Gait in children with and without ADHD: A systematic literature review.

BACKGROUND: There is increasing speculation whether Attention-Deficit/Hyperactivity Disorder (ADHD) has phenotypic or secondary motor symptoms. Some evidence suggests even fundamental motor skills such as walking can differ in ADHD, however, the evidence is limited and has not been reviewed. Therefore, we conducted a systematic review to summarize the findings regarding gait in ADHD compared to typically developing children in (1) normal (i.e., self-paced), (2) paced or complex (i.e., walking backwards), and (3) dual-task contexts. METHOD: Following a thorough literature search and application of stringent exclusion criteria, a total of 12 studies were included in this review. All studies examined normal walking with a variety of gait parameters in children (age range: 5-18), however, selected parameters and group differences were often inconsistent. RESULTS: In self-paced walking, studies reporting gait with coefficients of variance (CVs) indicated several between-group differences, whereas averages of gait variables were the same for those with ADHD and typically developing children. Paced or complex walking contexts often differed between ADHD and typically developing groups, favoring the ADHD group in some cases, but primarily the typically developing participants. Finally, walking contexts with dual-tasks showed more frequent performance losses in the ADHD group. DISCUSSION: Children with ADHD seem to have specific patterns of gait variability compared to typically developing children, particularly in complex walking contexts and at faster paces. The influence of age, medication, and method of gait normalization may have influenced the results of studies. Overall, this review highlights the potential for a unique gait profile in children with ADHD.

"What If Others Think I Look Like " The Moderating Role of Social Physique Anxiety and Sex in the Relationship between Physical Activity and Life Satisfaction in Swiss Adolescents.

BACKGROUND: Physical activity has been shown to have a positive effect on life satisfaction in adolescents. Despite these benefits, physical activity levels constantly drop during adolescence, suggesting potential interfering factors in this link. Since worries about physical appearance are an important issue at this age, this study aims to examine the relationship between physical activity and life satisfaction in adolescents and explores possible moderating effects of social physique anxiety and sex. METHODS: We used data from a longitudinal study with N = 864 vocational students (mean age = 17.87 years, range: 16-25, 43% female) from Switzerland. To test our hypotheses, we used multiple hierarchical regression analyses as well as simple slope analyses. RESULTS: We did not find a significant direct effect of physical activity on life satisfaction. However, we found a significant two-way interaction between physical activity and social physique anxiety. An additional significant three-way interaction occurred, indicating that a positive effect of physical activity on life satisfaction holds only for female adolescents with low social physique anxiety levels. CONCLUSIONS: This study highlights the importance of developing a healthy relationship with one's body to fully benefit from physical activity, especially for female adolescents. Taken together, these results reveal important considerations for physical activity educators.

Gait Variability Relates to Prosocial, Emotional and Risk-Taking Behavior in Typically Developing Children.

Motor skills enable multi-facetted interactions with the environment and allow children to develop social skills and respond appropriately to situational social demands when interacting with peers and adults. Previous research with clinical samples (e.g., children diagnosed with Developmental Coordination Disorder) showed that children's motor skills are closely linked to their psychosocial behavior (e.g., prosocial, hyperactive, inattentive, interpersonal), but studies with typically developing children are rare. We sought to fill this research gap by examining relationships between gait variability as an indicator of motor skills and prosocial behavior, problem behavior, and risk-taking behavior in typically developing children. Participants were a large cross-section of 7-13-year-olds (N = 221). They were asked to walk normally across an electronic pathway (GAITRite). We assessed their gait variability (i.e., stride time, stride length and stride velocity). Their parents completed the Strengths and Difficulties Questionnaire that assessed their child's prosocial behavior, hyperactivity, emotional symptoms, and any conduct or peer relationship problems. Parents also provided information on an adapted scale of the Tridimensional Personality Questionnaire assessing risk-taking behavior. We used multilevel modeling to account for individual interdependence and to analyze the maximum number of strides for each participant. Children with greater stride length variability and velocity showed significantly less prosocial behavior, had more emotional symptoms and demonstrated less risk-taking behavior. Stride time variability was not significantly related to any variables. These results align with past findings that gait is sensitive to motor skill differences, and they extend past findings of these associations between gait and facets of intra- and interpersonal characteristics among children within clinical disorders to typically developing children.

Aerobic fitness and fine motor skills are related to switching and updating in typically developing children.

Movement is essential for everyday life and closely related to cognitive skills. The aim of the current research was to investigate whether different aspects of physical activity, i.e., aerobic fitness and motor skills, contribute above and beyond each other to the variance in children's executive functioning. Children aged 8-13 years (N = 129, 58 females, Mage = 10.7 years, SDage = 1.6 years) participated in the current cross-sectional study. Aerobic fitness was assessed by the Progressive Aerobic Cardiovascular Endurance Run (PACER). Motor skills were assessed using the standardized Movement Assessment Battery for Children 2nd edition (M-ABC-2), including fine motor skills, balance skills, and object control. Components of executive functions (inhibition, switching, updating) were assessed using the following tasks: an animal Stroop task, a local-global task, and a 2n-back task. Hierarchical regressions were conducted to analyze the relative importance of aerobic fitness and motor skills for children's executive functions. Results indicated that aerobic fitness and fine motor skills were significantly related to switching and updating, whereas relations to inhibition were non-significant. Furthermore, it was found that fine motor skills explained additional variance above aerobic fitness in switching and updating whereas aerobic fitness did not add additional variance above fine motor skills in switching and updating. Balance and object control skills were not related to the three core executive functions. Results support the notion that aerobic fitness and fine motor skills are differently related to executive functions and highlight the importance of considering multiple components of constructs in future research.

Cognitive and Developmental Functions in Autistic and Non-Autistic Children and Adolescents: Evidence from the Intelligence and Development Scales-2.

Autistic individuals often show impairments in cognitive and developmental domains beyond the core symptoms of lower social communication skills and restricted repetitive behaviors. Consequently, the assessment of cognitive and developmental functions constitutes an essential part of the diagnostic evaluation. Yet, evidence on differential validity from intelligence and developmental tests, which are commonly used with autistic individuals, varies widely. In the current study, we investigated the cognitive (i.e., intelligence, executive functions) and developmental (i.e., psychomotor skills, social-emotional skills, basic skills, motivation and attitude, participation during testing) functions of autistic and non-autistic children and adolescents using the Intelligence and Development Scales-2 (IDS-2). We compared 43 autistic (Mage = 12.30 years) with 43 non-autistic (Mage = 12.51 years) participants who were matched for age, sex, and maternal education. Autistic participants showed significantly lower mean values in psychomotor skills, language skills, and the evaluation of participation during testing of the developmental functions compared to the control sample. Our findings highlight that autistic individuals show impairments particularly in motor and language skills using the IDS-2, which therefore merit consideration in autism treatment in addition to the core symptoms and the individuals' intellectual functioning. Moreover, our findings indicate that particularly motor skills might be rather neglected in autism diagnosis and may be worthy of receiving more attention. Nonsignificant group differences in social-emotional skills could have been due to compensatory effects of average cognitive abilities in our autistic sample.

Mental disorders into adulthood among adolescents placed in residential care: A prospective 10-year follow-up study.

BACKGROUND: Child welfare and juvenile justice placed youths show high levels of psychosocial burden and high rates of mental disorders. It remains unclear how mental disorders develop into adulthood in these populations. The aim was to present the rates of mental disorders in adolescence and adulthood in child welfare and juvenile justice samples and to examine their mental health trajectories from adolescence into adulthood. METHODS: Seventy adolescents in shared residential care, placed by child welfare (n = 52, mean age = 15 years) or juvenile justice (n = 18, mean age = 17 years) authorities, were followed up into adulthood (child welfare: mean age = 25 years; juvenile justice: mean age = 27 years). Mental disorders were assessed based on the International Classification of Diseases 10th Revision diagnoses at baseline and at follow-up. Epidemiological information on mental disorders was presented for each group. Bivariate correlations and structural equation modeling for the relationship of mental disorders were performed. RESULTS: In the total sample, prevalence rates of 73% and 86% for any mental disorder were found in adolescence (child welfare: 70%; juvenile justice: 83%) and adulthood (child welfare: 83%; juvenile justice: 94%) respectively. General psychopathology was found to be stable from adolescence into adulthood in both samples. CONCLUSIONS: Our findings showed high prevalence rates and a high stability of general psychopathology into adulthood among child welfare and juvenile justice adolescents in Swiss residential care. Therefore, continuity of mental health care and well-prepared transitions into adulthood for such individuals is highly warranted.

Within-Couple Associations Between Communication and Relationship Satisfaction Over Time.

Relationship science contends that the quality of couples' communication predicts relationship satisfaction over time. Most studies testing these links have examined between-person associations, yet couple dynamics are also theorized at the within-person level: For a given couple, worsened communication is presumed to predict deteriorations in future relationship satisfaction. We examined within-couple associations between satisfaction and communication in three longitudinal studies. Across studies, there were some lagged within-person links between deviations in negative communication to future changes in satisfaction (and vice versa). But the most robust finding was for concurrent within-person associations between negative communication and satisfaction: At times when couples experienced less negative communication than usual, they were also more satisfied with their relationship than was typical. Positive communication was rarely associated with relationship satisfaction at the within-person level. These findings indicate that within-person changes in negative communication primarily covary with, rather than predict, relationship satisfaction.

Limited Internal Comparability of General Intelligence Composites: Impact on External Validity, Possible Predictors, and Practical Remedies.

Research on comparability of general intelligence composites (GICs) is scarce and has focused exclusively on comparing GICs from different test batteries, revealing limited individual-level comparability. We add to these findings, investigating the group- and individual-level comparability of different GICs within test batteries (i.e., internal score comparability), thereby minimizing transient error and ruling out between-battery variance completely. We (a) determined the magnitude of intraindividual IQ differences, (b) investigated their impact on external validity, (c) explored possible predictors for these differences, and (d) examined ways to deal with incomparability. Results are based on the standardization samples of three intelligence test batteries, spanning from early childhood to late adulthood. Despite high group-level comparability, individual-level comparability was often unsatisfactory, especially toward the tails of the IQ distribution. This limited comparability has consequences for external validity, as GICs were differentially related to and often less predictive for school grades for individuals with high IQ differences. Of several predictors, only IQ level and age were systematically related to comparability. Consequently, findings challenge the use of overall internal consistencies for confidence intervals and suggest using confidence intervals based on test-retest reliabilities or age- and IQ-specific internal consistencies for clinical interpretation. Implications for test construction and application are discussed.

How do self-efficacy and self-concept impact mathematical achievement? The case of mathematical modelling.

BACKGROUND: According to the self-enhancement perspective, self-efficacy and self-concept are shaped by prior achievement and have a crucial impact on future development. Their role in improving performance on challenging tasks, such as mathematical modelling (i.e., solving realistic problems mathematically), has barely been studied. AIMS: We investigated patterns of self-efficacy and self-concept and their predictive effects on mathematical modelling while taking into account school grades as measure of prior achievement and reasoning to reveal cognitive and motivational effects on achievement. SAMPLE: N = 279 secondary students in Grade 8 or 9 from 16 classes and 6 schools participated in the study. METHOD: The multi-informant design consisted of teachers' reports of school grades, students' reports of self-efficacy and self-concept (questionnaire-based), and assessment of students' reasoning and mathematical modelling. RESULTS: Using random-intercept models, we found that the predictive effect of self-efficacy on mathematical modelling withstood taking the school-classroom-related nested structure into account, whereas self-concept lost its predictive value. Further, self-efficacy fully mediated the effect of school grades on mathematical modelling. CONCLUSIONS: In line with the self-enhancement perspective on self-efficacy, our findings highlight the strength of motivational effects on mathematical modelling. When we take the nested structure into account, our results indicate an impact of school grades via self-efficacy on mathematical modelling independent of students' cognitive level or classroom. Given the diverse challenges such complex tasks present, important pedagogical and didactical recommendations, such as targeting the enhancement of students' self-efficacy by teachers and educational decision makers, can be drawn.

The comparability of intelligence test results: Group- and individual-level comparisons of seven intelligence tests.

A significant body of research has demonstrated that IQs obtained from different intelligence tests substantially correlate at the group level. Yet, there is minimal research investigating whether different intelligence tests yield comparable results for individuals. Examining this issue is paramount given that high-stakes decisions are based on individual test results. Consequently, we investigated whether seven current and widely used intelligence tests yielded comparable results for individuals between the ages of 4-20 years. Results mostly indicated substantial correlations between tests, although several significant mean differences at the group level were identified. Results associated with individual-level comparability indicated that the interpretation of exact IQ scores cannot be empirically supported, as the 95% confidence intervals could not be reliably replicated with different intelligence tests. Similar patterns also appeared for the individual-level comparability of nonverbal and verbal intelligence factor scores. Furthermore, the nominal level of intelligence systematically predicted IQ differences between tests, with above- and below-average IQ scores associated with larger differences as compared to average IQ scores. Analyses based on continuous data confirmed that differences appeared to increase toward the above-average IQ score range. These findings are critical as these are the ranges in which diagnostic questions most often arise in practice. Implications for test interpretation and test construction are discussed.

The mirror's curse: Weight perceptions mediate the link between physical activity and life satisfaction among 727,865 teens in 44 countries.

PURPOSE: The present study aimed to examine the link between physical activity (PA) and life satisfaction in a large international study of adolescents. We also aimed to test whether overweight and underweight perceptions act as mediators and whether age and sex acted as moderators. METHODS: For this purpose, we analyzed data from the Health Behavior in School-aged Children study, which comprises 727,865 observations from 44 nations at 4 measurement occasions. RESULTS: Multilevel analyses revealed a positive link between PA and life satisfaction. In addition, underweight and overweight perceptions mediated the effect of PA on life satisfaction. We further found that age and sex acted as moderators. In older adolescents, stronger effects were found in the links between PA and life satisfaction, PA and overweight perception, and both weight perceptions and life satisfaction. In addition, in female adolescents, the link between overweight perception and life satisfaction was stronger. Conversely, the links between PA and both weight perceptions were stronger for boys. CONCLUSION: The results suggest that weight perception explains part of the relationship between PA and life satisfaction in adolescents and that these effects vary as a function of age and sex.

Age-related changes in children's cognitive-motor dual tasking: Evidence from a large cross-sectional sample.

Children coordinate two tasks simultaneously at several occasions throughout the day; however, this dual-task ability and its development across childhood are poorly understood. Therefore, the current study investigated age-related changes in children's dual-task ability using a large cross-sectional sample of 8- to 13-year-old children (N = 135). In our dual-task methodology, children were asked to walk across an electronic pathway while performing three concurrent cognitive tasks. These tasks targeted at children's executive function components: inhibition, switching, and updating skills. Our findings indicate associations between age and children's stride time variability but not with normalized velocity. Younger children showed higher stride time variability in the dual-task situation as compared with older children after accounting for their single-task performance, intelligence, anthropometric variables, and sex, indicating a more regular gait pattern in older children. Furthermore, age was differently related to children's accuracy in solving the concurrent cognitive tasks. Whereas age was associated with children's performance in the updating and switching task, there was no relation between age and children's inhibitory skills. In addition, our data imply that children's dual-task ability was associated with a number of individual variables. In particular, children with higher intelligence scores showed fewer errors and girls showed lower stride time variability in the dual tasks. Our results suggest a considerable developmental progression in children's ability to coordinate two simultaneous tasks across middle childhood. Furthermore, our study qualifies previous dual-task research and implies that heterogeneous findings may be related to a differential involvement of executive function components in the dual task.

Physical Activity, Mental Health, and Well-Being in Very Pre-Term and Term Born Adolescents: An Individual Participant Data Meta-Analysis of Two Accelerometry Studies.

This study examined whether physical activity is associated with better mental health and well-being among very preterm (≤32 weeks) and term born (≥37 weeks) adolescents alike or whether the associations are stronger in either of the groups. Physical activity was measured with accelerometry in children born very preterm and at term in two cohorts, the Basel Study of Preterm Children (BSPC; 40 adolescents born ≤32 weeks of gestation and 59 term born controls aged 12.3 years) and the Millennium Cohort Study (MCS; 45 adolescents born ≤32 weeks of gestation and 3137 term born controls aged 14.2 years on average). In both cohorts, emotional and behavioral problems were mother-reported using the Strengths and Difficulties Questionnaire. Subjective well-being was self-reported using the Kidscreen-52 Questionnaire in the BSPC and single items in the MCS. Hierarchical regressions with 'preterm status × physical activity'-interaction effects were subjected to individual participant data (IPD) meta-analysis. IPD meta-analysis showed that higher levels of physical activity were associated with lower levels of peer problems, and higher levels of psychological well-being, better self-perception/body image, and school related well-being. Overall, the effect-sizes were small and the associations did not differ significantly between very preterm and term born adolescents. Future research may examine the mechanisms behind effects of physical activity on mental health and wellbeing in adolescence as well as which type of physical activity might be most beneficial for term and preterm born children.

Shared residential placement for child welfare and juvenile justice youth: current treatment needs and risk of adult criminal conviction.

BACKGROUND: Although child welfare youth and juvenile offenders in residential care have different judicial placement reasons, there seems to be overlap in their demographic and psychosocial backgrounds. This could raise the question whether these adolescents should be placed in strictly separated institutions based on their judicial title (civil or criminal law) or together based on their needs. As systematic knowledge on the effects of shared placement of these groups is limited, the aim of the current paper is to examine the demographic, crime-related and psychosocial characteristics of child welfare and juvenile justice youths in shared residential care and subsequently examine its relationship with offending behavior in adulthood. METHODS: The sample was drawn from the Swiss study for clarification and goal-attainment in youth welfare and juvenile justice institutions (MAZ.) and consisted 354 juveniles (252 child welfare, 102 juvenile justice; 223 boys, 131 girls) between 10 and 18 years. Mental health problems were assessed with the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2), official adult criminal conviction data up to 10 years later was obtained from the Swiss Federal Office of Statistics. Three sets of logistic regressions were conducted investigating any, violent and non-violent convictions. RESULTS: Univariate results showed that that the child welfare sample included more females, more juveniles with the Swiss nationality, and was younger at the time of assessment and at first placement compared to the juvenile justice sample. Furthermore, child welfare youths showed less alcohol/drug use problems and offending behavior than their juvenile justice counterparts. Unadjusted models demonstrated that committing authority predicted adult criminal convictions, but that this distinction disappeared when it was controlled for demographic, crime-related and psychosocial factors. Gender and time at risk were found to be related to adult conviction in all three models. In addition, alcohol/drug use problems were risk factors for general, previous convictions for violent, and traumatic experiences for non-violent convictions in adulthood. CONCLUSIONS: Our results support the approach of placement in residential care institutions based on treatment needs instead of on judicial title. Special attention should be devoted to trauma informed care and substance use coping. However, more research is needed.

Relations between fine motor skills and intelligence in typically developing children and children with attention deficit hyperactivity disorder.

BACKGROUND: The embodied cognition hypothesis implies a close connection between motor and cognitive development. Evidence for these associations is accumulating, with some studies indicating stronger relations in clinical than typically developing samples. AIMS: The present study extends previous research and investigates relations between fine motor skills and intelligence in typically developing children (n = 139, 7-13 years) and same-aged children with attention deficit hyperactivity disorder (ADHD, n = 46). In line with previous findings, we hypothesized stronger relations in children with ADHD than in typically developing children. METHODS AND PROCEDURE: Fine motor skills were assessed using the standardized Movement Assessment Battery for Children. Intelligence was measured with the standardized Wechsler Intelligence Scale for Children. OUTCOMES AND RESULTS: Regression analyses indicated significant relations between fine motor skills and full-scale IQ, perceptual reasoning, working memory, and processing speed. Moderation analyses identified stronger relations between fine motor skills and full-scale IQ, perceptual reasoning, and verbal comprehension in children with ADHD compared to typically developing children. CONCLUSIONS AND IMPLICATIONS: Results suggest a close relation between fine motor skills and intelligence in children with and without ADHD, with children diagnosed with ADHD showing stronger relations. Findings support combined motor-cognitive interventions in treating children with ADHD.

Executive Functions and Visual-Spatial Skills Predict Mathematical Achievement: Asymmetrical Associations Across Age.

Children's mathematical achievement depends on their domain-specific abilities and their domain-general skills such as executive functions (EFs) and visual-spatial skills (VSS). Research indicates that these two domain-general skills predict mathematical achievement. However, it is unclear whether these skills are differently associated with mathematical achievement across a large age range. The current cross-sectional study answered this question using a large, representative sample aged 5-20 years (N = 1754). EFs, VSS, and mathematical achievement were assessed using the Intelligence and Development Scales-2. Hierarchical regression analyses were computed with EFs and VSS as predictor variables and mathematical achievement as dependent variable. We examined (non-) linear effects and interactions of EFs and VSS with age. Results indicated that EFs and VSS were distinctly associated with mathematical achievement above and beyond effects of age, sex, maternal education, and verbal reasoning. Effects of EFs were linear and age-invariant. Effects of VSS were curvilinear and stronger in adolescents than in children. Our results indicated that EFs and VSS related differently to mathematical proficiency across age, suggesting a varying impact on mathematics across age.

Multimethod Assessment of Attention, Executive Functions, and Motor Skills in Children With and Without ADHD: Children's Performance and Parents' Perceptions.

Objective: We examined whether children with attention-deficit/hyperactivity disorder (ADHD) differ from children without ADHD in attention, executive functions, and motor skills and whether measures of parents' perceptions and children's performance reveal comparable results. Method: About 52 children with ADHD and 52 children without ADHD aged 6 to 13 years completed performance-based measures of attention, executive functions, and motor skills. Parents completed questionnaires to rate their children's skills. Results: Parent questionnaires but not performance-based measures revealed higher inattention and lower executive function skills in children with ADHD compared to controls. For motor skills, both measurement methods revealed lower mean values and a higher number of children showing an impairment in the ADHD group. Parent-reported difficulties but not performance-based measures were related to the presence of an ADHD diagnosis. Conclusion: Our findings suggest that considering both parent questionnaires and performance-based measures will lead to a comprehensive picture of a child's strengths and difficulties.

Interdependence of Approach and Avoidance Goals in Romantic Couples Over Days and Months.

OBJECTIVES: Despite the centrality of people's approach goals (i.e., approach toward positive outcomes) and avoidance goals (i.e., avoidance of negative outcomes) in romantic relationships, little is known about the interdependence of approach and avoidance relationship goals between partners. Assuming that short-term, state-level goals accumulate into general goal tendencies, the present research tested whether partners' daily (i.e., state level) and aggregated daily (i.e., trait level) approach and avoidance goals are mutually predictive in the short term (after one day) and the long term (after 10-12 months). In addition, we explored whether goal interdependence unfolds differently across adulthood and in relationships of different duration. METHOD: Approach and avoidance goals were assessed daily on two 14-day measurement-burst occasions that were conducted 10-12 months apart. The sample consisted of N = 456 female-male couples (age: M = 33.6, SD = 13.8 years; relationship duration: M = 9.6, SD = 10.7 years). RESULTS: We observed significant short- and long-term partner effects in the prediction of couple members' approach and avoidance goals. These partner effects were restricted to trait level and they did not emerge at the state level. Almost all effects were independent of age and relationship duration. DISCUSSION: The present research underscores the importance of disentangling state- and trait-level goal tendencies when investigating the interdependence of approach and avoidance goals within romantic relationships.

Effects of various executive functions on adults' and children's walking.

Walking is human's most important locomotion. Until recently, walking was seen as an automated motor task that requires only minimal cognitive resources. However, recent studies indicate that walking requires higher-level cognitive processes such as executive functions. A different line of research suggests that executive functions consist of 3 core components: inhibition, switching, and updating. Combining these findings, the present study clarified which executive-function component is most essential for human walking. Applying a dual-task methodology, adults (n = 37) and 8- to 13-year-old children (n = 134) walked repeatedly across an electronic pathway while solving an inhibition, switching, and updating task. Both adults and children showed the largest gait alterations in the updating and switching task as opposed to inhibition. Likewise, their cognitive performance revealed the largest performance reductions from single- to dual-task situations in the updating task. Overall, our results highlight remarkable similarities in children's and adults' performance with updating working memory representations and switching between rule sets being the most essential cognitive processes for walking. These findings point to a general gait-cognition process. Results have important theoretical value and hold practical implications for creating effective intervention programs. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Midwives' engagement in smoking- and alcohol-prevention in prenatal care before and after the introduction of practice guidelines in Switzerland: comparison of survey findings from 2008 and 2018.

BACKGROUND: Evidence suggests that cigarette smoking and alcohol consumption during pregnancy negatively impacts fetal health. Health agencies across countries have developed specific guidelines for health professionals in perinatal care to strengthen their role in smoking and alcohol use prevention. One such example is the "Guideline on Screening and Counselling for prevention of cigarette smoking and alcohol consumption before, during, and after pregnancy" introduced by the Swiss Midwives Association in 2011. The current study assesses the changes in midwives' engagement in smoking and alcohol use prevention before (2008) and after the introduction of the Guideline (2018). Further, the current study examines differences across regions (German vs. French speaking regions), graduation years (before and after the introduction of the Guideline) and different work settings (hospital vs. self-employed). METHODS: Survey data were collected in 2008 (n = 366) and in 2018 (n = 459). Differences in how midwives engaged in smoking and alcohol use prevention between 2008 and 2018 were assessed with chi-square tests, as were differences across German and French speaking regions, graduation years (before and after the introduction of the Guideline) and across different work settings (working in hospitals or as self-employed). RESULTS: An increase in midwives' awareness of the risks of consuming even small quantities of cigarettes and alcohol for the unborn child between 2008 and 2018 is evident. Explaining the risks to pregnant women who smoke or use alcohol remained the most frequently reported prevention strategy. However, engagement with more extensive smoking and alcohol use preventive strategies across the whole course of pregnancy, such as assisting women in the elaboration of a plan to stop smoking/alcohol use, remained limited. CONCLUSIONS: Seven years after its introduction, the effectiveness of the Guideline in increasing midwives' engagement in smoking and alcohol use prevention appears limited despite midwives' increased awareness.