Vivienne Chisholm

Maternal sensitivity and infant and mother adrenocortical function across challenges

Findings regarding associations between maternal sensitivity and infant and mother adrenocortical function have been inconsistent. Nor have studies addressed the issue of intra-individual, between-challenge cortisol variability in the context of maternal sensitivity. In this study, we combine several design features aimed at sensitizing analyses to these issues. Cortisol secretion of 297 infants and their mothers was assessed in response to different challenges at 16 and 17 months. Extensive, structured observations of maternal sensitivity were conducted at infant age 16 months. Data were analyzed with multilevel modeling using an actor-partner interdependence model. We found that maternal sensitivity was related to infant, but not maternal, cortisol levels and also to infant-mother cortisol attunement. Infants of more sensitive mothers, as compared to infants of less sensitive mothers, showed greater cortisol variability across challenges, with relatively steep cortisol decreases and increases, depending on challenge. Mother and infant cortisol levels were highly correlated and this attunement was higher among dyads with more sensitive mothers than among dyads with less sensitive mothers. The results show nuanced attunement in a low-risk sample, with the infants of higher sensitivity mothers showing greater intra-individual variability across challenges. High cortisol response variability across challenges may simultaneously permit adaptation to threat and protect the infant from overexposure to corticosteroids.

Cumulative Risk, Cumulative Outcome: A 20-Year Longitudinal Study

Cumulative risk (CR) models provide some of the most robust findings in the developmental literature, predicting numerous and varied outcomes. Typically, however, these outcomes are predicted one at a time, across different samples, using concurrent designs, longitudinal designs of short duration, or retrospective designs. We predicted that a single CR index, applied within a single sample, would prospectively predict diverse outcomes, i.e., depression, intelligence, school dropout, arrest, smoking, and physical disease from childhood to adulthood. Further, we predicted that number of risk factors would predict number of adverse outcomes (cumulative outcome; CO). We also predicted that early CR (assessed at age 5/6) explains variance in CO above and beyond that explained by subsequent risk (assessed at ages 12/13 and 19/20). The sample consisted of 284 individuals, 48% of whom were diagnosed with a speech/language disorder. Cumulative risk, assessed at 5/6-, 12/13-, and 19/20-years-old, predicted aforementioned outcomes at age 25/26 in every instance. Furthermore, number of risk factors was positively associated with number of negative outcomes. Finally, early risk accounted for variance beyond that explained by later risk in the prediction of CO. We discuss these findings in terms of five criteria posed by these data, positing a “mediated net of adversity” model, suggesting that CR may increase some central integrative factor, simultaneously augmenting risk across cognitive, quality of life, psychiatric and physical health outcomes.

Maternal communication style, problem-solving and dietary adherence in young children with type 1 diabetes.

The incidence of type 1 diabetes (T1D) in young children is increasing markedly however young children have been overlooked in paediatric adherence research despite the unique challenges their care presents. We investigated the relation between maternal communication style and adherence to the dietary regimen in 40 children with T1D, aged 2—8 years, and their mothers. Mothers completed measures of children’s sugar consumption, parent—child communication quality, and child psychological functioning. Mothers and children engaged in a videotaped problem-solving task related to the dietary regimen, with maternal utterances analysed for behavioural control style (e.g., commands versus suggestions) and cognitive complexity (e.g., provision of labels versus questions). Maternal communications which engaged children, behaviourally and cognitively, in the task were associated with better adherence, medical, communication quality, and child adjustment outcomes. We conclude that adherence and health (medical and psychological) are optimized when young children are given opportunities to participate in their care.

Brief intelligence testing in Australia, Canada, the United Kingdom, and the United States

Do you use brief measures of intelligence? There is available an increasing variety of short forms and new and revised quick tests of intelligence. However, little is known about clinical practice using these abbreviated instruments. The authors report the results of a 4-country exploratory survey of the extent and circumstances of the use of short forms and quick tests. Such measures are commonly used, and practitioners generally followed literature-based advice about the role of brief measures. However, idiosyncratic subtest combinations and inappropriate prorating were also prevalent with short forms. Frequently used quick tests were identified, as were the reasons for using brief measures. The authors offer specific recommendations for the appropriate use of brief measures.

The adjustment to diabetes of school-age children with psychological adjustment problems.

OBJECTIVE To determine whether diabetic children with psychological adjustment problems have greater difficulties in specific areas of disease adaptation than their well-adjusted diabetic peers by comparing their diabetes-related adjustments in the family, school and peer environments. METHOD Mothers of 47 school-age preadolescent children with diabetes completed a standardized assessment of general psychological functioning. Children with psychological adjustment problems were then compared with children who did not exhibit problems along the following dimensions: their demographic and medical profiles, maternal diabetes knowledge, associations between general psychological functioning and diabetes control, and the quality of their diabetes adjustment. RESULTS No differences were found between children with psychological adjustment problems and their better-adjusted peers along any of the demographic or health status variables tested or in maternal diabetes knowledge. However, children with adjustment problems were more likely to receive visits from the hospitals home-care team and to be absent from school. Also, for children with psychological difficulty, indices of diabetes control and general psychological functioning were related, and the nature of this relation differed across the school and family environments. In addition, poorer psychological adjustment was associated with diabetes-specific problems in both mother and child. These included individual adjustment problems such as feeling different, relationship difficulties with family and peers, and difficulties with the treatment protocol, in particular, with the dietary regime. CONCLUSION These findings are considered in relation to (1). the importance of multi-method techniques in research which concerns adjustment to diabetes, in particular the need to use both psychological and disease-specific instruments, and (2). clinical evaluations and interventions for children with diabetes and their families.

An exploratory study of positive and incongruent communication in young children with type 1 diabetes and their mothers.

BACKGROUND The incidence of type 1 diabetes is increasing in young children. However, they are overlooked in treatment adherence and intervention research despite evidence that parents often experience difficulty securing their treatment cooperation, especially with the diet. We investigated positive and incongruent (i.e. the co-occurrence of contradictory verbal and non-verbal messages) communication in the mother-child dyad and their association with child adjustment and dietary adherence outcomes. METHODS Participants were 23 6- to 8-year-old children with type 1 diabetes and their mothers. We conducted dietary adherence interviews with mothers and performed nutritional analyses to assess childrens consumption of extrinsic sugars (e.g. confectionary). Mothers completed a standardized assessment of child psychological adjustment. Mothers and children engaged in a videotaped problem-solving task related to the dietary regimen, with maternal and child utterances and non-verbal behaviours analysed for positive dyadic and incongruent communication. RESULTS Positive dyadic communication correlated with lower levels of child incongruent communication, fewer behavioural problems and better overall adjustment. Higher levels of maternal and child incongruent communication correlated with more behavioural and emotional problems and poorer overall adjustment. Higher levels of maternal incongruent communication correlated with poorer dietary adherence. CONCLUSIONS Results converged to form a conceptually and empirically coherent pattern in that behavioural indices of poorer communication in both mother and child consistently correlated with poorer child adjustment outcomes. This study shows that specific features of dyadic, child and maternal communication could be targeted in developmentally sensitive interventions to promote positive communication in the home management of type 1 diabetes care for young children.

Interpersonal Engagement Mediates the Relation between Maternal Affect and Externalising Behaviour in Young Children with Type 1 Diabetes

Mother-child interactions around a shared activity have been shown to play a key role in the development of young children’s capacity to interact cooperatively with others. This evidence is particularly germane to type 1 diabetes (T1D) management in younger children where cooperation with parental treatment efforts is crucial for treatment success and where maternal distress and child behavioural problems are risk factors for treatment management, biomedical and psychological outcomes. In 49 4-to-8 year old children with T1D, we investigated whether the association between maternal affect and child problematic behaviour is mediated by mother-child interactions in the context of a T1D-relevant collaborative problem-solving activity. Mothers completed standardised measures of maternal and child psychological adjustment and interacted with their children in the problem-solving activity, analysed for quality of interpersonal engagement based on evaluations of maternal (sensitivity and cognitive stimulation) and dyadic (joint attention and warmth) behaviours. Mediation analyses confirmed the hypothesis that interpersonal engagement mediates the relation between maternal affective state and child behavioural problems. Specifically, more negative maternal affect is associated with lower levels of interpersonal engagement; these less engaged interactions in turn are associated with more behavioural problems in children. These findings are consistent with research involving typically developing children. The implications of our findings are twofold. First, in the context of psychological adjustment to T1D, maternal affect and mother-child interactions are 2 potential targets for interventions which promote cooperative interactions. Second, understanding and caring for children at biological risk requires attention to developmental psychology theory and method; in particular, research addressing parent-child cooperation carries both conceptual and clinical relevance.

Relationship between maternal and child behaviors in pediatric food allergy: an exploratory study

In children with food allergies, the development of food habits and preferences takes place in the context of their continuing condition. Mothers often have primary responsibility for the dietary management of their childs allergies in early childhood. Although few studies have addressed mother–child interactions in the food allergy literature, research in the pediatric chronic illness literature and in the literature with healthy children indicate that, in early childhood in particular, developmentally typical feeding difficulties include transient food preferences, picky or fussy eating, and food refusal, which are stressful for parents and a potential cause of interaction difficulties. Collectively these findings point to the importance of redressing the neglect of mother–child interactions in early childhood in the context of food allergies.