Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Behavioral correlates of maternal depressive symptomatology in conduct-disorder children: II. Systemic effects involving fathers and siblings

This study tested a systemic hypothesis of the relation between maternal depressive symptomatology and the behavior of conduct-disordered children (n = 47) toward their mothers, fathers, and siblings. Maternal symptomatology interacted with the children's behavior toward all family members. Children whose mothers were distressed tended to be more compliant and less aversive toward them than toward their fathers, and the opposite applied to children whose mothers were not distressed. Comparable results were obtained in comparisons of child interactions with mothers and siblings, although in the latter case the children's behaviors differed in absolute magnitude as a function of their interaction partner.     

Mothers' representations of relationships with their children: relations with mother characteristics and feeding sensitivity

OBJECTIVE: To examine parenting representations and feeding interactions of mothers and their children with cerebral palsy (CP) and the extent to which mothers' representations predict their feeding behavior beyond other mother and child characteristics. METHODS: Fifty-eight mothers of children with mild to severe CP ages 16 to 52 months were interviewed with an adapted form of the Parent Development Interview (PDI). Correlation and regression analyses examined relations between representations (compliance with parental requests, achievement, secure base, enmeshment, worry about the child's future, and emotional pain), demographic characteristics, diagnostic severity, and developmental status. RESULTS: Mothers with more compliance-related concerns showed less sensitivity, acceptance, and delight during feeding. Mothers experiencing more emotional pain displayed more hostility. Mothers reporting worries about the child displayed sensitivity and delight. Representations of compliance-related experiences and worry about the child's future accounted for significant increments in explained variance in mothers' feeding behavior, after we controlled for children's skills and abilities. CONCLUSIONS: Findings suggest maternal representations of relationships are associated with caregiving behavior for mothers of children with CP apart from other child and maternal characteristics and may be a useful focus for research and practice related to parenting children with special needs.     

Effective treatment for postpartum depression is not sufficient to improve the developing mother-child relationship

Maternal depression is prevalent, and puts children at risk. Little evidence addresses whether treatment for maternal depression is sufficient to improve child outcomes. An experiment was conducted testing whether psychotherapeutic treatment for mothers, suffering from major depression in the postpartum period, would result in improved parenting and child outcomes. Participants included depressed women randomly assigned to interpersonal psychotherapy (n = 60) or to a waitlist (n = 60), and a nondepressed comparison group (n = 56). At 6 months, depressed mothers were less responsive to their infants, experienced more parenting stress, and viewed their infants more negatively than did nondepressed mothers. Treatment affected only parenting stress, which improved significantly but was still higher than that for nondepressed mothers. Eighteen months later, treated depressed mothers still rated their children lower in attachment security, higher in behavior problems, and more negative in temperament than nondepressed mothers. Initial response to treatment did not predict reduced risk for poor child outcomes. Early maternal negative perceptions of the child predicted negative temperament and behavior problems 18 months after treatment. Treatment for depression in the postpartum period should target the mother-infant relationship in addition to the mothers' depressive symptoms.     

Parent Stress and Coping in Relation to Child ADHD Severity and Associated Child Disruptive Behavior Problems

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

A Structural Modeling Approach to the Understanding of Parenting Stress

Tested and cross-validated a multidimensional model of predictors of parenting stress on data from a population-based sample of Swedish mothers (N = 1,081) with children ages 6 months to 3 years. The study was a cross-sectional questionnaire study, focusing on the explanation of variance in parenting stress. Structural equation modeling procedures permitted disentanglement of total, direct, and indirect effects. A Swedish instrument based on parts of the Parent Domain in the Parenting Stress Index was used as a measure of stress. The results provided general support for the proposed model. High workload, low social support, perception of the child as fussy-difficult, negative life events, child caretaking hassles, more children in the family, and high maternal age related directly to more stress. Child irregularity contributed indirectly to mother´s experienced stress. No buffering effects of social support were found. Forty-eight percent of the variance in the parenting stress measure was explained by the model. Implications for interventions were discussed.     

The role of child gender,problem behaviors,and the family environment on maternal depressive symptoms: findings from mothers of substance abusing runaway adolescents

This study examined the relation between maternal depressive symptoms and adolescents' problem behaviors, moderated by adolescent gender, as well as the association between maternal depressive symptoms and the family environment characteristics above and beyond child variables. Data were collected from 137 mothers of runaway adolescents with alcohol and/or substance abuse problems. Results showed that both internalizing and externalizing problem behaviors of adolescent girls, as opposed to problem behaviors of boys, were significantly associated with maternal depressive symptoms. In addition, higher family cohesion was significantly related to lower maternal depressive symptoms even after controlling for adolescent problem behaviors. However, no significant relationship was found between family conflict and maternal depressive symptoms. These findings indicate that both adolescents' problem behaviors and mothers' perceptions of the family environment are associated with maternal depressive symptoms, highlighting the potential utility of the family systems theoretical framework for understanding and intervening mothers' emotional problems in the family context. © 2011 Wiley Periodicals, Inc.     

Cortisol circadian rhythms and stress responses in infants at risk of allergic disease

BACKGROUND: The cortisol circadian rhythm and response to stressful stimuli are altered in children and adults with allergic disease, including asthma. It is not known whether these alterations precede or follow the onset of allergic disease. OBJECTIVE: We sought to evaluate the cortisol circadian rhythm and stress response among infants at risk for the development of allergic disease. METHODS: Infants with and without risk factors for allergic disease were evaluated at age 6 months. Saliva was obtained at 8 am, 2 pm, and 8 pm at home (n = 68) by parents when their infants were comfortable and in the clinic (n = 88) before and after their physical examination and vaccinations. Information regarding parental allergy and exposure to other children at home or in child care were obtained by questionnaire. RESULTS: In multivariate analysis the circadian rhythm of cortisol was flattened because of the lack of the expected morning surge of cortisol, resulting in decreased diurnal variation of cortisol in infants of mothers with allergy (P = .035) or asthma (P = .002) or an asthmatic father (P = .022). The cortisol stress response was greater in infants of mothers with allergy (P = .045) or asthma (P = .039), those with fewer siblings (P = .066), and those not entering day care early in life (P = .017). CONCLUSIONS: These alterations in both basal and stress levels of endogenous cortisol among infants predisposed to allergic disease might affect the development of allergic immune responses early in life through interactions with inflammatory mediators.     

Child-rearing practices and psychological disorders in children: cross-cultural comparison of Korea and Australia

The present study was designed to explore cultural differences in the relationship between parenting behaviors and psychological adjustment of the child. Mother-son interaction behaviors of 37 Korean boys (11 with Anxiety Disorder, 10 with Externalizing Disorders and 16 Non-clinical boys) and 54 Australian boys (20 with Anxiety Disorder, 17 with Externalizing Disorders and 17 Non-clinical boys) between the ages of 7 and 15 were compared in terms of parental negativity and involvement. The results indicated that Korean mothers displayed more overall negativity and lower overall involvement than Australian mothers. Furthermore, anxiety diagnosis was associated with low maternal involvement in the Korean subjects, while in the Australian subjects, high maternal involvement was associated with clinical status in the child.     

Mother Perceptions and Mother-Child Interactions: Comparison of a Clinic-referred and a Nonclinic Group

The purpose of this study was to compare 40 clinic-referred conduct-disordered children and their mothers with 28 "normal" or nonclinic children and their mothers on mother behaviors, child behaviors, and mother reports of child behaviors. The study used two independent observational systems: One assessed the quantity of negative behaviors both 'in mothers and children, and the second assessed the qualitative and affective aspects of parent-child interactions. The results indicated that the two groups differed on child positive affect and dominance behaviors; on mother positive affect, submissiveness, praise, commands, and criticisms; and on maternal reports of child adjustment. Although maternal report of child:adjustment was the best discriminator between the two groups, the two observational systems provided additional information on the qualitative differences between clinic and nonclinic mother-child interactions. The implications of these findings for the assessment and treatment of conduct-disordered children and their families are discussed.     

Relation of Adolescent Mothers' History of Antisocial Behavior to Child Conduct Problems and Social Competence

We examined the extent to which maternal antisocial behavior (ASB) is directly related to child conduct problems and social competence and assessed the potential mediating role of negative parenting. The sample included 93 adolescent mothers and their children (44 boys, 49 girls). Mothers retrospectively reported about their ASB since the child's birth, through Grade 2. Negative parenting was coded during a parent–child interaction task (PCIT) at Grade 2. Teachers assessed child outcomes at Grade 3. Maternal ASB during the child's life was directly related to parenting and both child outcomes. In the overall sample, negative parenting partially mediated the relation between maternal ASB and child conduct problems. However, the pattern of relations differed by sex. For boys, maternal ASB was directly related to conduct problems, independent of parenting. For girls, maternal ASB was strongly related to parenting but not conduct problems. Negative parenting did not mediate the relation between maternal ASB and child social competence. Implications for intervention and future research are discussed.     

Revisiting the Accuracy Hypothesis in Families of Young Children With Conduct Problems

Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.     

Infant gender and postpartum sadness in the light of region of birth and some other factors: a contribution to the knowledge of postpartum depression

The purpose of this paper is to analyse postpartum depressive symptoms as related to baby gender, maternal region of birth, stress, perception of child difficult temperament and some demographic factors. The setting was 36 Swedish child health centres. Mothers of 1,848 19-month-old children completed a questionnaire, including an item about recall of postpartum sadness. A subsample of 360 answered the Edinburgh Postnatal Depression Scale (EPDS). Overall, significantly more mothers of boys than of girls recalled postpartum sadness. The same was found in mothers born in Sweden and in other regions, except for the Middle East (no significant result). Among those born in Sweden and in other regions, more mothers of boys than of girls scored ≥12 on the EPDS, except for Middle East mothers with the opposite pattern (no significant finding). More mothers of “difficult” boys than of “difficult” girls recalled postpartum sadness. Our findings are tentative but may inspire future research. Immigrant mothers in Sweden seem rather like the majority population, possibly with the exception of Middle East mothers. The significance of parents’ knowledge of their child’s gender in advance is an important area for research. Future parents could benefit from discussing gender expectations with a nurse or other professional.     

Matched follow-up study of 5 8-year-old ICSI singletons: child behaviour, parenting stress and child (health-related) quality of life

BACKGROUND: Psychosocial follow-up of ICSI children is scarce. We compared child behaviour, parenting stress and quality of life for singletons aged 5-8 years born after ICSI, IVF and natural conception (NC). METHODS: All singletons born between June 1996 and December 1999 after ICSI in the Leiden University Medical Center were invited (n = 110). Matched singletons born after IVF and NC were recruited. Parents completed the Child Behaviour Checklist (measures problem behaviour), the Parenting Stress Index (Nijmeegse Ouderlijke Stress Index) and two quality of life questionnaires (Dux25 and TACQOL). Children completed the Dux25 Child form. RESULTS: Eighty-seven ICSI children (79%), 92 IVF children (73%) and 85 NC children enrolled. Prevalence of behavioural disorders-as reported by the parents-was comparable in the three groups. Three of 87 ICSI children had autism or an autistic spectrum disorder (ASD). Problem behaviour scores were similar for ICSI and NC children; IVF children (mainly girls) scored less problem behaviour (P < 0.05) and their scores were less often in the (borderline) clinical range. Parenting stress was similar for ICSI and IVF, but lower for NC than ICSI parents, mainly on the child scale. Quality of life scores were similar in the three conception groups. CONCLUSIONS: Prevalence of autism/ASD seemed higher after ICSI, but this unexpected finding should be confirmed by future studies with larger group sizes. ICSI parents experienced more stress than NC parents, although selection bias cannot be ruled out. The majority of ICSI singletons assessed at age 5-8 years showed a normal psychosocial well-being.     

Prenatal maternal emotional complaints are associated with cortisol responses in toddler and preschool aged girls

Associations between prenatal maternal emotional complaints and child behavioral and cognitive problems have been reported, with different relations for boys and girls. Fetal programming hypotheses underline these associations and state that the early development of the HPA‐axis of the children may have been affected. In the present study, differences in cortisol responses of prenatally exposed and nonexposed children are examined for both sexes separately. Cortisol response patterns of a group preschool aged children that were prenatally exposed to high levels of maternal emotional complaints (N = 51) were compared to a nonexposed group (N = 52). Child saliva was collected at the start of a home visit (T1), 22 min after a mother–child interaction episode (T2), and 22 min after a potentially frustrating task (T3). Repeated measures analyses showed that prenatally exposed girls showed higher cortisol levels across the three episodes compared to nonexposed girls. No differences were found in boys. Maternal prenatal emotional complaints might be related to child HPA‐axis functioning differently for boys and girls. © 2009 Wiley Periodicals, Inc. Dev Psychobiol 51: 553–563, 2009.     

Relation of adolescent mothers' history of antisocial behavior to child conduct problems and social competence.

We examined the extent to which maternal antisocial behavior (ASB) is directly related to child conduct problems and social competence and assessed the potential mediating role of negative parenting. The sample included 93 adolescent mothers and their children (44 boys, 49 girls). Mothers retrospectively reported about their ASB since the child's birth, through Grade 2. Negative parenting was coded during a parent-child interaction task (PCIT) at Grade 2. Teachers assessed child outcomes at Grade 3. Maternal ASB during the child's life was directly related to parenting and both child outcomes. In the overall sample, negative parenting partially mediated the relation between maternal ASB and child conduct problems. However, the pattern of relations differed by sex. For boys, maternal ASB was directly related to conduct problems, independent of parenting. For girls, maternal ASB was strongly related to parenting but not conduct problems. Negative parenting did not mediate the relation between maternal ASB and child social competence. Implications for intervention and future research are discussed.     

Parenting stress and parental bonding

Attachment experiences are thought to be important because of their implications for later development. The authors' aim with the questionnaire-based study was to investigate the differences between recalled parental bonding regarding 4 types of maternal and paternal bonding with respect to experienced parenting stress caused by child characteristics, parent attributes, and life events under the consideration of the child's gender and age. The authors gathered parental bonding behavior data with the German version of the Parental Bonding Instrument (PBI). The authors assessed parenting stress with their German version of the "Parenting Stress Index (PSI)." They found significant differences among 120 mothers grouped in the 4 maternal and the 4 paternal bonding types regarding parenting stress caused by child, maternal bonding: F(5, 113) = 4.13, p = .002, paternal bonding: F(5, 111) = 8.50, p < or = .0001, and parent characteristics, maternal bonding: F(5, 113) = 3.33, p = .008, paternal bonding: F(5, 111) = 7.80, p < or = .0001. The lowest level of parenting stress was experienced by mothers who themselves recalled the "optimal parental bonding type" with respect to the child and parental domain. The authors did not find any significant differences between the 4 maternal, F(5, 113) = 1.25, p = .29, and the 4 paternal, F(5, 111) = 1.87, p = .106, bonding types with respect to the life stress. According to the authors' findings, the representation of attachment relationships seems to have a special impact on the adult's capacity to cope with challenges and stress, either directly or indirectly as an internal working model of attachment. For the clinical practice, these findings seem to recommend the combination of both the PSI and PBI regarding the diagnostic of stressful mother-child system to plan an optimal intervention program.     

幼儿母亲育儿压力的特点及其与婚姻质量的关系

目的：考察幼儿母亲育儿压力的特点及其与婚姻质量间的关系，为改善婚姻质量，提高养育成效提供依据。方法：采用育儿压力问卷和婚姻质量问卷，对在北京市4所普通幼儿园中随机抽取的535名幼儿的母亲进行调查并做出统计分析。结果：2岁儿童的母亲由于儿童适应问题所引起的压力感明显高于5岁儿童的母亲：不同教育水平的母亲育儿压力存在显著差异：婚姻质量对母亲育儿压力的不同侧面影响不同，对母亲侧面影响更明显。结论：孩子年龄不同、受教育水平不同的母亲育儿压力存在显著差异：不同婚姻质量组母亲育儿压力存在显著差异。     

Predictors of stress in mothers of children with cerebral palsy in Bangladesh

OBJECTIVE: To identify the stress experienced by mothers of young children with cerebral palsy in Bangladesh and to determine predictive factors. METHODS: We recruited 91 mothers of children with cerebral palsy ages 1.5 to 5 years as they sought services at an urban and a rural center for their children. Mothers were interviewed with the Self-Report Questionnaire and other family background and child behavior measures. The children were examined by a pediatrician and by a psychologist. RESULTS: Out of 91, 38 (41. 8%) mothers were at risk for psychiatric morbidity. Significantly associated factors included living in the rural area within a poor family, with a relatively older child. The strongest predictor of maternal stress in multivariate analysis was child behavior problems, especially those related to burden of caring. CONCLUSIONS: Ensuring practical help for mothers and advice on managing common behavior problems are important components of intervention, as they may directly help to relieve stress on mothers of young disabled children in developing countries.     

Family-based intervention to enhance infant-parent relationships in the neonatal intensive care unit

OBJECTIVE: To examine how family-based interventions in the neonatal intensive care unit (NICU) may change parental knowledge and behaviors and decrease stress. METHODS: Eighty-four high-risk mother-infant dyads were randomly assigned to two intervention and one control groups. Group 1 (n = 28) participated in a demonstration of infant reflexes, attention, motor skills, and sleep-wake states. Group 2 (n = 31) viewed educational materials. Group 3 (n = 25), controls, participated in an informal discussion. Parent-infant interactions (Nursing Child Assessment Feeding Scale) were videotaped. Mothers completed measures of stress (Parenting Stress Index) and knowledge of infant cues (Knowledge of Preterm Infant Behavior Scale). RESULTS: Mothers in both intervention groups evidenced greater knowledge and more contingent and sensitive interactions with their infants than did the control group. Stress also differed across groups, and all mothers reported scores above norms. CONCLUSIONS: In a high-risk sample, short-term, family-based NICU interventions may enhance mothers' knowledge, sensitivity, contingency, and stress.