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Background: Most young children (0–3 years) attend formal childcare in Denmark, many of them fulltime. Yet recent reports of the quality of Danish childcare centers have shown that in more than one-third of nurseries, the interactions between caregivers and young children (0–3 years) are of “insufficient” quality, which constitutes a risk for affected children’s well-being and development. Effective interventions to improve childcare providers’ interactive skills are necessary. Methods: In this randomized controlled trial, we test the effectiveness of the Caregiver Interaction Profile training, which focuses on improving six core interactive skills: sensitive responsiveness, respecting children’s autonomy, structuring and limit setting, verbal communication, developmental stimulation, and fostering positive peer interactions. We will recruit N = 200 childcare providers from nursery groups in Copenhagen (n = 100 training group, n = 100 waiting-list control group). Our primary outcomes are childcare providers’ six interactive skills named above, observed from video-recorded interactions in the nursery groups. The secondary goal of our study is to test whether the training boosts children’s social-emotional and linguistic development. To this end we aim to recruit N ≈ 500 children from participating childcare providers’ nursery groups (n ≈ 250 training group, n ≈ 250 waiting-list control group). We measure social-emotional and linguistic development with various standardized questionnaires, filled out by parents and childcare providers. Discussion: If the training is effective at improving childcare providers’ interactive skills, then this will be an important foundation for implementation efforts, such as offering the training as part of the educational program of childcare providers. Future research should also evaluate whether the Caregiver Interaction Profile training is effective for childcare providers of older children (3–5 years) in Danish kindergartens. Tri

Background Early diagnosis of cerebral palsy (CP) is important to enable intervention at a time when neuroplasticity is at its highest. Current mean age at diagnosis is 13 months in Denmark. Recent research has documented that an early-diagnosis set-up can lower diagnostic age in high-risk infants. The aim of the current study is to lower diagnostic age of CP regardless of neonatal risk factors. Additionally, we want to investigate if an early intervention program added to standard care is superior to standard care alone. Methods The current multicentre study CP-EDIT (Early Diagnosis and Intervention Trial) with the GO-PLAY intervention included (Goal Oriented ParentaL supported home ActivitY program), aims at testing the feasibility of an early diagnosis set-up and the GO-PLAY early intervention. CP-EDIT is a prospective cohort study, consecutively assessing approximately 500 infants at risk of CP. We will systematically collect data at inclusion (age 3–11 months) and follow a subset of participants (n = 300) with CP or at high risk of CP until the age of two years. The GO-PLAY early intervention will be tested in 80 infants with CP or high risk of CP. Focus is on eight areas related to implementation and perspectives of the families: early cerebral magnetic resonance imaging (MRI), early genetic testing, implementation of the General Movements Assessment method, analysis of the GO-PLAY early intervention, parental perspective of early intervention and early diagnosis, early prediction of CP, and comparative analysis of the Hand Assessment for Infants, Hammersmith Infant Neurological Examination, MRI, and the General Movements method. Discussion Early screening for CP is increasingly possible and an interim diagnosis of “high risk of CP” is recommended but not currently used in clinical care in Denmark. Additionally, there is a need to accelerate identification in mild or ambiguous cases to facilitate appropriate therapy early, Background: Early diagnosis of cerebral palsy (CP) is important to enable intervention at a time when neuroplasticity is at its highest. Current mean age at diagnosis is 13 months in Denmark. Recent research has documented that an early-diagnosis set-up can lower diagnostic age in high-risk infants. The aim of the current study is to lower diagnostic age of CP regardless of neonatal risk factors. Additionally, we want to investigate if an early intervention program added to standard care is superior to standard care alone. Methods: The current multicentre study CP-EDIT (Early Diagnosis and Intervention Trial) with the GO-PLAY intervention included (Goal Oriented ParentaL supported home ActivitY program), aims at testing the feasibility of an early diagnosis set-up and the GO-PLAY early intervention. CP-EDIT is a prospective cohort study, consecutively assessing approximately 500 infants at risk of CP. We will systematically collect data at inclusion (age 3–11 months) and follow a subset of participants (n = 300) with CP or at high risk of CP until the age of two years. The GO-PLAY early intervention will be tested in 80 infants with CP or high risk of CP. Focus is on eight areas related to implementation and perspectives of the families: early cerebral magnetic resonance imaging (MRI), early genetic testing, implementation of the General Movements Assessment method, analysis of the GO-PLAY early intervention, parental perspective of early intervention and early diagnosis, early prediction of CP, and comparative analysis of the Hand Assessment for Infants, Hammersmith Infant Neurological Examination, MRI, and the General Movements method. Discussion: Early screening for CP is increasingly possible and an interim diagnosis of “high risk of CP” is recommended but not currently used in clinical care in Denmark. Additionally, there is a need to accelerate identification in mild or ambiguous cases to facilitate appropriate therapy early. Most studies on early diagnosis

Background: An early diagnosis of chronic disability, such as risk of Cerebral Palsy (CP), is likely to affect the quality of parent-infant interactions by affecting both infant and parental factors. Due to adverse perinatal events, infants at high risk of CP may exhibit less engagement in interactions, while parents may experience increased mental health problems and disrupted parental representations that can have a negative effect on parental sensitivity. Recent clinical guidelines on early intervention among families with infants at risk of CP recommends supporting parental sensitivity and mutual enjoyable interactions more research is needed to inform such interventions. This includes understanding how infant and parental risk as well as resilience factors impact parent-infant interactions and how existing parenting programs developed among typical developing infants should be adapted to families with infants at risk of CP. In addition, as majority of research on infant neurohabilitation focus on improving motor and cognitive outcomes research on infant emotional development is needed. The study aim is to assess the quality of early parent-infant interactions in families with high-risk infants, compared to families with low-risk infants, and to explore how interaction quality is affected by infant and parental factors. Three potential mediating factors explaining the association between CP risk and less optimal parent-infant interactions will be explored: infant interactional capacities, parental mental health and well-being, and parents' representations of their child. Methods: The prospective, longitudinal design will follow infants at high risk for CP and their parents and a control group at three time points from 15 weeks to 15 months corrected infant age (CA). Measures comprise infant developmental assessments, questionnaires and interviews with both parents, and global ratings of video-recorded parent-infant interactions. Discussion: Study results will

Introduction Contractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2-3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care. Methods and analysis A two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9-17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respe

Psychopathology poses a risk for optimal parenting. The current study explored antenatal caregiving representations as markers for later risk of nonoptimal maternal behavior among mothers with severe mental illness. Sixty-five mothers diagnosed with psychosis, bipolar disorder, depression (psychopathology group), and nonclinical controls participated in a longitudinal study from pregnancy to 16 weeks after birth. Mental health diagnoses and caregiving representations were assessed during pregnancy. Maternal behavior was assessed during the 5-min recovery phase of the still-face paradigm at 16 weeks. Mothers with psychopathology reported significantly higher levels of “heightened” caregiving representations (i.e., separation anxiety from the child) than did controls. The only significant diagnostic group difference in perinatal maternal behavior was that mothers diagnosed with depression exhibited more overriding-intrusive behavior than did nonclinical control mothers. Regression modeling results showed that antenatal caregiving representations of “role reversal” predicted significantly lower levels of sensitivity and higher levels of overriding-intrusive behavior independent of the effect of psychopathology. The findings can be interpreted in the context of representational transformation to motherhood during pregnancy. The results provide preliminary evidence for the potential of a new questionnaire measure of caregiving representations as a screening instrument for antenatal representational risk.

Pregnancy offers a unique period for initiating preventive parenting interventions. Disturbances in maternal-fetal bonding may indicate suboptimal parenting and a need for intervention. However, more knowledge is needed on the development of maternal-fetal bonding among at-risk groups. The study aim was to examine psychosocial correlates of maternal-fetal bonding among pregnant women identified to be at risk socially and regarding their mental health. The sample consisted of 78 at-risk pregnant women participating in a perinatal intervention study: Godt på Vej Sammen [A Good Start to Life-an Early Cross-sectorial Intervention]. This study was cross-sectional reporting on the baseline characteristics of the participants. In the beginning of the second trimester, participants completed questionnaires assessing maternal-fetal bonding (the Maternal Antenatal Attachment Scale [MAAS]), prenatal parental reflective functioning, adult attachment style, and depressive symptoms. We compared the distribution of MAAS styles with norms from a recent Dutch community sample. In addition, we tested associations between psychosocial variables and the quality and intensity of MAAS scores in regression models and performed Chi-square analyses to assess the association of MAAS styles with psychosocial variables. First, compared to women from a community sample, approximately half of the women in our sample presented lower and suboptimal MAAS scores. Second, insecure avoidant adult attachment style was negatively associated with MAAS intensity, and depressive symptoms were negatively associated with MAAS quality. Third, prenatal parental reflective functioning positively correlated with both quality and intensity of MAAS. Fourth, we found no association between insecure anxious adult attachment style and MAAS scores. Fifth, women with a negative disinterested MAAS style demonstrated the highest avoidant attachment scores, while women with a positively preoccupied MAAS style demonstra

The present study explored the Danish cross-cultural validity of the Caregiving Experiences Questionnaire (CEQ), a new measure of caregiving representations in parent-child relationships. Low-risk Danish mothers (N=159) with children aged 1.5-5 years completed the CEQ and predictive validity measures of parenting stress and child behavior problems. Exploratory factor analyses supported a four-factor model. Analyses showed significant theoretically meaningful associations between the CEQ scales and predictive validity measures. The current study adds evidence to the cross-cultural validity of the CEQ, The present study explored the Danish cross-cultural validity of the Caregiving Experiences Questionnaire (CEQ), a new measure of caregiving representations in parent-child relationships. Low-risk Danish mothers (N = 159) with children aged 1.5–5 years completed the CEQ and predictive validity measures of parenting stress and child behavior problems. Exploratory factor analyses supported a four-factor model. Analyses showed significant theoretically meaningful associations between the CEQ scales and predictive validity measures. The current study adds evidence to the cross-cultural validity of the CEQ.

Objective: The study explores predictors of antenatal caregiving representations among mothers with a history of severe mental illness (SMI). Background: Attachment research has demonstrated that multifactorial assessment of antenatal caregiving representations predicts later maternal behaviour and child attachment. However, the field lacks research among clinical groups. Knowledge of factors influencing caregiving representations during pregnancy can contribute to our understanding of caregiving risk among SMI-mothers and inform intervention decisions. Method: The current study is a cross-sectional subsample of the WARM study. Participants were 65 Danish or Scottish pregnant women with a history of either schizophrenia, bipolar disorder, moderate–severe depression, or non-clinical controls. Caregiving representations, adverse childhood experiences, social support and current symptom severity were assessed during pregnancy. Results: Symptom severity was associated with more non-optimal caregiving representations expecting less parental enjoyment, more difficulties separating from the child, and more feelings of caregiving helplessness. Lack of social support and adverse childhood experiences served as independent predictors of caregiving representations. Parental mental illness during own childhood predicted role reversed expectations. Conclusion: Antenatal caregiving representations can be assessed with a time-efficient self-report measure that assesses caregiving as a multidimensional construct. Prenatal treatment planning should target individual difficulties in undertaking transformation of the caregiving system., Objective: The study explores predictors of antenatal caregiving representations among mothers with a history of severe mental illness (SMI). Background: Attachment research has demonstrated that multifactorial assessment of antenatal caregiving representations predicts later maternal behaviour and child attachment. However, the field lacks research among clinical groups. Knowledge of factors influencing caregiving representations during pregnancy can contribute to our understanding of caregiving risk among SMI-mothers and inform intervention decisions. Method: The current study is a cross-sectional subsample of the WARM study. Participants were 65 Danish or Scottish pregnant women with a history of either schizophrenia, bipolar disorder, moderate–severe depression, or non-clinical controls. Caregiving representations, adverse childhood experiences, social support and current symptom severity were assessed during pregnancy. Results: Symptom severity was associated with more non-optimal caregiving representations expecting less parental enjoyment, more difficulties separating from the child, and more feelings of caregiving helplessness. Lack of social support and adverse childhood experiences served as independent predictors of caregiving representations. Parental mental illness during own childhood predicted role reversed expectations. Conclusion: Antenatal caregiving representations can be assessed with a time-efficient self-report measure that assesses caregiving as a multidimensional construct. Prenatal treatment planning should target individual difficulties in undertaking transformation of the caregiving system.

Introduction: In the attachment literature “the caregiving system” has been described as the parental behavioral system that has the function of “providing protection, comfort, and care for a child”, and it is proposed as a mediating link between the mother´s own attachment status and infant attachment classification (George & Solomon, 2008). Aims of the Study: As little is known on how the caregiving system develops when the mother suffers from severe mental illness (SMI), this presentation will explore the role of maternal psychopathology for the pre- and postnatal development of caregiving representations in the WARM study. The hypothesis is that higher level of psychopathology is associated with higher levels of the caregiving representations: Deactivation, cognitive disconnection and the segregated systems – all dimensions found among mothers with children that show a pattern of insecure or disorganized attachment. Material and Methods: Caregiving Representations are assessed in pregnancy and at 1 and 4 weeks postnatal with the Prenatal Caregiving Experience Questionnaire (PCEQ, Brennan, George, & Solomon, 2013) and at 16 weeks with the Caregiving Experience Quenstionnaire (CEQ, Brennan, George, & Solomon, 2013). The development of psychopathology is assessed in pregnancy and at 4 and 16 weeks with The Positive and Negative Syndrome Scale (PANSS, Kay et al., 1989), The Montgomery Asberg Depression Rating Scale (MADRS, Montgomery and Asberg, 1979) and The Bech-Rafaelsen Mania Rating Scale (BRMRS, Bech et al, 1979). Results: Preliminary results from the WARM study will be presented. Associations between severity of psychopathology and development of caregiving representations in the transition to motherhood will be explored.

A new questionnaire that assess caregiving regulation representations is presented as an important measure of parenting that contributes to the field with information on how mothers understand themselves as caregivers and their relationship with the child. Preliminary data from the WARM study – a longitudinal study that explores transmission of risk and resilience from mothers with SMI to their children – are presented, showing that mothers with SMI express more feelings of helpless and heigtened caregiving than non-clinical mothers in preganancy and in the early postnatal period from birth to 16 weeks. It is argued that as overactivation of emotional arousel normally is associated with mothers less able to regulate self and child , the PCEQ and CEQ could be useful and interesting measures that would allow for easy assessment and maybe screenng of vulnerable mothers and child-at-risk. More research on the associations between maternal behavior and caregiving regulation representations are needed, as well as research that explore the signifance of maternal characteristics, such as psyhopathology, for the development of caregiving representations.

Denne artikel beskæftiger sig med, hvordan risiko og modstandsdygtighed overføres fra forældre til barn, når mor lider af en alvorlig psykisk lidelse. Vi vil argumentere for, at det er helt centralt at undersøge forældre-barn relationen og det tidlige samspil, hvis man vil forstå spædbarnets psykosociale udvikling. Artiklen handler om, hvordan mor-barn samspillet er påvirket, når mor har alvorlige psykiske vanskeligheder, og pointerer, at mors diagnose ikke alene kan forklare kvaliteten af hendes samspil med barnet. Forældrerollen udvikles på baggrund af et samspil mellem forældrenes egne tilknytningserfaringer, de aktuelle sociale ressourcer og samspillet, som det formes med netop dette barn og dets særlige karakteristika. Derfor tror vi, at mere forskning i forældre-barn samspillet kan medvirke til at udvikle mere målrettede forebyggende interventioner, der kan støtte gravide kvinder med psykiske vanskeligheder.

The caregiving system was originally described by Bowlby and has been conceptually developed by George and Solomon (1989; 1996; 2008). It is “the other half” of the social bond between parent and child and is described as a behavioural system in its own right that is reciprocally linked to the child´s attachment system. The Prenatal Caregiving Experiences Questionnaire (PCEQ) (Brennan, George, & Solomon, 2013) is the first questionnaire that directly assesses prenatal caregiving representation. This poster presentation brings together different researchers who use the instrument in ongoing longitudinal research projects. The poster includes a description of the development of the PCEQ questionnaire, the theoretical background, as well as preliminary data on future mothers and fathers from the WARM study., The caregiving system was originally described by Bowlby and has been conceptually developed by George and Solomon (1989; 1996; 2008). It is “the other half” of the social bond between parent and child and is described as a behavioural system in its own right that is reciprocally linked to the child´s attachment system. The Prenatal Caregiving Experiences Questionnaire (PCEQ) (Brennan, George, & Solomon, 2013) is the first questionnaire that directly assesses prenatal caregiving representation. This poster presentation brings together different researchers who use the instrument in ongoing longitudinal research projects. The poster includes a description of the development of the PCEQ questionnaire, the theoretical background, as well as preliminary data on future mothers and fathers from the WARM study.

I artiklen præsenteres between-agerne – piger mellem ti og tolv, der klæder sig i seksuelt udfordrende tøj – og den bekymring, de gøres til genstand for i debatten i medierne. Essentielt i denne bekymring er misforholdet mellem pigernes seksuelle tegn og det traditionelle syn på, hvordan børn bør opfører sig. Denne problemstilling udfordres, idet der i artiklen argumenteres for, at bekymringen er baseret på en romantisk forestilling om forholdet mellem barndommens naturlighed og seksualitetens kulturelle oprindelse, der både er ensidig, forkert og begrænsende for en forståelse af between-agerne. Der argumenteres for, at der er behov for en fornyet og kvalificeret diskussion, således at pigernes seksuelle adfærd kan begribes på adækvat vis. Der konkluderes i den forbindelse, at leg og seksualitet ikke nødvendigvis skal ses som modsætninger, idet legen kan fungere som en ramme for between-agernes seksuelle ageren. Legen rummer således en forståelseskvalitet i forhold til betweenagerne, som det er relevant at undersøge nærmere.