Parent-child Interaction Problems Research Articles

Parent-Child Inpatient Treatment in Child and Adolescent Mental Healthcare: Predictors of Child Outcomes.

Family inpatient units in child and adolescent mental health (CAMH) services engage all admitted family members in the treatment of children's symptoms. Studies demonstrated improvements in child and family functioning following family inpatient treatment, but evidence regarding predictors of treatment outcome is lacking. We analyzed data of families (n = 66) who received a four-week inpatient treatment for families with severe parent-child interaction problems. Hierarchical linear regression analyses revealed that parents who recalled harsher parenting practices of their own fathers reported greater improvements in their children's externalizing and internalizing problems. Greater improvements in externalizing problems were further predicted by lower parental educational level, less adverse impacts of stressful life events, and less internalizing child problems prior to admission. We therefore conclude that family inpatient treatment was particularly effective for children in families with lower parental education and a history of harsh parenting.

Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project

BackgroundAfter the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child’s well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0–12 months).Methods/designIn this open, randomized controlled intervention trial 180 mother-infant-dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated.DiscussionThere is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This randomized controlled trial (RCT) represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centers in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help in developing preventive and therapeutic strategies for the fragmented German health care system.Trial registrationGerman Register for Clinical Trials, ID: DRKS00016353.

Parent–child inpatient treatment for children with behavioural and emotional disorders: a multilevel analysis of within-subjects effects

BackgroundThe importance of parental involvement in child treatment is well-established. Several child psychiatric clinics have, therefore, set up inpatient family units where children and parents are both actively involved in the treatment. Unfortunately, evidence supporting the benefits of these units is sparse.MethodsWe evaluated the effectiveness of inpatient treatment for families with severe parent–child interaction problems in a child psychiatric setting. Consecutive admissions to the parent–child ward (N = 66) were studied. A within-subjects design was used with four assessment points (baseline, admission, discharge, four-week follow-up). Outcome measures were 1) parent and teacher ratings of child behaviour, and 2) parent self-ratings of parenting practices, parental strains and parental mental health. Data were analyzed using multilevel modelling for longitudinal data (piecewise growth curve models).ResultsAll parent-rated measures improved significantly during the four-week treatment period (d = 0.4 – 1.3). These improvements were significantly greater than those observed during the four-week pre-admission period. In addition, benefits were maintained during the four-week follow-up period. Only parents’ self-efficacy in managing their child’s behaviour showed continued improvement during follow-up. Teacher ratings of children’s disruptive behaviour at school were stable during the pre-admission period and showed significant improvements at follow-up (d = 0.3 – 0.4).ConclusionsWe conclude that parent–child inpatient treatment has positive effects on child and parent behaviour and mental health, and can therefore be recommended for children with behavioural and emotional disorders and severe parent–child interaction problems.

Neurodevelopmental Profile, Growth, and Psychosocial Environment of Preterm Infants with Difficult Feeding Behavior at Age 2 Years

To examine the association of difficult feeding behaviors in very preterm infants at age 2 years with growth and neurodevelopmental outcomes and family factors and functioning. Eighty children born ≤30 weeks gestation were studied from birth until age 2 years. Feeding difficulties were assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment at age 2 years, along with growth measurement and developmental testing. Maternal mental health and family factors were assessed using standardized questionnaires. ANOVA and χ(2) analyses were performed to determine associations between feeding difficulties and growth, neurodevelopmental outcomes, and family characteristics. Twenty-one children (26%) were at risk for feeding difficulties, and an additional 18 (23%) had definite feeding difficulties at age 2 years. Those with feeding difficulties were more likely to be subject to a range of neurodevelopmental problems, including impaired cognition (P = .02), language (P = .04), motor (P = .01), and socioemotional (P < .007) skills. Compared with the parents of children with fewer feeding difficulties, parents of the children with feeding difficulties had higher parenting stress (P = .02) and reported more difficulty managing their child's behavior (P = .002) and more frequent parent-child interaction problems (P = .002). No associations were found between difficult feeding behaviors and growth, maternal mental health, or family factors. Difficult feeding behaviors in children born very preterm appear to be highly comorbid with other developmental and family challenges, including neurodevelopmental impairment and parent-child interaction difficulties. Focusing on improving feeding skills, in conjunction with supporting positive parent-child interactions, may be beneficial for improving outcomes.

Children of Mentally Ill Parents Participating in Preventive Support Groups: Parental Diagnoses and Child Risk

In the Netherlands, preventive support groups are offered to children of mentally ill parents. Given the variety of parental diagnoses it might be questionable if offering a standardized program for all these children is the most effective response. While no overall knowledge exists about the type of parental disorder and varying risk levels and support needs among the participating children, we examined whether there are differences between these children that are related to their parents’ diagnoses. With questionnaires we assessed risk factors in 122 mentally ill parents and their children: high parental illness severity, low perceived parental competence, parent–child interaction problems, poor family functioning, difficult child temperament, and low child competence. We also assessed the children’s psychosocial problems and negative cognitions about their parent’s illness. Results showed that most parents had co-morbidity (multiple diagnoses) and/or personality disorders. Children of parents with either of these conditions were more likely to be exposed to the risk factors: high parental illness severity, low perceived parental competence, problematic parent–child interaction, and low perceived child competence, compared to children of parents without these conditions. They were also faced with more risk factors and had more psychosocial problems and negative cognitions. From these results we may conclude that children of parents with co-morbidity and/or personality disorders require more extensive support than children of parents without these conditions. We suggest strengthening the children’s competence and involving parents as important focuses of preventive interventions for children at high risk. Longitudinal studies should test these assumptions.

Understanding the role parents play in tennis success: a national survey of junior tennis coaches

Objectives: To assess coaches’ perceptions about the role of parents and their positive and negative behaviours in junior tennis. Methods: A national survey of 132 United States junior tennis coaches...

Recherches concernant le comportement du nouveau-né prématuré

To examine the association of difficult feeding behaviors in very preterm infants at age 2 years with growth and neurodevelopmental outcomes and family factors and functioning.Eighty children born ≤30 weeks gestation were studied from birth until age 2 years. Feeding difficulties were assessed using the Eating Subscale of the Infant-Toddler Social Emotional Assessment at age 2 years, along with growth measurement and developmental testing. Maternal mental health and family factors were assessed using standardized questionnaires. ANOVA and χ2 analyses were performed to determine associations between feeding difficulties and growth, neurodevelopmental outcomes, and family characteristics.Twenty-one children (26%) were at risk for feeding difficulties, and an additional 18 (23%) had definite feeding difficulties at age 2 years. Those with feeding difficulties were more likely to be subject to a range of neurodevelopmental problems, including impaired cognition (P = .02), language (P = .04), motor (P = .01), and socioemotional (P < .007) skills. Compared with the parents of children with fewer feeding difficulties, parents of the children with feeding difficulties had higher parenting stress (P = .02) and reported more difficulty managing their child's behavior (P = .002) and more frequent parent–child interaction problems (P = .002). No associations were found between difficult feeding behaviors and growth, maternal mental health, or family factors.Difficult feeding behaviors in children born very preterm appear to be highly comorbid with other developmental and family challenges, including neurodevelopmental impairment and parent–child interaction difficulties. Focusing on improving feeding skills, in conjunction with supporting positive parent–child interactions, may be beneficial for improving outcomes.

PRENATAL ANTECEDENTS OF CHILD MALTREATMENT

Child maltreatment remains a major problem in the United States, the etiology of which is complicated by contributions from biological and social factors. To further clarify the antecedents of child maltreatment, 100 consecutive mothers seen in an urban community hospital obstetric clinic for indigent women (80% medicaid) were studied to determine prenatal and perinatal biological and social factors related to a subsequent report to a department of social services (DSS) for suspected child maltreatment. Fourteen mothers from this study group were referred to DSS before their child was 24 months old. Of the 24 variables assessed, 7 were associated with referral to DSS. 1) Maternal smoking during pregnancy, 2) C-section, 3) NICU admission, and prenatal maternal feelings of: 4) inadequate daily task-sharing among family members, 5) dissatisfaction with visits from extended family, 6) dissatisfaction with male support, 7) dissatisfaction with other support figures. An index was constructed with each of these factors scored “1” when present and “0” when absent. Using this index 86% of mothers referred to DSS vs 43% of mothers not referred to DSS had scores ≤ 3 (p<.01). These data support the findings of previous work on the antecedents of child maltreatment. They emphasize the relationship between prenatal maternal dissatisfaction with support networks, perinatal biological difficulties and subsequent parent-child interaction problems.

29 MATERNAL EMOTIONAL DEPRIVATION ASSOCIATED WITH LOW BIRTH WEIGHT

Early prenatal identification of the mother who is likely to produce a low birth weight (LBW) infant is difficult, but would be helpful in management. Thirty very low birth weight (VLBW, < 1500 grams) infant-mother pairs and 30 full-term controls (C) were selected sequentially over an 18-month period. They were matched by maternal age, parity and sex of infant. The Michigan Screening Profile for Parenting (MSPP, Helfer et al), which identified potential for problems in parent-child interaction, was administered to each mother at the time of the infant's discharge and again one month later. Preliminary analysis shows significant differences between VLBW's and C's: 1) 42% of VLBW mothers responded negatively or inconsistently to “Emotional needs met” (reflecting a non-nurturing upbringing) versus 19% of C's; 2) 21% of VLBW mothers reported poor relationships with their parents versus 6% of C's; 3) 17% of VLBW mothers had realistic expectations for their children, versus 44% of C's; 4) 29% of VLBW mothers reported a pregnancy interval of less than 1 year versus 7% of C's. 67 LBW's (1500-2500 grams) showed 38% with pregnancy interval less than 1 year, and 45% with psychosocial problems. These results suggest that knowledge of emotional deprivation might lead to earlier identification of women at risk for LBW infants, and to more effective prevention of LBW.

28 NEONATAL TRANSPORT, MATERNAL ATTITUDES AND INFANT BEHAVIOR

Low birthweight infants have been shown to be at greater risk than full-term infants for problems in parent-child interaction. Whether or not transporting babies to neonatal centers might increase the risk has been questioned. This study evaluated the effects of early parent-child separation upon parental attitudes and neonatal behavior in the very low birthweight (VLBW) infant (< 1500 grams). During an 18 month period, 30 VLBW infant-mother pairs and 30 full-term controls (C) entered the study. They were matched by maternal age and parity, and sex of the infant. The VLBW cases consisted of 10 inborn (Gp. I), 10 transported (Gp. II) and 10 maternal/fetal transports (Gp. III). Parental visiting patterns and behavior were unobtrusively recorded by the nursing staff. The Michigan Screening Profile for Parenting (MSPP - Helfer, et al.) was administered to each mother, and the Brazelton Assessment Scale (BAS) was used to evaluate the newborn at the time of discharge and again one month later. There were no differences in parental attitudes between Groups I-III. However, there were differences between VLBW and C groups on a) emotional needs met and b) realistic expectations. When infants with intracranial hemorrhage were excluded, there were no differences on BAS between Groups I-III, or VLBW compared to C. Visiting patterns were variable. These findings support the concept of regionalized care.