Impacts of a tiered intervention on child internalizing and externalizing behavior in the context of maternal depression.

Greater maternal depressive symptoms are consistently associated with higher levels of behavioral difficulties in children, emerging in early childhood and with long-lasting consequences for children's development. Interventions promoting early relational health have been shown to have benefits for children's behavior; however, these impacts are not always realized in the context of maternal depression. This study examined whether tiered programs could address this limitation by focusing on both parenting, through universal primary prevention, and psychosocial stressors and parent mental health, through tailored secondary prevention. Analysis of a randomized controlled trial (RCT) of the Smart Beginnings (SB) intervention was conducted to determine whether SB attenuated the association between maternal depression and early childhood internalizing and externalizing behaviors. Maternal depression significantly predicted both internalizing and externalizing behaviors in linear regression models. Further, there was a significant interaction between maternal depression and treatment group, such that among mothers with higher depressive symptoms, the SB treatment attenuated the magnitude of the association between depression and child behavior. Findings suggest that while parenting support is important for all families, it may be particularly critical for those with higher levels of depression and underscores the need to consider multidimensional family processes in both research and clinical practice.

Promoting Cognitive Stimulation in Parents Across Infancy and Toddlerhood: A Randomized Clinical Trial.

OBJECTIVE: To test the impact of the fully integrated Smart Beginnings model on parental support of cognitive stimulation from 6 to 24 months across infancy and toddlerhood. STUDY DESIGN: This was a single-blind, 2-site randomized clinical trial of the Smart Beginnings intervention. Enrollment took place at birth in postpartum units of hospitals in New York City and Pittsburgh, Pennsylvania, with a consecutive sample of 403 mother-infant dyads. Smart Beginnings combines a Video Interaction Project-14-session universal primary prevention program delivered in the pediatric clinic at the time of well-child visits birth-36 months-with potential for Family Check-Up-3-4 sessions targeted secondary prevention home-visiting program. The principal outcome was parental support of cognitive stimulation assessed via parent survey and video-recorded observations of parent-child interactions. Ordinary least squares and mixed effects regressions were conducted. RESULTS: Families were mostly Black/African-American (50%) or Latinx (42%); all were Medicaid eligible (100%). Smart Beginnings significantly promoted cognitive stimulation during infancy and toddlerhood for most survey outcomes across time, including StimQ common total (effect size [ES] = 0.25, P = .01) and READ Quantity (ES = .19, P = .04) and Quality (ES = .30, P = .001). For the observations, the impact of Smart Beginnings varied by time, with significant impacts at 6 (ES = 0.37-.40, P < .001) and 24 (ES = 0.27-.30, P < .001) months, but not 18 months. CONCLUSIONS: Smart Beginnings positively promotes cognitive stimulation from infancy through toddlerhood using the integrated model. This study adds to the body of research showing preventive interventions in pediatric primary care and home visiting can support early relational health including parental support of cognitive stimulation. TRIAL REGISTRATION: NCT02459327.

Improving Parent-Child Interactions in Pediatric Health Care: A Two-Site Randomized Controlled Trial.

BACKGROUND AND OBJECTIVES: Heterogeneity in risk among low-income families suggests the need for tiered interventions to prevent disparities in school readiness. Smart Beginnings (SB) integrates two interventions: Video Interaction Project (VIP) (birth to 3 years), delivered universally to low-income families in pediatric primary care, and Family Check-Up (6 months to 3 years), targeted home visiting for families with additional family risks. Our objective was to assess initial SB impacts on parent-child activities and interactions at 6 months, reflecting early VIP exposure. METHODS: Two-site randomized controlled trial in New York City (84% Latinx) and Pittsburgh (81% Black), with postpartum enrollment and random assignment to treatment (SB) or control. At 6 months, we assessed parent-child interactions through surveys (StimQ, Parenting Your Baby) and observation (video-recorded play, coded by using Parent-Child Interaction Rating Scales - Infant Adaptation). RESULTS: A total of 403 families were enrolled at child's birth (201 treatment) with 362 (89.8%) assessed at 6 months. Treatment families had increased StimQ, including total score (Cohen's d = 0.28; P < .001) and domains reflecting reading (d = 0.23; P = .02) and teaching (d = 0.25; P = .01), and Parent-Child Interaction Rating Scales - Infant Adaptation, including a cognitive stimulation factor (d = 0.40; P < .001) and domains reflecting support for cognitive development (d = 0.36; P < .001), and language quantity (0.40; P < .001) and quality (d = 0.37; P < .001). Thus, significant effects emerged across a broad sample by using varied methodologies. CONCLUSIONS: Findings replicate and extend previous VIP findings across samples and assessment methodologies. Examining subsequent assessments will determine impacts and feasibility of the full SB model, including potential additive impacts of Family Check-Up for families at elevated risk.

Early Caregiver-Child Interaction and Children's Development: Lessons from the St. Petersburg-USA Orphanage Intervention Research Project.

We review a series of interrelated studies on the development of children residing in institutions (i.e., orphanages) in the Russian Federation or placed with families in the USA and the Russian Federation. These studies rely on a single population, and many potential parameters that typically vary in the literature are similar across studies. The conceptual focus is on the role of early caregiver-child interactions and environmental factors that influence those interactions in children's development. Generally, children residing in institutions that provided minimal caregiver-child interactions displayed delayed physical, cognitive, and social-emotional development. Children and adolescents adopted from such institutions at 18 months of age or older had higher rates of behavioral and executive function problems, even many years after adoption. An intervention that improved the institutional environment by increasing the quality of caregiver-child interactions-without changes in nutrition, medical care, sanitation, and safety-led to substantial increases in the physical, cognitive, and social-emotional development of resident children with and without disabilities. Follow-up studies of children in this intervention who were subsequently placed with USA and Russian families revealed some longer-term benefits of the intervention. Implications are discussed for theoretical understanding of the role of early caregiver-child interactions in development as well as for practice and policy.

Potential Selective Responding in a Parent Questionnaire Study of Post-Institutionalized Children.

Selective responding bias, though under-researched, is of particular concern in the study of post-institutionalized children because many studies rely on mailed questionnaires and response rates are often low. The current study addresses the impact of selective responding in a single wave of data collection and in a multi-wave study. Participants were 121 parents from a larger four-wave study of post-institutionalized children, identified as Never Responders, Previous Responders (but not to the current wave), or Wave 4 Responders. Parents were telephoned and asked about their adopted child's family, school, peer, and behavioral adjustment. The children (47% male) ranged in age from 2 to 20 years (M = 10.79, SD = 4.59) and had been adopted between 5 and 54 months of age (M = 15.49, SD = 9.94). There were no differences in parent ratings of adjustment for a single wave of data collection; however, participants who never responded reported poorer family and peer adjustment than those who had responded to at least one wave of data collection. Within a single wave of data collection, there was no evidence that selective responding contributes much bias. Over a multi-wave study, however, results may under-represent adjustment difficulties, especially with family and friends.

[Sodium valproate as a cause of acute pancreatitis: a case report]. / Valproato de sodio como causa de pancreatitis aguda: Reporte de un caso.

Valproic acid (VPA) is a commonly used medication approved by the U.S. FDA for the treatment of epilepsy, migraines and bipolar disorders. Adverse effects associated with VPA are typically benign, but there are more serious effects that are less frequent. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect and acute pancreatitis. Even though acute pancreatitis is an adverse effect of very low frequency, it is very important due to the high mortality rate of patients with acute pancreatitis as a consequence of the use of valproic acid. In medical literature, by 2005, 80 cases of acute pancreatitis caused by valproic acid were reported, 33 of these cases were patients under the age of 18. This is a description of the clinical case of a 16 year old patient with necrotic pancreatitis caused by VPA, who was treated at the Acute Pancreatitis Unit of Edgardo Rebagliati Martins National Hospital.

Valproato de sodio como causa de pancreatitis aguda: reporte de un caso / Sodium valproate AS a cause of acute pncreatitis: a case report

El ácido Valproico (VPA) es un medicamento de uso común aprobado para su uso por la F.D.A. en los Estados Unidos para tratar la epilepsia, migraña y desórdenes bipolares. Los efectos menos frecuentes que son más serios. Estos efectos incluyen a la hepatotoxidad, teratogenicidad, posible ovarios poliquísticos con potencial efecto estéril y la pancreatitis aguda. Si bien la pancreatitis aguda es un efecto adverso muy poco frecuente tiene mucha importancia por la altísima tasa de mortalidad que presentan los pacientes que sufren de pancreatitis como consecuencia del uso del ácido valproico. En la literatura hasta el año 2005, existen reportados 80 casos de pancreatitis aguda por ácido valproico de los cuales, 33 fueron en pacientes menores de 18 años. Aquí se describe el caso clínico de un paciente de 16 años que presento pancreatitis con necrosis por VPA y fue manejado en la Unidad de Pancreatitis Aguda del Hospital Nacional Edgardo Rebagliati Martins.

Valproic acid (VPA) is a commonly used medication approved by the U.S. FDA for the treatment of epilepsy, migraines and bipolar disorders. Adverse effects associated with VPA are typically benign, but there are more serious effects that are less frequent. These effects include hepatotoxicity, teratogenicity, possible polycystic ovaries with a potential sterile effect and acute pancreatitis. Even though acute pancreatitis is an adverse effect of very low frequency, it is very important due to the high mortality rate of patients with acute pancreatitis as a consequence of the use of valproic acid.In medical literature, by 2005, 80 cases of acute pancreatitis caused by valproic acid were reported, 33 of these cases were patients under the age of 18.This is a description of the clinical case of a 16 year old patient with necrotic pancreatitis caused by VPA, who was treated at the Acute Pancreatitis Unit of Edgardo Rebagliati Martins National Hospital).