Narratives of attachment in middle childhood: do gender, age, and risk-status matter for the quality of attachment?

Attachment in middle childhood increasingly attracts the interest of developmental psychologists and clinicians. Recent studies using attachment narratives elicited by story stems reported gender-specific aspects of attachment development, potentially evoked by developmental tasks during this period of the life span. There is evidence that children with risk factors present more insecure and disorganized attachment narratives compared to children without risk. Yet, there is little research concerning the joint effects of gender, risk, and age for attachment classifications. The paper presents a pooled analysis of 22 samples (eight risk samples) including 887 children (411 girls), aged between 4.5 and 8.5 years who were assessed with the same "German Attachment Story Completion Procedure" (GASCP). Girls were 1.8 times more likely to present secure and 0.4 times less likely to present disorganized narratives compared to boys when controlling for risk status and age. Children from risk samples were more likely (odd ratio 5.4) to display disorganized and less likely to show a secure attachment (odd ratio 0.3) compared to those from no-risk samples in multilevel logistic regressions. Remarkably, the effect of risk was not moderated by age and gender, and gender effects were not moderated by age.

Successful implementation of a neonatal pain and sedation protocol at 2 NICUs.

OBJECTIVE: To evaluate the implementation of a neonatal pain and sedation protocol at 2 ICUs. METHODS: The intervention started with the evaluation of local practice, problems, and staff satisfaction. We then developed and implemented the Vienna Protocol for Neonatal Pain and Sedation. The protocol included well-defined strategies for both nonpharmacologic and pharmacologic interventions based on regular assessment of a translated version of the Neonatal Pain Agitation and Sedation Scale and titration of analgesic and sedative therapy according to aim scores. Health care staff was trained in the assessment by using a video-based tutorial and bedside teaching. In addition, we performed reevaluation, retraining, and random quality checks. Frequency and quality of assessments, pharmacologic therapy, duration of mechanical ventilation, and outcome were compared between baseline (12 months before implementation) and 12 months after implementation. RESULTS: Cumulative median (interquartile range) opiate dose (baseline dose of 1.4 [0.5-5.9] mg/kg versus intervention group dose of 2.7 [0.4-57] mg/kg morphine equivalents; P = .002), pharmacologic interventions per episode of continuous sedation/analgesia (4 [2-10] vs 6 [2-13]; P = .005), and overall staff satisfaction (physicians: 31% vs 89%; P < .001; nurses: 17% vs 55%; P < .001) increased after implementation. Time on mechanical ventilation, length of stay at the ICU, and adverse outcomes were similar before and after implementation. CONCLUSIONS: Implementation of a neonatal pain and sedation protocol at 2 ICUs resulted in an increase in opiate prescription, pharmacologic interventions, and staff satisfaction without affecting time on mechanical ventilation, length of intensive care stay, and adverse outcomes.

The impact of teacher-child relationships on child cognitive performance as explored by a priming paradigm.

The present study involved 120 kindergartners, of whom n = 60 were followed up to first grade. Upon making inquiries regarding closeness in teacher-child relationships in the classrooms, the children participated in a laboratory situation in which they were exposed to computerized tasks. These tasks challenged the cognitive processes thought to govern basic knowledge and belief systems. Before each task commenced, however, the image of the child's teacher (affective prime stimulus), with whom the relationship had been measured, was displayed for an experimental group of children. In contrast to a control group being exposed to a neutral prime, it was assumed that the teachers' images displayed in the experimental group would affect cognitive performance in a defined way (i.e., if primed by a person schema of a close relationship, these children should perform better than the rest). Whereas solving scores remained unaffected, children displayed shorter solving times under affective primes when in close relationships with their teachers. This effect could even be evidenced after the transition to school. Results suggest that cognitive processing is much more effective if close teacher-child relationships are involved.

Student-teacher relationships and classroom climate in first grade: how do they relate to students' stress regulation?

The present study involved 105 German students at the end of their first semester in elementary school in order to explore the stress that students may experience within the school environment, and how the relationship with the teacher buffers or exacerbates the stress. Student-teacher relationships were explored on both classroom and individual interaction levels. Classrooms were described by external observers in terms of teachers' support and classroom organization. Teachers reported on the relationships with their students regarding closeness, conflict, and dependency, which determined four specific patterns of student-teacher relationships. Furthermore, saliva samples were taken on a Monday and a Friday of the same week (four times each day) to display diurnal cortisol profiles. These profiles were later evaluated by means of slopes and intercepts, reflecting students' daily stress regulation. Comparisons between Monday and Friday profiles of the same student served as an estimate for the stress regulation throughout the week. Finally, associations between the profiles and the specific relationship patterns provided information on significant environmental conditions for students' stress. Students in non-supportive, as compared to supportive, classrooms had flatter cortisol profiles, suggesting that classrooms of low quality hindered sufficient down-regulation of cortisol levels at both the beginning and the end of the week. Moreover, students with conflict-loaded relationships with their teachers were less able to appropriately down-regulate stress (especially on Fridays) than students with proximal-balanced relationships, showing the most optimal cortisol profiles.