The longitudinal association of combined regulatory problems in infancy and mental health outcome in early childhood: a systematic review

Early Struggles-The Relationship of Psychopathology and Development in Early Childhood

BACKGROUND/OBJECTIVES

Early childhood psychopathology has a profoundly negative impact on various areas of psychosocial functioning. Psychopathology and child development are closely linked and influenced by a range of factors, such as socioeconomic status and pre- and postnatal risks. This cross-sectional study aims to gain a deeper understanding of child development in children with early psychopathology and to derive implications for the diagnosis and treatment of the youngest children.

METHODS

This cross-sectional study examines the developmental status of children aged 0 to 5 years with early psychopathology (EPP) in comparison to gender- and age-matched healthy controls (HC). A newly self-developed objective, semi-structured, symptom-based interview was administered in each subgroup by trained research assistants. This interview is based on the DC: 0-5 classification system. The ET 6-6-R was used as a standardized developmental test, covering the developmental areas of gross and fine motor skills, cognition, language development, and socioemotional development. Demographic characteristics, including maternal education and household income, were considered as potential confounders.

RESULTS

Children with early pathology elicited a lower total developmental quotient than healthy controls. HC demonstrated a better performance in fine motor skills, language development, and socioemotional development than their counterparts with EPP. HC showed better gross motor skills as well, but statistical significance was p = 0.08. After controlling for maternal education, overall development and socioemotional development were found to be lower in the EPP group than in the HC group.

CONCLUSIONS

These findings highlight the need to identify psychopathology and associated developmental deficits early in childhood which might allow more targeted treatments, enhancing developmental opportunities for affected children.

Bridging gaps in healthcare: child health services and specialist care collaboration for young children with autism and coexisting conditions

Aim

This study aimed to evaluate a clinical project aiming to address gaps in healthcare for young children in an immigrant, low-resource district from early identification of regulatory problems, autism, and other neurodevelopmental symptoms by child health services to assessment and interventions in specialist care.

Methods

A mixed-model design was employed, consisting of a description of the clinical project and data from healthcare statistics to evaluating the care chain. Qualitative in-depth interviews were conducted to capture the perspectives of participating child health nurses. Data were analyzed using content analysis.

Results

The mean age for referral from primary to specialist care for suspected autism decreased from 38 to 27 months at (n = 59). A total of 55 children were diagnosed with autism. The mean age at autism diagnosis decreased from 44 to 31 months. Waiting times from referral to intervention were shortened. Interventions were already initiated in primary care at the time of referral. Qualitative analyses of nurse experiences revealed three main categories: (1) new and increased knowledge, (2) great importance for every child and family, and (3) an efficient method with fewer gaps, which holds further potential for development.

Conclusion

Professionals' increased knowledge of early symptoms in children, combined with novel healthcare methods for close collaboration, made it possible to bridge the gaps and provide young children and their families with early assessments and essential early interventions. The study results point to opportunities for integrated healthcare and collaboration with families and preschools.

Optimizing parenting and child outcomes following parent-child interaction therapy - toddler: a randomized controlled trial

BACKGROUND

Parent-Child Interaction Therapy-Toddler (PCIT-T) is an attachment-informed intervention model designed to meet the specific developmental needs of toddlers aged 12-24 months presenting with challenging behaviors.

METHODS

This study used a randomized controlled design to evaluate outcomes of PCIT-T for children aged 14-24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior were randomly allocated to PCIT-T (intervention), an active control condition (Circle of Security- Parenting™; COS-P), or a non-treatment control condition (wait-list; WL). Outcomes were assessed at baseline (Time 1), post treatment/post waitlist (Time 2) and 4-month follow-up (Time 3).

RESULTS

At follow-up, the PCIT-T group displayed the highest levels of parenting sensitivity and positive parental verbalizations, and the lowest levels of negative child-directed verbalizations and non-attuned mind-minded statements. Of the three groups, the PCIT-T group showed the greatest degree of change on these variables, followed by the COS-P group and then the non-treated controls. The PCIT-T group were also the only group to show significant within-group improvements in sensitivity, self-reported parental reflectiveness, empathy and emotional understanding, parent-reported child social competence, child internalizing problems, and general behavior issues. Significant reductions in parental stress, child externalizing behaviors and parenting behaviors were seen for both the PCIT-T and COS-P groups.

CONCLUSIONS

Delivered in the early intervention period of toddlerhood, Parent-Child Interaction Therapy-Toddler has the potential to bring about significant changes for children presenting with early onset behavioral issues.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR), 12,618,001,554,257. Registered 24 September 2018 - retrospectively registered, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001554257 .

Early childhood multiple or persistent regulatory problems and diurnal salivary cortisol in young adulthood

BACKGROUND

Early childhood multiple or persistent regulatory problems (RPs; crying, sleeping, or feeding problems) have been associated with a risk of behavioural problems in young adulthood. It has been suggested that this may be due to the possible influence of early RPs on the functioning of the hypothalamic-pituitary-adrenal (HPA) axis. However, associations between early RPs and HPA-axis activity in young adulthood remain unexplored. Thus, the aim of the current study was to investigate whether early childhood multiple or persistent RPs are associated with diurnal salivary cortisol in young adulthood.

METHODS

At the ages of 5, 20 and 56 months, RPs of 308 children from the Arvo Ylppö Longitudinal Study were assessed via standardized parental interviews and neurological assessments. Multiple RPs were defined as two or three RPs at the age of 5 months and persistent RPs as at least one RP at 5, 20 and 56 months. At the mean age of 25.4 years (SD= 0.6), the participants donated saliva samples for cortisol at awakening, 15 and 30 min thereafter, 10:30 am, at noon, 5:30 pm, and at bedtime during one day. We used mixed model regressions, and generalized linear models for testing the associations, controlling for important covariates.

RESULTS

Of the 308 children, 61 (19.8%) had multiple or persistent RPs in early childhood: 38 had multiple, and 27 had persistent RPs. Persistent RPs were associated with significantly higher cortisol peak and output in the waking period, and cortisol awakening response. On the other hand, multiple RPs were not associated with salivary cortisol.

CONCLUSION

Children displaying persistent RPs throughout early childhood show, over two decades later, increased HPA axis activity in response to awakening stress. This may be one physiological mechanism linking early childhood RPs to adulthood behavioural outcomes.

Regulatory problems and developmental psychopathology within the first 2 years of living-a nested in cohort population-based study

Background

Infancy regulatory problems (RP) of sleep, feeding and eating, and excessive crying are thought to play a key role in the development of psychopathology in childhood, but knowledge of the early trajectories is limited.

Objective

To explore RP at ages 8-11 months and the associations with mental health problems at 1½ years, and assess the influences of maternal mental health problems and relationship problems.

Methods

RP was explored in a nested in-cohort sample (N = 416) drawn from a community-based cohort (N = 2,973). Cohort children were examined by community health nurses, using a mental health screening, which included seven items of RP. Follow-up at 1½ years included diagnostic assessment according to the International Classification of Diseases, ICD-10, and the Diagnostic Classification of Mental Health and Developmental Disorders in Infancy and Early Childhood: Revised edition, DC:0-3R. Data analyses included logistic regression models and analyses of the mediation effect of maternal mental health and relationship problems.

Results

RP of sleep were associated with a 2-fold increased risk of child mental disorder specifically sleep disorders, adjusted odds ratio (OR) 9.3 [95% confidence interval (CI): 2.0-42.9], disorders of behavior and emotions, adjusted OR 2.9 (95% CI: 1.0-8.4), and DC:0-3R regulatory disorders, adjusted OR 2.7 (95% CI: 1.0-7.5). Children with RP of feeding and eating showed an increased risk of overall mental disorder, adjusted OR 1.4 (95% CI: 0.7-2.4), and specifically, feeding and eating disorders, adjusted OR 6.0 (95% CI: 1.6-21.7), disorders of behavior and emotions, adjusted OR 2.2 (95% CI: 0.9-5.8), as well as DC:0-3R regulatory disorders, adjusted OR 1.6 (1.0-7.5). RP of emotional regulation were associated with increased risk of any mental disorder, adjusted OR 1.5 (1.0-2.4), and specifically behavioral and emotional disorders, adjusted OR 2.2 (95% CI: 0.9-5.9) and DC:0-3R relationship disorders, adjusted OR 1.8 (95% CI: 0.9-3.8). The mediation effect of maternal mental health problems and relationship problems ranged between 0% and 48%.

Conclusion

RP at ages 8-11 months is associated with increased risk of ICD-10 and DC:0-3R disorders at 1½ years. Study findings highlight a group of vulnerable infants in need of preventive intervention to break the early trajectories of psychopathology.

Community health nurses' concerns about infant regulatory problems are predictive of mental disorders diagnosed at hospital: a prospective cohort study

Introduction

Regulatory problems of eating, sleeping, and crying in infancy may index mental health vulnerability in older ages, and knowledge is needed to inform strategies to break the developmental trajectories of dysregulation in early childhood. In this study, we examined the prospective associations between infant regulatory problems at the age of 8-10 months identified by community health nurses (CHN) and mental disorders diagnosed in hospital settings in children aged 1-8 years.

Methods

From a cohort of all newborn children in 15 municipalities in the Capital Region of Copenhagen (N = 43,922) we included all children who were examined by CHNs at the scheduled home visit at the age of 8-10 months (N = 36,338). Outcome measures were ICD-10 mental disorders diagnosed at public hospitals and reported to the National Patient Register. Logistic regression included data on child and family covariables obtained from population registers.

Results

The CHNs reported concerns regarding sleep in 7.7% of the study population, feeding and eating in 19.1%, combined sleeping and eating problems in 3.6%, and incessant crying in 0.7%. A total of 1,439 children (4% of the study population) were diagnosed in hospital settings with an ICD-10 mental disorder between the ages of 11 months and 8 years. Analyses adjusted for a range of perinatal and family adversities showed an increased risk of any neurodevelopmental disorder among children with CHN concerns of feeding and eating (odds ratio (OR) 1.36 (95% confidence interval (CI) 1.14-1.63)) and co-occurrent problems of feeding and eating and sleep (OR 1.60 (95% CI 1.14-2.26)). For autism-spectrum disorders, an increased risk was seen among children with co-occurrent problems of both feeding and eating and sleep (OR 1.73 (95% CI 1.07-2.79)). Concern about feeding and eating was also associated with an increased risk of behavioral and emotional disorders (OR 1.27 (95% CI 1.03-1.56)). Concern about incessant crying at the age of 8-10 months was not associated with a diagnosed mental disorder, but findings may reflect low statistical power due to low frequency of concern.

Discussion

CHN concerns mirror a group of developmentally vulnerable children. Further research is needed to explore the possibilities of preventive intervention within the general child health surveillance to address the developmental psychopathology of dysregulation in early ages.