Maternal mental health modifies the association of food insecurity and early child development

We examined the association between household food insecurity and early child development and whether or not maternal depression and anxiety modifies this association. The cross‐sectional study included 468 mother–infant pairs recruited at primary health centers of the Federal District, Brazil. Mothers answered a questionnaire that evaluated early child development (outcome), household food insecurity (independent variable), maternal depression and trait anxiety (effect modifiers). Variables were collected with validated questionnaires for the Brazilian population. Pearson's χ² test and logistic regression analyses were conducted. Infants who lived in a moderate or severe food insecure household had 2.52 times (95% confidence interval [CI] [1.13, 5.65]) the odds of having early child development delays compared with infants in secure households. Maternal depression and anxiety modified the strength of association between household food insecurity and early child development, which is an innovative finding. Among infants with depressed mothers, those experiencing mild (adjusted odds ratio [aOR] 3.33, 95% CI [1.17, 9.46]) and moderate/severe household food insecurity (aOR 10.13, 95% CI [2.18, 47.10]) had higher odds of having early child development delays, compared with infants in food secure households. Among infants with both anxious and depressed mothers, these associations were even stronger for mild (aOR 4.69, 95% CI [1.41, 15.59]) and moderate/severe household food insecurity (aOR 16.07, 95% CI [2.70, 95.66]). In conclusion, household food insecurity is a risk factor for early child development delays, and this association is modified by maternal depression and anxiety. Future studies should evaluate the impact of intervention packages that address maternal depression and anxiety and household food insecurity on preventing early child development delays.     

Expressed emotion,attributions and depression in mothers of children with problem behaviour

BACKGROUND: This was an initial study seeking to examine the relationship between Expressed Emotion (EE), spontaneous causal attributions and depression in mothers of children referred for problem behaviour. METHOD: Sixty-one mothers were interviewed using the Camberwell Family Interview (CFI). The CFI was coded for maternal EE and spontaneous causal attributions regarding the child's behaviour. Self-report measures of child problem behaviour and maternal depressive symptoms were also completed. RESULTS: Consistent with previous research, high EE mothers, compared to low EE mothers, were more likely to make attributions thatjudged the cause of problem behaviour to be personal to and controllable by the child and also made more 'child-blaming' attributions than low EE mothers. Mothers' scores on the Beck Depression Inventory were found to be associated with 'child-blaming' attributions and higher levels of EE. Regression analyses did not support the hypothesised role of attributions as a mediator between depression and EE but did identify EE as a potential mediator in the relationship between maternal depressed mood and ratings of child problem behaviour. CONCLUSIONS: These results indicate the relevance of both EE and attributions in mothers of children with problem behaviour and suggest that maternal depressed mood is an important factor which is related to both of these.     

Quality of interaction between at‐risk infants and caregiver at 12–15 months is associated with 3‐year autism outcome

Background: Recent models of the early emergence of autism spectrum disorder (ASD) propose that infant intrinsic risk susceptibilities in behaviour may be amplified by interaction within the early social environment into an increasingly atypical developmental trajectory. This study examines whether 6‐ and 12‐month parent–infant interactions in at‐risk siblings differ from those with low‐risk and whether – in at‐risk siblings – such interactions predict later 3‐year classification of ASD or no ASD. Method: Within the British Autism Study of Infant Siblings (BASIS), 6‐min videotaped episodes of parent–infant free play in infants at 6–10 months (45 at‐risk siblings and 47 low‐risk siblings) and 12–15 months (43 at‐risk siblings and 48 low‐risk siblings) in a laboratory setting were rated on the Manchester Assessment of Caregiver‐Infant Interaction (MACI), blind to participant information. Standard tests were administered for concurrent behavioural signs of ASD features and developmental level. Systematic consensus diagnostic classification of ASD was made at 3 years for the at‐risk siblings. Results: Parent nondirectiveness and sensitive responsiveness differed in relation to ASD/risk status (at‐risk ASD, at‐risk no‐ASD and low‐risk) at both 6 and 12 months. At 6 months, infant liveliness was lower in the at‐risk groups; at 12 months, infant attentiveness to parent and positive affect were lower in the at‐risk group later diagnosed with ASD. Dyadic mutuality and intensity of engagement showed a group effect at 12 months. Dyadic mutuality, infant positive affect and infant attentiveness to parent at 12 months (but not 6 months) predicted 3‐year ASD outcome, whereas infant ASD‐related behavioural atypicality did not. Conclusions: This is the first prospective evidence that early dyadic interaction between at‐risk infants and their parents is associated with later diagnostic outcome in ASD. Possible explanations for these findings and their theoretical implications are considered.     

Psychiatric problems associated with subthreshold ADHD and disruptive behaviour diagnoses in teenagers

Aim: To study the coexistence of subthreshold diagnoses of both attention deficit hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD) with other symptoms of child and adolescent psychiatric disorders as well as risk behaviours associated with smoking, alcohol and drug use. Methods: A population‐based sample of twins including 177 girls and 135 boys was interviewed using the Swedish version of Kiddie‐SADS Present and Lifetime Version (K‐SADS‐PL). Subthreshold diagnoses were compiled based on the ADHD and DBD criteria, where each criterion was assessed as ‘possible’ or ‘certain’ according to K‐SADS‐PL. The odds ratios (OR) between the subthreshold diagnoses and each of the screening questions in K‐SADS‐PL were calculated. Results: Subthreshold diagnoses of ADHD and DBD coexisted with the screening questions concerning depression, mania, panic attack, phobias, anorexia nervosa, motor tics and posttraumatic stress disorder (PTSD) in girls. In boys, these subthreshold diagnoses coexisted with symptoms of depression and PTSD. For both boys and girls, smoking and high alcohol consumption contributed to a high OR with regard to ADHD and DBD. Conclusion: Subthreshold diagnoses of ADHD and DBD were risk factors for several other psychiatric symptoms as well as smoking and high alcohol consumption. Thus, a broad clinical assessment is needed for adolescents with such preliminary diagnoses.     

Long‐term effects of a home‐visiting intervention for depressed mothers and their infants

Background: Whereas preventive interventions for depressed mothers and their infants have yielded positive short‐term outcomes, few studies have examined their long‐term effectiveness. The present follow‐up of a randomised controlled trial (RCT) is one of the first to examine the longer‐term effects of an intervention for mothers with postpartum depression and their infants at school‐age. In early infancy, the intervention was found effective in improving mother–infant interaction and the child’s attachment to its mother. Methods: Twenty‐nine mother–child pairs who completed the intervention are compared with 29 untreated mother–child dyads as to the quality of maternal interactive behaviour and the child outcomes of attachment security to the mother, self‐esteem, ego‐resiliency, verbal intelligence, prosocial behaviour, school adjustment, and behaviour problems at age 5 (M = 68 months). Results: In the total sample no lasting treatment benefits were found, but in families reporting a higher number of stressful life events, children in the intervention group had fewer externalising behaviour problems as rated by their mothers than children in the control group. Conclusions: In the context of multiple stressful life events the intervention served as a buffer by preventing the development of externalising problems in the child. The results warrant cautious interpretation because of the relatively small sample size and differential attrition revealing the mothers that completed the follow‐up assessment to have improved less on maternal sensitivity following the intervention than the mothers who did not participate in the follow‐up.     

The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach

Background: Postnatal depression (PND) is associated with poor cognitive functioning in infancy and the early school years; long‐term effects on academic outcome are not known. Method: Children of postnatally depressed (N = 50) and non‐depressed mothers (N = 39), studied from infancy, were followed up at 16 years. We examined the effects on General Certificate of Secondary Education (GCSE) exam performance of maternal depression (postnatal and subsequent) and IQ, child sex and earlier cognitive development, and mother–child interactions, using structural equation modelling (SEM). Results: Boys, but not girls, of PND mothers had poorer GCSE results than control children. This was principally accounted for by effects on early child cognitive functioning, which showed strong continuity from infancy. PND had continuing negative effects on maternal interactions through childhood, and these also contributed to poorer GCSE performance. Neither chronic, nor recent, exposure to maternal depression had significant effects. Conclusions: The adverse effects of PND on male infants’ cognitive functioning may persist through development. Continuing difficulties in mother–child interactions are also important, suggesting that both early intervention and continuing monitoring of mothers with PND may be warranted.     

Depression in mothers and behaviour problems with their preschool children

A follow-up study of 224 families of a birth cohort of 272 families in a multi-ethnic poor socio-economic municipality in Melbourne when the children were 4 years old showed that 27% of the mothers were depressed. There was no difference in the depression rate between Australian-born and immigrant mothers, a finding in marked contrast to the first year of the study when the depression rate was significantly higher in those immigrant mothers who had been in Australia for less than 3 years, were unable to speak English and who did not have an extended family or close friends. Depression in this group of mothers was attributed to resettlement problems, which over a period of three years had ameliorated. At 4 years the most important factor associated with depression in both Australian-born and immigrant mothers was the quality of marital relationships. Lack of an intimate support relationship made mothers more vulnerable to the stresses of child care and rearing, home-making and life events. In Australian-born mothers only, another significant factor in vulnerability to depression, was their early childhood experiences of being reared in a disruptive home or in an institution and of being unwanted. In immigrant mothers, but not in Australian-born mothers, life events were significantly correlated with depression. The depressed mothers, both Australian-born and immigrant, perceived their 4 year old children to have significantly more behavioural problems than mothers who were not depressed.     

Expressed emotion, parenting stress, and adjustment in mothers of young children with behavior problems

Expressed Emotion (EE), a measure of the emotional climate of the family, predicts subsequent adjustment of adults with mental disorder (Leff & Vaughn, 1985). Despite the acknowledged importance of the family in childhood disorders, there have been relatively few studies of expressed emotion with adolescents and school-aged children and virtually none focused on preschoolers. The present study utilized the Five Minute Speech Sample (FMSS) to examine how Expressed Emotion relates concurrently and longitudinally to child problem status in a community sample of 112 preschool-aged children. At preschool, the proportion of high EE increased significantly across three child groups: Comparison (8.1%), Borderline Problem (15.8%), and High Problem (41.2%); however, preschool EE was not predictive of subsequent child status at 1st grade. Expanded FMSS codes. tapping positive affect and worry about the child, were also related to child problem group at preschool and were predictive of subsequent child status at 1st grade. Because parents' stress and adjustment were also highly related to child problem group status, we examined whether the FMSS codes were essentially a proxy for these or whether they explained unique variance. In two stepwise regressions on preschool child group status (divided by total problems and by externalizing problems), maternal stress was the only variable to enter. Also, in predicting to 1st grade externalizing child group status, only maternal stress entered. Discussion focused on the extension of the EE construct and other FMSS coding to young children, and the need to recognize that to some extent these variables may reflect maternal stress and adjustment.     

Parent‐adolescent influences on everyday dietary practices: Perceptions of adolescent females with obesity and their mothers

Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family‐based obesity interventions continue to exhibit limited success among adolescents. To further inform family‐based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent‐adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12–17 years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific intentional and unintentional types of influences from children that affected the food and drink they consumed, prepared, and acquired. Findings provide a fuller view of the varied social influences on everyday dietary practices within the parent‐adolescent relationship. They indicate the importance of examining both parent‐to‐child and child‐to‐parent influences and begin to illuminate the value of attending to the social circumstances surrounding dietary behaviors to strengthen family‐based obesity treatment approaches.     

Predictive familial risk factors and pharmacological responses in ADHD with comorbid disruptive behavior disorders

Background: The aim of the present study was to examine the putative familial risk factors and evaluate the pharmacological effects in children and adolescents of attention‐deficit–hyperactivity disorder (ADHD) with comorbid disruptive behavior disorders (DBD) and normal IQ. Methods: The retrospective study included 144 Japanese subjects (age, 5–18 years) with ADHD, of whom 35 subjects (24%) met the diagnostic criteria for DBD. Using multiple regression analysis, the familial background risk factors that might increase any comorbid antisocial behaviors were assessed. Furthermore, the 20 methylphenidate (MPH)‐resistant DBD subjects were divided into three treatment groups: MPH plus risperidone (n= 8); MPH plus carbamazepine (n= 5); and MPH plus lithium carbonate (n= 4). The effectiveness of the treatment was evaluated both before and after the add‐on therapy using the Clinical Global Impressions–Improvement (CGI‐I) and CGI‐Severity (CGI‐S) scale. Results: The putative familial risk factors were child abuse (odds ratio [OR], 19.48; P= 0.013) and maternal psychiatric disorders (OR, 15.59; P= 0.027). The addition of risperidone had the strongest tendency to improve the CGI‐S score (P= 0.063) and the highest rate of responses (50%) among the three treatment groups, albeit with no significant differences. Very few remarkable adverse clinical symptoms were observed. Conclusions: Child abuse and maternal psychiatric disorders are suggested to be significant risk factors in influencing the development of comorbid DBD in offspring. The use of risperidone appears to be well tolerated and is moderately effective in MPH‐resistant aggression in ADHD children and adolescents with comorbid DBD.