Clinical validity of a brief measure of early childhood social-emotional/behavioral problems

Screen Exposure and Early Childhood Development in Resource-Limited Regions: Findings From a Population-Based Survey Study

BACKGROUND

The content of children's screen exposure and interactive coviewing with caregivers are important determinants of early childhood development (ECD) that have been overlooked in past research in resource-limited rural regions. Given the prevalence of digital devices and diverse digital content today, determining screen use practices that minimize the negative impacts on children's development is crucial for promoting healthy screen use among children.

OBJECTIVE

This study aims to examine screen exposure among children aged <3 years in rural China and investigate its relationship with ECD outcomes, focusing on duration, content, coviewing, and interaction.

METHODS

The sample includes all children aged between 6 and 26 months and their primary caregivers residing in the study area. A survey of screen exposure and household characteristics was conducted for 1052 eligible households. Caregivers reported the duration of screen exposure, defined as the average daily screen time over the past month; the content of exposure, defined by the time spent on educational and child-friendly content; and the caregiver's presence and interaction with the child during exposure. ECD outcomes were evaluated using the third edition of the Bayley Scales of Infant and Toddler Development assessment scale and the Brief Infant Toddler Social Emotional Assessment. Ordinary least squares regression, logistic regression, and chi-square tests were conducted.

RESULTS

In total, 28.23% (297/1052) of the children in our sample were first exposed to screens before the age of 12 months. Children exposed to screens had an average daily screen time of 27.57 (SD 38.90) minutes. Children who were exposed to screens before the age of 12 months and those who had longer screen time between the ages of 12 and 18 months were more likely to be at risk of motor developmental delays. Children exposed to educational content for >15 minutes on a daily basis had fewer social-emotional or behavioral problems than those with no screen exposure and a lower risk of delay in motor skills development than those exposed to educational content for <15 minutes on a daily basis. Caregiver interaction during screen exposure was associated with a lower risk of cognitive and language delays and better socioemotional skills.

CONCLUSIONS

The type of content viewed and how caregivers engaged in children's screen time were strongly associated with ECD outcomes. Guiding parents to select educational content for their children and engaging in interactive coviewing may better protect children from the negative effects of screen exposure. The findings complement conclusions regarding the impact of screen exposure on ECD in resource-limited rural areas.

Potential Moderators of the Association between Parental Psychological Distress and Perceived Child Externalizing Behaviors

Parental psychological distress is a commonly examined risk factor for the emergence of child problem behaviors, but the factors that may influence that relationship-like parental social support satisfaction and coping skills-have not been adequately explored. The current longitudinal study examined the association between maternal and paternal psychological distress in relation to subsequent perceived child externalizing behaviors, considering these two parental resources as moderators. The sample included a racially and socioeconomically diverse group of first-time mothers and their partners. Mothers and fathers reported their current psychological distress, social support satisfaction, and problem-focused coping at child age 6 months, 18 months, and 4 years of age, as well as reporting on child externalizing behaviors in the last two waves. For mothers, both social support satisfaction and coping at 18 months moderated the relationship between their psychological distress and subsequent perceived child externalizing behaviors. Specifically, higher coping self-efficacy predicted lower perceived child externalizing behaviors at lower levels of maternal psychological distress but did not buffer at higher distress levels. Further, lower levels of social support satisfaction exacerbated the link between maternal psychological distress and child externalizing behaviors, whereas higher social support satisfaction buffered this association. No significant interactions were observed for fathers. Results of this study emphasize the distinct relations among these variables for mothers and fathers, while highlighting potentially interactive processes involved in understanding the emergence of parent-reported children's externalizing behaviors.

Longitudinal Stability and Predictive Value of Socio/Emotional/Behavioral Screening in an Outpatient Pediatric Network

BACKGROUND

In 2022, the American Academy of Pediatrics recommended annual social/emotional/behavioral (SEB) screening at preventive pediatric visits. Numerous SEB screeners have considerable empirical support for children of all ages. However, few studies inform the longitudinal use of SEB screeners in pediatrics.

METHODS

Using electronic health records (EHR) from seven pediatric clinics in a large hospital system, we analyze the longitudinal stability of three SEB screeners among 9153 children and adolescents who were screened multiple times over a 3-year period, and we evaluate associations with International Classification of Disease (ICD) codes for SEB diagnoses.

RESULTS

Moderate stability was documented for the Baby Pediatric Symptom Checklist (intraclass correlation coefficient [ICC]=.57), Preschool Pediatric Symptom Checklist (ICC=.60), and Pediatric Symptom Checklist-17 (ICC=.69). Stability of positive/negative results was sensitive to each screener's threshold. Across a range of thresholds that classify 7-20% of children as positive, all three screeners achieved positive predictive values (PPVs) of approximately 40-65% and diagnostic odds ratios ranging from 8 to 15. These findings compare favorably to published results for longer measures and structured interviews. Recommended thresholds varied markedly across screeners, and associations with ICD codes demonstrate that higher thresholds yield higher specificity but lower sensitivity (ie, a majority of ICD codes are not anticipated by positive screens).

CONCLUSIONS

Three common SEB screeners display longitudinal stability similar to longer, more established measures. Results demonstrate that recommended thresholds vary markedly across measures and that choice of threshold strongly influences sensitivity and specificity, underscoring the need for greater attention to selection of thresholds.

The utility of multiple assessments in infancy and toddlerhood to predict middle childhood ADHD symptoms: Temperamental, behavioral, and genetic contributions

BACKGROUND

Early intervention is effective for reducing ADHD symptoms and related impairments, yet methods of identifying young children in need of services are lacking. Most early predictors of ADHD previously identified are of limited clinical utility. This study examines several theoretically relevant predictors of ADHD in infancy and toddlerhood and whether assessment at multiple time points improves prediction. We also examine whether links between early risk factors and middle childhood ADHD are driven by shared genetic and/or environmental mechanisms to identify potential early intervention targets.

METHOD

614 twins (52.12 % female, 58.50 % non-Hispanic White) participated in a larger study on genetic and environmental contributions to mental health outcomes. Caregiver-reported attention and behavior problems in infancy (M = 12.67 months) and toddlerhood (M = 32.18 months) and caregiver-reported temperament (attentional focusing, impulsivity, inhibitory control) in toddlerhood were used to predict caregiver-reported ADHD symptoms in middle childhood (M = 8.78 years).

RESULTS

Only behavior problems in infancy and toddlerhood were robust predictors of caregiver-reported ADHD symptoms in middle childhood. Using multiple timepoints did not improve predictive ability. The relationship between infant behavior problems and caregiver reported middle childhood ADHD symptoms was explained by both environmental and genetic influences, whereas environmental influences almost entirely explained the relationship between toddler behavior problems and caregiver-reported middle childhood ADHD symptoms.

IMPLICATIONS

Behavior problems in toddlerhood showed the strongest predictive utility, and links to later ADHD were largely driven by environmental factors, suggesting that psychosocial interventions modifying the child's environment may be particularly effective for reducing ADHD risk.

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 .

A longitudinal path model examining the transactional nature of parenting and child externalizing behaviors in a large, sociodemographically diverse sample

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

Identifying vulnerable mother-infant dyads: a psychometric evaluation of two observational coding systems using varying interaction periods

Introduction

Clinical services require feasible assessments of parent-infant interaction in order to identify dyads requiring parenting intervention. We assessed the reliability and predictive validity of two observational tools and tested whether briefer forms could be identified which retain acceptable psychometric properties over short observation periods.

Methods

A stratified high-risk community sample of 250 mother-infant dyads from The Wirral Child Health and Development Study completed 7-min play-based interaction at 6-8 months. Film-footage was independently coded by two trained raters using PIIOS and NICHD-SECCYD systems. Incremental predictive validity was assessed from 3, 5 and 7 min observation to attachment outcomes (Strange Situation; 14 months) and infant mental health (BITSEA; 14 and 30 months).

Results

Excellent inter-rater reliability was evident at code and subscale level for each tool and observation period. Stability of within-rater agreement was optimal after 5 min observation. ROC analysis confirmed predictive (discriminant) validity (AUCs >0.70) to top decile age 2 mental health outcomes for PIIOS total score and a brief 3-item composite from NICHD-SECCYD (sensitivity, intrusiveness, positive regard; NICHD-3), but not to attachment outcomes. Logistic regression showed dyads rated at-risk for externalizing problems using NICHD-3 were also at significantly higher risk for insecurity at 14 months (OR = 2.7, p = 0.004).

Conclusion

PIIOS total and NICHD-3 ratings from 5 min observation are both reliable and valid tools for use in clinical practice. Findings suggest NICHD-3 may have greater utility due to its comparative brevity to train and code, with suitability for use over a broader developmental time frame (3-24 months).

Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study

PURPOSE

To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden.

METHODS

In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models.

RESULTS

In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings.

CONCLUSIONS

Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.

Longitudinal associations between parents' prosocial behavior and media use and young children's prosocial development: The mediating role of children's media use

Research has found that media is associated with children's prosocial behavior (PB) from an early age, and that parents play a key role in children's media use and behavior. However, few studies explore these relations as early as infancy while also controlling for well-established predictors of PB (e.g., empathic concern). Thus, the present study examined longitudinal associations between parents' PB and media use, and prosocial development during early childhood, mediated by children's own media use. Participants were 519 children (M age at Time 1 = 17.77 months) and parents who participated in three timepoints of an ongoing, longitudinal study. A longitudinal path model suggested that children's media use was still significantly associated with PB 1 year later after accounting for factors such as parents' PB, media use, and empathy. These findings have important implications for the early development of behaviors that serve as a foundation for social and moral development.

Young mother risk-taking moderates doula home visiting impacts on parenting and toddler social-emotional development

This longitudinal randomized controlled trial examined the impact of a doula home visiting intervention for young, low-income mothers on parenting and toddler social-emotional development and tested whether intervention effects were moderated by maternal emotional and behavioral health characteristics. 156 mothers were offered home visits from a home visitor starting in mid-pregnancy through several years postpartum, with a community doula also working with the mother during pregnancy and after the birth. 156 received case management. Interviews, video recordings of mother-child interactions, and toddler assessments were conducted at 3 weeks, 3 months, 13 months, and 30 months of age. Intent-to-treat analyses conducted with the full sample showed some intervention effects. Moderation analyses, however, showed that most effects were concentrated among mothers engaged in high levels of risk-taking (delinquent behaviors, school suspensions, smoking, alcohol use, sexual risk-taking). Among higher risk-taking mothers, the intervention was related to less intrusiveness during early infancy, less psychological and physical aggression during toddlerhood, more sensitive parenting attitudes, and greater toddler social relatedness. Maternal depressive symptoms were only a moderator for toddler behavior problems. These findings suggest that doula home visiting may be a particularly effective model for enhancing sensitive, non-aggressive parenting among young mothers with a history of risk-taking behavior.

Silencing screaming with screens: The longitudinal relationship between media emotion regulation processes and children's emotional reactivity, emotional knowledge, and empathy

Many parents use screens to regulate their young children's emotions. We know very little, however, about how this parenting practice is related to the development of emotional competencies (i.e., emotional reactivity, emotion knowledge, and empathy) over time. The current longitudinal study examined bidirectional associations between media emotion regulation and various emotional competencies across a 1-year period during early childhood (between ages 3.5 and 4.5 on average). Participants included 269 child/parent dyads who completed a number of in-home tasks and questionnaires. Results revealed that higher levels of media emotion regulation were associated with worse emotional knowledge and empathy and higher emotional reactivity at the cross-sectional level. However, early media emotion regulation was associated with higher levels of child empathy 1 year later. We discuss these results in the context of general parenting practices and encourage future research on the topic with a focus on how these processes develop over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Stressful life events, psychosocial health and general health in preschool children before age 4

BACKGROUND

The impact of stressful life events (SLEs) in early childhood is often ignored. We aimed to examine longitudinal associations between SLEs and psychosocial and general health in preschool children.

METHODS

Twelve SLEs occurring before the age of 24 months were assessed and categorized by frequency (no events, 1-2 SLEs, and > 2 SLEs) and overall tension (no events, low, and high) (n = 1431). Psychosocial and general health were measured three times at the age of 24, 36 and 45 months. The associations were examined by logistic regression models using generalized estimating equations to handle repeated measurements.

RESULTS

Half (48.4%) of the families experienced SLEs, and 23.8% perceived high-tension SLEs before the children were aged 24 months. Gender differences were observed in the association between SLEs and psychosocial health. Compared to girls without SLEs, girls who experienced > 2 SLEs [OR = 3.31, 95% confidence interval (CI) 2.05-5.35] or high-tension SLEs (OR = 3.01, 95% CI 2.07-4.39) had higher odds of psychosocial problems from 24 to 45 months. The odds ratios in boys were 2.10 (95% CI 1.36-3.24) and 1.47 (95% CI 1.06-2.03), respectively. Moreover, only girls' risk of psychosocial problems increased after experiencing 1-2 SLEs (OR = 2.15, 95% CI 1.54-3.00) or low-tension SLEs (OR = 1.90, 95% CI 1.31-2.74). Regarding general health, children who experienced > 2 SLEs (OR = 1.96, 95% CI 1.21-3.18) and high-tension SLEs (OR = 1.60, 95% CI 1.12-2.28) had higher odds of poor general health from 24 to 45 months.

CONCLUSIONS

The findings emphasized that young children's psychosocial and general health can be impacted by experiencing SLEs in early childhood. Attention and adequate support for families experiencing SLEs are needed to minimize the potential negative effect of SLEs on child health, particularly in girls.

Psychosocial health disparities in early childhood: Socioeconomic status and parent migration background

The association between low socioeconomic status (SES), migration background and psychosocial health could be various in different age stages, rare research has investigated associations in very early childhood. Cross-sectional data of SES, parental migration background, and child's psychosocial problems among 2149 children were collected (M _age = 24.6 ± 1.8 months, 49.9% girls) from a community population. Indicators of SES included parental education level, maternal work status, and family composition. Child's psychosocial problems, including social-emotional problems and delay in social-emotional competence, were assessed by the Brief Infant-Toddler Social and Emotional Assessment Problem scale and Competence scale, respectively. Interaction effects between SES and maternal migration background in risk of psychosocial problems were found. Among children of a native-born mother, lower maternal and paternal education levels indicated a higher risk of social-emotional problems and competence delay, respectively. Children of a migrant mother had a higher risk of both social-emotional problems and competence delay if they had a migrant father. The results highlight psychosocial health disparities in 2-year-old children and the need for research into mechanisms underlying these associations.

Maternal-fetal attachment, parenting stress during infancy, and child outcomes at age 3 years

Maternal-fetal attachment (MFA), a woman's relationship with and affiliative behaviors toward her unborn child, has been linked to near-term infant physical and developmental outcomes. However, further longitudinal research is needed to understand whether the impact of MFA extends past the earliest years of life. The current study explored relationships between MFA and child socioemotional competence and behavior problems at age 3 and whether parenting stress mediated the association between MFA and child outcomes. Data were collected from 221 primarily Black/African-American mothers who completed a scale of MFA during pregnancy. Mothers reported on parenting stress at infant age 7 months and reported on child socioemotional competence and problem behaviors at child age 3 years. In path analyses, MFA was directly associated with child socioemotional competence at age 3 years, but an indirect association between MFA and socioemotional competence via parenting stress was not significant. We also observed a significant indirect association between lower MFA and child internalizing behavior problems via parenting stress that was related to maternal dissatisfaction regarding interactions with her child. Findings suggest that assessing MFA may serve as a means to identify dyads who would benefit from support to promote individual health outcomes.

Quality of life and other patient-reported outcomes across the lifespan among people with Fontan palliation

Traditional congenital heart disease (CHD) outcomes include mortality (survival to adulthood and life expectancy) as well as cardiac and non-cardiac morbidity. Strategies to identify and manage sequelae have primarily focused on objective data obtained though invasive and non-invasive diagnostic approaches. In contrast, patient-reported outcomes (PROs) provide subjective information, using standardized measures, about patients' health and wellbeing as reported directly by patients, without interpretation, interference, or assumptions made by clinicians or others. Selection of PRO measures entails thoughtful consideration of who the individuals being surveyed are, why assessment is occurring (e.g., what are the domains of interest; clinical vs. research), and what processes are in place for acquisition, administration, interpretation, and response. In this review, we focus on three domains of PROs for pediatric and adult patients with Fontan physiology: physical health status, psychological functioning, and quality of life (QOL). Infants, children, adolescents, and adults with CHD face a spectrum of challenges that may influence PROs across the lifespan. In general, patients with Fontan palliation tend to have lower physical health status, experience more psychological distress, and have equivalent or reduced QOL compared to healthy peers. Herein, we provide an overview of PROs among people with Fontan circulation as a group, yet simultaneously emphasize that the optimal way to understand the experiences of any individual patient is to ask and listen. We also offer clinical and research initiatives to improve the adoption and utility of PROs in CHD settings, which demonstrate commitment to capturing, understanding, and responding to the patient voice.

Understanding links between maternal perinatal posttraumatic stress symptoms and infant socioemotional and physical health

Maternal posttraumatic stress symptoms (PTSS) are associated with adverse consequences for older children, but very few studies have examined links between perinatal maternal PTSS and infant outcomes. Trauma exposure and psychopathology, including PTSS, is often heightened for women during pregnancy through 1 year postpartum. Therefore, the perinatal period may be a critical time for understanding the risk maternal PTSS and other mental health factors pose to the socioemotional and physical health of infants. The present study explored the relation between maternal PTSS and infant socioemotional and physical health problems in a sample of racially and ethnically diverse mother-infant dyads (N = 295) assessed prenatally and at 12 months postpartum. This study also examined whether there are: (1) moderating effects of maternal depressive symptoms and parenting stress on these associations and (2) indirect effects of PTSS on infant outcomes through observed maternal sensitivity. Results indicated that postpartum depressive symptoms and parenting stress, rather than PTSS, were associated with greater infant socioemotional health problems. However, prenatal PTSS were associated with greater infant physical health problems when mothers also reported clinically significant levels of postpartum depressive symptoms. Maternal sensitivity was not associated with maternal PTSS, depressive symptoms, or parenting stress, nor was it related to infant socioemotional and physical health; thus, maternal sensitivity was not tested as an intermediary mechanism linking maternal mental health with infant outcomes. Implications for promoting maternal mental health in the perinatal period to bolster socioemotional and physical health of infants are discussed.

Prenatal urinary metabolites of polycyclic aromatic hydrocarbons and toddler cognition, language, and behavior

BACKGROUND

Animal and epidemiological studies suggest that prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) may negatively impact toddler neurodevelopment.

METHODS

We investigated this association in 835 mother-child pairs from CANDLE, a diverse pregnancy cohort in the mid-South region of the U.S. PAH metabolite concentrations were measured in mid-pregnancy maternal urine. Cognitive and Language composite scores at ages 2 and 3 years were derived from the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3). Behavior Problem and Competence scores at age 2 were derived from the Brief Infant and Toddler Social Emotional Assessment (BITSEA). We used multivariate linear or Poisson regression to estimate associations with continuous scores and relative risks (RR) of neurodevelopment delay or behavior problems per 2-fold increase in PAH, adjusted for maternal health, nutrition, and socioeconomic status. Secondary analyses investigated associations with PAH mixture using Weighted Quantile Sum Regression (WQS) with a permutation test extension.

RESULTS

1- hydroxypyrene was associated with elevated relative risk for Neurodevelopmental Delay at age 2 (RR = 1.20, 95% CI: 1.03,1.39). Contrary to hypotheses, 1-hydroxynaphthalene was associated with lower risk for Behavior Problems at age 2 (RR = 0.90, 95% CI: 0.83,0.98), and combined 1- and 9-hydroxyphenanthrene was associated with 0.52-point higher (95% CI: 0.11,0.93) Cognitive score at age 3. For PAH mixtures, a quintile increase in hydroxy-PAH mixture was associated with lower Language score at age 2 (βwqs = -1.59; 95% CI: -2.84, -0.34; p_permutation = 0.07) and higher Cognitive score at age 3 (βwqs = 0.96; 95% CI: 0.11, 1.82; p_permutation = 0.05). All other estimates were consistent with null associations.

CONCLUSION

In this large southern U.S. population we observed some support for adverse associations between PAHs and neurodevelopment.

Signaled night awakening and its association with social information processing and socio-emotional development across the first two years

STUDY OBJECTIVES

Night awakening is common in infancy, and some infants continue to have signaled night awakenings throughout early childhood. However, the influence of signaled night awakening on children's social development is less explored. In the present study, longitudinal associations between signaled night awakening, social information processing, and socio-emotional development were measured within the CHILD-SLEEP birth cohort in two groups formed based on parent-reported night awakenings.

METHODS

At 8 months, there were 77 infants in the waking group (≥3 awakenings) and 69 infants in the nonwaking group (≤1 awakening). At 8 and 24 months, social information processing was measured as children's attention to neutral and emotional faces, and at 24 months, parent-reported socio-emotional behavior was measured with the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) questionnaire.

RESULTS

The two groups showed different patterns of attention to emotional faces. The waking group had a more pronounced attentional bias to fearful versus happy faces, whereas in the nonwaking group, attention to fearful and happy faces did not differ. In addition, at 24 months, the waking group had more dysregulation problems and lower social competence than the nonwaking group, but no clear differences in internalizing or externalizing problems were found.

CONCLUSIONS

Our results contribute to the literature by showing that during the first 2 years of life, signaled night awakening is associated with social information processing and socio-emotional behavior.

Paid maternal leave is associated with better language and socioemotional outcomes during toddlerhood

The United States is the only high-income country that does not have a national policy mandating paid leave to working women who give birth. Increased rates of maternal employment post-birth call for greater understanding of the effects of family leave on infant development. This study examined the links between paid leave and toddler language, cognitive, and socioemotional outcomes (24-36 months; N = 328). Results indicate that paid leave was associated with better language outcomes, regardless of socioeconomic status. Additionally, paid leave was correlated with fewer infant behavior problems for mothers with lower levels of educational attainment. Expanding access to policies that support families in need, like paid family leave, may aid in reducing socioeconomic disparities in infant development.

Supporting Infant Emotion Regulation Through Attachment-Based Intervention: a Randomized Controlled Trial

Infant emotion regulation has long-term implications for human development, highlighting the need for preventive interventions that support emotion regulation early in life. Such interventions may be especially important for infants higher in emotional reactivity who need to regulate their emotions more frequently and intensely than infants lower in emotional reactivity. The current randomized trial examined main and moderated effects of an attachment-based intervention on (a) infants' use of mother-oriented and self-soothing emotion regulation strategies and (b) infant emotion dysregulation in 186 low-income, predominantly Latino infants. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start (EHS) services. Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses with covariates revealed main effects of the intervention on infants' use of mother-oriented emotion regulation strategies during a brief (40-s) novel and potentially fear-inducing procedure (d = 0.31). Infant emotional reactivity moderated intervention impacts on mother-oriented emotion regulation strategies and on infant emotion dysregulation: We found stronger effects of the intervention for infants relatively higher in emotional reactivity. Findings are discussed in terms of the preventive value of attachment-based interventions for supporting early emotion regulation.

Third trimester maternal vitamin D and early childhood socioemotional development

BACKGROUND

Whether maternal vitamin D affects offspring socioemotional development in early childhood has been underexplored.

OBJECTIVES

This study examined associations between maternal vitamin D during in the 3rd trimester and offspring socioemotional development between 30 and 59 months.

METHODS

Data from 87 maternal-offspring pairs enrolled in the National Children's Study were used. Total plasma maternal vitamin D (25-hydroxyergocalciferol + 25-hydroxycholecalciferol) was measured between 28 and 35 gestational weeks and categorised as quartiles (Q). Multivariable regression models, adjusting for maternal race/ethnicity, education, and prepregnancy body mass index (BMI [kg/m² ]), were used to estimate the association between vitamin D and offspring scores on the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

RESULTS

The mean (standard deviation) vitamin D concentration was 86.5 (27.8) nmol/L. The median (range) BITSEA problem score was 6.0 (0.0-30.0), and competence score was 19.0 (7.0-22.0). Maternal vitamin D was inversely related to offspring problem scores. Compared to offspring of women with 25(OH)D in Q1, offspring problem scores were -4.80 (95% confidence interval [CI] -8.29, -1.33) units lower for Q2 vs Q1, -5.64 (95% CI -9.60, -1.68) units lower for Q3 vs Q1, and -4.70 (95% CI -8.59, -0.82) units lower for Q4 vs Q1. Vitamin D was not associated with offspring competence score.

CONCLUSIONS

Higher maternal vitamin D was associated with lower offspring behaviour problems and not associated with socioemotional competence. These data indicate the association of maternal vitamin D and offspring development may be dependent on the specific developmental component being investigated.

The Mitigating Toxic Stress study design: approaches to developmental evaluation of pediatric health care innovations addressing social determinants of health and toxic stress

Background

Health care administrators must establish and promote effective partnerships with community agencies to address social determinants of health, including reducing exposure of infants and young children to chronic stress. Because infants’ experiences are inextricably tied to their caregivers, an important target for mitigating “toxic” stress exposure in early childhood is through reducing parents’ experiences of chronic stress in addition to protecting children from direct experiences of harm such as physical or sexual abuse. Conducting screening to identify when children are exposed to early life adversity is a first step; connecting families to needed support services is an essential component to addressing identified challenges. This paper presents the methodology of a three-year study of health care systems innovations designed to engage and support parents of infants to prevent and mitigate children’s toxic stress exposures.

Methods

Key study features included: 1) multi-component study in five U.S. communities and nine pediatric health care clinics and the families they serve, 2) a developmental evaluation approach to describe how innovations are experienced over time at three levels—community systems, pediatric providers, and families, and 3) rapid cycle feedback conducted with communities, clinics and families to co-interpret data and findings. Data sources included: 1) focus groups and interviews with community stakeholders, clinic staff, and families, 2) electronic health record and Medicaid services data extracted to assess health care quality, utilization, and financial impact, and 3) clinic-recruitment of 908 parents of infants in a longitudinal survey. Results. The sample is briefly characterized based on responses to the enrollment phase of the parent survey.

Conclusions

We discuss the study design elements’ contribution to generating evidence needed by innovators, communities, and clinics to modify and sustain investments in these innovations to prevent or mitigate the effects of exposure to toxic stress on young children.

The association between social emotional development and symptom presentation in autism spectrum disorder

Understanding differences in social-emotional behavior can help identify atypical development. This study examined the differences in social-emotional development in children at increased risk of an autism spectrum disorder (ASD) diagnosis (infant siblings of children diagnosed with the disorder). Parents completed the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) to determine its ability to flag children with later-diagnosed ASD in a high-risk (HR) sibling population. Parents of HR (n = 311) and low-risk (LR; no family history of ASD; n = 127) children completed the BITSEA when their children were 18 months old and all children underwent a diagnostic assessment for ASD at age 3 years. All six subscales of the BITSEA (Problems, Competence, ASD Problems, ASD Competence, Total ASD Score, and Red Flags) distinguished between those in the HR group who were diagnosed with ASD (n = 84) compared to non-ASD-diagnosed children (both HR-N and LR). One subscale (BITSEA Competence) differentiated between the HR children not diagnosed with ASD and the LR group. The results suggest that tracking early social-emotional development may have implications for all HR children, as they are at increased risk of ASD but also other developmental or mental health conditions.

Early Origins of Autism Comorbidity: Neuropsychiatric Traits Correlated in Childhood Are Independent in Infancy

Previous research has suggested that behavioral comorbidity is the rule rather than the exception in autism. The present study aimed to trace the respective origins of autistic and general psychopathologic traits-and their association-to infancy. Measurements of autistic traits and early liability for general psychopathology were assessed in 314 twins at 18 months, ascertained from the general population using birth records. 222 twins were re-evaluated at 36 months. Standardized ratings of variation in social communication at 18 months were highly heritable and strongly predicted autistic trait scores at 36 months. These early indices of autistic liability were independent from contemporaneous ratings of behavior problems on the Brief Infant-Toddler Social and Emotional Assessment (which were substantially environmentally-influenced), and did not meaningfully predict internalizing or externalizing scores on the Achenbach Scales of Empirically Based Assessment at 36 months. In this general population infant twin study, variation in social communication was independent from variation in other domains of general psychopathology, and exhibited a distinct genetic structure. The commonly-observed comorbidity of specific psychiatric syndromes with autism may arise from subsequent interactions between autistic liability and independent susceptibilities to other psychopathologic traits, suggesting opportunities for preventive amelioration of outcomes of these interactions over the course of development.

The Early Childhood Irritability-Related Impairment Interview (E-CRI): A Novel Method for Assessing Young Children's Developmentally Impairing Irritability

Irritability is a substrate of more than one dozen clinical syndromes. Thus, identifying when it is atypical and interfering with functioning is crucial to the prevention of mental disorder in the earliest phase of the clinical sequence. Advances in developmentally based measurement of irritability have enabled differentiation of normative irritable mood and tantrums from indicators of concern, beginning in infancy. However, developmentally sensitive assessments of irritability-related impairment are lacking. We introduce the Early Childhood Irritability-Related Impairment Interview (E-CRI), which assesses impairment associated with irritable mood and tantrums across contexts. Reliability and validity are established across two independent samples varied by developmental period: the Emotional Growth preschool sample (EmoGrow; N = 151, M = 4.82 years) and the When to Worry infant/toddler sample (W2W; N = 330, M = 14 months). We generated a well-fitting two-factor E-CRI model, with tantrum- and irritable mood-related impairment factors. The E-CRI exhibited good interrater, test-retest, and longitudinal reliability. Construct and clinical validity were also demonstrated. In both samples, E-CRI factors showed association to internalizing and externalizing problems, and to caregiver-reported concern in W2W. Tantrum-related impairment demonstrated stronger and more consistent explanatory value across outcomes, while mood-related impairment added explanatory utility for internalizing problems. The E-CRI also showed incremental utility beyond variance explained by the Family Life Impairment Scale (FLIS) survey indicator of developmental impairment. The E-CRI holds promise as an indicator of impairment to inform identification of typical versus atypical patterns reflecting early emerging irritability-related syndromes in the initial phase of the clinical sequence.

Triadic interactions, parental reflective functioning, and early social-emotional difficulties

Early childhood is a critical period for social-emotional development; during this period, the child's immediate family is the system with the greatest influence on his or her development. The parents' capacity to reflect on the children's ability to process and interact within a social environment, called parental reflective functioning (RF), is considered an important factor in protecting children from highly prevalent social-emotional difficulties and may have a strong influence on children's long-term development.

OBJECTIVE

To describe and analyze the relationships among parents' RF, the quality of the mother-father-child triadic interaction, and children's social-emotional difficulties.

METHOD

A nonexperimental, cross-sectional, correlational study was conducted. Fifty mother-father-child triads, each in a current relationship that included at least one child aged 12-36 months, were evaluated. Sociodemographic background, triadic interaction, parental RF, and social-emotional difficulties were assessed.

RESULTS

Triadic interaction was found to have a significant effect on the child's social-emotional difficulties, explaining 9% of the variance. In addition, the mothers' RF had a significant influence on triadic interaction, explaining 19% of the variance. An exploratory finding showed that triadic interaction mediates the relationship between mothers' RF and children's social-emotional difficulties.

Trans-generational stress regulation: Mother-infant cortisol and maternal mental health across the perinatal period

Understanding maternal mental health and cortisol regulation across pregnancy and the relationship to the development of the offspring's stress regulation is critical to a range of health outcomes. The aim of this study was to investigate infant and maternal cortisol in women with depression. Data were obtained from 241 pregnant women within the Mercy Pregnancy and Emotional Wellbeing Study (MPEWS), a selected pregnancy cohort study. Depression was measured using the Structured Clinical Interview for DSM-IV (SCID-IV) and repeat Edinburgh Postnatal Depression Scale (EPDS). Repeated measures of antidepressant use, stressful events, anxiety symptoms and maternal hair cortisol concentrations (HCC) and infant cortisol at 12 months postpartum in saliva and hair. Socio-emotional outcomes were measured at 12 months by maternal report on the Brief Infant and Toddler Socio-emotional Assessment (BITSEA). This study found that maternal depression was not associated with maternal HCC. Anxiety, stress and antidepressant use were not associated with maternal HCC. Independently, higher maternal 3rd trimester maternal depressive and anxiety symptoms were associated with lower infant cortisol response at 12 months of age. A higher number of postpartum stressful events was associated with lower infant cortisol response. Lower infant stress reactivity was associated with higher externalizing symptoms at 12 months of age. Future studies are required to understand implications for later mental health.

Psychometric Properties of Child (0-5 Years) Outcome Measures as used in Randomized Controlled Trials of Parent Programs: A Systematic Review

This systematic review is one of the three which sought to identify measures commonly implemented in parenting program research, and to assess the level of psychometric evidence available for their use with this age group. This review focuses specifically on measures of child social-emotional and behavioral outcomes. Two separate searches of the same databases were conducted; firstly to identify eligible instruments, and secondly to identify studies reporting on the psychometric properties of the identified measures. Five commercial platforms hosting 19 electronic databases were searched from their inception to conducted search dates. Twenty-four measures were identified from Search 1: a systematic search of randomized controlled trial evaluations of parenting programs. For Search 2, inclusion/exclusion criteria were applied to 21,329 articles that described the development and/or validation of the 24 measures identified in Search 1. Thirty articles met the inclusion criteria. resulting in 11 parent report questionnaires and three developmental assessment measures for review. Data were extracted and synthesized to describe the methodological quality of each article using the COSMIN checklist alongside the overall quality rating of the psychometric property reported for each measure. Measure reliability was categorized into four domains (internal consistency, test-re-test, inter-rater, and intra-rater). Measure validity was categorized into four domains (content, structural, convergent/divergent, and discriminant). Results indicated that supporting evidence for included measures is weak. Further work is required to improve the evidence base for those measures designed to assess children's social-emotional and behavioral development in this age group. PROSPERO Registration number: CRD42016039600.

Interaction between maternal and paternal parenting styles with infant temperament in emerging behavior problems

This study examined the interaction effects of infant temperament (negative affect, orienting/regulatory capacity, surgency) on the relationship between maternal and paternal parenting styles (authoritative, authoritarian, permissive) and externalizing and internalizing behaviors simultaneously. A diverse sample of mothers (N = 186) and fathers (N = 142) reported on infant temperament of their 6-month-olds and their children's internalizing and externalizing behaviors one year later. Significant interactions revealed: (a) surgency moderated maternal authoritative and paternal permissive parenting style and externalizing behaviors; and (b) surgency moderated maternal authoritarian and paternal authoritative parenting style and internalizing behaviors. No significant interactions were found between maternal and paternal parenting styles and their report of their infants' orienting/regulatory capacity and negative affect. Findings suggest interaction effects may appear beginning in infancy.

Emerging behavior problems: Bidirectional relations between maternal and paternal parenting styles with infant temperament

The present study examined bidirectional effects between maternal and paternal parenting styles (authoritative, authoritarian, permissive) and infant temperament (negative affect, orienting/regulatory capacity, surgency) in a diverse sample of 201 mothers and 151 fathers. Using 3 waves of longitudinal data (prenatal, 6 months, and 18 months), this study examined (a) whether maternal and paternal parenting styles prospectively predicted infant temperament; (b) whether mother- and father-reported infant temperament domains predicted parenting styles at 18 months; and (c) whether infant temperament and parenting styles at 6 months predicted parent-reported externalizing and internalizing problem behaviors at 18 months. Mothers and fathers reported on their expected parenting styles at all three waves, infant temperament at 6 months, and their toddler's emerging internalizing and externalizing problems at 18 months. Prospective parenting style effects revealed that maternal authoritative and permissive parenting style predicted infant orienting/regulatory capacity. Child evocative effects indicated infant orienting/regulatory capacity and negative affect predicted greater maternal permissive parenting style. Significant prospective parenting style effects on infant temperament and child evocative effects on paternal parenting style were largely not observed. Several parenting styles and infant temperament domains at 6 months predicted toddlers' externalizing and internalizing problem behaviors but results differed by parent. Findings suggest maternal prenatal perceptions of parenting style predict infant temperament, but temperament can also affect subsequent parenting. More research is needed to identify fathers' bidirectional effects including how fathering is affected by their children's characteristics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

How are social-emotional and behavioral competences and problems at age 1 year associated with infant motor development? A general population study

Based on limitations in previous research evidence, we concluded that more research is needed for deeper understanding of how social-emotional and behavioral (SEB) outcomes among infant-toddler-aged children in the general population are associated with early motor development. In this study, we investigated associations between early competencies and problems, as measured by the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), and the timing of achievement of the main gross and fine motor milestones usually attained during the first year of life in a general population context. The study sample consisted of 515 infants (mean age 12.9 [SD 0.9] months) and their parents (514 mothers, 434 fathers), who were recruited in child health centers in Northern Finland. The infants were divided into two groups, based on their BITSEA screen status, and motor milestone achievement ages were compared across BITSEA screen status No Concern and Of-Concern infants. An Of-Concern screen status on the maternal and paternal Competence scale and Autism spectrum disorder (ASD) item cluster was associated with later infant achievement ages for gross motor milestones. By contrast, infants who were screened to be in the Of-Concern range on the maternal Problem scale achieved gross motor milestones earlier than infants with the corresponding No Concern screen status. No significant associations were found between the paternal Problem scale screen status and infant motor development. In further analyses, the strongest associations were found between an Of-Concern screen status on the paternal Competence scale and ASD item cluster and infant motor development. The findings indicate that the inclusion of infant motor developmental information may assist early identification and the clinical interpretation of parental reports of early SEB problems. Clinical implications of the current findings are discussed in the paper.

Ontogeny of emotional and behavioral problems in a low-income, Mexican American sample

Clinically meaningful behavior problems are thought to be present beginning in the early toddler years, yet few studies have investigated correlates of behavior problems assessed before age 2 years. The current study investigated the direct and interactive contributions of early infant and caregiver characteristics thought to play an important role in the ontogeny of behavior problems. Specifically, the study examined: (a) the links between infant temperamental reactivity and toddler behavioral symptoms, (b) whether maternal sensitivity moderated associations between temperamental reactivity and behavioral symptoms, (c) whether variability in temperamental reactivity was explained by exposure to maternal stressful life events (SLEs) in utero, and (d) whether child sex moderated these pathways. Data were collected from 322 low-income, Mexican American families. Mother reports of SLEs were obtained between 23 and 40 weeks gestation; temperamental negativity and surgency at 6 weeks and 12 months; and internalizing and externalizing behaviors at 18 months. Maternal sensitivity during structured mother-infant interaction tasks at a 12-month visit was assessed by objective raters. Results indicated that significant paths linked maternal prenatal SLEs with 6-week negativity, 6-week negativity with 12-month negativity, and 12-month negativity with 18-month behavioral symptoms. Sex-specific effects were also observed. Maternal SLEs were directly associated with internalizing behaviors for girls only. Surgency and maternal sensitivity moderated the associations of negativity with subsequent externalizing behaviors for girls only. Results suggest that ecological stressors associated with sociodemographic risk factors such as low-income and ethnic minority status begin to exert cascades of influence on children's developmental outcomes even before birth. (PsycINFO Database Record

Examining pathways linking maternal depressive symptoms in infancy to children's behavior problems: The role of maternal unresponsiveness and negative behaviors

The extent to which maternal depressive symptoms in the first 6 months of life is linked with internalizing and externalizing behaviors in childhood through specific insensitive maternal behaviors (unresponsive and overtly negative behaviors) was examined in a sample of 259 mother-infant dyads. In addition, the extent to which these paths were moderated by infant negative emotionality was also examined. Maternal depressive symptoms were assessed prenatally and when infants were 6 months and 2 years old. Maternal unresponsive and overtly negative behaviors and infant negative emotionality were observed when infants were 6 months old. Mothers reported on infant's internalizing and externalizing behaviors when infants were 2 years old. Maternal depressive symptoms were directly associated with higher internalizing behaviors; this path was not mediated by maternal behaviors. Depressive symptoms were unrelated to externalizing symptoms. Infant negative emotionality did not moderate these effects, but was related positively to overtly negative maternal behaviors, and temperament interacted with maternal depressive symptoms to predict unresponsive maternal behaviors. Results suggest that early maternal depressive symptoms, infant negative emotionality, and negative maternal behavior pose risk for infants' later internalizing behaviors, but the proposed moderated mediation model was not supported.

Developing Autism Screening Criteria for the Brief Infant Toddler Social Emotional Assessment (BITSEA)

There is a critical need for evidence-based, broadband behavioral, and ASD screening measures for use in pediatric and early educational settings to ensure that young children at risk for developing social-emotional disorders and/or ASD are provided with early intervention services to optimize long-term outcomes. The BITSEA is a 42-item screener designed to identify social-emotional/behavioral problems and delays/deficits in social-emotional competence among 11-48-month-olds; 19 items describe behaviors consistent with ASD. Secondary data analysis was employed to develop cut-scores for ASD subscales using Receiver Operating Curves, discriminating children with (n = 223) and without (n = 289) ASD. Cut-scores demonstrated moderate-to-high discriminative power, sensitivity, specificity, and PPV. Findings highlight feasibility of using a broadband social-emotional competence and behavior problem screener to improve early detection of ASD.

Behavioral Problems and Socioemotional Competence at 18 to 22 Months of Extremely Premature Children

BACKGROUND

Behavior and socioemotional development are crucial aspects of child development .

METHODS

A total of 2505 children born at <27 weeks' gestation was evaluated at 18 to 22 months' corrected age between January 1, 2008 and December 12, 2012 (86% follow-up). The Brief Infant and Toddler Social and Emotional Assessment was used to evaluate behavioral and socioemotional problems. Cognition and language were evaluated by using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Logistic regression analysis was used to evaluate for perinatal and demographic factors associated with behavioral problems (≥75th percentile) and delayed socioemotional competence (≤15th percentile). Structural equation modeling with bootstrapping was used to identify possible associated risk factors and Bayley-III scores as mediators.

RESULTS

Thirty-five percent (873) of children had behavioral problems, and 26% (637) displayed deficits in socioemotional competence. Male sex, public insurance, mothers with less than a high school education, and lower maternal age were associated with behavioral problems. Deficits in competence were associated with lower birth weight, public insurance, mothers with less than a high school education, and abnormal neuromotor exam. Bayley-III language and cognitive scores were significant mediators of the relationships between risk factors and both behavioral and competence scores (P < .05).

CONCLUSIONS

Extremely premature children are at risk for behavioral problems and deficits in socioemotional competence. Sociodemographic factors were associated with both socioemotional competence and behavioral problems. Deficits in socioemotional competence were also associated with neuromotor abnormalities and cognitive and language function.

Interparental conflict and infants' behavior problems: The mediating role of maternal sensitivity

Although the negative effect of interparental conflict on child behavior problems has been well established, few studies have examined this association during infancy. This study examined the associations between mother-reported interparental conflict and young children's behavior problems over the first 2 years of their lives in a sample of 212 mothers and infants. Two aspects of maternal sensitivity, sensitivity during distressing and nondistressing contexts, were examined as possible mediators between interparental conflict and infants' behavior problems. Results indicated that interparental conflict was associated directly with infants' externalizing problems over time but was associated indirectly with infants' internalizing problems over time via compromised maternal sensitivity within distressing contexts but not through maternal sensitivity within nondistressing contexts. No significant child gender differences were found. Such findings add to a limited body of research suggesting that the early interparental relationship context is relevant for infant adjustment. The salient mediating role of maternal sensitivity within distressing contexts provides important theoretical and practical insights for future studies. (PsycINFO Database Record

Interparental conflict and infants' behavior problems: The mediating role of maternal sensitivity

Although the negative effect of interparental conflict on child behavior problems has been well established, few studies have examined this association during infancy. This study examined the associations between mother-reported interparental conflict and young children's behavior problems over the first 2 years of their lives in a sample of 212 mothers and infants. Two aspects of maternal sensitivity, sensitivity during distressing and nondistressing contexts, were examined as possible mediators between interparental conflict and infants' behavior problems. Results indicated that interparental conflict was associated directly with infants' externalizing problems over time but was associated indirectly with infants' internalizing problems over time via compromised maternal sensitivity within distressing contexts but not through maternal sensitivity within nondistressing contexts. No significant child gender differences were found. Such findings add to a limited body of research suggesting that the early interparental relationship context is relevant for infant adjustment. The salient mediating role of maternal sensitivity within distressing contexts provides important theoretical and practical insights for future studies. (PsycINFO Database Record

Parent report measures of infant and toddler social-emotional development: a systematic review

BACKGROUND

Identifying young children at risk for socio-emotional developmental problems at an early stage, to prevent serious problems later in life, is crucial. Therefore, we need high quality measures to identify those children at risk for social-emotional problems who require further evaluation and intervention.

OBJECTIVE

To systematically identify parent report measures of infant and toddler (0-24 months) social-emotional development for use in primary care settings.

METHODS

We conducted a systematic review applying a narrative synthesis approach. We searched Medline, PsychInfo, Embase and SocIndex for articles published from 2008 through September 2015 to identify parent-report measures of infant and toddler social-emotional development. Data on the characteristics of the measures, including psychometric data, were collected.

RESULTS

Based on 3310 screened articles, we located 242 measures that were screened for eligibility. In all 18 measures of infant and toddler social-emotional development were included. Ten of the measures were developed specifically for measuring social-emotional development, and eight were measures including subscales of social-emotional development. The measures varied with respect to, e.g. the time of publication, number of items, age span, cost and amount of psychometric data available.

CONCLUSIONS

Several measures of infant and toddler social-emotional development have been developed within the last decade. The majority of psychometric data are available through manuals, not peer-reviewed journals. Although all measures show acceptable reliability, the most comprehensive and psychometrically sound measures are the Ages and Stages Questionnaires: Social-Emotional-2, Infant-Toddler Social and Emotional Assessment, Brief Infant-Toddler Social and Emotional Assessment and Child Behaviour Checklist 1½-5.

Do child healthcare professionals and parents recognize social-emotional and behavioral problems in 1-year-old infants?

Growing evidence supports the existence of clinically significant social-emotional/behavioral (SEB) problems among as young as 1-year-old infants. However, a substantial proportion of early SEB problems remain unidentified during contacts with child healthcare professionals. In this study, child healthcare nurse (CHCN; N = 1008) and parental (N = 518) reports about SEB worries were gathered, along with the maternal and paternal Brief Infant-Toddler Social and Emotional Assessment (BITSEA) ratings, for 12-month-old infants randomly recruited through Finnish child health centers. Only 1.4-1.8 % of CHCNs, 3.9 % of mothers, and 3.2 % of fathers reported of being worried about the assessed child's SEB development. When the CHCNs' and parental reports were combined, 7.7 % (33/428) of the infants assessed each by all three adults had one (7.0 %), two (0.7 %) or three (0 %) worry reports. Even the combination of the CHCN's and parental worry reports identified only 7.0-13.8 % of the infants with the maternal and/or paternal BITSEA Problem or Competence rating in the of-concern range. Identified associations across the three informants' worry reports, parental BITSEA ratings and sociodemographic factors are discussed in the paper. Routine and frequent use of developmentally appropriate screening measures, such as the BITSEA, might enhance identification and intervening of early SEB problems in preventive child healthcare by guiding both professionals and parents to pay more attention to substantial aspects of young children's SEB development and encouraging them to discuss possible problems and worries.

Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex

Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity.

The Long Term Impact of Micronutrient Supplementation during Infancy on Cognition and Executive Function Performance in Pre-School Children

Brain growth and development are critically dependent on several micronutrients. During early development cellular activity may be sensitive to micronutrient deficiencies, however the evidence from human studies is equivocal. The objective of this study was to examine the long-term cognitive and social-emotional effects of multiple micronutrient supplementation compared with iron supplementation alone, administered during infancy. This study was a follow-up to an initial randomized, double-blind controlled trial (RCT) in 2010 in which 902 infants, aged 6–17 months, from Lima, Peru, were given daily supplements of either iron (Fe) or multiple micronutrients (MMN) including zinc (451 in each group). The supplementation period for both groups was six months. In 2012, a subsample of 184 children from the original cohort (now aged 36–48 months) was randomly selected to participate in a follow-up trial and was assessed for intelligence, working memory, inhibition, and executive function. The tests showed no significant differences between the supplementation groups though there were some gender differences, with girls displaying higher scores than boys across both groups on the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) Verbal IQ sentences subtest, the Day-Night cognitive test and on the Brief Infant-Toddler Social Emotional Assessment (BITSEA) social competency, and boys scoring higher than girls in problem behaviour. The results indicate that MMN supplementation had no long term additional effects on cognitive function compared with iron supplementation alone. The timing of supplement administration for maximum impact on a child’s cognitive development requires further investigation.

Targeted prevention of childhood anxiety: engaging parents in an underserved community

Selective prevention programs hold the promise of alleviating child anxiety symptoms, decreasing the risk for emotional problems across the lifespan. Such programs have particular public health import for young children of poor, underserved communities. Identifying factors related to parent engagement, and methods to improve engagement, are paramount in the effort to develop anxiety-focused, community prevention programs. This feasibility study investigated the effect of an enhanced recruitment strategy to maximize parent engagement, as well as factors related to attendance in a single session focused on anxiety prevention. Participants were poor, ethnic minority parents of children aged 11-71 months (n = 256) who completed a survey that assessed anxiety risk according to trauma exposure, child anxiety, or parent anxiety, as well as preferences for preventive services (phase 1). Those meeting risk criteria (n = 101) were invited to a preventive group session (phase 2). Half of parents received enhanced recruitment (ER), which included personalized outreach, matching parent preferences, and community endorsement. Other parents were invited by mail. Chi square analyses indicated that ER was associated with planning to attend (49 vs. 6% of control). Parents receiving ER were 3.5 times more likely to attend. Higher sociodemographic risk was correlated with higher child anxiety symptoms but not attendance. Results highlight the need for improved strategies for engaging parents in preventive, community-based interventions.

French version of the Brief Infant-Toddler Social and Emotional Assessment questionnaire-BITSEA

OBJECTIVE

The aim of the present study was to examine the psychometric properties of the French version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA).

METHODS

The sample consisted of 589 low-risk infants aged 12-36 months and their parents. Parents completed the BITSEA, the Child Behavior Checklist 1½-5 (CBCL - 18 months to 5 years version), and the Parenting Stress Index - Short Form (PSI-SF).

RESULTS

Multitrait-multimethod and confirmatory factor analyses revealed adequate psychometric properties for the French version of the BITSEA. Scores on the BITSEA Problem scale were positively correlated to all CBCL and PSI-SF subscales, whereas negative correlations were found between BITSEA Competence scale and CBCL and PSI-SF subscales. The BITSEA Problem score significantly increased with level of parental worry, examined through a single-item question that is part of the BITSEA.

CONCLUSION

Findings support the validity of the French version of the BITSEA. However, additional work on the clinical validity of the BITSEA, including with at-risk children, is warranted.

Early adversity, socioemotional development, and stress in urban 1-year-old children

OBJECTIVE

To determine demographic, maternal, and child factors associated with socioemotional (SE) problems and chronic stress in 1-year-old children.

STUDY DESIGN

This was a prospective, longitudinal, community-based study, which followed mother-infant dyads (n = 1070; representative of race, education, and income status of Memphis/Shelby County, Tennessee) from midgestation into early childhood. Child SE development was measured using the Brief Infant-Toddler Social and Emotional Assessment in all 1097 1-year-olds. Chronic stress was assessed by hair cortisol in a subsample of 1-year-olds (n = 297). Multivariate regression models were developed to predict SE problems and hair cortisol levels.

RESULTS

More black mothers than white mothers reported SE problems in their 1-year-olds (32.9% vs 10.2%; P < .001). In multivariate regression, SE problems in blacks were predicted by lower maternal education, greater parenting stress and maternal psychological distress, and higher cyclothymic personality score. In whites, predictors of SE problems were Medicaid insurance, higher maternal depression score at 1 year, greater parenting stress and maternal psychological distress, higher dysthymic personality score, and male sex. SE problem scores were associated with higher hair cortisol levels (P = .01). Blacks had higher hair cortisol levels than whites (P < .001). In the entire subsample, increased hair cortisol levels were associated with higher parenting stress (P = .001), lower maternal depression score (P = .01), lower birth length (P < .001), and greater length at 1 year of age (P = .003).

CONCLUSION

Differences in maternal education, insurance, mental health, and early stress may disrupt SE development in children. Complex relationships between hair cortisol level in 1-year-olds and maternal parenting stress and depression symptoms suggest dysregulation of the child's hypothalamic-pituitary-adrenal axis.