Caregiver-Child Relationships in Early Childhood: Interventions to Promote Well-Being and Reduce Risk for Psychopathology

Co-creating a conceptual model of Indigenous relational wellbeing in early childhood: Planting seeds of connectedness

The purpose of this article is to share our story of conceptualizing Indigenous early relational wellbeing (ERW), specifically reflecting American Indian and Alaska Native worldviews. Our approach is grounded in Indigenous methodologies and guided by a Community of Learning comprised of Indigenous and allied Tribal early childhood community partners, researchers, practitioners, and federal funders. We describe the steps we took to conceptualize caregiver-child relationships from an Indigenous perspective, center Indigenous values of child development, apply an established Indigenous connectedness framework to early childhood, and co-create a conceptual model of Indigenous ERW to guide future practice and research. This model highlights relational practices as seeds of connectedness and relational wellbeing, and includes the roles of spirituality, culture, and ceremony in nurturing ERW; the manifestations of relational wellbeing across the lifespan; and the interdependence of relational wellbeing within communities and families, across generations, and with the environment. The model also informs the creation of a measure to understand practices that foster relational wellbeing among Indigenous children and families and their relationship to positive development, thus informing research, practice, and policy.

The Bridge Between Childhood Trauma and Alexithymia Among Adolescents with Depressive and Bipolar Disorders: A Network Bridge Analysis

Childhood trauma and alexithymia are significant risk factors for adolescent mental health issues. Prior research has linked these factors to psychopathology, but the complexities of their interrelation remain underexplored. This study aims to elucidate the relationship between various forms of childhood trauma and alexithymia in adolescents with depressive and bipolar disorders. Structural Equation Modeling (SEM) and network analysis were utilized on data from 2343 Chinese adolescents (aged 12-18 years, 77.93% female) diagnosed with depression or bipolar disorder. Measures included the Childhood Trauma Questionnaire (CTQ) and the Toronto Alexithymia Scale (TAS-20). SEM demonstrated a significant correlation between childhood trauma and alexithymia. Network analysis identified emotional abuse and difficulty identifying feelings as central nodes. Emotional abuse emerged as a key factor for difficulty in emotional identification among adolescents. This study highlights the need for early intervention and the importance of emotional nurturing in childhood to prevent long-term socioemotional difficulties.

Setting the Stage for Play: Exploring the Relationship Between Play Type and Positive Caregiving Strategies During Therapeutic Playgroup

IMPORTANCE

Although play and positive caregiving strategies have been associated with child well-being, little is known about the relationship between play type and strategies used by caregivers in early childhood.

OBJECTIVE

To investigate whether a relationship exists between play type and positive caregiving strategies.

DESIGN

Exploratory correlational nonexperimental design.

SETTING

Early childhood center.

PARTICIPANTS

A convenience sample that included 60 observations of 14 caregivers during a therapeutic playgroup with 14 children with and without disabilities ages 15 mo to 3 yr (4 fathers, 3 mothers, 1 nanny, and 6 female early childhood teachers; age range = 30-39 yr). The caregivers were Black (n = 1; 7.1%), Hispanic (n = 5; 35.7%), and White (n = 8; 57.1%).

OUTCOMES AND MEASURES

Positive caregiving strategies were scored using the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes.

RESULTS

Results revealed no significant correlations between play type and positive caregiving strategy. There was a positive, significant correlation between caregiving strategies (affection, responsiveness, encouragement, teaching, and total; rpbs = .767-.970, n = 58, p = .001). The play type and caregiver type variables did not predict total positive caregiving strategies, F(2, 57) = 2.147, p = .126. One variable, caregiver type, added statistical significance to the prediction (p = .045).

CONCLUSIONS AND RELEVANCE

The findings show no relationship between play type and positive caregiving strategy. Consideration of the types of caregivers participating in a therapeutic playgroup and their roles and use of positive strategies during play is worthy of further investigation. Plain-Language Summary: This study explored how parent and teacher caregivers supported children (both with and without disabilities) during a therapeutic playgroup at an early childhood center. Therapeutic playgroups are a special type of group play in which a trained professional helps guide play activities to support participation. The researchers wanted to see whether there was a connection between the type of play the children engaged in and how the adult caregivers interacted with them. The surprising finding was that there was no link between play type and how caregivers interacted. However, the caregivers often used positive strategies with the children, regardless of the play activity. Interestingly, type of caregiver (parent, teacher) seemed to make a slight difference in how they interacted with the children during playtime. Overall, this study suggests that more research is needed to understand how the types of play activities and objects might influence caregiver interactions during group play.

I'm with you, baby: Using parental embodied mentalizing in a pilot study to capture change following the circle of security parenting intervention

Supported by a large body of work demonstrating the impact of infant attachment representations on subsequent development, numerous therapeutic programs have been developed to promote secure attachment, with increasing focus on parental mentalizing. Nonetheless, empirical evidence supporting their effectiveness has yet to be fully established. The current pilot study (N = 24) was designed to evaluate whether and to what extent parents' shifts in parental mentalizing following a brief attachment-based group intervention, namely circle of security parenting (COSP; Cooper, Hoffman & Powell, 2009) can be captured using the parental embodied mentalizing instrument (PEM; Shai & Belsky, 2017). Compared to a waiting list-control group, this small-scale study examined whether community-based low-risk mothers of infants aged 5-48 months show an increase in their observed PEM capacities following the intervention. Secondary self-reported outcome variables parental stress, feeling of competence, and self-compassion. Findings show that PEM ratings improved significantly over time in the COSP group, but not in the control group. Intervention group mother-infant dyads also presented significantly longer embodied interactions communication post intervention compared to the control group. No effects of the COSP on parental stress, competence, or self-compassion were found. Despite the small sample size, these results tentatively suggest that COSP can improve embodied mentalizing abilities.

Infant fearful distress, parent intrusiveness, and adversity in families experiencing homelessness

Infants experiencing homelessness face risk for developing mental health problems in the future. Parents residing in shelters experience adverse events at elevated rates compared to non-homeless individuals, which can impact their infants during a time of rapid development depending on how the parent copes. For some, trauma linked to these events may manifest in an intrusive parenting style that interferes with the child's developing capacity for self-regulation. We utilized a sample of 60 parent-infant dyads recruited while residing in emergency homeless shelters to evaluate associations among parents' history of adversity, intrusive parenting behaviors, and infants' fearful distress. Observed parent intrusiveness during a free play interaction was significantly associated with infant fearfulness observed in a separate behavioral task during which infants viewed a series of masks. Furthermore, there was a moderating effect for parent history of adversity such that the association between parent intrusiveness and infant fearful distress was stronger among parents with more past experiences of adversity.

Parental Anxiety, Practices, and Parent-Child Relationships among Families with Young Children in China: A Cross-Sectional Study

This study explored the ambiguous characteristics and influencing factors of parental anxiety, practices, and parent-child relationships among families with young children during a sudden COVID-19 lockdown in Shanghai, China. An online survey was conducted from 1 June to 10 November 2022, with 477 valid responses. Parental anxiety, practices, and parent-child relationships were evaluated. During this lockdown, 72.6% caregivers felt anxious about parenting to different degrees, with only a small proportion experiencing extreme anxiety. Parental anxiety was mainly influenced by whether the caregivers faced parenting issues and external parenting difficulties. The frequency of two-parent-child activities of reading books or looking at picture books with their children and telling stories to them significantly increased. Caregivers' occupations of either professional or technical personnel and working from home were the most significant influencing factors. Mother-child relationships were relatively good. In conclusion, parental anxiety, practices, and parent-child relationships were relatively good and stable among families with young children during this lockdown. In the context of public health emergencies like COVID-19, more parenting support and knowledge should be provided to caregivers from professionals in CHCs or hospitals to decrease parental anxiety and improve parent-child relationships. Full advantage should be taken of working from home to promote parent-child activities.

Early relational health - A promising approach for equitable systems change in pediatrics: A commentary

Pediatric primary care plays a critical role in supporting the healthy development of young children. Wisdom and research suggest that every developmental domain is shaped by the quality of close relationships, particularly the caregiver-child relationship. Therefore, pediatric primary care has a unique opportunity to support and nurture early relationships using the Early Relational Health (ERH) framework and its applications Early Relational Health Screen, and Early Relational Health Conversations. ERH and its applications recognize years of innovation focused on the promotion of the wellbeing of caregiver-child relationships, and children's long-term development. Central to enhancing and elevating pediatric practice is intentional effort in using diversity-informed, anti-racist, equitable systems of care frameworks. This Commentary offers a call to action for pediatric primary care to create more equitable and inclusive practice via ERH. The call to action includes deepening self and institutional awareness; allocating resources for systems change, including infusing greater equity into departmental structures; and, building authentic relationships with patients, families, and communities. This will result in intentional systems change centered on equitable practice.

The context and development of the early relational health screen

Early relational experiences are key drivers for developing social emotional capacities, educational achievement, mental health, physical health, and overall wellbeing. The child health sectors are committed to promotion, prevention, and early intervention that optimize children's health and development, often employing evidence-based screening as foundational practices. Despite a variety of validated parent-infant observational assessment tools, few are practical within busy practice settings, acceptable with all racial and ethnic groups and ready for universal adoption. In response to this need, a team of clinicians, early childhood educators, researchers and infant mental health specialists collaborated to develop and test a novel video-based, dyadic relational screening and monitoring tool, the Early Relational Health Screen (ERHS). This tool uniquely focuses on the early parent-child relationship (6-24 months), within the construct of early relational health (ERH). Initial testing demonstrated that the ERHS is a valid, reliable, feasible, and useful screening and monitoring tool for clinical applications. The ERHS was further developed within a population-based, prospective research study and adapted with brief video feedback for parents in the home visiting and child health sectors. The ERHS and its adaptations appear to advance ERH and equity within the transforming child health and public health care systems of today.

A Community-based Responsive Caregiving Program Improves Neurodevelopment in Two-year Old Children in a Middle-Income Country, Grenada, West Indies

Many young children in low- and middle-income countries (LMICs) are at risk of developmental delays. Early child development (ECD) interventions have been shown to improve outcomes, but few interventions have targeted culturally normative violence such as corporal punishment (CP). We partnered with an existing community-based ECD organization in the LMIC of Grenada to implement a parallel controlled-trial single-blind responsive caregiving intervention that educates parents about the developing brain and teaches alternatives to corporal punishment while building parental self-regulation skills and strengthening social-emotional connections between parent and child. Parents and primary caregivers with children under age two were eligible. Allocation to the intervention and waitlist control arms was unblinded and determined by recruitment into the program. Neurodevelopment was assessed by blinded testers when each child turned age two. Primary comparison consisted of neurodevelopmental scores between the intervention and waitlist control groups (Clinicaltrials.gov registration # NCT04697134). Secondary comparison consisted of changes in maternal mental health, home environment, and attitudes towards CP. Children in the intervention group (n = 153) had significantly higher scores than children in the control group (n = 151) on measures of cognition (p = .022), fine motor (p < .0001), gross motor (p = .015), and language development (p = .013). No difference in secondary outcomes, including CP, was detected.

Teaching home-visitors to support responsive caregiving: A cluster randomized controlled trial of an online professional development program in Brazil

Background

Home-visiting programs are a common and effective public health approach to promoting parent and child well-being, including in low- and middle-income countries. The World Health Organization and UNICEF have identified responsive caregiving as one key component of the nurturing care children need to survive and thrive. Nonetheless, the importance of responsive caregiving and how to coach it is often overlooked in trainings for staff in home-visiting programs.

Methods

To determine whether it is possible to enhance home-visitors’ understanding of responsive caregiving and how to coach it, we conducted a cluster randomized controlled trial with 181 staff working in Brazil’s national home-visiting program. We used a computerized random number generator to randomly assign half of participants to take an online professional development course about responsive caregiving immediately and the other half to a waitlist. Individuals assessing outcome data were blind to group assignment.

Results

Compared to those in the control group (N = 90, both randomized and analyzed), participants assigned to take the course (N = 91, both randomized and analyzed) were more knowledgeable about responsivity (Cohen’s d = 0.64, 95% Confidence Interval (CI) = 0.34, 0.94) and its importance for children’s socioemotional (odds ratio (OR) = 1.88, 95% CI = 1.00, 3.50) and cognitive (OR = 2.57, 95% CI = 1.15, 5.71) development, better able to identify responsive parental behaviors in videotaped interactions (d = 1.86, 95% CI = 1.51, 2.21), and suggested more effective strategies for coaching parents on responsivity (d = 0.51, 95% CI = 0.21, 0.80) and tracking goal implementation (OR = 3.20, 95% CI = 1.28, 7.99). There were no significant changes in participants’ tendency to encourage goal setting and reflection, or their perspective-taking skills. Participants were very satisfied with the course content and mode of delivery and there was no drop-out from the program.

Conclusions

A short, online professional development program created moderate to large improvements in home-visitors’ knowledge and intended coaching practices. This suggests that such programs are feasible, even in low-income and rural areas, and provide a low-cost, scalable option for possibly maximizing the impact of home-visiting programs – particularly with regard to parental responsivity, and in turn, child outcomes.

School age effects of Minding the Baby-An attachment-based home-visiting intervention-On parenting and child behaviors

Multiple interventions have been developed to improve the caregiver-child relationship as a buffer to the effects of early life adversity and toxic stress. However, relatively few studies have evaluated the long-term effects of these early childhood interventions, particularly on parenting and childhood behaviors. Here we describe the early school-age follow-up results of a randomized controlled trial of Minding the Baby ® (MTB), a reflective, attachment-based, trauma-informed, preventive home-visiting intervention for first-time mothers and their infants. Results indicate that mothers who participated in MTB are less likely to show impaired mentalizing compared to control mothers two to eight years after the intervention ended. Additionally, MTB mothers have lower levels of hostile and coercive parenting, and their children have lower total and externalizing problem behavior scores when compared to controls at follow-up. We discuss our findings in terms of their contribution to understanding the long-term parenting and childhood socio-emotional developmental effects of early preventive interventions for stressed populations.

Relation of parenting child abuse based on attachment styles, parenting styles, and parental addictions

The purpose of this study was to complete the cycle of recognizing these relationships. In this regard, the effect of parenting styles, attachment styles, and the mediating variable of addiction was investigated on child abuse (CA). Multi-stage random sampling and sample size were selected based on the sample size estimation software (510 people) and according to the 20% probability of a drop in the number of subjects, 530 people (265 boys and 265 girls) and 1060 parents were selected. The available method was selected from a sample of 530 people who were selected based on the Addiction Severity Index (ASI) and answered Baumrind's Parenting Styles Questionnaire (PSQ), Childhood Trauma Questionnaire (CTQ), and Adult Attachment Scale (AAS). Data were assessed by analysis of variance, mediator analysis, and path analysis. The results showed that differences in parenting styles cause differences in their attachment styles. The results supported only the relationship between the two components of parental affection and control with the attachment avoidance index, and no relationship was observed between these components and the anxiety index. Perceived emotional abuse, mediates the relationship between parental parenting components and the child attachment avoidance index. Finally, it was achieved to a model that shows how the two factors of affection and control simultaneously affect the avoidance index, mediated by parental addiction.

Infant DNA methylation: an early indicator of intergenerational trauma?

Exposure to adverse childhood experiences (ACEs) increases risk for mental and physical health problems. Intergenerationally, mothers' ACEs predict children's health problems including neurodevelopmental and behavioural problems and poorer physical health. Theories of intergenerational trauma suggest that ACEs experienced in one generation negatively affect the health and well-being of future generations, with DNA methylation (DNAm) being one of several potential biological explanations. To begin exploring this hypothesis, we tested whether infant DNA methylation associated with intergenerational trauma. Secondary analysis employed data from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Subsample data were collected from mothers during pregnancy and postpartum on measures of distress, stress and ACEs and from infants at 3 months of age on DNAm from blood (n = 92) and buccal epithelial cells (BECs; n = 124; primarily nonoverlapping individuals between tissues). Blood and BECs were examined in separate analyses. Preliminary associations identified in blood and BECs suggest that infant DNAm patterns may relate to maternal ACEs. For the majority of ACE-related DNAm sites, neither maternal perinatal distress, nor maternal cortisol awakening response (CAR; a measure of hypothalamic-pituitary-adrenocortical axis function), substantially reduced associations between maternal ACEs and infant DNAm. However, accounting for maternal perinatal distress and cortisol substantially changed the effect of ACEs in a greater proportion of blood DNAm sites than BEC DNAm sites in the top ACEs-associated correlated methylated regions (CMRs), as well as across all CMRs and all remaining CpGs (that did not fall into CMRs). Possible DNAm patterns in infants, thus, might capture a signature of maternal intergenerational trauma, and this effect appears to be more dependent on maternal perinatal distress and CAR in blood relative to BECs.

Longitudinal Relations Between Parental Strain, Parent-Child Relationship Quality, and Child Well-Being During the Unfolding COVID-19 Pandemic

As COVID-19 sweeps across the globe, scientists have identified children and families as possibly particularily vulnerable populations. The present study employed a developmental framework with two measurement points (the first at the peak of the lockdown restrictions (N = 2,921), the second after restrictions had been majorly loosened (N = 890)) to provide unique insights into the relations between parental strain, child well-being, and child problem behavior. Cross-lagged panel analyses revealed longitudinal effects of child well-being and problem behavior at T1 on parental strain at T2 with parent-child relationship quality as a moderator. True intraindividual change models showed that decreases in parental strain between measurement points predicted increases in child well-being and decreases in child problem behavior. Thus, the present research points to parental stress coping and child emotional adjustment as promising avenues for professionals and policy makers in their efforts to ensure child and family well-being throughout the pandemic.

Minding the Baby®: Enhancing parental reflective functioning and infant attachment in an attachment-based, interdisciplinary home visiting program

In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.

Promoting parent-infant responsiveness in families experiencing homelessness

My Baby's First Teacher is an intervention designed specifically for parents with infants staying in emergency homeless shelters. Infants are overrepresented in shelter populations and face considerable risk to their development, including mental health. We utilized a randomized controlled design across three family shelters to evaluate the program's effectiveness with 24 dyads assigned to the intervention compared to 21 dyads in care-as-usual. Dyads were randomized by round at each site to account for shelter effects. We used path analysis to illustrate change over time and in relation to intervention assignment.