Debate: How far can we modify the expression of autism by modifying the environment?

Following Green (Child and Adolescent Mental Health, 2023, 28, 438) the emergence of a manifest autistic phenotype, during preschool years, represents a discontinuity from preclinical or subclinical states. We propose that this discontinuity suggests that autistic children experience superior interest for, and processing of non-social information, whereas children without autism favor social information processing. This is produced by perceptual over-functioning, still allowing self-taught non-social language learning in a substantial fraction of prototypical autistic children. A new set of rigorous intervention studies using Pediatric Autism Communication Therapy (PACT), based on the synchrony principle, brought autistic children below the ADOS diagnostic threshold (Whitehouse et al., JAMA Pediatrics, 2021, 175, e213298). We now know that adaptation of the child's social environment can produce changes in the manifestations of autism in the pre-school period and later. However, the limitation of these changes, combine with evidence of non-social learning of language suggests that clinicians should combine lateral tutorship (the parallel, unsynchronous exposure of information) with the synchrony (early dyadic communication and engagement) principle to create a new generation of strength-based interventions.

Reciprocal associations between parental depression and child cognition: Pathways to children's internalizing and externalizing symptoms

Parental depression is a risk factor for children's cognitive and psychological development. Literature has found reciprocal relations between parental depression and child psychopathology and effects of parental depression on children's cognition. The present study is the first to examine reciprocity among parental depression and child cognition, and pathways to child psychopathology. Structural equation models were conducted using data from the Early Head Start Research and Evaluation Project, a nationally representative sample of 3,001 economically marginalized families. Measures were collected in four waves from 14 months to 10-11 years. Reciprocal associations emerged between maternal and paternal depression at from 14 months to 5 years. Reciprocal parental depression was associated with greater psychopathology at age 10-11. Maternal depression predicted poorer child cognition, which indirectly predicted increased depression in mothers of children aged 3-5 through paternal depression, and in fathers at age 3, through earlier paternal depression. This study was unable to parse within- and between-person effects. Additionally, data for paternal depression was limited to ages 2 and 3. Findings emphasize the transactional nature of child cognition and child and parent psychopathology, supporting family focused intervention and prevention efforts that target parent psychopathology and child cognition.

Standardization vs Customization: Finding the Right Balance

There is an inherent tension between standardization and customization of care delivery processes. The challenge for health care systems is to achieve the right balance. At its best, standardized work can create efficiencies that generate the additional time needed for personalized care. Similarly, at its best, customization allows the people within a system to accommodate the needs, preferences, and circumstances of the unique individuals and local communities they serve. We provide examples and offer principles to decide when standardization offers the most successful path and when customization may be preferred. We believe that, in sum, the balance has shifted too far toward standardization and that a rebalancing toward customization will benefit patients, clinicians, and the health care system.

A prenatal programming perspective on the intergenerational transmission of maternal adverse childhood experiences to offspring health problems

Decades of research indicate that individuals exposed to childhood adversity are at risk for poor physical and mental health across their life span. More recently, intergenerational transmission of trauma and prenatal programming frameworks suggest an even longer reach for adverse childhood experiences (ACEs), with consequences that extend to subsequent generations. Beyond the individual-level consequences typically observed by empirical studies of ACEs, mothers' experiences of early adversity may also compromise the maternal-child dyadic relationship. We propose a conceptual model whereby mothers' ACEs impact maternal-infant dyadic functioning and later biobehavioral health outcomes through heightened perinatal psychosocial risk. We provide support for the proposed paths and mechanistic processes in our model with data drawn from Las Madres Nuevas, a longitudinal study of low-income Mexican-origin families who participated in a series of home and laboratory visits from the prenatal period through early childhood. Higher ACEs exposure among Las Madres Nuevas participants was associated with numerous perinatal psychosocial risk factors, which predicted poorer mother-infant dyadic functioning. Compromised dyadic functioning during infancy was associated with later maternal mental health and child behavior problems. We conclude with discussion of prevention and treatment strategies that can buffer against proposed risk pathways, including perinatal assessment of maternal ACEs and psychosocial risk, perinatal treatment of maternal distress, and mother-infant therapy in the postpartum period. It is our hope that the proposed conceptual model will serve as a guide for future research to examine the lasting consequences of childhood adversities within and across generations among high-risk populations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Transactional relations between early child temperament, structured parenting, and child outcomes: A three-wave longitudinal study

While child self-regulation is shaped by the environment (e.g., the parents' caregiving behaviors), children also play an active role in influencing the care they receive, indicating that children's individual differences should be integrated in models relating early care to children's development. We assessed 409 children's observed temperamental behavioral inhibition (BI), effortful control (EC), and the primary caregiver's parenting at child ages 3 and 5. Parents reported on child behavior problems at child ages 3, 5, and 8. Mediation analyses were conducted to examine relations between child temperament and parenting in predicting child problems. BI at age 3 was positively associated with structured parenting at age 5, which was negatively related to child internalizing and attention-academic problems at age 8. In contrast, parenting at child age 3 did not predict child BI or EC at age 5, nor did age 3 EC predict parenting at age 5. Findings indicate that child behavior may shape the development of caregiving and, in turn, long-term child adjustment, suggesting that studies of caregiving and child outcomes should consider the role of child temperament toward developing more informative models of child-environment interplay.

Does leadership style of modern matrons contribute to safer and more effective clinical services?

At the time of writing, the author was a modern matron in a surgical division of an NHS teaching hospital in London. This article considers the differences between leadership and management, and discusses the skills required by modern matrons to lead safe and successful clinical services. It also examines three leadership styles - transactional, transformational and situational - and their relevance to the role of modern matron.

Transactional processes in children born preterm: Influences of mother-child interactions and parenting stress

This prospective, longitudinal study examined the transactional relations among perceived maternal parenting stress, maternal insensitivity, and child behavior across toddlerhood through age 6 within families of a child born preterm. A sample of 173 mother-child dyads were followed from just before the infant was discharged from the neonatal intensive care unit to 6 years of age, with observational measurements of maternal insensitivity and child noncompliance (24 and 36 months), maternal self-reports of perceived parenting stress (24 months, 36 months, 6 years), and maternal reports of child externalizing behavior at 6 years. Results indicated that maternal insensitivity at 36 months significantly mediated the relation between parenting stress at 24 months and externalizing behaviors at 6 years. Parenting stress was also directly associated with child noncompliance at 36 months and with child externalizing behavior at 6 years. Neonatal risk was associated with increased maternal insensitivity at 24 months, but also decreased parenting stress at 24 months. No significant "child effects" from child behavior to either maternal insensitivity or parenting stress were found. Parenting stress appears to play a critical role for children born preterm, and it is associated with children's behavior both directly and through its influence on parenting. The role of neonatal risk needs continued investigation, as families traditionally considered to be at lower risk may still face significant challenges.

Coping and social problem solving correlates of asthma control and quality of life

In a sample of adults with asthma receiving care and medication in an outpatient pulmonary clinic, this study tested for statistical associations between social problem-solving styles, asthma control, and asthma-related quality of life. These variables were measured cross sectionally as a first step toward more systematic application of social problem-solving frameworks in asthma self-management training. Recruitment occurred during pulmonology clinic service hours. Forty-four adults with physician-confirmed diagnosis of asthma provided data including age, gender, height, weight, race, income, and comorbid conditions. The Asthma Control Questionnaire, the Mini Asthma Quality of Life Questionnaire (Short Form), and peak expiratory force measures offered multiple views of asthma health at the time of the study. Maladaptive coping (impulsive and careless problem-solving styles) based on transactional stress models of health were assessed with the Social Problem-Solving Inventory-Revised: Short Form. Controlling for variance associated with gender, age, and income, individuals reporting higher impulsive-careless scores exhibited significantly lower scores on asthma control (β = 0.70, p = 0.001, confidence interval (CI) [0.37-1.04]) and lower asthma-related quality of life (β = 0.79, p = 0.017, CI [0.15-1.42]). These findings suggest that specific maladaptive problem-solving styles may uniquely contribute to asthma health burdens. Because problem-solving coping strategies are both measureable and teachable, behavioral interventions aimed at facilitating adaptive coping and problem solving could positively affect patient's asthma management and quality of life.

Corumination, interpersonal stress generation, and internalizing symptoms: accumulating effects and transactional influences in a multiwave study of adolescents

This multiwave longitudinal study investigated potential transactional and accumulating influences among corumination, interpersonal stressors, and internalizing symptoms among a sample of early and middle adolescents (N = 350; 6th-10th graders). Youth completed self-report measures of corumination at Times 1, 2, and 4, and negative life events, internalizing symptoms (general depressive, specific anhedonic depressive, anxious arousal, general internalizing), and externalizing problems at all four time points (5 weeks between each assessment across 4 months). Results supported hypotheses. First, baseline corumination predicted prospective trajectories of all forms of internalizing symptoms but not externalizing problems. Second, baseline corumination predicted generation of interpersonal-dependent, but not interpersonal-independent or noninterpersonal stressors. Third, interpersonal-dependent events partially mediated the longitudinal association between baseline corumination and prospective internalizing symptoms. Fourth, a transactional, bidirectional set of associations was supported in that initial internalizing symptoms and stressors predicted later elevations in corumination, and in turn, corumination predicted later symptoms through the mediating role of interpersonal stressors to complete both streams in the transactional chain of influence. Fifth, girls and older adolescents exhibited higher corumination, but neither age nor sex moderated any associations. These findings are discussed within a transactional, developmental cascade model.