Abstract:AbstractChildren of adolescent mothers are a high-risk group for negative child development. Previous findings suggest that early interventions may enhance child development by improving mother–child interaction. The purpose of the current study was to evaluate a mother–child intervention (STEEP-b) program in high-risk adolescent mother–infant dyads (N = 56) within a randomized controlled trial (RCT). Mother–child interaction was assessed at basel… Show more
“…Due to limited studies and high heterogeneity, we were unable to pool parenting stress outcomes through meta-analysis. Five of these studies were in favor of AE in reducing parenting stress (Adkins et al, 2021 ; Baker et al, 2015 ; Firk et al, 2020 ; Opiola & Bratton, 2018 ; Sprang, 2009 ) and two found no statistically significant difference between AE and the comparator condition in reducing parenting stress (Ozturk et al, 2019 ; Spieker et al, 2012 ). Fig.…”
Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.
“…Due to limited studies and high heterogeneity, we were unable to pool parenting stress outcomes through meta-analysis. Five of these studies were in favor of AE in reducing parenting stress (Adkins et al, 2021 ; Baker et al, 2015 ; Firk et al, 2020 ; Opiola & Bratton, 2018 ; Sprang, 2009 ) and two found no statistically significant difference between AE and the comparator condition in reducing parenting stress (Ozturk et al, 2019 ; Spieker et al, 2012 ). Fig.…”
Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.
“…The AAP policy statement emphasizes that family-centered pediatric medical homes (FCPMH) are integral to the universal promotion of ERH. 1 Despite this, only three identified RCTs 91,99,102 were implemented by pediatricians or in FCPMH. Also, a majority of studies in this review focused on biological mothers and parent/caregiver-infant dyads at high risk of impaired ERH.…”
Section: Discussionmentioning
confidence: 99%
“…The EA-Z is scored on a 100-point scale that is divided into four categories: (a) emotionally available, (b) complicated, (c) detached, and (d) problematic/disturbed (Wurster et al, 2019). These categories correlate with the four attachment styles: secure, insecure-anxious, insecure-avoidant, and insecure-disorganized, respectively 91,195,199 .…”
Section: Emotional Availability Scales (Eas) and Emotional Attachment...mentioning
Importance: In 2021, the American Academy of Pediatrics published a policy statement seeking to create a paradigm shift away from a focus on childhood toxic stress and toward the emphasis on early relational health (ERH) as a buffer for childhood adversity and promoter of life-course resilience. A comprehensive appraisal of the efficacy of contemporary parent/caregiver-child interventions in — primarily — improving ERH, and — secondarily — enhancing child wellbeing and neurodevelopment is needed to guide widespread implementation and policy. Objective: Determine the effectiveness of contemporary early dyadic parent/caregiver-infant interventions on ERH, child socio-emotional functioning and development, and parent/caregiver mental health. Data Sources: PubMed, Medline, Cinhal, ERIC, and PsycInfo were searched on April 28, 2022. Additional sources: clinical trial registries (clinicaltrials.gov, ISRCTN Registry, EU Clinical Trials Register, Australian New Zealand Clinical Trials Registry), contacting authors of unpublished/ongoing studies, backward/forward reference-searching. Study Selection: Studies targeting parent/caregiver-infant dyads and evaluating effectiveness of a dyadic intervention were eligible. Study selection was performed in duplicate, using Covidence. Data Extraction and Synthesis: Cochrane methodological guidance presented per PRISMA guidelines. Data extraction and risk of bias assessment were completed in duplicate with consensuses by first author. Data were pooled using inverse-variance random effects models. Main Outcomes and Measures: The primary outcome domain was ERH. Secondary outcome domains were child socio-emotional functioning and development, and parent/caregiver mental health, and were only considered in studies where at least one ERH outcome was also measured. The association between dose of intervention and effect estimates was explored. Results: 93 studies (14,993 parent/caregiver-infant dyads) met inclusion criteria. Based on very low to moderate quality of evidence, we found significant non-dose-dependent intervention effects on several measures of ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions, and a significant effect on parent/caregiver anxiety, but no significant effects on other child outcomes. Conclusion: Current evidence does not support the notion that promoting ERH through early dyadic interventions ensures optimal child development, despite effectively promoting ERH outcomes. Given the lack of an association with dose of intervention, the field is ripe for novel, innovative, cost-effective, potent ERH intervention strategies that effectively and equitably improve meaningful long-term child outcomes.
“…Her main research interests are eating disorders in childhood and adolescence, especially AN. She has conducted several clinical trials among which are the ANDI study [ 39 ], the Home Treatment study [ 40 ] and the TeeMo-study (study on adolescent mothers and their children; [ 64 ]).…”
Background
Anorexia nervosa (AN) is a severe psychiatric disease that often takes a chronic course due to insufficient treatment options. Emerging evidence on the gut-brain axis offers the opportunity to find innovative treatments for patients with psychiatric disorders. The gut microbiome of patients with AN shows profound alterations that do not completely disappear after weight rehabilitation. In previous studies, the administration of polyunsaturated fatty acids (PUFA) resulted in effects that might be beneficial in the treatment of AN, affecting the microbiome, body weight and executive functions. Therefore, the MiGBAN study aims to examine the effects of a nutritional supplementation with PUFA on the gut microbiome and body mass index (BMI) in patients with AN.
Methods
This is a longitudinal, double-blind, randomized, placebo-controlled trial. Within 2 years, 60 adolescent patients aged 12 to 19 years with AN will receive either PUFA or placebo for 6 months additional to treatment as usual. After 1 year, the long-term effect of PUFA on the gut microbiome and consecutively on BMI will be determined. Secondary outcomes include improvement of gastrointestinal symptoms, eating disorder psychopathology, and comorbidities. Additionally, the interaction of the gut microbiome with the brain (microbiome-gut-brain axis) will be studied by conducting MRI measurements to assess functional and morphological changes and neuropsychological assessments to describe cognitive functioning. Anti-inflammatory effects of PUFA in AN will be examined via serum inflammation and gut permeability markers. Our hypothesis is that PUFA administration will have positive effects on the gut microbiota and thus the treatment of AN by leading to a faster weight gain and a reduction of gastrointestinal problems and eating disorder psychopathology.
Discussion
Due to previously heterogeneous results, a systematic and longitudinal investigation of the microbiome-gut-brain axis in AN is essential. The current trial aims to further analyse this promising research field to identify new, effective therapeutic tools that could help improve the treatment and quality of life of patients. If this trial is successful and PUFA supplementation contributes to beneficial microbiome changes and a better treatment outcome, their administration would be a readily applicable additional component of multimodal AN treatment.
Trial registration
German Clinical Trials Register DRKS00017130. Registered on 12 November 2019.
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