A behavioural description of meaningful moments of interaction between people with profound intellectual disabilities and support staff.

BACKGROUND: It can be challenging for support staff to develop meaningful moments of interaction with people with profound intellectual disabilities. Gathering information on observable behaviour characterising such meaningful moments is expected to be beneficial. METHOD: Three staff-client dyadic interactions were videotaped for 30 min. During reviewing the recording, staff members indicated which moments of interaction they experienced as meaningful. Per dyad, one meaningful moment was microanalytically coded via a developed coding system, and behaviourally described. RESULTS: The coding system reliably coded behaviour at the micro level. Exploratory results indicated that looking, movement and touching were most shown, and that staff displayed this behaviour more frequently than their clients. Both exhibited behaviours substantially more often during meaningful moments than at their onset. DISCUSSION: People with profound intellectual disabilities are more engaged during meaningful moments of interaction compared to at their onset. In daily practice, cultivating circumstances increasing their involvement is important.

Postponement of the Newborn Hearing Screening during the COVID-19 Pandemic; Parental Experiences and Worries.

Early identification of hearing loss through newborn hearing screening followed by an early start of intervention has proven to be effective in promoting speech and language development in children with hearing loss. During the COVID-19 pandemic, newborn hearing screening was postponed for a group of newborns in the Netherlands. Therefore, meeting the guidelines for early identification was at risk. In this study, we examine parental attitudes, beliefs, and experiences concerning the hearing screening during the COVID-19 pandemic. Our results indicated that parents (n = 1053) were very positive about newborn hearing screening and their experiences with the screening, even during the COVID-19 pandemic. Parents' beliefs on the information provision around newborn hearing screening were more inconsistent. The results showed that parents with a postponed hearing screening felt less informed about the hearing screening than parents without a postponed screening. Furthermore, child and family characteristics affected how parents experienced newborn hearing screening. Parents with a premature child were more worried about the hearing abilities of their child before the screening took place. The results also indicate that deafness in the family might lead to parental worries around newborn hearing screening.

Factors contributing to realizing valuable goals of students with dyslexia in higher education.

When students with dyslexia enter higher education, studying often creates challenges at different levels. Universities differ in the way they facilitate students with dyslexia in their educational careers. This study focusses on studying with dyslexia from a value-driven perspective. The aim of the study is to investigate valuable goals of students with dyslexia in higher education and the conversion factors that are stimulating and inhibiting in the realization of these valuable goals. Data were collected during focus groups: five focus groups of students with dyslexia (23 participants) and two focus groups of student counsellors (10 participants). Important values for students are their personal development and to prove they can succeed at university level. Not all students are able or being enabled to show their knowledge and skills and to grow within the educational system. Different personal and environmental factors are described that inhibit or facilitate the realization of valuable goals. The results are presented from two perspectives: of students and student counsellors. The implications of the results and guidelines for future research are discussed.

Meaningful moments of interaction with people with profound intellectual disabilities: Reflections from direct support staff.

BACKGROUND: High-quality, affective relationships are built on meaningful moments of interaction, which are challenging for support staff to establish with people with profound intellectual disabilities. Therefore, we explored what makes a moment of interaction meaningful to support staff and what circumstances facilitate meaningful moments of interaction taking place. METHOD: Five direct support staff took part in unstructured, in-depth interviews. The interviews were analysed using interpretative phenomenological analysis (IPA). Member checks were also conducted. RESULTS: Support staff experienced moments of interaction as meaningful because they felt a connection with a person with profound intellectual disabilities and/or they had the feeling of being meaningful for this person. Staff-related and contextual circumstances facilitating meaningful moments of interaction to take place were described. CONCLUSIONS: Meaningful moments of interaction are highly valued by support staff, who believe these moments are valued by persons with profound intellectual disabilities as well. Implications for daily practice are described.

Mental health problems among Dutch adolescents of the general population before and 9 months after the COVID-19 outbreak: A longitudinal cohort study.

The aim of the present study is to examine whether the COVID-19 pandemic has increased the risk of mental health problems (MHP) in adolescents nine months post-outbreak. For this purpose, a longitudinal cohort study was conducted based on a probability sample of the Dutch population. We compared the prevalence and incidence of MHP in 16-20 year-old adolescents in November-December 2020 (N = 251) with the prevalence and incidence in adolescents in November-December 2012 (N = 346) and November-December 2016 (N = 253). Results showed a higher prevalence of moderate anxiety and depression symptoms in the 2020 than in the 2012 and 2016 cohorts, but differences in mean scores were absent or small. The prevalence of sleep problems, fatigue, use of medicines for symptoms did not differ between the three cohorts. The use of mental health services was more prevalent in the 2020 than in 2016 cohort, but there was already a statistical trend of higher use in the 2016 compared to the 2012 cohort. No differences in the incidence of any MHP, based on data of the previous year (2011, 2015, and 2019, respectively) were found. Results suggest a very limited negative effect of this pandemic on MHP among Dutch adolescents 9 months post-COVID-19 outbreak.

Chronic mental health problems and use of mental health services among adults with and without adverse childhood experiences: a 6-year longitudinal population-based study.

BACKGROUND: The negative effects of single and multiple adverse childhood experiences (ACE) on adult mental health are well-documented. However, little is known about the prevalence of chronic mental health problems (MHPs) and use of mental health services (MHSs) compared to adults without an ACE history. AIMS: Examine differences in the prevalence of chronic MHP and MHS use between adults without and with a single and multiple ACE history, and MHS use among ACE and no-ACE adults with chronic MHP. METHOD: A 6-year longitudinal study was conducted based on a random sample of the Dutch adult population (n = 2427). RESULTS: Multivariate logistic regression analyses showed that adults with a single (n = 280) and multiple ACE (n = 92) history suffered more often from chronic MHP such as chronic depressive and anxiety symptoms. Both ACE subgroups also made greater use of MHS than no-ACE adults (n = 2055). Multiple ACE compared to single ACE, increased the risk of MHP. However, among those with chronic MHP respondents with and without an ACE history did not differ in MHS use. CONCLUSIONS: ACE history is strongly related to chronic MHP and persistent use of MHS. However, MHS use among those with chronic MHP is not related to an ACE history.

Child Care in Times of COVID-19: Predictors of Distress in Dutch Children and Parents When Re-entering Center-Based Child Care After a 2-Month Lockdown.

As a consequence of the outbreak of the Coronavirus Disease 2019 (COVID-19) child care facilities all over the world were temporarily closed to minimize the spread of the virus. In Netherlands, the first closure lasted for almost 2 months. The return to the child care center after this significant interruption was expected to be challenging, because earlier studies demonstrated that transitions into child care can be stressful for both children and their parents. The current paper retrospectively examined the distress of Dutch children (aged 0-4) and their parents during the first 2 weeks after the reopening of child care centers, and what factors accounted for individual differences in distress. In total, 694 parents filled out an online questionnaire about stress during closure and distress after the reopening of child care centers. Furthermore, questions regarding several demographic variables and child care characteristics were included, as well as questionnaires measuring child temperament, parental separation anxiety, and parental perception of the child care quality. Results showed that younger children and children with parents scoring higher on separation anxiety experienced more distress after the reopening, as reported by parents. Furthermore, children were more distressed upon return when they attended the child care center for less hours per week after the reopening, experienced less stress during closure, and grew up in a one-parent family. With regard to parental distress after the reopening, we found that parents scoring higher on separation anxiety and fear of COVID-19 experienced more distress. Moreover, parents experiencing less stress during closure and mothers were more distressed when the child returned to the child care center. Finally, concurrent child and parental distress after reopening were positively related. The results of the current study may help professional caregivers to identify which children and parents benefit from extra support when children return to the child care center after an interruption. Especially the role that parental separation anxiety played in predicting both child and parental distress deserves attention. More research is required in order to study the underlying mechanisms of these associations and to design appropriate interventions.

Validity of the Parental Burnout Inventory Among Dutch Employees.

The purpose of this study was to validate the Parental Burnout Inventory (PBI) in a Dutch sample of working parents. The Dutch version of the PBI and questionnaires about work were administered to 627 working parents, with at least one child living at home. We investigated whether the tri-dimensional structure of the PBI held in a sample of male and female employed parents. Furthermore, we examined the relationships between PBI and the constructs work-related burnout, depressive mood, parenting stress and work-family conflict, which we assessed with widely used and validated instruments, i.e., emotional exhaustion [a subscale of the Dutch version of Maslach's Burnout Inventory], a Dutch Parental Stress Questionnaire and Work-Family Conflict. The results support the validity of a tri-dimensional parental burnout syndrome, including exhaustion, distancing and inefficacy. Low to moderate correlations between parents' burnout symptoms and professional exhaustion, parenting stress, depressive complaints and work-family conflict experiences were found, suggesting that the concept of PBI differs significantly from the concepts of job burnout, depression and stress, respectively. The current study confirms that some parents are extremely exhausted by their parental role. However, the number of Dutch employees reporting extreme parental burnout is rather low.

Maternal psychological distress after preterm birth: Disruptive or adaptive?

BACKGROUND: Maternal postpartum distress is often construed as a marker of vulnerability to poor parenting. Less is known, however, about the impact of postpartum distress on parenting an infant born prematurely. The present study investigated whether high distress levels, which are particularly prevalent in mothers of preterm born infants, necessarily affect a mother's quality of parenting. METHOD: Latent Class Analysis was used to group mothers (N=197) of term, moderately, and very preterm born infants, based on their levels of distress (depression, anxiety, and PTSD symptoms) at one month postpartum, and their quality of parenting at one and six months postpartum. Parenting quality was assessed on the basis of maternal interactive behaviors (sensitivity, intrusiveness, and withdrawal) using observations, and maternal attachment representations (balanced, disengaged, or distorted) using interviews. RESULTS: A 5-Class model yielded the best fit to the data. The first Class (47%) of mothers was characterized by low distress levels and high-quality parenting, the second Class (20%) by low distress levels and low-quality parenting, the third Class (22%) by high distress levels and medium-quality parenting, the fourth Class (9%) by high distress levels and high-quality parenting, and finally the fifth Class (2%) by extremely high levels of distress and low-quality parenting. CONCLUSIONS: While heightened distress levels seem inherent to preterm birth, there appears to be substantial heterogeneity in mothers' emotional responsivity. This study indicates that relatively high levels of distress after preterm birth do not necessarily place these mothers at increased risk with regard to poor parenting. Conversely, low distress levels do not necessarily indicate good-quality parenting. The results of the present study prompt a reconsideration of the association between postpartum distress and parenting quality, and challenge the notion that high levels of maternal distress always result in low-quality parenting practices.

MATERNAL INTERACTION QUALITY MODERATES EFFECTS OF PRENATAL MATERNAL EMOTIONAL SYMPTOMS ON GIRLS' INTERNALIZING PROBLEMS.

The role of mother-infant interaction quality is studied in the relation between prenatal maternal emotional symptoms and child behavioral problems. Healthy pregnant, Dutch women (N = 96, M = 31.6, SD = 3.3) were allocated to the "exposed group" (n = 46), consisting of mothers with high levels of prenatal feelings of anxiety and depression, or the "low-exposed group" (n = 50), consisting of mothers with normal levels of depressive or anxious symptoms during pregnancy. When the children (49 girls, 47 boys) were 23 to 60 months of age (M = 39.0, SD = 9.6), parents completed the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, ), and mother-child interaction quality during a home visit was rated using the Emotional Availability Scales. There were no differences in mother-child interaction quality between the prenatally exposed and low-exposed groups. Girls exposed to high prenatal emotional symptoms showed more internalizing problems, if maternal interaction quality was less optimal. No significant effects were found for boys.

Longitudinal Associations Between Parental Bonding, Parenting Stress, and Executive Functioning in Toddlerhood.

Early executive functioning is an important predictor for future development of children's cognitive skills and behavioral outcomes. Parenting behavior has proven to be a key environmental determinant of child executive functioning. However, the association of parental affect and cognitions directed to the child with child executive functioning has been understudied. Therefore, in the present study we examine the associations between parental bonding (i.e., the affective tie from parent to child), parenting stress, and child executive functioning. At 26 weeks of pregnancy, and at 6 months and 24 months postpartum the quality of the maternal (N = 335) and paternal (N = 261) bond with the infant was assessed. At 24 months, postnatal parenting stress and child executive functioning were measured by means of parent-report questionnaires. Results indicated that for both mothers and fathers feelings of bonding negatively predicted experienced parenting stress over time. In addition, for both parents a negative indirect effect of bonding on child executive functioning problems was found via experienced parenting stress. These findings indicate the importance of monitoring parents who experience a low level and quality of early parent-child bonding, as this makes them vulnerable to parenting stress, consequently putting their children at risk for developing executive functioning problems.

The relationship between parenting stress and parent-child interaction with health outcomes in the youngest patients with type 1 diabetes (0-7 years).

UNLABELLED: To test whether parenting stress and the quality of parent-child interaction were associated with glycemic control and quality of life (QoL) in young children (0-7 years) with type 1 diabetes (T1DM), we videotaped 77 families with a young child with T1DM during mealtime (including glucose monitoring and insulin administration). Parent-child interactions were scored with a specifically designed instrument. Questionnaires assessed general and disease-related parenting stress and (diabetes-specific (DS)) QoL. HbA(1c) (glycemic control) was extracted from the medical records. Both general and disease-related parenting stress were associated with a lower (DS)QoL (r ranged from -0.39 to -0.70, p < 0.05), but not with HbA(1c) levels. Furthermore, with regard to the parent-child interaction, emotional involvement of parents (r = 0.23, p < 0.05) and expressed discomfort of the child (r = 0.23, p < 0.05) were related to suboptimal HbA(1c) levels. There was no clear pattern in the correlations between parent-child interaction and (DS)QoL. CONCLUSION: The results support the notion that diabetes does not only affect the child with T1DM: T1DM is a family disease, as parenting factors (like stress and parent-child interactions) are associated with important child outcomes. Therefore, it is important for health-care providers to not only focus on the child with T1DM, but also on the family system.

Continuous feelings of love? The parental bond from pregnancy to toddlerhood.

Both prenatal and postnatal parental bonding (i.e., the affective tie from parent to child) have important effects on parental and child functioning. However, research on the continuity and correlates of parental bonding is lacking. Therefore, the goal of the present study was to examine the stability of bonding levels and to explore distinct bonding patterns with a latent class analysis. Moreover, the correlates of these bonding patterns in the parental-, child-, and contextual domain were studied. Levels of maternal (N = 370) and paternal (N = 292) bonding and potential correlates were assessed at 26 weeks of pregnancy, 6 months, and 24 months postpartum. Results showed moderate stability of bonding from pregnancy to toddlerhood. For both mothers and fathers, 4 distinct bonding patterns were found. Parents with low bonding patterns were characterized by increased anxiety and parenting stress, less partner support, less adaptive personality profiles, and children with difficult temperament. These findings indicate the importance of monitoring young children's parents with poor levels of bonding as their bonding patterns remain stable from pregnancy until toddlerhood and because those parents experience problems in multiple domains.

FATHERS' AND MOTHERS' REPRESENTATIONS OF THE INFANT: ASSOCIATIONS WITH PRENATAL RISK FACTORS.

Parents' representations of their infants consist of parents' subjective experiences of how they perceive their infants. They provide important information about the quality of the parent-infant relationship and are closely related to parenting behavior and infant attachment. Previous studies have shown that parents' representations emerge during pregnancy. However, little is known about prenatal (risk) factors that are related to parents' representations. In a prospective study, 308 mothers and 243 fathers were followed during pregnancy and postpartum. Prenatal risk factors were assessed with an adapted version of the Dunedin Family Services Indicator (T.G. Egan et al., ; R.C. Muir et al., ). At 26 weeks' gestation and 6 months' postpartum, parents' representations of their children were assessed with the Working Model of the Child Interview (C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan). Results showed stability between pre- and postnatal representations, with fathers having more disengaged representations than did mothers. In addition, prenatal risk factors of parenting problems were associated with the quality of parents' prenatal (only in mothers) and postnatal representations. This study provides valuable information concerning parents at risk of developing nonbalanced representations of their children. In clinical practice, these families could be monitored more intensively and may be supported in developing a more optimal parent-infant relationship.

Parenting in Complex Conditions: Does Preterm Birth Provide a Context for the Development of Less Optimal Parental Behavior?

OBJECTIVE: To examine the predictive value of parent, infant, and contextual factors related to preterm childbirth for later parenting behaviors. METHODS: Mothers (n = 217) and fathers (n = 204) of term, moderately preterm, and very preterm infants were interviewed 1 month postpartum using the Clinical Interview for Parents of high-risk infants (CLIP), to assess their experiences and perceptions related to the pregnancy, delivery, infant, hospitalization, support system, and their narratives. Their responses were factor analyzed and entered into prediction models of parental behaviors (National Institute of Child Health and Human Development observations) 6 months postpartum. RESULTS: Preterm birth was associated with negative experiences and concerns in parents. Regression analyses revealed, however, that irrespective of preterm birth, negative and unrealistic parental perceptions predicted less sensitive, more intrusive, and more withdrawn behavior. CONCLUSIONS: Not prematurity per se, but particularly the presence of negative perceptions in parents, is predictive of difficulties in parent-infant interaction. The CLIP is a potentially useful instrument to identify families at risk.

Effectiveness of hospital-based video interaction guidance on parental interactive behavior, bonding, and stress after preterm birth: A randomized controlled trial.

OBJECTIVE: This study examined the effectiveness of hospital-based Video Interaction Guidance (VIG; Eliëns, 2010; Kennedy, Landor, & Todd, 2011) for mothers and fathers of infants born preterm (25-37 weeks of gestation). METHOD: VIG is a preventive video-feedback intervention to support the parent-infant relationship. One hundred fifty families (150 infants, 150 mothers, 144 fathers) participated in a pragmatic randomized controlled trial to evaluate the effects of VIG as adjunct to standard hospital care. Primary outcome was parental interactive behavior (sensitivity, intrusiveness, and withdrawal) as observed in videotaped dyadic parent-infant interaction. Secondary outcomes comprised parental bonding, stress responses, and psychological well-being based on self-report. The intervention effects were assessed at baseline, mid-intervention, 3-week, 3-month, and 6-month follow-ups. Data were analyzed on an intention-to-treat basis, using multilevel modeling and analyses of covariance. RESULTS: VIG proved to be effective in enhancing sensitive behavior and diminishing withdrawn behavior in mothers (Cohen's d range = .24-.44) and in fathers (d range: .54-.60). The positive effects of VIG were particularly found in mothers who experienced the preterm birth as very traumatic (d range = .80-1.04). The intervention, however, did not change parents' intrusive behavior. Analyses additionally revealed positive effects on parental bonding, especially for fathers, yet no significant effects on stress and well-being were detected. CONCLUSIONS: The results indicate that VIG is a useful addition to standard hospital care, reducing the possible negative impact of preterm birth on the parent-infant relationship. VIG appeared particularly beneficial for fathers, and for mothers with traumatic birth experiences. High levels of parental intrusiveness, however, need complementary intervention. (PsycINFO Database Record

Maternal and paternal infant representations: a comparison between parents of term and preterm infants.

OBJECTIVE: Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations. METHOD: Mothers and fathers of term infants (≥ 37 weeks of gestational age, n=71), moderately preterm infants (≥ 32-37 weeks of gestational age, n=62) and very preterm infants (<32 weeks of gestational age, n=56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D). RESULTS: The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal. CONCLUSION: Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.

Stability of fathers' representations of their infants during the transition to parenthood.

Studies investigating fathers' roles in child development have focused on a range of different aspects. However, few studies have focused on the early father-infant relationship, which already emerges before the child is born. The aim of this study is to examine the concordance of fathers' representations of their children during the transition to parenthood. The influences of demographic variables, psychological wellbeing, and personality on the stability of these representations are investigated. At 26 weeks gestational age and when infants were six months old, fathers (N = 243) completed questionnaires and the Working Model of the Child Interview during a home visit. A strong association was found between fathers' prenatal and postnatal representations. First-time fathers more often had balanced representations than fathers who already had children. Furthermore, agreeable fathers were more likely to evolve from a non-balanced prenatal representation to a balanced postnatal representation.

Pictorial representation of attachment: measuring the parent-fetus relationship in expectant mothers and fathers.

BACKGROUND: Over the past decades, attachment research has predominantly focused on the attachment relationship that infants develop with their parents or that adults had with their own parents. Far less is known about the development of feelings of attachment in parents towards their children. The present study examined a) whether a simple non-verbal (i.e., pictorial) measure of attachment (Pictorial Representation of Attachment Measure: PRAM) is a valid instrument to assess parental representations of the antenatal relationship with the fetus in expectant women and men and b) whether factors such as gender of the parent, parity, and age are systematically related to parental bonding during pregnancy. METHODS: At 26 weeks gestational age, 352 primi- or multiparous pregnant women and 268 partners from a community based sample filled in the PRAM and the M/PAAS (Maternal/Paternal Antenatal Attachment Scale, Condon, 1985/1993). RESULTS: Results show that the PRAM was significantly positively associated to a self-report questionnaire of antenatal attachment in both expectant mothers and fathers. Age and parity were both found significantly related to M/PAAS and PRAM scores. CONCLUSIONS: The present findings provide support that the PRAM is as a valid, quick, and easy-to-administer instrument of parent-infant bonding. However, further research focusing on its capacity as a screening instrument (to identify parents with serious bonding problems) and its sensitivity to change (necessary for the use in evaluation of intervention studies) is needed, in order to prove its clinical value.

Effect of situation on mother-infant interaction.

Research has shown that the early parent-infant relationship is of critical importance for children's developmental outcomes. While the effect of different settings on mother-infant interactive behavior is well studied, only few researchers systematically examined the effect of situational variables on mother-infant interaction. In the present study the effect of situational variables within the home setting on the quality of mother-infant interaction at 6 months was examined as well as the consistency in the quality of behaviors of mother and infant across these situations. During a home visit 292 mother-infant dyads were videotaped in three different situations (i.e., free play, face-to-face play, and diaper change). Interactive behaviors of mother and infant were assessed with the NICHD global ratings scales. Results showed substantial effects of situation on the interactive behavior of the mother-infant dyad. Despite the observed situational effects maternal sensitivity to non-distress, intrusiveness, stimulation of development, and positive regard and all five infant behavioral scales remained stable across the different situations. Insight into situational effects within the home setting on the quality of mother-infant interactive behavior may assist researchers to make well-informed decisions about measuring the parent-infant interaction in one or more specific situations.