Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress

Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence.

Antenatal depression and anxiety affect postpartum parenting stress:a longitudinal, prospective study

Postpartum depression has been associated with parenting stress, impacting attachment and child development. However, the relation between antenatal depression or anxiety and postpartum parenting stress has not been investigated. We studied the effect of antenatal depression and anxiety and treatment with selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors (antidepressants [ADs]) on postpartum parenting stress.

Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infants

Procedural pain in the neonatal intensive care unit triggers a cascade of physiological, behavioral and hormonal disruptions which may contribute to altered neurodevelopment in infants born very preterm, who undergo prolonged hospitalization at a time of physiological immaturity and rapid brain development. The aim of this study was to examine relationships between cumulative procedural pain (number of skin-breaking procedures from birth to term, adjusted for early illness severity and overall intravenous morphine exposure), and later cognitive, motor abilities and behavior in very preterm infants at 8 and 18 months corrected chronological age (CCA), and further, to evaluate the extent to which parenting factors modulate these relationships over time. Participants were N=211 infants (n=137 born preterm 32 weeks gestational age [GA] and n=74 full-term controls) followed prospectively since birth. Infants with significant neonatal brain injury (periventricular leucomalacia, grade 3 or 4 intraventricular hemorrhage) and/or major sensori-neural impairments, were excluded. Poorer cognition and motor function were associated with higher number of skin-breaking procedures, independent of early illness severity, overall intravenous morphine, and exposure to postnatal steroids. The number of skin-breaking procedures as a marker of neonatal pain was closely related to days on mechanical ventilation. In general, greater overall exposure to intravenous morphine was associated with poorer motor development at 8 months, but not at 18 months CCA, however, specific protocols for morphine administration were not evaluated. Lower parenting stress modulated effects of neonatal pain, only on cognitive outcome at 18 months.

Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years.

Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear. To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills. We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews. We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems. Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information. This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.

Parenting Programmes: The Best Available Evidence

Parenting programmes have been provided to a wide range of child and parent groups across a number of countries, but are they effective? This aim of this paper is to examine the findings from a number of systematic reviews that summarise the best available research evidence on the impact of these programmes on a range of parental and child outcomes. In addition to examining the findings from systematic reviews, the paper also takes a selective look at the uptake of parenting programmes in the United Kingdom, the evidence for effectiveness and the efficacy of adopting a population-based approach to parent education.

The findings from systematic reviews indicate that parenting programmes can have a positive impact on a range of outcomes, including improved child behaviour, increased maternal self-esteem and relationship adjustment, improved mother–child interaction and knowledge and decreased maternal depression and stress. While there is a need for greater evaluation of the long-term impact of these programmes, preliminary evidence indicates that these positive results are maintained over time, with group-based, behaviourally orientated programmes tending to be more effective.

While several recent trials indicate that that these programmes can be effective within the United Kingdom, high drop-out rates may mean that they only reach a minority of parents. However, multi-level parent education strategies such as the Australian Triple P Positive Parenting Strategy that incorporate an array of mediums aimed at different levels of need may provide an opportunity to reach a wider range of parents. This approach is currently being evaluated in order to ascertain whether it is effective in improving child outcomes in the general population.

While there is no coherent strategy for parent training across the United Kingdom, within the Northern Ireland context there is a move towards the development of a family support strategy. While uptake of parent education and training is currently unknown the best available evidence highlights the positive impact that parent training can have, suggesting the importance of including parent education as one aspect of this strategy

Adolescents' educational outcomes in a social ecology of parenting, family, and community risks in Northern Ireland

This study examines the influence of social ecological risks within the domains of parenting, family environment, and community in the prediction of educational outcomes for 770 adolescents (49% boys, 51% girls, M = 13.6 years, SD = 2.0) living in a setting of protracted political conflict, specifically working class areas of Belfast, Northern Ireland. Controlling for religious community, age, and gender, youths' lower academic achievement was associated with family environments characterized by high conflict and low cohesion. School behaviour problems were related to greater exposure to community violence, or sectarian and nonsectarian antisocial behaviour. Youths' expectations about educational attainment were undermined by conflict in the family environment and antisocial behaviour in the community, as well as parenting low in warmth and behavioural control. Findings underscore the importance of considering family and community contributions to youths' educational outcomes. Suggestions regarding targeted interventions toward promoting resilience are discussed, such as assessing both child and family functioning, developing multidimensional interventions for parents, and building community partnerships, among others.

Assessing parenting capacity in child protection: towards a knowledge-based model

The assessment of parenting capacity continues to engender public concern in cases of suspected harm to children. This paper outlines a model for approaching this task based on the application of three key domains of knowledge in social work relating to facts, theory and practice wisdom. The McMaster Model of Family Assessment is identified out of this process and reworked to give it a sharper focus on parenting roles and responsibilities. Seven formative dimensions of parenting are then elicited and combined with an analytical process of identifying strengths, concerns, prospects for growth and impact on child outcomes. The resulting assessment framework, it is argued, adds rigour to professional judgements about parenting capacity and enhances formulations on risk in child protection.

Fathers and Parenting

The aim of this chapter is to present a contextual and empirical account of men as fathers in Ireland along with an analysis of recent, relevant developments in policies and laws. Much of parenting of a child occurs in the home. Consequently, how couples inhabit the home greatly influences how their children experience childhood and, in many ways, the story of fatherhood in Ireland is the product of the on-going changes in the domestic sphere. Whether men are driving these changes, embracing or resisting them will provide the substance of much of this chapter. Section one presents basic demographic figures and trends based on census data to answer the questions: who are the fathers, what type of families do the live in and how involved are they in childcare? Section two presents recent research on contemporary fatherhood, both international and, where possible, national. Section three explores the policies and legal measures that affect fathers, their duties and their rights in the home and at work. Section four will discuss the historical legacy of fatherhood that is particular to Ireland. The final section will draw together these threads and ask what might be the future of fatherhood in Ireland, its challenges and possible successes.

A randomised controlled trial evaluation of the Lifestart parenting programme in Ireland

This randomised controlled trial evaluated the impact of the Lifestart parenting initiative, a five-year home visiting programme, on parent and child outcomes. 424 parents and children aged less than 12 months were recruited from across Ireland and randomly assigned to either the intervention or control group. The intervention group received the programme for five years; the control group did not, but continued as normal. Both groups were tested at three time points: pre-test, mid-point (child aged 3 years) and post-test (child aged 5 years). Post-test data collection is still on-going and will be completed by November 2014. Indicative findings (using available data) are presented here, however the analysis of the full dataset will be presented at the April 2015 meeting.