Lessons Learned from Remote Assessment of Mother-Infant Interactions Among Women with Postpartum Depression.

Purpose: The COVID-19 pandemic posed challenges to measuring mother-infant interactions, a critical outcome for many interventions to support mothers with postpartum depression symptoms and their new infants. The current study describes the process and lessons learned from implementing a remote assessment of mother-infant interactions during the pandemic. Description: At the onset of the COVID-19 pandemic, we pivoted from in-person to using two different strategies to remotely assess mother-infant interactions: (1) participants independently recorded and uploaded videos of free-play with their child; and (2) research team conducted a live-video recording of the free-play. Assessment: We found initial barriers including technical and video quality issues but overall, a remote option could increase enrollment and retention rates in a sample of postpartum women across various racial/ethnic groups and economic levels. Conclusion: Our experiences in conducting remote assessments with postpartum women add to growing evidence for the feasibility and validity of remote visits. This showed how our methods can be implemented in future research and in practice with postpartum mothers and their infants.

Comparative Study of Pharyngeal Flap Outcomes between Children With 22q11.2 Deletion Syndrome and Non-Syndromic Cleft Lip and Palate.

BACKGROUND: Management of velopharyngeal insufficiency (VPI) in 22q11.2 deletion syndrome (22q) is challenging. This study compares pharyngeal flap outcomes in children with 22q to those with non-syndromic cleft lip and palate (CLP) to assess risk of poor speech outcomes and negative sequelae. METHODS: Children with 22q or CLP treated with pharyngeal flap through a multidisciplinary VPI clinic between 2009 and 2020 were retrospectively reviewed. Pre- and postoperative speech assessments, perioperative characteristics, and complications were identified. RESULTS: 36 children with ​22q and 40 with CLP were included. Age at surgery (p=0.121), pre-operative velopharyngeal competence score (VPC) (p=0.702), and pre-operative resonance (p=0.999) were similar between groups. Pharyngeal flaps were wider (p=0.038*) and length of stay longer in the 22q group (p=0.031*). On short term follow 4 months after surgery, similar speech outcomes were seen between groups. At long term follow up >12 months after surgery, 86.7% 22q v. 100% CLP (p=0.122) had improvement in velopharyngeal function, however fewer children with 22q (60.0%) achieved a completely "competent" VPC score compared to those with CLP (92.6%) (p=0.016*). Nasal regurgitation improved for both groups, with a greater improvement in those with 22q (p=0.026*). Revision rate (p=0.609) and new onset OSA (0.999) were similar between groups. CONCLUSION: Children with 22q have improved speech after pharyngeal flap, but may be less likely to reach normal velopharyngeal function over the long term than those with CLP; however, negative sequelae do not differ. Improvement in nasal regurgitation is a uniquely positive outcome in this population.

Social Media-based Parenting Program for Women With Postpartum Depressive Symptoms: An RCT.

OBJECTIVES: To test effects of a social media-based parenting program for mothers with postpartum depressive symptoms. METHODS: We conducted a randomized controlled trial from December 2019 to August 2021 of a parenting program using Facebook. Women with mild-to-moderate depressive symptoms (Edinburgh Postnatal Depression Scale [EPDS] 10-19) were randomized to the program, plus online depression treatment or depression treatment alone for 3 months. Women completed the EPDS monthly and the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, and Parenting Sense of Competence pre- and postintervention. Differences among groups were assessed using intention-to-treat analysis. RESULTS: Seventy-five women enrolled and 66 (88%) completed the study. Participants were predominantly Black (69%), single (57%), with incomes <$55 000 (68%). The parenting group reported a more rapid decline in depressive symptoms than the comparison group (adjusted EPDS difference, -2.9; 95% confidence interval, -4.8 to -1.0 at 1 month). There were no significant group X time interactions for the Parent-Child Early Relational Assessment, Parenting Stress Index-Short Form, or Parenting Sense of Competence scores. Forty-one percent of women sought mental health treatment for worsening symptoms or suicidality. Women in the parenting group who exhibited greater engagement or reported mental health treatment had greater parenting responsiveness. CONCLUSIONS: A social media-based parenting program led to more rapid declines in depressive symptoms but no differences in responsive parenting, parenting stress, or parenting competence relative to a comparison group. Social media can provide parenting support for women with postpartum depressive symptoms, but greater attention to engagement and treatment access are needed to improve parenting outcomes.

Laryngeal pathologies in dysphonic children with Down Syndrome.

INTRODUCTION: Down syndrome is the most common chromosomal abnormality and is associated with a higher incidence of congenital heart defects, which often require surgery within the first year of life. Previous studies have found that children with Down syndrome are at higher risk for subglottic stenosis, vocal fold paralysis, and laryngomalacia. The goal of this study is to review children with Down syndrome presenting with dysphonia and to characterize their laryngeal pathologies. METHODS: A retrospective review was performed of patients with Down syndrome seen at a tertiary pediatric hospital's department of otolaryngology from Jan. 2007-Jul. 2021 for voice-related concerns. Inclusion criteria included age less than 18 years, diagnosis of Trisomy 21, and complaint of dysphonia. The data extracted included history of dysphonia, co-morbidities, demographic information, age at presentation, perceptual voice assessments, voice quality of life scores, acoustic data, laryngoscopic and/or videostroboscopic exams, and surgical procedures. RESULTS: Twenty-three total patients met the study criteria. Of these children, 13 (57%) were male and 10 (43%) were female. The mean age at first presentation was 4.08 years (range 12 days-16.3 years). Eleven of the 23 patients presented within the first 12 months of life. Sixteen patients were diagnosed with vocal fold immobility, 13 of which were left-sided unilateral immobility and the remaining 3 were bilateral immobility. 5 patients were diagnosed with vocal fold nodules. 12 children in the immobility group had a history of cardiothoracic surgery at our institution. Only 3 patients had Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) assessments, though all three showed overall dysphonia ratings of severely deviant, with roughness and strain scores being the most severe. DISCUSSION: The most common etiology of dysphonia in our Down syndrome patient population was vocal fold immobility and hypomobility, as opposed to vocal fold nodules (which is the most common in the general pediatric population). The higher likelihood of cardiac surgery in patients with Trisomy 21 may result in the increased incidence of vocal fold immobility. There should be a low threshold to refer dysphonic patients with Down syndrome for laryngoscopic evaluation, as treatment options may be available.

Optimal Outcomes Reporting (OOR): A New Value-Based Metric for Outcome Reporting Following Cleft Palate Repair.

OBJECTIVE: Palatoplasty outcome measurements vary widely among institutions. A standardized outcome metric would help provide quality benchmarks. DESIGN: Retrospective review of primary palatoplasty patients from 2007 to 2013. SETTING: Tertiary care children's hospital. MAIN OUTCOME MEASURES: We created a novel conceptual quality metric called "OOR" (Optimal Outcome Reporting). Optimal Outcome Reporting is designed to reflect the percentage of patients with cleft palate who experience the best outcomes: one operation, velar competence by age 5 years, and no unintended palatal fistula. RESULTS: Optimal Outcome Reporting was 72.3% (68/94). Eight patients had "suboptimal" outcomes for having undergone more than one operation. Eighteen patients failed for velar incompetence. No additional patients fell out of the algorithm for fistula. A significantly higher proportion of nonsyndromic patients demonstrated an "optimal" result compared to syndromic patients (61/80, 76.3% vs 7/14, 50.0%; P = .04). Patients who required more than one procedure had significantly more clinic visits (32.6 vs 14.9; P < .01) and accrued higher costs compared to "optimal" patients (US$34 019.88 vs US$15 357.25; P < .01). CONCLUSIONS: Optimal Outcome Reporting represents a novel quality metric that can provide meaningful information for patients with cleft palate. Optimal Outcome Reporting utilization can help cleft centers adopt changes that matter to patients and their families. By allowing for cross-institutional comparisons in a clear and objective manner, OOR can promote competition, innovation, and value in cleft palate care.

Adverse impact of multiple separations or loss of primary caregivers on young children.

Background: Young children may be adversely impacted by separation from and loss of caregivers and other loved ones. Such experiences often co-occur with interpersonal violence, unpredictability and other traumas. Whether separation/loss has unique effects independent of those other adversities is not known. Objective: This study aimed to establish whether separation/loss is associated with trauma-related symptoms, psychiatric disorders, and functional impairment in 18- to 48-month-old children independent of other adversities. Methods: Data from a cross-sectional community and clinical cohort were analyzed. Recruitment occurred in pediatric primary care, mental health, and developmental services sites. Children (33% female) were heterogeneous in ethnic background (55% minority) and family socioeconomic status (40% living in poverty). Results: Separation/loss was common (30.9% single type, 15.0% multiple types) and frequent amongst violence-exposed children (84.4% of violence-exposed children had experienced separation/loss from a loved one). However, violence exposure was uncommon amongst children with separation/loss experiences (only 23.9% were violence-exposed). Separation/loss was significantly associated with symptoms of posttraumatic stress and reactive attachment, as well as impairment and psychiatric disorders in models that controlled for sociodemographic and contextual risks, including other traumas. Psychiatric disorders were approximately 2.5 times more likely in children who had experienced multiple separations/losses, after accounting for interpersonal violence which was also significant. Conclusion: Professionals working with young children, policy-makers and caregivers should be aware that an accumulation of caregiver separations/losses, irrespective of violence and other traumatic exposure, may have detrimental effects on young children especially in the context of prior separations/losses or disruptions in their lives.

Antecedentes: los niños pequeños pueden verse afectados negativamente por la separación y la pérdida de los cuidadores y otros seres queridos. Tales experiencias a menudo se producen conjuntamente con la violencia interpersonal, la imprevisibilidad y otros traumas. Se desconoce si la separación/pérdida tiene efectos únicos independientes de esas otras adversidades.Objetivo: Este estudio tuvo como objetivo establecer si la separación/pérdida está asociada con síntomas relacionados con el trauma, trastornos psiquiátricos y deterioro funcional en niños de 18 a 48 meses de edad, independientemente de otras adversidades.Métodos: Se analizaron datos de una comunidad de corte transversal y una cohorte clínica. El reclutamiento se realizó en los centros de atención primaria pediátrica, salud mental y servicios de desarrollo. Los niños (33% mujeres) eran heterogéneos en cuanto a antecedentes étnicos (55% de minorías) y estatus socioeconómico familiar (40% que viven en la pobreza). Resultados: la separación/pérdida fue común (30.9% tipo único, 15.0% tipos múltiples) y frecuente entre los niños expuestos a la violencia ((84.4% de los niños expuestos a la violencia habían experimentado la separación/pérdida de un ser querido). Sin embargo, la exposición a la violencia fue poco frecuente entre los niños con experiencias de separación/pérdida (solo el 23,9% estaba expuesto a la violencia). La separación/pérdida se asoció significativamente con los síntomas de estrés postraumático y el apego reactivo, así como con el deterioro y los trastornos psiquiátricos en modelos que controlaban riesgos sociodemográficos y contextuales, incluidos otros traumas. Los trastornos psiquiátricos fueron aproximadamente 2.5 veces más probables en los niños que habían sufrido múltiples separaciones/pérdidas, después de considerar la violencia interpersonal, que también fue importante.Conclusión: Los profesionales que trabajan con niños pequeños, políticos y cuidadores deben ser conscientes de que una acumulación de separaciones/pérdidas de cuidadores, independientemente de la violencia y otras exposiciones traumáticas, puede tener efectos perjudiciales en los niños pequeños, especialmente en el contexto de separaciones/pérdidas previas o interrupciones en sus vidas.

Dissecting maternal care: Patterns of maternal parenting in a prospective cohort study.

Parental care has a strong impact on neurodevelopment and mental health in the offspring. Although numerous animal studies have revealed that the parental brain is a highly complex system involving many brain structures and neuroendocrine systems, human maternal parenting as a multidimensional construct with cognitive, emotional, and behavioural components has not been characterised comprehensively. This unique multi-method analysis aimed to examine patterns of self-reported and observed parenting from 6 to 60 months postpartum in a cohort of 496 mothers (mean maternal age = 32 years). Self-report questionnaires assessed motivational components of mothering, parenting stress, parenting-related mood, maternal investment, maternal parenting style, mother-child relationship satisfaction, and mother-child bonding at multiple time points. Observed parenting variables included the Ainsworth Sensitivity Scales at 6 and 18 months, the Behavioral Evaluation Strategies Taxonomies at 6 months, an Etch-A-Sketch cooperation task at 48 months, and the Parent-Child Early Relationship Assessment at 60 months. To examine whether different latent constructs underlie these measures of maternal parenting, we conducted an exploratory factor analysis. Self-report measures of parenting correlated only weakly with behavioural observations. Factor analysis on a subsample (n = 197) revealed four latent factors that each explained from 7% to 11% of the variance in the data (32% total variance explained). Based on the loadings of the instruments, the factors were interpreted as: Supportive Parenting, Self-Enjoyment Parenting, Overwhelmed Parenting, and Affectionate Parenting. These factor scores showed specific associations with maternal education and depressive symptoms, as well as with child outcomes, including maternally reported internalising and externalising behavioural problems, school readiness, and child-reported symptoms of mental health. These findings parallel the complexity of the parental brain, suggesting that maternal parenting consists of multiple components, each of which is associated with different maternal characteristics and child outcomes.

Factors affecting parent-child relationships one year after positive newborn screening for cystic fibrosis or congenital hypothyroidism.

OBJECTIVE: Examine factors that mediate parent-infant relationships 12 months after positive newborn screening (NBS). METHODS: We examined effects of infant diagnosis, parents' perceptions of child vulnerability and child attachment, parental depression and anxiety on parent-infant feeding interactions for 131 mothers and 118 fathers of 131 infants whose NBS and diagnostics confirmed cystic fibrosis (CF, n = 23), congenital hypothyroidism (CH, n = 35), CF carrier status (CF-C, n = 38), or healthy normal NBS (H, n = 35). RESULTS: Separate composite indicator structural equation models for mothers and fathers showed that neonatal diagnosis was not associated with increased anxiety or depression. In comparison with the healthy group, CF group parents reported higher perceptions of child vulnerability (p < .001, p = .002), and CF-C group fathers viewed their children as more attached (p = .021). High maternal perception of child vulnerability was associated with low perceptions of child attachment (p = .001), which was associated with task-oriented feeding behavior (p = .016, p = .029). Parental task-oriented feeding behavior was associated with less positive (p < .001, p < .001) and more negative interactions (p < .001, p = .001) with their infants. High paternal perception of child vulnerability was associated with negative parent interactions (p < .001). High parental affective involvement and verbalization was associated with high infant affective expressiveness, communicative skills, and social responsiveness (mothers' p < .001, fathers' p < .001). High parental negative effect and/or inconsistent and intrusive behavior were associated with infant dysregulation and irritability (mothers, p < .001, fathers, p < .001). CONCLUSION: The severity of conditions identified through NBS can affect parents' perceptions of their child's vulnerability and attachment. Infant feeding problems in the context of chronic health conditions, like CF, could represent signs of more deeply rooted concerns regarding the parent-child relationship that merit additional clinical evaluation.

Mother-child interactions in the NICU: relevance and implications for later parenting.

OBJECTIVE: This study examined the feasibility of observing mother-child interactions in the neonatal intensive care unit (NICU), whether NICU interactions related to later interactions, and how interactions related to child and maternal characteristics. METHODS: The sample included 130 preterm infants and their mothers, observed in a feeding interaction in the NICU. Dyads were observed through 36 months postterm. RESULTS: Observed maternal positive affective involvement and verbalizations in the NICU were associated with the same parenting behaviors at 24 months, social support, socioeconomic status, and being born in the late preterm period. Maternal negative affect and behavior were unrelated to later maternal negativity or child and maternal characteristics. CONCLUSIONS: Positive parenting assessed in the NICU appears related to later parenting interaction quality, suggesting early assessment is possible. Maternal negative affect and behavior toward children may not consistently emerge until later in development.

Alan S. Gurman (1945-2013).

Alan S. Gurman, one of the most distinguished and influential family psychologists of our day, was born in Winthrop, Massachusetts, May 26, 1945, and died in Madison, Wisconsin, September 6, 2013. The consummate editor and author, Al held many editorial posts. Al can be credited with moving couple and family therapy from a collection of approaches to a field of study. He pioneered bringing science to practice and in doing so brought credibility to couple and family therapy to those outside the field.

Clinical validity of a brief measure of early childhood social-emotional/behavioral problems.

OBJECTIVE: To address a pressing need for measures of clinically significant social-emotional/behavioral problems in young children by examining several validity indicators for a brief parent-report questionnaire. METHODS: An ethnically and economically diverse sample of 213 referred and nonreferred 2- and 3-year-olds was studied. The validity of the Brief Infant-Toddler Social-Emotional Assessment (BITSEA) Problem Index and Internalizing and Externalizing scales was evaluated relative to a "gold standard" diagnostic interview, as well as the Child Behavior Checklist (CBCL). RESULTS: The validity of the BITSEA Problem Index relative to Diagnosis (sensitivity = 72.7%-80.8%, specificity = 70.0%-83.3%) and clinical-range CBCL scores (sensitivity = 80.0%-96.2%, specificity = 75.0%-89.9%) was supported in the full sample and within minority/nonminority groups. Additional results supported the validity of the BITSEA Internalizing and Externalizing scales. CONCLUSIONS: Documented validity suggests that the BITSEA may be a valuable tool to aid screening, identification, and assessment efforts targeting early-emergent social-emotional/behavioral problems. Practical implications and generalizability are discussed.

Nutritional status of Palestinian preschoolers in the Gaza Strip: a cross-sectional study.

BACKGROUND: The authors examined factors associated with nutritional resilience/vulnerability among preschoolers in the Gaza Strip in 2007, where political violence and deprivation are widespread. METHODS: This cross-sectional study was carried out in 2007 using random sampling of kindergartens in order to select 350 preschoolers. Binary logistic regression was used to compare resilient (adequate nutrition) and vulnerable (stunted) groups with those with moderate nutrition. RESULTS: Approximately 37% of the subjects demonstrated nutritional resilience and 15% were vulnerable. Factors associated with nutritional resilience were child younger age, normal birth weight, actively hand- or spoon-feeding when the child was below two years, and residential stability in the past two years. The only factor associated with nutritional vulnerability was lower total score on the mother's General Health Questionnaire, which we interpret as a marker of maternal mental health. CONCLUSIONS: Children with low-birth weight and older children had worse nutritional resiliency outcomes. Further, poorer outcomes for children were associated with lower maternal mental health status, as well as increased family residential instability. Our results add to the large literature on the pervasive effects of violence and instability on children and underscore the need for resources for early intervention and for the urgent resolution of the Palestinian and other armed conflicts.

Health-related quality of life of Palestinian preschoolers in the Gaza Strip: a cross-sectional study.

BACKGROUND: Research on children's responses to wartime trauma has mostly addressed Post-Traumatic Stress Disorder (PTSD). However, PTSD is only one aspect of a complex set of responses. This study proposes to expand knowledge of well-being in children exposed to political violence through widening the conceptualization of well-being beyond PTSD, morbidity, and mortality by measuring health-related quality of life (HRQOL) and its facets, physical health, and psychosocial health. METHODS: In 2007, we used a cross-sectional random sample of kindergartens to examine factors associated with HRQOL, as measured by the PedsQL 4.0, in 350 preschoolers in the Gaza Strip, Palestine, where political violence and deprivation are widespread. RESULTS: About 65% of the mothers reported severely impaired psychosocial and emotional functioning in their children. Preschoolers had lower HRQOL than the US reference sample and samples of children in other low income countries with large effect size. HRQOL was comparable to those of US children with several chronic diseases. Factors associated with lower HRQOL were older child age, male gender, and more exposures to traumatic events. Factors associated with HRQOL subscales were for lower psychosocial health: older child age, history of food, water, and electricity deprivation during incursion, and witnessing assassination of people by rockets. For lower physical health: older child age, history of food, water, and electricity deprivation during incursion, and having heard of a killing of a friend by soldiers. CONCLUSIONS: HRQOL, including psychosocial health and emotional functioning is often severely impaired among preschoolers in the Gaza Strip. Exposure to both violent and non-violent negative events was associated with HRQOL in preschoolers.

Stability in Mother-Child Interactions from Infancy through Adolescence.

OBJECTIVE: The current study examines homotypic stability in mother-child interactions, applying similar rating scales of mother-child interactions at 1 and 4.5 years, and heterotypic stability from 1 to 13 years and 4.5 to 13 years, using conceptually similar but not identical rating scales at age 13. DESIGN: We coded videotaped mother-child interactions in 202 families when children were 1, 4.5, and 13 years of age during age-appropriate and developmentally salient structured tasks for relationship quality. RESULTS: Multiple regression analyses controlled for the effects of child birth order and gender as well as maternal age and education. Maternal and dyadic, but not child, mother-child interaction qualities at 1 year significantly predicted similar or equivalent constructs at 4.5 and 13 years. Heterotypic stability from 1 to 13 years was partially or fully mediated by the same constructs at 4.5 years. CONCLUSIONS: Maternal behaviors showed a pattern of homotypic and heterotypic stability, whereas dyadic behaviors were somewhat less stable. Child behaviors showed evidence of both homotypic and heterotypic instability.

Exposure to potentially traumatic events in early childhood: differential links to emergent psychopathology.

OBJECTIVE: To examine associations between exposure to potentially traumatic events (PTEs) and clinical patterns of symptoms and disorders in preschool children. METHOD: Two hundred and thirteen referred and non-referred children, ages 24 to 48 months (MN = 34.9, SD = 6.7 months) were studied. Lifetime exposure to PTEs (family violence and non-interpersonal events) and recent stressful life events were assessed with the Preschool Age Psychiatric Assessment (PAPA) and Child Life Events Scale. Child psychiatric symptoms and disorders were assessed with parent-reports in the PAPA, a comprehensive, developmentally sensitive interview. Sociodemographic risk, parental anxiety and depressive symptoms (Center for Epidemiologic Studies Depression, Beck Anxiety Inventory), and child developmental level (Mullen Scales of Early Learning) also were assessed. RESULTS: Violence exposure was broadly associated with psychiatric status in the areas of depression, separation anxiety, posttraumatic stress, and conduct problems, whereas potentially traumatic non-interpersonal exposure was associated with phobic anxiety. The majority of the associations between violence exposure and preschoolers' symptoms were significant even when other key factors, including economic disadvantage and parental mood and anxiety symptoms, were controlled statistically. However, parental depressive/anxious symptoms may have partially or fully mediated the relationships between violence exposure and depressive and conduct symptoms. CONCLUSIONS: Evidence of robust associations between violence exposure and early childhood internalizing and externalizing disorders and symptoms highlights the need for longitudinal prospective research concerning neurodevelopmental mechanisms and pathways. Findings underscore the relevance of assessing trauma exposure, particularly interpersonal violence, to identify young children at risk.

Task-oriented and bottle feeding adversely affect the quality of mother-infant interactions after abnormal newborn screens.

OBJECTIVE: To examine effects of newborn screening and neonatal diagnosis on the quality of mother-infant interactions in the context of feeding. METHODS: Study compared the quality of mother-infant feeding interactions among 4 groups of infants classified by severity of newborn screening and diagnostic results: cystic fibrosis (CF), congenital hypothyroidism, heterozygote CF carrier, and healthy with normal newborn screening. The Parent-Child Early Relational Assessment and a task-oriented item measured the quality of feeding interactions for 130 dyads, infant ages 3 to 19 weeks (M = 9.19, SD = 3.28). The Center for Epidemiologic Studies Depression Scale and State-Trait Anxiety Inventory measured maternal depression and anxiety. RESULTS: Composite Indicator Structure Equation Modeling showed that infant diagnostic status and, to a lesser extent, maternal education predicted feeding method. Mothers of infants with CF were most likely to bottle feed, which was associated with more task-oriented maternal behavior than breastfeeding. Mothers with low task-oriented behavior showed more sensitivity and responsiveness to infant cues, as well as less negative affect and behavior in their interactions with their infants than mothers with high task-oriented scores. Mothers of infants with CF were significantly more likely to have clinically significant anxiety and depression than the other groups. However, maternal psychological profile did not predict feeding method or interaction quality. CONCLUSIONS: Mothers in the CF group were the least likely to breastfeed. Research is needed to explicate long-term effects of feeding methods on quality of mother-child relationship and ways to promote continued breastfeeding after a neonatal CF diagnosis.

The Contribution of Infant, Maternal, and Family Conditions to Maternal Feeding Competencies.

OBJECTIVE: Because little is known about the role of family problem-solving processes in the development of mothers' competencies in feeding a very low birth-weight (VLBW) infant, we explored the contribution made by the competence in negotiating displayed by a mother and family member as they jointly problem solve infant-care issues. The infant's neonatal biomedical condition, maternal depressive symptoms, and family poverty status may also contribute to feeding competencies. DESIGN: A sample of 41 mothers of VLBW infants from 2 longitudinal studies who were observed during feeding at 1 and 8 months infant postterm age, with a family member of their choosing, participated in a dyadic problem-solving exercise. We assessed maternal feeding competencies with the Parent-Child Early Relational Assessment (Clark, 1997) and dyadic negotiating competence using an observational scale from the Iowa Family Interaction Rating Scales (Melby & Conger, 2001). We classified infant condition through medical record audit. Maternal depressive symptoms were assessed with the Center for Epidemiologic Studies-Depression (CES-D) Scale (L. S. Radloff, 1977), and family poverty status was determined through the mother's report of family income. RESULTS: Mothers' feeding competencies, structured into 2 factors, Parental Positive Affective Involvement, Sensitivity, and Responsiveness (PPAISR) and Parental Negative Affect and Behavior (PNAB, scored in the direction of low negativity) were stable from 1 to 8 months, accounting for the entire set of predictor variables. Neonatal biomedical condition had no effect on either PPAISR or PNAB; depressive symptoms were negatively associated with PNAB at 8 months; poverty status negatively predicted both PPAISR and PNAB at 1 and 8 months; and negotiating competence of the mother-family member dyad was positively associated with PNAB at 1 month. CONCLUSIONS: Evidence that family poverty status and dyadic negotiating competence were both associated with maternal feeding competencies supports inclusion of these family-level variables in a model of feeding competencies. A mother's negotiating competence with another family member who takes a responsible role in infant care may support maternal feeding competencies during a VLBW infant's early weeks when parenting patterns are forming.

A mother-infant therapy group model for postpartum depression.

This pilot study examined the feasibility and efficacy of a manualized, 12-week mother-infant therapy group (M-ITG) model for women with moderate to severe depressive symptoms during the postpartum period. Study participants were referred to the psychiatric clinic of a university medical center for assessment and treatment for postpartum depression. Results of pre- and post comparisons utilizing self-report and observational measures showed that women in the M-ITG groups (n = 18) reported significantly fewer depressive symptoms and experienced their infants as more reinforcing following 12 weeks of treatment than did the depressed women in the waitlist control group (WLCG) (n = 14). Mothers in the M-ITG group also were rated as exhibiting significantly more positive affective involvement and communication in interactions with their infants following treatment than did mothers in the WLCG. The M-ITG model is described, and the implications of utilizing a mother-infant treatment approach for postpartum depression that focuses on the relationships as well as the mother's depressive symptoms is discussed. The importance of further examining the efficacy of the M-ITG model for women with postpartum depression and their families in a large-scale, randomized clinical trial is underscored.

Effect of guided participation on feeding competencies of mothers and their premature infants.

The effect of guided participation (GP) on premature infant and maternal feeding competencies was examined, controlling for infant, maternal, and family conditions. Competencies were examined longitudinally and within age (1, 4, 8, and 12 months post-term age) for 42 mother-infant pairs randomly assigned to either GP or Standard Care (SC) groups. The hypothesized GP effect on competencies across infant age received support for infants (at 1 and 8 months) and for mothers (at 4 months). The hypothesized contribution of conditions was most strongly supported by the negative relationship between family poverty status and the two maternal competency variables. The hypothesized GP moderator effect on the relationship between depressive symptoms and maternal competency variables was supported for regulation of negative affect and behavior at 8 months. Despite study limitations in power and sensitivity to detect effects, findings indicate that further study of the GP intervention is merited.

Father involvement moderates the effect of maternal depression during a child's infancy on child behavior problems in kindergarten.

This research investigated whether father involvement in infancy may reduce or exacerbate the well-established adverse effect of maternal depression during a child's infancy on behavior problems in childhood. In a community sample (N = 350), the authors found that fathers' self-reported parenting styles interacted with the amount of time fathers spent caring for their infants to moderate the longitudinal effect of maternal depression during the child's infancy on children's internalizing, but not externalizing, behaviors. Low to medium amounts of high-warmth father involvement and high amounts of medium- or high-control father involvement at this time were associated with lower child internalizing behaviors. Paternal depression during a child's infancy exacerbated the effect of maternal depression, but this moderating effect was limited to depressed fathers spending medium to high amounts of time caring for their infants. Results emphasize the moderating role fathers may play in reducing or exacerbating the adverse long-term effects of maternal depression during a child's infancy on later child behavior problems.