Continuation of Treatment in Children With ADHD: A Multicenter Turkish Sample Study.

OBJECTIVES: The aim of this study was to investigate the variables that may affect treatment continuation in children aged 6 to 12 years who were newly diagnosed with ADHD. METHODS: A total of 132 children diagnosed with ADHD and their parents participated in the study. Sociodemographic and clinical risk factors affecting continuation of treatment were examined using logistic regression analysis. RESULTS: Multiple model examination revealed that greater age increased the risk of treatment discontinuation 1.824 times (p = .003) while a lower total length of paternal education increased the risk of discontinuation (1/0.835) 1.198 times (p = .022). Other variables emerging as significant in the univariate model lost that significance in the multiple model. CONCLUSIONS: Understanding the variables associated with medication discontinuation in ADHD in different populations and taking these variables into account in the development of health policies, will be useful in improving the long-term devastating effects of the disorder.

Evaluation of carotid intima media thickness as an early marker of atherosclerosis in children and adolescents with autism spectrum disorder: a case-control study.

There are studies reporting different results on whether there is an increased incidence of cardiovascular problems in autism spectrum disorder (ASD). The aim of this study was to examine carotid intima-media thickness (cIMT), an early marker of atherosclerosis in children and adolescents with ASD. This single-center case-control study was conducted in a tertiary care hospital. Eighty-five children (36 children with autism and 49 healthy controls) aged 6-18 were enrolled. After a clinical interview, Children's Global Assessment Scale (CGAS) and Autism Behavior Checklist (ABC) were filled out and laboratory measures were collected for ASD group. Anthropometric measurements (height, weight, waist and hip) of each participant were assessed. The cIMT was measured with an ultrasound probe on both sides of the neck. Age, gender, body mass index percentile and waist/hip ratio adjusted right/left common carotid arteries IMT and right/left bulb IMT were statistically significantly higher in the autism group than controls (0.45 ± 0.01 mm and 0.55 ± 0.01 mm, respectively, p < 0.001). We performed multiple linear regression analysis to determine statistically significant related factors of the cIMT in ASD. Early onset of autism symptoms were related with high carotid IMT (ß = -0.496, p = 0.01). These findings suggest that atherosclerosis may begin earlier in children with ASD, which is one of the most common neurodevelopmental disorders in childhood. The cIMT measurement, which is an easy and noninvasive method in the cardiovascular assessment and follow-up can be recommended for clinical use for individuals with ASD.

Sexual Abuse of Children in Turkey: Psychiatric Evaluation of 1785 Cases.

Introduction: This study aims to investigate the characteristic features of sexual abuse of children with a focus on psychiatric consequences and other associated elements. Methods: We evaluated 1785 child sexual abuse cases who were referred to the Ondokuz Mayis University Faculty of Medicine Forensic Medicine Department for examination and forensic reports during the 14-year period between 2006 - 2019. The study involved the examination of the patient files/records of victims of child sexual abuse. Results: The girls represented 81.8% of victims of sexual abuse, while all perpetrators were male. The mean ages at the time of abuse were 12.7±3.1 (2-17) years in girls and 10.7±3.2 (2-17) years in boys. In vast majority of the cases, perpetrators were found to be acquaintances of the victims (87.2%). 43% of child sexual abuse cases involved penetration. Psychological examination revealed that psychiatric pathology developed in 64.6% of the children who were exposed to sexual abuse. Being female, the presence of penetration and the presence of incest significantly increased the development of any psychiatric pathologies. Conclusion: Sexual abuse of children is a multidimensional public health problem. Additional education services to raise awareness of the children and their relatives, and the establishment of social and legal support schemes for victims and the families for sexual abuse and its consequences are deemed necessary.

Towards a definitive symptom structure of obsessive-compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals.

BACKGROUND: The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques. METHODS: A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM). RESULTS: Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables. CONCLUSIONS: Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.

An examination of the relationship between regulatory T cells and symptom flare-ups in children and adolescents diagnosed with chronic tic disorder and Tourette syndrome.

BACKGROUND: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by several motor and phonic tics. AIMS: In this study, we aimed to compare activated regulatory T cell (Treg) values between patients with TS/chronic tic disorder (CTD) and age- and sex-matched healthy controls (HCs). MATERIALS AND METHOD: Patients with TS/CTD and age- and sex-matched HCs were included in the study. The severity of the disease was evaluated using the Yale Global Tic Severity Scale. CD4+CD25+CD127low Tregs from the patient group and the control group were compared using flow cytometry. RESULTS: The study included 48 patients diagnosed with TS/CTD (36 males and 12 females, mean age: 11.58 ± 2.61) and 24 HCs (18 males and 6 females, mean age: 11.63 ± 2.60). The TS/CTD group had significantly higher activated regulatory T percentile with respect to the T helper value compared to the HCs (p = 0.010). Lymphocyte count, T lymphocyte count, T lymphocyte percentage, T-helper lymphocyte count, and T-helper lymphocyte percentage were lower in the patient group compared to the control group (p = 0.024, 0.003, 0.007, <0.001, <0.001, respectively). The comparison of three groups (mild, moderate-severe, and HCs) revealed that T lymphocyte number and percentage and the T helper number and percentage were significantly higher in the HC group compared to the moderate-severe group, whereas the activated Treg percentage with respect to the T helper value was significantly higher in the moderate-severe group compared to the HC group (0.002, 0.026, <0.001, <0.001, 0.027, respectively). CONCLUSION: Our results suggest that Tregs may have a role in the pathogenesis of TS/CTD.

Does the Psychopathology of the Parents Predict the Developmental-Emotional Problems of the Toddlers?

INTRODUCTION: Parental psychopathology has been defined in respect of psychopathological development in early childhood. This study aimed to investigate the effects of parental psychopathologies on social and emotional problems in the age range of 1-3 years and to determine children at risk. METHODS: The study data were obtained from the 2009 Early Childhood Mental Health Profile taking population distribution into consideration with the properties representing Turkey. The primary caregiver of the child completed the Psychiatric Evaluation Form for 1-3 years, the Brief Infant-Toddler Social Emotional Assessment (BITSEA), the Ages and Stages Questionnaire (ASQ), and the Brief Symptom Inventory (BSI) for themselves. Machine learning models used for prediction. The performance of prediction models was evaluated with the ten-fold cross-validation method. Area Under Curve (AUC) values were calculated with Receiver Operating Characteristic (ROC) curves to evaluate the performance of each model. RESULTS: The evaluation was made of the data of 2775 children, comprising 1507 (54.3%) males and 1268 (45.7%) females with a mean age of 26.19±9.11 months (range, 10-48 months). A total of 106 children were identified as at risk, as they were above the clinical cut-off point (1.5 standard deviations) of the BITSEA points and below the cut-off points of any one of the developmental areas of the ASQ. Modeling was applied to the data of these 106 children. The Support Vector Machines (SVM) model was selected for prediction with the automatically optimized highest AUC value. Weighting for the SVM algorithm showed mothers' BSI scores, fathers' education and health problems, duration of breastfeeding, unplanned pregnancy are significant for predicting BITSEA-problem scores in the model. CONCLUSION: To be able to understand the complex relationship with parental psychopathology and behavioral problems, machine learning methods were used successfully in this study. Further studies with more massive data sets, more extended follow-up periods, and stronger algorithms will be able to identify risk groups earlier and allow early interventions to be implemented.

Decreased serum orexin A levels in drug-naive children with attention deficit and hyperactivity disorder.

Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood and characterized by inattention, hyperactivity, and impulsivity. ADHD is a neurodevelopmental disorder, and its etiology has not yet been determined precisely. Orexin A is thought to play an important role in different forms of learning, memory, and attention. Despite its importance in attention and learning, no study has investigated serum orexin levels in patients with ADHD. In the present study, we aimed to compare serum orexigenic neuropeptides such as orexin A and orexin B, neuropeptide Y, and ghrelin between drug naive children with ADHD and healthy children. Fifty-six drug-naive children with ADHD and 40 healthy controls were enrolled in the study. After comparison of serum orexin A and orexin B, neuropeptide Y, and ghrelin, we found that serum orexin A levels were significantly lower in the ADHD group (p = 0.001). Furthermore, serum orexin A levels were compared between ADHD subgroups. Orexin A levels were significantly lower in the inattentive subtype compared with the hyperactive subtype and combined subtype (p = 0.009). Our results indicate that orexin A might be a neurobiological etiological factor in ADHD, particularly associated with attention symptoms. The present study is the first to demonstrate decreased serum orexin A levels in drug-naive children with ADHD. Further studies are needed to confirm our results and to show the effects of treatments involving orexin A in patients with ADHD.

An Examination of the Relations Between Symptom Distributions in Children Diagnosed with Autism and Caregiver Burden, Anxiety and Depression Levels.

High stress levels and impairment of physical/mental health in parents can delay early and effective intervention in autism. The purpose of this study was to examine relations between the clinical characteristics of children diagnosed with autism spectrum disorder (ASD) and caregiver burden, and anxiety and depression levels. Seventy cases under monitoring at the Namik Kemal University Medical Faculty Child and Adolescent Psychiatric Polyclinic with a diagnosis of ASD, and their principal caregivers, were included in the study. The Autism Behavior Checklist (ABC), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and the Zarit Caregiver Burden Scale were completed. At multiple regression analysis, autism symptom severity and caregiver depressive symptom levels emerged as significant predictors of total caregiver burden scores. Only the ABC language subscale score had a determining effect on caregiver burden (r = 0.51, r2 = 0.26, p = 0.04). ABC body and object use subscale scores were identified as the symptom cluster affecting depression and anxiety scores (r = 0.25, r2 = 0.06, p = 0.03 and r = 0.28, r2 = 0.08, p = 0.01). Our findings show that ASD symptom severity and depressive symptoms in the caregiver are the most important factors giving rise to the caregiver burden, and that the main ASD symptom cluster affecting the caregiver burden was problems associated with language development. Better understanding of variables impacting on the caregiver burden will increase the quality of psychosocial services for caregivers.

Altered methyltetrahydrofolate reductase gene polymorphism in mothers of children with attention deficit and hyperactivity disorder.

Attention Deficit and Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders in childhood and causes significant functional impairments in children. Behavioral genetic and molecular genetic studies have provided significant evidence in terms of highlighting the etiology of ADHD. Folate deficiency during pregnancy is an established risk factor for ADHD. Polymorphisms in the Methyltetrahydrofolate Reductase (MTHFR) encoding gene, such as A1298C and C667T, are associated with the decreased bioavailability of folate, and this condition can act like folate deficiency. In the literature, no study has investigated MTHFR polymorphisms in mothers of children with ADHD. Sixty-four children diagnosed with ADHD and their mothers as well as 40 healthy children and their mothers participated in this study. MTHFR polymorphisms were investigated in all participants. Comparison of the C677C and A1298C MTHFR polymorphisms in children with and without ADHD revealed no significant differences. We found that the maternal C677C_CT genotype counts, both observed and expected values, were significantly different from those based on Hardy-Weinberg Principle Analysis in the ADHD group. The most important result of this study was that maternal C677C MTHFR gene polymorphisms are significant risk factors in for ADHD, and we argue that children with ADHD are exposed to folate deficiency, even if their mothers received a sufficient amount of folate during pregnancy. This result also highlights one of the genetic factors of ADHD. Further studies should be performed to confirm this finding.

The Relationship of Clinical Symptoms with Social Cognition in Children Diagnosed with Attention Deficit Hyperactivity Disorder, Specific Learning Disorder or Autism Spectrum Disorder.

OBJECTIVE: One of the areas of social cognition is Theory of Mind (ToM) is defined as the capacity to interpret, infer and explain mental states underlying the behavior of others. When social cognition studies on neurodevelopmental disorders are examined, it can be seen that this skill has not been studied sufficiently in children with Specific Learning Disorder (SLD). METHODS: In this study, social cognition skills in children diagnosed with attention deficit hyperactivity disorder (ADHD), SLD or Autism Spectrum Disorder (ASD) evaluated before puberty and compared with controls. To evaluate the ToM skills, the first and secondorder false belief tasks, the Hinting Task, the Faux Pas Test and the Reading the Mind in the Eyes Task were used. RESULTS: We found that children with neurodevelopmental disorders as ADHD, ASD, and SLD had ToM deficits independent of intelligence and language development. There was a significant correlation between social cognition deficits and problems experienced in many areas such as social communication and interaction, attention, behavior, and learning. CONCLUSION: Social cognition is an important area of impairment in SLD and there is a strong relationship between clinical symptoms and impaired functionality.

Associations Between Father Temperament, Character, Rearing, Psychopathology and Child Temperament in Children Aged 3-6 Years.

Temperament refers to the totality of individual characteristics present from birth that determine a child's unique style of behavior. Maternal personality and attitudes, one of the factors affecting temperament traits in children, is a frequently investigated subject. However, paternal variables have remained insufficiently studied. The purpose of this study is to investigate the associations between the fathers' temperament, character, attitudes, psychopathology and temperament of the 3-6 years-old children. The parents of 36-60 months-old children in the preschool settings in Samsun were included in the study (n:200). Their mothers completed "Maternal Sociodemographic Form" prepared by the researcher, and the temperament of children "Children Behaviour Questionnare" were scored by the mothers. Their fathers completed "Paternal Sociodemographic Form", and to assess father psychopathology "Brief Symptom Inventory", to determine father temperament and character "Temperament and Character Inventory" and to determine attitudes "Parenting Attitudes Scale" were scored by the fathers. In this study, we found several significant associations between children's temperament and fathers temperament and character, attitudes styles and psychopathology. The scores of paternal harm avoidance increase and self directedness decrease were found to be significantly positivily correlated with negative temperamental charecteristics of the children. The democratic attitudes of fathers were significantly correlated with positive temperamental scores of the children. All domains of paternal psychopathology were found to be in significant association with negative temperamental characteristics of the children. Our findings showed the complex interplay between determinants of parenting. Specifically, this study is one of the first to investigate paternal personality, psychopathology and attitudes, alone and in interaction with preschool child temperament.

Basal blood DHEA-S/cortisol levels predicts EMDR treatment response in adolescents with PTSD.

OBJECTIVE: In literature, recent evidence has shown that the hypothalamic-pituitary-adrenal (HPA) axis can be dysregulated in patients with post-traumatic stress disorder (PTSD) and HPA axis hormones may predict the psychotherapy treatment response in patients with PTSD. In this study, it was aimed to investigate changing cortisol and DHEA-S levels post-eye movement desensitization and reprocessing (EMDR) therapy and the relationship between treatment response and basal cortisol, and DHEA-S levels before treatment. METHOD: The study group comprised 40 adolescents (age, 12-18 years) with PTSD. The PTSD symptoms were assessed using the Child Depression Inventory (CDI) and Child Post-traumatic Stress Reaction Index (CPSRI) and the blood cortisol and DHEA-S were measured with the chemiluminescence method before and after treatment. A maximum of six sessions of EMDR therapy were conducted by an EMDR level-1 trained child psychiatry resident. Treatment response was measured by the pre- to post-treatment decrease in self-reported and clinical PTSD severity. RESULTS: Pre- and post-treatment DHEA-S and cortisol levels did not show any statistically significant difference. Pre-treatment CDI scores were negatively correlated with pre-treatment DHEA-S levels (r: -0.39). ROC analysis demonstrated that the DHEA-S/cortisol ratio predicts treatment response at a medium level (AUC: 0.703, p: .030, sensitivity: 0.65, specificity: 0.86). CONCLUSION: The results of this study suggested that the DHEA-S/cortisol ratio may predict treatment response in adolescents with PTSD receiving EMDR therapy. The biochemical parameter of HPA-axis activity appears to be an important predictor of positive clinical response in adolescent PTSD patients, and could be used in clinical practice to predict PTSD treatment in the future.

Psychometric properties of the DY-BOCS in a Turkish sample of children and adolescents.

BACKGROUND: Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising scale for assessing frequency and severity of symptom dimensions. The main objective of the study was to assess the psychometric properties of the DY-BOCS in a large sample of children and adolescents from Turkey. METHODS: We studied 143 children and adolescents, 7-18years, with well characterized DSM-IV-R OCD, ascertained from seven collaborating university or state hospital sites. We compared the DY-BOCS scores with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Children's Depression Inventory (CDI), the Yale Global Tic Severity Scale (YGTSS) and the Child Behavior Checklist 6-18years (CBCL 6-18). RESULTS: The internal consistency of the DY-BOCS symptom dimensions and inter-rater agreement of component scores were excellent. The agreement between global DY-BOCS score and the total CY-BOCS score was highly significant (Pearson's r=0.55, p<0.0001). Severity scores for individual symptom dimensions were independent of one another, only modestly correlating with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. CONCLUSION: The DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in children and adolescents from Turkey.

Maternal stress and perinatal features in autism and attention deficit/hyperactivity disorder.

BACKGROUND: We investigated the shared and non-shared perinatal risk factors for autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) in a clinical sample. Additionally, we compared these groups regarding pre/postpartum maternal stress and the duration of breastfeeding. METHODS: Children aged 3-18 years old with ASD (n = 100) were compared with age- and gender-matched children with ADHD (n = 100) and with age- and gender-matched healthy controls (n = 80). RESULTS: Prematurity of the neonate and maternal stress/depressive mood in pregnancy were common risk factors shared by ASD and ADHD. Postpartum maternal depressive mood may be more specific to ASD, while shorter duration of breastfeeding may be related to ADHD. CONCLUSIONS: ASD and ADHD may have some perinatal features in common. Identification of perinatal factors for ASD and ADHD carries clinical implications in terms of primary prevention.

Associations with violent and homicidal behaviour among men with schizophrenia.

Objective We aimed to assess the risk factors associated with homicidal behaviour in male patients diagnosed with schizophrenia. Methods In a period of 1 year, male schizophrenia cases between 18-65 years of age (n = 210) were included. The clinical evaluation included the Positive and Negative Syndrome Scale (PANSS) and Overt Aggression Scale (OAS). The patients were divided into three groups in terms of violent behaviour history: (1) homicide group (n = 30), (2) a violent act resulting in serious injury (n = 71), (3) control group (patients without a history of a violent act) (n = 109). Results Lower level of education, rural residence, being unemployed and living alone were found to be significantly more common in patients who had committed a violent act compared to the schizophrenia patients in the control group. In order to explore the predictive value of several factors associated with violent behaviour, a logistic regression model was used, and variables (shorter duration of education, living alone, and lack of insight) significantly predicted the presence of violent behaviour (murder and/or injury) (χ(2)=31.78, df = 12, p = 0.001). Conclusions In order to be able to determine causality of homicidal acts in schizophrenia patients, our significant findings between homicidal violence, non-homicidal violence and the control group would merit further attention and exploration in further studies.

[Relationship between the Psychiatric Symptoms in Expecting Parents and Postpartum Depression and Infantile Colic: A Multicenter Follow up Study]. / Anne ve Baba Adaylarinda Psikiyatrik Belirtiler ile Dogum Sonrasi Depresyon ve Infantil Kolik Arasi Iliski: Çok Merkezli Bir Takip Çalismasi.

OBJECTIVE: The aim of this study is to evaluate the relationship between postpartum depression (PPD), infantile colic (IC) and different psychosocial variables, psychiatric symptoms, attachment style and perceived social support in expecting parents. METHOD: Two hundred forty five expecting mothers and 150 expecting fathers were first interviewed between the 22-34 weeks of pregnancy. Sociodemografic data form, Adult Attachment Style Scale (AASS), State Anxiety Inventory (SAI), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Brief Symptom Inventory (BSI) were filled out by each expecting parent. Second interview was conducted between the postpartum 4-24 weeks. Data form consisting health, nutrition, sleep and crying problems of the infant and EPDS and SAI were filled out by mothers and SAI by fathers. RESULTS: One in every four mothers had PPD symptoms above the threshold on EPDS. Maternal and paternal insecure attachment style, maternal psychiatric symptoms and postpartum anxiety level were found to be the predictors of PPD. One in every five infants had IC and maternal education level, hostility score and PPD symptoms along with paternal insecure attachment style and psychiatric symptoms were the main predictors of IC. CONCLUSION: Results about PPD and IC regarding maternal variables are consistent with the literature. In addition, paternal insecure attachment style is found to be an important risk factor for both PPD and IC. Fathers should also be included in further studies exploring PPD or IC.

Abuse Characteristics and Psychiatric Consequences Associated with Online Sexual Abuse.

The current study examined the rate and psychiatric correlates of sexual abuse involving the use of digital technologies by the offender in a wide sample of juvenile victims. Sociodemographic, abuse, and psychiatric characteristics of 662 sexually abused children and adolescents were evaluated. Of these, 93 reported that digital devices were used by the offender in several ways to facilitate the sexual abuse. The offender-victim relationship was initiated through the Internet in 39 victims. Involvement of digital technologies in sexual abuse was significantly associated with penetrative and recurrent form of sexual abuse commited by multiple offenders with coexisting violence. Additionally, victims of sexual abuse with a digital component were 4.21 times more likely to develop any psychopathology, 3.77 times more likely to have depression, and 2.14 times more likely to have post-traumatic stress disorder as a result of sexual abuse. These results indicated that the offender's use of digital technology may aid the initiation and facilitation of the sexual abuse of youths and may relate to more severe outcomes. This study revealed the importance of raising the awareness of professionals and the community about the potential risks associated with digital technologies and sexual abuse. Mental health professionals should consider this additional form of victimization, especially when dealing with sexual abuse victims.

Mother-Child Interactions of Preterm Toddlers.

INTRODUCTION: We aimed to investigate the mother-toddler relationship in preterm toddlers. METHODS: The sample consisted of 18 mothers and their preterm toddlers (group 1) and 20 mothers and their fullterm toddlers (group 2). Anxiety and depressive symptom levels, attachment pattern, and parental attitudes of mothers and social-emotional problems and developmental level of the toddlers were explored to assess possible confounding factors in the mother-toddler relationship. Two researchers rated the Parent Infant Relationship Global Assessment Scales (PIRGAS). RESULTS: Both the mothers in group 1 and group 2 had similar Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores. However, the mothers who gave birth before 32 weeks of gestation had higher trait anxiety scores than others (46±2.4 vs. 42.3±5.4, p=0.01). The groups had similar Brief Infant Toddler Social Emotional Assessment Scale (BITSEA) problem and competency scores. The parenting style of group 1 revealed that they had higher scores on the Parenting Attitude Research Instrument (PARI) subscale 5 (excessive discipline) (39.6 vs. 32.1; p=0.02). CONCLUSION: Mother-toddler interaction and attachment security were found to be similar in fullterm and moderately preterm healthy toddlers. Our findings suggest that not the preterm birth itself but the medical, developmental, and/or neurological consequences of prematurity may affect the mother-toddler interaction. To explore the independent effect of prematurity in mother-toddler dyadic relationship, longitudinally designed studies are warranted.