Guidelines for Specialized Epilepsy Centers: Executive Summary of the Report of the National Association of Epilepsy Centers Guideline Panel.

The National Association of Epilepsy Centers first published the guidelines for epilepsy centers in 1990, which were last updated in 2010. Since that update, epilepsy care and the science of guideline development have advanced significantly, including the importance of incorporating a diversity of stakeholder perspectives such as those of patients and their caregivers. Currently, despite extensive published data examining the efficacy of treatments and diagnostic testing for epilepsy, there remain significant gaps in data identifying the essential services needed for a comprehensive epilepsy center and the optimal manner for their delivery. The trustworthy consensus-based statements (TCBS) process produces unbiased, scientifically valid guidelines through a transparent process that incorporates available evidence and expert opinion. A systematic literature search returned 5937 relevant studies from which 197 articles were retained for data extraction. A panel of 41 stakeholders with diverse expertise evaluated this evidence and drafted recommendations following the TCBS process. The panel reached consensus on 52 recommendations covering services provided by specialized epilepsy centers in both the inpatient and outpatient settings in major topic areas including epilepsy monitoring unit care, surgery, neuroimaging, neuropsychology, genetics, and outpatient care. Recommendations were informed by the evidence review and reflect the consensus of a broad panel of expert opinions.

Intergenerational Continuity in Adverse Childhood Experiences and Rural Community Environments.

OBJECTIVES: To understand the role of the community environment on intergenerational continuity in adverse childhood experiences (ACEs) among a rural White sample. METHODS: Parents in 12 counties in rural Iowa reported retrospectively on their own ACEs in 1989. We measured their child's ACEs retrospectively and prospectively across adolescence (n = 451 families). We measured structural and social process-related measures of community environment (i.e., community socioeconomic status, parents' perception of community services, perceived community social cohesion, and neighborhood alcohol vendor density) on multiple occasions during the child's adolescence. RESULTS: The 4 measures of community environment were all correlated with the child's ACEs, but only alcohol vendor density predicted ACEs after inclusion of covariates. Intergenerational continuity in ACEs was moderated by both social cohesion (b = -0.11; SE = 0.04) and alcohol vendor density (b = -0.11; SE = 0.05). CONCLUSIONS: Efforts to increase community social cohesion and manage alcohol vendor density may assist families in breaking the cycle of maltreatment across generations.

Family health and income: A two-sample replication.

The current study examined psychological and family health predictors of change over time in household income, using data from longitudinal studies of African American (N = 889, 93.5% female) and Mexican origin (N = 674, 100% female) families. Participants self-reported their household income, as well as their emotional, personality, and cognitive resources. Participant behavioral and physical resources were coded from observed family interactions. Although income did not predict change in any personal resources, all five classes of personal resources (i.e., emotional, personality, cognitive, behavioral, physical) predicted change in income across a 10-year span (Study 1) and a 6-year span (Study 2). Income is potentially caused by these personal resources, or both income and these personal resources share a common cause. The dominant approach of assuming income causes personal and family health needs stronger support. (PsycINFO Database Record

Breastfeeding duration predicts greater maternal sensitivity over the next decade.

The current study represents the first longitudinal investigation of the potential effects of breastfeeding duration on maternal sensitivity over the following decade. This study also examined whether infant attachment security at 24 months would mediate longitudinal relations between breastfeeding duration and changes in maternal sensitivity over time. Using data from 1,272 families from the National Institute of Child Health and Human Development's Study of Early Child Care and Youth Development, we found that longer breastfeeding duration (assessed up to age 3) predicted increases in observed maternal sensitivity up to child age 11, after accounting for maternal neuroticism, parenting attitudes, ethnicity, maternal years of education, and presence of a romantic partner. Additionally, secure attachment at 24 months was predicted by breastfeeding duration, but it did not act as a mediator of the link from breastfeeding duration to maternal sensitivity in this study. Generating a more specific understanding of how breastfeeding impacts the mother-child dyad beyond infancy will inform recommendations for best practices regarding breastfeeding. (PsycINFO Database Record

Mother-Adolescent Proficiency in a Common Language Facilitates Socialization Among Mexican-Origin Families.

The primary goal of this study was to test how mother and adolescent proficiency in a common language moderates the link from parenting to adolescent development. A sample of Mexican-origin fifth-grade adolescents (N = 674, 50% female) was measured longitudinally on self-control and aggression. Mothers were rated on observed positive discipline, warmth, and harsh discipline. Positive discipline and warm parenting predicted increases in self-control and decreases in aggression, but only among mother-adolescent dyads who were proficient in a common language. Harsh parenting predicted decreases in self-control and increases in aggression, but only among dyads who were not proficient in a common language. Similar results were found in a conceptual replication among a second sample of 167 Mexican-origin adolescents.

Parenting and later substance use among Mexican-origin youth: Moderation by preference for a common language.

The primary goal of the current study was to test whether parent and adolescent preference for a common language moderates the association between parenting and rank-order change over time in offspring substance use. A sample of Mexican-origin 7th-grade adolescents (Mage = 12.5 years, N = 194, 52% female) was measured longitudinally on use of tobacco, alcohol, and marijuana. Mothers, fathers, and adolescents all reported on consistent discipline and monitoring of adolescents. Both consistent discipline and monitoring predicted relative decreases in substance use into early adulthood but only among parent-offspring dyads who expressed preference for the same language (either English or Spanish). This moderation held after controlling for parent substance use, family structure, having completed schooling in Mexico, years lived in the United States, family income, and cultural values. An unintended consequence of the immigration process may be the loss of parenting effectiveness that is normally present when parents and adolescents prefer to communicate in a common language. (PsycINFO Database Record

Intergenerational continuity in attitudes: A latent variable family fixed-effects approach.

Attitudes are associated with behavior. Adolescents raised by parents who endorse particular attitudes are relatively more likely to endorse those same attitudes. The present study addresses conditions that would moderate intergenerational continuity in attitudes across 6 domains: authoritative parenting, conventional life goals, gender egalitarianism, deviancy, abortion, and sexual permissiveness. Hypothesized moderators included the attitudes of the other parent, and adolescent sex. Data come from a 2-generation study of a cohort of 451 adolescents (52% female), a close-aged sibling, and their parents. After employing a novel specification in which family fixed-effect models partitioned out variation at the between-family level, hypotheses were tested on the within-family variance. Unlike typical family fixed-effect models, this specification accounted for measurement error. Intergenerational continuity was not significant (deviancy), negative (sexual permissiveness), and conditional on the attitudes of the coparent (authoritative parenting, conventional life goals, and gender egalitarianism). Adolescent age, sex, and conscientiousness were accounted for in all analyses. (PsycINFO Database Record

Disrupting intergenerational continuity in harsh parenting: Self-control and a supportive partner.

Harsh, abusive, and rejecting behavior by parents toward their children is associated with increased risk for many developmental problems for youth. Children raised by harsh parents are also more likely to treat their own children harshly. The present study addresses conditions that would break this intergenerational cycle of harsh parenting. Data come from a three-generation study of a cohort of 290 adolescents (Generation 2 [G2], 52% female) grown to adulthood and their parents (Generation 1 [G1]). During adolescence, observers rated G1 harsh parenting to G2. Several years later observers rated G2 harsh parenting toward their oldest child (Generation 3 [G3]). Several adaptive systems fundamental to human resilience attenuate intergenerational continuity in harshness. G2 parents were relatively less harsh to G3 children (notwithstanding a history of harshness from G1) when G2's romantic partner (a) communicated positively with G2 and (b) had a good relationship with G3, and (c) when G2 was high on self-control. Interventions that target all of these protective factors may not only break but also reverse the intergenerational cycle of child maltreatment.

Harsh parenting, physical health, and the protective role of positive parent-adolescent relationships.

RATIONALE: Harsh, abusive and rejecting behavior by parents toward their adolescents is associated with increased risk of many developmental problems for youth. OBJECTIVE: In the present study we address behaviors of co-parents that might help disrupt the hypothesized health risk of harsh parenting. METHOD: Data come from a community study of 451 early adolescents followed into adulthood. During early adolescence, observers rated both parents separately on harshness towards the adolescent. Adolescents reported on their physical health at multiple assessments from age 12 through age 20, and on parental warmth. RESULTS: Harsh parenting predicted declines in adolescent self-reported physical health and increases in adolescent body mass index (BMI). Although the health risk associated with harshness from one parent was buffered by warmth from the other parent, warmth from the second parent augmented the association between harshness from the first parent and change over time in adolescent BMI. CONCLUSION: As appropriate, preventive interventions should include a focus on spousal or partner behaviors in their educational or treatment programs. Additional research is needed on the association between self-reported physical health and BMI in adolescence.

Optimal assessment of parenting, or how I learned to stop worrying and love reporter disagreement.

The purpose of this study was to examine differences and similarities across ratings of parenting by preadolescents, parents, and observers. Two hundred forty-one preadolescents rated their parents on warmth and harshness. Both mothers and fathers self-reported on these same dimensions, and observers rated each parents' warmth and harshness during a 10 min interaction task with the preadolescent. For the majority of outcomes assessed, the differences between preadolescent, parent, and observer ratings accounted for significant amounts of variance, beyond the levels accounted for by the average of their reports. A replication sample of 929 mother-child dyads provided a similar pattern of results. This methodology can help standardize the study of reporter differences, supports modeling of rater-specific variance as true score, and illustrates the benefits of collecting parenting data from multiple reporters. (PsycINFO Database Record

Unsupervised self-care predicts conduct problems: The moderating roles of hostile aggression and gender.

Despite widespread speculation about the detrimental effect of unsupervised self-care on adolescent outcomes, little is known about which children are particularly prone to problem behaviors when left at home without adult supervision. The present research used data from a longitudinal study of 674 Mexican-origin children residing in the United States to examine the prospective effect of unsupervised self-care on conduct problems, and the moderating roles of hostile aggression and gender. Results showed that unsupervised self-care was related to increases over time in conduct problems such as lying, stealing, and bullying. However, unsupervised self-care only led to conduct problems for boys and for children with an aggressive temperament. The main and interactive effects held for both mother-reported and observational-rated hostile aggression and after controlling for potential confounds.

Democratic parenting beliefs and observed parental sensitivity: Reciprocal influences between coparents.

Three hundred sixty-five 2-parent families from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care and Youth Development were rated by trained observers on their parenting behavior at 6 assessments ranging from 6 months after the child's birth to when the child was in fifth grade (M = 10.4 years old at fifth grade). Across assessments, parents reported on their parenting beliefs and mothers reported on the child's externalizing behavior problems. Parenting beliefs predicted change in parenting behavior, and to a lesser degree parenting behavior predicted change in parenting beliefs. Parenting behavior and parenting beliefs both showed reciprocal effects between coparents, after controlling for child externalizing behavior and parent education. (PsycINFO Database Record

Early adolescent substance use in Mexican origin families: Peer selection, peer influence, and parental monitoring.

BACKGROUND: Because adolescents vary in their susceptibility to peer influence, the current study addresses potential reciprocal effects between associating with deviant peers and use of alcohol, tobacco and other drugs (ATOD), as well as the potential buffering role of parental monitoring on these reciprocal effects. METHOD: 674 children of Mexican origin reported at fifth and seventh grade (10.4 years old at fifth grade) on the degree to which they associated with deviant peers, intended to use alcohol, tobacco or other drugs (ATOD) in the future, and had used controlled substances during the past year. Trained observers rated parental monitoring from video-recorded family interactions at the first assessment. RESULTS: Youth who intended to use ATODs during fifth grade experienced a relative increase in number of deviant peers by seventh grade, and youth with more deviant peers in fifth grade were more likely to use ATODs by seventh grade. Parental monitoring buffered (i.e., moderated) the reciprocal association between involvement with deviant peers and both intent to use ATODs and actual use of ATODs. CONCLUSIONS: Parental monitoring can disrupt the reciprocal associations between deviant peers and ATOD use during the transition from childhood to adolescence.

The Impact of Economic Pressure on Parent Positivity, Parenting, and Adolescent Positivity into Emerging Adulthood.

The current study describes how positivity can be incorporated into the Family Stress Model to explain resilience to disrupted family processes in the face of economic distress. Prospective, longitudinal data came from 451 mothers, fathers, and youth participating from their adolescence through early adulthood. Assessments included observational and self-report measures. Information regarding economic pressure, parental positivity, and parenting were collected during early adolescence, positivity was collected in late adolescence and emerging adulthood. Results indicated that economic pressure was indirectly associated with adolescent positivity through parental positivity. Economic pressure was negatively associated with parent positivity, whereas parental positivity was positively associated with parenting. Moreover, parental positivity and parenting were both related to positivity in adolescence. Results suggest that personal resources linked to a positive outlook can foster nurturant parenting, even in times of economic strain. Such parenting seems to positively influence adolescent development into emerging adulthood.

Mediation and moderation of divorce effects on children's behavior problems.

Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, we examined children's internalizing and externalizing behavior problems from age 5 to 15 years in relation to whether they had experienced a parental divorce. Children from divorced families had more behavior problems compared with a propensity-score-matched sample of children from intact families, according to both teachers and mothers. They exhibited more internalizing and externalizing problems at the first assessment after the parents' separation and at the last available assessment (age 11 years for teacher reports, or 15 years for mother reports). Divorce also predicted both short-term and long-term rank-order increases in behavior problems. Associations between divorce and child behavior problems were moderated by family income (assessed before the divorce) such that children from families with higher incomes prior to the separation had fewer internalizing problems than children from families with lower incomes prior to the separation. Higher levels of predivorce maternal sensitivity and child IQ also functioned as protective factors for children of divorce. Mediation analyses showed that children were more likely to exhibit behavior problems after the divorce if their postdivorce home environment was less supportive and stimulating, their mother was less sensitive and more depressed, and their household income was lower. We discuss avenues for intervention, particularly efforts to improve the quality of home environments in divorced families.

Positive parenting, beliefs about parental efficacy, and active coping: three sources of intergenerational resilience.

Prior research involving parents (G1) and their adult children (G2) shows intergenerational continuity in positive parenting. Previous research, however, has not shown circumstances under which the typically modest effect size for intergenerational continuity is augmented or attenuated. Using a multigenerational data set involving 290 families, we evaluated 2 potential moderators of intergenerational continuity in positive parenting (i.e., beliefs about parenting efficacy and active coping strategies) drawn from prior theoretical work on predictors of parenting (Belsky, 1984). These personal resources of the second-generation (G2) parent interacted with G1 positive parenting to predict G2 parenting behavior. Beliefs about parental efficacy and active coping both compensated for low levels of G1 positive parenting by promoting G2 positive parenting when G1 parents were comparatively low on positive parenting. An alternative interpretation of this moderation is that G1 positive parenting compensated for low levels of these personal resources by promoting G2 positive parenting when G2 parents were comparatively low on parenting efficacy and effective coping. These findings indicate the different roles that these personal resources and a history of positive parenting appear to play in promoting a positive parenting environment for the next generation of children.

For better and for worse: genes and parenting interact to predict future behavior in romantic relationships.

We tested the differential susceptibility hypothesis with respect to connections between interactions in the family of origin and subsequent behaviors with romantic partners. Focal or target participants (G2) in an ongoing longitudinal study (N = 352) were observed interacting with their parents (G1) during adolescence and again with their romantic partners in adulthood. Independent observers rated positive engagement and hostility by G1 and G2 during structured interaction tasks. We created an index for hypothesized genetic plasticity by summing G2's allelic variation for polymorphisms in 5 genes (serotonin transporter gene [linked polymorphism], 5-HTT; ankyrin repeat and kinase domain containing 1 gene/dopamine receptor D2 gene, ANKK1/DRD2; dopamine receptor D4 gene, DRD4; dopamine active transporter gene, DAT; and catechol-O-methyltransferase gene, COMT). Consistent with the differential susceptibility hypothesis, G2s exposed to more hostile and positively engaged parenting behaviors during adolescence were more hostile or positively engaged toward a romantic partner if they had higher scores on the genetic plasticity index. In short, genetic factors moderated the connection between earlier experiences in the family of origin and future romantic relationship behaviors, for better and for worse.

Disrupting intergenerational continuity in harsh and abusive parenting: the importance of a nurturing relationship with a romantic partner.

PURPOSE: Harsh, abusive, and rejecting behavior by parents toward their children is associated with increased risk for many developmental problems for youth. Earlier research also shows that children raised by harsh parents are more likely to treat their own children harshly. The present study evaluated nurturing and supportive behaviors of spouses or cohabiting romantic partners hypothesized to strengthen co-parent relationships and help break this intergenerational cycle of harsh parenting. METHODS: Data come from the Family Transitions Project, a 22-year, 3-generation study of a cohort of over 500 early adolescents (G2) grown to adulthood. During adolescence, observers rated G1 (parent of G2) harsh parenting to G2. Several years later, observers rated G2 harsh parenting toward their oldest child (G3). In addition, G2's romantic partner (spouse or cohabiting partner) was rated by observers on a range of behaviors expected to affect G2 harsh parenting. RESULTS: Romantic partner warmth and positive communication with G2 were associated with less G2 harsh parenting toward G3 (a compensatory or main effect) and when these partner behaviors were high, there was no evidence of intergenerational continuity from G1 to G2 harsh parenting (a moderating or protective effect). G1 harsh parenting slightly decreased the likelihood that G2 would select a supportive spouse or romantic partner (evidence of cumulative continuity). CONCLUSIONS: Romantic partner warmth and positive communication appear to disrupt continuity in harsh and abusive parenting. As appropriate, preventive interventions designed to reduce risk for child maltreatment should include a focus on spousal or partner behaviors in their educational or treatment programs.

Safe, stable, nurturing relationships as a moderator of intergenerational continuity of child maltreatment: a meta-analysis.

PURPOSE: The present paper summarizes findings of the special issue papers on the intergenerational continuity of child maltreatment and through meta-analysis explores the potential moderating effects of safe, stable, nurturing relationships (SSNRs). METHODS: Studies were selected for inclusion in this meta-analysis if they (1) were published in peer-reviewed journals; (2) tested for intergenerational continuity in any form of child maltreatment, using prospective, longitudinal data; and (3) tested for moderating effects of any variable of SSNRs on intergenerational continuity of child maltreatment. The search revealed only one additional study beyond the four reports written for this special issue that met inclusion criteria for the meta-analysis. RESULTS: Estimates of intergenerational stability of child maltreatment from the studies included in this special issue are consistent with several other studies, which find that child maltreatment in one generation is positively related to child maltreatment in the next generation. Furthermore, meta-analytic results from the five studies that met the inclusion criteria suggest a protective, moderating effect of SSNRs on intergenerational continuity of child maltreatment. The calculated fail-safe index indicated that 49 unpublished intergenerational studies with an average null effect would be required to render nonsignificant the overall moderation effect of SSNRs on child maltreatment. CONCLUSIONS: This special issue expanded the examination of SSNRs beyond the caregiver-child dyad. That is, these studies considered SSNRs in adult relationships as well as parent-child relationships. Results suggest that certain types of SSNRs between parents and other adults (e.g., romantic partner, co-parent, or adult social support resource) may decrease maltreatment continuity.

Understanding adolescent and family influences on intimate partner psychological violence during emerging adulthood and adulthood.

The intergenerational transmission of violence directed toward intimate partners has been documented for the past three decades. Overall, the literature shows that violence in the family of origin leads to violence in the family of destination. However, this predominately cross-sectional or retrospective literature is limited by self-selection, endogeneity, and reporter biases as it has not been able to assess how individual and family behaviors simultaneously experienced during adolescence influence intimate partner violence throughout adulthood. The present study used data from the Iowa Youth and Families Project (IYFP; N = 392; 52 % Female), a multi-method, multi-trait prospective approach, to overcome this limitation. We focused on psychological intimate partner violence in both emerging adulthood (19-23 years) and adulthood (27-31 years), and include self and partner ratings of violence as well as observational data in a sample of rural non-Hispanic white families. Controlling for a host of individual risk factors as well as interparental psychological violence from adolescence (14-15 years), the results show that exposure to parent-to-child psychological violence during adolescence is a key predictor of intimate partner violence throughout adulthood. In addition, negative emotionality and the number of sexual partners in adolescence predicted intimate partner violence in both emerging adulthood and adulthood. Exposure to family stress was associated positively with intimate partner violence in adulthood but not in emerging adulthood, whereas academic difficulties were found to increase violence in emerging adulthood only. Unlike previous research, results did not support a direct effect of interparental psychological violence on psychological violence in the next generation. Gender differences were found only in emerging adulthood. Implications of these findings are discussed in light of the current literature and future directions.