Karen Milligan's research while affiliated with Ryerson University and other places

Publications (50)

Article
Introduction: Parenting stress is often heightened in mothers receiving treatment for substance use. Experiences of trauma are commonly seen in this population, which may give rise to Posttraumatic Stress Disorder (PTSD) symptoms, including intrusion, avoidance, negative cognition and mood, and affective arousal. While past research has demonstrat...
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Purpose of Review Chronic substance use among parents has been associated with poor family outcomes. Parental reflective function (PRF), which refers to the capacity to reflect on mental states (i.e., thoughts, feelings, desires) in relation to oneself and child, may be part of the mechanism that increases risk for child socio-emotional challenges...
Article
The universal experience of COVID-19 and its associated public health response presents an opportunity to see inequities that exist within our population when accessing community services and supports. In this article, we cast a spotlight on one group who is at risk for experiencing such inequity: women with problematic substance use who are pregna...
Article
Neural and psychological processes in pregnancy may be important antecedents for caregiving postpartum. Employing event-related potentials, we examined neural reactivity to infant emotional faces during the third trimester of pregnancy in expectant mothers (n = 38) and expectant fathers (n = 30). Specifically, expectant parents viewed infant distre...
Article
Objective: To inform a shared care model between developmental and behavioural (DB) and mental health specialists and primary care physicians by having members of primary care family health teams (FHTs) report on strengths of and barriers to providing care for children with DB disorders and mental health concerns. Design: Qualitative study using...
Article
Background At our inner city hospital, we developed a shared care model between family health teams (FHTs), pediatricians and developmental pediatricians to care for children with mental health and developmental disorders. In phase one of our study, 84 FHT members participated in focus groups to inform the development of our clinic. Family physicia...
Article
Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined p...
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Objectives Deficits in attentional control are often associated with academic and mental health challenges experienced by youth with learning disabilities (LDs). Mindfulness treatments may improve attentional control; however, findings in youth populations to date have been mixed. Neural measures of attentional control may be more sensitive to trea...
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Implementation of mindfulness programs in secondary schools has increased dramatically in the past decade. Evaluations of these programs have primarily emphasized outcomes of participation, with less focus on implementation processes. Both are important to establish the initial evidence base and support dissemination and replication. The present st...
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Background Women who are seeking services for problematic substance use are often also balancing responsibilities of motherhood. Integrated treatment programs were developed to address the diverse needs of women, by offering a holistic and comprehensive mix of services that are trauma- and violence-informed, and focus on maternal and child health p...
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Integrated treatment programs for pregnant and parenting women who use substances operate at the intersection of multiple service systems, including specialized substance use services, the broader health system, child protection, and social services. Our objectives were to describe the composition and structure of community care networks surroundin...
Article
Integrated treatment programs comprehensively address the unique and varied needs of pregnant and parenting women with problematic substance use. Despite the growth of these programs and evidence supporting their effectiveness, a clear picture of services that comprise integrated treatment is lacking. To address this gap in knowledge, we explored t...
Chapter
In this chapter, we explore the ways in which social competence has been defined. Cognitive, emotional, and behavioral factors associated with social competence are explored, drawing from research in developmental psychology, as well as research with clinical populations, such as children with neurodevelopmental disorders (e.g., learning disabiliti...
Article
Increasingly, adolescents report experiencing levels of stress that exceed their coping resources. Chronic stress is associated with emotion regulation challenges that increase risk for poor mental health and educational outcomes. This qualitative study examined the impact of Integra Mindfulness Martial Arts™ (Integra MMA™) on the perceived academi...
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Objective: The current study examined the impact of an activity-based mindfulness treatment on EEG indices of attention in youth with ADHD aged 11 to 17 years compared with a waitlist control group. Method: Pre- and post-treatment, EEG was recorded as participants completed a single-point focus rest task and two active attention tasks. Theta pow...
Article
Objective: Youth with ADHD and comorbid anxiety (ADHD+ANX) experience increased social and academic impairment compared with youth with ADHD without anxiety (ADHD). Group differences in attentional and impulse control may underlie this increased impairment. Examination of group differences using behavioral measures of attentional and impulse contr...
Article
Treatment of maternal substance-related problems is often complicated by complex pictures of risk, including mental and physical illness and social-contextual risk. In motherhood, systemic barriers, such as lack of childcare and stigma, further complicate access and sustained treatment engagement. Integrated programs are designed to address this is...
Article
Objectives. Motherhood is a time of increased motivation for entering addictions treatment and changing maladaptive patterns of substance use. However, treatment engagement is limited by challenges in navigating traditionally distinct health and social services to meet complex needs, as well as by unique barriers related to pregnancy and parenting....
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Adolescence is a developmental period marked by considerable biological, social, and psychological changes, with rates of self-reported stress on the rise mirroring those of adults. Mindfulness interventions are increasingly being implemented in high schools to improve students’ stress management and psychosocial outcomes. Despite the well-research...
Article
Objective: Fetal alcohol spectrum disorders (FASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. Method: The present meta-analysis was undertaken to disentangle the behavioral phenotype of FASD and ADHD by qua...
Article
Paediatricians are more likely than ever to encounter patients with mental health problems on a daily basis. There is a need for investment in proven treatments, such as psychology-based interventions, for children identified with mental health disorders. There are four main arguments supporting the engagement of psychologists for children with men...
Article
Paediatricians are more likely than ever to encounter patients with mental health problems on a daily basis. There is a need for investment in proven treatments, such as psychology-based interventions, for children identified with mental health disorders. There are four main arguments supporting the engagement of psychologists for children with men...
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Youth with learning disabilities (LDs) have information processing challenges that place them at increased risk for emotion dysregulation and often rely on coping strategies that emphasize avoidance of challenging emotions, experiences or tasks. Integra mindfulness martial arts (MMA) was developed to address and help participants cope with these ch...
Article
Challenges in social competence are common in children with Learning Disabilities (LDs), particularly those who present with co-occurring mental health challenges (LD + MH). Social competence calls upon a complex set of skills, including social skills, perspective-taking abilities, and an understanding of the social environment. Successful enactmen...
Article
Prenatal alcohol exposure is associated with a constellation of adverse physical, neurocognitive and behavior outcomes, which comprise a continuum of disorders labeled Fetal Alcohol Spectrum Disorders (FASD). Extant research has consistently identified executive functions (EF) as a central impairment associated with FASD. Despite this, heterogeneit...
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We explored the relation between maternal mind-mindedness (i.e., a mother's tendency to verbally refer to her infant's mental world through use of infant-directed mental state terms) and maternal attachment. Mothers (N = 76), classified prenatally as Autonomous, Dismissing, Preoccupied, and Unresolved using the Adult Attachment Interview (AAI), sim...
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Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicabili...
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The current study evaluated the impact of a 20-week mindfulness training program on executive function (EF), internalizing and externalizing behavior and social skills in a clinical sample of adolescent boys with learning disabilities (LD). Integra Mindfulness Martial Arts (MMA) is a manualized group treatment program incorporating elements of mind...
Article
Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. To examine the impact and effects of integrated programs for women with substance abuse i...
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Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes. As part...
Article
  To model variables influencing the dissemination of evidence-based practices to addiction service providers and administrators.   A discrete-choice conjoint experiment. We systematically varied combinations of 16 dissemination variables that might influence the adoption of evidence-based practices. Participants chose between sets of variables.  ...
Article
Background: Infants born to women with substance abuse issues are at increased risk for prematurity, low birth weight, and impaired physical development. Integrated programs (programs that integrate on-site pregnancy-, parenting-, or child-related services with substance use treatment) have been developed to address these risks, barriers to accessi...
Article
Children with genetic syndromes offer a unique opportunity to combine genetic and environmental approaches to the study of aggression. Children with genetic syndromes associated with developmental delay are at increased risk for behavior problems, but little is known about risk and resilience factors. In this study, we examined maternal sensitivity...
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Aim: To examine the effects of integrated treatment programmes (those with addiction services and pregnancy-, parenting- or child-related services) on length of stay and treatment completion. Methods: We systematically reviewed studies published between 1990 and 2008 comparing integrated programmes with non-integrated programmes on length of stay (...
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The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet...
Article
To examine the impact of integrated treatment programs (those with substance use treatment and pregnancy-, parenting-, or child-related services) on maternal mental health, we compiled a database of studies of integrated programs published between 1990 and 2007 with outcome data on maternal mental health. There were 18 cohort studies, 3 randomized...
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Across cultures, approximately one third of people with drug dependence are women of child-bearing age. There is emerging evidence regarding the effectiveness of integrating pregnancy, parenting, and child development services with addiction services. In 2007, we conducted a national survey of addiction agencies serving women to provide preliminary...
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There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are asso...
Article
Numerous studies show that children's language ability is related to false-belief understanding. However, there is considerable variation in the size of the correlation reported. Using data from 104 studies (N=8,891), this meta-analysis determines the strength of the relation in children under age 7 and examines moderators that may account for the...
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We explored the relationship between vocal expressiveness in song and maternal attachment representation. Mothers (N=36), classified as Autonomous, Dismissing, or Preoccupied, sang a play song of their choice in their 6-month-old infants’ presence and absence. Raters (N=50) who were naı̈ve to maternal attachment classifications listened to excerpts...
Article
The attachment and social rank systems are biological-evolutionary systems that can serve as models for conceptualizing family interaction. By exploring both their unique and interrelated impact on affect regulation, we can differentiate between processes that foster healthy growth and those leading to individual psychopathology. This perspective f...

Citations

... Difficulties in making sense of the emotional turmoil evoked by pregnancy and addiction also make it hard to form a close affective relationship with the baby, already evident during pregnancy in lower prenatal attachment to the fetus (Alhusen, 2008). Targeting maternal RF in substance use interventions has become especially central, as low RF is considered an underlying mechanism for both addiction and parenting difficulties (Macfie et al., 2020;Milligan et al., 2021). ...
... COVID-19-related studies have reported an increase in mental health problems, such as anxiety and stress (Bate et al., 2021;Bean et al., 2021;Caldwell et al., 2020;Gayatri & Irawaty, 2021;Huang & Ougrin, 2021;Kerr et al., 2021;McFadden et al., 2021;de Winter et al., 2020;Wu & Xu, 2020). Parenting stress is heightened, particularly in already at-risk families (Becker et al., 2020;Bik-Multanowska et al., 2022;Sonnenschein et al., 2022;Valeriote & Milligan, 2021;Yael et al., 2022), and has been found to result from issues related to remote schooling and worries about health and children's well-being (Garbe et al., 2020;Goldberg et al., 2022;Wang et al., 2022). Several studies (Hails et al., 2022;Mc Rae et al., 2021;Zafar et al., 2022;Weeland et al., 2021) have found that greater levels of parental distress during the pandemic have negatively affected parenting practices. ...
... Neural research with a community sample of expectant parents suggests that infant faces communicating distress, relative to neutral, are associated with greater P300 amplitude (reflecting increased attentional processing) in fathers but not mothers. Further, this neural difference is associated with fathers being more likely to describe their child in the future considering their mental states [43]. Zeegers et al. [44] also identified motherfather differences in maternal mind-mindedness (MM), a construct related to PRF, which assesses the proclivity to attend to a child's mental states to interpret behavior as stemming from their mental experience [45]. ...
... Parents recommended the creation of a one-stop shop for services with a team approach led by a navigator to facilitate and support coordinated care across disciplines and sectors, from health care to schools, social service, among other community services. Care coordination has a positive effect on timeliness of care (Miller, 2014), including rapid access and early interventions (Settipani et al., 2019), and promotes favourable attitudes by the care team for the children in their care (Young et al., 2020). Coordinated care has been reported to be desired by parents and beneficial for children with mental healthcare needs (Miller, 2014;Settipani et al., 2019); however, it remains an unmet need with a number of barriers to its implementation (Brown et al., 2014). ...
... 133 The authors of a Canadian systematic review found that parenting knowledge, psychosocial risk, and maternal emo tional regulation were most commonly addressed in the group programming designed to support the needs of mothers using substances. 134 ...
... Using different inhibitory control tasks (including Stop sign task, Go-no-Go, Flanker tasks, Visuospatial attention paradigm, decision making, and the attention sustained subtest of the Leiter international performance scale), multiple studies found improved behavioral performance and/or associated neuroplastic changes in EEG/fNIRS/fMRI neural activity after movement interventions in individuals with ADHD, ASD, DCD, and LD (84, 86, 96, 97, 99-103, 105, 106, 108, 110). In terms of behavioral effects of movement interventions, although a few studies failed to report significant changes in inhibitory control performance in children with developmental disabilities (101,103,108), others reported increased response accuracy (84,102,105), and reduced reaction time during inhibitory control tasks (99,100,106,110), as well as improved parent-reported performance in tasks assessing self-control abilities in individuals with developmental disabilities (86). ...
... Pregnancy has been described as a "window of opportunity," featuring enhanced treatment motivation for substance-using mothers [19,20]. There is also an increasing understanding of the role of pregnancy process in the development of parenting among substance-using mothers, with an emphasis on prenatal interventions targeting the maternal-fetal attachment bond as well as the maternal ability to reflect upon her baby, mothering, and her own attachment history [21,22]. ...
... Scheduling challenges, fitting the training into the curriculum and students not being keen to give up their free time to attend the program were noted as barriers to implementation as intended. A more recent study by Meixner et al., [27] explored factors that supported the initial implementation of a mindfulness-based martial arts intervention delivered in a secondary school setting for youth with or at risk for self-regulation challenges. Interviews and focus groups with students, leaders, and teachers found that fidelity to program characteristics, program delivery, and communication were key areas where barriers and facilitators to implementing the program existed. ...
... Health care virtual spaces have divers structures for medical institutions administration (inner activities organization and splitting by strong points), equipments reserves (shared resources), information networks (data raising to calibrate the information policy) (Choudhury et al. 2018), which offers the members suffering from diseases an opportunity to change their lives, connect with others, and share problems. Medical institutions are to an increasing extent assuming the purpose of virtual medical circles for a diversification of momentous engagements, counting: coaching and training and wellness instructions, emergency interchange, crew and volunteer workout, functionaries' enrollment, information involvement and contribution, clinical studies, public relations and marketing (Long et al. 2019;Urbanoski et al. 2018;Fylan et al. 2018;Gonçalves et al. 2018;Fischer et al. 2018;Hernandeza et al. 2019;Hinojo-Lucena et al. 2018;Zong et al. 2021). ...
... Internalizing symptoms did not differ significantly between groups. Many studies report that externalizing symptoms are more affected by PAE than internalizing symptoms at this age [12]. However, internalizing symptoms can be hard to measure with parent reports since internalizing symptoms are not as easily observed, which may contribute to an under-reporting of internalizing symptoms across one or both groups. ...