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Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent–child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent–child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, β = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.

The ability to regulate one’s emotions is foundational for healthy development and functioning in a multitude of domains, whereas difficulties in emotional regulation are recognized as a risk factor for a range of adverse outcomes in childhood, adolescence, and adulthood. Caregivers play a key role in cultivating the development of emotion regulation through coregulation, or the processes by which they provide external support or scaffolding as children navigate their emotional experiences. The vast majority of research to date has examined coregulation in the context of caregiver–child dyads. In this paper, we consider emotion regulation and coregulation as family-level processes that unfold within and across multiple family subsystems and explore how triadic and whole family interactions may contribute to the development of children’s emotion regulation skills. Furthermore, we will examine the implications of a family-centered perspective on emotion regulation for prevention of and intervention for childhood emotional and behavioral disorders. Because emotion regulation skills undergo such dramatic maturation during children’s first several years of life, much of our focus will be on coregulation within and across the family system during early childhood; however, as many prevention and intervention approaches are geared toward school-aged children and adolescents, we will also devote some attention to later developmental periods.

The Strategies for Enhancing Early Developmental Success (SEEDS) Preschool Program aims to promote school readiness in families connected to the child welfare system by enhancing children's self-regulation, parents' engagement in their children's early learning experiences, and parent/child/teacher relationships. Given high levels of prenatal alcohol exposure and early adversity in welfare-connected children, the SEEDS Program integrates evidence-based interventions for fetal alcohol spectrum disorders and early childhood stress and trauma. From an early education perspective, an innovative aspect of the program is the conceptualization of school readiness as occurring at the family level; in SEEDS, parental participation is as intensive as children's participation, both during dyadic activities and in a separate but highly coordinated parent group curriculum. To illustrate design and implementation of the program, the current paper uses parent- and teacher-reported data to summarize the progress of three participating families with diverse histories and presenting issues. Each individual family's response to intervention was examined (1) by calculating individual reliable change index scores using pre- and post-intervention reports on standardized measures of child adjustment and parental stress, and (2) by plotting the time series of teacher-reported progress on family goals over the course of the program. Although emotional, behavioral, and executive functioning difficulties appeared to initially interfere with children's engagement in learning material, enhancing social-emotional functioning at the level of the parent, child, and the dyad addressed many of the parent- and teacher-identified intervention goals. Consideration of mixed outcomes in one of the three cases highlights areas of improvement for future implementations of the SEEDS Program.

A significant body of research has explored the transition to parenthood as a critical period of adult development that requires reorganization of relationships in which romantic partners also become coparents and dyadic interactions are transformed into family interactions. Much of this research has been aimed at understanding how both historical influences and current relationships shape this major life transition. This chapter focuses on emotion regulation and coregulation as a key set of processes that may link past and present, with an examination of how early attachment relationships, adult intimate relationships, and coparenting relationships may converge during the prenatal period to lay the foundation for how emotions will be navigated in the newly constituted family postnatally. Emotion regulation and coregulation will be explored as family level phenomena that unfold in the context of interactions within and across multiple family subsystems. Finally, we consider how viewing emotion regulation and coregulation at the family level can enhance current prevention and intervention efforts to support families through the transition to parenthood.

Parents' behaviors-particularly their emotion socialization behaviors (ESBs)-drive children's emotion socialization (Eisenberg, Cumberland, & Spinrad, 1998). We propose that a major next step in the effort to promote healthy emotional development is to improve the field's understanding of the most proximal contributor to parent ESBs: parents' own experience and regulation of emotions in the context of caregiving. As an initial step, this paper integrates Eisenberg and colleagues' model of emotion socialization with theoretical and empirical work on parental emotion. We review the literature on the emotionally evocative nature of parenting, which influences parental ESBs, including parents' expressions of emotions and their responses to children's emotions. However, whereas parental emotions influence behavior, they do not necessarily determine it; parents may regulate their emotions to engage in optimal ESBs. Thus, parental regulation contributes to emotion socialization not only by modeling emotion regulation strategies for children, but also by influencing the quality of parents' ESBs. From a clinical perspective, parental emotion regulation is of utmost importance due to the degree of parental involvement in interventions for childhood emotional and behavioral disorders, which are often aimed at promoting child self-regulation. To illustrate practical applications of Eisenberg's model, we discuss evidence-based practices that include enhancement of parent emotion regulation as a primary target, with the ultimate goal of promoting child emotional development. Ultimately, we aim to spur future theoretical, empirical, and translational work in this area. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.

The risk for mental health problems and relational difficulties in military service members, spouses, and children is well-established. Yet, few services are available for families, particularly during the formative preschool years, when healthy parent–child relationships are crucial to the attainment of major socio-emotional milestones that form the foundation for later development. This paper describes the adaptation of a previously established military and trauma-informed preventive intervention, Families OverComing Under Stress (FOCUS) for use with families with a preschool-aged child (FOCUS for Early Childhood; FOCUS-EC). Grounded in theory and research on family resilience, FOCUS-EC aims to support parents as leaders of the family by providing developmental guidance and psychoeducation on deployment and reintegration, facilitate the construction of a family narrative, and enhance parenting strategies and the parent–child relationship. Furthermore, FOCUS-EC was adapted for use in a telehealth platform, enabling clinicians to reach military and veteran families in their homes, which is particularly useful for high-risk civilian-dwelling military families (including Reserve and National Guard). Pilot work and ongoing data collection as part of a randomized control trial suggest that FOCUS-EC is acceptable and feasible for military and veteran families with preschoolers.

BackgroundThere is a notable absence of evidence based early interventions for young children with FASD. ObjectiveThis study examines clinicians' perspectives regarding the needs of caregivers of children with FASD and how such perspectives informed the development of a family-centered early intervention for young children with prenatal alcohol exposure. Method19 professionals who work with children with prenatal alcohol exposure and / or in out-of-home care were recruited to participate in focus groups. The facilitator used a semi-structured topic guide to elicit feedback from participants. These data were transcribed, coded, and categorized to reflect themes in a manner informed by a grounded theory approach. A second investigator repeated the process. Codes were chosen and assigned to data by consensus. ResultsThe coded data yielded five distinct perceived challenges faced by caregivers: (1) seeking and possibly receiving a diagnosis; (2) processing emotions and coming to terms with the child's difficulties; (3) seeking support and belonging within a knowledgeable community; (4) developing a new understanding of the child's behavior; and (5) becoming an educator, advocate, and expert on the child and FASD. ConclusionProfessionals believe specific capacities are essential insofar as the human service systems that caregivers engage are perceived to be under-equipped to respond to the distinct set of challenges faced by children with FASD and their families. Findings are discussed in terms of how the proposed intervention was designed to address such challenges and to cultivate those key capacities in order for families to meet their children's needs.

Background: Children with prenatal alcohol exposure (PAE) have significant social skills deficits and are often treated in community mental health settings. However, it remains unclear whether these children can be effectively treated using manualized, evidence-based interventions that have been designed for more general mental health populations. Methods: To shed light on this issue, the effectiveness of Children’s Friendship Training (CFT) versus Standard of Care (SOC) was assessed for 85 children ages 6 to 12 years with and without PAE in a community mental health center. Results: Children participating in CFT showed significantly improved knowledge of appropriate social skills, improved self-concept, and improvements in parent-reported social skills compared to children in the SOC condition. Moreover, results revealed that within the CFT condition, children with PAE performed as well as children without PAE. Findings indicated that CFT, an evidence-based social skills intervention, yielded greater gains than a community SOC social skills intervention and was equally effective for children with PAE as for those without PAE. Conclusions: Results suggest that children with PAE can benefit from treatments initiated in community settings in which therapists are trained to understand their unique developmental needs, and that they can be successfully integrated into treatment protocols that include children without PAE.

Children with Fetal Alcohol Spectrum Disorders (FASD) are at a greatly increased risk for developmental delays, learning disabilities, and behavioral, social, and emotional problems. High rates of secondary disabilities have been reported in this population, including mental health problems, school failure, delinquency, plus alcohol and substance abuse problems. Long-term outcomes for adolescents and adults with FASD include increased risk for unemployment, suicidal ideation and behavior, and confinement in psychiatric facilities and correctional institutions. Many children impacted by prenatal alcohol exposure are raised in out-of-home placements, and thus will likely have extensive involvement with the child welfare and dependency court systems. However, child welfare agencies and dependency courts are often not well-equipped to handle cases involving these children. This article will address the challenges that children with FASD and their families face in those systems, as well as recommendations for improvements in how those systems respond to the needs of these highly vulnerable children.

This article describes the use of fetal alcohol spectrum disorders (FASDs) as a theme to connect the learning of basic neurosciences with clinical applications across the age span within a systems-based, integrated curricular structure that emphasizes problem-based learning.In collaboration with the Centers for Disease Control and Prevention (CDC) and the National Organization on Fetal Alcohol Syndrome, the Western Regional Training Center for Fetal Alcohol Exposure at UCLA developed and integrated educational materials on FASDs into the curriculum for first-year medical students.Quantitative and qualitative evaluations suggested materials were effective in enhancing student knowledge and skills related to FASDs, as well as embryology, brain development, substance abuse, developmental psychopathology, and medical ethics.The use of a unifying theme integrating basic science and clinical information and skills is effective for medical student training in the prevention and treatment of common medical problems.

Since the identification of fetal alcohol syndrome (FAS) over 35 years ago, mounting evidence about the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities that are characterized by physical, cognitive, and behavioral impairments. These disabilities include a continuum of developmental disorders known as fetal alcohol spectrum disorders (FASDs). Longitudinal studies suggest that individuals with FASDs are at a greatly increased risk for adverse long-term outcomes, including mental health problems and poor social adjustment. This review summarizes the existing literature on mental health outcomes for individuals with PAE across the lifespan, including findings in infancy and early childhood, middle childhood, and adolescence and early adulthood. Research on the psychiatric disabilities suffered by individuals with FASDs throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability since early identification and treatment have been demonstrated to be protective against more serious secondary disabilities. It is hoped that with greater awareness of the mental health problems experienced by individuals with FASDs, these individuals can receive appropriate and early treatment resulting in more adaptive and rewarding lives.

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs.

Using latent transition analysis, this study identified Constructive and Destructive marital problem-solving patterns in couples prenatally and at 3, 12, and 24 months postbirth. Most couples remained in the same group across the 2 years (27.5% and 52.2% who started as Destructive and Constructive, respectively). Always Destructive spouses reported more depressive symptomatology and more negative and less positive views of marriage than Always Constructive couples. Mixed wives mirrored Always Constructive wives in their depressive symptomatology and concurrent views of marriage; mixed husbands mirrored Always Constructive husbands in their depressive symptomatology and Always Destructive husbands in their concurrent views of marriage. Mixed couples divorced or separated at the highest rates (35.7%), while Always Constructive couples tended to remain married (93.1%).

Prenatal exposure to alcohol is a leading preventable cause of birth defects and developmental disabilities. Individuals exposed to alcohol during fetal development can have physical, mental, behavioral, and learning disabilities, with lifelong implications. These conditions are known as fetal alcohol spectrum disorders (FASDs). Health care professionals play a crucial role in identifying women at risk for an alcohol-exposed pregnancy and in identifying the effects of prenatal alcohol exposure among individuals. The Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities has funded four universities as FASD Regional Training Centers (RTCs). The RTCs, in collaboration with the CDC and the National Organization on Fetal Alcohol Syndrome, are developing, implementing, and evaluating educational curricula for medical and allied health students and practitioners and seeking to have the curricula incorporated into training programs at each grantee's ...

Previous research attests to the marked impairments in social functioning exhibited by children with Fetal Alcohol Spectrum Disorders (FASD), suggesting that such children are in need of social skills intervention. Recently, an existing evidence-based manualized behavioral treatment for improving children's friendships was implemented and demonstrated to be effective with children aged 6–12, diagnosed with FASD. In the present report, we describe methods for adapting this behavioral intervention in line with the specific cognitive and behavioral deficits seen in children with FASD and other developmental disabilities to enhance treatment efficacy.

This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the child"s executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.

OBJECTIVES. Prenatal exposure to alcohol interferes with fetal development and is the leading preventable cause of birth defects and developmental disabilities. The purpose of this study was to identify current knowledge, diagnosis, prevention, and intervention practices related to fetal alcohol syndrome and related conditions by members of the American Academy of Pediatrics. METHODS. This study was developed collaboratively by the American Academy of Pediatrics and the Centers for Disease Control and Prevention. Questionnaires were mailed to a 3% random sample (n = 1600) of American Academy of Pediatrics members in the United States. General pediatricians, pediatric subspecialists, and pediatric residents were included. RESULTS. Participation rate was 55% (n = 879). Respondents almost universally knew the teratology and clinical presentation of fetal alcohol spectrum disorders. However, they were less likely to report comfort with routine pediatric care of these children. Whereas 62% felt prepared to identify and 50% felt prepared to diagnose, only 34% felt prepared to manage and coordinate the treatment of children with fetal alcohol spectrum disorders. Even fewer (n = 114 [13%]) reported that they routinely counsel adolescent patients about the risks of drinking and pregnancy. CONCLUSIONS. The survey confirms that pediatricians are knowledgeable about fetal alcohol syndrome but do not feel adequately trained to integrate the management of this diagnosis or prevention efforts into everyday practice. Furthermore, the respondents were not active in routine anticipatory guidance with adolescents for prevention of alcohol-affected pregnancies. The development, dissemination, and implementation of best practice tools for prevention, diagnosis, and referral of fetal alcohol syndrome that are specific for general and subspecialist pediatricians are recommended.

This study examined the role of parental adult attachment and couples' prenatal and postnatal marital interactions in predicting the quality of family interactions 24 months after the birth of the couple's first child. Father's prenatal marital withdrawal and mother's postnatal marital withdrawal were associated with less adaptive family interactions at 24 months. Families with fathers who had an insecure attachment, as assessed by the Adult Attachment Interview, showed less positive and more negative interactions at 24 months, but only when there were higher levels of negative escalation in the couple's marriage prenatally. Findings are discussed in terms of the importance of exploring the transition to parenthood at the broader family level.

Objective. This study examined linkages between prenatal exposure to alcohol, current maternal alcohol use, child externalizing behavior, and maternal stress in a sample of 4- to 6-year-old children and their mothers. Design. Questionnaires, interviews, and behavioral observations were used to assess study variables in 42 mother - child dyads. Results. Current maternal alcohol use did not relate to children's behavior problems. However, children with higher levels of prenatal exposure to alcohol exhibited more externalizing behavior. In turn, higher levels of child externalizing behavior were associated with increased maternal stress. An alternative model, in which maternal stress was assumed to relate to less supportive mother - child interactions and higher levels of current maternal alcohol consumption, which in turn were expected to relate to higher rates of child externalizing behavior, did not fit the data. Conclusions. The impact of prenatal alcohol exposure likely extends to caregivers. Interventi...

Prior research regarding the role of parent-child relationships in children's social development generally has been limited to concurrent or short-term longitudinal data and has focused primarily on mothers' influence in the early or middle childhood years. Using a multimethod, multiinformant design, the present study extends previous findings by examining whether maternal and paternal affect predicted adolescent social behavior and peer acceptance 2 years later. Both maternal and paternal affect had significant direct and indirect effects (via adolescent cognitive representations of parents) on adolescent negative social behavior as reported by siblings, which in turn predicted decreased peer acceptance as rated by teachers. Findings suggest that both mothers and fathers shape adolescent social development and attest to the importance of exploring multiple pathways that may account for continuity in parent-child and peer relationships.

In a sample of 138 couples, the present study examined whether individuals' marital functioning related to both their own and their partner's attachment stance. Earned-secure wives managed their affect as well as continuous-secure wives during problem-solving discussions and better than preoccupied or dismissing wives. However, preoccupied and dismissing wives did not exhibit markedly different patterns of affect regulation in their marriages. Regarding individuals' marital functioning and partners' attachment stance, neither husbands' behavior nor perceptions related to their wives' attachment stance. However, wives of continuous-secure husbands exhibited more positive marital behavior than wives of dismissing and earned-secure husbands. Findings are discussed in terms of how attachment working models may account for both continuities and discontinuities between earlier caregiving experiences and functioning in adult relationships.

This longitudinal study of 137 female high school seniors investigated the relationship of attachment cognitions, current psychological functioning, and psychological functioning 12 months later. Attachment cognitions, assessed with the Revised Adult Attachment Scale and the Inventory of Parent and Peer Attachment, were significantly associated with current symptomatology. The Revised Adult Attachment Scale, in interaction with initial symptomatology, predicted depression, substance abuse, eating disorders, and personality disorders 12 months later. The Inventory of Parent and Peer Attachment parent subscales predicted eating disorder and personality disorder symptomatology, whereas the peer subscales predicted substance abuse, eating disorder, and personality disorder symptomatology.

As the longest war in US history winds down, military families are preparing for a new phase of dealing with its impact: the enduring consequences of deployment separations, physical and psychological injuries, and loss. The urgency and uniqueness of two simultaneous wars of long duration fought by an all-volunteer military have propelled the rapid evolution of research and practice regarding the impact of war on military families. Consistent with existing developmental and prevention science research, data emerging from the study of military and veteran families suggest that both stress and resilience reverberate across the family system. There is growing evidence that the impact of war and its sequelae are experienced by not only the service member or veteran, but also their children, partners, and other family members. Recognizing that the implications of these experiences do not end with active duty service, but may cascade for decades underscores the need for ongoing research focused not only on the impact of wartime military service on children and families, but also on shaping a science-informed approach to costeffective, and scalable behavioral health preventive interventions and treatment for military and veteran families. The scale and tempo of this war has left our country with a large social, psychological, and medical footprint that now must be addressed by our systems of care; an undertaking that may well require unprecedented levels of support and coordination across military, veteran and public health institutions for years to come. Both Parts 1 and 2 of this special issue are designed to contribute to the current national dialogue on how best to plan for and provide services for our military families. Part 1

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent–child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.

Two potential correlates of interpersonal problem-solving strategies were studied: attachment cognitions, and global beliefs about self-worth. Problem-solving strategies were assessed through an interview in which participants were asked to conceptualize and solve hypothetical interpersonal problems. Direct and indirect associations between the variables were tested in a sample of 94 women making the transition to adulthood. The results showed that poor problem solving was associated with both low levels of global self-worth and attachment insecurity. Furthermore, global self-worth mediated the relationship between attachment cognitions and interpersonal problem-solving strategies, indicating that attachment insecurity had an indirect association with poor problem solving through low self-worth. A model for how early experience could lead to negative beliefs about self and others, and how these beliefs could lead to poor problem solving, is discussed.

The authors tested a cognitive-interpersonal hypothesis of depression by examining the role of interpersonal cognitions in the prediction of depression associated with interpersonal stressors. A measure of adult attachment assessed interpersonal cognitions about ability to be close to others and to depend on others and anxiety about rejection and abandonment. Participants were women who had recently graduated from high school; they were followed for 1 year with extensive interview evaluation of life events, depression, and other symptomatology. Generally, cognitions, interpersonal events, and their interactions contributed to the prediction of interview-assessed depressive symptoms, but the effects were not specific to depression and predicted general symptomatology measured by diagnostic interviews as well, and results also varied by attachment subscale. Results were discussed in terms of a developmental psychopathology approach to disorders in young women.

Background: Prenatal alcohol exposure (PAE) has been linked to a wide array of developmental deficits, including significant impairments in social skills. Given the extensive body of evidence linking social information-processing patterns with social behavior, it is possible that social information-processing may represent one mechanism of behavioral change. The present investigation sought to answer the question of whether a well-established social skills intervention decreased the hostile attributions of children with PAE. Further, was there a differential impact of the intervention on hostile attributions in the context of peer provocation versus group entry scenarios? Methods: Participants consisted of 100 children (51% male) with PAE between the ages of 6 and 12 years. Participants were randomly assigned to either a social skills intervention, Children’s Friendship Training (CFT), or to a Delayed Treatment Control (DTC) condition. Results: Analyses indicated that the social skills intervention resulted in a significantly lower proportion of hostile attributions in peer group entry, but not peer provocation, scenarios. This decrease was maintained over a 3-month follow-up period. Conclusions: Deficits in social information-processing among individuals with PAE can be improved through social skills intervention, and these changes may lead to more positive developmental outcomes.

Children with fetal alcohol spectrum disorders (FASDs) evidence an array of structural brain abnormalities and neurocognitive deficits. Furthermore, previous research suggests that deficits in executive functioning (EF) may be associated with significant difficulties in the formation of positive peer relationships in this population. The purpose of the current study was to examine the role of EF as a predictor of treatment response to a controlled social skills intervention for children with FASDs. A total of 100 children between the ages of 6 and 12 received Children's Friendship Training (CFT). Prior to treatment, parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF). Treatment outcome was measured using parent report on the Social Skills Rating System (SSRS). The results demonstrated that behavioral regulation as measured on the BRIEF predicted the effectiveness of CFT for children with FASDs, regardless of general intellectual functioning. Specifically, the ability to control impulses, solve problems flexibly, and monitor emotional responses significantly predicted improvement in social skills and reduction in problem behaviors following CFT.

Peer relationship problems are a significant part of the clinical presentation of children with Fetal Alcohol Spectrum Disorders (FASD). Many of these children have been prescribed psychotropic medications by community practitioners. The present study reports on the interaction between medication status and parent and teacher-reported outcomes for parent-assisted Children's Friendship Training (CFT).Seventy seven children (40 boys and 37 girls, age range was 71-139 months) diagnosed with FASD were given 12 sessions of CFT. Parent- and teacher-reported social outcomes were compared across four subgroups of children who were prescribed either stimulant or neuroleptic medication, neither or both types of medications.According to parent and teacher reports, children prescribed neuroleptic medication showed greater improvement on all outcome measures when compared to children not prescribed neuroleptics. In contrast, children prescribed stimulant medication either failed to show improvement or showed poorer outcomes when compared to children not prescribed stimulants.Children with FASD frequently present with symptoms of inattention and hyperactivity. The present results suggest physicians routinely ask about prenatal alcohol exposure as part of history taking to treat children more effectively who appear to be displaying attention-deficit/hyperactivity disorder symptomatology but who may have FASD.

Objective This study examined the association between prenatal alcohol exposure and child depressive symptoms, and the mediating effects of maternal and child characteristics. Methods Participants were 42 children aged 4-5 years and their biological mothers. Prenatal alcohol consumption was assessed by self-report of maximum drinks per drinking occasion. The Pictorial Depression Scale (PDS) measured child depressive symptoms. Mother-child interactions were assessed using the family interaction puzzle task. Results Structural equation modeling indicated that prenatal alcohol exposure was associated with more negative child affect. In turn, mothers of more negative children were less emotionally connected to their children, and those children had higher levels of depressive symptomatology. Results could not be explained by current maternal drinking patterns or maternal depression. Conclusions Study findings highlight the importance of examining prenatal alcohol exposure as a risk factor in the prediction of childhood-onset depression and the environmental mechanisms that may mediate that relationship.

The relationship between adult attachment and marital perceptions was examined in couples making the transition to parenthood. The Adult Attachment Interview was administered to spouses prenatally, and marital perceptions were assessed prenatally and 3, 12, and 24 months postnatally. The couples were also observed during a marital interaction task. Spouses were assigned to groups based on their attachment security (secure/insecure) and mean level (low/high) of negative emotional escalation in their marital interactions. A series of two-way (attachment security by negative emotional escalation) repeated multivariate analyses of variance, followed by univariate analyses, revealed that insecure husbands and the wives of insecure husbands exhibited different patterns in their marital perceptions than secure husbands and the wives of secure husbands when in high negative escalation marriages. Insecure husbands and the wives of insecure husbands in high negative escalation marriages reported greater declines in positive marital perceptions or less positive marital perceptions overall across the two-year postnatal period than secure husbands and wives of secure husbands in similarly high conflict marriages. Such differences between secure and insecure husbands (and their wives) were not apparent in low negative escalation marriages. Findings are discussed in terms of the protective effect a secure attachment may convey upon spouses during stressful periods in their marriage.

The Young Family Interaction Coding System (YFICS) is an observational coding system that was designed to assess family interactions beyond the dyadic level-that is, to assess verbal and nonverbal behavior among multiple members of a family. In particular, the YFICS was designed to examine interactions among new parents and their 24-month-old child. This system is most appropriate for family interactions with young children (2 to 3 years of age) because it attempts to capture interactions around regulation of emotion and support for autonomy within a family context, issues that are important developmentally for 2-to 3-year-old children. The YFICS is used with a family play task in which parents are asked to build something together as a family. When the task is complete, parents are asked to have the 2-year-old clean up. This task elicits information about the affective quality of family exchanges, the parents’ strategies for approaching the task (whether they promote autonomous functioning in the child), and the ex-tent to which the parents assist the child in regulating emotion and maintaining a positive and enthusiastic approach to the task.

The relationship between personality pathology and depression has been the focus of increasing attention, but few investigators have examined this issue prospectively or in adolescent community samples. The present study used both self report and interviewer assessments of personality disorder symptomatology and depression in a sample of 155 late adolescent women followed over three years. Personality pathology cluster and total scores demonstrated moderate to fairly high degrees of stability, indicating endurance of these traits in late adolescence. As predicted, Axis II symptoms were associated with concurrent depressive symptomatology. Overall, self-reported personality disorder symptoms, as well as those specifically in Clusters A and B, predicted interviewer-rated depression over two years beyond the contribution of initial depression, indicating that subclinical Axis II symptoms are a risk factor for subsequent depressive symptomatology.

▪ Abstract In this chapter, we discuss theoretical and conceptual models that use an organismic or systems metaphor for understanding families. We suggest that such theories are important for stimulating new research and organizing existing data, and that advances in these theories over the past few decades have expanded the potential for understanding child development, as well as adult adaptation and the development of close relationships. These paradigms follow from models that view development as resulting from the transactional regulatory processes of dynamic systems. Such models are helpful for considering multiple influences on development and adaptation and have implications for the design of effective interventions. We focus on the specifics of systems theories as applied to families, and the research generated by or consistent with these views. Our review is not exhaustive; rather, we intend to give a sense of the direction of this work and its importance for the understanding of development and adaptation.

The authors examined C. Hammen's (1991) model of stress generation in depression and the role of interpersonal problem-solving strategies (IPS) in the stress generation process in a longitudinal sample of 140 young women who entered the study at ages 17-18. Structural equation modeling was used to test a model in which IPS and subsequent interpersonal stress mediated the relationship between initial and later depressive symptoms. Results supported the main prediction of the stress generation model: Interpersonal stress mediated the relationship between initial and later depressive symptoms. In addition, IPS predicted interpersonal stress. However, no association was found between depressive symptoms and IPS. An alternative model in which IPS moderated the relationship between stress and depressive symptoms was tested; it was not supported.

Context: In 2003, UCLA introduced a new, systemsbased, integrated curricular structure for first year medical students. The curriculum emphasises small group and independent learning, limiting lectures to 10 h per week. A problem-based learning (PBL) case presents the clinical theme of each week, and provides the framework for incorporating the basic science learning. The exemplary case: In an integrated curriculum organised around a clinical case, the ideal case simultaneously serves as an exemplar that assists students in integrating their knowledge, while teaching them about commonly encountered diseases. Fetal Alcohol Syndrome (FAS) was chosen as a commonly encountered clinical disorder, which was able to carry teaching about the basic sciences of embryology, neuroanatomy and brain development, and epidemiology, as well as other important clinical topics such as ethics and law, counselling, and health behaviour. During the portion of the curriculum covering the neurosciences, a week was designed to address ‘Nurture or Nature’ using FAS as an exemplar clinical case. A PBL case began the week with a webadministered presentation of a school-aged child with physical features and learning and behaviour problems potentially attributable to a number of prenatal (including alcohol, cocaine, and nicotine exposure) and postnatal factors. An evidence-based portion of PBL required students to investigate the literature to either research a related learning issue or to defend or refute the position that ‘It is safe for a woman to drink a little during pregnancy’. The PBL case ended with a discussion of the impact of fetal alcohol exposure on child development and ‘hands-on’ practice screening a child for FAS, including conducting a facial dysmorphology exam to assess physical features associated with prenatal alcohol exposure. In another exercise, small groups of students worked with a standardised patient case learning to screen adolescents for alcohol and drug use and practising a brief intervention to reduce binge drinking. A portion of a Law and Order television episode in which a woman is prosecuted for drinking while pregnant facilitated students’ consideration of legal and ethical issues as they formed juries and wrestled with a verdict. Evaluation: Results of assessments and course evaluations by the 146 students completing the FAS elements of the curriculum suggest increased awareness, knowledge and appreciation of the potential damage alcohol causes to the developing embryo and fetus and the consequences of FAS to the family and broader society. On a quiz testing knowledge of alcohol’s effect on the fetus, students completing the embryology lab had a mean score of 5.65 (maximum 1⁄4 6) and rated the lab’s effectiveness as 4.11 (maximum 1⁄4 5). Students attained a mean score of 4.31 (maximum 1⁄4 5) on the FAS items in the weekly quiz. Students’ end of course evaluations yielded mean ratings of 3.7 and 3.6 on the FAS-related PBL and standardised patient cases, respectively, using a 5-point scale (1 1⁄4 not effective; 5 1⁄4 very effective). These rating compared favourably to ratings of other first year cases in the curriculum.

Observed interaction of couples during a problemsolving task and self-reports of spouses concerning their marriage were investigated before the birth of their first child and at 3, 12, and 24 months after the birth of the child. The study focuses on the impact of a first child's birth on the marriage. Hierarchical linear model analyses were performed. Patterns of change in the marital relationship were related to whether the pregnancy was planned, to depressive symptoms of spouses, to the couple's problem-solving behavior, and to the gender of the child. There is a long history of research on the transition to parenthood as a crisis for couples, and the premise of much of that literature is that becoming a parent is a risk factor for individual and marital distress. Many cross-sectional studies have documented the negative correlation between the presence of children and marital satisfaction (e.g., Glenn & McLanahan, 1982; Miller, 1976). Additionally, several longitudinal studies that followed couples from before the birth of the child through a period after the birth show overall linear declines in marital satisfaction (Belsky, Lange & Rovine, 1985; Cowan et al., 1985; Feldman & Nash, 1984). More recently, however, scholars are calling for studies that go beyond documenting declines in marital satisfaction and that illuminate the variety of adaptations couples make and the factors related to different adaptations (Belsky & Rovine, 1990; Cox, 1985; Huston & Vangelista, 1995; Cowan & Cowan, 1992). Not only each partner's satisfaction with the marriage should be of interest, but also observations of the couple's interactions. In the study presented here, both spouses' perceptions of their marriage and their behavior during a marital problem-solving task were investigated before the birth of their first child and at 3, 12, and 24 months after the birth. The study focused on the impact of a first child's birth on the marnage. We assumed that couples would show a variety of adaptations. BACKGROUND Patterns of Change Transitions are times when a marriage may be particularly vulnerable because the relationship has to be reorganized to meet new challenges. Yet, parenthood actually may enhance some relationships, undermine others, and have little effect on others (Cox, 1985; Huston & Vangelisti, 1995). Some couples may develop new skills in resolving problems, for example, and others may find resolving problems a major difficulty. As Cowan (1991) has noted, "a central task for researchers is to determine the conditions under which both normative and nonnormative events stimulate developmental advances, produce dysfunctional crises, or leave the individual and the family relatively unchanged" (p. 5). Identifying couples who are likely to experience increased marital difficulty in the transition to parenthood is important in order to focus preventive efforts on the most vulnerable couples. At the same time, understanding the strengths of couples whose relationships are enhanced by the experience of parenthood or for whom the experience has minimal negative impact also may inform intervention. Couples who not only show distress in response to the birth of a child, but who also fail to show recovery over time may be of particular concern. Initial difficulties in a transition may be normative, but the lack of reorganization over time may be a sign of chronic problems that are likely to influence parenting and child development negatively. The possibility of such different patterns highlights the importance of considering transitions as processes over time (Cox, 1985) and the importance of using methods that can capture this process. When data are gathered from parents on only one or two occasions soon after the birth of the child, short-term fluctuations in satisfaction may be detected, but more gradually emerging effects remain undiscovered. If one expects an initial change in the marital relationship followed by recovery over the first 2 years, data that longitudinally cover that period are needed. …