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The articles in this special issue are informed by the historic changes in the twentieth century (i.e., decreasing family size, changing family roles, and youth demonstrating more independent behaviors) that propelled intensive study of fathers’ impacts on child development. The papers are conceptualized within a developmental systems framework and focused on a father’s presence rather than on his absence in the family, going beyond the study of merely father involvement. Papers reflect longitudinal and cross-sectional methods and examine issues related to paternal mental health, parenting behavior, cultural context, and children’s physical and mental health. Refereed/Peer-reviewed

Poor parental mental health and stress have been associated with children's mental disorders, including attention-deficit/hyperactivity disorder (ADHD), through social, genetic, and neurobiological pathways. To determine the strength of the associations between parental mental health and child ADHD, we conducted a set of meta-analyses to examine the association of parent mental health indicators (e.g., parental depression, antidepressant usage, antisocial personality disorder, and stress and anxiety) with subsequent ADHD outcomes in children. Eligible ADHD outcomes included diagnosis or symptoms. Fifty-eight articles published from 1980 to 2019 were included. We calculated pooled effect sizes, accounting for each study's conditional variance, separately for test statistics based on ADHD as a dichotomous (e.g., diagnosis or clinical cutoffs) or continuous measurement (e.g., symptoms of ADHD subtypes of inattentiveness and hyperactivity/impulsivity). Parental stress and parental depression were significantly associated with increased risk for ADHD overall and both symptoms and diagnosis. Specifically, maternal stress and anxiety, maternal prenatal stress, maternal depression, maternal post-partum depression, and paternal depression were positively associated with ADHD. In addition, parental depression was associated with symptoms of ADHD inattentive and hyperactive/impulsive subtypes. Parental antisocial personality disorder was also positively associated with ADHD overall and specifically ADHD diagnosis. Prenatal antidepressant usage was associated with ADHD when measured dichotomously only. These findings raise the possibility that prevention strategies promoting parental mental health and addressing parental stress could have the potential for positive long-term impacts on child health, well-being, and behavioral outcomes.

Legacy for Children™ is a group-based parenting intervention that has been culturally adapted for Spanish-speaking mothers (Legacy Spanish). In the current study, we used qualitative methods to examine how Legacy Spanish informed parenting knowledge and practices related to early development. Fourteen low-income Spanish-speaking Latina mothers of children aged 21–31 months participated in focus groups that explored their experience in Legacy Spanish. A template analysis procedure was used to analyze focus group transcripts and identify themes. We identified five primary themes and two secondary themes. Mothers described gaining new knowledge about parenting and child development from Legacy Spanish and attributed positive changes in their parenting and self-efficacy to the program. Reported changes included use of more sensitive behavioral management strategies, increased maternal investment of time and energy, and improved mother-child communication. Mothers also attributed changes in their child’s cognitive and socioemotional development to Legacy Spanish, perceived long-term benefits of program participation, and shared lessons learned from Legacy Spanish with their social network. Additionally, mothers noted that Legacy Spanish provided a unique opportunity for one-to-one time with their child. To provide additional context for the focus group data, we present scores on an observational measure of parent-child interactions. Mean scores in the Affection, Responsiveness, and Teaching domains, which measure behaviors discussed in the focus groups, fell in the average score range. Together, these findings demonstrate that a culturally adapted parenting intervention has the potential to support nurturing parent-child relationships among low-income Spanish-speaking Latino families.

Legacy for Children™ (Legacy) is an evidence-based program focused on promoting sensitive, responsive parenting for socioeconomically disadvantaged families. Legacy has recently been culturally and linguistically adapted for Spanish-monolingual Latino families and is being piloted in partnership with an early childhood education program. We conducted a mixed methods study to identify barriers and facilitators to engagement, using program monitoring data sources from both participant and group leader perspectives. We conducted qualitative analyses of open-ended data to identify distinct barriers (e.g., employment challenges, health-related challenges and appointments) and facilitators (e.g., other mothers in group, interest in program topics) to engagement that emerged across English and Spanish language curriculum versions; curriculum-specific barriers and facilitators were also documented. We interpret these findings in light of quantitative data on measures of engagement, showing that participants in the Spanish curriculum evidenced comparable levels of parent-group leader relationship quality relative to the English group, and higher levels of parent's group support/connectedness and overall satisfaction. These results offer promising considerations for optimizing families' engagement in parenting programs in the context of early care and education settings.Legado para los Niños™ (Legado) es un programa basado en la evidencia que se centra en promover una crianza sensible y susceptible para familias con desventajas socioeconómicas. Recientemente, Legado se ha adaptado cultural y lingüísticamente para familias Latinas en las que sólo se habla español, y está siendo puesto en práctica experimental en asociación con un programa de educación en la temprana niñez. Llevamos a cabo un estudio con una variedad mixta de métodos para identificar obstáculos y promotores para ser incluidos usando recursos de información de la supervisión del programa provenientes de las perspectivas tanto de participantes como de líderes de grupo. Realizamos análisis cuantitativos de información no limitada de antemano para identificar diferentes obstáculos (v.g. dificultades de empleo, dificultades y citas relacionadas con la salud) y promotores (v.g. otras madres en el grupo, interés en los temas del programa) para ser incluidos los cuales surgieron a lo largo de las versiones curriculares del inglés y del español; también se documentaron los obstáculos y promotores relacionados con el currículo específico. Interpretamos estos resultados a la luz de la información cuantitativa sobre medidas de participación, mostrando que los participantes en el currículo en español demostraron comparables niveles de calidad de la relación progenitor-líder de grupo en relación con el grupo de inglés, y más altos niveles de apoyo del grupo a los progenitores y satisfacción en general. Estos resultados ofrecen consideraciones prometedoras para lograr una óptima participación de las familias en programas de crianza en el contexto de escenarios de cuidado y educación tempranos.Le programme Legacy for ChildrenTeilnahme von Eltern an einem originalen und einem kulturell adaptierten, evidenzbasierten Elternprogramm: "Vermächtnis für Kinder“ „Vermächtnis für Kinder“ (Legacy) ist ein evidenzbasiertes Programm zur Förderung sensibler, responsiver Erziehung für sozioökonomisch benachteiligte Familien. Legacy wurde vor kurzem kulturell und sprachlich für einsprachig-spanische Latino-Familien angepasst und wird in Zusammenarbeit mit einem frühkindlichen Bildungsprogramm pilotiert. Wir haben eine gemischte Methodenstudie durchgeführt, um Barrieren und vereinfachende Faktoren für eine Teilnahme zu identifizieren. Dafür haben wir zur Programmüberwachung Datenquellen sowohl aus Sicht der Teilnehmenden als auch der Gruppenleitenden verwendet. Wir haben qualitative Analysen offener Daten durchgeführt, um bestimmte Barrieren (z. B. berufliche Schwierigkeiten, gesundheitliche Probleme und Terminierung) und vereinfachende Faktoren (z. B. andere Mütter in der Gruppe, Interesse an Programmthemen) für eine Teilnahme zu identifizieren, die sich in der englischen und der spanischen Version des Curriculums abzeichneten. Curriculumsspezifische Barrieren und vereinfachende Faktoren wurden ebenfalls dokumentiert. Wir interpretieren diese Ergebnisse angesichts quantitativer Daten zur Teilnahme und zeigen, dass die Teilnehmenden am spanischen Curriculum im Vergleich zur englischen Gruppe eine vergleichbare Qualität der Beziehung zwischen Eltern und Gruppenleitenden sowie eine höhere Unterstützung / Verbundenheit und allgemeine Zufriedenheit unter den Eltern aufweisen. Diese Ergebnisse bieten vielversprechende Überlegungen zur Optimierung der Beteiligung von Familien an Erziehungsprogrammen im Kontext von Frühförderung und Bildung.オリジナルで、文化的に改変されたエビデンスに基づく子育てプログラム−レガ シー・フォー・チルドレンTM−に対する親の関与度 レガシー・フォー・チルドレンTM(Legacy)は、 社会経済的に恵まれない家族の ための繊細で応答的な子育てを促進することに焦点を置いたエビデンスに基づく プログラムである。Legacyは最近、スペイン語だけを使用するラテンアメリカ系 の家族のために、文化的言語的に改変され、幼児教育プログラムと共に試験的に 実施された。我々は、参加者とグループリーダーのそれぞれの視点からの、プロ グラムをモニタリングしたデータソースを使って、関与度に関しての障壁要素と 促進要素を同定するために混合研究法を使った。英語版とスペイン語版のカリキ ュラムにまたがって表れた関与度に関する明確な障壁要素 (例:雇用の課題、健 康の課題と予約に関する課題) と促進要素 (例:グループの中の他の母親達、プ ログラムのテーマに対する興味) を同定するために、自由回答のデータの定性分 析を行った。それぞれのカリキュラムに特有の障壁要素と促進要素も記録された。 これらの結果を、関与度を測定した定量データに照らして解釈した。その結果、 スペイン語のカリキュラムへの参加者は、英語のグループと比較して、親とグル ープリーダーの関係性の質は同等レベルであり、親のグループのサポート／つな がりと全体的な満足度はより高いレベルであることが証明されたことを示した。 これらの結果は、幼児教育・保育の設定の文脈において子育てプログラムにおけ る家族の関与度を最適化するための有望な考慮事項を提供している。.“儿童传承”是一项循证项目, 致力于推动社会经济上处于弱势的家庭开展体贴的、积极的育儿方式。该项目最近在文化和语言上适合了西班牙语单语的拉丁裔家庭, 并且正在与一个幼儿教育计划合作进行试点。我们进行了一项混合方法研究, 从参与者和小组负责人的角度, 利用项目监控数据源, 确定参与的障碍和促进因素。我们对开放式数据进行了定性分析, 以确定英语和西班牙语课程版本中明显的参与障碍 (例如, 就业挑战, 与健康相关的挑战和任命) 和促进 (例如, 小组中的其他母亲, 对项目主题感兴趣) 因素;课程特定的障碍和促进因素也被记录在案。我们根据参与度的量化数据来解释这些发现。结果表明, 西班牙语课程的参与者在育儿小组的领导关系质量方面与英语组的参与者水平相当, 并且其育儿的小组支持、沟通以及整体满意度更高。这些结果为儿童早期看护和教育机构优化家庭参与育儿计划提供了可能的参考。.مشاركة الوالدين في برنامج أصلي معدل ثقافيا قائم على الأدلة (برنامج إرث للأطفال: Legacy) برنامج إرث للأطفال (Legacy) هو برنامج قائم علي الادله يرتكز علي تعزيز الرعاية الوالدية الحساسة وسريعة الاستجابة عند العائلات المحرومة اجتماعيا. وقد تم مؤخرا تطويع برنامج (Legacy) ثقافيا ولغويا للأسر الاسبانيه اللاتينية أحاديه اللغة ويجري تجريبه بالشراكة مع برنامج تعليمي للطفولة المبكرة. وقد أجرينا دراسة مختلطة المنهج لتحديد العوائق والعوامل الميسرة للمشاركة ، وذلك باستخدام مصادر بيانات رصد البرامج من منظور كل من المشاركين وقادة المجموعات. وأجرينا تحليلات وصفية للبيانات لتحديد العوائق البارزة (مثل تحديات العمالة ، والتحديات الصحية ومشاكل المواعيد) والعوامل الميسرة (مثل الأمهات الأخريات في المجموعات ، والاهتمام بمواضيع البرنامج) للمشاركة التي برزت من خلال الإصدارات الإنجليزية والأسبانية للمنهج. وتم أيضا توثيق العوائق والعوامل الميسرة الخاصة بالمناهج. ونحن نفسر هذه النتائج في ضوء البيانات الكمية المتعلقة بمقاييس المشاركة ، والتي تبين ان المشاركين في المنهج الاسباني اثبتوا مستويات مماثله من جوده علاقة الآباء بقائد المجموعة بالمقارنة مع المجموعة الانجليزيه ، ومستويات اعلي من دعم/ترابط مجموعة الآباء والرضا العام. وتقدم هذه النتائج اعتبارات واعدة لتحسين مشاركه الأسر في برامج الرعاية الوالدية في سياق الرعاية المبكرة وسياقات التعليم.

Context Nearly 1.2 million children with disabilities received federally administered Supplemental Security Income (SSI) payments in 2017. Based on a robust review of research and evaluation evidence and microsimulations, The National Academies of Sciences, Engineering, and Medicine committee identified modifications to SSI (ie, increasing the federal SSI benefit maximum by one-third or two-thirds) as 1 of 10 strategies that could reduce the US child poverty rate, improving child health and well-being on a population level. Objective Describing the availability and amount of SSI and State Supplementary Payment (SSP) program benefits to support families of children with disabilities may be a first step toward evaluating The National Academies of Sciences, Engineering, and Medicine-proposed modification to SSI as a potential poverty alleviation and health improvement tool for children with disabilities and their families. Design We used public health law research methods to characterize the laws (statutes and state agency regulations) governing the federal SSI program and SSP programs in the 50 states and District of Columbia from January 1, 1996, through November 1, 2018. Results The number of jurisdictions offering supplementary payments (SSP) was relatively stable between 1996 and 2018. In 2018, 23 US jurisdictions legally mandated that SSP programs were available for children. Among the states with SSP payment amounts in their codified laws, SSP monthly benefit amounts ranged from $8 to $64.35 in 1996 and $3.13 to $60.43 in 2018. Conclusion Our initial exploration of SSI-related policies as a tool for improving the economic stability of children with disabilities and their families suggests that current SSPs, in combination with SSI, would not rise to the level of SSI increases proposed by The National Academies of Sciences, Engineering, and Medicine. Understanding more about how SSI and SSP reach children and work in combination with other federal and state income security programs may help identify policies and strategies that better support children with disabilities in low-income households.

Parenting and family environment have significant impact on child development, including development of executive function, attention, and self-regulation, and may affect the risk of developmental disorders including attention-deficit/hyperactivity disorder (ADHD). This paper examines the relationship of parenting and family environment factors with ADHD. A systematic review of the literature was conducted in 2014 and identified 52 longitudinal studies. A follow-up search in 2021 identified 7 additional articles, for a total of 59 studies that examined the association of parenting factors with ADHD outcomes: ADHD overall (diagnosis or symptoms), ADHD diagnosis specifically, or presence of the specific ADHD symptoms of inattention and hyperactivity/impulsivity. For parenting factors that were present in three or more studies, pooled effect sizes were calculated separately for dichotomous or continuous ADHD outcomes, accounting for each study's conditional variance. Factors with sufficient information for analysis were parenting interaction quality (sensitivity/warmth, intrusiveness/reactivity, and negativity/harsh discipline), maltreatment (general maltreatment and physical abuse), parental relationship status (divorce, single parenting), parental incarceration, and child media exposure. All factors showed a significant direct association with ADHD outcomes, except sensitivity/warmth which had an inverse association. Parenting factors predicted diagnosis and overall symptoms as well as inattentive and hyperactive symptoms when measured, but multiple factors showed significant heterogeneity across studies. These findings support the possibility that parenting and family environment influences ADHD symptoms and may affect a child's likelihood of being diagnosed with ADHD. Prevention strategies that support parents, such as decreasing parenting challenges and increasing access to parent training in behavior management, may improve children's long-term developmental health.

Adverse childhood experiences (ACEs) are associated with poor health. Childhood experiences of racial/ethnic discrimination and other forms of racism may underlie or exacerbate other ACEs. We explored health-related associations with perceived racial/ethnic discrimination relative to other ACEs, using data from 2016–2019 National Survey of Children’s Health, an annual cross-sectional, nationally representative survey. Parent responses for 88,183 children ages 6–17 years with complete data for ACEs (including racial/ethnic discrimination) were analyzed for associations between racial/ethnic discrimination, other ACEs, demographics, and physical and mental health conditions with weighted prevalence estimates and Wald chi-square tests. To assess associations between racial/ethnic discrimination and health conditions relative to other ACEs, we used weighted Poisson regressions, adjusted for exposure to other ACEs, age, and sex. We assessed effect modification by race/ethnicity. Prevalence of other ACEs was highest among children with racial/ethnic discrimination, and both racial/ethnic discrimination and other ACEs were associated with having one or more health conditions. Adjusted associations between racial/ethnic discrimination and health conditions differed by race/ethnicity (interaction P-values < 0.001) and were strongest for mental health conditions among Hispanic/Latino (adjusted prevalence ratio (aPR)=1.62, 95% confidence interval (CI): 1.24–2.10) and non-Hispanic/Latino Asian American (aPR=2.25, 95% CI: 1.37–3.71) children. Results suggest racial/ethnic discrimination and other ACEs are associated with child health conditions, with differences in relative associations by race/ethnicity. Public health efforts to prevent childhood adversity, including racial/ethnic discrimination and other forms of racism could be associated with improvements in child health.

OBJECTIVE: Evidence suggests that caring for a child with special health care needs can affect many domains of family life, including caregiver mental health. However, few studies have examined these outcomes among families impacted by the Zika virus (ZIKV). This study examines depressive symptom severity and care demands among primary caregivers of children, aged 15 to 26 months, with evidence of congenital Zika virus infection (ZVI). METHODS: A sample of primary caregivers of children with evidence of congenital ZVI in northeastern Brazil (n = 150) reported on depressive symptoms, care demands, and their children’s development. Children were categorized into groups according to their developmental delay status. Bivariate analyses were run to test for differences between groups. A path analysis model was used to examine the indirect effects of developmental delay on depressive symptoms through economic challenges and time spent providing health care at home and whether these associations varied by child care support. RESULTS: Compared to primary caregivers of children without developmental delay, primary caregivers of children with developmental delay had higher depression scores (p = 0.002), reported more economic (p < 0.001) and child care (p < 0.001) challenges, and spent more time providing health care at home (p < 0.001). Among primary caregivers who did not have child care support, developmental delay had a significant indirect effect on depressive symptoms through economic challenges but not through time spent providing health care at home. CONCLUSION: For families impacted by the ZIKV outbreak in Brazil, economic and child care challenges may be associated with primary caregiver mental health.

OBJECTIVE: In an effort to promote the health and developmental outcomes of children born into poverty, the Centers for Disease Control and Prevention (CDC) conceptualized and designed the Legacy for Children™ (Legacy) public health prevention model. This article examines the impact of Legacy on children’s cognitive and language development (intelligence quotient [IQ], achievement, language skills, and early reading skills) using both standardized assessments and parent-reported indictors through third grade. METHODS: Data were collected from 2001 to 2014 from 541 mother-child dyads who were recruited into the 2 concurrent randomized controlled trials of Legacy in Miami and Los Angels. Cognitive and/or language outcomes of children were assessed annually from age 2 to 5 years as well as during a follow-up visit in the third grade. RESULTS: Children experiencing Legacy at the Los Angeles site had significantly higher IQ and achievement scores at 2 and 6 years postintervention, equivalent to approximately one-third of an SD (4 IQ points). IQ results persisted over time, and the difference between intervention and comparison groups on achievement scores widened. There were no significant differences in cognitive outcomes in the Miami sample. There were no significant differences in language outcomes for either site. CONCLUSION: Legacy shows evidence of effectiveness as an intervention to prevent cognitive delays among children living in poverty. The mixed findings across sites may not only reflect the impact of heterogeneous risk profiles noted by other intervention research programs but also warrant additional study.

Infant and early childhood mental health (IECMH) has been defined as the capacity of infants and young children to regulate their emotions, form secure relationships, and explore their environments. For this special issue, we conducted a review of IECMH outcomes from evaluations of couple- and family-based psychosocial interventions not explicitly designed for trauma exposure published from 2010 through 2019, following Evidence Base Update criteria and the current convention of classifying general categories of intervention approaches rather than the former practice of evaluating specific brand-name packaged programs. Full-text review of 695 articles resulted in 39 articles eligible for categorization into intervention approaches, taking into consideration the theoretical orientation of the treatment, the population served, the intervention participants, the target outcomes, the treatment theory of change, and the degree to which the intervention was standardized across participants. Four intervention approaches were identified in this review as Probably Efficacious: Behavioral Interventions to Support Parents of Toddlers, Interventions to Support Adolescent Mothers, Tiered Interventions to Provide Support Based on Assessed Risk, and Home Visiting Interventions to Provide Individualized Support to Parents. Other intervention approaches were classified as Possibly Efficacious, Experimental, or did not have sufficient evidence in this time period to classify under these criteria. Further research could explore how to ensure that all families who need support can receive it, such as by increasing the reach of effective programs and by decreasing the number of families needing additional support.

OBJECTIVE: The aim of the present study was to describe self-regulation (the ability to influence or control one’s thoughts or behavior in response to situational demands and social norms) in children ages 3–5 years using a nationally representative sample and examine risk and protective factors to identify opportunities to support children and families. METHODS: Using a cross-sectional design, we examined data from a parent-reported pilot measure of self-regulation from the 2016 National Survey of Children’s Health (NSCH). We compared U.S. children aged 3–5 years who were described by parents as “on track” with self-regulation development with children who were not. In addition, we described how health care and developmental services, community, family, and child health and development factors are associated with children’s self-regulation. RESULTS: The majority of children (4 of 5) were described by their parents to be developmentally on track with self-regulation. Compared to children described as not on track, children described as on track more often lived in financially and socially advantaged environments and less often experienced family adversity. They also had other positive health and development indicators, whether or not they were receiving developmental services. However, only half of children not on track received developmental surveillance, and only 1 in 4 children described as not on track received educational, mental health, or developmental services. CONCLUSION: The findings are a step towards using self-regulation as an indicator of healthy child development and as a potential strategy to identify groups of children who may need additional support.

OBJECTIVE The objective of this article was to assess the impact on behavioral and socioemotional development, 2 to 6 years postintervention (depending on the curriculum), of Legacy for Children, a public health approach to improve child developmental outcomes among families living in poverty. METHODS Mothers who were recruited prenatally or at the time of childbirth participated in a set of Legacy parallel design randomized control trials between 2001 and 2009 in Miami, Florida, or Los Angeles, California. Of the initial 574 mother-child dyads, 364 completed at least 1 behavioral or socioemotional outcome measure at the third-grade follow-up. Intention-to-treat analyses compared Legacy and comparison groups on behavioral and socioemotional outcomes. RESULTS Children of Legacy mothers in Los Angeles were at lower risk for externalizing behaviors and poor adaptive skills than children whose mothers did not participate in the intervention. No significant outcome differences by group assignment were found in Miami. CONCLUSION Group-based positive parenting interventions such as Legacy may have a sustained impact on children's behavioral and socioemotional development several years after intervention completion.

Objective To assess the national and state prevalence of being “Healthy and Ready to Learn” (HRL) and associated sociodemographic, health, family and neighborhood factors. Methods Cross-sectional analysis of the 2016 National Survey of Children's Health, a nationally representative parent-reported survey administered by web and paper June 2016 to February 2017. Four domains were constructed from 18 items through confirmatory factor analyses: “Early Learning Skills”, “Social-Emotional Development”, “Self-Regulation”, and “Physical Well-being and Motor Development.” Each item and domain were scored according to age-specific standards as “On-Track”, “Needs Support”, and “At Risk” with overall HRL defined as “On-Track” in all domains for 7565 randomly selected children ages 3 to 5 years. Results In 2016, 42.2% of children ages 3 to 5 years were considered HRL with the proportion considered “On-Track” ranging from 58.4% for Early Learning Skills to 85.5% for Physical Well-being and Motor Development”; approximately 80% of children were considered “On-Track” in Social-Emotional Development and Self-Regulation, respectively. Sociodemographic differences were mostly non-significant in multivariable analyses. Health, family, and neighborhood factors (ie, special health care needs status/type, parental mental health, reading, singing and storytelling, screen time, adverse childhood experiences, and neighborhood amenities) were associated with HRL. HRL prevalence ranged from 25.5% (NV) to 58.7% (NY), but only 4 states were significantly different from the U.S. overall. Conclusions Based on this pilot measure, only about 4 in 10 US children ages 3 to 5 years may be considered “Healthy and Ready to Learn.” Improvement opportunities exist for multiple, modifiable factors to affect young children's readiness to start school.

Childhood mental, behavioral, and developmental disorders (MBDDs) are associated with adverse outcomes that can persist into adulthood (1,2). Pediatric clinical settings are important for identifying and treating MBDDs (3). Early identification and treatment of MBDDs can promote healthy development for all children (4), especially those living in poverty who are at increased risk for MBDDs (3,5) but might have reduced access to care (6). CDC analyzed data from the 2016 National Survey of Children's Health (NSCH) on MBDDs, risk factors, and use of federal assistance programs (e.g., Supplemental Nutrition Assistance Program [SNAP]) to identify points to reach children in poverty. In line with previous research (3,6), compared with children in higher-income households, those in lower-income households more often had ever received a diagnosis of an MBDD (22.1% versus 13.9%), and less often had seen a health care provider in the previous year (80.4% versus 93.8%). Among children living below 200% of the federal poverty level (FPL) who did not see a health care provider in the previous year, seven of 10 were in families receiving at least one public assistance benefit. Public assistance programs might offer collaboration opportunities to provide families living in poverty with information, co-located screening programs or services, or connection to care.

This article presents the findings of a qualitative study of maternal perceptions of parenting following participation in Legacy for ChildrenTM (Legacy), an evidence-based parenting program for low-income mothers of young children and infants. To further examine previous findings and better understand participant experiences, we analyzed semistructured focus-group discussions with predominantly Hispanic and Black, non-Hispanic Legacy mothers at two sites (n = 166) using thematic analysis and grounded theory techniques. The qualitative study presented here investigated how mothers view their parenting following participation in Legacy, allowing participants to describe their experience with the program in their own words, thus capturing an "insider" perspective. Mothers at both sites communicated knowledge and use of positive parenting practices targeted by the goals of Legacy; some site-specific differences emerged related to these parenting practices. These findings align with the interpretation of quantitative results from the randomized controlled trials and further demonstrate the significance of the Legacy program in promoting positive parenting for mothers living in poverty. This study emphasizes the importance of understanding real-world context regarding program efficacy and the benefit of using qualitative research to understand participant experiences.

Problem/Condition Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources. Reporting Period 2011–2012. Description of System The National Survey of Children’s Health (NSCH) is a cross-sectional, random-digit–dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged

Sociodemographic, health care, family, and community attributes have been associated with increased risk for mental, behavioral, and developmental disorders (MBDDs) in children (1,2). For example, poverty has been shown to have adverse effects on cognitive, socio-emotional, and physical development (1). A safe place to play is needed for gross motor development, and accessible health care is needed for preventive and illness health care (3). Positive parenting and quality preschool interventions have been shown to be associated with prosocial skills, better educational outcomes, and fewer health risk behaviors over time (2). Protective factors for MBDDs are often shared (4) and conditions often co-occur; therefore, CDC considered MBDDs together to facilitate the identification of factors that could inform collaborative, multidisciplinary prevention strategies. To identify specific factors associated with MBDDs among U.S. children aged 2-8 years, parent-reported data from the most recent (2011-2012) National Survey of Children's Health (NSCH) were analyzed. Factors associated with having any MBDD included inadequate insurance, lacking a medical home, fair or poor parental mental health, difficulties getting by on the family's income, employment difficulties because of child care issues, living in a neighborhood lacking support, living in a neighborhood lacking amenities (e.g., sidewalks, park, recreation center, and library), and living in a neighborhood in poor condition. In a multivariate analysis, fair or poor parental mental health and lacking a medical home were significantly associated with having an MBDD. There was significant variation in the prevalence of these and the other factors by state, suggesting that programs and policies might use collaborative efforts to focus on specific factors. Addressing identified factors might prevent the onset of MBDDs and improve outcomes among children who have one or more of these disorders.

In recognition of the need to reach more families, the Legacy for Children™ (Legacy) program was translated and culturally adapted for Spanish-speaking Hispanic mothers and their infants. This study examined the cultural adaptations and logistical supports needed for successful implementation with Spanish-speaking mothers. The research team used purposive techniques to sample Hispanic bi-lingual providers (N = 14) and supervisors (N = 5) of local home-based parenting programs (Healthy Families, Parents as Teachers, and SafeCare®). The goal of the study was to determine from providers and supervisors the social validity (satisfaction, relevancy, importance, and acceptability of the intervention) and cultural congruency of the adapted Legacy curriculum. Researchers conducted a qualitative analysis of the transcriptions using a template approach within NVivo 10 software to identify broad themes within focus group data. Overall, results indicated many positive aspects of the Legacy program including content, approach, pace, topics, structure, social engagement, and straightforward curriculum language. Emergent themes from the focus groups included best practices in identifying, recruiting, and approaching Hispanic mothers, as well as key engagement strategies. Recommended revisions of the adapted Legacy curriculum focused on enhancing visual and auditory supplements, making minor improvements to lower the reading level, and reducing barriers to attendance. Implications for cultural adaptation of parenting programs are discussed.

This chapter describes a group-based public health approach to prevent developmental delays associated with poverty by supporting positive parenting. Legacy for Children™ (Legacy) is designed to support sensitive, responsive mother–child relationships, build maternal self-efficacy, and foster peer networks of support among mothers living in poverty. Legacy groups start during pregnancy or infancy, and mothers in the group all have children within several months of the same age. Mothers can attend the group until their children are age 3 or 5 years, depending on the curriculum version. As the children age, the curriculum covers developmentally appropriate topics such as attachment, discipline, maternal self-care and stress reduction, reading and literacy, safety and nutrition, and promotion of child social skills. Randomized controlled trial (RCT) data from Legacy indicate intervention effects 3–6 years post-intervention for child socioemotional and cognitive outcomes. Legacy is currently being implemented in sites across the United States in a variety of infrastructures: child care, health care, and community-based organizations. Implementation has been supported by the Centers for Disease Control and Prevention (CDC) through training and technical assistance. Legacy has been adapted and translated for Spanish speakers; implementation and evaluation of Legacy for Spanish-speaking mothers is underway. Implementation, scalability, and next steps for the program are discussed as well as the importance of a developmental focus in programming.

Purpose To identify sociodemographic, healthcare, family, and community factors associated with mental, behavioral, or developmental disorders (MBDDs) in early childhood within a nationally representative U.S. sample. Methods As part of the National Survey of Children’s Health, parents of 35,121 children aged 2-8 years reported whether a health care provider ever told them their child had any of the following MBDDs: …

Research suggests that many disparities in overall health and well-being are rooted in early childhood (1,2). Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes (1). However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory (3,4). The first 8 years of a child's life build a foundation for future health and life success (5-7). Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child's development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories (4,7). By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.

In this article, the authors posit that programs promoting nurturing parent–child relationships influence outcomes of parents and young children living in poverty through two primary mechanisms: (a) strengthening parents' social support and (b) increasing positive parent–child interactions. The authors discuss evidence for these mechanisms as catalysts for change and provide examples from selected parenting programs that support the influence of nurturing relationships on child and parenting outcomes. The article focuses on prevention programs targeted at children and families living in poverty and closes with a discussion of the potential for widespread implementation and scalability for public health impact.

Social information processing (SIP) theory has been useful in understanding male aggression both generally and within intimate relationships. This study examined a SIP model of parenting risk in adolescent males (N = 77) who are not yet parents but have characteristics found in adult men who have physically abused children. Three SIP factors were predicted to play a role in the use of punishment: rigid and inappropriate child expectations (schema), problem-solving abilities and attributions of negative child intent. The adolescents in this study exhibited SIP difficulties at levels similar to those found in maltreating mothers and mothers at risk for perpetrating child maltreatment. As predicted, those who had more unrealistic expectations gave significantly more irrelevant solutions to child-rearing problems, made more negative intent attributions and assigned higher levels of punishment when presented with aversive child behaviour scenarios. Testing of the full model using structural equation modeling revealed, as predicted, significant direct paths between two SIP elements (problem-solving and attributions) and punishment levels assigned to children. An indirect path between expectations and punishment through attributions was also found. History of abuse did not add to the model in this at-risk sample. Implications of findings for prevention and future directions are discussed. Copyright © 2013 John Wiley & Sons, Ltd. ‘Three SIP factors were predicted to play a role in the use of punishment’ ‘Significant direct paths between two SIP elements and punishment levels assigned to children’ Key Practitioner Message The SIP model argues that caregivers who have unrealistic expectations of children show poorer problem-solving in child-rearing situations, and make more negative intent attributions to children's behaviour are at greater risk for inadequate and inappropriate parenting, including child maltreatment.

Background Previous research suggests that parents of a child with Tourette Syndrome (TS) have lower self-concepts, higher caregiver burden, and more difficulties with home activities. However, the contributions of TS and mental, emotional, or behavioral (MEB) conditions to family functioning are difficult to identify from previous research due to relatively small TS sample sizes and high rates of co-occurring conditions within samples of children with TS. Objective The current study hypothesized that families of children with TS would report significantly more family functioning difficulties (more parenting aggravation, more difficulty with coping with the child's care, less parent–child communication, and less consistent family routines). Specifically, co-occurring conditions would contribute substantially to reported parenting aggravation. Method Parent-reported data from the 2007 National Survey of Children's Health were analyzed, including whether the child had been diagnosed with TS or an MEB. Weighted analyses were restricted to US children 6–17 years of age (n = 64,034) and adjusted for child age, sex, race and ethnicity. Results Parents of children with TS were more likely to fall into the high parenting aggravation index category compared with parents of children without TS (aPR = 3.8, 95% CI: 2.2–6.6). Controlling for the co-occurring MEB conditions attenuated the relations between TS and parenting aggravation; however, a significant effect for TS remained in some cases. Conclusion Parents of children with TS may face significant challenges in raising their children, leading to increased parenting aggravation; these challenges appear to be primarily associated with the presence of co-occurring MEB conditions.

Child neglect has negative effects throughout the life span. Although an argument for a link between intellectual disabilities and neglectful parenting can be made, this article argues for a more fine-grained view of the cognitive problems that underlie child neglect perpetration and provides evidence for a social information processing model of it's etiology. Based on this model and what is known about the efficacy of behaviorally based interventions, implications for enhancements to the social service system to adapt to the needs of parents with intellectual disabilities are presented. The areas covered include improvements to screening and assessment of parents, provision of adapted services, and changes in selection processes and training of staff. Future directions for integrating social information processing elements into interventions are discussed with examples from empirically supported treatment and prevention programs.

Mixed results in the literature related to type of permanent placement and developmental outcomes of maltreated children suggest differences in postmaltreatment placement environments may be an important mechanism to consider. The goal of this study was to identify how home environment variables mediate risk in maltreated children in different types of placements. Participants included 71 maltreated and 70 non-maltreated (mean age = 7.14). Child outcomes were caregiver report of behavior problems (Child Behavior Checklist, CBCL) and cognitive assessment (Peabody Picture Vocabulary Test, PPVT, and Kaufman Brief Intelligence Test, KBIT). The home environment was examined using the Home Observation for Measurement of the Environment (HOME). The maltreated and non-maltreated groups differed significantly on cognitive scores, F(6, 268) = 3.05, p

Young maltreated children, birth to three years, represent the age group with the highest rates of maltreatment in the United States (ACYF 2007). There are few studies to date that have investigated early childhood maltreatment and its effects on emotion regulatory processes and psychopathology. In response, the current investigation uses a dyadic assessment procedure to examine the relationship between parenting, emotion regulation, and symptoms of psychopathology among maltreating and non-maltreating parent–child interactions. The participants in this study were 123 children (66 maltreated and 57 nonmaltreated) from ages 1–3. Child and parent affect and child effortful control were observed during a parent–child interaction task. Symptoms of psychopathology were measured using the Child Behavior Checklist. The maltreated children exhibited more anger, more internalizing symptomatology, and less positive affect compared to non-maltreated children. Among maltreated children, emotion dysregulation was associated with internalizing symptomatology. Moreover, these data reveal parental positive affect was associated with lower child internalizing symptomatology and parental anger was associated with higher child internalizing symptomatology in the entire sample. This investigation offers evidence that emotion dysregulation subsequent to poor dyadic interactions is associated with early child maltreatment. These data suggest that maltreated children experience difficulties in emotion regulation which may be related to their higher levels of behavioral symptomatology.

Most children and adolescents older than five years spend at least six hours of their day in school settings. Like parents, education professionals can promote health and protect youth from harm by providing safe, stable, nurturing relationships and environments. The Centers for Disease Control and Prevention (CDC) has developed a framework which posits that safe, stable, nurturing relationships and environments are Essentials for Childhood and are fundamental to promoting health and well-being; protecting youth from maltreatment and other violence and victimization; and ensuring optimal, healthy development. In this paper, the authors propose an approach to applying safe, stable, nurturing relationships and environments to the school ecology; review select survey measures to examine these constructs within educational settings; and suggest available indicators to measure safety, stability, and nurturance within the school context.

Approximately 16 million US children currently live in poverty [1]. Children living in poverty experience significant disparities on indicators of physical and mental health and academic success [2–6]. The importance of positive early experiences and the benefits of early intervention to mitigate the life-long effects of poverty have been confirmed in biologic [7], economic [8, 9], and social models [10]. Unfortunately, early childhood interventions have historically been limited in producing impacts when taken to scale. This has been attributed in part to a lack of quality assurance when moving from research to practice [11] and poor attention to scalability and dissemination when developing programs [12].

This study examined the role of effortful control, behavior problems, and peer relations in the academic adjustment of 74 kindergarten children from primarily low-income families using a short-term longitudinal design. Teachers completed standardized measures of children’s effortful control, internalizing and externalizing problems, school readiness, and academic skills. Children participated in a sociometric interview to assess peer relations. Research Findings: Correlational analyses indicate that children’s effortful control, behavior problems in school, and peer relations are associated with academic adjustment variables at the end of the school year, including school readiness, reading skills, and math skills. Results of regression analyses indicate that household income and children’s effortful control primarily account for variation in children’s academic adjustment. The associations between children’s effortful control and academic adjustment did not vary across sex of the child or ethnicity. Mediational analyses indicate an indirect effect of effortful control on school readiness, through children’s internalizing problems. Practice or Policy: Effortful control emerged as a strong predictor of academic adjustment among kindergarten children from low-income families. Strategies for enhancing effortful control and school readiness among low-income children are discussed.

Parents with intellectual disabilities (ID) are disproportionately represented in the child welfare system. Parents with ID can be better served by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, interactive, and self-instructional. SafeCare® is an evidence-based parenting program with flexibility to adapt its curricula while maintaining fidelity. This research presents the results of a pilot study that examined the effectiveness of an adaptation to the SafeCare® parent-infant interactions (PII) module for a mother with ID by using a digital picture frame with pictures of the mother and her infant engaged in skills that met the performance criteria for PII. A multiple-probe design across behaviors was used with the mother and her infant, showing a dramatic increase in PII skills that was maintained across 3 monthly follow-ups. Although further research is necessary, the preliminary data suggest the digital picture frame enhancement to the SafeCare® PII module may be a promising instructional tool for parents with ID.

Exposure to potentially traumatic events is common, with lifetime exposure estimates ranging from 56% to 85% of men and women (Frazier et al., 2009; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Although much research is focused on the development of posttraumatic stress disorder (PTSD), only approximately 3.6% of men and 9.7% of women (6.8% overall) develop PTSD (National Comorbidity Survey, 2005). Trauma reactions occur along a dimension of severity (Broman-Fulks et al., 2006) and, beyond PTSD symptoms, a host of negative consequences can occur, including interpersonal difficulties such as the perpetration of intimate partner violence (IPV; Schumacher, Feldbau-Kohn, Slep, & Heyman, 2001). Thus, a broader consideration of the effects of trauma is warranted. Cognitions regarding trauma and its sequelae play an important role in emotional and behavioral responses. Maladaptive appraisals of the trauma and overgeneralization from the trauma to normal events are theorized to result in external threat (e.g., belief that the world is dangerous) and internal threat (e.g., self-view as incapable and unacceptable; Ehlers & Clark, 2000). Such maladaptive posttraumatic cognitions have not previously been associated with perpetration of IPV. Research among non-traumatized populations indicating that perpetration of IPV is associated with hostile attribution biases and low self-esteem (Schumacher et al., 2001) leads to the possibility that post-traumatic cognitions are implicated in the perpetration of IPV by those who have been exposed to and affected by traumatic stressors. From the perspective of Ehlers and Clark (2000), two mechanisms may account for the relation between maladaptive post-traumatic cognitions and perpetration of IPV. First, posttraumatic cognitions are hypothesized to include selective misappraisal of threat. Because expressions of anger are conceptualized as signs of threat (Whalen et al., 2001), mistakenly appraising the emotional expressions of others as anger may occur. Misappraisal of anger has not been examined in relation to posttraumatic cognitions or IPV, although generalized deficits in the recognition of emotion have been associated with PTSD (Freeman, Hart, Kimbrell, & Ross, 2009) and perpetration of IPV (Marshall & Holtzworth-Munroe, 2010). Second, posttraumatic cognitions are hypothesized to lead to strong emotional reactions and dysfunctional strategies for regulating such emotions. Although emotion dysregulation has not been examined in relation to posttraumatic cognitions, it has been linked to PTSD (Tull, Barrett, McMillan, & Roemer, 2007) and perpetration of IPV (McNulty & Hellmuth, 2008). We hypothesized that misappraisal of anger as well as dysregulation of emotion would mediate the expected relation between maladaptive posttraumatic cognitions and perpetration of IPV. Because aggression occurs on a continuum of severity and IPV is often preceded by psychological aggression (Murphy & O’Leary, 1989), we examined whether our predictions extend to the perpetration of psychological aggression.

Children's responses on a Narrative Story Stem Technique (NSST) were coded using scales reflecting essential attachment constructs, specifically, attachment, exploratory, sociability, and caregiving behavioral systems, as originally conceived by Bowlby ( 1973 , 1982 ) and elaborated upon by his followers (Cassidy, 2008 ). NSST responses were examined in relation to both mother- and teacher-reported psycho-social adjustment and risk using the MacArthur HealthBehavior Questionnaire (HBQ). Forty-six children participated (average age 6 years 10 months), 19 of whom had high-risk backgrounds, and the rest demographically matched. Findings indicate that NSST scales were associated with behavior on certain HBQ scales, in expected directions. NSST responses appeared to differentiate socially competent children from children with the specific psycho-social risks of externalizing behavior problems and social isolation, according to mother-reports, on the one hand, and peer vulnerability and internalizing problems, according to teacher-reports, on the other. Implications for clinical applications are discussed.

This article reviews current literature examining associations between components of the family context and children and adolescents' emotion regulation (ER). The review is organized around a tripartite model of familial influence. Firstly, it is posited that children learn about ER through observational learning, modeling and social referencing. Secondly, parenting practices specifically related to emotion and emotion management affect ER. Thirdly, ER is affected by the emotional climate of the family via parenting style, the attachment relationship, family expressiveness and the marital relationship. The review ends with discussions regarding the ways in which child characteristics such as negative emotionality and gender affect ER, how socialization practices change as children develop into adolescents, and how parent characteristics such as mental health affect the socialization of ER.

H. Ginott and H. W. Goddard. (2003). Between Parent and child. New York: Three Rivers Press. 231 pp. Paperback ISBN: 0-609-80988-1, $13.00. Words can hurt, especially when spoken by a parent. As acknowledged in the revised and updated version of Between Parent and Child, many parents are unaware of how devastating their words and actions can be to a child. This classic parenting book is distinctively informative in its recognition of the importance of emotions in the parent-child relationship. The late Haim Ginott's Between Parent and Child, originally published in 1965, revised and updated by Alice Ginott and Wallace Goddard, is a must-read for parents, educators, and anyone who works with children. In the new edition, the chapters are organized more clearly with a central lesson and supporting vignettes. Although the material in the chapters has remained essentially the same, the wording has been updated, and the chapter headings are revised to reflect the current sentiment. For example, older editions called the discipline chapter "Permissiveness and limits," whereas in the updated edition it is "Discipline: Finding effective alternatives to punishment." The revised version includes an updated list of parenting resources and new approaches for helping children with problem behavior from a more individual perspective, with recommendations on how to deal with problems in specific types of children (e.g., fearful and aggressive children). The book is divided into 10 chapters, the order of which fall into three main categories: communication, positive discipline, and specific parenting issues. Readers gain a basic understanding of Ginott's principles prior to being introduced to parenting techniques and solutions. The first three chapters concentrate on parent-child communication, emphasizing the difference between encouraging words and threats and acknowledging that communicating with children is learned and requires practice. The authors argue that parent-child communication should be based on respect. Instead of instituting blame and criticism during the course of parent-child conversations, parents should seek to praise children for their accomplishments and encourage positive interactions with the open expression of emotion. The authors argue that before problems can be solved, emotions must first be acknowledged. The next section (chapters 4-6) focuses on positive parenting and encouraging dual responsibility, while finding successful alternatives to punishment. Parents have a tendency to overplay their responsibility for children's socialization, consequently not allowing children to gain a sense of responsibility themselves. The authors insist that responsibility cannot be forced but must grow from within and be fed by the values of home and community. Parents and children will disagree, but how parents handle disagreement can be the difference between having a disciplined yet happy child versus an enraged child. The authors encourage parents to limit acts rather than wishes or feelings. When children understand their own feelings and the reason for a disciplinary act, they will develop an internal standard of selfregulation. …