Longitudinal caregiver-reported motor development in infants born at term and preterm

AIM

To examine the extent to which estimates of a latent trait or underlying construct of motor ability differ in infants born at term and preterm, based on caregiver ratings of the motor domain of PediaTrac v3.0.

METHOD

The sample consisted of 571 caregiver-infant dyads (331 born at term, 240 born preterm), 48% female, with 51.7% of caregivers identifying as an ethnic minority. Latent trait of motor ability was estimated based on item response theory modeling. Gestational group differences (term and preterm birth) were examined at the newborn/term-equivalent, 2-, 4-, 6-, 9-, and 12-month time points.

RESULTS

Caregiver ratings of latent trait of motor ability were reliably modeled across the range of abilities at each time point. While the group born preterm exhibited significantly more advanced motor abilities at the term-equivalent time point, by 6 months the group born at term was more advanced. Biological sex difference main and interaction effects were not significant.

INTERPRETATION

Caregivers provided reliable, longitudinal estimates of motor ability in infancy, reflecting important differences in the motor development of infants born at term and preterm. The findings suggest that significant motor development occurs in infants born preterm from birth to the term-equivalent time point and provide a foundation to examine motor growth trajectories as potential predictors in the early identification of neurodevelopmental conditions and needs.

WHAT THIS PAPER ADDS

Longitudinal caregiver ratings of motor function in early infancy yielded reliable estimates of the latent trait of motor ability. Motor ability at the term-equivalent time point was higher in infants born preterm than infants born at term.

Convergent Validity Between the Motor Domain of PediaTracTM and Ages and Stages in Term and Preterm Infants at 2, 4, 6, and 9 Months of Age

The primary aim of this study was to evaluate the convergent validity of the Motor domain (MOT) of PediaTracTM v3.0, an online developmental tracking instrument based on caregiver reports, with fine and gross motor domains (ASQ-FM and ASQ-GM) of the Ages and Stages Questionnaire (ASQ-3) in infants between 2- and 9 months of age. Participants were caregivers of 571 infants born term or preterm (gestational age <37 weeks) enrolled in a multi-site psychometric study of PediaTracTM. Findings revealed significant correlations between MOT and ASQ-3 scores at 2, 4, 6, and 9 months across time periods, term-preterm status, and biological sex. A significantly higher percentage of infants born preterm, compared with those born at term, was identified as a moderate or high risk on both the ASQ-3 and PediaTrac. Future investigations are warranted to further examine the psychometric properties of the MOT domain, including sensitivity, specificity, and positive and negative predictive value.

Measuring Early Relational Health Using PediaTrac TM in a Diverse Sample of Infant-Caregiver Dyads

OBJECTIVE

Early relational health (ERH) is a key developmental predictor and outcome in infancy and early childhood that reflects social-emotional well-being and promotes resilience throughout childhood. Currently, there is no gold-standard developmental screening tool for ERH in pediatric care settings. This study examined the psychometric properties of items assessing ERH that are part of a web-based, caregiver-report screening tool called PediaTrac TM . It was hypothesized that ERH could be reliably estimated and that second-order factors would be revealed within the latent construct ERH.

METHOD

Participants included 571 caregivers of term (n = 331; ≥37 weeks) and preterm (n = 240; <37 weeks) infants recruited shortly after birth from several academic medical centers and a community health clinic. Caregivers completed PediaTrac modules at birth and 2, 4, 6, 9, 12, 15, and 18 months; data for this study are from the newborn through 12-month periods.

RESULTS

Results from Item Response Theory Graded Response Modeling revealed excellent reliability for the PediaTrac ERH domain at all time points, ranging from 0.96 to 0.98. Exploratory factor analyses revealed 4 to 5 second-order factors, representing Parent-Child Relationship, Parent Distress, Parenting Stress, Parenting Efficacy, Sensitivity, and Perceptions of Child, depending on period.

CONCLUSION

The caregiver-report developmental screening tool, PediaTrac, reliably measures ERH during the first year of life. The measure has promising clinical utility in pediatric clinic settings for tracking ERH over time to ensure early social-emotional well-being and to identify concerns as early as possible.

Caregiver-reported infant motor and imitation skills predict M-CHAT-R/F

Altered motor and social-communicative abilities in infancy have been linked to later ASD diagnosis. Most diagnostic instruments for ASD cannot be utilized until 12 months, and the average child is diagnosed substantially later. Imitation combines motor and social-communicative skills and is commonly atypical in infants at risk for ASD. However, few measures have been developed to assess infant imitation clinically. One barrier to the diagnostic age gap of ASD is accessibility of screening and diagnostic services. Utilization of caregiver report to reliably screen for ASD mitigates such barriers and could aid in earlier detection. The present study developed and validated a caregiver-report measure of infant imitation at 4, 6, and 9 months and explored the relationship between caregiver-reported imitation and motor abilities with later ASD risk. Participants (N = 571) were caregivers of term and preterm infants recruited as part of a large multi-site study of PediaTrac™, a web-based tool for monitoring and tracking infant development. Caregivers completed online surveys and established questionnaires on a schedule corresponding to well-child visits from birth to 18 months, including the M-CHAT-R/F at 18 months. Distinct imitation factors were derived from PediaTrac at 4, 6, and 9 months via factor analysis. The results supported validity of the imitation factors via associations with measures of infant communication (CSBS; ASQ). Imitation and motor skills at 9 months predicted 18-month ASD risk over and above gestational age. Implications for assessment of infant imitation, detecting ASD risk in the first year, and contributing to access to care are discussed.

Longitudinal associations between parental reflective functioning and maternal mind-mindedness

Little work has examined longitudinal associations between parental reflective functioning (PRF) and mind-mindedness (MM), limiting the understanding of separate or bidirectional trajectories of these related but distinct forms of mentalization. We examined cross-lagged associations between PRF, assessed via interview, and MM, coded from play interactions, over 12 months among 90 parents (86% female; 57% White, 43% Black) of infants (Mage = 10.56 months, SD = 8.20) who were participating in The Michigan Model of Infant Mental Health Home Visiting. Data were collected at study enrollment Time 1 (T1) and at 6-month Time 2 (T2) and 12-month Time 3 (T3) postenrollment. Mind-minded comments were coded as appropriate, reflecting accurate interpretation of mental states or nonattuned, characterizing inaccurate interpretations. PRF and appropriate MM each remained stable over time. PRF at the T1 positively predicted appropriate MM at T2. No other cross-lagged associations between PRF and appropriate MM were significant. Concurrent correlations between appropriate MM and PRF were significant only at T3. Nonattuned MM showed stability from T1 to T2 but nonattuned MM at the T2 did not predict nonattuned MM at T3. Greater PRF at T1 predicted less nonattuned MM at T2. No other cross-lagged associations between PRF and nonattuned MM were significant. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Associations between adverse childhood experiences and obstetrical outcomes in a predominantly Black-identifying and low-income pregnant population

BACKGROUND

Recent literature indicates that adverse childhood experiences have been associated with poor obstetrical outcomes, including pregnancy loss, preterm birth, and low birthweight. Several studies have been conducted in primarily self-identified White individuals who report middle to high income levels. Less is known about the impact of adverse childhood experiences on obstetrical outcomes in minority-identifying and low-income populations, who are known to experience a greater number of adverse childhood experiences and are at higher risk of maternal morbidity.

OBJECTIVE

This study aimed to examine associations between adverse childhood experiences and a broad range of obstetrical outcomes among predominantly Black-identifying pregnant persons who have low income and live in an urban area.

STUDY DESIGN

This is a single-center retrospective cohort study of pregnant persons referred to a mental healthcare manager because of elevated psychosocial risks identified by screening tools or provider concerns during the study period from April 2018 to May 2021. Pregnant persons aged <18 years and those who did not speak English were excluded. Patients completed validated mental and behavioral health screening tools including the Adverse Childhood Experiences Questionnaire. Medical charts were reviewed for obstetrical outcomes, including preterm birth, low birthweight, hypertensive disorders of pregnancy, gestational diabetes mellitus, chorioamnionitis, sexually transmitted infection, maternal group B streptococcus carrier status, type of delivery, and attendance of a postpartum visit. Associations between high (≥4) and very high (≥6) of 10 adverse childhood experience score and obstetrical outcomes were analyzed using bivariate analysis and multivariate logistic regression, adjusting for confounding factors (significant at P<.05 in bivariate analysis).

RESULTS

Our cohort included 192 pregnant persons, of whom 176 (91.7%) self-identified as Black or African American and 181 (94.8%) had public insurance (used as a proxy for low income). Adverse childhood experience score ≥4 was reported by 91 (47.4%) individuals and score ≥6 by 50 (26%). On univariate analysis, adverse childhood experience score ≥4 was associated with preterm birth (odds ratio, 2.17; 95% confidence interval, 1.02-4.61). Adverse childhood experience score ≥6 was associated with hypertensive disorders of pregnancy (odds ratio, 2.09; 95% confidence interval, 1.05-4.15) and preterm birth (odds ratio, 2.29; 95% confidence interval, 1.05-4.96). After accounting for chronic hypertension, associations between adverse childhood experience score and obstetrical outcomes were no longer significant.

CONCLUSION

Approximately half of the pregnant persons referred to a mental healthcare manager had a high adverse childhood experience score, underscoring the high burden of childhood trauma on populations facing long-standing systemic racism and barriers to healthcare access. High and very high adverse childhood experience score may be associated with chronic health conditions that predate pregnancy and can alter obstetrical outcomes. Obstetrical care providers have a unique opportunity to mitigate risk of associated poor health outcomes during preconception and prenatal care by screening for adverse childhood experiences.

Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care

Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.

Caregiver-reported development in term and preterm infants from birth to nine months of age: Psychometrics of the PediaTracTM social/communication/cognition domain

Term and preterm neonates were assessed at the newborn (NB) period (term, term equivalent) and at 2, 4, 6, and 9 months in a study of the psychometric properties of the Social/Communication/Cognition (SCG) domain of PediaTrac™ v3.0, a novel caregiver-based developmental monitoring instrument. Item response theory (IRT) was used to model item parameters and estimate theta, an index of the latent trait, social/communication/cognition. Exploratory factor analysis (EFA) was conducted to further clarify the dimensionality of the domain. In a cohort of 571 caregiver-infant dyads (331 term, 240 preterm), mean theta values could be reliably estimated at all time periods, with term infants demonstrating significantly more advanced social/communication/cognition abilities at 9 months of age. Item discrimination and item difficulty of the 15, 15, 35, 47, and 57 items at the NB, 2-, 4-, 6-, and 9-month periods, respectively, could be reliably modeled across the range of ability. Total Information for the SCG domain was high and the reliability ranged from 0.97 to 0.99 (NB = .98, 2 month = .97, 4 month = .98, 6 month = .99 and 9 month = .99). EFA revealed second-order factors at each time period, with two factors at the NB period (affect/emotional expression, social responsiveness) accounting for 43% of variance; three factors at 2, 4, and 6 months (affect/emotional expression, social responsiveness imitation/emerging communication), accounting for 43%, 34%, and 34% of the variance, respectively; and four factors at 9 months (imitation/communication, nonverbal/gestural communication, affect expression, and social responsiveness), accounting for 34% of the variance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Caregiver-reported newborn term and preterm motor abilities: psychometrics of the PediaTracTM Motor domain

BACKGROUND

Approximately 5-10% of children exhibit developmental deviations in motor skills or other domains; however, physicians detect less than one-third of these abnormalities. Systematic tracking and early identification of motor deviations are fundamental for timely intervention.

METHODS

Term and preterm neonates were prospectively assessed at the newborn (NB) period in a study of the psychometric properties of the Motor (MOT) domain of PediaTrac^TM v3.0, a novel caregiver-based development tracking instrument. Item response theory graded response modeling was used to model item parameters and estimate theta, an index of the latent trait, motor ability. Exploratory factor analysis (EFA) was conducted to examine the dimensionality and factor structure.

RESULTS

In a cohort of 571 caregiver/infant dyads (331 term, 240 preterm), NB MOT domain reliability was high (rho = 0.94). Item discrimination and item difficulty of each of the 15 items could be reliably modeled across the range of motor ability. EFA confirmed that the items constituted a single dimension with second-order factors, accounting for 43.20% of variance.

CONCLUSIONS

The latent trait, motor ability, could be reliably estimated at the NB period.

IMPACT

The caregiver-reported Motor domain of PediaTrac provides a reliable estimate of the latent trait of motor ability during the newborn period. This is the first known caregiver-reported instrument that can assess motor ability in the newborn period with high reliability in term and preterm infants. Item response theory methods were employed that will allow for future characterization of developmental subgroups and motor trajectories. The PediaTrac Motor domain can support early identification of at-risk infants. Including caregivers in digital reporting and child-centered monitoring of motor functioning may improve access to care.

Infant Mental Health Home Visiting Mitigates Impact of Maternal Adverse Childhood Experiences on Toddler Language Competence: A Randomized Controlled Trial

OBJECTIVE

The goal of this study was to test the impact of maternal adverse childhood experiences (ACEs) on subsequent child language competence; higher parental ACEs were expected to predict risk of toddler language delay. Participation in Infant Mental Health Home Visiting (IMH-HV) treatment, which aims to enhance responsive caregiving and improve child social-emotional development, was expected to mitigate this association.

METHODS

A randomized controlled trial (RCT) design was used. ACEs data were collected at baseline. Child language screening (using the Preschool Language Scales Screening Test) was conducted 12 months later by masters-level evaluators who were blind to treatment condition. Visits occurred in participants' homes. Participants were community-recruited and were randomized to treatment (psychotherapeutic IMH-HV) or control (treatment as usual). Data come from 62 families who participated in all waves of an RCT testing the efficacy of IMH-HV; mothers were eligible based on child age (<24 mo at enrollment) and endorsement of ≥2 sociodemographic eligibility criteria (economic disadvantage, depression, perceived parenting challenges, and/or high ACEs).

RESULTS

The age of mothers enrolled in this ranged from 19 to 44 years (M = 31.91; SD = 5.68); child age at baseline ranged from prenatal to 26 months (M = 12.06; SD = 6.62). The maternal ACE score predicted child language competence (t (5,55) = -3.27, p = 0.002). This effect was moderated by treatment (t (6,54) = 1.73, p = 0.04), indicating no association between maternal ACEs and child language for those randomized to IMH-HV.

CONCLUSION

The results highlight that the effects of parent ACEs on early childhood outcomes may be buffered by participation in psychotherapeutic home visiting (trial registration: NCT03175796).

Establishing Trauma-Informed Primary Care: Qualitative Guidance from Patients and Staff in an Urban Healthcare Clinic

Patients present to primary care clinics with a variety of experiences, including exposure to adverse childhood experiences (ACEs) and other social determinants of health. The pervasive impact of early adversity on later healthcare outcomes has resulted in the development of trauma-informed care principles that can be applied to healthcare settings. The primary aim of this study is to improve understanding of patient and staff experiences within a trauma-informed urban healthcare setting to guide considerations and recommendations when implementing such a model. A phenomenologic approach was taken using an interpretivist paradigm to collect qualitative data by conducting patient and staff focus groups. The following themes were identified: the communal experience of significant trauma, lack of continuity of care and time for each appointment, the importance of a sense of community and standardization and normalization of asking about trauma, development of social support networks, and creating a safe and non-judgmental healthcare space. Based on findings, considerations for implementing a trauma-informed healthcare model are provided.

The influence of sociodemographic factors and response style on caregiver report of infant developmental status

Caregiver report is the most feasible way to assess early childhood development but is susceptible to the influences of response style and sociodemographic factors. In a sample of 571 caregiver-infant dyads (47.8% female; 48% White), we compared caregiver reports on the Ages and Stages Questionnaire-Third Edition (ASQ-3) with reports on a novel, web-based assessment, PediaTrac™. Ratings on PediaTrac correlated with ratings on the ASQ-3 at all time points (2, 4, 6, and 9 months). Caregiver age, response style, and sociodemographic factors accounted for significant variance on both measures. Developmental reporting of early childhood skills is influenced by caregiver response style and sociodemographic factors. These influences must be considered in order to ensure the accurate identification of infant developmental status.

PediaTrac V.3.0 protocol: a prospective, longitudinal study of the development and validation of a web-based tool to measure and track infant and toddler development from birth through 18 months

INTRODUCTION

The need for an efficient, low-cost, comprehensive measure to track infant/toddler development and treatment outcomes is critical, given the importance of early detection and monitoring. This manuscript describes the protocol for the development and testing of a novel measure, PediaTrac, that collects longitudinal, prospective, multidomain data from parents/caregivers to characterise infant/toddler developmental trajectories in term and preterm infants. PediaTrac, a web-based measure, has the potential to become the standard method for monitoring development and detecting risk in infancy and toddlerhood.

METHODS AND ANALYSES

Using a multisite, prospective design, primarcaregivers will complete PediaTrac V.3.0, a survey tool that queries core domains of early development, including feeding/eating/elimination, sleep, sensorimotor, social/sensory information processing, social/communication/cognition and early relational health. Information also will be obtained about demographic, medical and environmental factors and embedded response bias indices are being developed as part of the measure. Using an approach that systematically measures infant/toddler developmental domains during a schedule that corresponds to well-child visits (newborn, 2, 4, 6, 9, 12, 15, 18 months), we will assess 360 caregiver/term infant dyads and 240 caregiver/preterm infant dyads (gestational age <37 weeks). Parameter estimates of our items and latent traits (eg, sensorimotor) will be estimated by theta using item response theory-graded response modelling. Participants also will complete legacy (ie, established) measures of development and caregiver health and functioning, used to provide evidence for construct (discriminant) validity. Predictive validity will be evaluated by examining relationships between the PediaTrac domains and the legacy measures in the total sample and in a subsample of 100 participants who will undergo a neurodevelopmental assessment at 24 months of age.

ETHICS AND DISSEMINATION

This investigation has single Institutional Review Board (IRB) multisite approval from the University of Michigan (IRB HUM00151584). The results will be presented at prominent conferences and published in peer-reviewed scientific journals.

Parenting Mediates Associations Between Intimate Partner Violence at Different Life Stages and Toddler Social-Emotional Problems

BACKGROUND

Researchers have linked parent experiences of intimate partner violence (IPV) to engagement in more negative and less positive parenting behaviors with their own children. This parenting behavior is associated with more negative child social-emotional outcomes. There is little research examining the impact of exposure to IPV during childhood on subsequent parenting and child outcomes in the next generation. This study aimed to better understand the complex relationship between IPV, parenting, and child social-emotional development among mothers of toddler-aged children, using both mothers' self-reported and observed parenting.

METHOD

This study utilized longitudinal data from an economically disadvantaged, racially diverse sample of 120 women who participated in data collection across the perinatal period, until children were 2 years of age. Measures included self-reported and observed parenting, mother-reported IPV history, and mother-report of toddler social-emotional difficulties.

RESULTS

Childhood exposure to IPV predicted observed parenting problems, which in turn predicted greater toddler social-emotional problems. Conversely, adult experiences of IPV predicted self-reported parenting difficulties, which predicted greater toddler social-emotional problems.

SUMMARY

Findings suggest that exposure to IPV at different time points may influence parenting in different ways, representing unique pathways between maternal IPV experiences and child social-emotional difficulties.

Infant mental health home visiting: intervention dosage and therapist experience interact to support improvements in maternal reflective functioning

This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.

Maternal prenatal depression, PTSD, and problematic parenting: the mediating role of maternal perceptions of infant emotion

Background: Perinatal illness is alarmingly common and has negative effects on maternal and infant well-being. Depression and posttraumatic stress disorder (PTSD), specifically, are characterised by negative views of the self and others, which may impact a mother's perceptions of herself and her child. Objective: This study examined the relationship between depression and PTSD symptoms, maternal perceptions of infant emotions, and parenting behaviours. Methods: 120 pregnant, mostly low-income women and their infants (after birth) participated in a longitudinal study. Maternal depression and PTSD symptoms were assessed during pregnancy and 1 year postpartum; maternal perceptions of infant emotions and parenting quality were assessed at 1 year. Results: Correlation analyses revealed significant, negative associations between prenatal (but not postnatal) psychiatric symptoms and positive perceptions of infant emotions, as well as between positive perceptions of infant emotions and negative parenting. Results also revealed significant indirect effects of prenatal depressive and PTSD symptoms on negative parenting via perceptions of infant emotion (95% CIs:.0013 -.0200 and.0008 -.0083, respectively). Conclusion: Findings highlight that mothers should be routinely screened for psychiatric symptoms during the perinatal period, and perceptions of infant emotions may be an important target for parent-infant mental health interventions.

C-48 Attachment and SES at Newborn, Two, and Four Months Related to Communication Development at Nine and Twelve Months

Objective

Previous literature linked secure infant attachment to subsequent communication competency (Murray & Yingling, 2000). Less is known about that relationship in families of varying SES. This study explores how attachment and income at newborn, two, and four months correspond with communication development at nine and twelve months.

Methods

Longitudinal (n = 30) and cross-sectional (n = 102) reports from PediaTrac□, a parent-report web-based survey to track development (Lajiness-O’Neill, et al., 2018), were collected at newborn (NB; n = 41), two (2m; n = 38), four (4m; n = 37), nine (9m; n = 38), and twelve months (12m; n = 36). The cross-sectional sample had higher income (p = .01). Attachment was measured using PediaTrac□ and the Postpartum Bonding Questionnaire (PBQ; Brockington, Fraser & Wilson, 2006). Communication was measured using PediaTrac□.

Results

A linear regression model predicted communication development at 9m and 12m from attachment and income at NB, 2m, and 4m. PBQ attachment at 2m significantly predicted communication at 9m (b = 0.12, t = 2.28, p = .049). However, income was not significant, and neither attachment nor income at NB, 2m, or 4m predicted communication at 12m.

Conclusions

More secure attachment at two months was related to better communication outcomes at nine months regardless of SES. This finding highlights the importance of parent-infant relationships at two months of age on development, indicating further research on methods to promote secure attachment and positive parent-infant interaction in families of varying SES.

Development and validation of PediaTrac™: A web-based tool to track developing infants

OBJECTIVE

PediaTrac™, a 363-item web-based tool to track infant development, administered in modules of ∼40-items per sampling period, newborn (NB), 2--, 4--, 6--, 9-- and 12--months was validated. Caregivers answered demographic, medical, and environmental questions, and questions covering the sensorimotor, feeding/eating, sleep, speech/language, cognition, social-emotional, and attachment domains.

METHODS

Expert Panel Reviews and Cognitive Interviews (CI) were conducted to validate the item bank. Classical Test Theory (CTT) and Item Response Theory (IRT) methods were employed to examine the dimensionality and psychometric properties of PediaTrac with pooled longitudinal and cross-sectional cohorts (N = 132).

RESULTS

Intraclass correlation coefficients (ICC) for the Expert Panel Review revealed moderate agreement at 6 -months and good reliability at other sampling periods. ICC estimates for CI revealed moderate reliability regarding clarity of the items at NB and 4 months, good reliability at 2--, 9-- and 12--months and excellent reliability at 6 -months. CTT revealed good coefficient alpha estimates (α ≥ 0.77 for five of the six ages) for the Social-Emotional/Communication, Attachment (α ≥ 0.89 for all ages), and Sensorimotor (α ≥ 0.75 at 6-months) domains, revealing the need for better targeting of sensorimotor items. IRT modeling revealed good reliability (r = 0.85-0.95) for three distinct domains (Feeding/Eating, Social-Emotional/Communication and Attachment) and four subdomains (Feeding Breast/Formula, Feeding Solid Food, Social-Emotional Information Processing, Communication/Cognition). Convergent and discriminant construct validity were demonstrated between our IRT-modeled domains and constructs derived from existing developmental, behavioral and caregiver measures. Our Attachment domain was significantly correlated with existing measures at the NB and 2-month periods, while the Social-Emotional/Communication domain was highly correlated with similar constructs at the 6-, 9- and 12-month periods.

CONCLUSION

PediaTrac has potential for producing novel and effective estimates of infant development via the Sensorimotor, Feeding/Eating, Social-Emotional/Communication and Attachment domains.

Defense Mechanisms of Pregnant Mothers Predict Attachment Security, Social-Emotional Competence, and Behavior Problems in Their Toddlers

OBJECTIVE

For at-risk (single parent, low income, low support) mothers, healthy adaptation and the ability to manage stress have clear implications for parenting and the social-emotional well-being of their young offspring. The purpose of this longitudinal study was to examine associations between defense mechanisms in pregnant women and their toddlers' attachment security, social-emotional, and behavioral adjustment.

METHOD

Participants were 84 pregnant women during their last trimester of pregnancy, recruited from community agencies primarily serving low-income families. Women were followed prospectively from pregnancy through 2 years after birth and completed several multimethod assessments during that period. Observations of mother-child interactions were also coded after the postnatal visits.

RESULTS

Multiple regression analyses revealed that mothers' defense mechanisms were significantly associated with several toddler outcomes. Mature, healthy defenses were significantly associated with greater toddler attachment security and social-emotional competence and fewer behavior problems, and less mature defenses (disavowal in particular) were associated with lower levels of attachment security and social-emotional competence. Associations remained significant, or were only slightly attenuated, after controlling for demographic variables and partner abuse during pregnancy.

CONCLUSIONS

The study findings suggest that defensive functioning in parents preparing for and parenting toddlers influences the parent-child attachment relationship and social-emotional adjustment in the earliest years of life. Possible mechanisms for these associations may include parental attunement and mentalization, as well as specific caregiving behavior toward the child. Defensive functioning during times of increased stress (such as the prenatal to postnatal period) may be especially important for understanding parental influences on the child.

Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security

This study examined relationships among maternal reflective functioning, parenting, infant attachment, and demographic risk in a relatively large (N = 83) socioeconomically diverse sample of women with and without a history of childhood maltreatment and their infants. Most prior research on parental reflective functioning has utilized small homogenous samples. Reflective functioning was assessed with the Parent Development Interview, parenting was coded from videotaped mother-child interactions, and infant attachment was evaluated in Ainsworth's Strange Situation by independent teams of reliable coders masked to maternal history. Reflective functioning was associated with parenting sensitivity and secure attachment, and inversely associated with demographic risk and parenting negativity; however, it was not associated with maternal maltreatment history or PTSD. Parenting sensitivity mediated the relationship between reflective functioning and infant attachment, controlling for demographic risk. Findings are discussed in the context of prior research on reflective functioning and the importance of targeting reflective functioning in interventions.

Adolescent peer relationships and mental health functioning in families with domestic violence

Examined the impact of domestic violence, child abuse, and attachment style on adolescent mental health and relationship functioning. Data were collected on 111 adolescents, ages 14 to 16, and their mothers. Results indicate that both attachment and family violence experiences negatively impact mental health. In addition, family violence significantly predicted attachment style. Significant protective and vulnerability factors included maternal psychological functioning, maternal positive parenting, and perceived social support from friends. However, findings provided only limited support for the model of attachment as a mediator of the impact of family violence on adolescent relationships.