A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial.

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

El ensayo controlado aleatorizado analizó la eficacia de un un programa personalizado de parentalidad a distancia mediante feedback por vídeo dirigido a mejorar la parentalidad y el comportamiento de los niños. Se distribuyó aleatoriamente a 92 madres de niños de entre 2 y 6 años de edad en el grupo de intervención (n = 50) y un grupo control de lista de espera (n = 42). Para mejorar la parentalidad positiva se utilizó el programa preventivo Strengthening Bonds, en el que las madres participaron en una sesión de grupo presencial. Durante seis semanas recibieron por teléfono móvil feedback en vídeo personalizado sobre su interacción madre-hijo durante el juego. El resultado primario fue la conducta parental, y el resultado secundario la conducta del niño. Se llevaron a cabo mediciones preintervención y posintervención. El análisis de ecuaciones de estimación general no tuvo resultados significativos en los análisis por intención de tratar (AIT). En los análisis por protocolo (APP) hubo efectos significativos, reduciendo las prácticas parentales coercitivas de las madres y los problemas de conducta de los niños. El análisis de modelos de ecuaciones estructurales reveló que la disminución de los problemas de conducta de los niños producida por la intervención era mediada por la mejora en las prácticas coercitivas. La intervención tenía un efecto directo en la mejora del sentimiento de competencia parental. A pesar de la falta de resultados del AIT, el APP dio resultados prometedores en cuanto a la mejora de las conductas y creencias parentales positivas y en la reducción de los problemas de conducta de los niños.

Unpacking the Impacts of a Universal Parenting Program on Child Behavior.

This study examined the theory of change of the ACT Raising Safe Kids parenting program, including whether intervention effects on children's behavior problems were explained by improvements in mothers' reported parenting practices, as well as whether baseline child behavior problems moderated these relations. Adult mothers of 3-to 8-year-old Brazilian children were assigned to the intervention (n = 97) or control (n = 46) groups. Results showed that the intervention improved mothers' perceptions of their parenting practices (positive discipline, emotional and behavioral regulation, and communication). Intervention-induced reductions in children's internalizing and externalizing behavior problems were mediated by improvements in mothers' emotional and behavioral regulation. Program effects were strongest for children with high levels of baseline behavior problems.

Effects of Neonatal Pain and Temperament on Attention Problems in Toddlers Born Preterm.

Objective: To examine the effects of individual characteristics of neonates and neonatal pain-related stress on attention problems and externalizing behavior problems of toddlers born preterm, analyzing the moderating effects of the dispositional traits of temperament. Methods: The sample included 62 toddlers aged 18-36 months and their mothers. The mothers were interviewed using the Child Behavior Checklist 1.5-5 for toddlers' attention and externalizing behavior problems assessment, the Early Childhood Behavior Questionnaire for toddlers' temperament assessment, and the Adult Temperament Questionnaire for their temperament assessment. The Neonatal Infant Stressor Scale analyzed the number of pain-related stress events during neonatal intensive care unit (NICU) hospitalization recorded in the medical charts. Statistical descriptive, correlation, and multiple linear regression analyses were performed. Results: High neonatal pain-related stress total index, associated with toddler's temperament with less Effortful Control, and mother's temperament with high Surgency explained 23% variability of the attention problems. Otherwise, the externalizing behavior problems were explained by temperament, but not by neonatal pain-related stress. Conclusions: The findings support the impact of neonatal pain experiences, and current toddlers' and mothers' temperament characterized by poorer self-regulation on attention problems in toddlers born preterm. Developmental care in the NICU and follow-up programs after discharge are recommended to promote regulated temperament of the mother-child dyads, aiming to prevent attentional problems in toddlers born preterm.

International child abuse prevention: insights from ACT Raising Safe Kids.

BACKGROUND: Evidence-based practices are often viewed as lofty goals endorsed by wealthy academics in developed nations, but impossible to implement in other contexts. This article will provide evidence suggesting that, to the contrary, we can indeed scale up western-developed parenting interventions that can be both effective and warmly received by parents in diverse cultural and economic contexts. METHODS/RESULTS: This paper gives a brief overview of the ACT Raising Safe Kids Program and summarizes the results of evaluation studies done with parents around the world. It discusses specific strategies facilitators use to modify the program as necessary to fit cultural contexts while also maintaining fidelity, implementing the manualized curriculum under varied, and complex circumstances. CONCLUSIONS: It is hoped that the lessons learned from our work will inspire practitioners to adapt ACT or other programs to diverse contexts, evaluate those programs, and thereby improve the mental health and life trajectories of children and families around the world.

PREMATURITY, NEONATAL HEALTH STATUS, AND LATER CHILD BEHAVIORAL/EMOTIONAL PROBLEMS: A SYSTEMATIC REVIEW.

Preterm birth can impact on child development. As seen previously, children born preterm present more behavioral and/or emotional problems than do full-term counterparts. In addition to gestational age, neonatal clinical status should be examined to better understand the differential impact of premature birth on later developmental outcomes. The aim of the present study was to systematically review empirical studies on the relationship between prematurity, neonatal health status, and behavioral and/or emotional problems in children. A systematic search of the PubMed, PsycINFO, Web of Science, and LILACS databases for articles published from 2009 to 2014 was performed. The inclusion criteria were empirical studies that evaluated behavioral and/or emotional problems that are related to clinical neonatal variables in children born preterm. Twenty-seven studies were reviewed. Results showed that the degree of prematurity and birth weight were associated with emotional and/or behavioral problems in children at different ages. Prematurity that was associated with neonatal clinical conditions (e.g., sepsis, bronchopulmonary dysplasia, and hemorrhage) and such treatments as corticoids and steroids increased the risk for these problems. The volume and abnormalities of specific brain structures also were associated with these outcomes. In conclusion, the neonatal health problems associated with prematurity present a negative impact on later child emotional and adapted behavior.

Neonatal Invasive Procedures Predict Pain Intensity at School Age in Children Born Very Preterm.

INTRODUCTION: Children born very preterm display altered pain thresholds. Little is known about the neonatal clinical and psychosocial factors associated with their later pain perception. OBJECTIVE: We aimed to examine whether the number of neonatal invasive procedures, adjusted for other clinical and psychosocial factors, was associated with self-ratings of pain during a blood collection procedure at school age in children born very preterm. MATERIALS AND METHODS: 56 children born very preterm (24 to 32 weeks gestational age), followed longitudinally from birth, and free of major neurodevelopmental impairments underwent a blood collection by venipuncture at age 7.5 years. The children's pain was self-reported using the Coloured Analog Scale and the Facial Affective Scale. Parents completed the Child Behavior Checklist and the State-Trait Anxiety Inventory. Pain exposure (the number of invasive procedures) and clinical factors from birth to term-equivalent age were obtained prospectively. Multiple linear regression was used to predict children's pain self-ratings from neonatal pain exposure after adjusting for neonatal clinical and concurrent psychosocial factors. RESULTS: A greater number of neonatal invasive procedures and higher parent trait-anxiety were associated with higher pain intensity ratings during venipuncture at age 7.5 years. Fewer surgeries and lower concurrent child externalizing behaviors were associated with a higher pain intensity. CONCLUSIONS: In very preterm children, exposure to neonatal pain was related to altered pain self-ratings at school age, independent of other neonatal factors. Neonatal surgeries and concurrent psychosocial factors were also associated with pain ratings.

Cuidado ao desenvolvimento: intervenções de proteção ao desenvolvimento inicial de recém-nascidos pré-termo: [revisão] / Developmental care: protection approach for early development of preterm infants: [review]

OBJETIVO: Revisar ensaios clínicos randomizados, publicados entre 2002 e 2009, sobre a eficácia de intervenções em Cuidado ao Desenvolvimento em recém-nascidos pré-termo em Unidade de Terapia Intensiva Neonatal. FONTES DE DADOS: Foram selecionados estudos randomizados dos bancos de dados Medline, PsycINFO, ISI Web of Science, LILACS e SciELO, usando-se as palavras-chave "developmental care" e "neonate". Realizou-se uma análise metodológica dos estudos, com base nos critérios: randomização, estimativa do tamanho amostral, perda amostral, critérios de inclusão e exclusão, controle de variáveis de confusão, validade dos instrumentos, condição "cega" do pesquisador, realização de seguimento, validades externa e ecológica e cuidados éticos. SÍNTESE DOS DADOS: As intervenções em Cuidado ao Desenvolvimento promoveram melhora em curto prazo nos resultados fisiológicos, comportamentais, neurológicos e clínicos dos recém-nascidos. Observou-se diminuição da reatividade à dor nos recém-nascidos durante procedimentos de pesagem e troca de fraldas. Os pais que receberam intervenções em Cuidado ao Desenvolvimento passaram a apresentar maior senso de competência para cuidar do recém-nascido. Os profissionais treinados em Cuidado ao Desenvolvimento demonstraram melhor desempenho na assistência ao recém-nascido e valorizaram mais os estímulos ambientais, físicos e sociais. CONCLUSÕES: Intervenções em Cuidado ao Desenvolvimento na Unidade de Terapia Intensiva Neonatal promoveram benefícios ao desenvolvimento e saúde dos recém-nascidos pré-termo no período neonatal e no primeiro ano de vida. Em estudos futuros, recomenda-se maior rigor metodológico no que se refere à condição de pesquisador "cego" em relação às intervenções e controle das variáveis de confusão. Estudos prospectivo-longitudinais são necessários para avaliar a eficácia das intervenções em médio e longo prazo no desenvolvimento.

ABSTRACT OBJECTIVE: To review randomized clinical trials published from 2002 to 2009 focusing on the efficacy of Developmental Care interventions in preterm infants in a Neonatal Intensive Care Unit. DATA SOURCE: Randomized trials were selected from Medline, PsycINFO, ISI Web of Science, LILACS, and SciELO databases using the keywords "developmental care" and "neonate". A critical methodological analysis of the studies was performed based on the following criteria: random allocation, estimate of sample size, drop-out sample, inclusion and exclusion criteria, control of confounding variables, validity of instruments, researcher "blind" condition for intervention group, presence of follow-up, external and ecological validities, and ethical approval. DATA SYNTHESIS: The Developmental Care interventions improved short-term outcomes as physiological, behavioral, neurological and clinical status of newborns. Decreased infants' pain reactivity was noted during weighing and diaper change procedures. Parents exposed to Developmental Care interventions showed higher sense of competence to take care of the newborns. The staff trained in Developmental Care interventions showed better performance when looking after infants and paid more attention to the environmental, physical and social stimuli. CONCLUSIONS: The Developmental Care interventions in a Neonatal Intensive Care Unit promoted beneficial effects on development and health of preterm infants in the neonatal period and the first year of life. In future studies, a higher methodological control of blindness of intervention and confusion variables is recommended. Prospective-longitudinal studies should address the evaluation of this intervention on medium- and long-term developmental outcomes.

[The efficacy of sucrose for the relief of pain in neonates: a systematic review of the literature]. / A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura.

OBJECTIVE: To present a review of empirical studies published from 1993 to 2004 on the efficacy of sucrose solution for relieving pain in neonates. SOURCES OF DATA: Information was obtained from the MEDLINE/PsycINFO/ISI WEB of SCIENCE/LILACS and SciELO databases by searching for "sucrose", "pain", "newborn" and "neonate". SUMMARY OF DATA: Sucrose solution has demonstrated efficacy in pain relief during puncture procedures on samples of preterm and fullterm neonates. The recommendation is to administer oral sucrose, to the front of the tongue, 2 minutes before the painful procedure. Other non-pharmacological interventions, such as human breastmilk via nasogastric tube, non-nutritional suckling and being held at the breast, also demonstrated synergic analgesic effects when administered in association with sucrose. The majority of studies demonstrated a positive pain relief effect with a single 2 ml dose at 25%. Conclusions could not be drawn on the best repeat administration scheme; in the few studies that did provide an indication, the dose was 0.1 ml at 24%. The analgesic pain relief effect promoted by the sucrose was observed through altered behavioral responses, facial activity and crying. Heart rate underwent larger reductions as a result of sucrose administration during painful procedures than any of the other physiological responses. CONCLUSIONS: The efficacy of a single dose of sucrose for the relief of acute pain neonates is well documented in the literature. However, there are not yet definite conclusions on the scheme of use for repeated doses of sucrose.

A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura / The efficacy of sucrose for the relief of pain in neonates: a systematic review of the literature

OBJETIVO: Apresentar uma revisão de estudos empíricos, publicados entre 1993 e 2004, sobre a eficácia da solução de sacarose no alívio de dor em neonatos. FONTES DE DADOS: As informações foram coletadas nos bancos de dados, MEDLINE/PsycINFO/ISI WEB of SCIENCE/LILACS/SciELO, usando as palavras-chave sucrose, pain, newborn e neonate. SíNTESE DOS DADOS: Solução de sacarose mostrou eficácia no alívio da dor no procedimento de punção em amostras de neonatos pré-termo e a termo. A administração da sacarose oral, na parte anterior da língua, foi recomendada 2 minutos antes do procedimento doloroso. Outras intervenções não-farmacológicas, como leite humano via sonda nasogástrica, sucção não-nutritiva e colo, mostraram efeito analgésico sinérgico quando administradas em associação com a sacarose. Na maior parte dos estudos, a dose única de 2 ml de sacarose a 25 por cento demonstrou resultado positivo no alívio de dor. Não há conclusão sobre a melhor dose em um esquema de administração repetida; em poucos estudos, foi indicada a dose de 0,1 ml de sacarose a 24 por cento. O efeito analgésico de alívio de dor promovido pela sacarose foi observado pelas alterações nas respostas comportamentais de atividade facial e choro dos neonatos. A freqüência cardíaca apresentou maior decréscimo no procedimento doloroso sob a intervenção da sacarose do que outras respostas fisiológicas. CONCLUSÕES: A eficácia da dose única da sacarose no alívio da dor aguda em neonatos encontra-se bem documentada na literatura. Entretanto, não há ainda conclusão sobre o esquema de uso da sacarose em doses repetidas.

Aspectos afetivos e o desempenho acadêmico de escolares / Affective behavior and academic achievement

Objetivou-se caracterizar através do Desenho da Casa-Árvore-Pessoa (HTP) e do Teste das Pirâmides Coloridas de Pfister (TPC) o funcionamento afetivo de 50 crianças com idade entre 8 e 12 anos, de ambos os sexos, com nível intelectual médio. Elas foram distribuídas em dois grupos de 25 sujeitos, um deles com atraso escolar, e o outro grupo apresentando desempenho escolar satisfatório e idade compatível a serie cursada. Observou-se através destas técnicas que o rendimento escolar rebaixado nas crianças do grupo com atraso escolar pareceu relacionado a sentimentos de fracasso e a uma autoimagem depreciativa. No grupo de crianças sem atraso escolar predominou, uma melhor utilização dos recursos intelectuais e afetivos, contudo associado a elevado nível de exigência. O estudo das variáveis afetivas e sua associação ao rendimento escolar puderam favorecer uma compreensão mais aprofundada da maneira como as crianças estão experimentando esta etapa do desenvolvimento.

Aspectos afetivos e o desempenho acadêmico de escolares / Affective behavior and academic achievement

Objetivou-se caracterizar através do Desenho da Casa-Árvore-Pessoa (HTP) e do Teste das Pirâmides Coloridas de Pfister (TPC) o funcionamento afetivo de 50 crianças com idade entre 8 e 12 anos, de ambos os sexos, com nível intelectual médio. Elas foram distribuídas em dois grupos de 25 sujeitos, um deles com atraso escolar, e o outro grupo apresentando desempenho escolar satisfatório e idade compatível a serie cursada. Observou-se através destas técnicas que o rendimento escolar rebaixado nas crianças do grupo com atraso escolar pareceu relacionado a sentimentos de fracasso e a uma autoimagem depreciativa. No grupo de crianças sem atraso escolar predominou, uma melhor utilização dos recursos intelectuais e afetivos, contudo associado a elevado nível de exigência. O estudo das variáveis afetivas e sua associação ao rendimento escolar puderam favorecer uma compreensão mais aprofundada da maneira como as crianças estão experimentando esta etapa do desenvolvimento (AU)

Teste de audibilizacao em criancas com historia de dificuldade na aquisicao da leitura e da escrita

Investigou-se a adequacao de Teste de Audibilizacao para a avaliacao de habilidades de linguagem receptiva em criancas com problemas de aprendizagem escolar. O teste foi administrado a 60 criancas encaminhadas a um servico de psicopedagogia, cuja idade media estava aproximadamente dois anos acima da idade da amostra de padronizacao do teste. A analise dos dados inclui comparacoes com as normas do teste para criancas de sete anos, correlacao com resultados obtidos no WISC e comparacao entre grupos de criancas com diferentes niveis de leitura oral. Os resultados sugerem que o instrumento tem valor diagnostico em casos individuais de criancas mais velhas com resultados abaixo das normas do teste, fornecendo informacoes uteis tanto a respeito de prejuizo global na linguagem receptiva como a respeito de dificuldades varbais especificos.