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One in eight children aged 5-19 years in the UK suffer from a psychiatric disorder, while fewer than 35% are identified and only 25% of children access mental health services. Whilst government policy states that primary schools are well-placed to spot the early warning signs of mental health issues in children, the implementation of early identification methods in schools remains under-researched. This study aims to increase understanding of the acceptability and feasibility of different early identification methods in this setting. Four primary schools in the East of England in the UK participated in a qualitative exploration of views about different methods that might enhance the early identification of mental health difficulties (MHDs). Twenty-seven staff and 20 parents took part in semi-structured interviews to explore current and future strategies for identifying pupils at risk of experiencing MHDs. We presented participants with four examples of identification methods selected from a systematic review of the literature: a curriculum-based approach delivered to pupils, staff training, universal screening, and selective screening. We used NVivo to thematically code and analyse the data, examining which models were perceived as acceptable and feasible as well as participants' explanations for their beliefs. Three main themes were identified; benefits and facilitators; barriers and harms, and the need for a tailored approach to implementation. Parents and staff perceived staff training as the most acceptable and feasible approach to systematic identification, followed by a curriculum-based approach. Universal and selective screening garnered mixed responses. Findings suggest that a systematic and tailored approach to early identification would be most acceptable and feasible, taking into consideration school context. Teacher training should be a core component in all schools.

A growing body of research suggests that, compared with single parent-child attachment relationships, child developmental outcomes may be better understood by examining the configurations of child-mother and child-father attachment relationships (i.e., attachment networks). Moreover, some studies have demonstrated an above-chance level chance of concordance between the quality of child-mother and child-father attachment relationships, and child temperament has been offered as a plausible explanation for such concordance. To assess whether temperament plays a role in the development of different attachment network configurations, in this preregistered individual participant data meta-analysis we tested the degree to which the temperament dimension of negative emotionality predicts the number of secure, insecure-avoidant, insecure-resistant, and disorganized attachment relationships a child has with mother and father. Data included in the linear mixed effects analyses were collected from seven studies sampling 872 children (49% female; 83% White). Negative emotionality significantly predicted the number of secure ( d = -0.12) and insecure-resistant ( d = 0.11), but not insecure-avoidant ( d = 0.04) or disorganized ( d = 0.08) attachment relationships. Nonpreregistered exploratory analyses indicated higher negative emotionality in children with insecure-resistant attachment relationships with both parents compared to those with one or none ( d = 0.19), suggesting that temperament plays a small yet significant role in child-mother/child-father insecure-resistant attachment relationships concordance. Taken together, results from this study prompt a more in-depth examination of the mechanism underlying the small yet significantly higher chance that children with increased negative emotionality have for developing multiple insecure-resistant attachment relationships. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Background: Policy and practice encourages patients to engage in self-care, with individual patient management and remote monitoring of disease. Much is known of the moderate stage of chronic disease, without a clear understanding of how self-care applies towards the end of life., Aim: To review the current evidence on practices of self-care in life-limiting conditions and its impacts on healthcare utilisation, quality of life and associated costs., Design: We systematically searched 10 scientific databases (MEDLINE, CINAHL, Embase, PsycINFO, Cochrane Central, Cochrane Database of Systematic Reviews, Scopus, Sociological Abstracts, Social Work Abstracts and Health Management Information Consortium) from inception to October 2023 with citation and hand searching. A narrative synthesis was undertaken, with quality and relevance assessed using Gough's Weight of Evidence framework. Titles and abstracts were independently screened by three researchers., Results: Findings from 33 studies revealed self-care as increasingly burdensome or unfeasible towards the end of life, with patients delaying use of professional care. Self-care became increasingly burdensome for patients, carers and professionals as illness progressed. Self-monitoring may exacerbate hospitalisations as patients delayed seeking professional help until crises arose. Findings regarding quality were inconclusive, with some evidence suggesting that self-care can decrease care costs., Conclusions: This review has shown that research on self-care is an evolving area of study, with a current focus on acute care and hospitalisations. Future research should seek to provide a more complete account of the relation between self-care and non-acute care use, and quality, with further efforts to study self-care costs incurred through self-funding., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Brett Kahr has referred to the death of Mary Main as the loss of "the queen of attachment research." However, how well is Main's work actually known? In this portrait and tribute, I argue that Main's transformative contributions have become a taken-for-granted part of the basic environment of attachment research, but that readers have faced obstacles in understanding and responding to their strengths and limitations. Drawing from interviews with Main, in this paper I describe some of her early life experiences and mental and physical health challenges, which she felt had influenced what was possible for her in her research. I then highlight less well-known aspects of her ideas regarding the role of attention within attachment strategies, the nature of disorganised attachment, the implications of alarming caregiving behaviours, and what is ultimately measured by the Adult Attachment Interview. My goal throughout is to help reader see both how much Main's rich and exciting works still have to teach, and identify their many loose threads still to follow.

The relationship between attachment and posttraumatic stress symptoms (PTSS) has been researched extensively within adult samples, with findings consistently demonstrating a relationship between insecure attachment and increased PTSS, and between secure attachment and decreased PTSS. To a lesser extent, such relationships have also been explored within child and adolescent samples. The evidence to date is equivocal and there have been no attempts to synthesize studies. This meta-analysis aimed to provide a quantitative synthesis of studies reporting a relationship between attachment orientation (on both developmental and social psychological measures) and PTSS within children and adolescents. A random effects model was used to pool 30 studies ( N = 10,431) reporting exposure to a range of traumatic events including maltreatment and war trauma. Results demonstrate a negative correlation between secure attachment and PTSS ( r = -.16) and a positive correlation between insecure attachment ( r = .20), avoidant attachment ( r = .20), anxious attachment ( r = .32), and disorganized attachment ( r = .17) and PTSS. These findings indicate a small but significant relationship between attachment and PTSS in children and adolescents. Exposure to maltreatment did not moderate the relationship between secure attachment and PTSS, though strengthened the relationship between insecure attachment and PTSS.

Sensitive caregiving behavior, which involves the ability to notice, interpret, and quickly respond to a child's signals of need and/or interest, is a central determinant of secure child-caregiver attachment. Yet, significant heterogeneity in effect sizes exists across the literature, and sources of heterogeneity have yet to be explained. For all child-caregiver dyads, there was a significant and positive pooled association between caregiver sensitivity and parent-child attachment ( r = .25, 95% CI [.22, .28], k = 174, 230 effect sizes, N = 22,914). We also found a positive association between maternal sensitivity and child attachment security ( r = .26, 95% CI [.22, .29], k = 159, 202 effect sizes, N = 21,483), which was equivalent in magnitude to paternal sensitivity and child attachment security ( r = .21, 95% CI [.14, 27], k = 22, 23 effect sizes, N = 1,626). Maternal sensitivity was also negatively associated with all three classifications of insecure attachment (avoidant: k = 43, r = -.24 [-.34, -.13]; resistant: k = 43, r = -.12 [-.19, -.06]; disorganized: k = 24, r = -.19 [-.27, -.11]). For maternal sensitivity, associations were larger in studies that used the Attachment Q-Sort (vs. the Strange Situation), used the Maternal Behavior Q-Sort (vs. Ainsworth or Emotional Availability Scales), had strong (vs. poor) interrater measurement reliability, had a longer observation of sensitivity, and had less time elapse between assessments. For paternal sensitivity, associations were larger in older (vs. younger) fathers and children. These findings confirm the importance of both maternal and paternal sensitivity for the development of child attachment security and add understanding of the methodological and substantive factors that allow this effect to be observed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Aim: To identify and analyse ways in which parents are supported to deliver rehabilitation exercises to their child after traumatic brain injury (TBI), conceptualized as strategies., Method: A systematic search was completed using seven online databases and three grey literature databases, from inception to November 2021. The included studies focused on physical rehabilitation in children after TBI with the involvement of parents as hands-on deliverers or facilitators of rehabilitation (e.g. supervising the exercise). Intervention descriptions were reviewed to identify strategies; this was followed by fine-grained analysis using the Behaviour Change Wheel to identify intervention components. Risk of bias was analysed using the revised Cochrane Risk-of-Bias Tool for Randomized Trials or the Risk Of Bias In Non-randomized Studies - of Interventions., Results: Six interventions including 211 participants and one trial protocol met the inclusion criteria. All studies included a proportion of children diagnosed with TBI and four studies included mixed samples of acquired brain injury or cerebral palsy. All interventions included elements of goal setting and instruction., Interpretation: Interventions focus heavily on the initiation of physical rehabilitation, but focus less on the longer-term maintenance of rehabilitation delivery. Further research should integrate perspectives from parents to inform the development of new interventions., What This Paper Adds: Parents need support to deliver or supervise rehabilitation exercises. The interventions identified in this review supported goal setting, action planning, and learning rehabilitation exercises. Interventions focused primarily on the initiation of exercises but less on maintenance. Rehabilitation is complex and new approaches are needed to better support parents., (© 2024 The Authors. Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)

Background: Children and young people (CYP) seen by child and adolescent mental health services (CAMHS) often experience safeguarding issues. Yet little is known about the volume and nature of these risks, including how different adversities or risks relate to one another. This exploratory study aims to bridge this gap, examining rates at entry to services and profiles of risk using a latent class analysis., Methods: Data were extracted for CYP who received at least one risk assessment at CAMHs in South London between January 2007 and December 2017. In total, there were 21,688 risk assessments. Latent class analysis was used to identify profiles of risk from the risk assessments., Results: Concerns about parent mental health ( n  = 5274; 24%), emotional abuse ( n  = 4487; 21%), violence towards others ( n  = 4210; 19%), destructive behaviour ( n  = 4005; 18%), and not attending school ( n  = 3762; 17%) were the most commonly identified risks. Six distinct profiles of risk were identified from the latent class analyses: (1) maltreatment and externalising behaviours, (2) maltreatment but low risk to self and others, (3) antisocial behaviour, (4) inadequate caregiver supervision and risk to self and others, (5) risk to self but not others, and (6) mental health needs but low risk., Conclusions: These findings provide fresh insights into adverse experiences and risks identified by CAMHS. For professionals, the profiles identified in this study might provide insights into profiles of identified risks, in contrast to traditional cumulative approaches to risk. For researchers, these profiles may be fertile ground for hypothesis-driven work on the association between adversity and later outcomes., Competing Interests: The authors have declared that they have no competing or potential conflicts of interest., (© 2024 The Author(s). JCPP Advances published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Objectives: Clinical communication needs of teenagers and young adults with cancer (TYACs) are increasingly recognised to differ significantly from younger children and older adults. We sought to understand who is present with TYACs, TYACs' experiences of triadic communication and its impact. We generated three research questions to focus this review: (1) Who is present with TYACs in healthcare consultations/communication?, (2) What are TYACs' experiences of communication with the supporter present? and (3) What is the impact of a TYAC's supporter being present in the communication?, Design: Systematic review with narrative synthesis., Data Sources: The search was conducted across six databases: Medline, CINAHL, Embase, PsycINFO, Web of Science and AMED for all publications up to December 2023., Eligibility Criteria for Selecting Studies: Included papers were empirical research published after 2005; participants had malignant disease, diagnosed aged 13-24 years (for over 50% of participants); the research addressed any area of clinical communication., Data Extraction and Synthesis: Three independent reviewers undertook full-text screening. A review-specific data extraction form was used to record participant characteristics and methods from each included paper and results relevant to the three review questions., Results: A total of 8480 studies were identified in the search, of which 36 fulfilled the inclusion criteria. We found that mothers were the most common supporter present in clinical communication encounters. TYACs' experiences of triadic communication are paradoxical in nature-the supporter can help or hinder the involvement of the young person in care-related communication. Overall, young people are not included in clinical communication and decisions at their preferred level., Conclusion: Triadic communication in TYACs' care is common, complex and dynamic. Due to the degree of challenge and nuances raised, healthcare professionals need further training on effective triadic communication., Prospero Registration Number: CRD42022374528., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Parental mental ill-health is often described as a risk factor for child maltreatment. Yet the literature commonly foregrounds maternal mental ill-health. To obtain a more complete picture, it is crucial to also understand the associations between fathers' mental health and child maltreatment., Aim: To provide a narrative synthesis of evidence about the relationship between fathers' mental health and child maltreatment., Method: Four electronic databases were searched, identifying 5479 citations. 151 studies were brought to full-text review. 37 were included in the study., Results: Studies revealed mixed evidence for associations between forms of paternal mental ill health and child maltreatment, with stronger evidence for paternal depression and weak or no evidence for PTSD and anxiety. Many confounding factors were identified across the papers., Discussion: The small number and limited range of good quality studies indicate the need to correct the relative invisibility of fathers within research about mental health and child maltreatment. At present, the available evidence is not sufficient to draw firm conclusions about the association between fathers' mental health and child maltreatment or appropriate policy and practice responses., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: Emotional eating is a barrier to weight management. Interventions based on Acceptance and Commitment Therapy (ACT) promote the acceptance of uncomfortable feelings, which can reduce the urge to use food as a coping mechanism. We aimed to explore how participants of an ACT-based weight management intervention (WMI) experience emotional eating and relevant intervention content., Methods: We conducted semi-structured telephone interviews with participants of a digital ACT-based guided self-help WMI. Fifteen participants were purposefully selected to represent a range of demographic characteristics and emotional eating scores. We used reflexive thematic analysis to explore experiences of emotional eating., Results: We generated five themes. Participants improved emotional eating by disconnecting emotions from behaviours though increased self-awareness (theme 1) and by implementing alternative coping strategies, including preparation, substitution, and acceptance (theme 2). Most participants maintained improvements in emotional eating over time but wished for more opportunities to re-engage with intervention content, including more immediate support in triggering situations (theme 3). Participants who struggled to engage with emotional eating related intervention content often displayed an external locus of control over emotional eating triggers (theme 4). The perceived usefulness of the intervention depended on participants' prior experiences of emotional eating, and was thought insufficient for participants with complex emotional experiences (theme 5)., Discussion: This ACT-based WMI helped participants with emotional eating by improving self-awareness and teaching alternative coping strategies. Intervention developers may consider adding ongoing forms of intervention that provide both real-time and long-term support. Additionally, a better understanding of how to support people with an external locus of control and people with complex experiences of emotional eating is needed. Future research may explore ways of personalising WMIs based on participants' emotional needs., Competing Interests: Declaration of competing interest CH has received honoraria for educational work around Obesity, unrelated to this research from Novo Nordisk, and Ethicon. SG has received honoraria from Astra Zeneca for speaking at postgraduate education meetings for primary care teams. AA is a member of the WW Scientific Advisory Board, for which payment is made to her institution, and is the Principal Investigator of two publicly funded trials where the intervention was provided by WW at no cost. AJH receives payment for advice to Slimming World (UK). Other authors do not report any conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

An individual participant data meta-analysis was conducted to test pre-registered hypotheses about how the configuration of attachment relationships to mothers and fathers predicts children's language competence. Data from seven studies (published between 1985 and 2014) including 719 children (M age : 19.84 months; 51% female; 87% White) were included in the linear mixed effects analyses. Mean language competence scores exceeded the population average across children with different attachment configurations. Children with two secure attachment relationships had higher language competence scores compared to those with one or no secure attachment relationships (d = .26). Children with two organized attachment relationships had higher language competence scores compared to those with one organized attachment relationship (d = .23), and this difference was observed in older versus younger children in exploratory analyses. Mother-child and father-child attachment quality did not differentially predict language competence, supporting the comparable importance of attachment to both parents in predicting developmental outcomes., (© 2023 The Authors. Child Development © 2023 Society for Research in Child Development.)

Children with autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD) and disinhibited and reactive attachment disorders (RAD/DAD) often experience socioemotional problems. Elucidating a clear picture of these profiles is essential. Strengths and Difficulties Questionnaires (SDQs) were analysed from cohort of children with ASD (n = 1430), ADHD (n = 1193), and RAD/DAD (n = 39). Kruskal-Wallis Tests and network analytic techniques were used to investigate symptom profiles. Children with ASD experienced more emotional problems, peer problems and fewer prosocial behaviours. Children with ADHD and RAD/DAD had higher levels of hyperactivity and conduct problems. Overall, ASD and ADHD networks were highly correlated (r s = 0.82), and we did not observe a statistically significant difference in terms of global Strength.

Objectives: Travelling communities are a significant, but poorly understood, group of ethnic minorities known to experience inequalities in many aspects of healthcare, including at the end of life. This study explored the end of life care experiences and needs of Travellers, along with the perspectives of healthcare professionals., Methods: Secondary thematic analysis of data from two focus groups and 16 interviews. Eighteen UK-based members of Travelling communities and three healthcare professionals took part in two focus groups. Sixteen hospice staff were interviewed. Data were collected by UK charity One Voice 4 Travellers in 2018., Results: Tensions permeated the healthcare experience of Travellers. The perceived need for concealment of ethnic identity in the healthcare setting conflicted with participants' desire for personalised care and tailored services. Healthcare professionals' limited awareness of Travellers' cultural rituals around death led to difficulties, including misunderstandings relating to the large numbers of family gathered at the bedside of dying relatives in hospital and hospice settings. Approaches that could increase the acceptability of healthcare included Travellers working in liaison roles, increased provision of space for visiting family and cultural competency training for staff. However, challenges remain in converting ideal solutions into feasible changes., Conclusions: Improved communication and understanding between Travelling communities and healthcare professionals is needed to relieve the multilevel tensions experienced at the end of life. At an individual level, this would enable personalised care; at a systems level, cocreation of end of life care services with Travellers would help ensure that their cultural needs are met., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Unresolved states of mind regarding experiences of loss/abuse (U/d) are identified through lapses in the monitoring of reasoning, discourse, and behavior surrounding loss/abuse in response to the Adult Attachment Interview. Although the coding system for U/d has been widely used for decades, the individual indicators of unresolved loss/abuse have not been validated independently of the development sample. This study examined the psychometric validity of U/d, using individual participant data from 1,009 parent-child dyads across 13 studies. A latent class analysis showed that subsets of commonly occurring U/d indicators could differentiate interviewees with or without unresolved loss/abuse. Predictive models suggested a psychometric model of U/d consisting of a combination of these common indicators, with disbelief and psychologically confused statements regarding loss being especially important indicators of U/d. This model weakly predicted infant disorganized attachment. Multilevel regression analysis showed no significant association between ratings of unresolved other trauma and infant disorganized attachment, over and above ratings of unresolved loss/abuse. Altogether, these findings suggest that the coding system of U/d may have been overfitted to the initial development sample. Directions for further articulation and optimization of U/d are provided.

Lay Abstract: Autism and attention deficit hyperactivity disorder are common behaviourally diagnosed conditions. One of the key aspects of diagnosis is clinical judgement. Yet despite decades of research, it is only in recent times that researchers have started exploring clinicians' perspectives on diagnosing these conditions. We aimed to add to this body of knowledge by conducting interviews with 17 experienced health care professionals in the United Kingdom to hear their perspectives on diagnosing autism and attention deficit hyperactivity disorder. Clinicians reflected that for some children and young people, diagnosis is reasonably straightforward; however, in other situations, decisions are made on more pragmatic grounds (i.e. will this be helpful). We identified some differences of opinion between professionals and organisation which adds to the complexity of applying a diagnosis. We recommend several areas for future research and point to some practical and philosophical implications of the work.

This meta-analysis synthesized the distribution of attachment classifications as coded with the Cassidy-Marvin Preschool Attachment Coding System and the Main-Cassidy Six-Year-Old System. These systems have extended scholars' capacity to measure differences in the developing child-parent attachment relationship, and its sequelae, beyond the infancy period; however, the global distribution of the attachment categories in these systems, and the potential factors influencing this distribution, remain unknown. The meta-analysis included 97 samples ( N = 8,186 children; 55% boys), mostly drawn from North American or European populations (89%; M = 76% White). Results indicated that the distribution of child-mother attachment was 53.5% secure, 14.0% avoidant, 11.0% ambivalent, and 21.5% disorganized/controlling. Moderator analyses showed that rates of security were lower, and rates of disorganization were higher, in samples of at-risk families, specifically when children were exposed to maltreatment. Variations in the procedure also moderated the distribution. The discussion calls for greater unity around methodological practices.

This article examines how 'trauma' has been conceptualised in the unresolved state of mind classification in the Adult Attachment Interview, introduced by Main and Hesse in 1990. The unresolved state of mind construct has been influential for three decades of research in developmental psychology. However, not much is known about how this measure of unresolved trauma was developed, and how it relates to other conceptualisations of trauma. We draw on previously unavailable manuscripts from Main and Hesse's personal archive, including various editions of unpublished coding manuals, and on Main-Bowlby correspondence from the John Bowlby Archive at the Wellcome Trust in London. This article traces the emergence of the unresolved state of mind classification, and examines the assumptions about trauma embedded in the construct. These assumptions are situated both in the immediate context of the work of Main and Hesse and in terms of wider discourses about trauma in the period. Our analysis considers how a particular form of trauma discourse entered into attachment research, and in doing so partly lost contact with wider disciplinary study of trauma., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)