Katherine L. Rosenblum

Psychosocial Constraints on the Development of Resilience

Abstract:  Although resilience is usually thought to reside in individuals, developmental research is increasingly demonstrating that characteristics of the social context may be better predictors of resilience. When the relative contribution of early resilience and environmental challenges to later child mental health and academic achievement were compared in a longitudinal study from birth to adolescence, indicators of child resilience, such as the behavioral and emotional self‐regulation characteristic of good mental health, and the cognitive self‐regulation characteristic of high intelligence contributed to later competence. However, the effects of such individual resilience did not overcome the effects of high environmental challenge, such as poor parenting, antisocial peers, low‐resource communities, and economic hardship. The effects of single environmental challenges become very large when accumulated into multiple risk scores even affecting the development of offspring in the next generation.

Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?

Objective: The utility of several self‐report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD).

Mindfulness yoga during pregnancy for psychiatrically at-risk women: Preliminary results from a pilot feasibility study

Prenatal psychopathology may have an adverse impact on mother and baby, but few women receive treatment. We offered a 10-week mindfulness yoga (M-Yoga) intervention to psychiatrically high-risk pregnant women as an alternative to pharmacological treatment. Participants (N = 18) were primiparous, 12-26 weeks pregnant, and had elevated scores (>9) on the Edinburgh Postnatal Depression Screen at baseline. In addition to a baseline diagnostic assessment, women completed self-ratings on depression, mindfulness, and maternal-fetal attachment before and after M-Yoga. Findings suggest that M-Yoga was feasible, accepted and effective. Symptoms of depression were significantly reduced (p = 0.025), while mindfulness (p = 0.007) and maternal-fetal attachment (p = 0.000) significantly increased. Overall, this pilot study is the first to demonstrate that M-Yoga may be an effective treatment alternative or augmentation to pharmacotherapy for pregnant women at high risk for psychopathology.

Maternal reflective functioning among mothers with childhood maltreatment histories: links to sensitive parenting and infant attachment security

This study examined relationships among maternal reflective functioning, parenting, infant attachment, and demographic risk in a relatively large (N = 83) socioeconomically diverse sample of women with and without a history of childhood maltreatment and their infants. Most prior research on parental reflective functioning has utilized small homogenous samples. Reflective functioning was assessed with the Parent Development Interview, parenting was coded from videotaped mother–child interactions, and infant attachment was evaluated in Ainsworth’s Strange Situation by independent teams of reliable coders masked to maternal history. Reflective functioning was associated with parenting sensitivity and secure attachment, and inversely associated with demographic risk and parenting negativity; however, it was not associated with maternal maltreatment history or PTSD. Parenting sensitivity mediated the relationship between reflective functioning and infant attachment, controlling for demographic risk. Findings are discussed in the context of prior research on reflective functioning and the importance of targeting reflective functioning in interventions.

Associations between maternal depressive symptoms and child feeding practices in a cross-sectional study of low-income mothers and their young children

BackgroundMaternal depression may influence feeding practices important in determining child eating behaviors and weight. However, the association between maternal depressive symptoms and feeding practices has been inconsistent, and most prior studies used self-report questionnaires alone to characterize feeding. The purpose of this study was to identify feeding practices associated with maternal depressive symptoms using multiple methodologies, and to test the hypothesis that maternal depressive symptoms are associated with less responsive feeding practices.MethodsIn this cross-sectional, observational study, participants (n = 295) included low-income mothers and their 4- to 8-year-old children. Maternal feeding practices were assessed via interviewer-administered questionnaires, semi-structured narrative interviews, and videotaped observations in home and laboratory settings. Maternal depressive symptoms were measured using the Center for Epidemiologic Studies-Depression scale (CES-D). Regression analyses examined associations between elevated depressive symptoms (CES-D score ≥16) and measures of maternal feeding practices, adjusting for: child sex, food fussiness, number of older siblings; and maternal age, body mass index (BMI), education, race/ethnicity, single parent status, perceived child weight, and concern about child weight.ResultsThirty-one percent of mothers reported depressive symptoms above the screening cutoff. Mothers with elevated depressive symptoms reported more pressuring of children to eat (β = 0.29; 95% Confidence Interval (CI): 0.03, 0.54) and more overall demandingness (β = 0.16; 95% CI: 0.03, 0.29), and expressed lower authority in child feeding during semi-structured narrative interview (Odds Ratio (OR) for low authority: 2.82; 95% CI: 1.55, 5.12). In homes of mothers with elevated depressive symptoms, the television was more likely audible during meals (OR: 1.91; 95% CI: 1.05, 3.48) and mothers were less likely to eat with children (OR: 0.48; 95% CI: 0.27, 0.85). There were no associations between maternal depressive symptoms and encouragement or discouragement of food in laboratory eating interactions.ConclusionsMothers with elevated depressive symptoms demonstrated less responsive feeding practices than mothers with lower levels of depressive symptoms. These results suggest that screening for maternal depressive symptoms may be useful when counseling on healthy child feeding practices. Given inconsistencies across methodologies, future research should include multiple methods of characterizing feeding practices and direct comparisons of different methodologies.

The Effects of Domestic Violence on the Stability of Attachment from Infancy to Preschool

We hypothesized that trajectories of domestic violence (DV), maternal depression, and household income (from pregnancy to age 4) would be differentially associated with instability and stability of attachment, as measured by the Strange Situation at ages 1 and 4. Participants were 150 women and children. Women were first assessed during pregnancy and then yearly when the children were 1 to 4 years old. Overall, attachment was unstable for 56% of the sample from age 1 to age 4. Trajectories of DV and income both predicted attachment patterns. Positive outcomes (secure-secure and insecure-secure) were related to initially low levels of DV that stayed constant or became lower as well as initially high or low levels of income that increased over time.

Maternal Mobile Device Use During a Structured Parent–Child Interaction Task

OBJECTIVE To examine associations of maternal mobile device use with the frequency of mother-child interactions during a structured laboratory task. METHODS Participants included 225 low-income mother-child pairs. When children were ∼6 years old, dyads were videotaped during a standardized protocol in order to characterize how mothers and children interacted when asked to try familiar and unfamiliar foods. From videotapes, we dichotomized mothers on the basis of whether or not they spontaneously used a mobile device, and we counted maternal verbal and nonverbal prompts toward the child. We used multivariate Poisson regression to study associations of device use with eating prompt frequency for different foods. RESULTS Mothers were an average of 31.3 (SD 7.1) years old, and 28.0% were of Hispanic/nonwhite race/ethnicity. During the protocol, 23.1% of mothers spontaneously used a mobile device. Device use was not associated with any maternal characteristics, including age, race/ethnicity, education, depressive symptoms, or parenting style. Mothers with device use initiated fewer verbal (relative rate 0.80; 95% confidence interval 0.63, 1.03) and nonverbal (0.61; 0.39, 0.96) interactions with their children than mothers who did not use a device, when averaged across all foods. This association was strongest during introduction of halva, the most unfamiliar food (0.67; 0.48, 0.93 for verbal and 0.42; 0.20, 0.89 for nonverbal interactions). CONCLUSIONS Mobile device use was common and associated with fewer interactions with children during a structured interaction task, particularly nonverbal interactions and during introduction of an unfamiliar food. More research is needed to understand how device use affects parent-child engagement in naturalistic contexts.

Blunted cortisol response to stress is associated with higher body mass index in low-income preschool-aged children.

No known studies have tested the hypothesis that a blunted pattern of cortisol reactivity to stress, which is often found following exposure to chronic life stressors, is associated with a higher body mass index (BMI) in very young children. Low-income children (n=218, mean age 56.6 (range: 38.1-78.5; SD 7.0) months, 49.1% male, 56.4% white, 16.1% black, 11.5% Hispanic/Latino) participated in a series of behavioral tasks designed to elicit stress. Cortisol was sampled in saliva 5 times during the protocol, and area under the curve (AUC), representing total cortisol output during stress elicitation, was calculated. Children were weighed and height measured and body mass index (BMI) z-score was calculated. Linear regression was used to evaluate the association between cortisol AUC and BMI z-score, controlling for child age, sex, and race/ethnicity (non-Hispanic white vs. not); primary caregiver weight status (overweight, defined as BMI ≥ 25 vs. not); and family income-to-needs ratio. Mean child BMI z-score was 0.88 (SD=1.03). Mean cortisol AUC was 6.11 μg/dL/min (SD=10.44). In the fully adjusted model, for each 1-standard deviation unit decrease in cortisol AUC, the childs BMI z-score increased by 0.17 (SE 0.07) standard deviation units (p<0.02). A blunted cortisol response to stress, as is often seen following chronic stress exposure, is associated with increased BMI z-score in very young children. Further work is needed to understand how associations between stress, cortisol, and elevated body mass index may develop very early in the lifespan.

Maternal styles of talking about child feeding across sociodemographic groups.

This study sought to identify maternal styles of talking about child feeding from a semistructured interview and to evaluate associated maternal and child characteristics. Mothers of preschool-aged children (n=133) of diverse race/ethnicity and socioeconomic status (SES) (45 lower SES black, 29 lower SES white, 32 lower SES Hispanic, 15 middle to upper SES white, and 12 middle to upper SES Asian) participated in a semistructured interview about feeding. Interviews were audiotaped and transcribed. Themes were identified, and individual interviews were coded within these themes: authority (high/low), confidence (confident/conflicted/unopinionated), and investment (deep/mild/removed). Demographic characteristics were collected and a subset of children had measured weights and heights. Cluster analysis was used to identify narrative styles. Participant characteristics were compared across clusters using Fishers exact test and analysis of variance. Six narrative styles were identified: Easy-Going, Practical No-Nonsense, Disengaged, Effortful No-Nonsense, Indulgent Worry, and Conflicted Control. Cluster membership differed significantly based on maternal demographic group (P<0.001) and child weight status (P<0.05). More than half (60%) of children of mothers in the Conflicted Control cluster were obese. Maternal styles of talking about feeding are associated with maternal and child characteristics.

The role of infant sleep in intergenerational transmission of trauma.

INTRODUCTION Children of parents who experienced trauma often present emotional and behavioral problems, a phenomenon named inter-generational transmission of trauma (IGTT). Combined with antenatal factors, parenting and the home environment contribute to the development and maintenance of sleep problems in children. In turn, infant sleep difficulty predicts behavioral and emotional problems later in life. The aim of this study was to investigate whether infant sleep problems predict early behavioral problems indicative of IGTT. METHODS 184 first-time mothers (ages 18-47) participated. N=83 had a history of childhood abuse and posttraumatic stress disorder (PTSD+); 38 women reported childhood abuse but did not meet diagnostic criteria for PTSD (PTSD-); and the control group (N=63) had neither a history of abuse nor psychopathology (CON). Depression, anxiety, and sleep difficulty were assessed in the mothers at 4 months postpartum. Infant sleep was assessed using the Child Behavior Sleep Questionnaire (CSHQ). Outcome measures included the Parent Bonding Questionnaire (PBQ) at 4 months and the Child Behavior Check List (CBCL) at 18 months. RESULTS Infants of PTSD+ mothers scored higher on the CSHQ and had more separation anxiety around bedtime than PTSD- and CON, and the severity of their symptoms was correlated with the degree of sleep disturbance. Maternal postpartum depression symptoms mediated impaired mother-infant bonding, while infant sleep disturbance contributed independently to impaired bonding. Mother-infant bonding at 4 months predicted more behavioral problems at 18 months. CONCLUSIONS Infant sleep difficulties and maternal mood play independent roles in infant-mother bonding disturbance, which in turn predicts behavioral problems at 18 months.