psychiatric history in elevated symptom endorsement in the context of repeated concussion has not been investigated. Therefore, the objective of this work was to determine whether family psychiatric history moderates the association of concussion history and elevated symptom endorsement in active collegiate athletes.Participants and Methods:A total of 176 (mean age = 21.19 ± 1.63; 116 male) collegiate athletes completed this study at the Medical College of Wisconsin. Participant’s family psychiatric history was collected through a modified Family History Screen (FHS) regarding the participant’s biological parents, siblings, and children, focusing on questions relating to major depressive disorder (MDD; 3 total questions) and general psychiatric history (5 total questions). Concussion history was assessed through a semi-structured interview using American College of Rehabilitation Medicine criteria for mild traumatic brain injury. Concussion symptoms were measured via the Sport Concussion Assessment Tool (SCAT-5) and psychological distress was assessed using the Brief Symptom Inventory-18 (BSI-18). General linear models tested the association of the number of prior concussions with log-transformed SCAT-5 and BSI-18 scores. Additional general linear models were fit to assess the effects of number of prior concussions, family psychiatric history (MDD family history and general family history, each coded as Yes/No), and the interaction of prior concussion and family psychiatric history on log-transformed SCAT-5 and BSI-18 scores. Sex was included as a covariate in all models.Results:More prior concussions were significantly associated with greater symptom severity scores on the SCAT-5 (x2=26.87, p<0.001, unstandardized beta[B](standard error[SE])=0.25(0.05)) and BSI-18 (x2=20.94, p<0.00, B(SE)=0.19(0.04)). For the models investigating the effects of family psychiatric history, neither the main effect of MDD family history nor the MDD family history by prior concussion interaction were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). Similarly, for the general history model, neither the main effect of general family psychiatric history nor the interaction of general family psychiatric history and number of prior concussions were significant for either the SCAT-5 (ps>0.05) or BSI-18 (ps>0.05). For both the MDD family history and general psychiatric family history models, the number of prior concussions remained positively associated with subjective symptoms on both the SCAT-5 (X2=20.10, p<0.001, and x2=23.50, p<0.001) and BSI-18 (x2=16.46, p<0.001, and x2=20.68, p<0.001).Conclusions:The results of the current study provide further evidence for a relationship between elevated sub-clinical symptom endorsement and the number of prior concussions in active, collegiate athletes. The results do not, however, support the hypothesis that the association between prior concussion and an athletes’ level of symptom endorsement are moderated by the family psychiatric history. Additional research is needed to determine what factors predispose some individuals to the adverse chronic effects of repeated concussion.

Legal protection for abandoned children

Every child has the right to survive, grow and develop and is entitled to protection from various forms of violence, both physical and non-physical. Forms of violence and discrimination have often occurred in society. This raises concern because it is the parents or the child's relatives who carry out the neglect of the child because his biological parents have left him. In terms of children's rights are part of human rights that must be guaranteed, protected and fulfilled by parents, family, community, state and government. The purpose of this study is to find out how legal protection is for neglected children and whether parents can be subject to sanctions. While the method used in this research is normative law research or library research. The results of the study show that child neglect is a crime and can be subject to criminal sanctions. Meanwhile, the form of legal protection for neglected children is through the formation of laws and regulations, and through law enforcement efforts. Therefore in accordance with Article 26 of Law Number 23 of 2002 as amended by Law Number 35 of 2014 that children must be protected and educated without violence. It is even explained that it is the obligation of parents to look after their children and their rights as children.

1 The Influence of Depression and Anxiety on Working Memory in Children with ADHD

Objective:Previous research has explored the performance of working memory in children with ADHD and individual co-occurring disorders, finding that internalizing disorders such as depression and anxiety, both independently negatively impact working memory performance (Saarinen, Fontell, Vuontela, Carlson, & Aronen, 2015; Kofler, Rapport, Bolden, Sarver, Raiker, & Alderson, 2011; Skogan, Zeiner, Egeland, Rohrer-Baumgartner, Urnes, Reichborn-Kjennerud & Aase, 2013). However, there is limited research on the impact of co-occurring depression and anxiety on working memory, which are common in children with ADHD. When depression is present, parts of the prefrontal cortex regions are hypoactive and therefore lead to impairment in executive functioning abilities (Snyder, 2013). In regard to anxiety, previous literature (Moran, 2016) has found that anxious arousal competes with processes located in the prefrontal cortex leaving limited neural resources for executive functioning skills (Moran, 2016). The current study will evaluate the influences of depression and anxiety on working memory in children with ADHD.Participants and Methods:Participants were from an archived data set, which included 849 individual children ages 7-15 years old and their biological parents, recruited between 2009 and 2015. The 849 children included 76 sibling pairs. Families were part of an ongoing longitudinal study. The children completed a computerized version of a spatial working memory task identical to the spatial span task from CANTAB (De Luca et al., 2003). In regard to verbal working memory, children completed Digit Span from the WISC-IV, including both forward and backward conditions. Depression was measured by the Children’s Depression Inventory, 2nd edition (Kovac, 2004) and anxiety was measured by the Multidimensional Anxiety Scale for Children, 2nd edition (MASC-2) (March, 2012). ADHD was measured by having the parents and teachers complete two questionnaires: the ADHD rating scale (ADHD-RS; DuPaul et al. 1998), the Connor’s Rating Scale, 3rd edition (CRS-R, Connors 2003), and an in person semi-structured diagnostic interview (Kiddie Schedule for Affective Disorders and Schizophrenia -KSADS, Kaufman et al. 1997). A best estimate DSM-IV ADHD (American Psychiatric Association [APA], 1994) diagnosis was established by a multidisciplinary diagnostic team (ADHD diagnosis agreement kappa = .88). On cases where consensus was not achieved, they were excluded from the participant pool, and this became the clinical referred control group for the study.Results:The results indicated that children with ADHD and a co-occurring diagnosis of depression experience more difficulties with working memory abilities than those who do not have a co-occurring diagnosis of depression. Additionally, depression has a greater impact on verbal working memory in children with ADHD than anxiety does alone. This study also found that there were no significant gender differences between children with ADHD who identify as males and females on verbal or visual working memory tasks.Conclusions:The findings of this study indicate the importance of addressing depressive symptoms in children with ADHD. With a holistic understanding of working memory deficits in children with ADHD as well as potential gender differences, caretakers and providers can integrate more effective intervention plans to help mitigate significant working memory deficits.

Foster Parents’ Withdrawal of Childcare for Unaccompanied and Separated Children from Meheba Refugee Settlement in Kalumbila District, Zambia

Zambia has been hosting refugees of different nationalities in the various refugee settlements across the country namely Meheba refugee settlement, Mantapala refugee settlement and Mayukwayukwa settlement. With the influx of asylum seekers entering the country, there arises an occurrence of children arriving in the country without biological parents nor legally recognized guardians. This category of children is referred to as unaccompanied and separated children (UASC). The Zambian governments laws, regional guidelines and international laws maintain that each abandoned, unaccompanied and separated children, their safety and wellbeing should be guaranteed. Protection of these children in Meheba settlement has been through an approach known as foster care. However, there reported incidences of foster parents handing back unaccompanied and separated children to MCDSS living children without parental support or protection contrary to the Child Code Bill of 2022 for Zambia, UN general assembly, Refugee Act of 2017, National Framework for the Care of Children in Need of Care, 2019. Therefore, the intent of the study was to understand the causes of foster parents withdrawing the required parental care for UASC and explore approaches to improve childcare provided by foster parents to them in Meheba settlement. The study established that there were various gaps in the childcare procedures which include, noncompliance, inadequate monitoring, inadequate data management, flaws in case management, support for caregivers, training for caregivers. Recommendations include strengthening the referral and monitoring mechanisms in case management, childcare agencies to upsurge support for community structures and foster parents, improvement of training and sensitization to foster parents, prospective parents and community workers, orientation on UASC on her rights and responsibilities and the department of social welfare to develop a framework to make foster parents accountable.

41 Examining the independent and additive effects of family history of dementia and apolipoprotein e4 on neurocognitive performance among people with HIV

Objective:Among people with HIV (PWH), the apolipoprotein e4 (APOE-e4) allele, a genetic marker associated with Alzheimer’s disease (AD), and self-reported family history of dementia (FHD), considered a proxy for higher AD genetic risk, are independently associated with worse neurocognition. However, research has not addressed the potential additive effect of FHD and APOE-e4 on global and domain-specific neurocognition among PWH. Thus, the aim of the current investigation is to examine the associations between FHD, APOE-e4, and neurocognition among PWH.Participants and Methods:283 PWH (Mage=50.9; SDage=5.6) from the CNS HIV Anti-Retroviral Therapy Effects Research (CHARTER) study completed comprehensive neuropsychological and neuromedical evaluations and underwent APOE genotyping. APOE status was dichotomized into APOE-e4+ and APOE-e4-. APOE-e4+ status included heterozygous and homozygous carriers. Participants completed a free-response question capturing FHD of a first- or second-degree relative (i.e., biologic parent, sibling, children, grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling). A dichotomized (yes/no), FHD variable was used in analyses. Neurocognition was measured using global and domain-specific demographically corrected (i.e., age, education, sex, race/ethnicity) T-scores. t-tests were used to compare global and domain-specific demographically-corrected T-scores by FHD status and APOE-e4 status. A 2x2 factorial analysis of variance (ANOVA) was used to model the interactive effects of FHD and APOE-e4 status. Tukey’s HSD test was used to follow-up on significant ANOVAs.Results:Results revealed significant differences by FHD status in executive functioning (t(281)=-2.3, p=0.03) and motor skills (t(278)=-2.0, p=0.03) such that FHD+ performed worse compared to FHD-. Differences in global neurocognition by FHD status approached significance (t(281)=-1.8, p=.069). Global and domain-specific neurocognitive performance were comparable among APOE-e4 carriers and noncarriers (ps>0.05). Results evaluating the interactive effects of FHD and APOE-e4 showed significant differences in motor skills (F(3)=2.7, p=0.04) between the FHD-/APOE-e4+ and FHD+/APOE-e4- groups such that the FHD+/APOE-e4- performed worse than the FHD-/APOE-e4+ group (p=0.02).Conclusions:PWH with FHD exhibited worse neurocognitive performance within the domains of executive functioning and motor skills, however, there were no significant differences in neurocognition between APOE-e4 carriers and noncarriers. Furthermore, global neurocognitive performance was comparable across FHD/APOE-e4 groups. Differences between the FHD-/APOE-e4+ and FHD+/APOE-e4- groups in motor skills were likely driven by FHD status, considering there were no independent effects of APOE-e4 status. This suggests that FHD may be a predispositional risk factor for poor neurocognitive performance among PWH. Considering FHD is easily captured through self-report, compared to blood based APOE-e4 status, PWH with FHD should be more closely monitored. Future research is warranted to address the potential additive effect of FHD and APOE-e4 on rates of global and domain-specific neurocognitive decline and impairment over time among in an older cohort of PWH, where APOE-e4 status may have stronger effects.

Frequency of family mealtimes in foster and kinship families

Eating meals as a family is connected to positive mental and physical health of children and parents. However, studies in this area are limited to families with biological parents as caregivers. This ignores millions of children in foster and kinship families, many of whom have experienced trauma and may benefit from consistent mealtimes. Using a merger of the 2017–2019 National Survey of Children’s Health, we examined the frequency of family meals between a random sample of children living with a biological parent and those living with foster and kinship families (n = 81,562). We also explored predictors, including child special healthcare needs, of more frequent mealtimes for children living with foster and kinship families (n = 3,358). Results showed that 79 % of foster families ate together most days of the week, and that biological and kin families ate together less frequently. Interaction effects showed foster families caring for children with special needs were at 2.8 greater odds of more frequent mealtimes than children with special needs in kin or grandparent families. Further research is needed to explore how foster parents create the time and space to eat consistent meals, and how those strategies translate to families in the general population.

Foster Care Being a Second Home for Abandoned Children: An Analysis on Cathy Glass’s Saving Danny.

This paper explores the role of foster care as a secondary home for abandoned children and its significance in fulfilling the developmental needs of these youngsters. As biological parents seek support, recovery, and therapy, foster care offers a secure refuge for children and adolescents. Abuse and neglect often necessitate the removal of children and teenagers from their homes, making it imperative to find a secure environment for them. Foster care serves as a refuge for children and teenagers in need, even though it might be challenging to perceive it as a stable environment at first glance. The act of uprooting children from their homes may seem unsettling, but for those who have experienced abuse or neglect, foster care offers a stable and supportive home setting. Foster families provide essential elements like education, meals, shelter, and access to healthcare, which these children may have lacked before entering foster care. This, in turn, positively impacts their physical, mental, and emotional well-being. Additionally, foster care can provide biological parents with an opportunity to focus on establishing a stable home environment where their children can eventually return. This research draws inspiration from Cathy Glass's "Saving Danny," a powerful narrative. Cathy Glass is a prolific author with a portfolio of 34 books, each of which offers valuable insights into the lives of children in foster care. Through the lens of Cathy's experiences as a foster carer, these stories shed light on the challenges these vulnerable children face and how a nurturing and loving environment can help them overcome these obstacles.

A sensory signature of unaffected biological parents predicts the risk of autism in their offspring.

Despite the emphasis on sensory dysfunction phenotypes in the revised diagnostic criteria for autism spectrum disorder (ASD), there has been limited research, particularly in the field of neurobiology, investigating the concordance in sensory features between individuals with ASD and their genetic relatives. Therefore, our objective was to examine whether neurobehavioral sensory patterns could serve as endophenotypic markers for ASD. We combined questionnaire- and lab-based sensory evaluations with sensory fMRI measures to examine the patterns of sensory responsivity in 30 clinically diagnosed with ASD, 26 matched controls (CON), and 48 biological parents for both groups (27 parents of individuals with ASD [P-ASD] and 21 for individuals with CON [P-CON]). The ASD and P-ASD groups had higher sensory responsivity and rated sensory stimuli as more unpleasant than the CON and P-CON groups, respectively. They also exhibited greater hemodynamic responses within the sensory cortices. Overlapping activations were observed within these sensory cortices in the ASD and P-ASD groups. Using a machine learning approach with robust prediction models across cohorts, we demonstrated that the sensory profile of biological parents accurately predicted the likelihood of their offspring having ASD, achieving a prediction accuracy of 71.4%. These findings provide support for the hereditary basis of sensory alterations in ASD and suggest a potential avenue to improve ASD diagnosis by utilizing the sensory signature of biological parents, especially in families with a high risk of ASD. This approach holds promising prospects for early detection, even before the birth of the offspring.

Is blood thicker than water? Perceptions on the role of stepparents in medical decisions among minors.

Alternative family configurations are becoming more prevalent, yet current legislative statutory does not support stepparents in medical decisions for their stepchildren. We investigate opinions of Belgian and Dutch adults regarding inclusion of stepparents in medical decision-making in minors. We make two observations. First, participants wanted stepparents to be involved in cases when medical information had to be shared or informed consent signed. Second, when stepparents object against previously approved medical interventions by a biological parent, respondents were less likely to support stepparents. Participants with stepchildren were likely to favour inclusion of stepparents in decision-making. Overall, our findings indicate that Belgian and Dutch adults view stepparents as potential executive actors in medical decision-making for minors, but not as primary decision-makers. This study is a first step in showing to what extent stepparents could be included in medical information and decision-making regarding stepchildren. We reflect on these findings in light of implications for medical practice and legislative shortcomings.

Perspectives and factors associated with informal human milk sharing: a mixed-methods systematic review protocol

Background The practice of informal human milk sharing is a relatively new phenomenon and poses significant questions in the domain of infant feeding. Informal human milk sharing is a means of donating human milk from another lactating individual who is not the child’s biological parent, in a casual manner, that is, without the involvement of health professionals or agencies. The advent of digital technology has facilitated the donation and receipt of human milk through digital online platforms and thus has amplified this modern practice. This research aims to comprehensively examine and synthesize evidence about the motivations, barriers, facilitators and experiences of individuals who both donate (donors) and the primary care givers of the infants who receive (recipients) human milk informally to provide to infants. Methods A mixed-methods systematic review will be undertaken. This review will consider qualitative, quantitative and primary mixed-methods studies which report on the factors associated with informal milk sharing, and on donors’ and recipients’ experiences of the practice. Primary mixed-method studies will be included if the individual qualitative and quantitative components can be extracted. Five databases will be searched for studies on informal human milk sharing published from inception of the database. Study quality will be evaluated using the standardized JBI critical appraisal tools, selected based on the methodology in each individual study. Data extraction will be conducted using the JBI mixed methods data extraction form followed by data transformation, synthesis and integration. This mixed-methods systematic review will follow a convergent integrated approach in accordance with JBI guidance. Discussion Informal human milk sharing is a novel practice in the domain of infant feeding. This review will enable a thorough understanding of this practice from both the donors and recipients’ perspective and will have implications for healthcare professionals, policy and future clinical decision-making. Protocol registration number PROSPERO CRD42023405653

Grandparental income and adverse neonatal outcomes in Finland in 2000 − 2015

Abstract Background Pre-term births and other adverse neonatal outcomes are a major burden to healthcare systems, and they also contribute to long-term health problems. Socioeconomic inequalities in these outcomes are well-documented, but whether grandparental characteristics influence them over and above parental characteristics remains unclear. Methods We used population register data on all singleton children of non-migrant origin, born in Finland in 2000 − 2015 (n = 341,715), linked to their both biological parents and all four grandparents, including an indicator for deceased kin members. We examined whether grandparental income predicted grandchildren's neonatal outcomes (preterm birth, low birth weight, small for gestational age, congenital malformations) in addition to parental income, once accounting for sociodemographic family characteristics such as parental age, parity, education, family structure, and maternal smoking. Results We found a consistent association between lower income and adverse neonatal outcomes, for both mothers and fathers, as well as maternal and paternal grandparents. The gradient was stronger among young mothers (under age 25), e.g., the prevalence of being born small for gestational age was 11% for the highest parental or grandparental income quintile, while for the lowest it ranged from 13 to 15%. Overall, the income gradients clearly attenuated in adjusted models, but remained. Preliminary results suggest grandparental characteristics mainly influence grandchild outcomes through the middle generation, but depending on the outcome, partly independent associations remain. Conclusions Even in the context of a Nordic welfare state, offspring of lower income grandparents are at higher risk of adverse neonatal outcomes, particularly when born to young mothers. This influence mainly, but not fully, passes through the parental generation, suggesting more support should be offered to expecting parents with low income and from disadvantaged backgrounds. Key messages • Lower grandparental income predicts higher risk of adverse neonatal outcomes, particularly when born to young mothers. • Expecting parents with low income and disadvantaged family background should be supported to reduce adverse neonatal outcomes.

Sibling complexity and psychiatric disorders in late adolescence among the Finnish 2000 birth cohort

Abstract Background Due to the increasing family instability and multipartner fertility in Western countries, more children have half- and stepsiblings. While numerous studies link family instability and complexity with mental health problems, the focus has typically been on the parents while a small but growing literature suggest that sibling constellations with half- and stepsiblings may also be important for adolescent mental health. Methods This study is based on administrative register data of all children born in Finland in 2000 and residing there at ages 0 − 15 (n = 56,372). We identified the biological parents, their cohabiting partners, and any full, half and step siblings that the index child has from birth to age 15. We used Cox proportional-hazards models to compare differences in psychiatric disorders from age 16 to 19 for boys and girls by different sibling constellations. Psychiatric disorders were identified as any disorders treated in specialized outpatient or hospital care (n = 7,999). Results Almost one in five children in the birth cohort had a cohabiting half sibling and almost 4% had a step sibling. Psychiatric disorders in late adolescence were more prevalent among children in different sibling compositions with half or step siblings. For example, the preliminary results show that adjusting for confounders such as socioeconomic status and living with both biological parents or not, boys and girls with an older half sibling had a 44% (95% confidence interval 34-55) higher risk of psychiatric disorders when compared to children with biological siblings only. The corresponding difference in risk for those with younger half siblings was 24% (11-55). Conclusions Psychiatric disorders were more prevalent in late adolescence among children with half and/or step siblings. Future studies on family complexity are likely to benefit from including information on sibling characteristics in addition to those of the parents. Key messages • Adolescents growing up with half or stepsiblings had a higher prevalence of psychiatric disorders in late adolescence. • More studies on sibling composition and adolescent psychiatric disorders are needed to inform the type of supportive measures that may benefit children living with half and stepsiblings.

Parental education, ADHD in family and ADHD diagnosis incidence in Finnish children and adolescents

Abstract Background Lower parental education is linked to higher incidence of attention-deficit hyperactivity disorder (ADHD) diagnosis in offspring, as is having ADHD in family, but these associations are rarely studied together. We examined whether parental education predicts offspring ADHD diagnosis differently for children and adolescents with or without ADHD family members. Methods We used Finnish total population register-based data on individuals born between 1994-2003 with non-migrant background. We followed 228,247 boys and 217,866 girls for first ADHD diagnosis, measured from health care or medication registers, in childhood (4-12) and adolescence (13-17), and identified ADHD for biological parents or full siblings. We used Poisson regression to examine differences in diagnoses separately by offspring sex and age group. Results Preliminary results show that boys are more often diagnosed for ADHD in childhood and girls in adolescence, but incidence is higher for boys in both age groups. Among boys and girls without ADHD family members, lower parental education is associated with higher incidence in both childhood and adolescence. Among those with ADHD family members, lower parental education predicts higher incidence in childhood, but in adolescence the differences by parental education even out for boys, and for girls, higher parental education predicts higher incidence. Conclusions While lower parental education predicts higher ADHD diagnosis incidence in general, for adolescents in ADHD families, higher parental education seems to increase the likelihood of getting diagnosed -particularly for girls. This suggests that adolescents in ADHD families with lower parental education may remain without ADHD diagnosis if they are not diagnosed as children. Support measures should be developed to ensure equal access to diagnosis and care irrespective of age, gender and family background. Key messages • Lower parental education predicts higher ADHD diagnosis incidence in general. Yet, adolescents in ADHD families with lower educated parents may remain underdiagnosed. • Support measures should be developed to guarantee equal access to ADHD diagnosis and care regardless of family background.

NEPOTISM AS A PHENOMENON OF UKRAINIAN INGUOMENTALITY (BASED ON THE MATERIAL OF RITUAL SONGS)

The presented research is dedicated to the study of the tradition of nepotism in various rituals of both ritual cycles: family and calendar. Taking into account the fact that there is no single point of view among historians, cultural scientists and ethnologists on the understanding of the origins of nepotism, we included in the analysis the texts of ritual songs, in particular, christening songs, which contain information about godfathers, attitudes towards them, characterized their moral qualities and relationships between them. The purpose of the study was to analyse the texts of folk songs, which reveal the ancient folk tradition of nepotism among Ukrainians. The object of our attention was the phenomenon of nepotism, that is, the presence of them in separate rituals of the family and calendar cycle. The subject was the characteristics of godparents and the relationship between them, the attitude towards the godparents of godchildren, etc. In the process of working with the texts of ritual songs, we used the methods of induction and synthesis, descriptive and comparative methods, as well as the method of contextual and interpretive analysis of folklore texts. The etymology of the words kum and kuma confirms the information that most of the rites of the family cycle were purely female. Ethnographic materials testify to the importance and necessity of the presence of them in the christening ritual. After the christening ritual in the church, the organizers of the festive dinner could be both the parents of the newborn child and the godfather and godmother. At dinner, the main ones were the midwife and godparents, they were the ones who sang majestic songs. Taking into account the fact that the godfather and godmother were chosen for the child with the aim and the possibility of fully duplicating the duties of the biological parents in case of misfortune with the latter, in ancient times sexual relations between godfathers were not condemned, as between a real husband and wife. As a result of the research, we came to the following conclusions: the tradition of nepotism in family rites was primary; in calendar – secondary. Grooming in the broadest sense involved the establishment of family or blood relations; in a narrow way – duplication of married life in all its manifestations as a result of imitative magic, in which the ancestors believed. Godfathers were treated with great respect, even more than biological parents. Folk songs about godparents that have come down to our times record a later period when they were honoured and glorified, and intimate relationships between godparents were condemned.

Reframing as recourse: How women approach and initiate the end of fertility treatment

Hopeful parents facing infertility dedicate significant sums of money, not to mention time, energy, and their own bodies, in the pursuit of biological parenthood via assisted reproductive technology (ART). Yet because the success rate of ART varies depending on a range of factors and resources remain finite, many undergoing treatment will not manage to biologically conceive. How do people who do not conceive with ART come to terms with this reality and the possibility that they may need to walk away from future treatments? Supplementing prior research that explores why women end treatment and what makes it difficult, this study draws upon 23 semi-structured, in-depth interviews to examine how women diagnosed with infertility consider and/or initiate discontinuation of treatment aimed at biological reproduction. I find that women employ three core reframing strategies as they approach the end of treatment: broadening their anticipatory future, adjusting their investment logic, and recentering and decentering the self. These rhetorical techniques not only illuminate the evolving interpretive work that undergirds the process of discontinuation, but also constitute a key mechanism facilitating the ending of treatment—linking cognition with social action and shedding light on the mechanics of decision reversals. Moreover, the practice of reframing challenges the pervasive assumption that discontinuation is wholly or chiefly disempowering to women.