WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study.

Objectives: Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has numerous benefits, yet many eligible children remain unenrolled. This qualitative study sought to explore perceptions of a novel electronic health record (EHR) intervention to facilitate referrals to WIC and improve communication/coordination between WIC staff and healthcare professionals. Methods: WIC staff in three counties were provided EHR access and recruited to participate. An automated, EHR-embedded WIC participation screening and referral tool was implemented within 8 healthcare clinics; healthcare professionals within these clinics were eligible to participate. The interview guide was developed using the Consolidated Framework for Implementation Research to elicit perceptions of this novel EHR-based intervention. Semi-structured interviews were conducted via telephone. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis. Results: Twenty semi-structured interviews were conducted with eight WIC staff, seven pediatricians, four medical assistants, and one registered nurse. Most participants self-identified as female (95%) and White (55%). We identified four primary themes: (1) healthcare professionals had a positive view of WIC but communication and coordination between WIC and healthcare professionals was limited prior to WIC having EHR access; (2) healthcare professionals favored WIC screening using the EHR but workflow challenges existed; (3) EHR connections between WIC and the healthcare system can streamline referrals to and enrollment in WIC; and (4) WIC staff and healthcare professionals recommended that WIC have EHR access. Conclusions: A novel EHR-based intervention has potential to facilitate healthcare referrals to WIC and improve communication/coordination between WIC and healthcare systems.

Associations among eating behaviors, food security status, and dietary intake during pregnancy.

Dietary intake of certain food groups and/or nutrients during pregnancy has been associated with maternal and infant pregnancy-related outcomes. Few studies have examined how behavioral and environmental factors interact to influence prenatal diet. We examined associations between eating behaviors (dietary restraint, emotional eating, external eating) and food security status regarding dietary intake of selected nutrients/food groups during pregnancy. Participants (N = 299; 29% Non-Hispanic Black; 16% ≤ high school education; 21% food insecure) completed validated questionnaires to assess estimated daily intake of food groups/nutrients during pregnancy [e.g., added sugars from sugar-sweetened beverages (SSBs), % of energy from fat, fruit and vegetable (FV) intake] via National Cancer Institute Dietary Screener Questionnaires); eating behaviors (Dutch Eating Behavior Questionnaire); and food security status (6-item USDA Food security Module). Separate hierarchical multiple regressions for each dietary outcome were conducted controlling for maternal age, education, income-to-needs, race/ethnicity, pre-pregnancy BMI, and gestational diabetes. A significant interaction was found between dietary restraint and food security status on added sugar intake from SSBs (ß = -0.15, p = 0.02). The negative association between restraint and added sugar from SSBs was stronger among food insecure participants (ß = -0.47, p < 0.001 vs. ß = -0.15, p = 0.03). Higher external eating (ß = 0.21, p < 0.01) and lower restraint (ß = -0.13, p = 0.03) were associated with higher % of energy from fat and living in a food insecure household (ß = -0.15, p = 0.01) was associated with lower FV intake. Understanding dietary intake during pregnancy requires consideration of the broader context in which eating behaviors occur.

Rethinking family-based obesity treatment.

Emerging research in paediatric obesity has demonstrated that parental involvement in the weight management process can improve weight outcomes in children. Recent guidelines by the American Academy of Pediatrics note the importance of parent and family involvement in treatment. However, it is currently unknown if including the entire family in obesity treatment can supersede outcomes associated with participation of only one parent. Family Systems Theory (FST) provides the theoretical foundation for examining one's healthy behaviours as they exist within the context of their family, defined by family dynamics. This narrative review aims to reconsider prior definitions of paediatric family-based management using the FST framework to be inclusive of family and household diversity and in doing so, inform research not only within weight management but also other domains of clinical care requiring family support or change. Applying FST to paediatric weight management highlights the link between family dynamics and paediatric obesity, demonstrating the association of dysfunctional family dynamics with more severe obesity. While family-based weight management remains the gold standard for treatment of paediatric obesity, more investigation is needed in expanding family-based interventions to impact entire families and potentially improve outcomes more broadly for overall family health and wellbeing.

Longitudinal Associations Among Food Insecurity During Pregnancy, Parental Mental Health Symptoms, Controlling Feeding Styles, and Infant Food Responsiveness.

BACKGROUND: Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood. OBJECTIVES: This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive). METHODS: Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness. RESULTS: Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (ß = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (ß = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (ß = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness. CONCLUSIONS: Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being.

Bidirectional associations between maternal controlling feeding and food responsiveness during infancy.

Parental controlling feeding styles and practices have been associated with greater food-approaching appetitive behaviors (i.e., food responsiveness) linked to childhood obesity. Recent longitudinal research suggests that this relationship may be reciprocal such that controlling feeding predicts child appetite and vice versa. However, to date no studies have considered these associations during infancy. The current study investigates prospective bidirectional associations between controlling feeding (restriction, pressure, and food to soothe) and infant food responsiveness. Mothers (N = 176) reported their controlling feeding and their infant's food responsiveness at infant age 2, 6, and 14 months. A 3-wave cross-lagged panel model was used to test the effect of controlling feeding at an earlier time point on infant food responsiveness at a later time point, and vice versa. Maternal controlling feeding and infant food responsiveness showed moderate stability across infancy. Net of covariates, we observed parent-driven prospective relations between pressuring feeding styles and food to soothe with infant food responsiveness. Pressuring to finish was a significant predictor of increases in food responsiveness from 2 to 6 months (p = 0.004) and pressuring with cereal was a significant predictor of increases in food responsiveness from 6 to 14 months (p = 0.02). Greater use of situational food to soothe was marginally associated with higher food responsiveness from 2 to 6 months (p = 0.07) and 6 to 14 months (p = 0.06). Prospective associations between restrictive feeding styles and infant food responsiveness were not observed. Findings point to pressuring feeding styles and food to soothe as potential early life intervention targets to prevent increases in food responsiveness in infancy. Longitudinal research with follow-up in the toddler and preschool years are needed to understand how these associations unfold over time and whether child-driven effects of food responsiveness become apparent as children get older.

Maternal sleep problems, depression, and infant negative emotionality are associated with maternal feeding to soothe in early infancy.

Maternal overreliance on feeding to soothe to relieve infants' distress has been associated with higher rates of childhood obesity. Limited research has examined infant and maternal characteristics that predict maternal feeding to soothe. The goal of the present study was to examine the role of infant (temperament) and maternal (depression, sleep problems) characteristics as predictors of maternal feeding to soothe. Mothers (N = 176) completed the Food to Soothe Scale, the Infant Behavior Questionnaire-Revised Very Short Form, the Center for Epidemiological Studies Depression Scale, and the Pittsburgh Sleep Questionnaire when their infants were 6 months old. Hierarchical multiple regression was used. Maternal depression only predicted feeding to soothe among mothers receiving WIC benefits, and this association was no longer significant when maternal sleep problems were added to the model. Maternal sleep problems predicted higher feeding to soothe as a main effect and in interaction with infant negative emotionality, maternal depression, and to a lesser extent WIC status. Specifically, infant negative emotionality was only associated with greater feeding to soothe among mothers with higher sleep problems, and sleep problems were only associated with greater feeding to soothe among depressed mothers and mothers receiving WIC benefits. The findings suggest that addressing multiple stressors, including maternal sleep, in the early postnatal period may strengthen the effectiveness of early child obesity interventions that target maternal feeding behaviors.

Food insecurity is associated with higher food responsiveness in low-income children: The moderating role of parent stress and family functioning.

BACKGROUND: Food insecurity (FI) may increase the odds for childhood obesity, yet little is known about the mechanism explaining this relationship. Parents experience greater psychosocial stress in the context of FI. In these environments, children from FI households may exhibit different appetitive behaviours. OBJECTIVES: To examine associations between FI and appetitive behaviours in children (3-5 years) and to explore whether social, emotional and structural properties of the home environment moderate this relationship. METHODS: In a low-income sample of 504 parent-child dyads, parents completed the household food security module and the Children's Eating Behavior Questionnaire. A subsample (n = 361) self-reported perceived stress, depressive symptoms, household chaos and family functioning. Children were categorized as food secure, household FI and child FI. RESULTS: Food responsiveness (LSmeans ± SE; child FI: 2.56 ± 0.13; food secure: 2.31 ± 0.10, p < 0.05) and emotional overeating (LSmeans ± SE; child FI: 1.69 ± 0.10; food secure: 1.48 ± 0.08, p < 0.05) were higher among children in the child FI group compared to the food secure group. Child FI was only associated with higher food responsiveness among children of parents reporting high levels of perceived stress (p = 0.04) and low levels of family functioning (p = 0.01). There were no differences in food responsiveness by food security status at mean or low levels of perceived stress or at mean or high levels of family functioning (p > 0.05). CONCLUSIONS: Child FI may contribute to obesity risk through differences in appetitive behaviours. For low-income families, stress management and improving family dynamics may be important factors for interventions designed to improve children's appetitive behaviours.

The feeding to Manage Child Behavior Questionnaire: Development of a tool to measure' non-nutritive feeding practices in low income families with preschool-aged children.

The parent feeding literature has largely focused on the use of controlling, intrusive practices to manage children's food intake (e.g., restriction, pressure). Less research has been conducted on parents' use of food as a contingency to direct or motivate child behavior. The aim of this study was to develop and validate the Feeding to Manage Child Behavior Questionnaire (FMCBQ). A mixed-methods approach was used to develop the 10-item questionnaire. Cognitive interviews informed the modification, deletion and/or replacement of items. The survey was distributed to mothers of children aged 2-5 years participating in the Women, Infants, and Children program or Head Start (n = 334). Factor analysis was conducted to test our theoretical model and construct validity was assessed. Caregivers also completed the Structure and Control in Parenting Feeding (SCPF) questionnaire and Child Behavior Questionnaire (CBQ). Exploratory factor analysis revealed a 2-factor model; 5-item Food to Soothe (FTS) and 4-item Food as Reward (FAR) subscale. Internal consistencies were good (0.84, 0.70 respectively). Both subscales were weakly and negatively associated with maternal self-reported BMI. As predicted, both subscales were positively correlated with child negative affect and other control-based feeding practices, whereas only FTS was negatively associated with structure-based feeding. The FMCBQ provides a short, reliable, and valid tool to assess use of FAR and FTS in response to a variety of contexts to better understand how mothers feed their children.

The Relative Reinforcing Value of Cookies Is Higher Among Head Start Preschoolers With Obesity.

The relative reinforcing value (RRV) of food measures how hard someone will work for a high-energy-dense (HED) food when an alternative reward is concurrently available. Higher RRV for HED food has been linked to obesity, yet this association has not been examined in low-income preschool-age children. Further, the development of individual differences in the RRV of food in early childhood is poorly understood. This cross-sectional study tested the hypothesis that the RRV of HED (cookies) to low-energy-dense (LED; fruit) food would be greater in children with obesity compared to children without obesity in a sample of 130 low-income 3- to 5-year-olds enrolled in Head Start classrooms in Central Pennsylvania. In addition, we examined individual differences in the RRV of food by child characteristics (i.e., age, sex, and reward sensitivity) and food security status. The RRV of food was measured on concurrent progressive-ratio schedules of reinforcement. RRV outcomes included the last schedule reached (breakpoint) for cookies (cookie Pmax) and fruit (fruit Pmax), the breakpoint for cookies in proportion to the total breakpoint for cookies and fruit combined (RRV cookie), and response rates (responses per minute). Parents completed the 18-item food security module to assess household food security status and the Behavioral Activation System scale to assess reward sensitivity. Pearson's correlations and mixed models assessed associations between continuous and discrete child characteristics with RRV outcomes, respectively. Two-way mixed effects interaction models examined age and sex as moderators of the association between RRV and Body Mass Index z-scores (BMIZ). Statistical significance was defined as p < 0.05. Children with obesity (17%) had a greater cookie Pmax [F (1, 121) = 4.95, p = 0.03], higher RRV cookie [F (1, 121) = 4.28, p = 0.04], and responded at a faster rate for cookies [F (1, 121) = 17.27, p < 0.001] compared to children without obesity. Children with higher cookie response rates had higher BMIZ (r = 0.26, p < 0.01); and RRV cookie was positively associated with BMIZ for older children (5-year-olds: t = 2.40, p = 0.02) and boys (t = 2.55, p = 0.01), but not younger children or girls. The RRV of food did not differ by household food security status. Low-income children with obesity showed greater motivation to work for cookies than fruit compared to their peers without obesity. The RRV of HED food may be an important contributor to increased weight status in boys and future research is needed to better understand developmental trajectories of the RRV of food across childhood.

Head Start Parents With or Without Food Insecurity and With Lower Food Resource Management Skills Use Less Positive Feeding Practices in Preschool-Age Children.

BACKGROUND: Food resource management (FRM), strategies to stretch limited food resource dollars, may mitigate the impact of household food insecurity (HFI) on family members, including young children. However, little is known about how FRM and HFI are associated with child feeding practices. OBJECTIVES: The study aimed to explore relationships between HFI, FRM, and child feeding practices of low-income parents. METHODS: In a cross-sectional sample of 304 Head Start households, caregivers completed the USDA HFI module [classifying them as either food secure (FS) or food insecure (FI)], FRM behavior subscale (classifying them as being high or low in management skills based on a median score split), Comprehensive Feeding Practices Questionnaire, and Perceived Stress Scale. Households were categorized into 4 HFI-FRM subgroups: FS/high FRM (30.6%), FS/low FRM (31.3%), FI/high FRM (18.8%), and FI/low FRM (19.4%). Multivariable linear regression was used to examine whether feeding practices differed across HFI-FRM categories and whether the addition of parental perceived stress contributed to differences in feeding practices by HFI-FRM group. RESULTS: In our study, 38% of households were FI. Compared to the FS/high FRM group in the adjusted models, the FS/low FRM group used less monitoring (-0.53; 95% CI: -0.78 to -0.28), modeling (-0.38; 95% CI: -0.64 to -0.13), and involvement (-0.57; 95% CI: -0.82 to -0.32) in feeding. A similar pattern emerged for the FI/low FRM group. The use of food as a reward was higher in the FI/high FRM (0.35; 95% CI: 0.02-0.67) and FI/low FRM groups (0.33; 95% CI: 0.01-0.66) compared to the FS/high FRM group. Perceived stress was positively associated with the use of negative, controlling feeding practices, and contributed to differences in using food as a reward within the HFI-FRM group. CONCLUSIONS: Suboptimal child feeding is evident in low-income caregivers with low FRM skills, with or without food insecurity. Promoting high FRM skills, in addition to addressing food insecurity, could potentially synergistically improve child feeding practices in low-income households.

Validation of a Classroom Version of the Eating in the Absence of Hunger Paradigm in Preschoolers.

Eating in the absence of hunger (EAH), a measure of children's propensity to eat beyond satiety in the presence of highly palatable food, has been associated with childhood obesity and later binge eating behavior. The EAH task is typically conducted in a research laboratory setting, which is resource intensive and lacks ecological validity. Assessing EAH in a group classroom setting is feasible and may be a more efficient alternative, but the validity of the classroom assessment against the traditional individually-administered paradigm has not been tested. The objective of this study was to compare EAH measured in a classroom setting to the one-on-one version of the paradigm in a sample of Head Start preschoolers. Children (n = 35) from three classrooms completed both classroom and individual EAH tasks in a random, counterbalanced order. In the group condition, children sat with peers at their classroom lunch tables; in the individual condition, children met individually with a researcher in a separate area near their classroom. In both conditions, following a meal, children were provided free access to generous portions of six snack foods (~750 kcal) and a selection of toys for 7 min. Snacks were pre- and post-weighed to calculate intake. Parents completed a survey of their child's eating behaviors, and child height and weight were measured. Paired t-tests and intraclass correlation coefficients were used to compare energy intake between conditions, and correlations between EAH intake and child BMI, eating behaviors, and parent feeding practices were examined to evaluate concurrent validity. Average intake was 63.0 ± 50.4 kcal in the classroom setting and 53.7 ± 44.6 in the individual setting, with no significant difference between settings. The intraclass correlation coefficient was 0.57, indicating moderate agreement between conditions. Overall, the EAH protocol appears to perform similarly in classroom and individual settings, suggesting the classroom protocol is a valid alternative. Future studies should further examine the role of age, sex, and weight status on eating behavior measurement paradigms.

Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families.

Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.

Food insecurity is associated with suboptimal sleep quality, but not sleep duration, among low-income Head Start children of pre-school age.

OBJECTIVE: To examine the association between food insecurity and child sleep outcomes and to investigate whether parent psychosocial factors mediate such associations. DESIGN: Cross-sectional study. Usual wake time and bedtime, bedtime routine and sleep quality were reported by parents using the adapted Brief Infant Sleep Questionnaire. Food insecurity was assessed using the eighteen-item US Department of Agriculture Household Food Security Module. Parent psychosocial factors, including perceived stress, parenting self-efficacy and depressive symptomology, were assessed using validated scales. Multivariable logistic regression models were performed to determine the association between food insecurity and sleep outcomes controlling for potential confounders. Mediation analyses and Sobel tests were applied to test the mediating effect of psychosocial factors. SETTING: Head Start pre-school classrooms in four regions across central Pennsylvania, USA. PARTICIPANTS: Low-income children of pre-school age (n 362) and their caregivers. RESULTS: Prevalence of household, adult and child food insecurity was 37·3, 31·8 and 17·7 %, respectively. Food security status at any level was not associated with child sleep duration or bedtime routine. Child food insecurity, but not household or adult food insecurity, was associated with 2·25 times increased odds (95 % CI 1·11, 4·55) of poor child sleep quality in the adjusted model. Perceived stress, self-efficacy and depressive symptomology mediated less than 2 % of the observed effect (all Sobel test P > 0·6). CONCLUSION: Food insecurity, particularly at the child level, is a potential modifiable risk factor for reducing sleep-related health disparities in early childhood. Future studies are needed to explore the plausible mechanisms underlying the associations between food insecurity and adverse child sleep outcomes.

Restrictive feeding and excessive hunger in young children with obesity: A case series.

Treatment recommendations for childhood obesity include guidance to reduce portions and the consumption of high-energy-dense foods. These messages may unintentionally promote restrictive feeding among parents of children with obesity with excessive hunger. Clinical guidance may benefit from framing treatment messages to parents in the context of a nonrestrictive feeding style.

Exploratory factor analysis of The Comprehensive Feeding Practices Questionnaire (CFPQ) in a low-income hispanic sample of preschool aged children.

The Comprehensive Feeding Practices Questionnaire (CFPQ) is an important measure to assess parent feeding practices as it encompasses a broad range of feeding behaviors, not just behaviors negatively associated with child weight outcomes. However, parent feeding practices have been shown to differ across ethnicities and the CFPQ has not been tested among low-income, Hispanic-American parents with preschool-aged children, a group at elevated risk for developing obesity. A confirmatory factor analysis was performed with the present Hispanic-American sample of Head Start mothers with preschoolers to confirm the original 12-factor, 49-item structure of the CFPQ. Because the original factor structure was not confirmed in the present Hispanic-American sample, an exploratory factor analysis was conducted to examine the psychometric properties of the CFPQ in this sample (n = 187). Among this sample, a five-factor model with 34 items was found to more appropriately assess parent feeding practices than the original 12-factor, 49-item CFPQ. This study provides preliminary validation of the CFPQ for use among low income, Hispanic-American families. Although future research is needed to replicate findings among a larger sample, this study takes an important first step toward more accurately assessing parent feeding practices among this high-risk population to inform tailored interventions that aim to reduce economic and ethnic disparities in child obesity.

INSIGHT Study Maternal Return to Work and Infant Weight Outcomes.

OBJECTIVE: Maternal return to work within 12 weeks of delivery is associated with poor child health and development. However, little is known about the impact of return to work on the risk of child obesity. We examined whether timing of maternal return to work is associated with rapid infant weight gain from 0 to 6 months and weight-for-length at 1 year. METHODS: Secondary data analysis of 279 mother-newborn dyads from the Intervention Nurses Start Infants Growing on Healthy Trajectories Study, a randomized controlled trial evaluating a responsive parenting (RP) intervention. Rapid infant weight gain from 0 to 6 months was assessed using conditional weight gain (CWG) scores. Infant weight-for-length was calculated using World Health Organization reference values. Analysis of variance (ANOVA) examined whether infant weight outcomes differed by timing of maternal return to work (≤12 weeks vs >12 weeks after delivery). Moderation by study group (RP intervention vs safety control) and mediation by breastmilk feeding were examined in ANOVA models. RESULTS: Among 261 mothers, approximately one half (n = 130) returned to work within 12 weeks. Compared with infants of mothers who returned to work after 12 weeks, infants of mothers who returned to work within 12 weeks had greater CWG scores from 0 to 6 months (P = .006) and were heavier at 1 year (P = .05). These associations were not moderated by study group or mediated by breastmilk feeding. CONCLUSIONS: Maternal return to work within 12 weeks was associated with rapid infant weight gain in the first 6 months and greater weight-for-length at 1 year, although the mechanisms to explain our findings are unclear.

Neural responses to maternal praise and criticism: Relationship to depression and anxiety symptoms in high-risk adolescent girls.

BACKGROUND: The parent-child relationship may be an important factor in the development of adolescent depressive and anxious symptoms. In adults, depressive symptoms relate to increased amygdala and attenuated prefrontal activation to maternal criticism. The current pilot study examined how depressive and anxiety symptoms in a high-risk adolescent population relate to neural responses to maternal feedback. Given previous research relating oxytocin to maternal behavior, we conducted exploratory analyses using oxytocin receptor (OXTR) genotype. METHODS: Eighteen females (ages 12-16) listened to maternal praise, neutral, and critical statements during functional magnetic resonance imaging. Participants completed the Mood and Feelings Questionnaire and the Screen for Child Anxiety Related Emotional Disorders. The OXTR single nucleotide polymorphism, rs53576, was genotyped. Linear mixed models were used to identify symptom or allele (GG, AA/AG) by condition (critical, neutral, praise) interaction effects on brain activation. RESULTS: Greater symptoms related to greater right amygdala activation for criticism and reduced activation to praise. For left amygdala, greater symptoms related to reduced activation to both conditions. Anxiety symptoms related to differences in superior medial PFC activation patterns. Parental OXTR AA/AG allele related to reduced activation to criticism and greater activation to praise within the right amygdala. CONCLUSIONS: Results support a relationship between anxiety and depressive symptoms and prefrontal-amygdala responses to maternal feedback. The lateralization of amygdala findings suggests separate neural targets for interventions reducing reactivity to negative feedback or increasing salience of positive feedback. Exploratory analyses suggest that parents' OXTR genetic profile influences parent-child interactions and related adolescent brain responses.