Cortisol Reactivity and Observed Parenting among Mothers of Children with and without ADHD

Parenting is a robust predictor of developmental outcomes among children with ADHD. Early parenting predicts the persistence and course of ADHD and comorbid problems above and beyond risk associated with shared genetic effects. Yet, on average, mothers of children with ADHD are less positive and more negative in their parent-child interactions compared to mothers of non-disordered children. Little is known about psychobiological markers which may be associated with individual variations in maternal parenting in families of children with ADHD. Neurobiological models of parenting suggest that maternal cortisol levels following a stressor may be positively associated with hostile and intrusive parenting; however, to date no studies have examined maternal cortisol reactivity and parenting in school-age, or clinical samples of, children. Mothers’ regulation of physiological stress responses may be particularly important for families of children with ADHD, as parenting a child with chronically challenging behaviors represents a persistent environmental stressor. The current study sought to extend the existing literature by providing an empirical examination of the relationship between maternal cortisol reactivity following two laboratory stressors and parenting among mothers of children with and without ADHD. It was hypothesized that child ADHD group would moderate the relationship between cortisol reactivity and self-reported and observed parenting. Greater total cortisol output and greater increase in cortisol during the TSST were associated with decreased positive parenting and increased negative and directive parenting, with the exception of parental involvement, which was associated with increased cortisol output during the TSST. Conversely, cortisol output during the PCI was associated with increased positive parenting, increased parental involvement, and decreased negative parenting. In contrast to the TSST, a greater decrease in cortisol during the PCI indicated more positive parenting and parental involvement. These associations were specific to mothers of children with ADHD, with the exception of maternal directiveness, which was specific to comparison mothers. Findings add to our understanding of physiological processes associated with maternal parenting and contribute to an integrative biological, psychological, and cognitive process model of parenting in families of children with ADHD.

RACIAL/ETHNIC VARIABILITY IN THE EFFECT OF RADIATION ON SECOND PRIMARY THYROID CANCER IN CHILDREN: ANALYSIS USING SURVEILLANCE EPIDEMIOLOGY AND END RESULTS DATA

Increases in pediatric thyroid cancer incidence could be partly due to previous clinical intervention. This retrospective cohort study used 1973-2012 data from the Surveillance Epidemiology and End Results program to assess the association between previous radiation therapy exposure in development of second primary thyroid cancer (SPTC) among 0-19-year-old children. Statistical analysis included the calculation of summary statistics and univariable and multivariable logistic regression analysis. Relative to no previous radiation therapy exposure, cases exposed to radiation had 2.46 times the odds of developing SPTC (95% CI: 1.39-4.34). After adjustment for sex and age at diagnosis, Hispanic children who received radiation therapy for a first primary malignancy had 3.51 times the odds of developing SPTC compared to Hispanic children who had not received radiation therapy, [AOR=3.51, 99% CI: 0.69-17.70, p=0.04]. These findings support the development of age-specific guidelines for the use of radiation based interventions among children with and without cancer.

Nurturing Change: Lilly Martin Spencer's Images of Children

This dissertation is the first full-length study to concentrate on American genre painter Lilly Martin Spencer's images of children, which constituted nearly one half of her saleable production during the height of her artistic career from 1848 to 1869. At this time, many young parents received advice regarding child rearing through books and other publications, having moved away from their families of origin in search of employment. These literatures, which gained in popularity from the 1830s onward, focused on spiritual, emotional, and disciplinary matters. My study considers four major themes from the period's writing on child nurture that changed over time, including depravity and innocence, parent/child bonding, standards of behavior and moral rectitude, and children's influence on adults. It demonstrates how Spencer's paintings, prints, and drawings featuring children supported and challenged these evolving ideologies, helping to shed light not only on the artist's reception of child-rearing advice, but also on its possible impact on her middle-class audience, to whom she closely catered. In four chapters, I investigate Spencer's images of sleeping children as visual equivalents of contemporary consolation literature during a time of high infant and child mortality rates; her paintings of parent/child interaction as promoting separation from mothers and emotional bonding with fathers; her prints of mischievous children as both considering changing ideals about children's behavior and comforting Anglo-American citizens afraid of what they saw as threatening minority groups; and her pictures with Civil War and Reconstruction subject matter as contending with the popular concept of the moral utility of children. By framing my interpretations of Spencer's output around key issues in the period's dynamic child-nurture literature, I advance new comprehensive readings of many of her most well-known paintings, including Domestic Happiness, Fi, Fo, Fum!, and The Pic Nic or the Fourth of July. I also consider work often overlooked by other art historians, but which received acclaim in Spencer's own time, including the lithographs of children made after her designs, and the allegorical painting Truth Unveiling Falsehood. Significantly, I provide the first in-depth analysis of a newly rediscovered Reconstruction-era painting, The Home of the Red, White, and Blue.