Ursula Pauli-Pott

Neuropsychological basic deficits in preschoolers at risk for ADHD: A meta-analysis

Widely accepted neuropsychological theories on attention deficit hyperactivity disorder (ADHD) assume that the complex symptoms of the disease arise from developmentally preceding neuropsychological basic deficits. These deficits in executive functions and delay aversion are presumed to emerge in the preschool period. The corresponding normative developmental processes include phases of relative stability and rapid change. These non-linear developmental processes might have implications for concurrent and predictive associations between basic deficits and ADHD symptoms. To derive a description of the nature and strength of these associations, a meta-analysis was conducted. It is assumed that weighted mean effect sizes differ between basic deficits and depend on age. The meta-analysis included 25 articles (n=3005 children) in which associations between assessments of basic deficits (i.e. response inhibition, interference control, delay aversion, working memory, flexibility, and vigilance/arousal) in the preschool period and concurrent or subsequent ADHD symptoms or diagnosis of ADHD had been analyzed. For response inhibition and delay aversion, mean effect sizes were of medium to large magnitude while the mean effect size for working memory was small. Meta-regression analyses revealed that effect sizes of delay aversion tasks significantly decreased with increasing age while effect sizes of interference control tasks and Continuous Performance Tests (CPTs) significantly increased. Depending on the normative maturational course of each skill, time windows might exist that allow for a more or less valid assessment of a specific deficit. In future research these time windows might help to describe early developing forms of ADHD and to identify children at risk.

Infants with atopic dermatitis: maternal hopelessness, child-rearing attitudes and perceived infant temperament.

Background: Atopic dermatitis (AD) is a common disease of childhood. It frequently starts in the first year of life. There is agreement on the existence of psychological influences on this disease. Although some studies in this field examine aspects of the parent-child relationship, studies concerning early infancy are very rare. The present study was conducted in order to find out whether maternal characteristics relevant to the mother-infant relationship, i.e. depressiveness/hopelessness, child-rearing attitudes and perceived infant behaviour, associated with infant AD. Methods: Two cohorts (3- to 4-month- and 10- to 12-month-old infants), each with 20 infants suffering from AD, and 20 healthy infants were recruited. AD infants were further divided into subgroups according to the diagnostic criteria: atopic family history, itching and characteristic locations of eczema. After a paediatric examination of the infant, mothers completed standardized questionnaires concerning depressiveness/hopelessness, child-rearing attitudes and perception of infant behaviour. Results: Varying with different diagnostic features of the infants’ AD, mothers of AD infants described themselves as more depressive/hopeless, as more anxious/overprotective and characterized their infant as less frequently positive and more frequently negative in its emotional behaviour compared to the control group. Conclusion: The results underline the importance of psychological support for mothers of infants with AD.

Parental perceptions and infant temperament development

Abstract The assumption that subjective parental perceptions of infant affective temperament characteristics as measured by parent reports influence the development of these characteristics has occasionally been considered in the literature. The present study investigates whether parental perceptions concerning infant positive emotionality, negative emotionality and fear are predictive of the subsequent development of these characteristics. One hundred and one infants and their primary caregivers were observed at infant ages of 4, 8, and 12 months. At each age the temperament characteristics were assessed using standardized laboratory routines and parent reports. A structural equation model with observed variables was specified and evaluated. It was shown that in most cases parental perceptions preceded the observed temperament characteristic. Specifically, the caregiver’s perception of the 4-month-old as high in positive emotionality was followed by higher positive emotionality in the infant at 8 months and the perception of high negative emotionality at 8 months was followed by high negative emotionality at 12 months. In the case of fear, predictability from the caregiver’s preceding expectations was demonstrated between 4 and 8 as well as between 8 and 12 months. The findings suggest that parents shape the developing infant temperament characteristics according to their perceptions.

Contexts of relations of infant negative emotionality to caregiver’s reactivity/sensitivity☆☆

Abstract The aim of the study was to examine whether and how infant negative emotionality, depression in the caregiver, and marital emotional support are related to the caregiver’s reactivity/sensitivity. The central question concerned interaction effects between these risk factors. Furthermore, it was of special interest whether there were interaction effects of infant positive and negative emotionality on the reactivity/sensitivity of the caregiver. Participants were 101 mothers and their healthy 4-month-olds. The infant temperament characteristics were measured by parent report as well as in the laboratory. Caregiver behavior was observed during home visits. Hierarchical regression analyses were computed. Whereas there were no direct associations between either maternal depression or infant negative emotionality and maternal reactivity/sensitivity, the interaction of the two risk factors proved highly significant. Good marital support was directly linked to maternal reactivity/sensitivity. The relevance of positive infant emotionality could not be demonstrated.

Association between Inhibitory Control Capacity and Body Weight in Overweight and Obese Children and Adolescents: Dependence on Age and Inhibitory Control Component

It has been assumed that overweight individuals show weak inhibitory control capacity leading to a failure to resist external cues for palatable food and that this deficit underlies the recently reported empirical association between obesity and attention deficit/hyperactivity disorder (ADHD). In childhood and adolescence, empirical research on this issue is scarce. Here, the hypothesis is tested that high body weight is associated with weak inhibitory control performance and that this association is moderated by age. The sample included 177 overweight and obese children and adolescents (BMI: M = 29.2, SD = 4.33; BMI-SDS: M = 2.45, SD = 0.43) between 8 and 15 years. Inhibitory control was assessed by a Go/No-Go task and an Interference Task. A principal component analysis yielded two components: impulsivity (fast but invalid responses) and inattention (highly variable reaction times). While controlling for age, gender, and maternal education level, we found that more obese children/adolescents showed more inattention. As indicated by a significant interaction effect, exclusively at younger ages, high impulsivity was associated with high body weight. The results thus confirm a link between low inhibitory control capacity and high body weight and might point to a developmental period with heightened significance of impulsivity for weight gain.

Treating childhood obesity: Family background variables and the child's success in a weight‐control intervention

OBJECTIVE To analyze whether caregiver and family characteristics predict success in a family-based lifestyle intervention program for children and adolescents. METHOD Participants were 111 overweight and obese children (7-15 years) who attended a family-based weight-reduction program. Body mass index (BMI) and BMI standard deviation scores (BMI-SDS) of index child, and BMI of family members, family adversity characteristics, depression, and attachment attitudes of the primary caregiver were assessed. RESULTS Risk of nonresponse (<or=5% reduction of BMI-SDS or dropout) was elevated in older children, cases with obese sibling(s), maternal depression, and avoidant attachment attitude. In a logistic regression analysis, maternal depression, attachment attitude, and age of index child explained common variance whereas the presence of obese siblings explained unique variance in nonresponding. DISCUSSION To meet the specific needs of all participating families and to prevent the discouraging experience of failure in weight-control interventions, our data suggest that special support should be provided to adolescents with obese siblings, and cases of maternal depression, and avoidant attachment attitude.

Conditions of Long-term Success in a Lifestyle Intervention for Overweight and Obese Youths

OBJECTIVE: Childhood lifestyle interventions usually involve the families. However, knowledge of family characteristics that promote or constrain a childs weight-reduction outcome is limited. Candidates for such factors might be family characteristics that have proven to be associated with social adjustment (development) in childhood. Thus, we analyzed whether family adversity, maternal depression, and attachment insecurity predict long-term success in childrens weight reduction. PATIENTS AND METHODS: Participants in the study were 111 parent-child dyads with overweight and obese children/adolescents (BMI mean: 29.07 [SD: 4.7] [range: 21.4–44.9]; BMI SD score mean: 2.43 [SD: 0.44] [range: 1.31–3.54]) aged between 7 and 15 years. The families took part in a best-practice lifestyle intervention of 1 years duration. A longitudinal analysis with 3 assessment waves (baseline, conclusion, 1-year follow-up) was conducted. RESULTS: Hierarchical regression analyses revealed that long-term success (at least 5% weight reduction by the 1-year follow-up) versus failure (dropping out or less weight reduction) was significantly predicted by the set of psychosocial variables (family adversity, maternal depression, and attachment insecurity) when we controlled for familial obesity, preintervention overweight, age, and gender of the index child and parental educational level. Maternal depression proved to be the best predictor. Maintenance of weight reduction between the conclusion of the program and the 1-year-follow-up was also predicted by the set of psychosocial variables. Maternal insecure-anxious attachment attitudes best predicted this criterion. CONCLUSIONS: Although cross-validation is required, our results are the first evidence for proximal and distal family characteristics linked to long-term weight-reduction outcomes. The results suggest a need to create tailored intervention modules that address the difficulties of these families.

Negative emotionality, attachment quality, and behavior problems in early childhood

Negative emotionality, as well as attachment security and disorganization, are seen as major contributors to social adjustment and maladjustment in childhood. However, relatively little is known about whether infant negative emotionality and attachment quality operate together to affect developing behavior problems. The present study thus aims to contribute to this question. Participants were 64 healthy firstborn children and their primary caregivers. Negative emotionality was assessed at the infant ages of 4, 8, and 12 months using laboratory routines. At 18 months, the Strange Situation procedure was conducted to assess infant attachment security and disorganization, and at 30 months, the childs behavior problems were assessed within a structured clinical interview. Attachment security and attachment disorganization were significantly associated with subsequent behavior problems. There was no significant relation between infant negative emotionality and behavior problems. However, there were indications of a stronger association between attachment disorganization and behavior problems in infants high in negative emotionality. The results underpin the importance of attachment quality as well as negative emotionality in social adjustment. Disorganized attachment precedes poor adjustment, especially in infants high in negative emotionality.

Links between psychopathological symptoms and disordered eating behaviors in overweight/obese youths

OBJECTIVE Among overweight and obese youths, rates of depression, anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD) are elevated. We analyze whether these emotional and behavioral problems are associated with specifically disordered eating pattern. METHOD Participants in the study were 128 overweight and obese children/adolescents (BMI: m = 29.3, s = 4.5; BMI-SDS: m = 2.5, s = 0.4) between 8 and 15 years. Structured psychiatric assessments were conducted adopting a multimethod, multiinformant approach. RESULTS Children/adolescents with ODD symptoms showed increased eating in response to external cues and binge eating. ADHD symptoms were not associated with disordered eating behaviors. Children/adolescents with symptoms of depression and anxiety showed emotional and binge eating. In particular, overweight girls with symptoms of depression showed restrained eating. DISCUSSION Our results point to specific eating problems in overweight/obese children with ODD and depression/anxiety symptoms. The findings could help to tailor interventions to optimally meet the specific needs of overweight children with emotional and behavioral problems.

On the association of interparental conflict with developing behavioral inhibition and behavior problems in early childhood.

Associations between interparental conflict and the development of temperament characteristics have seldom been addressed; moreover, studies on the impact of interparental conflict on developing behavior problems in infancy and early childhood are relatively rare. The authors therefore aimed to contribute to the study of these issues. A sample of 64 families was investigated longitudinally. At the infant age of 4 months, negative emotionality was measured with a laboratory routine. When infants were 4, 8, and 12 months old, maternal sensitivity was assessed during home observations, and interparental conflict was measured by means of questionnaires. When infants were 30 months old, behavioral inhibition was measured in 2 laboratory fear episodes, and behavior problems were assessed with a structured clinical interview of the primary caregiver. Interparental conflict and infant negative emotionality were significantly and independently associated with subsequent behavioral inhibition. The association of interparental conflict with behavior problems was moderated by infant negative emotionality. Infants high in negative emotionality developed more serious behavior problems when exposed to high interparental conflict, whereas the association was not significant in infants low in negative emotionality.