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Chapter in Part II Themes of emotional development.

Chapter in Part III Diagnostics and support.

Background: In formal care for people with disabilities, data are routinely collected such as on physical, psychological, and practical characteristics, which could be a source of insights for improving care practices. With regard to the governance over care data for research, this study collected the opinions and experiences on this topic from people with intellectual disabilities or visual impairment (low sighted or blind). Method: 36 adults took part (18-65 years old; M=42.2; SD=14.7;47% female) of whom 20 with intellectual disability and 16 with visual impairment. 18 of the interviewees were from England, the United Kingdom, and 18 were from the Netherlands. Opinions and beliefs were assessed with a semi-structured interview and data were analysed inductively using the Framework approach (Ritchie & Spen-cer, 1994). Results: People from both countries and both disability groups in general believed that using and sharing routinely collected care data, which they considered their own, would be important to improve thecare and lives of people with disabilities. They also expressed con-cerns and worries. Conclusions: Benefits, risks, and issues of ownership need to be taken into account in research with routinely collected care data. Implications for data governance are discussed.

Summary Even though the relatively limited available scientific literature indicates that fathers are important for child development from the earliest stages of parenthood onward, parenting research still predominantly focusses on mothers only. In this thesis, we report on findings resulting from a series of randomized controlled trials investigating neurobiological parameters across men’s transition into parenthood; the Father Trials. In Chapter 2, we report that fathers’ behavioural responses to infant crying, as well as baseline testosterone, are stable across the perinatal period. In contrast, fathers’ neural response to infant crying was found to undergo a noteworthy change from the prenatal to the postnatal period, indicating that some neural response to infant crying (e.g., those involved in visual imagery) emerge after the birth of their child. We also found that postnatal neural activation in response to infant crying in the right precentral gyrus was strongly related to postnatal parenting sensitivity, possibly indicating an important association between neural reactivity in response to infant signals and parenting quality. In Chapter 3 we report that fathers’ experiences of childhood maltreatment were found to be associated with inadequate inhibitory control over behavioural responses and / or emotional hyperreactivity in response to infant crying in the perinatal period. Specifically, this effect was only present for fathers with low structural connectivity between the prefrontal cortex and the amygdala (i.e., uncinate fasciculus). These findings suggest that fathers are more or less resilient to the detrimental behavioural correlates of negative caregiving experiences dependening upon their brain’s white matter structure. In Chapter 4 we report on the behavioural effects of arginine vasopressin (AVP); a hormone which has been proposed to play a vital role in fatherhood. AVP administration in expectant fathers was found to lead to inadequate inhibitory control over behavioural responses and / or emotional hyperreactivity while viewing an unknown infant image compared to viewing an image representing fathers’ own infant, while the opposite was true under placebo. These findings suggest that AVP may be involved in the evolutionary selected ability to detect kinship and possibly induces an increase in protective aggression based on preference for facial resemblance in offspring. In Chapter 5 we report on the development and feasibility of the Prenatal Video-feedback Intervention to promote Positive Parenting (VIPP-PRE), aimed at improving postnatal parenting quality and stimulating involvement in first-time fathers. With the use of real-time ultrasound images, expectant fathers interacted with their unborn children and were given feedback aimed at improving their ability to detect and understand their child’s behavioural signals as well as reinforcing fathers’ timely sensitive responses to those signals. Based on the evaluation by participating fathers and sonographers, we concluded that the VIPP-PRE is feasible and is received positively. Moreover, we found that fathers receiving the VIPP-PRE, compared to those receiving a control intervention, reported to have gained more insight into their relationship with their child, a better understanding of their child and its feelings, and more insight into their communication with their child. In conclusion, we have found support for the claim that several neurobiological processes (i.e., neural reactivity to infant signals and the vasopressin system) play a role in preparing expectant fathers for parenthood. However, fathers’ quality of care is associated with their own childhood experiences, depending upon fathers’ brain architecture. Although there has been a sharp increase in studies examining paternal behaviour and its underlying mechanisms, there is still much unknown. Within the Father Trials project, we aimed to put fathers at the heart of studying parenting and have provided an evidence-based, prenatal, and interaction-focused intervention aimed at providing support during the transition into fatherhood.

Background To limit students’ medical absenteeism and premature school dropout in the Netherlands, the Medical Advice for Sick-reported Students (MASS) intervention was developed to enhance collaboration between students, parents, school, and health care professionals. MASS reduces medical absenteeism. However, it does not yet optimally support professionals in monitoring students nor automatically stimulating students’ autonomy regarding their situation. Objective This study aimed to identify professionals’ and students’ perceived need for an online supportive application to monitor and reduce absenteeism and stimulate student autonomy and school reintegration. Methods Concept mapping sessions were held with professionals (n=23) and secondary school students (n=27) in group meetings or online to identify their perspectives and needs. Multidimensional scaling and hierarchical clustering were done with Ariadne 3.0 software. The resulting concept maps were reclustered and interpreted by 4 researchers. Results Three heterogeneous groups of professionals generated 17 clusters (135 unique statements), with a mean importance rating ranging from 2.9 to 4.6 on a Likert scale with scores ranging from 1 to 5. Three heterogeneous groups of secondary school students generated 18 clusters (95 unique statements), with a mean importance rating ranging from 3.2 to 4.6. Professionals considered as most important the following: easily accessible contact with students; supporting, motivating, and rewarding students; monitoring absent students; providing information to students and their parents; exchanging information between professionals. Students considered as most important the following: better teacher-student communication and respect; communication between school professionals on the one hand and parents, other professionals, and students on the other hand; guidance in missed learning materials and tests. Students perceived an online format for support as the obvious option. Conclusions Both professionals and students were positive about an online application to support students in dealing with medical absenteeism, especially considering the need for better and easily accessible contact between students and professionals. An eHealth or mobile health (mHealth) application addressing these aspects could stimulate student autonomy and have positive effects on medical absenteeism.

Background: The consequences of the coronavirus crisis are considerable for everyone in the Netherlands. Although there were concerns about the many vulnerable families who were forced to stay at home because of the measures taken by the government to contain the coronavirus in the Netherlands, there has been no increase in the number of reports of domestic violence or child abuse. Objective: To gain insight by a mixed method study on what has happened during the lockdown within families who were already known to social services. Methods: A quantitative study was performed among 159 families recruited before the coronavirus crisis, and 87 families recruited during the lockdown in the Netherlands through child protection services. Family members (parents, children) completed questionnaires about interparental violence, (historical) child abuse and neglect, and emotional security. In a qualitative study 39 of these respondents and 13 professionals were interviewed. Results: No difference was found in violence between families who participated before and after the lockdown. The level of violence is still high in most families. The absence of assistance promoted the self-reliance of children and parents to deal with this difficult period. Professionals found new ways of connecting to families at risk. Every form of support is important to these families because it made children feel seen and heard. Isolation of families where domestic violence and child abuse occurred, remains a risk factor, even outside the coronavirus crisis.

Maternal anxiety during pregnancy is associated with adverse foetal, neonatal, and child outcomes, but biological mechanisms remain unclear. Altered foetal DNA methylation (DNAm) has been proposed as a potential underlying mechanism. In the current study, we performed a meta-analysis to examine the associations between maternal anxiety, measured prospectively during pregnancy, and genome-wide DNAm from umbilical cord blood. Sixteen non-overlapping cohorts from 12 independent longitudinal studies of the Pregnancy And Childhood Epigenetics Consortium participated, resulting in a combined dataset of 7243 mother-child dyads. We examined prenatal anxiety in relation to genome-wide DNAm and differentially methylated regions. We observed no association between the general symptoms of anxiety during pregnancy or pregnancy-related anxiety, and DNAm at any of the CpG sites, after multiple-testing correction. Furthermore, we identify no differentially methylated regions associated with maternal anxiety. At the cohort-level, of the 21 associations observed in individual cohorts, none replicated consistently in the other cohorts. In conclusion, contrary to some previous studies proposing cord blood DNAm as a promising potential mechanism explaining the link between maternal anxiety during pregnancy and adverse outcomes in offspring, we found no consistent evidence for any robust associations between maternal anxiety and DNAm in cord blood. Larger studies and analysis of DNAm in other tissues may be needed to establish subtle or subgroup-specific associations between maternal anxiety and the foetal epigenome.

The association between relational victimization and risk-taking development in children is understudied. Also, it is not clear how the social classroom norm may affect this link. The aim of this study was, therefore, to investigate the link between relational victimization and risk-taking behavior in elementary schoolchildren, and the potential moderating role of the classroom norm salience toward risk-taking. We expected that relationally victimized children would show an increase in risk-taking behavior in classrooms that are unfavorable toward risk-taking as a way to provoke and act against the classroom norm. However, alternatively, relationally victimized children could show an increase in risk-taking behavior in classrooms that are favorable toward risk-taking as a way to fortify the feeling of belonging to the classroom. Participants were 1,009 children (50% boys) in 69 classrooms of 13 mainstream elementary schools, followed annually across ages 7–11 (Grade 1–5). Risk-taking was assessed using the Balloon Analogue Risk Task. Relational victimization was assessed using teacher reports. The classroom norm salience toward risk-taking was based on the within-classroom correlation of risk-taking with children’s social preference score among peers. Results from multilevel modeling showed that there was no significant main effect of relational victimization on risk-taking behavior. However, the classroom norm salience toward risk-taking significantly moderated the effect of relational victimization on risk-taking. Relational victimization was related to relative increases in risk-taking when classroom norms were unfavorable toward risk-taking. In classrooms where risk-taking was favored, relational victimization was related to relative decreases in risk-taking. These findings suggest that children who are relationally victimized may engage in norm-defying behavior in their classroom. Implications for further research are discussed.

Contemporary research suggests that attachment has both a trait‐like, stable component, and a state‐like component that varies across contexts. In the current study we assessed state attachment variability across comparably distressing situations in middle childhood. In two samples, children reported their expectations of maternal support in each situation. Additionally, we administered trait attachment and psychological well‐being measures. Results indicated that, overall, children varied in their expectations across situations: more than half of the variance was explained by intra‐individual differences across situations. Results revealed two components underlying variability: a Signal‐and‐Support component reflecting expectations of support‐seeking and receiving, and a Back‐on‐Track component reflecting expectations of stress reduction and comfort. State attachment variability was related to individual differences in trait attachment: children who are more securely attached at the trait level, overall appear to vary less in their state attachment, likely due to their high mean state attachment scores across situations. When the mean state attachment scores are accounted for, more securely attached children seem to vary more, suggesting that their state attachment expectations are more sensitive to contextual fluctuations. Importantly, degree of state attachment variability explained psychological well‐being over and above trait attachment. ispartof: Social Development vol:29 issue:1 pages:196-216 status: published

PURPOSE: With the growing attention in pediatric rehabilitation services for supporting self-management, the need increases for more shared understanding of the concept. The aim of this study was to explore parent activation, associated factors of- and underlying perceptions on parental self-management of parents of children with chronic conditions.MATERIALS AND METHODS: Using a mixed-methods strategy, first variations in self-management behaviors, motivation and perceived autonomy support were assessed with a cross-sectional survey among parents of children with chronic conditions (N = 239). Statistical analysis involved descriptive statistics and univariate analysis of variance. The survey was followed by 18 in-depth interviews with parents. Thematic analysis was used to recognize relevant topics in the qualitative data.RESULTS: In the survey most parents reported being active self-managers. Nevertheless, only one third persisted in self-management when under stress. Autonomous motivation was strongly associated with parental self-management. In the interviews, parents mentioned attuning with professionals and finding balance as important aspects of self-management. To facilitate self-management, professionals were expected to have expert knowledge, be engaged and empathic.CONCLUSION: From the perspective of parents, self-management should be viewed as a collaborative effort in which they are supported by professionals, rather than having to manage it "by themselves". Implications for rehabilitation To facilitate self-management, parents expect professionals to have expert knowledge and additionally show interpersonal competences as openness, engagement and empathy. Motivating parents may facilitate their level of self-management regarding the care for their child with a chronic disorder. Good communication and collaboration with professionals appear to be key aspects of parental self-management. Parents expect pediatric rehabilitation teams to tune their services to the needs, desires and expectations of parents to support them in "self-managing" the care for their child.

This commentary argues for the need to revisit the foundations of attachment theory and its tradition of formulating testable mechanistic models of relationship development and change. Modeling and simulation may be useful to test novel theoretical propositions, such as the one stating that pleasure in parenting may be a determinant of secure father-infant attachment relationships (Brown & Cox, this issue). We discuss this proposition’s plausibility, by relating parenting pleasure to the temporal patterning of parenting, a neglected property in parent-child interaction. Simulation work may not only offer first test runs of novel hypotheses, but may also guide empirical researchers to the most likely time-scale on which such hypotheses should be tested.

Decisions regarding out-of-home placement of children are complicated and of high impact for children and parents. Previous studies show low agreement between professionals on these decisions, and research regarding the influence of characteristics of decision-makers on the content of the decisions taken remains inconclusive. This study explored the relation between general and psychological characteristics of 144 professionals (child welfare professionals, children’s court judges, and master students) using vignettes and questionnaires. Professionals’ mind-set regarding the ability of parents to achieve change (parent-specific mind-set) and their attitude toward the harmfulness of out-of-home placements were related to their decision-making. General decision-maker factors (the professional’s background and work experience), the mind-set toward the ability of people in general to change (dispositional mind-set), and professionals’ attitude toward the effectiveness of out-of-home placements were not related to their decisions. This field of practice needs to reflect on the role of implicit beliefs in making placement decisions about children.

Introduction: Reducing restrictive measures in long-term-care is known to be a challenge for support staff teams due to risks caused by aggressive behaviour of residents with intellectual disabilities. A randomized controlled trial tested the effect of implementing a Multi-disciplinary Expert Team (MDET) to reduce restrictive measures (RM). Despite the risks, accelerated reduction of RM was observed in units randomized to receive MDET. Following these results we retrospectively explored, through the theoretical lens of Normalization Process Theory, implementation interventions that might have helped professionals adopt MDET. The research question was: Which professional implementation interventions have been used to implement the MDET method in long term care for people with intellectual disabilities and what social mechanisms are manifest in interactions with staff? Methods: MDET was implemented in 19 residential units. The process notes and the MDET plans for each unit were coded both deductively (using EPOC framework for professional implementation interventions) and inductively, to identify and adapt (the meaning of) used interventions in the 6 consecutive phases of the MDET method. The NPT-EPOC professional intervention coding framework (Johnson & May, 2015) was applied to identify the social mechanisms of the implementation process of MDET. Results: A range of actions could be reconstructed and identified as implementation interventions described by EPOC. Additional implementation interventions and subcategories were identified that may be specific to long term care for people with ID. Descriptions of implementation interventions were adjusted to this care setting. The added and adapted interventions were mapped to NPT constructs, resulting in an adapted NPT-EPOC framework. Educational Outreach-treatment interventions, Patient-Related Interventions and Local Consensus Processes were most widely used during implementation of MDET. Implications: In long-term care, where support staff are at risk due to aggression from residents, equal interaction and cooperation is essential for the implementation of methods that reduce RM. Content analysis suggests adjustments to EPOC professional implementation interventions to meet the needs of this care setting. Adjusted interventions vary in how they relate to constructs of Normalization Process Theory, resulting in an adapted NPT-EPOC framework to understand the social mechanisms in implementing MDET or methods that aim to reduce restrictive measures in long term care.

Background Behaviour problems emerge early in childhood and place children at risk for later psychopathology. Objectives To evaluate the clinical effectiveness and cost-effectiveness of a parenting intervention to prevent enduring behaviour problems in young children. Design A pragmatic, assessor-blinded, multisite, two-arm, parallel-group randomised controlled trial. Setting Health visiting services in six NHS trusts in England. Participants A total of 300 at-risk children aged 12–36 months and their parents/caregivers. Interventions Families were allocated in a 1 : 1 ratio to six sessions of Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) plus usual care or usual care alone. Main outcome measures The primary outcome was the Preschool Parental Account of Children’s Symptoms, which is a structured interview of behaviour symptoms. Secondary outcomes included caregiver-reported total problems on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The intervention effect was estimated using linear regression. Health and social care service use was recorded using the Child and Adolescent Service Use Schedule and cost-effectiveness was explored using the Preschool Parental Account of Children’s Symptoms. Results In total, 300 families were randomised: 151 to VIPP-SD plus usual care and 149 to usual care alone. Follow-up data were available for 286 (VIPP-SD, n = 140; usual care, n = 146) participants and 282 (VIPP-SD, n = 140; usual care, n = 142) participants at 5 and 24 months, respectively. At the post-treatment (primary outcome) follow-up, a group difference of 2.03 on Preschool Parental Account of Children’s Symptoms (95% confidence interval 0.06 to 4.01; p = 0.04) indicated a positive treatment effect on behaviour problems (Cohen’s d = 0.20, 95% confidence interval 0.01 to 0.40). The effect was strongest for children’s conduct [1.61, 95% confidence interval 0.44 to 2.78; p = 0.007 (d = 0.30, 95% confidence interval 0.08 to 0.51)] versus attention deficit hyperactivity disorder symptoms [0.29, 95% confidence interval –1.06 to 1.65; p = 0.67 (d = 0.05, 95% confidence interval –0.17 to 0.27)]. The Child Behaviour Checklist [3.24, 95% confidence interval –0.06 to 6.54; p = 0.05 (d = 0.15, 95% confidence interval 0.00 to 0.31)] and the Strengths and Difficulties Questionnaire [0.93, 95% confidence interval –0.03 to 1.9; p = 0.06 (d = 0.18, 95% confidence interval –0.01 to 0.36)] demonstrated similar positive treatment effects to those found for the Preschool Parental Account of Children’s Symptoms. At 24 months, the group difference on the Preschool Parental Account of Children’s Symptoms was 1.73 [95% confidence interval –0.24 to 3.71; p = 0.08 (d = 0.17, 95% confidence interval –0.02 to 0.37)]; the effect remained strongest for conduct [1.07, 95% confidence interval –0.06 to 2.20; p = 0.06 (d = 0.20, 95% confidence interval –0.01 to 0.42)] versus attention deficit hyperactivity disorder symptoms [0.62, 95% confidence interval –0.60 to 1.84; p = 0.32 (d = 0.10, 95% confidence interval –0.10 to 0.30)], with little evidence of an effect on the Child Behaviour Checklist and the Strengths and Difficulties Questionnaire. The primary economic analysis showed better outcomes in the VIPP-SD group at 24 months, but also higher costs than the usual-care group (adjusted mean difference £1450, 95% confidence interval £619 to £2281). No treatment- or trial-related adverse events were reported. The probability of VIPP-SD being cost-effective compared with usual care at the 24-month follow-up increased as willingness to pay for improvements on the Preschool Parental Account of Children’s Symptoms increased, with VIPP-SD having the higher probability of being cost-effective at willingness-to-pay values above £800 per 1-point improvement on the Preschool Parental Account of Children’s Symptoms. Limitations The proportion of participants with graduate-level qualifications was higher than among the general public. Conclusions VIPP-SD is effective in reducing behaviour problems in young children when delivered by health visiting teams. Most of the effect of VIPP-SD appears to be retained over 24 months. However, we can be less certain about its value for money. Trial registration Current Controlled Trials ISRCTN58327365. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 29. See the NIHR Journals Library website for further project information.

Sensitive responsiveness refers to parents’ ability to recognize and respond to infants’ cues and has been linked to parental empathy. Additionally, oxytocin (OT) and vasopressin (AVP) are hormones important for sensitivity and empathy. The aim of this study is to test the links between dispositional empathy along with changing OT and AVP levels and responsiveness to a life-like doll in couples and to verify whether these factors are predictors of responsiveness to a child’s cues. Exploratory analyses include predictors of sensitive responsiveness: polymorphisms of OXTR, AVPR1a and CD38 genes, personal characteristics and relational factors. The project employs standardized experimental settings that can be used with non-parents and the assessment of parental sensitive responsiveness towards their child. The participants are couples expecting their first child (111) and childless couples (110). The procedure involves caretaking of a life-like doll. Salivary samples and questionnaire data are collected in a planned manner. In the second part, the expectant couples are invited for the assessment of their sensitivity to their own child (Free Play episodes). Parental sensitivity is assessed using the Ainsworth Sensitivity Scale. This paper presents an interdisciplinary research project that reaches beyond the questionnaire measurement, considering many factors influencing the dynamics of adult–infant interaction.

Summary Neural face processing Our mediation hypothesis that intervention effects on maternal sensitivity would be induced by changes in neural face processing was not supported. Although we found more efficient neural face processing after the intervention (Chapter 3), that change did not promote maternal sensitivity as VIPP-SD effects on a behavioral level were absent in our study (Chapter 4). These findings ask for careful reflection. Our findings showed a significant decrease in N170 amplitudes, a component reflecting the relatively early stage of encoding and processing faces in the intervention group compared to the control group. This finding indicated that the intervention resulted in less effortful, more efficient neural face processing. Although stronger N170 amplitudes have been related to more extensive information processing, reductions in neural activity during information processing may reflect neural efficiency. To illustrate, inverted faces elicit stronger N170 responses, which reflects the additional neural effort required to process this type of faces. Less effortful information processing, due to practice for instance, has been associated with a reduction in neural effort required to processes information. In the context of the VIPP-SD program, the intervention themes related to maternal sensitivity focus on accurate perception and interpretation of children’s displays of emotions, for which faces are a central communication channel. As such, training mothers’ observational skills might have improved their ability to scan their children’s faces for emotional cues and reduced the neural effort needed to process child faces. This interpretation would be consistent with the reduced N170 amplitudes that we observed. However, the results of the mediation analyses presented in Chapter 4 showed that the VIPP-SD program did not significantly enhance observed maternal sensitivity in our sample, and neural face processing was not involved as mediator. A possible explanation for this pattern of results might be found in the time-window between assessments. On average, there was a three-week period between our EEG measure and the maternal sensitivity assessments. That was perhaps too short for neural effects to translate into observable changes in maternal sensitivity. Inhibitory control We did not obtain evidence for our mediation hypothesis that intervention effects on sensitive discipline would be induced through improved inhibitory control. We found an intervention effect on inhibitory control, however opposite to our expectations, as inhibitory control improved in the control group whereas the intervention group did not significantly change over time. This finding could indicate a ‘normative’ time/practice-related improvement in the control group, something that is typically observed when participants perform the stop signal task more than once. Speculatively, that this normative improvement was interrupted in the intervention group, possibly due to VIPP-SD induced restructuring of parenting schemas. That is, the sensitive discipline themes of the intervention confront mothers with their own and their children’s behavior, which appeals to reinterpretation and reevaluation of the mothers’ behavioral repertoire. Restructuring parenting schemas requires cognitive effort. Such complex cognitive changes may have come at the cost of other cognitive operations, such as inhibitory control, that we observed at the time of our assessment. The mediation analysis showed that inhibitory control was unrelated to sensitive discipline and there was no evidence for the expected increase in observed sensitive discipline in the intervention group. Again, the time-window between assessments might explain the results. If the intervention indeed triggered reorganization of previously established parenting schemas, consolidation into stable updated parenting schemas that are accessible during the assessment of disciplining might take more time than the lag between our assessments. We speculate that parenting schemas of discipline strategies might have been ‘under reconstruction’ during our assessment of sensitive discipline, which could have diminished positive effects on a behavioral level.

BackgroundProviding professional support for people with mild to borderline intellectual disabilities (IDs) is supposed to support their autonomous participation in society and, in turn, enhance their well-being and quality of life. However, the motivation for seeking support may differ for people with mild to borderline IDs, varying in the extent to which the person's autonomy is self-determined. The present study tested the association between different types of motivation for seeking support and well-being.MethodAdults with mild to borderline IDs (N = 154) participated in a cross-sectional survey. Researchers administered the Self-Regulation Questionnaire – Support – II (SRQ-S-II) and a life satisfaction questionnaire. To determine the test–retest reliability of the SRQ-S-II, 30 participants completed a follow-up questionnaire.ResultsThe motivations cited by people with mild to borderline IDs for seeking support ranged from amotivation to intrinsic motivation. Multiple regression analysis indicated that the model explained 56.6% of the variance, with intrinsic motivation (β = 0.361, P < 0.001) and identified motivation (β = 0.381, P = 0.001) proving to be significant predictors in terms of explaining the highest percentage of variance in well-being. Amotivation (β = −0.247, P = 0.004) and introjected motivation (β = −0.145, P = 0.03) contributed significantly to the model with negative beta coefficients. Finally, reliability measures (Cronbach's alphas, MacDonald's omegas and test–retest reliabilities) indicated that all types of motivation for seeking support could be reliably assessed.ConclusionsThe results of the present study showed that people with mild to borderline IDs displayed the full range of types of motivations for seeking support and, moreover, that it was associated with well-being. Studying these motivational states, and increasing our awareness of what motivates this population to seek support, can aid the design of more effective support that respects self-determination and well-being. The SRQ-S-II is thus an important instrument for understanding the role of support in promoting well-being.

The development of social-cognitive abilities in infancy is subject to an intricate interaction between maturation of neural systems and environmental input. We investigated the role of infants’ attachment relationship quality in shaping infants’ neural responses to observed social interactions. One-hundred thirty 10-month-old infants participated in an EEG session while they watched animations involving a distressing separation event that ended with either comforting or ignoring behavior. Frontal asymmetry (FA) in the alpha range - which is indicative of approach-withdrawal tendencies - was measured with EEG. Attachment quality was assessed using the Strange Situation procedure at 12 months. Overall, infants with disorganized attachment showed a lack of right-sided – withdrawal related – FA compared to secure and insecure infants. Furthermore, only avoidant infants exhibited reduced right-sided FA responses following the separation. Contrary to our expectations, the type of response (comforting vs. ignoring) did not elicit differences in FA patterns, and attachment quality did not moderate the effects of the type of response on frontal asymmetry. Implications for research on attachment-related biases in social information processing and on the neural underpinnings of prosocial behaviors are discussed.

Contains fulltext : 226287.pdf (Publisher’s version ) (Closed access) Background: Young children with visual impairments (VIs) are at high risk for mental disorders, due to victimization and subsequent social withdrawal. Children with VIs have been shown to have a poorer self-concept and lower general psychosocial well-being compared with peers without VIs. Objective: The objective of this study was to examine the effectiveness of a serious game to improve psychosocial outcomes in children with VIs. Methods: A randomized controlled trial was conducted to evaluate the effectiveness of the computer game See for children with VIs. The game was developed based on rational-emotive behavioral therapy principles, with the aim of addressing self-concept (academic, social, and general), psychosocial well-being (social inclusion, exclusion, and emotions), and coping strategies (approach, avoidance). Sixty-four children aged 6-8 years were randomized to the intervention group, who played the game, or a control group, who received care-as-usual (CAU). Results: Our results showed that children with VIs who played the serious game scored significantly higher on academic self-concept and social inclusion compared with the control group. Furthermore, children rated the game positively, suggesting the desirability, validity, and feasibility of the intervention. Conclusions: The results provide preliminary evidence that a serious game can enhance psychosocial outcomes in children with VIs. This approach might also promote positive educational outcomes, such as academic achievement, and reduce the stigma of therapy for children with VIs. Implications and future directions are discussed. 9 p.

De rol van executief functioneren.Signalen uit de praktijk wijzen erop dat kinderen met een TOS (taalontwikkelingsstoornis) regelmatig zindelijkheidsproblemen ervaren. Zowel TOS als zindelijkheidsproblemen kunnen voor kind en ouders problematisch zijn, met een lagere kwaliteit van leven en opvoedstress als gevolg. Bovendien kan zindelijkheidsproblematiek negatieve consequenties hebben voor het sociaal functioneren bij deze toch al kwetsbare groep. Er is echter weinig wetenschappelijk onderzoek naar zindelijkheidsproblematiek bij kinderen met een TOS. Uit ons onderzoek blijkt dat kinderen met een TOS inderdaad meer zindelijkheidsproblemen ervaren en pas op latere leeftijd dag- en nachtzindelijkheid bereiken. Dit verschil hangt samen met een verminderde ontwikkeling van de executieve functies van kinderen met een TOS. Met name verminderde inhibitie en werkgeheugen lijken een rol te spelen in de zindelijkheid. Een combinatie van zindelijkheidstraining in executieve functies (EF) zou passend kunnen zijn bij kinderen met een TOS.

Background: The COVID-19 pandemic drastically impacted on family life and may have caused parental distress, which in turn may result in an overreliance on less effective parenting practices.Objective: The aim of the current study was to identify risk and protective factors associated with impaired parenting during the COVID-19 lockdown. Key factors predicting maternal harsh discipline were examined in China, Italy, and the Netherlands, using a cross-validation approach, with a particular focus on the role of allomaternal support from father and grandparents as a protective factor in predicting maternal harshness.Methods: The sample consisted of 900 Dutch, 641 Italian, and 922 Chinese mothers (age M = 36.74, SD = 5.58) who completed an online questionnaire during the lockdown.Results: Although marital conflict and psychopathology were shared risk factors predicting maternal harsh parenting in each of the three countries, cross-validation identified a unique risk factor model for each country. In the Netherlands and China, but not in Italy, work-related stressors were considered risk factors. In China, support from father and grandparents for mothers with a young child were protective factors.Conclusions: Our results indicate that the constellation of factors predicting maternal harshness during COVID-19 is not identical across countries, possibly due to cultural variations in support from fathers and grandparents. This information will be valuable for the identification of at-risk families during pandemics. Our findings show that shared childrearing can buffer against risks for harsh parenting during COVID-19. Hence, adopting approaches to build a pandemic-proof community of care may help at-risk parents during future pandemics.

DNA methylation (DNAm) is known to play a pivotal role in childhood health and development, but a comprehensive characterization of genome-wide DNAm trajectories across this age period is currently lacking. We have therefore performed a series of epigenome-wide association studies in 5019 blood samples collected at multiple time-points from birth to late adolescence from 2348 participants of two large independent cohorts. DNAm profiles of autosomal CpG sites (CpGs) were generated using the Illumina Infinium HumanMethylation450 BeadChip. Change over time was widespread, observed at over one-half (53%) of CpGs. In most cases, DNAm was decreasing (36% of CpGs). Inter-individual variation in linear trajectories was similarly widespread (27% of CpGs). Evidence for non-linear change and inter-individual variation in non-linear trajectories was somewhat less common (11 and 8% of CpGs, respectively). Very little inter-individual variation in change was explained by sex differences (0.4% of CpGs) even though sex-specific DNAm was observed at 5% of CpGs. DNAm trajectories were distributed non-randomly across the genome. For example, CpGs with decreasing DNAm were enriched in gene bodies and enhancers and were annotated to genes enriched in immune-developmental functions. In contrast, CpGs with increasing DNAm were enriched in promoter regions and annotated to genes enriched in neurodevelopmental functions. These findings depict a methylome undergoing widespread and often non-linear change throughout childhood. They support a developmental role for DNA methylation that extends beyond birth into late adolescence and has implications for understanding life-long health and disease. DNAm trajectories can be visualized at http://epidelta.mrcieu.ac.uk.

Children exposed to traumatic events are at increased risk for developing symptoms of a Post-Traumatic Stress Disorder. Children often discuss emotional, and therefore also traumatic, events in their lives with their parents, and the quality of these discussions can facilitate coping and further development. The study aim was 1) to explore whether the association between the quality of dialogue between mothers and children about emotional events and children’s posttraumatic stress symptoms (PTSS) might be indirectly linked through children’s adaptive coping skills, and 2) whether this association differed when discussing different negative emotions. 169 mother–child dyads with interpersonal trauma-exposure (86% domestic violence, 14% mother and/or child sexually abused) participated in the Autobiographical Emotional Events Dialogue (AEED). Quality of mother–child emotion dialogue, captured in maternal sensitive guidance and child cooperation, and approach-oriented coping were coded from transcripts. PTSS was measured with the Child Behavior Checklist. Lower quality of mother–child emotion dialogue was associated with less approach-oriented coping and more symptoms of posttraumatic stress. There was an indirect effect of approach-oriented coping with angry feelings linking quality of mother–child emotion dialogue and child PTSS. Children’s symptoms of posttraumatic stress were reflected in the quality of mother–child dialogues about traumatic and other emotional events. Findings support that dialogues about emotional events may be a promising target for intervention with children exposed to trauma.

How long does the average person sleep? Here, Kocevska et al. conducted a meta-analysis including over 1.1 million people to produce age- and sex-specific population reference charts for sleep duration and efficiency.We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including >= 100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1-100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40-69 years, 55.5% female) from the United Kingdom and 409,617 people (>= 18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the 'acceptable' sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8-10 h and 18% report daytime sleepiness. In adults (>= 18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6-19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending >= 9 h in bed, whereas poor sleep quality was more frequent in those spending = 41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Background: Due to the COVID-19 pandemic, governments of many countries announced regulations to prevent the virus from spreading. For people with a disability living in a sheltered care facility in the Netherlands, this meant that they were not able to receive any visitors for almost 3 months. Aim: This study examines how people with an intellectual and visual disability and their families experienced the period in which it was mandated not to have any physical contact. The aim is to examine the experiences of this target group and gain insight in the way measures were taken in order to be able to advise care organizations about adequate care with respect to possible restrictive measures in the future. Methods: In-depth interviews were conducted with two groups of people: (1) fourteen people with an intellectual and visual disability, living in sheltered care facilities and (2) twelve people being relatives of residents of these same sheltered care facilities. In the interviews, the participants were questioned about their experiences with respect to the adjusted visiting regulations and with respect to the relation with their family during this period. A thematic analysis was performed first separately and then combined. Results and Discussion: A number of themes resulted from the analysis that were related to (1) the instructed regulations of the sheltered care facilities and the government; (2) the relation with family and friends; and (3) the consequences of COVID-19 and the regulations. Both relatives and residents were understanding of the difficult situation, but also expressed criticism about the chosen regulations, the communication thereof, and the practical implementation. Both groups have experienced the interruption of close contact as emotional and difficult. However, also positive consequences of the restrictions due to COVID-19 were mentioned. The results provide a list of recommendations for sheltered care facilities.

Achtergrond: De eerste lockdown van 2020 vanwege de Covid-19 pandemie had ingrijpende gevolgen voor de reguliere zorgverlening aan mensen met verstandelijke beperkingen. Eerder onderzoek naar indirecte gevolgen via incidentmeldingen toonde een scherpe daling en vervolgens een stijging van meldingen van agressie. Meldingen van incidenten met medicatie lagen tijdens de eerste lockdown echter op een lager niveau dan voor de pandemie. Om antwoord te geven op de vraag wat de impact was van de versoepelingen na de eerste lockdown en de gedeeltelijke herinvoering van maatregelen in de vervolgfase van de pandemie zijn de incidentmeldingen gevolgd tot begin 2021. Methoden: De weektotalen van incidentmeldingen bij zorgorganisatie ‘s Heeren Loo werden aan tijdserie analyse onderworpen over de periode van medio 2016 tot februari 2021, rekening houdend met seizoensinvloeden. Resultaten: De versoepeling van de maatregelen per 1 juli 2020 markeerde een overgang van stijging in meldingen van agressie naar daling. De wekelijkse meldingen keerden terug op het niveau van voor de pandemie. Incidenten waarbij bewoners zonder verklaring afwezig waren bleven na de versoepelingen stabiel. Meldingen van incidenten met medicatie begonnen geleidelijk weer te stijgen na de versoepelingen. Conclusie: Uit de incidentmeldingen rijst het beeld van een tijdelijk schokeffect tijdens de eerste lockdown en een normalisatie qua incidenten tijdens de vervolgfase van de pandemie. Deze bevindingen sluiten aan bij ander onderzoek gebaseerd op ervaringsverhalen tijdens de pandemie. Tijdige en toegankelijke communicatie vanuit overheid en zorginstellingen naar mensen met verstandelijke beperking, naasten en professionals alsmede continuïteit van zorgteams verdienen aandacht met het oog op toekomstige crisissituaties.

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Funder: Gouvernement du Canada | Canadian Institutes of Health Research (Instituts de Recherche en Santé du Canada); doi: https://doi.org/10.13039/501100000024, Attention-deficit and hyperactivity disorder (ADHD) is a common childhood disorder with a substantial genetic component. However, the extent to which epigenetic mechanisms play a role in the etiology of the disorder is unknown. We performed epigenome-wide association studies (EWAS) within the Pregnancy And Childhood Epigenetics (PACE) Consortium to identify DNA methylation sites associated with ADHD symptoms at two methylation assessment periods: birth and school age. We examined associations of both DNA methylation in cord blood with repeatedly assessed ADHD symptoms (age 4-15 years) in 2477 children from 5 cohorts and of DNA methylation at school age with concurrent ADHD symptoms (age 7-11 years) in 2374 children from 9 cohorts, with 3 cohorts participating at both timepoints. CpGs identified with nominal significance (p < 0.05) in either of the EWAS were correlated between timepoints (ρ = 0.30), suggesting overlap in associations; however, top signals were very different. At birth, we identified nine CpGs that predicted later ADHD symptoms (p < 1 × 10-7), including ERC2 and CREB5. Peripheral blood DNA methylation at one of these CpGs (cg01271805 in the promoter region of ERC2, which regulates neurotransmitter release) was previously associated with brain methylation. Another (cg25520701) lies within the gene body of CREB5, which previously was associated with neurite outgrowth and an ADHD diagnosis. In contrast, at school age, no CpGs were associated with ADHD with p < 1 × 10-7. In conclusion, we found evidence in this study that DNA methylation at birth is associated with ADHD. Future studies are needed to confirm the utility of methylation variation as biomarker and its involvement in causal pathways.

Zintuiglijke en verstandelijke beperkingen kunnen het ontwikkelen van eenveilige gehechtheidsrelatie in de weg staan. Gericht samen spelen kan bijdragenaan het ontwikkelen van een veilige relatie. Een speelkleed, speciaal ontwikkeldvoor jonge kinderen met een visueelverstandelijke of verstandelijkebeperking, faciliteert verschillende spelmomenten.

Belsky's Process Model points to family-of-origin (especially experiences of mistreatment in childhood) as well as personality and marital relations as determinants of parenting quality, including parental sensitive responsiveness. Parental sensitivity might be intuitively developed during pregnancy and affects perinatal mental health. However, there is a lack of studies investigating effects of family-of-origin and relationship perceptions on expectant couples' parental sensitive responsiveness. The aim of the presented study was to test mediation and moderation effects of perceived partner's empathic concern and retrospectively assessed abuse experienced in childhood on sensitive parental responsiveness operationalized as caretaking behaviors and emotional reactions to a crying life-like doll. One hundred eleven expectant couples (N = 222; age: Mwomen = 28.4 years, SD = 3.03; age: Mmen = 29.2 years, SD = 3.31; relationship duration: Myears = 6.8, SD = 3.43; gestational week: M = 31.3, SD = 4.58) assessed the extent to which they experienced physical and emotional abuse from their parents in childhood and rated their current partner's empathic concern. In the experimental procedure, couples reacted to a crying life-like doll and were assessed by trained psychologists using the modified Ainsworth Sensitivity Scale to measure couples' sensitive responsiveness. The results confirmed a significant mediational effect of perceived women's (and not men's) empathic concern for the relationship between the reported experience of abuse in family-of-origin by expectant fathers (and not mothers) and couples' sensitivity. Support and interventions regarding couples' empathy and parenting competence can be offered to both mothers and fathers to identify those who are at risk of low parental sensitivity.

Pain is a common occurrence in life. For some groups of people expressing, communicating, and seeking pain relief is not possible, due to age, illness, disability, or unconsciousness. To support caregivers, pain detection through physiological measures can be a solution. Currently, an algorithm for an application indicating arousal according to electrodermal changes has been developed and tested. Pain is unique to every person, so new research and algorithm development are necessary to assess which measurable signals coincide with pain. A mobile application utilising such algorithms would allow caregivers to better attend to the patients' needs in daily practice. This study aims to develop an application that can signal pain for caregivers of persons with communication difficulties and examine whether utilizing this software solution, pain can be reliably detected in an experimental setting. Visual analysis of plotted results from a pilot study indicates that within the same person pain shows significant deviation from relaxation and neutral experiences. Further research is needed to examine the reliability of pain detection.

In this study, we aimed to develop a behavioral task that measures pro-social decision making in rats. A fully automated, operant pro-social two-choice task is introduced that quantifies pro-social preferences for a mutual food reward in a set-up with tightly controlled task contingencies. Pairs of same-sex adult Wistar rats were placed in an operant chamber divided into two compartments (one rat per compartment), separated by a transparent barrier with holes that allowed the rats to see, hear, smell, but not touch each other. Test rats could earn a sucrose pellet either for themselves (own reward) or for themselves and the partner (both reward) by means of lever pressing. On average, male rats showed a 60 % preference for the lever that yielded a food reward for both themselves and their partner. In contrast, females did not show lever preference, regardless of the estrous cycle phase. Next, the impact of juvenile environmental factors on male rat social decision making was studied. Males were group-housed from postnatal day 26 onwards in complex housing Marlau (TM) cages that provided social and physical enrichment and stimulation in the form of novelty. Complex housed males did not show a preference for the pro-social lever.

Background Intellectual disability (ID) is often accompanied by more significant delays in emotional development than in cognitive development. Diagnostic assessment can provide insight into emotional functioning. However, few standardized assessment instruments are available. Aims Examine the reliability and validity of the Scale of Emotional Development–Short (SED-S) in children with ID. Methods and procedures This methodological instrument validation study was conducted in the Netherlands and Switzerland with children (N = 118) older than 3 and younger than 18 years with ID ranging from profound to mild. Measures included: demographic and medical data, SED-S, and the Vineland. Coherence and reliability of the SED-S were determined using Cronbach’s alpha, and validity was examined using Goodman and Kruskal's γ, Kruskal-Wallis H, and Mann-Whitney U tests. Outcomes and results The reliability of the SED-S was high, the convergent validity was good, and divergent validity was indicated in relation to autism spectrum disorder (ASD), visual and/or auditory impairment, and adaptive functioning. Further research Research is needed to better understand the implications of ASD and visual and/or auditory impairment on emotional development and their association with (normal) intelligence. Children with ID may also benefit from (more) detailed guidelines for imbalanced profiles on the SED-S.