Parenting Difficulties Research Articles

Difficulties and Psychological Experiences of Parents of Children with Autism Spectrum Disorders (ASD): A Cross-Sectional Study

Introduction: Autism spectrum disorders are brain development disorders with multifactorial etiology, identified by difficulties in communication and social interrelation, like recurrent and stereotyped attitudes, activities, and interests. Families with children with developmental disorders may experience more difficulties than families with children without disorders. Therefore there is a need Finding ways to reduce or manage parental stress for improve the family's quality of life through the evaluation of the causes. This study aims to analyze the difficulties experienced by caregivers and the perceived inclusion and inclusion of parents and children with autism spectrum disorder (ASD) within the social fabric, thereby examining the difficulties parents face in daily life. Materials and Methods: A cross-sectional study was conducted online through snowball sampling until data saturation from November 2020 - March 2023, through the administration of an online questionnaire made through a Google form and disseminated through social media. Data analysis using the Statistical Package for Social Science (SPSS) Software version 17. Results: 404 parents of children with ASD 94.8% of whom are mothers with an average age of 40.23 years. The prevalence of parents correctly defined autism as "a neurodevelopmental disorder characterized by difficulties in social interaction and communication, limited interests, and repetitive behaviors". At final diagnosis, the study results reported for 87.9% of parents sadness and grief at diagnosis, followed by fear (83.9%). Conclusions: Research in this area is critical as it can assist health care providers and scholars in understanding the unique issues parents face in raising a child with ASD, as well as support parents themselves in identifying factors that contribute to their stress level in order to take the right steps to reduce it and improve their overall well-being.

Long-Term Effectiveness of Off-Label Risperidone Treatment in Children and Adolescents: A Randomized, Placebo-Controlled Discontinuation Study.

Objectives: Risperidone is commonly prescribed off-label in children and adolescents to manage disruptive behavior. This study aimed to investigate continued benefits of risperidone after at least 1 year of treatment and effects of discontinuation on physical health. Methods: Thirty-five youths (aged 6-18 years, intelligence quotient [IQ] >70) who were treated with risperidone for at least 1 year in regular clinical practice receiving outpatient care were randomly assigned to double-blind continuation of risperidone during 16 weeks or continuation for 2 weeks, gradual dose lowering over 6 weeks, and placebo for 8 weeks. Primary outcome was the total Disruptive Behavior (D-total) score of the parent-reported Nisonger Child Behavior Rating Form-Typical IQ (NCBRF-TIQ). Secondary outcome measures were the clinician-rated Clinical Global Impressions-Improvement scale (CGI-I), the parent, child, and teacher-rated Strengths and Difficulties Questionnaire (SDQ), the parent-rated Retrospective Modified Overt Aggression Scale (R-MOAS), and several health parameters (Udvalg for Kliniske Undersøgelser Side Effect Rating Scale [UKU-SERS], dyskinesia, akathisia, parkinsonism, body mass index (BMI), waist circumference, and laboratory outcomes). Mixed models for repeated measures were conducted for continuous outcomes and a chi-square test for the CGI-I. Results: Discontinuation of risperidone, as compared with continuation, was not associated with significant changes in parent-reported disruptive behaviors. However, discontinuation was related to significant deterioration in parent-rated verbal aggression, teacher-rated behavioral functioning, clinician-rated general functioning, and significant improvements in weight, BMI, waist circumference, and glucose, insulin, and prolactin levels. Although 56% of participants in the discontinuation group experienced relapse, causing premature withdrawal from the study, 44% was able to successfully discontinue risperidone. Conclusion: Discontinuation of risperidone was associated with deterioration on some, but not all behavioral measures according to this explorative study. Discontinuation was associated with important health gains. Despite long-term benefits of risperidone, attempts to withdraw risperidone should be undertaken in individual children. This is a crucial step in preventing harm and fostering health.

The impact of family communication patterns on parent-child attachment and child quality of life

IntroductionPrevious research has demonstrated stable patterns of family communication. The Revised Family Communication Pattern Instrument (RFCP) is a common measure of these patterns. It posits two orientations: conformity orientation, characterized by a tendency to seek agreement within the family and by authoritarian decision-making; and conversation orientation, characterized by shared decision-making with the child and frequent family discussion.ObjectivesThe primary aim of our research was to adapt the RFCP questionnaire to the Hungarian language. Based on previous research, we hypothesized a negative relationship of conversation orientation and a positive relationship of conformity orientation with parents’ mentalizing problems, parental stress and burnout. According to our hypothesis, conformity orientation would predict both attachment anxiety and avoidance, whereas conversation orientation would decrease attachment anxiety.MethodsParents of children aged 6–17 (N=269, female=86,2%, mean age=42,64 [SD=6,10] yrs) completed the following online questionnaires: Child Quality of Life Questionnaire (ILK) parent version, Reflective Function Questionnaire (RFQ-8), Experiences of Close Relationships Questionnaire (ECR-RS), Parent Burnout Questionnaire (PBA-HUN), Perceived Stress Questionnaire (PSS) and the RFCP instrument. We conducted a confirmatory factor analysis. Linear regression analyses predicting attachment anxiety and avoidance included two factors of the RFCP, the RFQ-8, the PBA-HUN, and the PSS total score, as predictors. In addition, two factors of the ECR-R were included in the linear regression analyses predicting quality of life.ResultsThe confirmatory factor analysis confirmed the original two-factor structure of RFCP (χ2=5482.21, df=325 p< .001, χ2/df=16.86, CFI=0.91, TLI=0.90, RMSEA=0.075 (90% CI 0.068–0.082)) and their internal reliability (Cronbach’s alpha = .78 and .74). Attachment avoidance (R2=0.12, F(5)=7.38, p< .001) was only predicted by conversation orientation (β=−0.28, p< .001), while attachment anxiety was predicted (R2=25.2, F(5)=17.7, p< .001) by conformity orientation (β=0.24, p< .001), parental mentalization difficulties (ß=0.20, p< .001) and parenting stress (β=0.15, p= .015). Parental report of the child’s quality of life was predicted most strongly by attachment anxiety (β=−0.28, p< .001), followed by conversation orientation (β=0.21, p< .001) and attachment avoidance (β=−0.18, p< .001, R2=28.8, F(7)=15.17, p< .001).ConclusionsThe Hungarian version of the RFCP questionnaire has proven to be a reliable questionnaire. The importance of family communication patterns is demonstrated by the fact that it explains both the quality of parent-child attachment and the parent’s report on the child’s quality of life.Disclosure of InterestNone Declared

Risk of child sexual abuse: A mixed-methods analysis of judicial decisions in the Youth Court of Québec

In Québec, Canada, the Youth Protection Act allows child protection services to intervene in situations of serious risk of sexual abuse. Although the litigation of these cases is frequent, few studies have focused on the decision-making process of judges in Youth Court. The present study aims to document the criteria used by the judges to substantiate allegation of serious risk of sexual abuse and to render a placement order. Using a sequential explanatory mixed-method design, we analyzed 104 judicial decisions of the Youth Court of Québec between January 2016 and January 2023 involving a situation of risk of sexual abuse in families with children aged 0 to 12 years. The quantitative phase of the study revealed that psychosocial difficulties of children and parents, as well as the number of reasons for intervention are associated to a placement order. Based on a thematic analysis (n = 24), the qualitative phase of the study highlighted three main types of criteria used by the judges to substantiate allegation of serious risk of sexual abuse: 1) the vulnerability of the child; 2) the characteristics of the family system; and 3) the parents' compliance with external demands.

Association between Psychological Aspects and Coping Strategies among Mothers of Children with Cancer

Background: Providing care for a child diagnosed with cancer presents significant emotional and psychological difficulties for parents, especially mothers. Objective: The study investigates association between psychological aspects and coping strategies among mothers of children with cancer. Materials and Methods: A Correlational study was undertaken at the Middle Euphrates Cancer Center in Al-Najaf Al Ashraf Governorate from July 31th, 2022, to September 28th, 2023. The questionnaire's validity was ensured through expert consultation, and its reliability was established through a preliminary pilot study. Data were collected by structured interviews using the questionnaire and subjected to thorough analysis employing both descriptive and inferential statistical methods. Results: The findings of this study show that a significant percentage (54.9%) of mothers with children diagnosed with cancer are experiencing significant psychological distress. Moreover, a substantial number (58.8%) of these mothers are using coping strategies that are not very effective. The study also reveals a strong, negative correlation between the psychological well-being of these mothers and their coping strategies, particularly in areas such as family integration (r = -.445; p < 0.01), social support (r = -.353; p < 0.01), communication with healthcare professionals (r = -.522; p < 0.01), and overall coping (r = -.624; p < 0.01). Conclusions: The study highlights the alarming prevalence of psychological distress among mothers with children diagnosed with cancer and underscores the ineffectiveness of many coping strategies employed by these mothers. It is recommended that healthcare professionals and support organizations prioritize the provision of tailored psychological support and social support networks to alleviate the psychological burden faced by these mothers.

Effectiveness of an online intervention for parents/guardians of children aged 4–7 years who are concerned about their child’s emotional and behavioural development: protocol for an online randomised controlled trial (EMERGENT study)

IntroductionThe demand for resources to support emotional and behavioural development in early childhood is ever increasing. However, conventional interventions are lacking in resources and have significant barriers. The Embers the...

Stigma and anxiety and depressive symptoms in parents of sexual and gender minority youth.

Parents of sexual and gender minority (SGM) youth play an important role in supporting their SGM child's mental health in the face of stigma. Yet, parents of SGM youth may themselves experience stigma, including discrimination/rejection, and its emotional consequences, including vicarious stigma and shame. The present cross-sectional study leveraged a national sample of parents of SGM youth to investigate associations between parents' stigma experiences and self-reported anxiety and depression symptoms. Further, we additionally explored sociodemographic and contextual correlates of parents' stigma experiences. Participants included 264 parents (Mage = 46) who reported having at least one SGM child under age 30 (Mage = 18). The Lesbian, Gay, Bisexual-Affiliate Stigma Measure (LGB-ASM) assessed parents' experiences of discrimination/rejection (e.g., actual and anticipated rejection experiences due to having an SGM child), vicarious stigma (e.g., worry and concern for one's SGM child), and shame (e.g., feeling embarrassed for having an SGM child). Parents indicated their anxiety and depressive symptoms using respective Patient-Reported Outcomes Measurement Information System-short forms. Results showed that vicarious stigma and shame, but not discrimination/rejection, were uniquely associated with parents' increased symptoms of anxiety (vicarious stigma: β = 1.59, p < .001; shame: β = 2.15, p < .001) and depression (vicarious stigma: β = 0.90, p < .01; shame: β = 2.77, p < .001). Further, parents with more accepting religious, racial, ethnic, and/or cultural communities reported lower stigma experiences. This study advances understanding of how the psychological consequences of stigma extend beyond SGM people themselves and contribute to mental health difficulties in parents of SGM youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parental mental health and reporting of their child's behaviour: measurement invariance of the French version of the parental strengths and difficulties questionnaire.

Symptomatic effects of mental disorders in parents could bias their reporting on their child's mental health. This study aimed to investigate the measurement invariance of the French version of the parental Strengths and Difficulties Questionnaire (SDQ) across parental mental health in a sample (N = 20,765) of parents of children aged 3 to 17years in France. Confirmatory factor analysis (CFA) and Exploratory Structural Equation Modelling (ESEM) were used to evaluate the fit of three known alternative SDQ factor structures (five, three, or second-order factor structures). Invariance was tested across parental mental health (present anxiety and depressive symptoms, psychiatric history) and across socio-demographic characteristics (child's age, child's gender, parent's gender, parent's educational level). CFA models showed a poor fit, while all ESEM models achieved acceptable or good fit, with the five-factor model presenting the best fit. Invariance was observed for all characteristics tested, indicating that the SDQ can be used to study the links between parental mental health and their child's mental health without bias. However, ESEM showed that the hyperactivity/inattention and conduct problems dimensions were not well differentiated in the French version of the SDQ.

Children's behavioural and emotional wellbeing during the COVID-19 pandemic: Findings from the Born in Bradford COVID-19 mixed methods longitudinal study.

The COVID-19 pandemic led to a multitude of immediate social restrictions for many across the world. In the UK, the lives of children and young people were quickly impacted when COVID-19 restrictions led to school closures for most children and restrictions on social interactions. The Born in Bradford COVID-19 longitudinal research study explored the impact of the COVID-19 pandemic on the lives of children and their families living in Bradford. Surveys were administered during the first wave of the pandemic (March to June 2020) and compared to findings from before the pandemic. The current study examined the social and emotional wellbeing of children from before to during the pandemic, measured using the parent completed Strengths and Difficulties questionnaire (SDQ). Regression analyses looked at associations between a range of social determinants of health and changes in SDQ scores. The results showed that those children most likely to experience difficulties during the pandemic were boys, younger children, those from White British ethnicity (compared to Pakistani heritage children) and those living in the most deprived areas. There were associations between experiencing difficulties and: food insecurity; financial worry; getting below recommended levels of physical activity; and having less than the recommended amount of sleep. The effect of COVID-19 restrictions are likely to have had negative consequences on children that could, in time, have long-lasting impacts on the health, wellbeing and development of children in the UK.

Comparisons of clinical subtypes, symptom severity, global functioning, emotional and behavior problems, and CPT test profiles in children and adolescents with ADHD with and without co-occurring internet gaming disorder

Objectives This study aims to assess whether the presence of Internet Gaming Disorder (IGD) is associated with disease severity, Attention Deficit Hyperactivity Disorder(ADHD) presentation, emotional problems, behavioral problems, and CPT profile in patients with ADHD. Method Forty children with IGD and sixty-four patients without IGD were included in the study, all of whom had a diagnosis of ADHD. Comorbid psychiatric disorders were determined using The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Conners’s Parent Rating Scale-Revised Short form (CPRS-RS), The Strengths and Difficulties Questionnaire (SDQ), Internet Gaming Disorder Questionnaire (IGD-20), and MOXO Continuous Performance Test (MOXO d-CPT) were performed on the children, and Clinical Global Impression (CGI), Children’s Global Assessment Scale (CGAS), comorbidities and ADHD presentations were evaluated. Results The IGD group was found to have the combined presentation of ADHD more commonly, and their CGI, CGAS, SDQ behavior problems subscale, cognitive problems, attention problems, and ADHD index in the CPRS-RS questionnaire were found to be higher (p < 0.05). No differences were found in attention, timing, impulsiveness, and hyperactivity scores in CPT between groups (p > 0.05). Conclusion Our study has shown that children with both ADHD and IGD had more severe symptoms, more behavioral problems, and differences regarding the prevalence of the ADHD presentations when compared to children having ADHD without IGD. Longitudinal studies with higher sample sizes are required to investigate this possible connection in the context of a cause-effect relationship and draw a conclusion.

Home or away? The relation between open or closed educational frameworks, parental distress, and child difficulties in the context of armed conflict

ABSTRACT While Early Childhood Education and Care (ECEC) play a crucial role in children's and parents' ability to maintain routines, their impact during armed conflicts remains understudied. During a 10-day military operation in Israel involving missile launches, we conducted an online survey among parents of children aged 1–7, to assess the relationship between ECEC closures during the security threat and parental stress, family interactions, and children's difficulties. Among 146 families experiencing 'a few' alarms, results indicated that when ECEC were closed, parents reported increased distress, negative parent-child interactions, and heightened difficulties among children. Positive interactions and book readings, however, showed no significant differences. Additionally, linear regressions involving 474 parents revealed that open ECEC were associated with reduced distress, even when accounting for background characteristics and external threat levels. This underscores the importance of ECEC during stressful times, serving as a crucial 'buffer' to reduce stress at home and maintain a routine.

The Big Three Perfectionism Scale: Validation of the Polish Version

The Big Three Perfectionism Scale (BTPS) was created to integrate different aspects of perfectionism, including the newly conceptualized concept of narcissistic perfectionism. The goal of our two studies ( N = 1341) was to examine the psychometric properties of the Polish adaptation of the BTPS, supporting the validity and portability of the measure. The studies were conducted among people who had a child, thus contributing to a better understanding of parental perfectionism, one of the key factors influencing parental well-being and a child’s functioning. Our analyses included investigating the structure of the scale, intercorrelations between subscales, reliability, and convergent validity by correlating BTPS scores with other measures of perfectionism and correlates of psychopathology (borderline symptoms) and parental difficulties (parental stress and parental burnout). Results supported the structure of the original BTPS. As predicted, confirmatory factor analysis indicated that items comprising the Polish adaptation of the questionnaire, like the original version, measure three related but specific aspects of perfectionism: rigid perfectionism, self-critical perfectionism, and narcissistic perfectionism. The three dimensions were also found to be specifically related to the difficulties experienced by parents. Further, the Polish version of the BTPS was found to have good internal reliability and validity. Our results from two independent Polish samples suggest that the Polish version of the BTPS is a psychometrically robust measure of perfectionism for assessing the three perfectionism factors.

The effect of paternal anxiety on mother-infant bonding in neonatal intensive care

BackgroundThe hospitalization of a preterm infant in the NICU can lead to mental health difficulties in parents, but not much is known how paternal anxiety might affect the mother-infant relationship.MethodsThis prospective cohort study is a secondary analysis investigating how paternal anxiety levels might affect maternal bonding in the NICU using the dataset of the multinational pragmatic randomized controlled trial LongSTEP. A linear mixed-effects model was used for correlations of paternal anxiety (GAD-7) and maternal bonding (PBQ) at NICU discharge, and at 6 and 12 months infant corrected age. Secondary analyses examined effects on paternal anxiety related to: site (Argentina, Colombia, Israel, Norway, and Poland), maternal depression (EPDS), infant gestational age at birth, paternal age, and type of pregnancy.ResultsPaternal anxiety did not predict maternal bonding at NICU discharge (p = 0.096), at 6 months (p = 0.316), or at 12 months infant corrected age (p = 0.473). Secondary outcomes showed a statistically significant site effect, with higher paternal anxiety levels at the two Colombian sites at baseline (p = 0.014 and p = 0.020) and for one site at discharge (p = 0.012), but not for paternal age (p = 0.925 and p = 0.793), infant gestational age at birth (p = 0.974 and p = 0.686 and p = 0.340), or type of pregnancy (p = 0.381). Maternal depression predicted paternal anxiety at baseline (p < 0.001) and at discharge (p = 0.003).ConclusionsIn this study, paternal anxiety did not predict maternal bonding. Paternal anxiety varied by site, indicating a need for research on potential cultural differences in manifestation of paternal anxiety. Maternal depression predicted paternal anxiety, confirming a previously reported correlation. Further research on variations in paternal mental health in the neonatal period is warranted, as well as exploration of the social contagion of mental health in preterm parents.Trial registrationClinicalTrials.gov NCT03564184.

Association between maltreatment, hair cortisol concentration, positive parent-child interaction, and psychosocial outcomes in Chinese preschool children.

Children now are facing an increasing risk of early life stress (ELS), which leads to detrimental psychosocial outcomes. Behavior studies suggested that positive parental interactions might moderate the negative impact of ELS, but the related biological alteration remains unclear. This study aims to investigate whether positive parent-child interactions moderate the association between maltreatment (as a severe form of ELS) and hair cortisol concentration (HCC), as well as between HCC and psychosocial outcomes in young children. Participants were 6-year-old Chinese children (N = 257, Mage = 6.2, 121 were male) selected by stratified cluster random sampling from a Shanghai population representative cohort. Proximal 3cm hair strands were analyzed using liquid chromatography coupled with tandem mass spectrometry for HCC. Children's psychosocial outcome was evaluated using the parental report Strengths and Difficulties Questionnaire (SDQ). Parents also reported the frequency of positive parent-child interactions using the Chinese Parent-Child Interaction Scale (CPCIS) as well as the history of maltreatment. Multi-level logistic regression models adjusting for individual, kindergarten, and district confounders were used to evaluate the associations between maltreatment, HCC, and psychosocial outcomes. Interactions terms tested whether more frequent positive parent-child interactions moderates the association between maltreatment and HCC, as well as between HCC and psychosocial outcomes. Maltreated children exhibited higher levels of HCC (B = 1.20, 95% CI: 0.38,2.02; p = 0.004), and children with higher HCC exhibited poorer psychosocial outcomes (B = 0.34, 95% CI: 0.18,0.51; p < 0.001). Positive parent-child interactions did not have a moderating effect on the association between maltreatment and HCC, but they demonstrated a moderating effect on the association between increased HCC and psychosocial outcomes (interaction term: B = -0.42, 95% CI: -0.75,-0.10; p = 0.01). These findings provide evidence that positive parental interaction may serve as a moderator between chronic cortisol exposure and psychosocial problems. It highlights the importance of frequent parent-child interactions, especially among children under a high risk of ELS.

Effect of a Financial Education and Coaching Program for Low-Income, Single Mother Households on Child Health Outcomes.

The financial difficulties of parents have a negative impact on the health of their children. This problem is more pronounced in single mother families. There is limited research on low-income, single mothers and how interventions to help them address financial difficulties may also benefit their children. The purpose of this study was to evaluate the effect of a year-long financial education and coaching program on school absenteeism and health care utilization of children in employed, low-income, single mother households. This was a post hoc analysis of the Finances First study, a randomized controlled trial conducted in 2017-2020 examining the impact of a financial coaching and education program on economic stability and health outcomes in 345 low-income, single mothers. Either generalized estimating equations (GEEs) or generalized linear mixed models (GLMMs) were used to account for relationships between participants. For the continuous outcomes of child absenteeism, physician visits, emergency room visits, and hospitalization days, a linear mixed-effects model was used. The Finances First study demonstrated improvements in various financial strain measures. Compared to the control group, children of intervention group participants experienced 1 fewer day of school absence (p = 0.049) and 1 fewer physician visit (p = 0.032) per year, but no impact was seen on emergency room visits (p = 0.55) or hospitalizations (p = 0.92). Addressing social determinants of health in parents is necessary for improving child health outcomes.

Ethnic differences in parental experiences during the first six months after PICU discharge in Singapore: a qualitative study.

Literature on parental experiences after childhood critical illness has limited representation from diverse ethnic backgrounds. Parents from global ethnic majority groups have reported worst psychological outcomes and required more social support after childhood critical illness. To explore the experiences of Chinese, Malay, and Indian parents in the first six months after Pediatric Intensive Care Unit (PICU) discharge of their child in Singapore. Sequential semi-structured qualitative interviews were conducted to collect data from a convenience sample of 28 parents at one month (n = 28) and at six months (n = 22) after their child's discharge from a multidisciplinary PICU. Framework Analysis was adopted as the qualitative analysis strategy. The PICS-p framework was applied a priori in the Framework Analysis. Three interdependent domains and seven themes framed the 28 accounts in which ethnically diverse parents reported psychological stressors (PICS-p: emotional health), support received (PICS-p: social health) and practical challenges (transitional health) in the first six months after childhood critical illness. In the emotional health domain, parents were affected by different stressors and had different priorities over their child's survivorship. Only Indian parents reported experiences of stress symptoms, at six months post discharge. Malay parents sought solace from their religion more than Chinese and Indian parents. In the social health domain, parents reported various sources and degree of support received. Familial supports were strong across all groups, while community support was more prominent in Malay as compared to Chinese and Indian parents. A third domain, transitional health, was introduced to capture the difficulties parents faced during the transition from PICU survival to home. Parents from non-Chinese families were more likely to report financial challenges and more involvement of spouses after discharge. Complementary medicine or commercial health products were utilized by Chinese and Malay families. These findings reveal preferred strategies that parents from a global ethnic employ to address the emotional, social and transitional health impacts of their child's critical illness. Future care delivery may consider tailored care plans, communication strategies, and emotional support in PICUs that address the unique ethnic needs of parents during the critical six-months post their child's illness.

Psychological well-being and needs of parents and carers of children and young people with mental health difficulties: a quantitative systematic review with meta-analyses

QuestionFor parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need?Study selection and analysisMedline, PsycINFO, EMBASE, AMED, CINAHL,...

Broadening understanding of executive function in children with different hearing histories: The roles of fathers and coparenting

Fathers and family-level characteristics are understudied but potentially impactful contributors to at-risk outcomes for deaf and hard-of-hearing (DHH) children who use spoken language. We investigated associations between paternal parenting stress, paternal self-efficacy for supporting language, and executive function (EF) development in DHH children and children with typical hearing (TH). Main and moderating effects of the coparenting relationship were also investigated. TH fathers of DHH children (n = 44) and TH children (n = 46) completed the Parenting Stress Index-4-Short Form, the Scale of Parental Involvement and Self-Efficacy, and the Coparenting Relationship Scale. Child EF was assessed via the Behavior Rating Index of Executive Function. Regression analyses revealed that paternal parenting stress was significantly associated with child EF difficulties regardless of child hearing status. Coparenting undermining moderated relations between paternal parenting stress and child difficulties with inhibition in the full sample. Coparenting undermining was associated with greater child difficulties with set-shifting for DHH children only. Paternal parenting stress represents a possible risk factor for child EF development, particularly in families with higher levels of coparenting undermining. DHH children might also be susceptible to adverse coparenting relations. Fathers of DHH children have previously been shown to be less involved and integrated during intervention, and a better understanding of the important contributions fathers have to child development could lead to novel, father-embedded intervention models.

Establishment of the Norwegian hearing register for children.

The Norwegian Directorate of Health approved the Norwegian Hearing Register for Children in 2022. The main objective of the register is to improve the quality of treatment for children with permanent hearing loss, by measures, follow-ups and monitoring the quality and results of the health care system. Inclusion criteria are children who do not pass universal newborn hearing screening and/or children with permanent hearing loss <18 years of age. Hearing loss is defined as pure-tone audiometry threshold of (PTA4) > 20 dB in at least one ear. Data are registered at the Ear, Nose and Throat departments at inclusion and at follow-ups at the age of 3, 6, 10, and 15 years. The register collects information about the child within a holistic perspective. The key elements of the register are (a) data concerning newborn hearing screening; (b) data concerning hearing, medical information, hearing amplification and intervention (c) patient reported outcome measures registered by caregivers using three questionnaires; Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire and Parents' Evaluation of Aural/Oral Performance of Children. The register has established four quality indicators regarding newborn hearing screening and early intervention (a) the rate of false positive neonatal screens; (b) testing for congenital cytomegalovirus within 3 weeks of age for children who do not pass newborn hearing screening; (c) audiological evaluation to confirm the hearing status no later than 3 months of age and (d) initiated intervention within 3 months after confirmation of hearing status. The register will include the total population of hearing impaired children over long time periods. Thus, the register enables each hospital to monitor their quality indicator scores continuously and compare them with national levels in real time. This facilitates and accelerates identification of improvement areas in the hospitals and will be an important contributor for quality improvement in NHS, diagnostics and hearing intervention for children in Norway. In addition, data from the register will be a unique source for research, and study designs with a long follow-up time can be applied.

Predictors of parenting difficulties at the 18-month health checkups: A retrospective study using administrative data from infant health checkups.

This study aimed to identify predictors of parenting difficulties at 18 months from the results of the 4-, 6-7-, and 9-10-month infant health checkups among caregivers who had not experienced difficulties at 4 months. This retrospective study used data from infant health checkups conducted in a city in Tokyo from November 2019 to October 2021. The participants were caregiver-child dyads of children who had undergone four checkups. Low birthweight, preterm, and multiple birth infants, and caregivers who experienced difficulties at 4 months were excluded. Data included caregiver, child-rearing environment, and child factors at the 4-, 6-7-, and 9-10-month checkups and caregivers' self-reported parenting difficulties at the 18-month checkup. Of the 555 caregivers, 48 (8.6%) experienced parenting difficulties at 18 months. Logistic regression analyses showed that mothers' physical condition (4 months), children being male, abnormal child growth (4 months), less than 10th percentile for children's height (6-7 and 9-10 months), and abnormal examination results (6-7 months) were significantly associated with parenting difficulties at 18 months. To prevent child abuse, public health nurses should consider the identified factors to detect and support caregivers with emerging parenting difficulties.