Sensitive Caregiving Research Articles

Supplemental Material for Parents’ Secure Base Script Knowledge Predicts Observed Sensitive Caregiving and Discipline Toward Twin Children

Supplemental Material for Parents’ Secure Base Script Knowledge Predicts Observed Sensitive Caregiving and Discipline Toward Twin Children

What Mediates the Link Between Foster Parents' Sensitivity Towards Child Posttraumatic Stress Symptoms and Job Satisfaction? The Role of Compassion Fatigue and Foster Parent-Child Relationship.

Purpose: It is very likely that many children who enter the foster care system have experienced at least one traumatic event, and can develop symptoms of PTSS. Consequently, foster parents' level of sensitivity towards child symptoms of PTSS plays a significant role in child development, but the link between sensitivity and several professional characteristics is not well understood. The current study aims to explain the effect foster parents' sensitivity towards child trauma exert on their job satisfaction, via foster parents' compassion fatigue and the quality of their relationship with the children in care. This study is one of the few to investigate foster parents' sensitivity towards child trauma, and the direct and indirect effects on other variables. Methods: Structural equation modeling was used to test a mediating model on this sample (N = 165) after using an online survey to collect the cross-sectional data. Results: The model produced good fit (RMSEA = 0.087; CFI = 0.899). The direct effects between variables are significant. The relationship between foster parents' sensitivity towards trauma and their job satisfaction can be better understood with the contribution of compassion fatigue. Conclusion: Findings confirm the mediation effect of compassion fatigue and reveal more aspects of the sensitivity towards trauma concept. These results could be implemented by considering more accurate measurements for the caregiver's sensitivity towards child trauma. The importance of considering interventions for increasing foster parents' trauma knowledge and skills is highlighted.

Caregiver sensitivity predicts infant language use, and infant language complexity predicts caregiver language complexity, in the context of possible emerging autism.

While theory supports bidirectional effects between caregiver sensitivity and language use, and infant language acquisition-both caregiver-to-infant and also infant-to-caregiver effects-empirical research has chiefly explored the former unidirectional path. In the context of infants showing early signs of autism, we investigated prospective bidirectional associations with 6-min free-play interaction samples collected for 103 caregivers and their infants (mean age 12-months; and followed up 6-months later). We anticipated that measures of caregiver sensitivity/language input and infant language would show within-domain temporal stability/continuity, but also that there would be predictive associations from earlier caregiver input to subsequent child language, and vice versa. Caregiver sensitive responsiveness (from the Manchester Assessment of Caregiver-Infant interaction [MACI]) predicted subsequent infant word tokens (i.e., amount of language, coded following the Systematic Analysis of Language Transcripts [SALT]). Further, earlier infant Mean Length of Utterance (MLU; reflecting language complexity, also derived from SALT coding) predicted later caregiver MLU, even when controlling for variability in infant ages and clear within-domain temporal stability/continuity in key measures (i.e., caregiver sensitive responsiveness and infant word tokens; and infant and caregiver MLU). These data add empirical support to theorization on how caregiver input can be both supportive of, and potentially influenced by, infant capacities, when infants have social-communication differences and/or communication/language delays suggestive of possible emerging autism.

Caregiver-Child Interaction in Children Placed into Different Types of Russian Families following an Institutional Intervention

The current study examined whether interventions in St. Petersburg, Russian Federation, institutions for infants (Baby Homes) that increased caregiver sensitivity (Training Only) or both caregiver sensitivity and consistency (Training plus Structural Changes: T + SC) versus care as usual (No Intervention: NoI), and the type of post-institutional (PI) families (Relatives versus Non-Relatives) in relation to the length of institutionalization would be associated with caregiver-child interaction advantages in the families. The Parent-Child Early Relational Assessment (Clark, 1985) method was used to assess the caregiver-child interactions at the stages of ≤24 months (n = 55), and 25-48 months of family placement (n = 48). Results suggest that at the stage of 24 months several interactional characteristics were better in families with children from T + SC than from NoI, especially the longer time children spent in these BH, and in families of Non-Relatives than Relatives. At 25-48 months, children in Non-Relative families displayed more Activity and Quality of Exploratory Play than in Relative families. Overall, these results suggest that at ≤24 months in PI families, advantages in caregiver-child interaction might be associated with better institutional caregiving and the type of families, whereas at 25-48 months it might be related only to the type of families.

Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model.

In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults’ intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults’ intended use of long-term care and contribute to the delivery of appropriate care services by public policy.

Sensitive caregiving and reward responsivity: A novel mechanism linking parenting and executive functions development in early childhood.

Sensitive caregiving is an essential aspect of positive parenting that influences executive functions development, but the mechanisms underlying this association are less clear. Using data from the Family Life Project, a large prospective longitudinal sample of 1292 families residing in rural, predominately low-income communities, the current study examined whether sensitive caregiving impacts executive functions development by shaping behavioral reward processing systems in early postnatal life. Results indicated that higher levels of sensitive caregiving during infancy were associated with heightened reward responsivity at age 4, which in turn predicted superior executive functions ability at age 5. Notably, children's reward responsivity partially mediated the relationship between sensitive caregiving in infancy and executive functions ability at school entry. These findings add to prior work on early experience and children's executive functions and highlight caregiver scaffolding of developing reward processing systems as a potential foundational mechanism for supporting adaptive behavior and self-regulation across the lifespan.

Continuity of psychopathology v. resilience across the transition to adolescence: role of hair cortisol and sensitive caregiving.

The transition to adolescence implicates heightened vulnerability alongside increased opportunities for resilience. Contexts of early life stress (ELS) exacerbate risk; still, little research addressed biobehavioral mediators of risk and resilience across the adolescent transition following ELS. Utilizing a unique cohort, we tested biosocial moderators of chronicity in adolescents' internalizing disorders v. resilience. Families exposed to chronic war-related trauma, v. controls, were followed. We utilized data from three time-points framing the adolescent transition: late childhood (N = 177, Mage = 9.3 years ± 1.41), early adolescence (N = 111, Mage = 11 0.66 years ± 1.23), and late adolescence (N = 138, Mage = 15.65 years ± 1.31). In late childhood and late adolescence children's internalizing disorders were diagnosed. At early adolescence maternal and child's hair cortisol concentrations (HCC), maternal sensitivity, and mothers' post-traumatic symptoms evaluated. War-exposed children exhibited more internalizing disorders of chronic trajectory and mothers were less sensitive and more symptomatic. Three pathways elucidated the continuity of psychopathology: (a) maternal sensitivity moderated the risk of chronic psychopathology, (b) maternal post-traumatic symptoms mediated continuity of risk, (c) trauma exposure moderated the association between child internalizing disorders at late childhood and maternal HCC, which linked with child HCC. Child HCC linked with maternal post-traumatic symptoms, which were associated with child disorders in late adolescence. Results demonstrate the complex interplay of maternal and child's biosocial factors as mediators and moderators of risk chronicity across the adolescent transition following trauma. Findings are first to utilize maternal and child's HCC as biomarkers of chronic stress v. resilience during adolescence, a period of neural reorganization and personal growth that shapes the individual's lifetime adaptation.

The association between family physical environment and child maltreatment

BackgroundA body of emerging research has indicated that adverse family physical environment is related to parenting problems such as parent-child conflict, decreased caregiver sensitivity, and less parental emotional availability. Yet, no study has examined if family physical environment is also associated with child abuse and neglect. ObjectiveThis study aimed to examine the relationships between family physical environment and different types of child maltreatment. Participants and SettingThe study sample includes 1,624 mothers who participated in both year 3 and year 5 surveys of the U.S. Fragile Family and Child Well-Being Study (FFCWS). MethodsFamily physical environment was measured by the Infant-Toddler Child Care Home Observation of Environment (HOME). Child maltreatment was assessed by the Conflict Tactics Scale: Parent-Child Version (CTS-PC), and mother’s self-report if child protective services had a concern about the family’s child maltreatment. Multivariate logistic regression models were run to test if family interior (i.e., inside house conditions) or exterior (i.e., immediate outside house conditions) environment would predict child abuse and neglect, while controlling for a series of covariates. ResultsResults indicated that family exterior environment was not related to any type of child abuse and neglect. However, family interior environment was significantly associated with child neglect (OR = 1.10; 95% CI = 1.02–1.20), but not with physical abuse, emotional abuse, and sexual abuse. ConclusionsStudy findings suggest that family interior environment is significantly associated with initial or ongoing child neglect. Implications for future research and practice are discussed.

Intervening with Opioid-Exposed Newborns:: Modifying an Evidence-Based Parenting Intervention.

BackgroundPrenatal opioid exposure predisposes infants to adverse development of regulatory systems and jeopardizes their long-term health outcomes. While sensitive caregiving promotes healthy development of emotional and physiological regulation and may remediate risks associated with prenatal opioid exposure, mothers with opioid use disorder often experience unique challenges that make providing sensitive care difficult.RationaleEmpirically tested early interventions, such as the Attachment and Biobehavioral Catch-up (ABC) intervention, can positively impact children’s development following adversity through promoting sensitive caregiving. ABC intervention targets correspond to those parenting behaviors that may be challenging for mothers with opioid use disorder (i.e., nurturing infants who may be difficult to soothe, responding sensitively to infants by following the child’s lead with delight, and avoiding intrusive/frightening behavior), and have positive impacts on child development and regulation. However, given the unique challenges for infants and mothers impacted by opioid use, some adaptations may strategically address those vulnerabilities and thereby maximize the potential benefits for this population.MethodsThe present paper describes modifications made to the ABC intervention for use with pregnant mothers in treatment for opioid use disorder. This modified intervention is currently being examined via a large scale randomized clinical trial (RCT) at the University of Delaware, and a case study is presented here to highlight considerations for working with mothers and infants impacted by opioid use and to exemplify ways that modified ABC addresses the needs of this population.

Auditory Processing of the Brain Is Enhanced by Parental Singing for Preterm Infants.

As the human auditory system is highly malleable in infancy, perinatal risk factors, such as preterm birth, may affect auditory development. In comparison to healthy full-term infants, preterm infants show abnormal auditory brain responses at term age, which may have long-term detrimental outcomes. To achieve an optimal neonatal care environment for preterm-born infants, many early interventions have been developed. Musical interventions developed for neonatal intensive care units (NICUs) have shown beneficial effects on vital functions and weight gain of preterm infants and might also influence basic auditory processing and thereby enhance outcomes. In the present study, we tested the effect of parental singing during kangaroo care on auditory processing of standardized audio stimuli. Preterm infants (born between 24 and 32 weeks of gestation) were randomized to singing intervention (n = 13) or control (n = 8) groups. The auditory processing was tested using two audio paradigms assessed with magnetoencephalography (MEG) at term corresponding age. To verify that the paradigms elicit responses in MEG, we studied 12 healthy full-term infants. In the singing intervention group, parents were instructed by a music therapist twice a week for 4 weeks to sing or hum during kangaroo care in an infant-directed way. The control group received standard kangaroo care. The results show that the infants in the singing intervention group show larger neural responses than those in the control group when controlling for the total amount of singing during kangaroo care. Our findings suggest that incorporating singing into kangaroo care may be beneficial for preterm infants, but the effect may not be due to exposure to singing but instead positive parenting, improved parental self-esteem and improved caregiver sensitivity.

The predictive significance of fluctuations in early maternal sensitivity for secure base script knowledge and relationship effectiveness in adulthood.

Attachment theory suggests that both the quality and consistency of early sensitive care should shape an individual's attachment working models and relationship outcomes across the lifespan. To date, most research has focused on the quality of early sensitive caregiving, finding that receiving higher quality care predicts more secure working models and better long-term relationship outcomes than receiving lower quality care. However, it remains unclear whether or how the consistency of early sensitive care impacts attachment working models and adult relationship functioning. In this research, we utilized data from the Minnesota Longitudinal Study of Risk and Adaptation to examine to what extent the quality (i.e., mean levels) and consistency (i.e., within-person fluctuations) in behaviorally coded maternal sensitive care assessed 7 times from 3 months to 13 years prospectively predicts secure base script knowledge and relationship effectiveness (i.e., interpersonal competence in close relationships) in adulthood. We found that larger fluctuations and lower mean levels of early maternal sensitivity jointly predict lower relationship effectiveness in adulthood via lower secure base script knowledge. These findings reveal that nonlinear models of early caregiving experiences more completely account for relationship outcomes across the lifespan, beyond what traditional linear models have documented. Implications for attachment theory and longitudinal methods are discussed.

Socioeconomic status and caregiving sensitivity among Chinese childcare centre teachers: adaptive caregiving belief as a mediator and childcare centre type as a moderator

ABSTRACT The critical developmental implications of childcare centre teachers’ caregiving sensitivity have been extensively documented. More efforts are pressing to identify antecedents of such sensitivity and elucidate implicated mechanisms. This study examined the association between socioeconomic status and caregiving sensitivity among Chinese childcare centre teachers, with adaptive caregiving belief as a mediator and childcare centre type as a moderator. Survey data for 1,316 Chinese teachers were used. The results indicated that teachers’ monthly income was positively associated with their caregiving sensitivity via positive associations with their verbal stimulation beliefs. This effect did not vary by childcare centre type. Our findings highlight possible avenues for interventions aimed at promoting caregiving quality in childcare centre setting, such as improving teachers’ adaptive caregiving belief.

Expressions of stress of people with severe intellectual disabilities and sensitive caregiving to regulate stress: A qualitative study

ABSTRACT Background People with severe to profound intellectual disabilities have particular needs for others to help them regulate stress. Such support may be hampered by difficulties in detecting and interpreting expressions of stress. This study aimed to describe and identify stress-related behaviours and sensitive, stress-regulating responses to these behaviours. Method Video recordings of psychotherapeutic interactions between four clients with severe intellectual disabilities and behavioural problems and two attachment therapists were analysed using a stepwise spiral of analysis approach. Stress-related behaviours were identified with a behaviour rating scale for arousal and valence. Results Distinct stress-related behaviours were subdivided into stress-specific, non-stress-specific, and client-specific behaviours. Additionally, examples of responsive behaviours to clients’ expressions of varying arousal and valence were found. Conclusions A wide variety of expressions indicative of different levels of arousal were found, with few expressions specific for stress. The descriptions of responsive behaviours might support parents and caregivers in external stress regulation.

Analysis of the theory of mind indicators in children from different baby home social-emotional environment

This study examined whether the structure of the theory of mind indicators in the group of institutionalized children would be associated with differences of social-emotional environment in two Russian Baby Homes (BHs), one of which received Training plus Structural Changes (T+SC) intervention, that increased caregiver sensitivity and consistency, the other continued to conduct baseness as usial (No Intervention, NoI) and defined as social-emotionally depriving. The relevant to the theory of mind items of the personal-social scale of the Battelle Developmental Inventory were selected and used to assess children in T+SC (N=70; M=2.37, SD=1.01 years) and NoI (N=50; M=2.18, SD=0.92 years). Results suggested between-group differences in the factor structure for the theory of mind indicators. The main factor for children from NoI reflected development of self-understanding in combination with understanding of adults and peers, while for children from T+SC — of self-understanding in combination with understanding of adults, which might be due to opportunity for children to live in the small size group and interact with more sensitive and consistent primary caregivers. The second factor in both BHs revealed development by children understanding of peer interactions and feelings, and difference between BHs was that for children from depriving NoI environment such understanding was combined with understanding of caregivers’ instructions and rules. Results suggest that children’s environment shapes their theory of mind and that positive changes in institutional caregiving can have some benefits in children’s self-understanding and understanding of other people.

Oxytocin system gene methylation is associated with empathic responses towards children

Empathy is an essential component of sensitive caregiving behavior, which in turn is an important predictor of children’s healthy social-emotional development. The oxytocin (OXT) system plays a key role in promoting sensitive parenting and empathy. In this study, we investigated how OXT system gene methylation was associated with empathic processes in nulliparous women (M age = 23.60, SD =0.44)—measuring both physiological facial muscle responses and ratings of compassion and positive affect to affective images depicting children. Linear mixed effects analyses demonstrated that lower methylation levels in the OXT and OXTR genes were related to enhanced empathic responses. The effect of OXT system gene methylation on empathic processes was partly qualified by an interaction with individual variations in women’s care motivation. Our findings provide experimental evidence for an association between the methylation of OXT system genes and empathy.

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.

Recollected caregiver sensitivity and adult attachment interact to predict mental health and coping

Receiving sensitive caregiving in early life is foundational for maintaining mental health and coping skills. The present study investigated how recollected experiences of caregiver sensitivity interact with adult attachment to predict psychosocial functioning. An online survey assessed adults' recollections of sensitive caregiving, current attachment anxiety and avoidance, depressive and anxious symptoms, and coping strategies. Higher levels of recollected sensitive caregiving were predicted to be associated with greater psychological resilience, regardless of adult attachment. Data from 299 adults were analyzed using hierarchical multiple regressions. Recollections of sensitive caregiving interacted with adult attachment when predicting mental health symptoms, dysfunctional coping, and socially supported coping. Higher caregiver sensitivity was associated with resilience in mental health and coping, despite adult attachment. In contrast, when adults reported lower caregiver sensitivity, increased attachment avoidance was associated with increased mental health symptoms. Considering varying histories of recollected sensitive caregiving can provide a more nuanced understanding of how attachment experiences contribute to adult psychosocial functioning.

Maternal caregiving moderates the impact of antenatal maternal cortisol on infant stress regulation.

Emerging evidence suggests that antenatal exposure to maternal stress signals affects the development of the infant stress response systems. Animal studies indicate that maternal sensitive caregiving can reverse some of these effects. However, the generalizability of these findings to humans is unknown. This study investigated the role of maternal caregiving in the association between multiple markers of maternal antenatal stress and infant stress regulation. The sample consisted of 94 mother-infant (N = 47 males, mean postnatal weeks = 12; SD = 1.84) dyads. Maternal levels of Interleukin-6, C-Reactive Protein (CRP), diurnal cortisol and alpha amylase, depressive and anxiety symptoms were assessed in late pregnancy (mean gestational age = 34.76; SD = 1.12), whereas postnatal symptomatology, caregiving, and infant cortisol response to the inoculation were evaluated at 3 months. Hierarchical linear models (HLMs) showed a significant interaction between maternal antenatal cortisol, caregiving, and time on infant cortisol reactivity, while controlling for gender, maternal age, and postnatal depression. Specifically, higher levels of maternal antenatal cortisol were associated with greater cortisol response only among infants of less emotionally available mothers. All other markers of antenatal stress were not significantly associated with infant cortisol reactivity either independently or in interaction with maternal caregiving. Albeit preliminary, results provide the first evidence in humans that maternal sensitive caregiving may eliminate the association between antenatal maternal cortisol and infant cortisol regulation.

Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care

BackgroundBreastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern. ObjectiveTo consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care. Participants and settingFoster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013–2018 completed an online survey. MethodsFoster carer's views were collected via an online survey and subjected to content analysis. ResultsRespondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal. ConclusionsThis study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them.

Reduced prefrontal cortex response to own vs. unknown emotional infant faces in mothers with bipolar disorder

Motherhood involves functional brain adaptations within a broad neural network purported to underlie sensitive caregiving behavior. Bipolar disorder (BD) is associated with aberrant brain response to emotional faces within a similar network, which may influence BD mothers’ sensitivity to infant faces. This functional magnetic resonance imaging (fMRI) study aimed to investigate whether mothers with BD display aberrant neural responses to own infant faces compared to healthy mothers. Twenty-six mothers with BD in remission and 35 healthy mothers underwent fMRI during which they viewed happy and distressed still facial photographs of their own and of unknown infants. After the scan, mothers viewed the pictures again on a computer screen and rated the intensity of infants’ facial emotions and their own emotional response to infant face images. Mothers with BD displayed lower left dorsolateral prefrontal cortex (dlPFC) response compared to healthy mothers to own vs. unknown infant faces specifically and abnormal positive functional connectivity between the left and right amygdala and prefrontal regions. BD mothers further displayed stronger deactivation of precuneus and occipital regions to all happy vs. distressed infant faces. After the scan, they rated their infants’ distress and own response to their infants’ distressed faces less negatively than healthy mothers. Blunted dlPFC response and aberrant fronto-limbic connectivity while viewing own infant faces and less negative ratings of own infants’ distress in BD mothers may affect their responses to their own infants in real-life mother-infant interactions.