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Implementation of the Alarm Distress Baby Scale as a universal screening instrument in primary care: Feasibility, acceptability, and predictors of professionals’ adherence to guidelines
Supplementary resource (1)
... In 2001, Guedeney and Fermanian 31 created the Alarm Distress Baby Scale (ADBB) to facilitate a more structured observation of social behavior in infants from 2 to 24 months old, using an independent trained observer in a standardized situation 27,31,32 . The methodology is based on Winnicott's famous 'set situation' 33 , as well as on the Neonatal Behavioral Assessment Scale 34 both of which provide a given stimulation and observe the way the infant makes use of it. ...
... The ADBB scale enables not only to provide a measure of infant well-being but also is able to highlight the importance of the parentinfant relationship. Smith-Nielsen et al. 27 suggested that adding the ADBB to existing routine developmental health follow-up practices may well increase the value of health care workers' practice by improving their awareness of the emotional well-being of infants under study. ...
... In 2001, Guedeney and Fermanian 31 created the Alarm Distress Baby Scale (ADBB) to facilitate a more structured observation of social behavior in infants from 2 to 24 months old, using an independent trained observer in a standardized situation 27,31,32 . The methodology is based on Winnicott's famous 'set situation' 33 , as well as on the Neonatal Behavioral Assessment Scale 34 both of which provide a given stimulation and observe the way the infant makes uses of it. ...
... The ADBB scale enables not only to provide a measure of infant well-being but also is able to highlight the importance of the parentinfant relationship. Smith-Nielsen et al. 27 suggested that adding the ADBB to existing routine developmental health follow-up practices may well increase the value of health care workers' practice by improving their awareness of the emotional well-being of infants under study. ...
Background Infant social withdrawal, recognizable from two months onwards as assessed by the Alarm Distress Baby Scale (ADBB), provides a further measure of infant well-being. It has been widely used studying normal infants and those subjected to major adverse psychosocial environments. An overview is presented together with its use to evaluate infants with underlying organic illness and to understand the importance of the psychosocial well-being of the parents.
... There is a burgeoning body of research examining effective methods to train pediatricians and other providers who work in pediatric primary care settings to consistently conduct pediatric screening. These studies show promise in that providers have consistently increased their screening practices following training (Allen et al. 2010;Bauer et al. 2009;Earls and Hay 2006;Hathorn et al. 2014;Honigfeld et al. 2012;Malik et al. 2014;McKay 2006;Smith-Nielsen et al. 2017;Swanson et al. 2014). We systematically reviewed the research on training primary care providers to use ASD identification tools and identify challenges related to their use. ...
... None of the studies reported the races/ethnicities or education level of the professionals receiving training, although level of education can be inferred in some studies based on professional role (e.g., a pediatrician has a medical degree). Smith-Nielsen et al. (2017) reported the age of professionals receiving training; they reported the mean age was 47 years. Researchers in five studies reported inclusion criteria for professionals receiving training: two studies included only medical residents; one study required that participants be willing to participate in training, testing, and evaluation; one study required that participants agree to the terms of the study; and one study required that participants be health visitors employed by one of the included districts who did not intend to retire or go on leave within 1 year, worked with children younger than 1 year old, and participated in training. ...
The American Academy of Pediatrics recommends using an autism-specific screening tool for all young children at primary care well visits. Screening can detect risk of autism spectrum disorder (ASD) in young children whose parents and pediatrician may not otherwise have developmental concerns. The identification of children with or at-risk for ASD increases their access to early intervention services, which helps ameliorate skill deficits associated with ASD. Recent studies indicate pediatricians use autism-specific screening and diagnostic tools infrequently. Some research has been conducted to determine whether providing training to primary care providers increases screening practices; however, evidence-based practices for training pediatricians to conduct ASD screenings or use other ASD identification tools have not been identified. We conducted a review of the research on training primary care providers (e.g., pediatricians) on the use of ASD identification tools with young children and their families. The results of this review point to a lack of high-quality research in this area. The information can be used to advance research, policy, and practice.
... A recent implementation study showed that health visitors in the capital municipality of Denmark generally held a positive attitude towards the ADBB: Many health visitors experienced that by using the ADBB, their own focus on child social and emotional development was sharpened, and they developed a more precise and nuanced professional language for talking about early risk with the parents [26]. However, during ADBB courses the health visitors have expressed a need for more extensive training and a systematic tool to support their ability to describe the infant's socioemotional cues and behavior during the ADBB and thereby share knowledge with the parents about the early socioemotional needs of the infant. ...
Background
Infant mental health represents a significant public health issue. The transition to parenthood provides optimal opportunities for supporting parenting competence. Especially parental mentalization, i.e. the caregiver’s ability to notice and interpret the child’s behavior in terms of mental states, is important in infancy where the caregiver-infant communication is based solely on the infant’s behavioral cues.
Methods
This study evaluates the efficacy of the intervention Understanding Your Baby (UYB) compared to Care As Usual (CAU) in 10 Danish municipalities. UYB aims at promoting parental competence in new parents by supporting them in noticing their infants’ behavioral cues and interpreting them in terms of mental states. Participants will be approximately 1,130 singletons and their parents. Inclusion criteria are first-time parents, minimum 18 years old, living in one of the 10 municipalities, and registered in the Danish Civil Registration Register (CPR). Around 230 health visitors deliver the UYB as part of their routine observation of infant social withdrawal in the Danish home visiting program. During an interaction between the health visitor and the infant, the health visitor articulates specific infant behaviors and helps the caregivers interpret these behaviors to mental states. The study is a controlled parallel group study with data obtained at four time points in two phases: First in the control group receiving the publicly available postnatal care (CAU), secondly in the intervention group after UYB implementation into the existing postnatal services. The primary outcome is maternal competence. Secondary measures include paternal competence, parental stress, parental mentalizing, and infant socioemotional development. Analysis will employ survey data and data from the health visitors’ register.
Discussion
Results will provide evidence regarding the efficacy of UYB in promoting parenting competences. If proved effective, the study will represent a notable advance to initiating the UYB intervention as part of a better infant mental health strategy in Denmark. Conversely, if UYB is inferior to CAU, this is also important knowledge in regard to promoting parenting competence and infant mental health in a general population.
Trial registrationhttps://ClinicalTrials.gov with ID no. NCT03991416. Registered at 19 June 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03991416
... In a large crosssectional French study with infants aged 14-18 months, the scale demonstrated good clinical validity [25]. After the initial French validation in 2001, the scale has been used in several counties and several settings, demonstrating satisfactory transcultural validity [22,[26][27][28][29][30][31][32][33][34][35]. ...
Little is known about the relationship between maternal affectivity, social withdrawal and temperament in infants in low-income countries. The goal of the study was to assess the prevalence of social withdrawal behavior in infants aged 8 ± 2.3 months and to explore associations between maternal affectivity during pregnancy and postpartum, infant social withdrawal (as a sign of stress) and ‘difficult’ temperament as assessed by the mothers. 458 mother–infant dyads were recruited in the city’s public mother and child health-care centers. The eight items of the Alarm Distress Baby scale (8-ADBB) and the five-item M (modified) ADBB (M-ADBB) were used to assess sustained withdrawal behavior (ISSWB). The Goldberg Depression and Anxiety Scales were used to assess maternal affectivity and mental well-being. A specially designed questionnaire was used to identify stressful events faced by the mother during pregnancy. The ELDEQ-QCB was used to assess the degree of difficulty in managing the baby. Using the M-ADBB, we found a striking figure of 69.2% for ISSWB with 8-ABB (range 0–29) and 72.7% with the M-ADBB (range 0–10). ISSWB was linked to negative maternal affectivity and to high incidence of stressful events for the mothers, and to the child being viewed as ‘difficult’ by the mother. Positive prenatal affectivity was a protective factor of ISSWB (OR 0.46). Results are compared with previous studies in Africa. Early screening for ISSWB and identification of factors affecting maternal mental well-being could help in early intervention and increase the chances of better child development.
... The ADBB is designed for healthcare workers to observe and assess social withdrawal behavior in children aged 2-24 months, in the context of routine pediatric examinations or during specific psychological assessments (1). In 2018, Smith-Nielsen et al. found it feasible to increase the use of the ADBB in primary healthcare centers; most (92%) of healthcare workers reported that the scale had made a positive contribution to their work (26). So far, there is no sufficient evidence on the correlation between the ADBB and other socioemotional scales. ...
Background: Sustained withdrawal behavior is an obstacle for child development. The present study aimed to preliminarily evaluate the prevalence of social withdrawal tendency in young Chinese children using the Alarm Distress Baby Scale (ADBB) and describe the characteristics of socially withdrawn children.
Method: This was a cross-sectional analysis as part of a prospective cohort study. A total of 114 children aged 3–24 months were included. The following instruments were administered: the Chinese version of ADBB, the Ages and Stages Questionnaire (ASQ-3), the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE), and the Infant Temperamental Questionnaire. The tendency of social withdrawal in children was assessed using the ADBB. Social withdrawal was defined as an ADBB score of 5 or above. Student's t -test, χ ² test, and Fisher's exact test were performed to identify the differences in maternal and child characteristics between the children with and without social withdrawal. Age-specific indicators of development in these two groups were also presented.
Results: About 16.7% of the children were socially withdrawn. Compared with those without social withdrawal, children with social withdrawal were older and had higher proportions of boys (68.4 vs. 42.1%) and social-emotional development delay (63.2 vs. 0%). In age-specific analyses, social-emotional development was poorer in children with social withdrawal across all age groups from 3 to 24 months.
Conclusion: Assessed by the ADBB, the prevalence of social withdrawal tendency in young Chinese children was similar to that reported in the European population; children with social withdrawal tended to have poorer social-emotional development. Further research with larger sample sizes is needed to validate the scale and confirm these findings.
... Validity and reliability studies of the scale have shown good results . The face validity of the ADBB scale has been evidenced in many studies and across several countries (Guedeney et al., 2012;Smith-Nielsen et al., 2018), as well as in public health centers (Puura et al., 2010). In a study in wellbaby clinics in Brazil, the interrater agreement was good, but the agreement was significantly higher between pediatricians [intraclass correlation coefficient (ICC) = 0.82] than between nurses (ICC = 0.61) (Lopes et al., 2008). ...
Background:
Sustained social withdrawal in infancy may have organic and nonorganic causes and could hinder normal development. The Alarm Distress Baby (ADBB) scale is a widely validated screening tool of social withdrawal in children 2-24 months. The aim of the current study was to evaluate the full and modified ADBB in Nepalese infants in a community-based study.
Methods:
We enrolled 600 infants who were video recorded during a pediatric examination. The 36 infants first enrolled were scored by an expert rater, and the subsequent 64 infants were scored by two trained staff with the full ADBB scale. Of the 600 enrolled infants, 597 videos (including the 100 infants scored with the full ADBB) were scored with the modified ADBB (m-ADBB) scale by the trained staff, with 7% double scoring. We measured the interrater agreement and psychometric properties of both scales.
Results:
In the 64 infants scored with the full ADBB by two raters, the concordance correlation coefficients (CCCs) indicated poor interrater agreement. For the m-ADBB, the CCCs were better indicating acceptable agreement between raters. The greatest lower bound (GLB) for reliability coefficient for the full ADBB scored by an expert rater indicated good internal consistency, whereas the GLB coefficient for the m-ADBB indicated poorer internal consistency. The Spearman correlation coefficient between the total scores of the two versions was 0.82 (P < 0.001). Among the infants scored with the full ADBB, 25% had a score above cutoff (≥5). Scored with the m-ADBB in the full sample, 11.4% of the infants had a score above the suggested cutoff (≥2). In both versions, children achieved high scores on vocalization.
Conclusion:
Our findings suggest that the m-ADBB is an acceptable approach to achieve adequate interrater agreement in a large community-based study in Nepal. Results indicate high prevalence of social withdrawal in this population. There are, however, uncertainties on the internal consistency of the scales in this setting, and the validity of the scales needs to be investigated further. More effective training strategies for administration and additional cultural-specific instructions could be important measures to explore before implementing the scale further in this setting.
... The Alarm Distress Baby Scale is a well-validated screening tool designed to assess sustained social withdrawal in infants between 2 and 24 months of age in primary care settings such as routine medical checkups or testing [21]. The infant can be assessed during the interaction with the medical professional which avoids putting pressure on the parents (because of their perception that it reflects their caregiving competence) [22]. ...
Background
Preterm newborns can be exposed early to significant perinatal stress, and this stress can increase the risk of altered socioemotional development. Sustained social withdrawal in infants is an early indicator of emotional distress which is expressed by low reactivity to the environment, and if persistent, is frequently associated with altered psychological development. Infants born prematurely have a higher probability of developing sustained social withdrawal (adjusted odds ratio 1.84, 95% CI 1.04-3.26) than infants born full term, and there is a correlation between weight at birth and sustained social withdrawal at 12 months of age.
Objective
The aims of this study are to compare the effect of the interactive guidance intervention to that of routine pediatric care on sustained social withdrawal in infants born moderately or late preterm and to explore the relationship between sustained social withdrawal in these infants and factors such as neonatal intensive care unit hospitalization variables, parental depression, and posttraumatic stress symptoms.
Methods
This study is designed as a multicenter randomized controlled trial. Moderate and late preterm newborns and their parents were recruited and randomized (1:1 allocation ratio) to control and experimental groups. During neonatal intensive care unit hospitalization, daily duration of skin-to-skin contact, breastfeeding, and parental visits were recorded. Also, a daily score for neonatal pain and painful invasive procedures were recorded. After discharge from neonatal intensive care, for the duration of the study, both groups will attend follow-up consultations with neonatologists at 2, 6, and 12 months of age (corrected for gestational age) and will receive routine pediatric care. Every consultation will be recorded and assessed with the Alarm Distress Baby Scale to detect sustained social withdrawal (indicated by a score of 5 or higher). The neonatologists will perform an interactive guidance intervention if an infant in the intervention group exhibits sustained social withdrawal. In each follow-up consultation, parents will fill out the Edinburgh Postnatal Depression Scale, the modified Perinatal Posttraumatic Stress Disorder Questionnaire, and the Impact of Event Scale–revised.
Results
Recruitment for this trial started in September 2017. As of May 2020, we have completed enrollment (N=110 infants born moderately or late preterm). We aim to publish the results by mid-2021.
Conclusions
This is the first randomized controlled trial with a sample of infants born moderately or late preterm infants who will attend pediatric follow-up consultations during their first year (corrected for gestational age at birth) with neonatologists trained in the Alarm Distress Baby Scale and who will receive this interactive guidance intervention. If successful, this early intervention will show significant potential to be implemented in both public and private health care, given its low cost of training staff and that the intervention takes place during routine pediatric follow-up.
Trial Registration
ClinicalTrials.gov NCT03212547; https://clinicaltrials.gov/ct2/show/NCT03212547.
International Registered Report Identifier (IRRID)
DERR1-10.2196/17943
... These results emphasise the need to detect social withdrawal behaviours in the first months of life as a silent signal of suffering that should be interpreted and treated, especially when the infants concerned present a medical condition [24]. Along these lines, Smith-Nielsen et al. [25] suggested that adding the ADBB to existing routine developmental health follow-up practices could add value to health care workers' practice by improving their knowledge about the socio-emotional development of infants. Even id ADBB scores are at the level of the ones found in general population, it is important to notice two main statements: EPDS is higher than general Table 4 Results of the univariate analysis for EOFS of the mother and the father at T0 and T1. ...
A joint assessment of the mental health of both infants and parents is required in the follow-up of cleft lip and palate. Even if most families are remarkably resilient faced with this major cause of stress, a significant proportion of them could require help to deal with the situation, especially during this first year of follow-up. An assessment of the
child’s social withdrawal behaviour and of the parental stress and depression appears useful, in order to adapt care to infant and parent’s needs.
... These results emphasise the need to detect social withdrawal behaviours in the first months of life as a silent signal of suffering that should be interpreted and treated, especially when the infants concerned present a medical condition [24]. Along these lines, Smith-Nielsen et al. [25] suggested that adding the ADBB to existing routine developmental health follow-up practices could add value to health care workers' practice by improving their knowledge about the socio-emotional development of infants. Even id ADBB scores are at the level of the ones found in general population, it is important to notice two main statements: EPDS is higher than general Table 4 Results of the univariate analysis for EOFS of the mother and the father at T0 and T1. ...
Background:
The objective of this prospective, multidisciplinary and multicenter study was to explore the effect of a cleft lip, associated or not with a cleft palate, on parents, on parent-infant relationship, and on the baby's relational development. It also highlighted how the type of cleft and the timing of the surgery could impact this effect.
Method:
158 infants, with Cleft lip with or without Palate, and their parents participated in this multicenter prospective cohort. Clinical evaluations were performed at 4 and 12 months postpartum. The impact on the parents and on the parent-infant relationship was evaluated by the Parenting Stress Index (PSI), the Edinburgh Post-partum Depression Scale (EPDS) and the Impact-on-Family Scale (IOFS). The relational development of the infant was assessed using the Alarm Distress Baby Scale (ADBB). The main criteria used to compare the infants were the severity of cleft and the time of surgery.
Results:
The timing of surgery, the type of malformation or the care structure had no effect on social withdrawal behaviors of the child at 4 and 12 months postpartum (ADBB). Furthermore, early intervention significantly decreased maternal stress assessed with the PSI at 4 months. Parents for whom it had been possible to give a prenatal diagnosis were much better prepared to accept the waiting time between birth and the first surgical intervention (IOFS). Higher postpartum depression scores (EPDS) were found for both parents compared to the general population.
Conclusion:
A joint assessment of the mental health of both infants and parents is required in the follow-up of cleft lip and palate. Even if most families are remarkably resilient faced with this major cause of stress, a significant proportion of them could require help to deal with the situation, especially during this first year of follow-up. An assessment of the child's social withdrawal behaviour and of the parental stress and depression appears useful, in order to adapt care to infant and parent's needs.
Trial registration:
ClinicalTrials.gov Identifier: NCT00993993. Registered 10/14/2009 <.
... These results emphasise the need to detect social withdrawal behaviours in the rst months of life as a silent signal of suffering that should be interpreted and treated, especially when the infants concerned present a medical condition (24). Along these lines, Smith-Nielsen et al. (25) suggested that adding the ADBB to existing routine developmental health follow-up practices could add value to health care workers' practice by improving their knowledge about the socio-emotional development of infants. Even id ADBB scores are at the level of the ones found in general population, it is important to notice two main statements: EPDS is higher than general population and ADBB tends to decrease between T0 and T1. ...
Background : The objective of this prospective, multidisciplinary and multicenter study was to explore the effect of a cleft lip, associated or not with a cleft palate, on parents, on parent-infant relationship, and on the baby’s relational development. It also highlighted how the type of cleft and the timing of the surgery could impact this effect.
Method : 158 infants, with Cleft lip with or without Palate, and their parents participated in this multicenter prospective cohort. Clinical evaluations were performed at 4 and 12 months postpartum. The impact on the parents and on the parent-infant relationship was evaluated by the Parenting Stress Index (PSI), the Edinburgh Post-partum Depression Scale (EPDS) and the Impact-on-Family Scale (IOFS). The relational development of the infant was assessed using the Alarm Distress Baby Scale (ADBB). The main criteria used to compare the infants were the severity of cleft and the time of surgery.
Results The timing of surgery, the type of malformation or the care structure had no effect on social withdrawal behaviors of the child at 4 and 12 months postpartum (ADBB). Furthermore, early intervention significantly decreased maternal stress assessed with the PSI at 4 months. Parents for whom it had been possible to give a prenatal diagnosis were much better prepared to accept the waiting time between birth and the first surgical intervention (IOFS). Higher postpartum depression scores (EPDS) were found for both parents compared to the general population.
Conclusion : A joint assessment of the mental health of both infants and parents is required in the follow-up of cleft lip and palate. Even if most families are remarkably resilient faced with this major cause of stress, a significant proportion of them could require help to deal with the situation, especially during this first year of follow-up. An assessment of the child’s social withdrawal behaviour and of the parental stress and depression appears useful, in order to adapt care to infant and parent’s needs.
Trial Registration: ClinicalTrials.gov Identifier: NCT00993993. Registered 10/14/2009 < https://clinicaltrials.gov/ct2/show/NCT00993993?term=grollemund&draw=2&rank=1.
... Our findings emphasise the need to detect social withdrawal behaviours in the first months of life as a silent signal of suffering that should be interpreted and treated, especially when the infants concerned present a medical condition (21). Along these lines, Smith-Nielsen et al. (22) suggested that adding the ADBB to existing routine developmental health surveillance practices could add value to health care workers' practice by improving their knowledge about the socio-emotional development of infants. ...
Background : The objective of this prospective, multidisciplinary and multicenter study was to explore the impact of a cleft lip, whether or not in association with a cleft palate (CLP) on the parents, on the parent-infant relationship, and on the infant’s relational development, depending on the type of malformation and the timing of the repair surgery, at 4 and 12 months postpartum. Method : 158 infants with CLP and their parents participated in this multicenter prospective cohort. Clinical evaluations were performed at 4 and 12 months postpartum. The impact on the parents and on the parent-infant relationship was evaluated by the Parenting Stress Index (PSI), the Edinburgh Post-partum Depression Scale (EPDS) and the Impact-on-Family Scale (IOFS). The relational development of the infant was assessed using the Alarm Distress Baby Scale (ADBB). The main criteria used to compare the infants were the severity of CLP and the time of surgery. Results 1) No effect was found in this sample of the timing of surgery, the type of malformation or the care structure on social withdrawal behaviors of the child at 4 and 12 months postpartum (ADBB). Furthermore, early intervention significantly decreased maternal stress assessed with the PSI at 4 months. 2) Parents for whom it had been possible to give a prenatal diagnosis were much better prepared to accept the waiting time between birth and the first surgical intervention (PSI, EPDS, IOFS). 3) Higher postpartum depression scores (EPDS) were found for both parents compared to the general population. Conclusion : A joint assessment of the mental health of both infants and parents is required in the follow-up of cleft lip and palate. Even if most families are remarkably resilient when faced with this major cause of stress, a significant proportion of them could require help to deal with the situation, especially during this first year of follow-up. An assessment of social withdrawal behaviours in the child and of the level of parental stress and depression appears useful, in order to adapt care to infant and parents alike. Trial Registration: ClinicalTrials.gov Identifier: NCT00993993. Registered 10/14/2009, https://clinicaltrials.gov/ct2/show/NCT00993993?term=grollemund&draw=2&rank=1.
... En kortlaegning foretaget af Sundhedsstyrelsen i 2017 (Sundhedsstyrelsen 2017), opdateret i 2018 (Skovgaard & Ammitzbøll 2019), viser, at der er stor interesse for at opruste de forebyggende indsatser i kommunerne. Mange kommuner har implementeret metoden ADBB (Alarm Distress Baby Scale), som er en metode til at screene for social og emotionel tilbagetraekning (Smith-Nielsen et al. 2018); BOEL-prøven, som tidligere har vaeret anvendt i alle kommuner i Danmark, er nu ved at blive udfaset; og PUFprogrammet, som er udviklet og valideret i Danmark ( ) er ved at blive implementeret i en raekke kommuner med henblik på at daekke hele spektret af mental sårbarhed hos små børn med udgangspunkt i sundhedsplejerskens undersøgelse ved ni-til timånedersalderen (Skovgaard & Ammitzbøll 2019). ...
Resumé
Undersøgelser viser, at der er et betydeligt mindretal i børnepopulationen, der har mentale helbreds- og sundhedsproblemer. Dette mindretal påkalder sig stor opmærksomhed, da der er kommet en stigende erkendelse af den mentale sundheds betydning for individets trivsel, udvikling, helbred og muligheder for at klare sig godt uddannelsesmæssigt og socialt. Derudover viser forskningen, at mentale helbreds- og sundhedsproblemer i barndommen ofte følger med ind i ungdoms- og voksenlivet. Mentale helbreds- og sundhedsproblemer i barndommen er således en stor udfordring for folkesundheden. Undersøgelser af større børn viser, at de fleste mentale helbreds- og sundhedsproblemer har deres oprindelse tidligt i børnenes liv, og den foreliggende forskning peger på, at der allerede i de to første leveår kan identificeres en række tidlige tegn på mentale helbreds- og sundhedsproblemer senere i barnealderen. For at Region Hovedstaden og kommunerne kan arbejde systematisk med sundhedsfremme og forebyggelse af mentale problemer, er det vigtigt at kende til forekomsten samt risikofaktorer og prædiktorer for senere mentale helbreds- og sundhedsproblemer. Formålet med denne rapport er derfor at belyse forekomsten og risikofaktorer for mentale helbreds- og sundhedsproblemer inden otteårsalderen samt forekomsten og risikofaktorer for markører herfor blandt børn i otte- til timånedersalderen. Derudover er formålet at undersøge, hvorvidt der kan identificeres tidlige markører ved sundhedsplejerskernes besøg i otte- til timånedersalderen, som er prædiktive for mentale helbreds- og sundhedsproblemer inden otteårsalderen. Rapporten er baseret på data indhentet fra sundhedsplejerskernes journaldata og registerdata om 95.266 børn i otte- til timånedersalderen født i 2002-2017 fra 27 af kommunerne i Region Hovedstaden samt 48.298 børn undersøgt af sundhedsplejersker ved indskolingsundersøgelsen i skoleårene 2007/08-2017/18 fra 15 af kommunerne i Region Hovedstaden. Resultaterne kan sammenfattes i tre hovedfund. Det første er, at 6,1 % af børnene diagnosticeres med en udviklingsforstyrrelse, 2,3 % diagnosticeres med en adfærds-, følelsesmæssig eller anden forstyrrelse, og at i alt 7,4 % af børnene har mindst én psykiatrisk diagnose inden de fylder otte år. Forekomsten er signifikant forhøjet i familier med risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer. Derudover viser rapporten, at i tiden omkring skolestart har 5,5 % af børnene en lav generel trivsel, og 11,1 % har en lav skoletrivsel. Fælles for disse variable er, at der er en signifikant øget forekomst blandt drenge og blandt børn, der ikke bor med begge forældre. Rapporten viser yderligere, at 7,6 % af børnene har problemer i forholdet til jævnaldrende i den periode, hvor de starter skole. Denne andel er signifikant forbundet med flere risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer. Det andet hovedfund, der vedrører de tidlige markører for mentale helbreds- og sundhedsproblemer, er, at sundhedsplejersken registrerer bemærkning til søvn/døgnrytme hos 6,8 % af børnene, bemærkning til ernæring/spisning hos 18,0 %, bemærkning til uro/gråd hos 0,7 %, bemærkning til motorisk udvikling hos 14,6 %, bemærkning til kommunikation/sprog hos 2,4 % samt bemærkning til forældre-barn kontakt og samspil hos 4,9 % af børnene ved otte- til timånedersalderen. Der er flere af disse tidlige markører, der er signifikant forbundet med flere risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer.
2
Det tredje hovedfund er, at sundhedsplejerskernes bemærkninger til barnets udvikling og trivsel i otte- til timånedersalderen er prædiktive for mentale helbredsproblemer diagnosticeret i hospitalsvæsenet inden otteårsalderen - og i mindre grad prædiktive for mentale sundhedsproblemer ved indskolingsundersøgelsen. Dette er helt ny og vigtig viden, og rapportens resultater peger på et vigtigt forebyggelsespotentiale, ikke mindst inden for sundhedsplejen.
... En kortlaegning foretaget af Sundhedsstyrelsen i 2017 (Sundhedsstyrelsen 2017), opdateret i 2018 (Skovgaard & Ammitzbøll 2019), viser, at der er stor interesse for at opruste de forebyggende indsatser i kommunerne. Mange kommuner har implementeret metoden ADBB (Alarm Distress Baby Scale), som er en metode til at screene for social og emotionel tilbagetraekning (Smith-Nielsen et al. 2018); BOEL-prøven, som tidligere har vaeret anvendt i alle kommuner i Danmark, er nu ved at blive udfaset; og PUFprogrammet, som er udviklet og valideret i Danmark ( ) er ved at blive implementeret i en raekke kommuner med henblik på at daekke hele spektret af mental sårbarhed hos små børn med udgangspunkt i sundhedsplejerskens undersøgelse ved ni-til timånedersalderen (Skovgaard & Ammitzbøll 2019). ...
Resumé
Undersøgelser viser, at der er et betydeligt mindretal i børnepopulationen, der har mentale helbreds- og sundhedsproblemer. Dette mindretal påkalder sig stor opmærksomhed, da der er kommet en stigende erkendelse af den mentale sundheds betydning for individets trivsel, udvikling, helbred og muligheder for at klare sig godt uddannelsesmæssigt og socialt. Derudover viser forskningen, at mentale helbreds- og sundhedsproblemer i barndommen ofte følger med ind i ungdoms- og voksenlivet. Mentale helbreds- og sundhedsproblemer i barndommen er således en stor udfordring for folkesundheden. Undersøgelser af større børn viser, at de fleste mentale helbreds- og sundhedsproblemer har deres oprindelse tidligt i børnenes liv, og den foreliggende forskning peger på, at der allerede i de to første leveår kan identificeres en række tidlige tegn på mentale helbreds- og sundhedsproblemer senere i barnealderen. For at Region Hovedstaden og kommunerne kan arbejde systematisk med sundhedsfremme og forebyggelse af mentale problemer, er det vigtigt at kende til forekomsten samt risikofaktorer og prædiktorer for senere mentale helbreds- og sundhedsproblemer. Formålet med denne rapport er derfor at belyse forekomsten og risikofaktorer for mentale helbreds- og sundhedsproblemer inden otteårsalderen samt forekomsten og risikofaktorer for markører herfor blandt børn i otte- til timånedersalderen. Derudover er formålet at undersøge, hvorvidt der kan identificeres tidlige markører ved sundhedsplejerskernes besøg i otte- til timånedersalderen, som er prædiktive for mentale helbreds- og sundhedsproblemer inden otteårsalderen. Rapporten er baseret på data indhentet fra sundhedsplejerskernes journaldata og registerdata om 95.266 børn i otte- til timånedersalderen født i 2002-2017 fra 27 af kommunerne i Region Hovedstaden samt 48.298 børn undersøgt af sundhedsplejersker ved indskolingsundersøgelsen i skoleårene 2007/08-2017/18 fra 15 af kommunerne i Region Hovedstaden. Resultaterne kan sammenfattes i tre hovedfund. Det første er, at 6,1 % af børnene diagnosticeres med en udviklingsforstyrrelse, 2,3 % diagnosticeres med en adfærds-, følelsesmæssig eller anden forstyrrelse, og at i alt 7,4 % af børnene har mindst én psykiatrisk diagnose inden de fylder otte år. Forekomsten er signifikant forhøjet i familier med risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer. Derudover viser rapporten, at i tiden omkring skolestart har 5,5 % af børnene en lav generel trivsel, og 11,1 % har en lav skoletrivsel. Fælles for disse variable er, at der er en signifikant øget forekomst blandt drenge og blandt børn, der ikke bor med begge forældre. Rapporten viser yderligere, at 7,6 % af børnene har problemer i forholdet til jævnaldrende i den periode, hvor de starter skole. Denne andel er signifikant forbundet med flere risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer. Det andet hovedfund, der vedrører de tidlige markører for mentale helbreds- og sundhedsproblemer, er, at sundhedsplejersken registrerer bemærkning til søvn/døgnrytme hos 6,8 % af børnene, bemærkning til ernæring/spisning hos 18,0 %, bemærkning til uro/gråd hos 0,7 %, bemærkning til motorisk udvikling hos 14,6 %, bemærkning til kommunikation/sprog hos 2,4 % samt bemærkning til forældre-barn kontakt og samspil hos 4,9 % af børnene ved otte- til timånedersalderen. Der er flere af disse tidlige markører, der er signifikant forbundet med flere risikofaktorer i graviditeten og ved fødslen samt med få socioøkonomiske ressourcer.
2
Det tredje hovedfund er, at sundhedsplejerskernes bemærkninger til barnets udvikling og trivsel i otte- til timånedersalderen er prædiktive for mentale helbredsproblemer diagnosticeret i hospitalsvæsenet inden otteårsalderen - og i mindre grad prædiktive for mentale sundhedsproblemer ved indskolingsundersøgelsen. Dette er helt ny og vigtig viden, og rapportens resultater peger på et vigtigt forebyggelsespotentiale, ikke mindst inden for sundhedsplejen.
... Validity and reliability studies of the scale have shown good results . The face validity of the ADBB scale has been evidenced in many studies and across several countries (Guedeney et al., 2012;Smith-Nielsen et al., 2018), as well as in public health centers (Puura et al., 2010). In a study in wellbaby clinics in Brazil, the interrater agreement was good, but the agreement was significantly higher between pediatricians [intraclass correlation coefficient (ICC) = 0.82] than between nurses (ICC = 0.61) (Lopes et al., 2008). ...
Background
The Ages and Stages Questionnaire 3rd edition (ASQ‐3) may be a feasible and cost‐effective tool to screen children`s development in resource poor settings. We have assessed the feasibility of the ASQ‐3 “home procedure” when conducted by field workers in a community based nutritional interventional trial on early child development in Nepal.
Method
Six hundred children aged 6‐11 months at risk of stunting were assessed by trained fieldworkers in their homes by the ASQ‐3. Three fieldworkers performed standardization exercises and were double scored with a gold standard during the study period. Intra class correlations (ICC) were calculated to measure the inter‐rater agreement. The internal consistency was expressed by standardized Cronbach`s alphas. The association between total ASQ score and gestation, low birth weight and stunted children is presented to give an estimate of the construct validity of the tool.
Result
Mean scores of the 600 Nepalese children were consistently lower than in the American norm sample. The ICCs from the standardization exercises were initially good to excellent, but declined throughout the study period. The standardized alphas for the total score in the different age groups indicate good internal consistency, but varied in the subscales. Children who were preterm, children with low birth weight and children who were stunted scored substantially lower on the total ASQ score than those who were not.
Conclusion
Although the ASQ‐3 “home procedure” is low at cost and easily accessible in a Nepalese context, the tool requires rigorous and stringent training to achieve acceptable inter‐rater agreement. Further adjustment is required to achieve satisfactory internal consistency.
Cette étude porte sur la micro-analyse de séances de thérapie « bébé-parents » d’approche psychanalytique. Un intérêt spécifique est porté à la fois au dispositif thérapeutique mis en place autour des bébés « à risques d’autismes », et plus particulièrement à ceux en retrait relationnel, et au bénéfice d’une thérapie au plus tôt pour ces bébés (cf. plasticité neuronale et épigénétique). L’objectif principal est ainsi de créer une méthodologie (micro-analyse de séances filmées) et un outil (codage) permettant de mesurer les effets de la thérapie menée auprès de ces bébés accompagnés de leurs « partenaires ». Méthode : Le matériel étudié est constitué de séances « bébé-parents » filmées (N=99 bébés). Chaque bébé a été catégorisé ou exclu selon différents paramètres définis préalablement : âge du bébé ; potentiels facteurs de risques (pathologie ; condition à la naissance ; environnement ; sexe) ; résultats obtenus à la suite de l’administration de la grille PREAUT-OLLIAC (Olliac et al., 2017). Cette catégorisation a permis la réalisation d’un échantillonnage via la sélection d’un cas clinique. Une méthode de codage de film a été créée (élaboration d’une grille ; définition d’une procédure d’application) et nous avons ainsi codé les 9 séances de l’échantillon en utilisant le logiciel ELAN pour en extraire des statistiques par séance sur plusieurs items (temps moyens, minimum, maximum, écart-type). Dans un second temps, un rééchantillonnage a été fait (sélection de « coeurs de séance ») pour en extraire de nouvelles données. Résultats : Les principaux résultats obtenus sont ainsi : une catégorisation complète de la cohorte (N=37 ; 25 bébés à « risques d’autismes » vs 12 bébés « sans risques d’autismes » selon la grille PREAUT-OLLIAC) ; une grille et une procédure de codage inédites adaptées au contexte de thérapie « bébé-parents » ; des analyses quantitatives (statistiques) et qualitatives (selon la théorie psychanalytique) sur les deux niveaux d’échantillonnage (séances entières ; « coeurs de séance »). Bien que l’intérêt principal de cette étude porte davantage sur la mise en place du dispositif de micro-analyse, les deux micro-analyses statistiques que nous avons effectuées nous ont notamment permis de faire ressortir une corrélation entre un discours de l’adulte en mamanais adressé au bébé et une réponse de celui-ci par le regard dans le contexte de thérapie « bébé-parents ». Conclusions et perspectives : La micro-analyse sur le cas pilote nous a d’ores et déjà permis d’affiner nos processus et nos outils d’analyse (procédure d’échantillonnage, codage, statistiques). Les résultats statistiques obtenus sont naturellement à mettre en perspective de la taille de l’échantillon et de la méthode de codage. Ce dispositif de micro-analyse permettra notamment d’analyser et affiner la performance de nos outils thérapeutiques dans la thérapie « bébé-parents » dans le cas spécifique de bébés en retrait relationnel. Il sera enfin envisageable d’étendre le dispositif de micro-analyse en élargissant la population à des bébés présentant d’autres caractéristiques
Background
Early identification of infants at-risk is imperative for proper referral to intervention programs. The Alarm Distress Baby Scale (ADBB) is an eight-item observer-rated screening tool detecting social withdrawal in infants. Previously, a shortened five-item version of the scale (m-ADBB) has been proposed. To date, few studies have examined the validity of the two scales, and no studies have examined the validity of the ADBB after implementation as a universal screening tool in primary care.
Objective
The aim of this study is to use Item Response Theory (IRT) to examine the construct validity of the ADBB when used by public health visitors in primary care.
Methods
Participants were 24,752 infants (aged: 2-12.9 months) screened by public health visitors using the ADBB. Screenings were categorized into three waves according to the infant's age at the screening time (2-3.9 months, 4-7.9 months, and 8-12.9 months). Analyses were conducted separately on each wave. We checked IRT assumptions: (a) Unidimensionality, (b) Monotonicity, (c) Local independence, and (d) No DIF in relation to infant sex and gestational age. The 2PLM was used to assess model fit and estimate model parameters.
Results
Items fulfilled assumptions regarding unidimensionality, monotonicity, and no clinical and significant DIF. Local independence was not present for all items (i.e. 2, 7, and 8). The items showed moderate to good discriminatory abilities (alpha values ≥ 1.11) and discriminated best above average levels of social withdrawal (theta values ≥ 1.33). Items 7 and 8 showed nearly identical ICC suggesting that the two items discriminate equally well at the same level of social withdrawal. In addition, items 4 and 6 discriminated best at very high levels of social withdrawal, which might be of limited interest for screening purposes. Finally, the items showed similar patterns in terms of discrimination and location parameters across the three waves.
Conclusions
The ADBB shows several psychometric strengths when used by public health visitors in primary care, and the items show good discriminatory abilities at the levels of social withdrawal of interest for screening purposes. Yet, the results also suggest that for first-line screening, the validity of the scale might be improved with the removal of items 4, 6, and 8 as suggested in the m-ADBB. However, before recommending implementation of the m-ADBB, studies comparing the criterion-related validity of the two scales are needed.
Drawing on ethnographic data from two Romanian and two Danish nurseries, we explore the agency of children aged 9 months to 2.5 years. Considering action, time, and place, the article reflects on crying as one of the children’s agentic practices. We identified five predominant types of crying and analysed peers’ and caregivers’ perceptions and reactions. The ethnographic approach uncovers the generational order and social logic of nurseries, making it possible to compare the ways in which children use crying in their communication with caregivers and peers in Romania and Denmark.
Background: Some studies suggest that favourable socioeconomic circumstances are associated with better parent–child relations but the documentation of such an association is limited and inconsistent. Few studies focused on infancy, few studies relied on objective measurement of parent–infant relations, and few studies included more than one measurement of parent–infant relations in the first year of life. Aims: To report the prevalence of objectively measured problems in parent–infant relations during the first year of life and to examine the association between socioeconomic circumstances and parent–infant relations in an unselected community sample of infants. Methods: Cross-sectional study of a community sample of children from birth to 10 months in 15 municipalities in Denmark, n = 11,765. The exposure variables were population register data about socioeconomic circumstances: (a) parents’ education, (b) family composition, (c) parents’ origin, and (d) parents’ occupational status. The outcome variable was the health visitor’s concerns about the parent–infant relation assessed at four home visits from birth to 10 months after delivery. Results: The proportion of children with concerns about the parent–infant relation was 10.5%, 7.8% at one home visit and 2.8% at two or more home visits. Logistic regression analyses showed that all four indicators of socioeconomic circumstances were associated with concerns about the parent–infant relation in the first year of life. Conclusions: The risk of problematic parent–infant relations were significantly elevated among, children of immigrant parents, and children of parents with shorter education and not in education or work.
Background: Sustained social withdrawal in infancy may be a first warning sign of infant distress with both internal and external causes. The Alarm Distress Baby (ADBB) scale is a widely validated screening tool for the assessment of social withdrawal in children 2-24 months. The aim of the current study was to evaluate the feasibility of the full and modified ADBB version to identify social withdrawal in infants 6-11 months old in a community-based trial in Bhaktapur, Nepal.
Background:
Mothers and infants are exposed to multiple stresses when cardiac surgery is required for the infant. This study reviewed infant responsiveness using a standardized objective observational measure of social withdrawal and explored its association with measures of maternal distress.
Methods:
Mother-infant pairs involving infants surviving early cardiac surgery were assessed when the infant was aged two months. Infant social withdrawal was measured using the Alarm Distress Baby Scale. Maternal distress was assessed using self-report measures for maternal depression (Edinburgh Postnatal Depression Scale), anxiety (Spielberger State-Trait Anxiety Scale), and parenting stress (Parenting Stress Index-Short Form). Potential associations between infant social withdrawal and maternal distress were evaluated.
Results:
High levels of maternal distress and infant social withdrawal were identified relative to community norms with a positive association. Such an association was not found between infant social withdrawal and the cardiac abnormality and surgery performed.
Conclusion:
The vulnerability of infants requiring cardiac surgery may be better understood when factors beyond their medical condition are considered. The findings suggested an association between maternal distress and infant social withdrawal, which may be consistent with mothers' distress placing infants subjected to cardiac surgery at substantially increased risk of social withdrawal. However, it is unclear to what extent infant withdrawal may trigger maternal distress and what the interactive effects are. Further research is warranted. Trialing a mother-infant support program may be helpful in alleviating distress and improving the well-being and outcomes for these families.
Background
Infant mental health is a significant public health issue as early adversity and exposure to early childhood stress are significant risk factors that may have detrimental long-term developmental consequences for the affected children. Negative outcomes are seen on a range of areas such as physical and mental health, educational and labor market success, social network and establishing of family. Secure attachment is associated with optimal outcomes in all developmental domains in childhood, and both insecure and disorganized attachment are associated with a range of later problems and psychopathologies. In disadvantaged populations insecure and disorganized attachment are common, which points to the need of identifying early risk and effective methods of addressing such problems. This protocol describes an experimental evaluation of an indicated group-based parental educational program, Circle of Security–Parenting (COS-P), currently being conducted in Denmark.
Methods/design
In a parallel randomized controlled trial of two intervention groups this study tests the efficacy of COS-P compared to Care as Usual (CAU) in enhancing maternal sensitivity and child attachment in a community sample in the City of Copenhagen, Denmark. During the project a general population of an estimated 17.600 families with an infant aged 2–12 months are screened for two known infant mental health risks, maternal postnatal depression and infant social withdrawal. Eligible families (N = 314), who agree to participate, will be randomly allocated with a ratio of 2:1 into the COS-P intervention arm and into CAU. Data will be obtained at inclusion (baseline) and at follow-up when the child is 12–16 months. The primary outcome is maternal sensitivity. Secondary outcomes include quality of infant attachment, language, cognitive and socioemotional development, family functioning, parental stress, parental mentalizing and maternal mental wellbeing.
Discussion
The potential implications of the experimental evaluation of an indicated brief group-based parenting educational program to enhance parental sensitivity and attachment are discussed.
Trial registration
ClinicalTrials.govID: NCT02497677. Registered July 15 2015
Available for download at
http://nirn.fpg.unc.edu/resources/implementation-research-synthesis-literature
Implementation science has progressed towards increased use of theoretical approaches to provide better understanding and explanation of how and why implementation succeeds or fails. The aim of this article is to propose a taxonomy that distinguishes between different categories of theories, models and frameworks in implementation science, to facilitate appropriate selection and application of relevant approaches in implementation research and practice and to foster cross-disciplinary dialogue among implementation researchers.
Theoretical approaches used in implementation science have three overarching aims: describing and/or guiding the process of translating research into practice (process models); understanding and/or explaining what influences implementation outcomes (determinant frameworks, classic theories, implementation theories); and evaluating implementation (evaluation frameworks). This article proposes five categories of theoretical approaches to achieve three overarching aims. These categories are not always recognized as separate types of approaches in the literature. While there is overlap between some of the theories, models and frameworks, awareness of the differences is important to facilitate the selection of relevant approaches. Most determinant frameworks provide limited "how-to" support for carrying out implementation endeavours since the determinants usually are too generic to provide sufficient detail for guiding an implementation process. And while the relevance of addressing barriers and enablers to translating research into practice is mentioned in many process models, these models do not identify or systematically structure specific determinants associated with implementation success. Furthermore, process models recognize a temporal sequence of implementation endeavours, whereas determinant frameworks do not explicitly take a process perspective of implementation.
Early childhood development typically follows a trajectory of achieving physical, cognitive, communication, social-emotional, and self-help milestones within a specified age range. Although most children reach these milestones within a similar range, others exhibit mild to severe developmental delays that indicate potential developmental disabilities. Developmental disabilities are a group of conditions caused by an impairment in one or more developmental domains (e.g., physical, learning, communication, behavior, or self-help). Developmental disabilities can become evident during the prenatal period through age 22 years, affect day-to-day functioning, and usually are lifelong. Approximately 15% of children aged 3-17 years in 2008 were estimated to have developmental disabilities of varying severity, such as language or learning disorders, intellectual disabilities, cerebral palsy, seizures, hearing loss, blindness, autism spectrum disorder (ASD), or other developmental delays.
The objective of the study was to examine how social withdrawal in infants aged 12 months predicted emotional and behavioural problems at ages 3 and 5 years. The sample included 1,586 infants from the French Eden Mother-Child Cohort Study who had a measure of social withdrawal with the Alarm Distress BaBy scale at age 1 year; among these children, emotional and behavioural difficulties were rated by mothers using the Strength and Difficulty Questionnaire (SDQ) at 3 years for 1,257 (79 %) children and at 5 years for 1,123 (72 %) children. Social withdrawal behaviour at age 1 year was significantly associated with the SDQ behavioural disorder scale at 3 years, independently of a host of familial and child temperament confounders. The association with the relational disorder, prosocial and total difficulty scales was close to significance at 3 years after taking into account familial and temperament confounders. Social withdrawal significantly predicted the three aforementioned scales when measured at 5 years. No significant predictivity of the emotional scale and hyperactivity scale was detected at any age. This study made with a large longitudinal sample confirms the negative effects on development of social withdrawal behaviour, shedding light on the unfolding of behavioural disorders and relational difficulties in children; this calls for early detection of sustained social withdrawal behaviour, as it seems to hamper emotional development.
Organizations in the United States alone spend billions on training each year. These training and development activities allow organizations to adapt, compete, excel, innovate, produce, be safe, improve service, and reach goals. Training has successfully been used to reduce errors in such high-risk settings as emergency rooms, aviation, and the military. However, training is also important in more conventional organizations. These organizations understand that training helps them to remain competitive by continually educating their workforce. They understand that investing in their employees yields greater results. However, training is not as intuitive as it may seem. There is a science of training that shows that there is a right way and a wrong way to design, deliver, and implement a training program. The research on training clearly shows two things: (a) training works, and (b) the way training is designed, delivered, and implemented matters. This article aims to explain why training is important and how to use training appropriately. Using the training literature as a guide, we explain what training is, why it is important, and provide recommendations for implementing a training program in an organization. In particular, we argue that training is a systematic process, and we explain what matters before, during, and after training. Steps to take at each of these three time periods are listed and described and are summarized in a checklist for ease of use. We conclude with a discussion of implications for both leaders and policymakers and an exploration of issues that may come up when deciding to implement a training program. Furthermore, we include key questions that executives and policymakers should ask about the design, delivery, or implementation of a training program. Finally, we consider future research that is important in this area, including some still unanswered questions and room for development in this evolving field.
The objective of this longitudinal study was to investigate the prevalence of infants' social withdrawal and mothers’ depressive symptoms in a cohort of full‐term infants and their mothers and in a cohort of moderately premature infants and their mothers at 3, 6, and 9 months’ postpartum. The Alarm Distress Baby Scale (ADBB) was used to assess social withdrawal; the Edinburgh Postnatal Depression Scale (EPDS) was administered to ascertain postpartum depressive symptoms. The results revealed a higher proportion of premature infants with social withdrawal at 6 months’ postpartum and significantly higher ADBB composite scores at 3 and 6 months of age, as compared with the full‐term infants. A higher proportion of mothers in the premature cohort had symptoms of postpartum depression at the 3‐month assessment, and they reported a significantly higher EPDS composite score at 3 months’ postpartum. There was a significant relation between maternal depressive symptoms at 3 and 6 months and infants’ social withdrawal at 9 months, and a significant concurrent relation between the two variables at 6 and 9 months in the full‐term cohort. The findings suggest a need to screen for both infant social withdrawal and maternal depressive symptoms in moderately prematurely born infants and their caregivers.
This article reviews the studies using or validating the Alarm Distress Baby Scale (ADBB; A. Guedeney & J. Fermanian, ) within different countries, different populations, and different settings. After a brief summary of the theoretical backgrounds of infant social behavior, the results of the main controlled and methodologically comparable studies are summarized and discussed. Second, the results of some observational studies as well as different models of factor analysis are presented. The modified, five-item ADBB (m-ADBB) Scale is described. Finally, perspectives for future research and training are presented.
The failure of better science to readily produce better services has led to increasing interest in the science and practice of implementation. The results of recent reviews of implementation literature and best practices are summarized in this article. Two frameworks related to implementation stages and core implementation components are described and presented as critical links in the science to service chain. It is posited that careful attention to these frameworks can more rapidly advance research and practice in this complex and fascinating area.
Sustained withdrawal behavior in infancy is an important alarm signal to draw attention to both organic and relationship disorders. A withdrawal scale, the Alarm Distress Baby scale (ADBB), for infants between 2 and 24 months of age was built. This article describes the construction of the scale and the assessment of its psychometric properties. The ADBB has good content validity, based on the advice of seven experts. The scale has good criterion validity: first, as a measure of the infant's withdrawal reaction, with a very good correlation between nurse and pediatrician on the ADBB (rs = 0.84), and second, as a screening procedure for detecting the developmental risk of the infant. The cutoff score of 5 with a sensitivity of 0.82 and a specificity of 0.78 was determined to be optimal for screening purposes. The scale has good construct validity, with good convergent validity with both the Spitz (1951) and the Herzog & Rathbun (1982) lists of symptoms of infant depression (rs = 0.61 and 0.60, respectively). Exploratory factor analysis showed two different factors, consistent with the scale's construct. Reliability was satisfactory with good internal consistency for both subscales (the Cronbach = 0.80 for the first subscale and 0.79 for the second) and for the global scale ( = 0.83). The test-retest procedure showed good stability over time (rs = 0.90 and 0.84 for the two different raters). The scale could be used in different clinical settings, provided a sufficient level of social stimulation is given to the infant in a relatively brief period of time. The scale can be used by nurses and psychologists or by medical doctors after a short period of training. © 2001 Michigan Association for Infant Mental Health.
The Alarm Distress Baby Scale (ADBB) aims at assessing infant withdrawal behavior. A previous validation study revealed acceptable reliability and validity indices. The present study investigated the psychometric properties of the scale in a larger sample from a culturally different population. Pediatricians evaluated the behavior of 122 infants, 2 and 19 months old, using the ADBB during routine physical consultation. Four investigators (two pediatricians and two nurses not specialized in pediatric care) examined video recordings of the evaluations. Results showed good interrater reliability coefficients among pediatricians and poor correlation when all professionals were grouped together. Test–retest reliability revealed good intraexaminer agreement (r = 0.91). The pediatricians' evaluation using the ADBB was compared with a psychiatric examination to investigate the scale's criterion validity. The cutoff point of 5 provided the best clinical validity (sensitivity of 79%, specificity of 81%). Results from construct validity showed that the scale had three dimensions. Comparison of the factor solution with other construct validity studies of the same instrument revealed similarities and differences. Results suggest that the ADBB may be a useful screening instrument to detect signs of psychiatric alterations related to withdrawal behavior in primary care services, and it is likely to provide consistent information.
The objectives of the study were (1) to assess prevalence of social withdrawal behaviour in infants aged 12 months included in the French Perinatal Risk Factor Study Eden; (2) To study the correlation between relational withdrawal and several perinatal and parental factors assessed in the EDEN study. A longitudinal study using the ADBB scale was conducted within the Eden Cohort in the year 2008. 1,586 infants were included in the study. Fourteen percent of the children who had an ADBB assessment had a score at 5 and over on the ADBB, a scale designed to assess social withdrawal behaviour at age 0-24 months. Social withdrawal at 12 months was associated with low birth weight, low gestational age and with intra uterine growth retardation. Social withdrawal was independently associated with several maternal and paternal risk factors. The level of social withdrawal behaviour increased with a score of maternal difficulties. This study on a large longitudinally followed volunteer sample demonstrate a clear association of social withdrawal behaviour at age one with low birth weight and preterm birth, possibly mediated by parental vulnerabilities. Social withdrawal behaviour seems to be an important alarm signal to detect early on particularly in premature and small for date babies.
Behavioral and emotional problems are highly prevalent in early childhood and represent an important focus of practice for clinical child and pediatric psychologists. Although psychological or psychiatric disorders are not typically diagnosed in children under the age of 2 years, recent research has demonstrated the appropriateness of assessing behavioral and emotional problems during the first 2 years of life (defined throughout as "infancy"). The current paper provides a systematic review of assessment procedures used to identify behavioral and emotional problems during infancy. Existing assessment procedures for infants take the form of parent- or caregiver-report questionnaires, observational coding procedures, and diagnostic classification systems. The questionnaires and observational coding procedures both had substantial psychometric evidence for use with infants, although observational coding may have limited utility in clinical practice. The classification systems have less empirical support for use with infants, and further research is necessary to demonstrate the appropriateness of these procedures with infants. Utilizing the reviewed procedures to assess behavioral and emotional problems in infants can have a substantial impact in research and practice settings, and further research is needed to determine the usefulness of these procedures in developing, testing, and implementing preventive and early intervention programs for infants and their families.
In 2005, the Enhancing Developmentally Oriented Primary Care (EDOPC) project of the Illinois chapter of the American Academy of Pediatrics and the Illinois Department of Healthcare and Family Services began a project to improve the delivery and financing of preventive health and developmental services for children in Illinois. The leaders of this initiative sought to increase primary care providers' use of validated tools for developmental, social/emotional, maternal depression, and domestic violence screening and to increase early awareness of autism symptoms during pediatric well-child visits in children aged 0 to 3 years. These screenings facilitate identification of children at risk and those who need referral for further evaluation. Primary barriers to such screenings include lack of practitioner confidence in using validated screening tools. In this article we describe the accomplishments of the EDOPC project, which created training programs to address these barriers. This training is delivered by EDOPC staff and peer educators (physicians and nurse practitioners) in medical practices. The EDOPC project enhanced confidence and intent to screen among a large group of Illinois primary health care providers. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites and increased social/emotional screening rates to the same target rate in nearly half of the participating practices.
To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.
In 2006, the AAP released a policy statement on developmental surveillance and screening that included an algorithm to aid practices in implementation. Simultaneously, the AAP launched a 9-month pilot project in which 17 diverse practices sought to implement the policy statement's recommendations.
Quantitative data from chart reviews were used to calculate rates of screening and referral. Qualitative data on practices' implementation efforts were collected through semistructured telephone interviews and inductively analyzed to generate key themes.
Nearly all practices selected parent-completed screening instruments. Instrument selection was frequently driven by concerns regarding clinic flow. At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.
A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.
The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.
We implemented the Parents' Evaluation of Developmental Status at Boston Children's Hospital Primary Care Center and at Joseph Smith Community Health Center as quality improvement initiatives. Each practice offered screening to all of the patients attending well-child care visits between 6 months and 8 years of age. The implementation process was investigated by using preimplementation and postimplementation surveys and a focus group of pediatric primary care providers. To assess outcomes, such as changes in identification rates and referrals for developmental and behavioral concerns, we reviewed medical charts of all of the 2- and 3-year-olds present at Children's Hospital Primary Care Center well-child care visits in the periods before and after screening implementation.
Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.
Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.
In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties.
To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties.
We mailed a survey to a random sample of AAP members. We used multivariate logistic/linearregression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities.
Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a >10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates.
Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities.
Through the use of 2-stage screening strategies, research studies have shown that autism spectrum disorders and other developmental disabilities can now be detected reliably and with greater validity and in children as young as 18 months of age. Screening and diagnostic practices in the medical and educational arena lag far behind clinical research, however, with the average patient age at time of diagnosis being 3 to 6 years.
We discuss the challenges of instituting universal developmental screening as part of pediatric care and present 2 models of existing or planned programs of early screening for autism spectrum disorder and developmental disability (1 in a community-based setting and 1 in a pediatric setting), and discuss the pros and cons of the different strategies.
https://pedstest.com/static/TheBook/index.html
This indispensible textbook supports life-long learning in medical and nursing school, to residency and fellowships, to precepting and community practice, and from there, into research and advocacy. Explained are the basics of child development and how parent-child communicative play and shared affect promote learning and well-being.
Provided are techniques for efficiently detecting and addressing developmental problems in busy clinical settings, i.e., by staggering the tasks of screening and surveillance over time from infancy through late adolescence. Because well-visits should also focus on addressing problems (e.g., “the worried well”) there is abundant guidance on how to work with families, promote development, deliver difficult news, monitor progress and collaborate with non-medical providers. Much attention is paid to unique populations (e.g., children in-care, families from diverse cultural backgrounds) and, to the most onerous issue in primary care: How to actually implement quality developmental-behavioral care. Work sheets and flow charts aid clinicians in planning and deploying an effective process.
Delineated are research methods for measuring child development including how to create new items for studies, ensure effective translations, standardize measures, and design quality research protocols. Options for Quality Improvement and Maintenance of Certification initiatives are described. Also specified is a range of techniques for public policy advocacy. Throughout, case examples and professional perspectives are used to illuminate content.
The book’s website offers downloadable tools for learning and teaching (e.g., observation forms, a detailed list of milestones, pre/post-tests for assessing learning) as well as tools for community practice (e.g., a list of evidence-based screening and surveillance tools, well-child visit encounter forms embracing health as well as developmental-behavioral care, two-way consent forms, live links to services, etc.). These instruments facilitate instruction and aid practicing clinicians in complying with American Academy of Pediatrics policy -- all within the time constraints of primary care.
The many contributors to this book are content experts but also practical advisors who themselves deal with real-world challenges facing families and work with graduate and under-graduate students, residents, fellows, clinicians, researchers, and advocates. In short, Identifying and Addressing Developmental-Behavioral Problems is a practical and essential handbook for all those interested in improving the development and well-being of children and their families.
Evidence-based programs will be useful to the extent they produce benefits to individuals on a socially significant scale. It appears the combination of effective programs and effective implementation methods is required to assure consistent uses of programs and reliable benefits to children and families. To date, focus has been placed primarily on generating evidence and determining degrees of rigor required to qualify practices and programs as "evidence-based." To be useful to society, the focus needs to shift to defining "programs" and to developing state-level infrastructures for statewide implementation of evidence-based programs and other innovations in human services. In this article, the authors explicate a framework for accomplishing these goals and discuss examples of the framework in use.
Eligibility criteria:
Qualitative studies written in English that focused on developmental screening in children from birth to school age and that included registered nurses, advanced practice nurses, pediatric or family physicians, or parents were considered.
Sample:
Ten studies met the inclusion criteria.
Results:
The analysis resulted in four main themes: developmental screening behaviors, developmental screening barriers, developmental screening facilitators, and parent interactions.
Conclusions:
Positive parent interactions and practice-wide engagement facilitated successful implementation of standardized developmental screening in primary care settings. Barriers associated with developmental screening included time, lack of reimbursement, poor communication with parents, and unfamiliarity with developmental screening instruments. A limited number of studies have examined developmental screening methods used by advanced practice nurses. Only two studies in the review included advanced practice nurses.
Implications:
The developmental screening experiences of providers and parents increases awareness about the challenges associated with conducting developmental screening in primary care. Recommendations for future research are offered with a focus on advanced practice nurses in primary care.
The American Academy of Pediatrics (AAP) recommends screening children for developmental delay and autism. Studies of current screening practice to date have been limited in scope and primarily focused on small, local samples. This study is designed to determine compliance with AAP screening recommendations: (1) developmental screening at 9, 18, and 24 or 30 months; (2) screening when concerns are raised at a surveillance visit; and (3) autism screening at 18 and 24 months and to examine pediatrician and practice characteristics associated with compliance. Pediatricians from 6 states completed a 38-item web-based questionnaire (N = 406) regarding compliance with recommendations, screening implementation, changes in screening practice since the publication of guidelines, and pediatrician and practice demographics. Overall, 17.8% of pediatricians were compliant with all 3 screening recommendations. A total of 41.6% of pediatricians screened for development at the 9-month visit, 58% at the 18-month visit, and 52% at the 24- or 30-month visit. A total of 59.8% of physicians screened for autism at the 18-month visit and 50.2% at 24-month visit. As compared with 5 years ago, 44.8% of pediatricians currently screen for development more often and 72.2% screen for autism more often. Pediatricians with 10%–50% of patients of non-White race/ethnicity in their practice were significantly less likely to screen for developmental delay than pediatricians with more than 50% of patients (odds ratio [OR] = 0.30; 95% confidence interval [CI] = 0.13, 0.69; p = .004). Similarly, pediatricians with 10%–30% of Medicaid-insured patients were less likely to screen for developmental delay than pediatricians with more than 30% of patients (OR = 0.45; 95% CI = 0.25, 0.80; p = .0007). In contrast, pediatricians with 10%–30% of Medicaid-insured patients were significantly more likely to screen patients for autism than pediatricians with more than 30% of patients (OR = 2.46; 95% CI = 1.38, 4.40; p = .0002). Increasing numbers of pediatricians are screening children for developmental delays and autism. Economically disadvantaged children are significantly more likely to be screened for developmental delay but less likely to be screened for autism than do less disadvantaged children.
Kaminski et al.(1) recently reported selected findings from a study evaluating two group-based parenting interventions designed to promote "more positive socioemotional, behavioral, cognitive, and health outcomes" for children in low-income families (defined as < 200% of the federal poverty line). The authors provide a laudably clear and detailed flow diagram of study enrollment and follow-up assessment rates. However, specific and meaningful information about intervention exposure, participation rates, and other fundamental implementation considerations are not provided alongside the reporting of outcomes. The omission of core implementation data brings into sharp focus two interrelated and chronic limitations in the intervention research literature, in general, and particularly in the knowledge base on parenting interventions. These gaps, described below, heavily constrain the public health impact of programming for vulnerable families and children. (Am J Public Health. Published online ahead of print August 15, 2013: e1-e2. doi:10.2105/AJPH.2013.301500).
The present study examined the association between a woman's close relationships and mental health and the quality of her maternal behaviour in early mother–infant interaction. A total of 131 mothers and their infants participated in the study. The quality of the mother's childhood relationship with her own mother and her marital relationship were investigated in a semi‐structured interview and, as a part of the interview, the Structured Clinical Interview for DSM‐IV (SCID) was used to assess her mental health. Mother–infant interaction was videotaped at 8–11 weeks of the infant's age, and scored using the Global Rating Scale for Mother–Infant Interaction. The mother's childhood relationship with her mother was significantly related to her own interactive and affective behaviour with her infant. A poor, disengaged marital relationship was also associated with poorer interactive behaviour but only among mothers with mental health problems. Thus the mother's close relationships had an effect on maternal behaviour; however, maternal perinatal psychopathology per se was not related to maternal behaviour at 2 months of the infant's age.
The goal of this study was to investigate the feasibility and outcome of a systematic autism screening process for all toddlers (aged 14-30 months) in a large, community-based pediatric practice.
All toddlers who presented to the clinic during the 6-month screening period were eligible. We used 2 screening questionnaires and allowed physicians to refer directly to capture as many children as possible. Receptionists and medical assistants distributed and collected screening questionnaires; research staff did all scoring and follow-up, either by telephone or in person when indicated.
We obtained a high rate of screening (80% of eligible children). Of the 796 children screened, 3 had already been diagnosed with an autism spectrum disorder (ASD); an additional 10 children who showed signs of early ASD that warranted further evaluation or intervention were identified. Formal screening measures identified more children with ASD than did clinical judgment or caregiver concerns; however, no single method (ie, questionnaire, caregiver concerns, provider concerns) identified all children with signs of early ASD. We had excellent participation from racially and ethnically diverse families, including Spanish-speaking families. Thirty-two percent of the children who were screened did not present for a well-child visit during the study period and were screened at a sick visit, follow-up visit, or injection appointment.
A partnership between pediatricians and autism specialists resulted in effective, systematic autism screening. Future studies should examine how to create effective systems of care.
The aim of this study was to examine parental reports of receiving a child developmental assessment (DA), and the child, family, and type of health care setting characteristics and well-child care processes associated with receiving this aspect of preventive developmental care.
The 2007 National Survey of Children's Health was used to study 16 223 children, aged 10 months to 4 years, who received a DA with a structured questionnaire from their primary care provider in the previous 12 months. Data were adjusted for child characteristics, family socioeconomic factors, type of health care setting, and processes of care.
Few children were assessed for developmental delays by using developmental questionnaires (28%). A greater percentage of parents of children with public insurance reported receiving a developmental questionnaire compared with parents of children who were uninsured or privately insured (32% vs 26% and 25%, respectively; P = .02). The adjusted odds of receiving a developmental questionnaire were higher for children with public insurance than private insurance (odds ratio [OR] 1.35, 95% confidence interval [CI], 1.05-1.73), higher for children whose usual place of care was a clinic or health center than a doctor's office (OR 1.36, 95% CI, 1.07-1.74), and higher for children reporting adequate family-centered care (OR 1.41, 95% CI, 1.14-1.74).
Parental receipt of developmental questionnaires is low and varies by type of insurance, type of place for usual source of care, and adequacy of family-centered care. There is room for improvement in the provision of developmental questionnaires and, our results suggest, areas for continuing research to understand variations in DA practices.
I hope that these questions and discussion raised useful points for consideration. To summarize some of the main points: ■ Consider assessment instruments to be reference, and not gold, standards. Be aware of psychometric issues. ■ Developmental evaluation requires a balance between concepts and pragmatics; pros and cons with regard to changes in tests should be carefully considered. ■ Percent delay is not accurate; standard deviation cutoffs are recommended. ■ Consider what abilities can be assessed at different ages (skill, function, integrated functional unit). An early developmental quotient (DQ) does not necessarily equal intelligence quotient. ■ Caution should be exercised regarding ratio developmental quotients due to significant psychometric concerns. ■ A better understanding of child, caretaker, and testing variables that affect caretaker report is needed. ■ Clinicians who possess a good understanding of normal development, awareness of pathognomonic indicators, and are well versed in testing methods should administer developmental tests. ■ The area of prediction needs further investigation and uniformity. In closing, perhaps addressing some of these points will produce positive change in what we do. If that is indeed the case, then it is possible, "The future ain't what it used to be," (Y. Berra) with regard to screening and assessment.
This study examined the association of infants' sustained social withdrawal with parents' self-reported current depressive symptoms and perceived mental health. Two hundred and sixty infants aged 4, 8 and 18 months were examined with the Baby Alarm Distress Scale (ADBB). Parents' depressive symptoms and perceived mental health during the preceding year were elicited through questionnaires. Mother's current depressive symptoms and father's perceived moderate or poor mental health during the preceding year both independently increased the infant's risk of withdrawal. When both parents had mental health problems, the infant was more likely to be withdrawn. Infant's social withdrawal should alert clinicians to examine parental mental health. Also, if the parent has mental health problems, the infant's social behavior and possible withdrawal should be examined. Families where both parents experience poor mental health should be identified, and treated, while the infants of these families in particular seem to be at risk for social withdrawal.
In a two-stage screening procedure using the Edinburgh Postnatal Depression Scale (EPDS) at 8 and 12 weeks postpartum and the Montgomery-Asberg Depression Rating Scale (MADRS) and DSM-III-R at about 13 weeks postpartum, 41 women identified as depressed were randomly allocated to a study and a control group. The women in the study group received 6 weekly, counselling visits by the Child Health Clinic nurse and the control group received routine primary care. Twelve (80%) of 15 women with major depression in the study group were fully recovered after the intervention compared to 4 (25%) of 16 in the control group. Counselling by health nurses is helpful in managing postnatal depression and seems to work well within the Swedish Primary Health Care system.
This study compared the efficacy of routine clinical evaluation with that of screening with the Edinburgh Postnatal Depression Scale for the detection of postpartum depression in a residency training program practice. Study Design: Three hundred ninety-one patients during a period of 1 year were assigned according to delivery date to screening for postpartum depression with the Edinburgh Postnatal Depression Scale or to a control group who had only spontaneous detection during routine clinical evaluation. The incidences of postpartum depression detection and demographic characteristics were compared between 79 patients in the Edinburgh Postnatal Depression Scale group and 96 patients in the clinical evaluation group by means of chi(2) analyses.
The incidence of postpartum depression detection with the Edinburgh Postnatal Depression Scale was significantly higher than the incidence of spontaneous detection during routine clinical evaluation (35.4% and 6.3%, respectively; P =.001).
The Edinburgh Postnatal Depression Scale is an effective adjunct to clinical interview for diagnosis of postpartum depression and should be considered in residency training.
Synchrony, a construct used across multiple fields to denote the temporal relationship between events, is applied to the study of parent-infant interactions and suggested as a model for intersubjectivity. Three types of timed relationships between the parent and child's affective behavior are assessed: concurrent, sequential, and organized in an ongoing patterned format, and the development of each is charted across the first year. Viewed as a formative experience for the maturation of the social brain, synchrony impacts the development of self-regulation, symbol use, and empathy across childhood and adolescence. Different patterns of synchrony with mother, father, and the family and across cultures describe relationship-specific modes of coordination. The capacity to engage in temporally-matched interactions is based on physiological mechanisms, in particular oscillator systems, such as the biological clock and cardiac pacemaker, and attachment-related hormones, such as oxytocin. Specific patterns of synchrony are described in a range of child-, parent- and context-related risk conditions, pointing to its ecological relevance and usefulness for the study of developmental psychopathology. A perspective that underscores the organization of discrete relational behaviors into emergent patterns and considers time a central parameter of emotion and communication systems may be useful to the study of interpersonal intimacy and its potential for personal transformation across the lifespan.
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