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This study aimed to identify coping factors for caregivers of children with medical complexity (CMC) to manage the stressors and experience associated with their child’s hospitalization.We conducted semistructured interviews with CMC caregivers over a video-conferencing platform to examine factors that they perceive impact their coping while their children are hospitalized. Interviews were audio-recorded, transcribed, and imported into a qualitative coding software (MAXQDA). Using a modified grounded theory approach, we assigned process and in vivo codes to the transcripts and conducted interpretive analysis to identify themes. Once we reached thematic saturation, we finalized themes by discussing them to achieve group consensus and processed themes through triangulation with our institution’s pediatric family advisory council.We interviewed 14 caregivers (11 mothers and 3 fathers) and identified 3 major themes. The factors that contributed to CMC caregiver coping with their child’s hospitalizations included caregivers: feeling that they are prioritizing their child’s needs over their own, feeling trust in their child’s interdisciplinary healthcare team, and feeling their self-care practices are well adjusted to the hospital setting.Our study found 3 coping factors for caregivers of CMC during their child’s hospitalization. Development and testing of interventions that enhance these coping practices may better support CMC caregivers during their child’s hospitalizations. Potential interventions could include developing structured processes to establish caregiver involvement in their child’s hospital care and helping caregivers modify their existing coping mechanisms to the hospital setting.

Fetal alcohol spectrum disorders (FASD) are highly prevalent developmental disabilities associated with prenatal alcohol exposure. In addition to varied strengths and unique talents, people with FASD experience significant challenges, including in adaptive functioning. Adaptive functioning refers to skills related to everyday life such as communication, practical skills, and social skills. For the current review, we aimed to understand how adaptive functioning in FASD compares to that of alcohol nonexposed individuals and those with attention deficit‐hyperactivity disorder (ADHD). Additionally, we investigated how this relationship may change based on IQ, executive functioning, and age. The current review was registered in the International Prospective Register of Systematic Reviews. Studies were eligible for inclusion if they measured adaptive functioning and included an FASD group and at least one eligible comparison group. Articles available in May 2021 in PubMed, PsycInfo, Scopus, and ProQuest Dissertations were searched. Publication bias was assessed using Egger's regression and three‐level random effects models were computed for all domains of adaptive functioning. Possible moderation by IQ, executive functioning, and age were investigated when heterogeneity analyses were significant. A post hocmoderation analysis of recruitment method was also completed. Thirty studies were included. Individuals with FASD had significantly lower adaptive functioning than other groups, with effect sizes ranging from 1.04 to 1.35 compared to alcohol nonexposed groups and from 0.30 to 0.43 compared to ADHD groups. No significant moderating effects were found for IQ or age; executive functioning significantly moderated communication skills in FASD compared to the alcohol nonexposed group. Recruitment method significantly affected this relationship, with larger effect sizes on average found for clinically identified samples than at‐risk or population samples. Individuals with FASD have impairments in adaptive functioning relative to alcohol nonexposed and ADHD groups, regardless of IQ, executive functioning, or age. Limitations of the review include small sample sizes in some comparisons and a limited age range. We conducted a meta‐analytic review of 30 studies of adaptive functioning in FASD. Individuals with FASD have significantly lower adaptive functioning relative to nonexposed and ADHD groups, regardless of IQ, executive functioning, and age. Clinically‐identified participants were significantly more impaired on average compared to at‐risk or population‐based samples. Results indicate people with FASD may not have adaptive skills in line with their other skills, and deficits may persist across development. Greater awareness and access to FASD‐informed care is urgently needed.

Few studies have investigated the partner's influence on risk factors such as alcohol consumption and depression during pregnancy. Partner substance use and lower relationship satisfaction predict higher maternal alcohol use and depressive symptoms. Because prenatal alcohol use and maternal depression affect infant outcomes, it is imperative to examine how the partner affects these maternal risk factors. The current study examined the effect of a latent construct of partner influence on maternal alcohol use and depressive symptoms, and the effects on infant development of these maternal factors. Participants were 246 pregnant women from 2 sites in Western Ukraine from whom longitudinal data were collected as part of a multisite study. In the first trimester, mothers reported on relationship satisfaction, partner substance use, and socioeconomic status (SES). In the third trimester, they reported on alcohol use and depressive symptoms. Infants were assessed using the Bayley Scale of Infant Development (average age = 6.93 months). A latent construct titled partner influence was formed using partner substance use and measures of relationship satisfaction, including the frequency of quarreling, happiness in the relationship, and the ease of talking with the partner. Using structural equation modeling, a model was specified in which partner influence and SES predicted maternal alcohol use and depressive symptoms, which in turn predicted infant neurodevelopmental outcomes. Higher partner influence significantly predicted lower prenatal alcohol use and lower depressive symptoms, controlling for the effect of SES. Higher maternal prenatal alcohol use significantly predicted lower infant mental and psychomotor development. Maternal depressive symptoms did not predict infant development over and above the effect of alcohol use. Partner influence is an important contributor to prenatal alcohol use and maternal depressive symptoms, over and above the effect of SES. The significant paths from prenatal alcohol exposure to infant neurodevelopmental outcomes underscore the importance of partner influence during pregnancy. We used structural equation modeling to understand the influence of the partner on maternal prenatal alcohol use and depressive symptoms, and the effect of these prenatal risk factors on the infant at six months. Partner influence was a latent construct made up of three relationship variables and two partner substance use variables. Controlling for socioeconomic status, partner influence significantly predicted alcohol use and depressive symptoms during the third trimester. Further, higher alcohol use predicted lower infant development at six months.

When the primary disabilities associated with fetal alcohol spectrum disorders (FASD) are not well supported, individuals are at higher risk for mental health problems and other secondary conditions. The Families on Track (FOT) intervention was designed to prevent secondary conditions and improve family functioning in children with FASD. Promising results from a pilot study demonstrated positive effects on child and caregiver outcomes immediately following the intervention. The objective of this study was to examine the sustainability of these effects 6 months postintervention. Thirty children (ages 4 to 8) with prenatal alcohol exposure and their caregivers were enrolled in the original study. Families were randomized to the FOT intervention or an active comparison group that provided comprehensive assessment and individualized feedback. The intervention integrated a positive parenting curriculum and a child skills group. Families were assessed at baseline, postintervention, and 6‐month follow‐up visits. Follow‐up data were available for 24 families on child and caregiver outcomes. Data were analyzed using effect size calculations and analysis‐of‐variance techniques. Relative to the comparison group, intervention families showed continued gains in parenting efficacy and maintained prior improvements in FASDknowledge over the follow‐up period. Although intervention families reported a decrease in their needs being met over the follow‐up period, they continued to report their needs being met to greater extent than those in the comparison group. Consistent with postintervention outcomes, children in both groups exhibited similar decreases in child disruptive behavior 6 months following the intervention. Unfortunately, positive gains seen at postintervention for child self‐esteem and emotion regulation were attenuated at follow‐up. This pilot study yielded promising effects on important areas of caregiver functioning. However, the intervention's impact on child functioning waned over time, suggesting the need for sustained or alternate child intervention. Selected outcomes from the Families on Track intervention pilot trial for children with fetal alcohol spectrum disorders (ages 4 to 8) and their caregivers. Group means for intervention and comparison groups are shown at pre‐intervention, immediate post‐intervention, and 6‐month follow‐up timepoints. Error bars represent standard error of the mean.

Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self‐regulatory abilities. As such, interventions have been developed that focus on improving varying aspects of self‐regulation for this population. The application of a multilevel theoretical framework that describes the development of self‐regulation during early childhood could further advance the field. First, this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and, second, informing the development of more precise assessment and interventions for those affected by PAE. The aims of the current review were to provide an overview of the self‐regulatory framework proposed by Calkins and colleagues (e.g., Calkins, 2007; Calkins and Fox, 2002); examine the self‐regulatory difficulties that are commonly experienced during infancy (i.e., 0 to 2 years) and early childhood (i.e., 3 to 8 years) in children with PAE in the context of the developmental framework; and describe how the framework can inform the development of future assessment and intervention provision for young children with PAE. The application of a developmental framework, such as proposed by Calkins and colleagues, allows for a systematic and theoretically driven approach to assessment and intervention programs for young children with PAE. Prenatal alcohol exposure (PAE) can be associated with significant difficulties in self‐regulatory abilities. This review summarizes the literature for young children with PAE (0 to 8 years) according to a multi‐level theoretical framework that describes the development of self‐regulation during early childhood. The application of this framework could assist in elucidating mechanisms in the trajectories of early adjustment problems in this population and inform the development of more precise assessment and interventions for those affected by PAE.

Individuals with fetal alcohol spectrum disorders (FASD) are at high risk for costly, debilitating mental health problems and secondary conditions, such as school disruption, trouble with the law, and substance use. The study objective was to pilot a multicomponent intervention designed to prevent secondary conditions in children with FASDand improve family adaptation. Thirty children with FASDor prenatal alcohol exposure (PAE) (ages 4 to 8) and their primary caregivers were enrolled. Families were randomized to either the Families on Track Integrated Preventive Intervention or an active control of neuropsychological assessment and personalized community referrals. The 30‐week intervention integrates scientifically validated bimonthly, in‐home parent behavioral consultation, and weekly child skills groups. Outcomes measured at baseline and follow‐up postintervention included intervention satisfaction, child emotional and behavioral functioning, child self‐esteem, caregiver knowledge of FASDand advocacy, caregiver attitudes, use of targeted parenting practices, perceived family needs met, social support, and self‐care. Data analysis emphasized calculation of effect sizes and was supplemented with analysis of variance techniques. Analyses indicated that families participating in the intervention reported high program satisfaction. Relative to comparison group outcomes, the intervention was associated with medium‐to‐large effects for child emotion regulation, self‐esteem, and anxiety. Medium‐sized improvements in disruptive behavior were observed for both groups. Medium and large effects were seen for important caregiver outcomes: knowledge of FASDand advocacy, attributions of behavior, use of antecedent strategies, parenting efficacy, family needs met, social support, and self‐care. This pilot study yielded promising findings from the multicomponent Families on Track Integrated Preventive Intervention for child and caregiver outcomes. An important next step is to complete a randomized control trial of the Families on Track Program with a larger sample fully representative of this underserved clinical population with built‐in study of implementation parameters. This pilot trial evaluated a multi‐component intervention program called Families on Track, which was designed to prevent secondary conditions in children with fetal alcohol spectrum disorders (FASD) and improve family adaptation. Children with FASD and their families who completed the Families on Track Program displayed greater improvements in multiple child and caregiver outcomes relative to families who received comprehensive assessment and community referrals.

The USA has relatively well-developed programs focused on the prevention of and intervention for prenatal alcohol exposure when compared with most other countries. This includes federal and state government programs involving extensive efforts by the Centers for Disease Control and Prevention (CDC). Despite these efforts and widely available and publicized information about the danger of alcohol exposure to the developing fetus, prenatal alcohol exposure remains a significant problem in the USA. As such, more advocacy efforts are needed to increase the research in this area and the dissemination of these findings. Pediatric neuropsychologists are ideally suited to consider the neurological compromise associated with prenatal alcohol exposure and how risk and resiliency factors in the environment influence neurodevelopment. As such, pediatric neuropsychologists can serve as effective advocates for improved services and research for children affected by prenatal alcohol exposure. Advocacy needs include increased funding for research and intervention, greater engagement, and coordination of the medical, educational, juvenile justice, and psychological communities as well as increased support of local, state, and federal government agencies to reduce the incidence of fetal alcohol spectrum disorder (FASD) and provide appropriate services. This article reviews the available literature regarding these concerns and discusses considerations for pediatric neuropsychologists for the current efforts on prevention and intervention for individuals with FASD in the USA.

Although governments around the world are increasingly recognizing the negative impact prenatal alcohol exposure can have on a child’s neurodevelopment, the prevalence of fetal alcohol spectrum disorder (FASD) remains highly concerning. Pediatric neuropsychologists have an important role in the prevention of and intervention with children with FASD given the neurocognitive, psychiatric, social, behavioral, and academic problems associated with the condition. This Special Issue reviews different countries’ responses to FASD including their prevention and intervention efforts as well as the role that pediatric neuropsychologists have in that country. This introduction discusses the issues that led to the creation of this Special Issue, describes each article, and summarizes common themes raised by contributing countries.

Youth who experience a greater number of caregiver transitions during childhood are at risk for developing a host of psychosocial problems. Although researchers have examined individual‐level factors that may moderate this association, no known studies have examined the impact of community‐level factors. The current study investigated whether community violence exposure (CVE) moderated the association between number of prior caregiver transitions and increases in levels of externalizing and internalizing problems for a sample of youth entering foster care. Participants included 156 youth (aged 9–11 at first assessment) removed from their homes because of maltreatment. Youth provided reports of caregiver transitions and CVE at baseline, and caregivers, teachers, and youth reported on externalizing and internalizing problems 18–22 months later. Results from hierarchical multiple regression analyses indicated that youth with a greater number of caregiver transitions and higher levels of CVE evidenced significant increases in levels of psychosocial problems. The results of the study are discussed in terms of their implications for child welfare services.