Julie Poehlmann-Tynan

Risk and resilience in preterm children at age 6.

Children born preterm are at risk for experiencing significant deleterious developmental outcomes throughout their childhood and adolescence. However, individual variation and resilience are hallmarks of the preterm population. The present study examined pathways to resilience across multiple domains (e.g., social activities, peer relations, attention-deficit/hyperactivity disorder symptomology, externalizing and internalizing behavior, and sleep quality) as children born preterm reached school age. The study also examined early child and family predictors of resilience. Using a prospective longitudinal design, 173 infants born preterm and without significant neurological complications were assessed at five time points: neonatal intensive care unit discharge, 9 months, 16 months, 24 months, and 6 years. Three pathways of adaptation emerged at 6 years: children who were resilient, those who remained at-risk, and children who exhibited significant difficulties. Resilient children were less likely to have experienced negative parenting at 9 and 16 months, more likely to delay gratification at 24 months, and more likely to experience neonatal health complications than nonresilient children.

The Influence of Children's Cognitive Delay and Behavior Problems on Maternal Depression

OBJECTIVE To determine the impact of childrens cognitive delay and behavior on maternal depressive symptoms using a large national cohort of US families. STUDY DESIGN Data were drawn from 2 waves of the nationally representative Early Childhood Longitudinal Study, Birth Cohort (n = 7550). Cognitive delay was defined at age 24 months by the lowest 10th percentile of the Bayley Short Form-Research Edition. At age 4 years, the childrens behavior was assessed using the Preschool and Kindergarten Behavior Scales, administered to mothers and primary nonparental child care providers, and maternal depressive symptoms with the Center for Epidemiological Studies Depression Scale. Weighted generalized estimating equation models examined whether the childrens behavior mediated the relationship between their cognitive delay status at 24 months and 4-year maternal depressive outcomes. RESULTS At age 4 years, 26.9% of mothers of children with cognitive delay reported high depressive symptoms, compared with 17.4% of mothers of typically developing children (P < .0001). When the childrens behavior was accounted for, the effect of cognitive delay on maternal depressive symptoms decreased by 36% (P < .0001). These findings remained significant when the childrens behaviors were assessed by their primary nonparental care providers. CONCLUSION Caring for a child with a cognitive delay influences maternal depressive symptoms in part through the childs behavior problems. Preventive interventions to ameliorate adverse outcomes for children with cognitive delay and their families should consider the impact of the childrens behavior.

Circadian Sleep Patterns in Toddlers Born Preterm: Longitudinal Associations with Developmental and Health Concerns.

Objective: Children born preterm are at elevated risk for several developmental and health concerns. Early sleep patterns may be associated with these concerns. The current study assesses the associations between toddler circadian sleep/activity patterns and later developmental, behavioral, attentional, and health concerns in this at-risk population. Method: We examined circadian sleep/activity patterns at 2 years of age in 99 children born preterm. Child cognitive skills were tested at 3 years of age, and behavior, attention, and health concerns were reported at 3 and 6 years of age. First, sleep/activity data collected via actigraphy were assessed using time series analysis (TSA). For this, we assessed how each childs sleep/activity pattern compared to a specified 24-hour circadian cycle (SCC) with an adjustment for daytime napping. Second, in a series of regression models child sleep/activity parameters from the TSA were assessed with child gender, prematurity, and family sociodemographic assets as covariates. Results: Toddlers with patterns that closely aligned with the SCC had higher abbreviated intelligence quotient scores at 3 years of age. Additionally, at 6 years these children had a lower risk for illness-related medical visits. Higher toddler average activity level was associated with fewer teacher-reported attention-deficit hyperactivity disorder symptoms and a lower risk for illness-related medical visits. Conclusion: The novel approach used in this study to index child circadian patterns provides a pattern-based analysis of sleep/activity, which may prove to be developmentally consequential. With replication, these findings may help practitioners promote optimal cognitive and health development via circadian sleep supports in infants born preterm.

Young Children’s Behavioral and Emotional Reactions to Plexiglas and Video Visits with Jailed Parents

Approximately 11.7 million individuals were admitted to jails in the US in 2013, similar to the previous year, and national estimates indicate that 36 % of these individuals are parents of children under 15 years of age. Many children with parents who are incarcerated in jail or prison experience multiple risk factors and they are more likely to develop a host of health and behavioral health difficulties in childhood and adulthood compared to their peers. Maintenance of relationships with incarcerated parents is often seen as important for children’s well-being during the parental incarceration period, yet concerns have been raised about visitation in corrections facilities, especially visits involving security procedures or non-contact visits. The present study is the first to report observational data about young children’s visits to jails that used Plexiglas barriers or video monitors for visitation. Results of observations of 20 children indicated that children engaged verbally and visually with their incarcerated parents. They stayed in close proximity to the caregivers who brought them and engaged in an increasing amount of contact maintenance as the visit progressed. Children spent a surprising amount of time watching the visits occurring adjacent to them because of the lack of privacy during visits.

Mother–Child Interactions in the NICU: Relevance and Implications for Later Parenting

OBJECTIVE This study examined the feasibility of observing mother-child interactions in the neonatal intensive care unit (NICU), whether NICU interactions related to later interactions, and how interactions related to child and maternal characteristics. METHODS The sample included 130 preterm infants and their mothers, observed in a feeding interaction in the NICU. Dyads were observed through 36 months postterm. RESULTS Observed maternal positive affective involvement and verbalizations in the NICU were associated with the same parenting behaviors at 24 months, social support, socioeconomic status, and being born in the late preterm period. Maternal negative affect and behavior were unrelated to later maternal negativity or child and maternal characteristics. CONCLUSIONS Positive parenting assessed in the NICU appears related to later parenting interaction quality, suggesting early assessment is possible. Maternal negative affect and behavior toward children may not consistently emerge until later in development.

Comparing Emotion Recognition Skills among Children with and without Jailed Parents

Approximately five million children in the United States have experienced a co-resident parent’s incarceration in jail or prison. Parental incarceration is associated with multiple risk factors for maladjustment, which may contribute to the increased likelihood of behavioral problems in this population. Few studies have examined early predictors of maladjustment among children with incarcerated parents, limiting scholars’ understanding about potential points for prevention and intervention. Emotion recognition skills may play a role in the development of maladjustment and may be amenable to intervention. The current study examined whether emotion recognition skills differed between 3- to 8-year-old children with and without jailed parents. We hypothesized that children with jailed parents would have a negative bias in processing emotions and less accuracy compared to children without incarcerated parents. Data were drawn from 128 families, including 75 children (53.3% male, M = 5.37 years) with jailed parents and 53 children (39.6% male, M = 5.02 years) without jailed parents. Caregivers in both samples provided demographic information. Children performed an emotion recognition task in which they were asked to produce a label for photos expressing six different emotions (i.e., happy, surprised, neutral, sad, angry, and fearful). For scoring, the number of positive and negative labels were totaled; the number of negative labels provided for neutral and positive stimuli were totaled (measuring negative bias/overextension of negative labels); and valence accuracy (i.e., positive, negative, and neutral) and label accuracy were calculated. Results indicated a main effect of parental incarceration on the number of positive labels provided; children with jailed parents presented significantly fewer positive emotions than the comparison group. There was also a main effect of parental incarceration on negative bias (the overextension of negative labels); children with jailed parents had a negative bias compared to children without jailed parents. However, these findings did not hold when controlling for child age, race/ethnicity, receipt of special education services, and caregiver education. The results provide some evidence for the effect of the context of parental incarceration in the development of negative emotion recognition biases. Limitations and implications for future research and interventions are discussed.

Children’s Contact with Incarcerated Parents: Summary and Recommendations

One in 28 children in the United States has a parent behind bars and even more children are affected if one examines risk for having an incarcerated parent across childhood. Given these statistics, it is not surprising that children are common visitors in corrections facilities. Because children are frequent visitors and the experiences can be emotionally intense for children and their family members, it is important to examine policies, procedures, and interventions that might improve the experience of visitation and other forms of contact for this vulnerable group of children. In the summary of this monograph, I first discuss important considerations when examining parent–child contact and delineate several methodological contributions of the papers in this volume. I then offer suggestions relating to changes in policies, procedures, and practices that may improve the experience of parent–child contact during parental incarceration as well as fostering the well-being of affected children and families.

Trajectories of Externalizing and Internalizing Behaviors in Preterm Children Admitted to a Neonatal Intensive Care Unit

OBJECTIVE To examine the trajectories of internalizing and externalizing behavior problems of preterm children between 16 months and 6 years of age and predictors of trajectories, including gestational age, child dysregulation, maternal depression, socioeconomic status, and parenting. STUDY DESIGN This longitudinal study followed 148 children and their mothers from neonatal intensive care unit discharge until 6 years of age. Gestational ages ranged from 23 to 36 weeks. The study included assessment of maternal-reported behavior problems, maternal depression, neonatal and socioeconomic characteristics, and observations of dysregulated behavior and parenting. Trajectories were identified with a semiparametric group-based analytic method, and multinomial logistic regression was used to identify significant risk factors. RESULTS Three distinct trajectories for preterm children were found for both internalizing and externalizing behavior problems. For the 2 groups with greater behavior problems (groups 1 and 2), trajectories reached their peak between 24 and 36 months of age, then leveled off or decreased. Group 3 showed a stable low level of externalizing behaviors, and a low, but slightly increasing level of internalizing behaviors. Maternal depression, child dysregulation, gestational age, and socioeconomic challenges were identified as risk factors that predicted less optimal behavior problem trajectories. CONCLUSIONS Children born prematurely followed 1 of 3 distinct developmental trajectories for both internalizing and externalizing behavior problems. The most severe behavior problems started early in development and were associated with increased child dysregulation, maternal depression, and lower socioeconomic status. These findings have implications for screening and monitoring preterm children.

Attachment in young children with incarcerated fathers

The present study examined young childrens attachment behaviors during paternal incarceration and reported on initial validity of a new measure used to rate childrens attachment-related behaviors and emotions during visits in a corrections setting. Seventy-seven children, age 2 to 6 years, and their jailed fathers and current caregivers participated in the home visit portion of the study, whereas 28 of these children participated in the jail visit. The results indicated that 27% of children witnessed the fathers crime and 22% of children witnessed the fathers arrest, with most children who witnessed these events exhibiting extreme distress; children who witnessed these events were more likely to have insecure attachments to their caregivers. Consistent with attachment theory and research, caregivers who exhibited more sensitivity and responsivity during interactions with children and those who provided more stimulating, responsive, learning-oriented home environments had children who were more likely to have secure attachments (measured with the Attachment Q-Sort). We also found preliminary evidence for the validity of our new measure, the Jail Prison Observation Checklist, in that childrens attachment-related behaviors and emotions during the jail visit correlated with their attachment security observed in the home. Our observations indicate that, in certain contexts, noncontact visits with incarcerated parents can be stressful for children and that childrens caregivers may play a significant role during these visits.