Family context assessment in a public health study

Poverty, social exclusion, and mental health: the role of the family context in children aged 7-11 years INMA mother-and-child cohort study

Mental health problems are common in childhood and tend to be more frequent in populations at risk of poverty or social exclusion (AROPE). The family environment can play a role in reducing the impact of economic hardship on these problems. The aim of this study was to assess the effect of multidimensional poverty on the mental health of children aged 7-11 years and the role of the family environment in two areas of Spain. Participants were 395 and 382 children aged 7 and 11 from Gipuzkoa and Valencia, respectively. Internalizing and externalizing problem scales of the child behaviour checklist (CBCL) were used. AROPE indicators were obtained by questionnaire, and three dimensions of the family context (Organization of the Physical Environment and Social Context, Parental Stress and Conflict, and Parental Profile Fostering Development) were measured through subscales 3, 4 and 5 of the Haezi-Etxadi family assessment scale (7-11) (HEFAS 7-11), respectively. Data were analysed using negative binomial regression and Structural Equation Modelling. AROPE prevalence was 7.1 and 34.5% in Gipuzkoa and Valencia, respectively. In both cohorts, there was a significant increase in internalizing and externalizing problems among participants with a higher AROPE score. However, AROPE did not affect internalizing problems in children from families living in a better physical environment and with social support (Subscale 3). The AROPE effect was jointly mediated by subscales 4 and 5 in 42 and 62% of internalizing and externalizing problems, respectively. Preventing economic inequities by economic compensation policies, improving the neighbourhood and immediate environment around the school, and promoting positive parenting programmes can improve mental health in childhood.

Assessing Parenting Interactions With Children: Spanish Validation of PICCOLO With Fathers

Background/Objective: To gain knowledge about mothers' and fathers' interactions with their sons and daughters, we need reliable and valid tools to assess parental behaviors that can be used for different caregivers and in a variety of cultural contexts. The aim of this study was to analyze the psychometric properties of Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) to assess fathers' interaction with their children at early ages. PICCOLO is an observational tool originally developed in the United States for mothers and fathers and previously validated in Spain with a sample of mothers. Methods: One hundred and ninety-one father-child dyads were observed during free-play situations at home when the children were between 10 and 47 months of age (55.0% male). The fathers auto recorded 8-10 minutes of interaction and trained evaluators assessed the recordings with PICCOLO. Results: Confirmatory factor analysis (CFA) confirmed the dimensional structure of the original version of the scale: four first-order factors (Affection, Responsiveness, Encouragement and Teaching) and one second-order factor (Parenting). The tool was found to have high inter-rater reliability at domain and total score level. Ordinal alpha and omega coefficients for each domain ranged between 0.79 and 0.85, and 0.64 and 0.79, respectively. No statistically significant differences were found in any PICCOLO domain or in the total score according to the child's gender. In assessments of the child's development with the Bayley-III scales, moderate positive correlations were found between Encouragement and receptive language (r = 0.32), and between Teaching and expressive (r = 0.34) and composite language (r = 0.31). Conclusion: The Spanish version of PICCOLO can be used to assess fathers' parenting. As PICCOLO is clearly linked to intervention goals, it is of particular interest for practitioners in early intervention and family programs.

Family Context Assessment in Middle Childhood: A Tool Supporting Social, Educational, and Public Health Interventions

Quality of the family context has an important role in the physical and mental health of children; that is why it is important to have reliable and updated tools. This study aims to design and validate a new tool, the Haezi Etxadi Family Assessment Scale 7-11 (HEFAS 7-11), to assess family context quality in middle childhood. A sample of two cohorts of 772 Spanish families with children aged between 7 and 11 (M = 9.39 years; SD = 1.57; 51.2% girls), participated in the study. Results showed good psychometric properties for the instrument and the confirmatory factor analysis showed a five individual subscales structure: 1. Promotion of Cognitive and Linguistic Development (α = 0.79); 2. Promotion of Socio Emotional Development (α = 0.83); 3. Organization of Physical Environment and Social Context (α = 0.73); 4. Parental Stress & Conflict (α = 0.75); and 5. Parental Profile Fostering Child Development (α = 0.80). The association between HEFAS 7-11 and Trial Making Test was also analyzed to determine the concurrent validity of the instrument. The new scale shows its potential in the fields of research, social and educational, to know those variables that need to be promoted under the approach of positive parenting from a public health perspective.

Prenatal Manganese Exposure and Long-Term Neuropsychological Development at 4 Years of Age in a Population-Based Birth Cohort

Background: Manganese (Mn) is an essential micronutrient for humans, the diet being the main source of exposure. Some epidemiological studies describe a negative association between prenatal Mn and later neuropsychological development, but results are inconsistent. The aim of this study was to explore the association between prenatal Mn exposure and neuropsychological development assessed at 4 years of age. Methods: Study subjects were 304 mother-child pairs from the Gipuzkoa cohort of the INMA (Environment and Childhood) Project. Mn was measured in newborns’ hair. Children’s neuropsychological development was assessed at 4 years of age using the McCarthy Scales of Children’s Abilities. Multivariate linear regression models were built. Stratified analysis by sex was performed. Generalized additive models were used to assess the shape of the relation. Results: The median Mn concentration in newborns’ hair was 0.42 μg/g (95% CI = 0.38, 0.46). The association between Mn levels and the neuropsychological development was not statistically significant for the general cognitive scale (β [95% CI] = 0.36 [−5.23, 5.95]), motor scale (β [95% CI] = 1.9 [−3.74, 7.55]) or any of the other outcomes. No sex-specific pattern was found. The best shape describing the relationship was linear for all the scales. Conclusion: Our results suggest that prenatal Mn concentrations measured in newborns’ hair do not affect cognitive or motor development at 4 years of age in boys or in girls at the observed Mn levels.

Demographic and Parental Factors Associated With Developmental Outcomes in Children With Intellectual Disabilities

The aim of the study was to examine the relation between demographic variables, parental characteristics, and cognitive, language and motor skills development in children with intellectual disabilities (ID). A sample of 89 children with ID, aged 20-47 months, completed the Bayley Scales of Infant Development to measure cognitive, motor, and linguistic development. Parents were administered questionnaires about demographic information and parental anxiety, depression, parental stress, conjugality and familial functioning. Parenting behaviors (affection, responsiveness, encouragement, and teaching) were observed using the Spanish version of PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). A bivariate analysis showed that cognitive development in infants was significantly related to the mother's and father's responsiveness, and to the father's teaching scores. Infant language development was related to a variety of maternal factors (educational level, anxiety, depression, maternal responsiveness) and to the father's teaching scores. None of the factors were statistically related to child motor development. A multivariate regression analysis indicated that children's cognitive development can be predicted by a linear combination of maternal responsiveness and paternal teaching scores. Language development can be predicted by a linear combination of maternal anxiety and responsiveness, and paternal teaching scores. The present study provides evidence of the importance of paternal involvement for cognitive and language development in children with intellectual disabilities, and contributes to the increasing literature about fathering. Gaining knowledge about parental contributions to children's development is relevant for improving positive parenting in early intervention programs.

Spanish Validation of the PICCOLO (Parenting Interactions With Children: Checklist of Observations Linked to Outcomes)

Background/Objective: The aim of this study was to explore the psychometric properties of the Spanish version of the Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO; Roggman et al., 2013a). This observational measure is composed of 29 items that assess the quality of four domains of parenting interactions that promote child development: affection, responsiveness, encouragement, and teaching. Methods: The sample included 203 mother-child dyads who had been video-recorded playing together. Fifty-six percent of the children were male, and 44% were female, aged from 10 to 47 months. Video-recorded observations were rated using PICCOLO items. Results: Confirmatory factor analysis supported that the instrument has four first-order factors corresponding to the hypothesized domains of parenting behaviors, and a second-order factor corresponding to a general factor of positive parenting. Construct validation evidence was compiled by examining the relationship between PICCOLO scores and child age. As expected, teaching domain and total PICCOLO scores were positively correlated with child age. The Spanish PICCOLO also demonstrated good inter-rater reliability (ranging from 0.69 to 0.84) and internal consistency reliability (ranging from 0.59 to 0.88) for the four domain scores and the total parenting score. Concurrent criterion-related validity was examined via correlations between parenting scores and child cognitive, language and motor skills outcomes, measured using the Bayley Scales of Infant Development. Conclusion: The Spanish version of the PICCOLO meets the criteria for a reliable and valid observational measurement of parenting interactions with children. The psychometric properties of the instrument make it appropriate for general research purposes, but also for program evaluation of Early Intervention and other parenting-support interventions. This measure, focused on parent strengths, could be used to facilitate family-centered practices in early intervention and other programs that have parenting as an outcome.

Parental separation: a risk for the psychomotor development of children aged 28 to 32 months? A cross-sectional study

BACKGROUND

In Western countries, about a quarter of children are affected by parental separation and a number of authors have previously investigated how familial structure impacts children's health. The purpose of the work: to analyze the psychomotor development of children aged 28 to 32 months based on family structure (parents together or separated), independently of the influence of socio-economic environment that is well documented. To analyse the psychomotor development of children younger than 3 years based on family structure (parents together or separated) independently of the influence of socio-economic environment that is well documented.

METHODS

Cross-sectional study by examination of 28 871 children as part of a free preventive medicine consultation. The data came from an assessment conducted 28 to 32 months after birth during which information was collected about the psychomotor development: to perform a standing jump, dress themselves, draw a vertical line and circle, use the "I" pronoun, build a three-word sentence, and say their first name

RESULTS

Ten percent of the children had separated parents. Compared to parents who were together, when adjusting for the socioeconomic environment, as well as all potential confounders, the adjusted odds ratios (ORs) (95 % confidence interval [CI]) for children with separated parents, in terms of their ability to perform a standing jump, dress themselves, and draw a vertical line and circle were respectively 0.9 (0.7-1.1), 1.1 (0.9-1.2), 1.3 (1.1-1.4) and 1.2 (1.1-1.4). The adjusted ORs (95 % CI) for children's inability to say the "I" pronoun, build a three-word sentence, and say their first name were respectively 1.2 (1.1-1.3), 1.3 (1.2-1.5), and 1.2 (0.9-1.5).

CONCLUSIONS

After adjusting for sociocultural factors and other potential confounders, we observed that the children exhibited slower progression in psychomotor development, especially in language and graphic abilities when their parents were separated. While the implications of our study are somewhat limited, they do provide us with the necessary arguments enabling us to set up a prospective cohort study. Such a study should be able to better assess the impact of parental separation on the child's development, confirming our preliminary results.

Postnatal arsenic exposure and attention impairment in school children

Over the last few decades there has been an increased concern about the health risks from exposure to metallic trace elements, including arsenic, because of their potential neurotoxic effects on the developing brain. This study assessed whether urinary arsenic (UA) levels are associated with attention performance and Attention-Deficit/Hyperactivity Disorder (ADHD) in children living in an area with high industrial and mining activities in Southwestern Spain. A cross-sectional study was conducted on 261 children aged 6-9 years. Arsenic levels were determined in urine samples. Attention was measured by using 4 independent tools: a) tests from the Behavioral Assessment and Research System (BARS) designed to measure attention function: Simple Reaction Time Test (RTT), Continuous Performance Test (CPT) and Selective Attention Test (SAT); b) AULA Test, a virtual reality (VR)-based test that evaluates children's response to several stimuli in an environment simulating a classroom; c) Child Behavior Checklist (CBCL), administered to parents; and d) Teacher's Report Form (TRF), administered to teachers. Multivariate linear and logistic regression models, adjusted for potential confounders, were used to estimate the magnitude of the association between UA levels and attention performance scores. Higher UA levels were associated with an increased latency of response in RTT (β = 12.3; 95% confidence interval (CI): 3.5-21.1) and SAT (β = 3.6; 95% CI: .4-6.8) as well as with worse performance on selective and focalized attention in the AULA test (β for impulsivity = .6; 95% CI: .1-1.1; β for inattention = .5; 95% CI: .03-1.0). A dose-response relationship was observed between UA levels and inattention and impulsivity scores. In contrast, results from the CBCL and TRF tests failed to show a significant association with UA levels. In conclusion, UA levels were associated with impaired attention/cognitive function, even at levels considered safe. These results provide additional evidence that postnatal arsenic exposure impairs neurological function in children.