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High-risk families exposed to toxic stressors such as family violence, depression, addiction, and poverty, have shown greater difficulty in parenting young children. In this study, we examined the effectiveness of ATTACH

Objective The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment. Method This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months. Results Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment. Conclusion When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.

Children's exposure to toxic stress (e.g., parental depression, violence, poverty) predicts developmental and physical health problems resulting in health care system burden. Supporting parents to develop parenting skills can buffer the effects of toxic stress, leading to healthier outcomes for those children. Parenting interventions that focus on promoting parental reflective function (RF), i.e., parents' capacity for insight into their child's and their own thoughts, feelings, and mental states, may understand help reduce societal health inequities stemming from childhood stress exposures. The Attachment and Child Health (ATTACHThe study is comprised of a quantitative pre/post-test quasi-experimental evaluation of the ATTACHThe proposed study will assess effectiveness and implementation to help understand the delivery of ATTACHName of registry: https://clinicaltrials.gov/.NCT04853888 . Date of registration: April 22, 2021.

Background Children exposed to adversity and toxic stress are at increased risk for poor health across the lifespan, possibly through alterations to immune pathways. Parenting interventions could buffer the effect of adversity on child immune activity. The purpose of this study was to test whether mothers and children who were randomly assigned to a parenting intervention (ATTACH™) had healthier post-intervention immune cell gene expression patterns, as indexed by the Conserved Transcriptional Response to Adversity (CTRA), compared with mothers and children in a wait-list control group. Methods A sample of 20 mother-child dyads were recruited from a domestic violence shelter in Calgary, AB, Canada. The ATTACH™ program is a 10-week psycho-educational intervention that fosters maternal reflective function, i.e. how to understand and respond to mental states. Dyads were randomly assigned to an intervention or wait-list group. Dried blood spots were collected from both groups post-intervention, subjected to RNA sequencing, and assessed for CTRA gene expression using mixed effect linear model analysis. Covariates were age, child sex, maternal race/ethnicity, and maternal medication use. Results In unadjusted models, differences by treatment group were detected, F(1,1794) ​= ​4.26, p ​= ​.039. Mothers and children who completed the ATTACH™ intervention had lower CTRA scores, indicating healthier immune cell gene expression profiles (Mn ​= ​−0.36, SE ​= ​0.17), compared with mothers and children in the wait-list control group (Mn ​= ​0.11, SE ​= ​0.15). Results persisted after controlling for covariates. Discussion ATTACH™ participation predicted healthier immune cell gene expression profiles post-intervention compared with wait-list controls. Parenting interventions could decrease the impact of toxic stress on maternal-child immune health., Highlights • The ATTACH™ program is a reflective function parenting intervention. • The ATTACH™ program predicted healthier immune cell gene expression in children. • The ATTACH™ program predicted healthier immune cell gene expression in mothers. • The ATTACH™ program could protect the health of families escaping domestic violence.

Reflective function (RF) is defined as an individual’s ability to understand human behavior in terms of underlying mental states including thoughts, feelings, desires, beliefs, and intentions. More specifically, the capacity of parents to keep their child’s mental states in mind is referred to as parental RF. RF has been linked to adult mental health and parental RF to children’s mental health and development. The gold standard measure of RF is the interview-based Reflective Functioning Scale (RFS) applied to the Parent Development Interview (PDI) or Adult Attachment Interview (AAI), which while well validated, is time-and labor-intensive to administer. Given the increasing need for reliable, valid, and rapid RF assessment in wide-ranging settings, two alternative measures were considered including the Reflective Function Questionnaire (RFQ) and Parental Reflective Function Questionnaire (PRFQ). We determined the convergent validity of these measures in comparison with the PDI-rated RFS. A sample of mothers and fathers (n= 150) was drawn from a sub-study of the ongoing Alberta Pregnancy Outcomes and Nutrition (APrON) longitudinal cohort when their children were 42–60 months of age. Pearson correlations and multiple linear regression was conducted, followed by splitting the sample to compute Cohen’s kappas measures of agreement. Two subscales of the PRFQ correlated significantly (p< 0.05) with the gold standard PDI-rated RFS, providing evidence for convergent validity. As a brief multidimensional measure of parental RF, the PRFQ offers an alternative for measurement of RF in large-scale studies of parental development and child health.

Toxic stressors (e.g., parental violence, depression, low income) place children at risk for insecure attachment. Parental reflective function-parents' capacity to understand their own and their child's mental states and thus regulate their own feelings and behavior toward their child-may buffer the negative effects of toxic stress on attachment. Our objective was to test the effectiveness of the Attachment and Child Health (ATTACH) intervention, focusing on improving reflective function and children's attachment security, for at-risk mothers and children36 months of age. Three pilot studies were conducted with women and children from an inner city agency serving vulnerable, low-income families and a family violence shelter. Randomized control trial (n = 20, n = 10 at enrollment) and quasi-experimental (n = 10 at enrollment) methods tested the effect of the ATTACH intervention on the primary outcome of reflective function scores, from transcribed Parent Development Interviews. Our secondary outcome was children's attachment patterns from Ainsworth's Strange Situation Procedure. Despite some attrition, mixed methods analysis of covariance and t tests revealed significant differences in maternal, child, and overall reflective function, with moderate effect sizes. While more children whose mothers received the ATTACH program were securely attached posttreatment, as compared with controls, significant differences were not observed, which may be due to missing observations (n = 5 cases). Understanding the effectiveness of programs like the ATTACH intervention contributes to improved programs and services to promote healthy development of children affected by toxic stress.Los factores tóxicos de estrés (v.g. violencia de los padres, depresión, bajos recursos económicos) colocan a los niños bajo riesgo de una insegura afectividad. La función de reflexión de los padres, o sea, lacapacidad de los padres de comprender su propio estado mental y el de sus niños y por tanto regular sus propios sentimientos y conductas hacia su niño, pudiera amortiguar los efectos negativos del estrés tóxico sobre la afectividad. Nuestro objetivo fue probar la eficacia de la intervención Afectividad y Salud del Niño (ATTACH), enfocándonos en mejorar la función de reflexión y la seguridad de la afectividad de los niños, para madres y niños de36 meses de edad bajo riesgos. Se llevaron a cabo tres estudios pilotos con mujeres y niños de una agencia del centro de la ciudad que les sirve a familias vulnerables de bajos recursos económicos y un albergue para casos de violencia familiar. Un ensayo controlado al azar (n = 20, n = 10 al momento de inscribirse) y métodos cuasi-experimentales (n = 10 al momento de inscribirse) pusieron a prueba el efecto de ATTACH sobre el resultado primario de los puntajes de la función de reflexión, a partir de las transcritas Entrevistas del Desarrollo del Progenitor. Nuestro secundario resultado fueron los patrones de afectividad de los niños con base en el Procedimiento de la Situación Extraña de Ainsworth. A pesar de algunas bajas (n = 2 casos), los análisis de co-variantes con métodos combinados y las pruebas-t revelaron significativas diferencias en la función de reflexión materna, del niño, y en términos generales, con niveles de efectos moderados. Aunque más niños cuyas madres recibieron el programa ATTACH presentaron seguridad en su afectividad después del tratamiento, comparados con el grupo de control, no se observaron diferencias significativas, lo cual pudiera ser consecuencia de observaciones ausentes (n = 5 casos). Comprender la eficacia de programas como ATTACH contribuye a programas y servicios mejorados con el fin de promover un saludable desarrollo de los niños afectados por el estrés tóxico.Les stresseurs toxiques (par exemple la violence parentale, la dépression, la pauvreté) placement les enfants à risque d'attachement insécure. La fonction parentale de réflexion, c'est-à-dire la capacité des parents à comprendre leurs propres états mentaux et celui de leur enfant et donc de réguler leurs propres sentiments et comportement envers leur enfant, peut servir de tampon aux effets négatifs du stress toxique sur l'attachement. Notre objectif était de tester l'efficacité de l'intervention Attachement et Santé de l'Enfant (en anglais, Attachment and Child Health, soit, ATTACH), en s'attachant à améliorer la fonction de réflexion et la sécurité de l'attachement des enfants, pour des mères à risques et leurs enfants36 mois d’âge. Trois études pilotes ont été faites avec des femmes et des enfants d'une agence de quartiers défavorisés servant des familles vulnérables, de milieu défavorisé, ainsi qu'un refuge familial pour les victimes de violence. Un essai contrôlé randomisé (n = 20, n = 10 à l'inscription) et des méthodes quasi-expérimentales (n = 10 à l'inscription) ont testé l'effet de ATTACH sur le résultat principal de scores de fonction de réflexion, à partir d'Entretiens du Développement du Parent transcrits. Notre deuxième résultat était les patterns d'attachement des enfants à partir de la Procédure de Situation Etrange d'Ainsworth. En dépit d'une attrition (n = 2 cas), une analyse mixte de la covariance et les tests-t ont révélé des différences importantes dans la fonction de réflexion générale, maternelle, et de l'enfant, avec une ampleur modérée. Alors que plus d'enfants dont les mères ont reçu le programme ATTACH étaient attachés de manière sécure après le traitement, comparés aux contrôles, aucune différence importante n'a été observée, ce qui pourrait s'expliquer par des observations manquantes (n = 5 cas). La compréhension de l'efficacité de programmes comme ATTACH contribue à améliorer des programmes et des services promouvant un développement sain des enfants affectés par le stress toxique.Pilotversuche von ATTACH (AttachmentChild Health; BindungKindesgesundheit): Effekt einer Intervention zur elterlichen Reflexionsfähigkeit für Familien, die von toxischem Stress betroffen sind Toxische Stressoren (z. B. elterliche Gewalt, Depressionen, geringes Einkommen) stellen ein Risiko dafür dar, dass Kinder eine unsichere Bindung aufbauen. Die Reflexionsfähigkeit der Eltern, d. h. ihre Fähigkeit die eigenen mentalen Zustände und die ihres Kindes zu verstehen und so Gefühle und Verhaltensweisen gegenüber dem Kind regulieren zu können, könnte die negativen Effekte toxischen Stresses auf die Bindung abfedern. Unser Ziel war es, die Wirksamkeit der ATTACH-Intervention für gefährdete Mütter und Kinder unter 36 Monaten zu testen, wobei der Schwerpunkt auf der Verbesserung der Reflexionsfähigkeit und der kindlichen Bindungssicherheit lag. Mit den Frauen und Kindern, rekrutiert in einer innerstädtischen Behörde für vulnerable Familien mit niedrigem Einkommen und einem Frauenhaus, wurden 3 Pilotstudien durchgeführt. Die Wirkung von ATTACH auf das Primärergebnis, die Reflexionsfähigkeits-Scores aus transkribierten Elternentwicklungsinterviews, wurde durch randomisierte, kontrollierte (n = 20, n = 10 bei der Aufnahme) und quasi-experimentelle (n = 10 bei der Aufnahme) Methoden getestet. Unser sekundäres Ergebnis waren die von den Kindern gezeigten Bindungsmuster aus Ainsworths Fremde-Situations-Test. Trotz einiger Dropouts (n = 2 Fälle) ergaben eine Kovarianz-Analyse und T-Tests signifikante Unterschiede in der mütterlichen, der kindlichen und der gesamten Reflexionsfähigkeit bei moderaten Effektstärken. Im Vergleich zur Kontrollgruppe waren zwar mehr Kinder, deren Mütter die ATTACH-Intervention erhalten hatten, sicher gebunden, allerdings wurden keine signifikanten Unterschiede beobachtet, was möglicherweise auf fehlende Beobachtungen zurückzuführen ist (n = 5 Fälle). Das Wissen um die Wirksamkeit von Programmen wie ATTACH trägt zu verbesserten Programmen und Angeboten bei, die eine gesunde Entwicklung von Kindern fördern sollen, die von toxischem Stress betroffen sind.“アタッチメントと乳幼児の健康” (ATTACH) のパイロット研究:過剰なストレスに晒されている家族に対する親の内省機能介入の効果 過剰なストレス要因 (例:親の暴力、抑鬱、低収入) は、乳幼児を不安定なアタッチメントの状況におくリスクがある。親の内省機能−例えば、親の、自分自身や子どもの心の状態を理解し、それ故に子どもに対して、その感情や行動を制御する能力―は、アタッチメントにおける過剰なストレスのマイナス効果を緩和させるかもしれない。我々の研究目的は、リスクのある母親と生後36か月以下の乳幼児における、内省機能と乳幼児のアタッチメント安定性の改善に焦点を当た“アタッチメントと子どもの健康”(ATTACH)介入の効果を分析することであった。3つのパイロット研究を、脆弱な低収入家族へ支援をしている市内の機関と家庭内暴力のシェルターにいる母子に実施した。無作為化対照試験(n = 20, n = 10 登録時) と疑似実験(n = 10 登録時) の方法でペアレント・デベロップメント・インタビューを筆記したものから、内省機能スコアの最初の結果を分析した。我々の2つめの結果は、エインズワースの ストレインジ・シチュエーション法における乳幼児のアタッチメント・パターンである。多少の擦れ(n = 2 cases)があるにもかかわらず、共分散とt検定の混合法分析では、母親、乳幼児及び全体的な内省機能において、中程度の効果量で有意差があった。ATTACHプログラムを受けた母親の乳幼児はコントロール群に比較して、治療後より安定的にアタッチメントを示す一方、有意差は見られなかった。それは恐らく欠測値(n = 5 cases)によるものと思われる。ATTACHのようなプログラムの効果性を理解することは、過剰なストレスに晒された乳幼児の健康的な発達を促進するためにプログラムやサービスを改善することに寄与する。.摘 要:毒性压力源 (如父母暴力、抑郁、低收入) 会使儿童处于不安全依恋的风险中。育儿反思功能, 即父母认知自己和孩子的心理状态, 进而调节自己对孩子的感觉和行为的能力。它可以缓冲毒性压力对依恋的负面影响。我们的目标是测试依恋与儿童健康 (ATTACH) 干预措施的有效性, 重点是为了改善处于风险中的母亲的反思功能和36月龄以下儿童的依恋安全。我们对一个贫民区代理机构中的妇女和儿童进行了三项试点研究, 这个机构为弱势低收入家庭和家庭暴力庇护所提供服务。研究使用了随机对照试验 (n = 20, 入组时n = 10) 和准实验 (入组时n = 10) 两种方法, 通过录制的“父母发展访谈”测试了ATTACH对反思功能得分主要结果的影响。我们的次要结果是来自安斯沃思“陌生情境法”的儿童依恋模式。尽管有一些损耗 (n = 2例) , 协方差和t检验的混合方法分析显示, 母亲、儿童和整体反思功能存在显著差异, 均为中度影响。虽然有更多的其母亲接受ATTACH计划的儿童, 在治疗后表现为安全型依恋, 但与对照组相比, 未观察到显著的差异, 这可能是由于缺少观察结果 (n = 5例) 。了解诸如ATTACH计划的有效性有助于改进计划及其服务, 以促进受毒性压力影响的儿童的健康成长。.تجارب التعلق وصحة الطفل (ATTACH): تأثير تدخل الأداء التأملي الوالدي مع العائلات المتضررة من الضغوط السامة ملخص الضغوط السامة (مثل عنف الوالدين، والاكتئاب، والدخل المنخفض) تعرض الأطفال لخطر التعلق غير الآمن. والأداء التأملي الوالدي، أي قدرة الوالدين على فهم حالاتهم الخاصة وحالة أطفالهم النفسية، وبالتالي تنظيم مشاعرهم الخاصة وسلوكهم تجاه أطفالهم، قد يحجب الآثار السلبية للضغوط على التعلق. كان هدفنا هو اختبار فعالية التدخل في التعلق وصحة الطفل (ATTACH) ، مع التركيز على تحسين الأداء التأملي وأمن تعلق الأطفال ، للأمهات المعرضين للخطر والأطفال الأصغر من 36 شهرا من العمر. وأجريت ثلاث دراسات تجريبية مع نساء وأطفال من وكالة داخل المدينة تخدم الأسر الضعيفة المنخفضة الدخل وملجأ للعنف العائلي. وتم اختبار تأثير ATTACH)) على النتيجة الأولية لدرجات الأداء التأملي من خلال إجراءات تجريبية وشبه تجريبية (N = 10) وذلك من واقع تفريغ مقابلات تطوير الوالدين. وكانت النتائج الثانوية هي أنماط تعلق الأطفال من خلال إجراء الموقف الغريب (آيسنوورث). بالرغم من تراجع الاشتراك في الدراسة (2 حالة) ، فقد كشف تحليل التباين المشترك واختبارات الفروق الإحصائية عن اختلافات كبيرة في الأداء التأملي للأم والطفل وبشكل عام ، مع أحجام تأثير معتدل. في حين أن المزيد من الأطفال الذين تلقت أمهاتهم برنامج ATTACH كانوا متعلقين بشكل آمن بعد العلاج ، مقارنة بالمجموعة الضابطة ، ولم يتم ملاحظة اختلافات ذات دلالة إحصائية، مما قد يكون بسبب الملاحظات المفقودة (5 حالات) .إن فهم فعالية برامج مثل ATTACH يساهم في تحسين البرامج والخدمات لتعزيز النمو الصحي للأطفال المتضررين من الضغوط السامة.

BackgroundExposure to chronic stressors (poverty, addiction, family violence) in early life can derail children’s development. Interventions focused on parental reflective function may promote parents’ abilities to regulate their feelings and behaviors toward their children and buffer the impact of chronic stressors on children’s development by nurturing high-quality parent–child interaction.PurposeTo test the effectiveness of parental reflective function-focused intervention entitled Attachment and Child Health on parent–child interaction and child development.MethodsWe conducted two pilots with vulnerable mothers and children ResultsFor randomized controlled trial, we found significant improvements in PCITS parent total, combined total, and cognitive growth fostering scores, and ASQ-3 personal-social scores post-intervention. For quasi-experimental study, we found significant improvements in PCITS combined total, sensitivity to cues, response to child’s distress, and responsiveness to caregiver scores.ConclusionIncorporating Attachment and Child Health contributed to effective programming for vulnerable families with young children.

Many nurses rely on the American Nursing Child Assessment Satellite Training (NCAST) Parent-Child Interaction (PCI) Teaching and Feeding Scales to identify and target interventions for families affected by severe/chronic stressors (e.g. postpartum depression (PPD), intimate partner violence (IPV), low-income). However, the NCAST Database that provides normative data for comparisons may not apply to Canadian families. The purpose of this study was to compare NCAST PCI scores in Canadian and American samples and to assess the reliability of the NCAST PCI Scales in Canadian samples.This secondary analysis employed independent samples t-tests (p 0.005) to compare PCI between the American NCAST Database and Canadian high-risk (families with PPD, exposure to IPV or low-income) and community samples. Cronbach's alphas were calculated for the Canadian and American samples.In both American and Canadian samples, belonging to a high-risk population reduced parents' abilities to engage in sensitive and responsive caregiving (i.e. healthy serve and return relationships) as measured by the PCI Scales. NCAST Database mothers were more effective at executing caregiving responsibilities during PCI compared to the Canadian community sample, while infants belonging to the Canadian community sample provided clearer cues to caregivers during PCI compared to those of the NCAST Database. Internal consistency coefficients for the Canadian samples were generally acceptable.The NCAST Database can be reliably used for assessing PCI in normative and high-risk Canadian families.Canadian nurses can be assured that the PCI Scales adequately identify risks and can help target interventions to promote optimal parent-child relationships and ultimately child development.

Postpartum depression (PPD) is a growing mental health concern in new mothers and fathers. The purpose of this study was to determine the predictors of depression at 3 months postpartum, comparing depressed couples to couples with only one depressed partner or no depressed partner, using data from the Alberta Pregnancy Outcomes and Nutrition study. Data from mothers and fathers were collected at second trimester and 3 months postpartum. Results showed predictors of PPD in mothers to be low household income, high prenatal depressive symptoms, and postnatally, low social support and higher number of stressful life events. Fathers had similar predictors, including low household income, high prenatal depressive symptoms, and postnatally low social support and smoking. Compared with non-depressed couples, factors that predicted PPD in both mothers and fathers in couples included low income, high prenatal depressive symptoms in mothers and low prenatal social support reported by fathers.

Nursing has a long history of attending to the importance of early attachment experiences to later development. Attachment strategies formed in infancy and early childhood can have lifelong effects...

Disruptive behaviour disorders are much more common in boys than girls (Office of National Statistics, 1999); in contrast, gender differences in normative problem behaviours are poorly understood. To address this issue, 228 6-year-olds (134 boys, 94 girls) were each observed playing a board game with a same-gender friend. Ratings of aggression, disruption, arousal and negativity were used to index problem behaviours. Multiple-groups confirmatory factor analyses demonstrated that the latent factor had the same metric for boys and girls, but a mean that was approximately half a standard deviation higher for boys than girls. In addition, the association between the latent factor and teachers' ratings of total difficulties was significantly stronger for boys than girls.