Tea Trillingsgaard

Adult attachment at the transition to motherhood: predicting worry, health care utility and relationship functioning

Primary objective: To study (a) the associations between attachment styles, worry, and care utilisation in third trimester of first pregnancy (n = 567) and (b) the associations between third trimester attachment style and one year postpartum relationship satisfaction and parenting stress (n = 1069). Based on Bowlby’s attachment theory, we expected attachment anxiety and attachment avoidance to differ with regard to short-term appraisal of threat and interpersonal neediness, while the dimensions were expected to have similar deteriorating effect on longer-term outcomes in relationship functioning. Research design: A cross-sectional study nested within a randomised controlled trial. Methods and procedures: An assessment battery consisting of three scales at T1 and T2. Main outcome and results: Results confirmed that attachment anxiety was significantly associated with high pregnancy worry compared to attachment avoidance. None of the dimensions were associated with health care utility. Both attachment anxiety and attachment avoidance were associated with high parenting stress at one year postpartum, while only attachment anxiety was associated with low relationship satisfaction. Conclusion: These findings partly confirm conceptual distinctions between the two attachment dimensions, and point to adult attachment as an important factor in understanding the ways women cope with the challenges during the transition to motherhood.

Assessing the effectiveness of the ‘Incredible Years® parent training’ to parents of young children with ADHD symptoms – a preliminary report

This study examined the effectiveness of an evidence-based parent training program in a real-world Scandinavian setting. Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self-referred to participate in the Incredible Years(®) Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self-report data with data from a recent efficacy study. Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months. The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence-based US protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy-access early intervention to families of children with or at risk of ADHD.

Associations between older maternal age, use of sanctions, and children’s socio-emotional development through 7, 11, and 15 years

Abstract In developed countries more women are giving birth later in life and this trend has been linked with perinatal medical risks as well as with improved psychosocial adaptation. This study examined whether older maternal age was associated with less use of sanctions and with positive child outcome at age 7, 11, and 15. A random population sample of 4741 mothers from the Danish Longitudinal Survey of Children was used. Data were obtained through face-to-face interviews and self-report questionnaires. Older maternal age was associated with less frequent use of verbal and physical sanctions towards children at age 7 and 11. At age 15 this association remained significant for verbal sanctions but not physical sanctions. Older maternal age was associated with fewer behavioral, social and emotional difficulties in children at age 7 and at age 11 but not at age 15. The associations reported were significant independently of all observed demographic and socioeconomic characteristics.

Video feedback promotes relations between infants and vulnerable first-time mothers: a quasi-experimental study

BackgroundSupporting early mother-infant relationships to ensure infants’ future health has been recommended. The aim of this study was to investigate whether video feedback using the Marte Meo method promotes a healthy early relationship between infants and vulnerable first-time mothers. Video feedback or usual care was delivered by health visitors during home visits in Danish municipalities.MethodsThis quasi-experimental study included pre- and post-tests of 278 vulnerable families. Mothers were allocated to an intervention group (n = 69), a comparison group (n = 209) and an exactly matched video subsample from the comparison group (n = 63). Data consisted of self-reported questionnaires and video recordings of mother-infant interactions. Outcomes were mother-infant dyadic synchrony (CARE-Index), maternal confidence (KPCS), parental stress (PSS), maternal mood (EPDS) and infant socialemotional behaviours (ASQ:SE). The data were analysed using descriptive and linear multiple regression analysis.ResultsThe levels of dyadic synchrony in the intervention group had significantly improved (p < 0.001) at follow-up with a mean score of 9.51 (95%CI;8.93–10.09) compared with 7.62 (95%CI;7.03–8.21). The intervention group also showed a higher level of maternal sensitivity with a mean score of 9.55 (95%CI;8.96–10.14) compared with 7.83 (95%CI;7.19–8.46) in the matched video subsample (p < 0.001). With respect to infant cooperation, similar improvements were found with a mean score of 9.43 (95% CI;8.88–9.99) in the intervention group compared with 7.73 (95%CI;7.13–8.33) in the matched video subsample from the comparison group (p < 0.001). Furthermore, mothers in the intervention group reported significantly lower levels of parental stress with a mean score of 32.04 (95%CI;30.13–33.94) compared with 35.29 (95%CI;34.07–36.52) in the comparison group (p = 0.03), as well as higher levels of maternal confidence with a mean score of 41.10 (95%CI;40.22–41.98) compared with 40.10 (95%CI;39.65–40.56) in the comparison group (p = 0.04). No significant differences were found in EPDS and ASQ:SE.ConclusionThe findings support the assumption that video feedback using the Marte Meo method early after birth may strengthen the relationship between infants and vulnerable firsttime mothers as well as improve maternal psychosocial functioning. Further research applying random assignment is needed to strengthen these conclusions; further research is also needed to assess any long term effects of the video feedback intervention using the Marte Meo method.Trial registrationThis study was registered on 24 January 2013 in ClinicalTrials.gov with the identifier: NCT01799447.

The Family Startup Program: study protocol for a randomized controlled trial of a universal group-based parenting support program

BackgroundInadequate parenting is an important public health problem with possible severe and long-term consequences related to child development. We have solid theoretical and political arguments in favor of efforts enhancing the quality of the early family environment in the population at large. However, little is known about effect of universal approaches to parenting support during the transition to parenthood. This protocol describes an experimental evaluation of group based parenting support, the Family Startup Program (FSP), currently implemented large scale in Denmark.Methods/designParticipants will be approximately 2500 pregnant women and partners. Inclusion criteria are parental age above 18 and the mother expecting first child. Families are recruited when attending routine pregnancy scans provided as a part of the publicly available prenatal care program at Aarhus University Hospital, Skejby. Families are randomized within four geographically defined strata to one of two conditions a) participation in FSP or b) Treatment As Usual (TAU). FSP aims to prepare new families for their roles as parents and enhance parental access to informal sources of support, i.e. social network and community resources. The program consists of twelve group sessions, with nine families in each group, continuing from pregnancy until the child is 15 months old. TAU is the publicly available pre- and postnatal care available to families in both conditions. Analyses will employ survey data, administrative data from health visitors, and administrative register based data from Statistics Denmark. All data sources will be linked via the unique Danish Civil Registration Register (CPR) identifier. Data will be obtained at four time points, during pregnancy, when the child is nine months, 18 months and seven years. The primary study outcome is measured by the Parenting Sense of Competence scale (PSOC) J Clin Child Psychol 18:167-75, 1989. Other outcomes include parenting and couple relationship quality, utility of primary sector service and child physical health, socio-emotional and cognitive development.DiscussionThe protocol describes an ambitious experimental evaluation of a universal group-based parenting support program; an evaluation that has not yet been made either in Denmark or internationally.Trial registrationClinicalTrials.gov ID: NCT02294968. Registered November 14 2014.

Adult attachment and the perceived cost of housework and child care

Objective: This study examined the link between new mothers’ attachment orientation and the perceived cost of sole responsibility in housework and child care. Background: The transition to motherhood can be very stressful, and according to the Vulnerability Stress Adaptation Model (VSA model), the way it affects the couple relationship is likely to depend on interacting factors from different domains of risk (e.g. individual and couple level). We expected interactions to appear between domains of attachment and labour division. The hypothesis was that sole responsibility in child care and housework would predict lower relationship satisfaction, particularly among mothers who were high on attachment insecurity. Methods: Data from self-report measures of adult attachment, child care, housework and relationship satisfaction were collected from 255 first-time mothers at six months postpartum. Results: Sole responsibility in child care predicted lower relationship satisfaction, particularly among mothers who were high on attachment avoidance. This interaction effect was significant but small. Among main effects, higher levels of either attachment anxiety or avoidance were linked with lower relationship satisfaction and lower levels of sole responsibility in childcare was linked with higher relationship satisfaction. Conclusion: These findings provide new data on the how risk factors from separate domains combine, and implications are discussed in terms of applying the VSA model when developing preventive interventions for new mothers.

Relationship Help-Seeking in a Danish Population Sample

Empirically supported couple interventions often transfer from the US to several other parts of the world yet we have little data on their final reach. This study investigated relationship help-seeking in a random population sample of 1,371 individuals living with a partner in Denmark, a European high income - high divorce country. Only a small fraction of respondents had ever sought couple education (3%) or counseling/therapy (7%) with their partner. Among respondents experiencing a severe relationship crisis, individual types of help-seeking were the most prevalent. Both women (38.9%) and men (27.8%) with a recent relationship crisis sought information online, and mostly women (19.4%) also sought individual therapy. Findings can inform strategies for increasing the reach of couples in new cultural contexts.