Quality Of Maternal Caregiving Research Articles

Imprinted genes and the manipulation of parenting in mammals.

Genomic imprinting refers to the parent-of-origin expression of genes, which originates from epigenetic events in the mammalian germ line. The evolution of imprinting may reflect a conflict over resource allocation early in life, with silencing of paternal genes in offspring soliciting increased maternal provision and silencing of maternal genes limiting demands on the mother. Parental caregiving has been identified as an area of potential conflict, with several imprinted genes serendipitously found to directly influence the quality of maternal care. Recent systems biology approaches, based on single-cell RNA sequencing data, support a more deliberate relationship, which is reinforced by the finding that imprinted genes expressed in the offspring influence the quality of maternal caregiving. These bidirectional, reiterative relationships between parents and their offspring are critical both for short-term survival and for lifelong wellbeing, with clear implications for human health.

Are adolescent diet quality and emotional eating predicted by history of maternal caregiving quality and concurrent inhibitory control?

The risk for unhealthy eating behaviour, including poor diet quality and emotional eating, is heightened in adolescence and could result in profound and long-lasting psychological and physical implications. Caregiving quality and adolescents' regulatory skills, such as inhibitory control, may play an essential role in the development of adolescent eating behaviour. This preregistered study investigated whether maternal caregiving throughout the first 14 years of life predicts adolescent diet quality and emotional eating and whether potential associations are mediated by adolescents’ inhibitory control. In this low-risk community cohort, maternal caregiving quality was observed at child ages five weeks, 12 months, 2.5, 10, and 14 years. At age 14, diet quality and emotional eating were assessed through self-report. Adolescent inhibitory control was assessed with three behavioural tasks and a maternal report. Mediation analyses were performed with structural equation modelling in R. No evidence was found for links between maternal caregiving quality and adolescent diet quality and emotional eating. Higher levels of adolescent inhibitory control predicted better adolescent diet quality. Longitudinal and experimental studies are needed to investigate directionality, and replication studies are needed in more representative samples (e.g. including high-risk families). Such studies will shed further light on potential links between the history of caregiving behaviour and adolescent regulatory and eating behaviour.

Atypical maternal interaction is associated with elevated levels of hair cortisol in children.

The quality of maternal caregiving is an important factor in the healthy development of a child. One consequence of prolonged insensitive and atypical maternal interaction behavior (e.g., withdrawing from interactions with the child and role-reversal, i.e., the takeover of the parental role or parts of it by the child) in mother-child-dyads can cause alteration of the child's stress response system. Higher salivary cortisol concentrations were reported in infants and toddlers directly after negative interactions with their parents. However, no study to date has examined the association between atypical maternal interaction behavior and hair cortisol concentrations (HCC) in infants. Here, we studied the association of maternal interaction behavior with HCC of the child. Mother-child dyads (N = 112) participated in the longitudinal study My Childhood-Your Childhood. The AMBIANCE scale and its subscales were used to assess atypical maternal interaction behavior during the Strange Situation Procedure. Chronic stress levels in the child were assessed by HCC of 3 cm hair strands at the age of 12 months. Maternal educational level (operationalized in highest education level) served as a control variable. Robust multiple linear regression analyses revealed that role/boundary confusion was associated with HCC, i.e., the higher atypical interaction behavior of the mother the higher the HCC in the children. By measuring hair cortisol in this study, it is possible to determine the average long-term activity of the child's stress response system.Thus, atypical maternal interaction behavior could be a risk factor for persistent stress in children, contributing to a higher risk for negative health outcomes in later life. The results of this study highlight the importance of early intervention programs that focus on the relationship between mother and child.

Longitudinal Influences of DRD4 Polymorphism and Early Maternal Caregiving on Personality Development and Problem Behavior in Middle Childhood and Adolescence.

Most studies examining gene-environment effects on self-regulation focus on outcomes early childhood or adulthood. However, only a few studies investigate longitudinal effects during middle childhood and adolescence and compare two domains of early caregiving. In a longitudinal follow-up with a sample of N = 87, we studied the effects of differences in the DRD4 tandem repeat polymorphisms and two domains of early maternal caregiving quality on children’s personality development using Block’s California Child Q-Set (CCQ) at age six and age 12 and on problem behavior at ages six and seven. Early maternal regulation quality predicted later ego-resiliency and aggressiveness. In addition, significant gene-environment interactions revealed that children with the 7+ DRD4 tandem repeat polymorphism and poor maternal regulation quality in infancy showed lower scores in ego-resiliency and higher scores in ego-undercontrol and CCQ aggressiveness. In contrast, children who had experienced effective maternal regulation in infancy showed a comparable level in personality traits and problem behavior as the DRD4 7- group independent of the levels of maternal regulatory behavior. Similarly, longitudinal caregiving × DRD4 interactions were found for behavior problems in middle childhood, especially for oppositional-aggression, inattentive-hyperactivity, and social competence. Early caregiving effects were only found for maternal regulation quality, but not for maternal responsiveness. Effective early maternal regulation in infancy can moderate the negative effect of DRD4 7+ on children’s self-regulation in middle childhood and adolescence. However, maternal responsiveness has no comparable effects. It seems relevant to consider several dimensions of early caregiving and to also measure the environment in more detail in gene-environment studies.

Effectiveness of Care for Child Development Program on the Sensitivity and Responsiveness Skills of Mothers.

ObjectivesThe present study was done to analyze the impact of the "care for child development" program on the sensitivity and responsiveness skills among mothers of children at risk of developmental delay.Materials & Methods This study was a quasi-experimental research with a pretest-posttest design and experimental and control groups. The statistical population included all mothers with children at risk of developmental delay in Tabriz. Fifty mothers were selected through purposive sampling. Then, they were divided into two groups of 25 cases (one experimental group and one control group) using simple random sampling. The experimental group received training about the “care for child development“ program, while the control group received no training. The Social-Emotional Assessment/Evaluation Measure Family Profile (SEAM TM family profile) and Maternal Caregiving Quality Scale were the research measurement tools. The obtained data were evaluated by analysis of covariance (ANCOVA) and independent t-test using SPSS software version 20.Results There was a significant difference between the experimental and control groups in maternal caregiving quality and responsiveness, provision of appropriate activities, predictable programs, and provision of play environment and safe home (P <0.05).Conclusion: The results showed that the care for child development program has positive effects on sensitivity and responsiveness skills of mothers of children at risk of developmental delays and can be considered and applied as a practical plan in national health policies.

Maternal caregiving, prosocial behavior, and self‐esteem in middle childhood

AbstractThis study assessed maternal caregiving quality and children's prosocial behavior as related to changes in child self‐esteem from early childhood across the transition into formal schooling. Although a robust literature indicates that sensitive caregiving promotes self‐esteem, less is known about the potential contribution of children's positive social behavior to enhanced self‐esteem. This study drew on a diverse sample of young children (N = 250; Mage = 4.085, SD = .249; 50% female, 50% male; 46% Latinx) to evaluate prospective relations between an observational assessment of sensitive maternal caregiving at the age of 4 and child reports of self‐esteem at the age of 8 as mediated by teacher‐reports of children's prosocial behavior at the age of 6. Analyses revealed a significant indirect pathway whereby sensitive maternal caregiving promoted children's self‐esteem via children's prosocial behavior. These findings highlight both sensitive caregiving and children's prosocial behavior as promising points of intervention to bolster children's self‐esteem.

The Relation between Maternal Psychological Distress and Maternal Caregiving Quality: Marital Satisfaction as a Moderator

The Relation between Maternal Psychological Distress and Maternal Caregiving Quality: Marital Satisfaction as a Moderator

Paternal incarceration and children's reading achievement: The role of maternal caregiving quality

AbstractObjectiveThis study examined early childhood paternal incarceration (PI; birth to Age 6) effects on children's elementary reading achievement (i.e., Ages 8–10) as mediated by mothers' supportive caregiving and moderated by child gender.BackgroundExtant research on PI has primarily focused on child behavioral problems. However, less is known about specific relations between PI and academic achievement.MethodParticipants were drawn from an ongoing, longitudinal study of development using a subsample of 180 children and their maternal caregivers (51.5% female children; 48.9% Latinx; 26.7% experienced PI). Study variables were assessed using semi‐structured incarceration interviews, observational parenting tasks, and standardized achievement tests. A moderated mediation analysis evaluated the hypothesized model by child gender.ResultsPI predicted decreased maternal supportive caregiving, which, in turn, predicted lower reading achievement, even when family socioeconomic status, child ethnicity‐race, prior supportive caregiving, prior reading achievement, and maternal psychopathology were held constant. Further, a moderation analysis indicated that the relation between maternal supportive caregiving and reading achievement was moderated by child gender.ConclusionThis investigation revealed a significant and negative indirect effect of early childhood PI on children's reading achievement via changes in maternal supportive caregiving. However, this indirect effect was significant for boys only.ImplicationsThese findings highlight the potential for interventions and resources that promote supportive maternal caregiving to mitigate the deleterious effects of PI on children's reading achievement, especially for boys.

Maternal Alexithymic Traits Are Related to Lower Maternal Sensitivity and Higher Hostility in Maternal Caregiving Behavior—The FinnBrain Birth Cohort Study

Background: The quality of parental caregiving behavior with their child plays a key role in optimal mother–infant interaction and in supporting child adaptive development. Sensitive caregiving behavior, in turn, requires the ability to identify and understand emotions. Maternal alexithymia, with difficulties in identifying and describing feelings or emotions, as well as a concrete way of thinking, could potentially complicate the quality of caregiving. In this study, we aim to explore the possible association between maternal alexithymic traits and the quality of maternal caregiving behavior.Methods: The study sample consisted of 158 mother–infant dyads within the FinnBrain Birth Cohort Study population with an available report of maternal alexithymic traits at 6 months postpartum and observational data on maternal caregiving behavior at 8 months postpartum. Alexithymia was measured using the 20-item Toronto Alexithymia Scale (TAS-20) including three alexithymia dimensions—Difficulty Identifying Feelings, Difficulty Describing Feelings (DDF), and Externally Oriented Thinking (EOT). Maternal caregiving behavior was assessed using the Emotional Availability Scale and in this study, all four parent dimensions (Sensitivity, Structuring, Non-intrusiveness and Non-hostility) were included. Maternal depressive and anxiety symptoms at 6 months postpartum were controlled for as potential confounders. In addition, background factors of mother's age and gestational weeks at the time of child birth, maternal educational level, monthly income and parity, as well as relationship status and the gender of the baby were assessed.Results: Maternal TAS-20 total score correlated negatively with Sensitivity (r = −0.169, p = 0.034) and with non-intrusiveness (r = −0.182, p = 0.022). In addition, maternal DDF correlated negatively with Sensitivity (r = −0.168, p = 0.035) and EOT with Non-hostility (r = −0.159, p = 0.047). Furthermore, in regression analyses with controlling for the associated background factors, maternal total score of alexithymic traits (p = 0.034, η2p = 0.029) and higher DDF (p = 0.044, η2p = 0.026) remained significantly associated with lower Sensitivity and higher EOT remained significantly associated with lower Non-hostility (p = 0.030, η2p = 0.030).Conclusions: In this explorative study we found preliminary evidence for the hypothesis that higher maternal alexithymic traits associate with lower maternal sensitivity and more hostile maternal caregiving behavior. Further studies are needed to explore these hypotheses and to investigate their possible implications for child development.

Dynamics of frontal alpha asymmetry in mother-infant dyads: Insights from the Still Face Paradigm

The parent-infant dynamic has a foundational role in emotion regulation development. Electroencephalography (EEG) hyperscanning from mother-infant dyads can provide an unprecedented window into inter-brain dynamics during the parent-infant exchange. This potential depends on the feasibility of hyperscanning with dyads in emotionally taxing contexts. We sought to demonstrate feasibility of hyperscanning from 10 mother-infant dyads during the Still Face Procedure (SFP). We measured frontal alpha asymmetry (FAA) to elucidate ongoing regulatory dynamics and considered maternal caregiving quality as a window into dyads’ history. Results showed dyads exhibited a rightward shift in FAA over the course of SFP, indicating growing negative emotionality and desire to withdraw. Results also showed growing variability in FAA for infants over the course of SFP, indicating less active emotional control as stress ensued. Variability was especially low for mothers during periods when asked to be emotionally unavailable, suggesting active control to match the task demands. Dyads with a more responsive mother exhibited higher (more left) FAA relative to dyads with a less responsive mother, which might reflect a more positive emotional experience overall. We raise important methodological and theoretical questions that hyperscanning during SFP can address, such as the developmental origins of trait-like self-regulatory dispositions.

Maternal caregiving and DNA methylation in human infants and children: Systematic review.

The integration of behavioral epigenetics' principles (eg, DNA methylation) into the study of human infants' development has mainly focused on the effects of early adverse exposures, paying less attention to protective caregiving experiences. The present review focused on DNA methylation linked to variations in maternal behavior in human infants and children. Literature search occurred on three databases (PubMed, Scopus and Web of Science) and 11 records were selected. Key variables were abstracted from each article including: sample size and characteristics, time and type of maternal caregiving behavior exposure, time and locus of methylation biomarker, presence/absence, time and type of adverse exposure. Six out of eleven records documented the predictive effect of maternal caregiving on DNA methylation, whereas the remaining five reported on the role of maternal behavior as an influencing factor of the adversity-to-methylation link. Consistent with evidence from the animal model, the quality of maternal caregiving in humans (a) might be associated with variations in DNA methylation status of specific genes involved in socio-emotional development and (b) might partially buffer the association between early adversities and epigenetic variations in infants and children. Current evidence suggests that the quality of maternal caregiving can contribute to behavioral development trajectories of human infants and children at least partially through epigenetic regulation. Open questions and methodological aspects are discussed to guide future human developmental research in behavioral epigenetics.

Systematic review of predictors of infant care competence among women with postpartum depression

Postpartum depression (PPD) is a serious illness that affects mothers worldwide. The symptoms of PPD such as low mood and fatigue undermine the quality of mothers’ interactions with their children, likely explaining the less than optimal development of children of mothers with PPD. In this way, PPD reduces mothers’ Infant Care Competence (ICC), that is, mothers’ perceived and performed infant caregiving ability. ICC is similar to other concepts such as maternal competence; however, ICC is specific in its focus on a mother’s perceptions of her infant care abilities. Knowledge of predictors of ICC in the context of PPD would inform interventions for mothers with PPD to increase maternal caregiving quality, preventing negative long-term effects on children’s development. Thus, an integrative systematic review was completed to determine predictors of ICC (both performed and perceived abilities) in the context of PPD. Six electronic databases were searched (MEDLINE, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], SocINDEX, and the Cochrane Library) for relevant studies that met search criteria. Twenty-one eligible articles were obtained. Results revealed variables that explained ICC in the context of maternal PPD including: depression severity and timing of depressive symptoms, social support, maternal adversities, infant characteristics, as well as demographic variables such as education and income. Overall, this review provides insight into common explanatory variables of ICC that could be used to target interventions in the postpartum period to promote maternal caregiving abilities, and ultimately children’s development and health in the context of PPD.

Evaluating the Effectiveness of an App-Based Nurse-Moderated Program for New Mothers With Depression and Parenting Problems (eMums Plus): Protocol for a Pragmatic Randomized Controlled Trial.

BackgroundPostnatal depression adversely affects many mothers and infants with good evidence that caregiving difficulties associated with depressive symptoms play a key role in later adverse childhood outcomes. In many countries, there is only limited support available for women who experience symptoms of depression during the postnatal period, particularly those experiencing subthreshold symptom levels. Furthermore, mental health services and community family health services in many countries tend to focus primarily on providing help for depressive symptoms or maternal caregiving, respectively, despite these problems commonly being comorbid. Group-based nurse-led interventions delivered over the Web through mobile phone “apps” have the potential to be a cost-effective method of providing a large number of mothers with easy access to integrated support for both maternal depressive symptoms and caregiving difficulties.ObjectiveThis paper describes the protocol for a pragmatic randomized controlled trial of a 4-month group-based nurse-led intervention delivered over the Web when infants were 2-6 months. The primary aims of the trial are to determine whether the intervention (1) reduces levels of maternal depressive symptoms and (2) improves the quality of maternal caregiving when infants are 8-12 months of age.MethodsThe trial aimed to recruit and randomize 160 mothers of infants aged 2-8 weeks to either the intervention (eMums plus) or standard care. Assessments were completed when infants were aged 1-2 (preintervention), 8, and 12 months. The primary outcomes were the level of maternal depressive symptoms and the quality of maternal caregiving assessed when infants were aged 12 months. The intervention provided specific support for problems with mood and problems with caregiving. The intervention was delivered by community health nurses as a part of routine service delivery to mothers via a mobile phone app.ResultsParticipant recruitment was carried out from March to July 2017. Follow-up data collection was completed in mid-2018. Data analysis has commenced.ConclusionsIn the past, many mothers participated in nurse-led face-to-face groups postnatally. However, mothers’ groups held in clinics can be difficult for busy mothers to attend. The eMums intervention was delivered over the Web by nurses, allowing easy access by mothers early in an infant’s life. The intervention was evaluated while delivered as part of the routine service practice by community child health nurses. The advantage of evaluating the effectiveness of the intervention in the routine service practice is that if it is found to be effective, it can be more easily adopted by the service provider than if it had been assessed in an efficacy trial.International Registered Report Identifier (IRRID)RR1-10.2196/11549

Epigenetic Transmission of Maternal Behavior: Impact on the Neurobiological System of Healthy Mothers.

Quality of maternal caregiving not only impacts children's development but can also result in heritable changes in gene expression (i.e., in an epigenetic manner). Consequently, when women become mothers, they adopt parenting behavior similar to that they received at family of origin. This transgenerational transmission of maternal behavior may also be associated with changes in the neurobiological system of future mothers. This review aims to highlight the effect quality of perceived parenting has on maternal behavior and the neurobiological system of mothers, specifically the oxytocin system, brain morphology and brain function. This would likely help in finding biomarkers that profile the impact of perceived parenting on mothers, and thus allow identification of mothers who experience poor-quality parenting for intervention.

The birth experience and subsequent maternal caregiving attitudes and behavior: a birth cohort study.

Optimal maternal caregiving is critical for children's healthy development, yet quality of maternal caregiving may be influenced by a negative birth experience. We examined whether the birth experience was associated with maternal caregiving attitudes and behavior throughout the first year. We conducted secondary analysis of the Avon Longitudinal Study of Parents and Children birth cohort on perinatal data. The birth experience was assessed using self-report data on level of support in labor. Maternal caregiving variables were self-report maternal attitudes at one and eight postnatal months, and observed maternal behavior at 12 postnatal months. Data were analyzed using multivariable logistic regression models adjusting for critical covariates at one (N = 4389), eight (N = 4580), and 12 (N = 842) postnatal months. Feeling supported in labor was associated with a report of "immediately falling in love" with one's baby after birth, surveyed at 1month (adjusted OR 1.41 [95% CI 1.20-1.65]), and with more positive parenting scores at 8months (adjusted OR 1.56 [95% CI 1.36-1.79]), but not with more positive observed maternal behavior at 12months. Additional risk factors were identified. Our findings suggest that we may be able to modify the risk of poor postnatal maternal caregiving by supporting women in labor and facilitating a positive birth experience.

3.48 MATERNAL PRENATAL PERCEIVED STRESS AND CHILD GESTATIONAL AGE AT BIRTH INDEPENDENTLY PREDICT ADOLESCENT MOTHERS' SENSITIVE RESPONSIVENESS

Given robust associations between diminished maternal-responsive caregiving and children’s risk of mental health problems, understanding the multiple determinants of the quality of maternal caregiving is critical, especially in an at-risk context. In this study, we investigated whether prenatal maternal-perceived stress and rumination predicted qualities in adolescent mothers’ caregiving with their infants. We also explored whether childbirth circumstances partially mediated the association of perceived stress and rumination with an index of sensitive caregiving.

Maternal Childhood Maltreatment History and Child Mental Health: Mechanisms in Intergenerational Effects

The objectives of this study were to examine whether a maternal history of maltreatment in childhood has a detrimental impact on young children’s mental health and to test theoretically and empirically informed pathways by which maternal history may influence child mental health. Mother–child dyads (N = 187) were evaluated between birth and 64 months of age via home and laboratory observations, medical and child protection record reviews, and maternal interviews to assess maternal history of childhood maltreatment and microsystem and exosystem measures of the caregiving context, including child maltreatment, maternal caregiving quality, stress exposures, and social support. When the children were 7 years of age, mothers and teachers reported on child emotional and behavioral problems. Analyses examined whether the caregiving context variables linked maternal maltreatment history with child emotional and behavioral problems, controlling for child sex (54% male), race/ethnicity (63% White), and family sociodemographic risk at birth. Maltreated mothers experienced greater stress and diminished social support, and their children were more likely to be maltreated across early childhood. By age 7, children of maltreated mothers were at increased risk for clinically significant emotional and behavioral problems. A path analysis model showed mediation of the effects of maternal childhood maltreatment history on child symptoms, with specific effects significant for child maltreatment. Interventions that reduce child maltreatment risk and stress exposures and increase family social support may prevent deleterious effects of maternal childhood maltreatment history on child mental health.

Family nurture intervention improves the quality of maternal caregiving in the neonatal intensive care unit: evidence from a randomized controlled trial.

This study assessed the impact of Family Nurture Intervention (FNI) on the quality of maternal caregiving behavior (MCB) while in the neonatal intensive care unit (NICU). FNI is a randomized controlled trial conducted in a high-acuity NICU to facilitate an emotional connection between mothers and their premature infants. FNI begins shortly after birth, continues until discharge, and involves mother/infant calming sessions that include scent cloth exchange, vocal soothing and emotion expression, eye contact, skin-to-skin and clothed holding, and family-based support sessions. Maternal caregiving behavior was coded during a single holding and feeding session (∼30 min) in the NICU before discharge at approximately 36 weeks gestational age (GA). Sixty-five mothers and their premature infants (34 male, 31 female; 26-34 wk GA) were included in these analyses (FNI, n = 35; standard care [SC], n = 30). Relative to mothers in the SC condition, those in the FNI group showed significantly higher quality MCB, which remained significant when controlling for birth order, twin status, maternal depression, and maternal anxiety. This is the first study to demonstrate that in-unit MCB can be enhanced by a hospital-based intervention. FNI provides a new rationale for integrating nurture-based interventions into standard NICU care.

Cortisol regulation in 12-month-old human infants: Associations with the infants' early history of breastfeeding and co-sleeping

Experiences during early life are suggested to affect the physiological systems underlying stress responses, including the hypothalamic–pituitary–adrenal axis (HPA axis). While stressful early experiences have been associated with dysregulated HPA-axis functioning, positive early experiences, i.e. high maternal caregiving quality, contribute to more optimal HPA-axis functioning. Influences of other early caregiving factors, however, are less well documented. The goal of this study was to examine whether breastfeeding and co-sleeping during the first 6 months of life were associated with infant cortisol regulation, i.e. cortisol reactivity and recovery, to a stressor at 12 months of age. Participants were 193 infants and their mothers. Information on breastfeeding and co-sleeping was collected using weekly and daily sleep diaries, respectively, for the first 6 months of life. Co-sleeping was defined as sleeping in the parents' bed or sleeping in the parents' room. At 12 months of age, infants were subjected to a psychological stressor [Strange Situation Procedure (SSP); Ainsworth et al. 1978]. Salivary cortisol was measured prestressor and at 25, 40, and 60 min poststressor to measure reactivity and recovery. Regression analyses showed that after controlling for maternal sensitivity, infant attachment status, feeding, and sleeping arrangements at 12 months of age and other confounders, more weeks of co-sleeping predicted lower infant cortisol reactivity to the SSP. Also, more weeks of breastfeeding predicted quicker cortisol recovery. These results indicate that an early history of co-sleeping and breastfeeding contributes positively to cortisol regulation in 12-month-olds.

The influence of different forms of early childcare on children's emotional and behavioural development at school entry

Over the past few decades there has been a dramatic increase in maternal employment and, as a result, an increase in the use of non-maternal childcare in the early years. The purpose of this longitudinal study was to examine, in a large representative English sample, the influence of different forms of childcare on children's behavioural and emotional development around the age of school entry. A sample of 991 families, originally recruited when the children were 3 months old, was assessed around school entry age at 51 months. The main outcome variable was the children's emotional and behavioural functioning, measured by questionnaire completed by both mothers and teachers. A range of repeated assessments were carried out at different time points, including direct observation of the quality of maternal caregiving and observations of the quality of non-parental care, and amount of time spent in different forms of care. The strongest and most consistent influences on behaviour and emotional problems were derived from the home, including lower socio-demographic status, poorer maternal caregiving, parental stress/maternal mental health problems, as well as child gender (being a boy). Non-parental childcare had small effects on child outcome. One finding that did emerge was that children who spent more time in group care, mainly nursery care, were more likely to have behavioural problems, particularly hyperactivity. These findings suggest that interventions to enhance children's emotional and behavioural development might best focus on supporting families and augmenting the quality of care in the home.