Barriers to health care and pregnancy experiences in relation to Black, low-income mothers' perinatal attachment and depression.

The goal of this study was to examine whether barriers to accessing health care and negative pregnancy experiences would predict depressive symptomatology and attachment to their neonates among Black mothers from low-income backgrounds across the perinatal period. We were also interested in examining whether these mothers' engagement in prenatal health practices would buffer against their pregnancy experiences to promote positive postnatal maternal functioning. Participants were 118 Black pregnant women from low-income backgrounds, recruited from WIC and Early Head Start programs. A prenatal assessment between 28 and 40 weeks gestation measured pregnancy experiences and prenatal health practices, and a postnatal assessment about 4 weeks postpartum measured maternal functioning in the form of depressive symptoms and attachment to their neonates. Linear regressions with prenatal health practices included as a moderator suggested that while engaging in positive health practices during pregnancy could potentially buffer against negative pregnancy experiences and prenatal depressive symptoms, it is unlikely to buffer against barriers to accessing health care. These results imply the need to provide support for accessing health care among pregnant women to address disparities in the United States. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effects of Caregiver Social Support and Depressive Symptoms on Child Medication Adherence and Asthma Control.

The purpose of this study was to examine relationships among caregiver social support, caregiver depressive symptoms, medication adherence, and asthma control in a sample of low-income, urban, Black children aged 3-12 years with uncontrolled asthma and their caregivers. Using longitudinal data from a randomized controlled trial (RCT) assessing the efficacy of an environmental control educational intervention, we used generalized estimating equations and ordered logistic regression models to evaluate the relationship between caregiver social support (Medical Outcomes Study Social Support Survey), depressive symptoms (Center for Epidemiologic Studies Depression scale), and two child asthma outcomes: (a) medication adherence (Asthma Medication Ratio) and (b) asthma control. At baseline, 45.7% of the 208 children had very poorly controlled asthma. Nearly a third of caregivers (97% female) had clinically significant depressive symptoms at each data collection point. Social support was not associated with either asthma outcome nor did it moderate the relationship between depressive symptoms and child asthma outcomes. Higher caregiver depressive symptoms predicted decreased medication adherence (b=-0.003, SE 0.002). Moderate asthma at baseline (OR: 0.305, SE: 0.251), severe asthma at baseline (OR: 0.142, SE: 0.299), household income < $20,000 per year (OR: 0.505, SE: 0.333), and fall season (OR: 0.643, SE: 0.215) were associated with poorer asthma control. Attending to the social context of low-income, urban, Black children with asthma is critical to reduce asthma morbidity. Maternal depressive symptoms are modifiable and should be targeted in interventions to improve child asthma outcomes in this vulnerable population. The RCT was registered with ClinicalTrials.gov (NCT01981564) in October 2013.

Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families.

Disparities in childhood obesity highlight the need for research to identify its early predictors in high-risk populations, such as low-income, Latino families. In the current study, the first of its kind in a low-income Latino sample (N = 55; Mchild age = 12.74 months, SD = 3.96), we investigated whether mothers' self-reported attachment style predicted their infants' weight-for-length (WFL; an early indicator of childhood obesity). We also explored whether observed maternal sensitivity, coded from a video-recorded semi-structured play assessment, mediated this association. We found a significant direct effect of maternal attachment style on infants' WFL z-scores (c' = -0.68, SE = 0.22, p = .004). Infants of mothers who classified themselves as secure had lower WFL z-scores than infants of insecure mothers (avoidant or anxious). Maternal sensitivity did not mediate this association, but was positively associated with infant WFL z-scores. We discuss implications of these findings for future research.

Increasing maternal sensitivity to infant distress through attachment-based intervention: a randomized controlled trial.

Maternal sensitivity to infant distress is a key predictor of infant attachment security and social-emotional development. Preventive interventions that support mothers' sensitive responses to infant distress are crucial, as are rigorous evaluations that test for whom such interventions are effective. The current randomized controlled trial tested main and moderated effects of an attachment-based intervention on mothers' sensitivity to their infants' distress in 161 low-income, predominantly Latino mother-infant dyads. We tested the brief (10-session) Attachment and Biobehavioral Catch-up (ABC) intervention in the context of home-based federal Early Head Start services. An intent-to-treat analysis with covariates revealed a positive main intervention effect on maternal sensitivity to distress following a brief novel and potentially fear-inducing procedure (d = 0.32). The intervention effect was not moderated by mothers' self-reported attachment security, avoidance, or anxiety. Findings are discussed in terms of the value and feasibility of increasing maternal sensitivity to infant distress through attachment-based intervention.

Improving infants' stress-induced cortisol regulation through attachment-based intervention: A randomized controlled trial.

Attachment-based parenting interventions have shown positive effects on early cortisol regulation, a key biomarker. Evaluations to date have focused on diurnal cortisol production in high-risk infants. It is important to understand whether attachment-based intervention may also improve stress-induced cortisol production in typically developing infants. This randomized controlled trial tested an enhanced model of U.S. Early Head Start (EHS) services that combined home-based EHS with a brief, attachment-based parenting intervention, Attachment and Biobehavioral Catch-up (ABC). The trial included 153 low-income mothers and their infants (M age 12.4 months [SD = 4.1]). Control participants received home-based EHS plus 10 weekly books. Intent-to-treat analyses using multilevel models revealed a significant indirect intervention effect on infants' rates of cortisol change in response to a series of mild stressors. The intervention increased maternal sensitivity, which in turn improved cortisol regulation, particularly infants' rates of cortisol recovery. The findings illustrate the efficacy of EHS plus ABC for supporting infants' stress-induced cortisol regulation and implicate sensitive maternal behavior as the underlying driver of the intervention effect. Findings are discussed in terms of the preventative value of attachment-based parenting interventions that improve both parenting and infants' physiological regulation.

Improving early head start's impacts on parenting through attachment-based intervention: A randomized controlled trial.

This randomized controlled trial tested an enhanced model of Early Head Start (EHS) that combined home-based EHS with Attachment and Biobehavioral Catch-up (ABC; Dozier & Bernard, 2017), a brief, attachment-based intervention. The trial included 208 low-income mothers (87% Latina) and their 6- to 18-month-old infants. Control participants received home-based EHS plus 10 weekly books. Follow-up observations revealed positive impacts of the enhanced EHS plus ABC model on maternal sensitivity/responsiveness, intrusiveness, and positive regard (ds = 0.23-0.77). Exploratory analyses of moderated effects suggested stronger impacts for those mothers who began the study with greater intrusiveness or who described their adult attachment style as secure or anxious. Findings are discussed in terms of implications for improving effects on parenting of publicly funded programs designed to support early development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

School readiness of maltreated preschoolers and later school achievement: The role of emotion regulation, language, and context.

Guided by bio-ecological theory, this study aimed to: (1) identify heterogeneity in the developmental patterns of emotion regulation for maltreated preschool-aged children; (2) examine the role of gender, language, placement instability, cognitive stimulation, and emotional support on patterns of stability and change of emotion regulation over time; and (3) elucidate the role of emotion regulation/dysregulation patterns on later academic achievement. This study utilized data from the first cohort of the National Survey of Child and Adolescent Well-Being. Results using LCA and LTA models indicated stability and change in emotionally regulated vs. emotionally dysregulated latent classes across 4, 5, and 6 ½ years of age. Placement instability significantly increased the likelihood of being classified as emotionally dysregulated at wave 1. Moreover, children classified as emotionally dysregulated by age 6 ½ scored significantly lower than children who were classified as emotionally regulated on measures of reading and math achievement by age 10. Based on these findings, placement stability at first contact with CPS should be promoted in order to prevent cascading negative effects on emotion regulation. Additionally, children who are more emotionally dysregulated by the time they transition to formal schooling should receive increased socioemotional and socioemotional learning supports.

IMPLEMENTING AN ATTACHMENT-BASED PARENTING INTERVENTION WITHIN HOME-BASED EARLY HEAD START: HOME-VISITORS' PERCEPTIONS AND EXPERIENCES.

Implementation of evidence-based interventions in "real-world" settings is enhanced when front-line staff view the intervention as acceptable, appropriate, and feasible. This qualitative study addresses Early Head Start (EHS) home visitors' perceptions and experiences of an evidence-based parenting intervention, the Attachment and Biobehavioral Catch-up program (M. Dozier, O. Lindhiem, & J. Ackerman, 2005), when added to EHS services as usual within the context of a research-practice partnership. Thematic analysis of in-depth, qualitative interviews indicates that home visitors experienced the intervention as positive and helpful for EHS families. Some challenges included scheduling and uncertainty regarding the goals of the intervention. Concerns over participation in the research centered on information exchange, confidentiality, and time limitations.

FIRST-GENERATION LATINA MOTHERS' EXPERIENCES OF SUPPLEMENTING HOME-BASED EARLY HEAD START WITH THE ATTACHMENT AND BIOBEHAVIORAL CATCH-UP PROGRAM.

This qualitative pilot study examined first-generation Latina mothers' experiences of supplementing home-based Early Head Start (EHS) services with the evidence-based Attachment and Biobehavioral Catch-up (ABC; M. Dozier, O. Lindheim, & J. Ackerman, 2005) program. Ten low-income, first-generation Latina mothers with infants and toddlers enrolled in home-based EHS were provided 10 ABC home visits by a supplemental parent coach. Following delivery of ABC, mothers participated in in-depth, semistructured, qualitative interviews about their experiences. Interview themes included positive experiences of both EHS and the ABC, a high value placed on receiving both programs, and cultural relevance of the ABC program for Latino families. Participants offered several suggestions for improved program delivery. Study findings suggest that a model of EHS supplemented by ABC delivered to the Latino community is feasible, valuable to participants, and culturally relevant. Considerations for sustainability of this supplemental model are discussed.

Detached parenting and toddler problem behavior in Early Head Start families.

This study examined detached parenting among Early Head Start mothers, and associated maternal characteristics and child behavior. Participants included 81 mother-child dyads. Data were collected in participants' homes during two visits. Mothers reported on demographic factors, parenting stress, and children's problem behaviors. Children's neurodevelopment was assessed, and videotaped parent-child play interactions were coded. Path analyses indicated that demographic risk factors and parenting stress were associated with higher levels of detached parenting. As a mediator, detached parenting significantly predicted children's later problem behavior. There was a direct effect of parenting stress on children's behavior problems, but no direct effect of children's neurodevelopmental risk. Detached parenting partially mediated the influence of parenting stress on children's problem behavior. The final model moderately accounted for the variance in detached parenting and children's problem behaviors. The results suggest that parents who experience multiple risks and high levels of parenting stress are more likely to demonstrate detached parenting. In addition, detached parenting leads to higher levels of toddler problem behavior, and may increase the problem behavior displayed by toddlers of parents experiencing multiple risks and parenting stress. These findings are discussed in the context of infant mental health practice.

The early promotion and intervention research consortium (E-PIRC): Five approaches to improving infant/toddler mental health in Early Head Start.

One planned consequence of the national Infant Mental Health Forum held in the United States in 2000 was the funding of five research projects conducted in Early Head Start (EHS) programs. Each project strengthened existing programs by integrating infant/toddler mental health approaches and testing the outcomes on infant/toddler development, behavior, and parent-child interactions. In two of the projects, the effect of offering enrichment for EHS staff was tested. The other three projects tested the effect of services offered directly to parents and children. This article describes the five projects and the theories, methods, and outcome measures used. In order to understand more fully the elevated risk factors in these families and the consequences for mental health in their infants and toddlers, a common set of measures was developed. Data have been used to explore the common threats to mental health and the factors that moderate the impact on infants and toddlers.