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Child Health Intervention and Longitudinal Development Studies (CHILD) Research Program

Nicole Letourneau PhD RN Professor & Norlien/ACHF Chair in Parent-Infant Mental Health Faculties of Nursing & Medicine (Pediatrics). Child Health Intervention and Longitudinal Development Studies (CHILD) Research Program. March 8, 2013 Eyes High Research Series. www.CHILDstudies.ca.

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Child Health Intervention and Longitudinal Development Studies (CHILD) Research Program

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  1. Nicole Letourneau PhD RN Professor & Norlien/ACHF Chair in Parent-Infant Mental Health Faculties of Nursing & Medicine (Pediatrics) Child Health Intervention and Longitudinal Development Studies (CHILD) Research Program March 8, 2013 Eyes High Research Series www.CHILDstudies.ca

  2. Overview CHILD Studies Program Next Steps • Attachment Intervention for vulnerable/ • disadvantaged families • Birth cohort follow-up on relationship of parental stress & distress on children’s neurodevelopment • Parenting, social support & child development • Community–based intervention research • Exemplar studies • Lien MOMS Link • Fetal Programming www.CHILDstudies.ca

  3. CHILD Studies Programparent-infant relationships &determinants of health www.CHILDstudies.ca

  4. CHILD Objectives • Develop and test parent support interventions to promote healthy infant/child development; • Conduct secondary analysis of longitudinal cohorts and systematic reviews to uncover intervention targets to promote children’s healthy development; • Conduct community-based research methods (integrated knowledge transfer). www.CHILDstudies.ca

  5. Social determinants of health • Early childhood development • Income and social status • Education and literacy • Social support networks • Biology and genetics • Employment, working conditions, and occupational health • Physical environment • Individual and public health services • Gender & culture • Personal health practices Public Health Agency of Canada, 2010 www.CHILDstudies.ca

  6. Healthy child development Parenting Social support Social determinants of health • Healthy child development • Social support • Health services interwoven www.CHILDstudies.ca

  7. Optimal parent-infant interaction is characterized by: www.CHILDstudies.ca

  8. www.CHILDstudies.ca

  9. Assessment Intervention Outcome Resiliency Risk Factors Protective Factors -Infant/child characteristics (e.g. temperament, chronic conditions) -Parental health (e.g. depression, chronic health conditions) -Adolescent parenting -Low education -Poverty -Lack of maternal support -Intimate partner violence Cognitive Development High-Quality Parent- Infant/Child Interaction Behavioural Development Social Support Figure 1. Clinical Model of Parent-Child Interaction (adapted from Letourneau, 1997). www.CHILDstudies.ca

  10. www.CHILDstudies.ca

  11. States of arousal • Flooded (e.g. crying) • Hyper-alert (e.g. fussy) • Calmly focused & alert • Hypo-alert • Drowsy • Asleep www.CHILDstudies.ca

  12. Maternal-child interaction &self-regulation Critical aspect of regulating a baby’s states involves modulating the intensity of stimulus to engage and sustain the baby’s attention i.e not trigger the impulse to cry, avert gaze, or shut down. www.CHILDstudies.ca

  13. Adult sensitivity is any pattern of behavior that pleases the infant and increases the infant’s comfort and attentiveness and reduces its distress and/or disengagement. (Crittenden, 2011) www.CHILDstudies.ca

  14. Mothers are “hidden” regulators of their infants’ endocrine & nervous systems www.CHILDstudies.ca

  15. What interferes with maternal sensitivity? Attachment & trauma history Mental health problems Current Family violence or Past Maternal addictions stress www.CHILDstudies.ca

  16. www.CHILDstudies.ca

  17. www.CHILDstudies.ca

  18. www.CHILDstudies.ca

  19. How does stress and adversity get under the skin to affect health and development??? www.CHILDstudies.ca

  20. negative perceptions of normal infant behavior ↓ likely to pick up on infants’ cues or respond to needs ↓ emotionally expressive ↓ affectionate and ↑anxious ↓ sensitive and appropriate interactions ↑ negative in their play speak more slowly and ↓ often Depressed mothers www.CHILDstudies.ca

  21. Relationships with infants PPD ↓ maternal-child interaction quality and enjoyment in maternal role--moderate to large effect (Beck, 1995; Murray et al. 2003) Disturbances in mother-child interactions are observed at one year postpartum, even when mothers are no longer depressed. www.CHILDstudies.ca

  22. When I tried to encourage some social interaction with her newborn, Stephanie would respond that she often just stared at Emma. While other relatives laughed and cooed to the baby, Stephanie claimed that she did not know how and had no desire to do that. Some of her responses were “ I don’t know what to say”, “Is it bad that I just stare at her?” and “Am I being a bad mother?” From Zauderer (2008) www.CHILDstudies.ca

  23. Lien MOMS LinkTelephone support for depressed mothers www.CHILDstudies.ca

  24. Exemplar: Lien MOMS Link

  25. Exemplar: Lien MOMS Link

  26. I have become increasingly interested in HOW maternal-infant interaction relates to better outcomes in children www.CHILDstudies.ca

  27. Hypothalamic-Pituitary Adrenal (HPA) Axis Cortisol is secreted by the adrenal cortex via pulsations that follow a 24-hour (diurnal) circadian profile (Hellhammer, 2009) • Stressors (like PPD) stimulate the activation of the HPA which triggers the release of the steroid hormone cortisol from the adrenal gland (Essex, 2002) www.CHILDstudies.ca

  28. Diurnal Rhythm www.CHILDstudies.ca

  29. b=.07, p=.01 www.CHILDstudies.ca

  30. b=.06, p=.04 www.CHILDstudies.ca

  31. HPA Axis • Sensitive periods of enhanced brain plasticity vulnerable to long-term effects of cortisol • Over-activation of the HPA system related to: • decreases in brain volume • inhibition of neurogenesis • disruption of neuronal plasticity • abnormal synaptic connectivity (Gunnar, 2009) www.CHILDstudies.ca

  32. HPA Axis Prolonged exposure to elevated levels of cortisol predict: • increased insulin resistance & obesity • diminished immune responses • reduced cognition, memory • fear behaviours, hypervigilance • attention deficits, behavioural problems • disturbances with emotional regulation & self control (Essex, 2002, Gunnar, 1998) www.CHILDstudies.ca

  33. Maternal child interaction quality regulates infants’ responses to stress www.CHILDstudies.ca

  34. Fetal Programming of Infant Stress Reactivity ApRON(Alberta Pregnancy outcomes & Nutrition Study) www.CHILDstudies.ca

  35. Questions About: ● Diet & activity ● Mental & physical health ● Medical history ● Biological fathers Questions About ● Infant health & development ● Maternal mental & physical health ● Infant/child feeding ● Maternal diet & activity 1st Trimester 2nd Trimester 3rd Trimester 3 months 6 1 2 3 (1-13 weeks) (14-26 weeks) (27-42 weeks) post partum months year years years Extended knowledge transfer work & potential future follow-up Delivery Physical Measurements ● Maternal nutrient status (blood) ● Prenatal & delivery records ● Child neurocognitive assessment (age 3) ● Child DNA (at 3 months only) ● Maternal and child anthropometrics ● Breast milk analysis Physical Measurements ● Maternal nutrient status (blood) ● Maternal urine (18 wks) ● Anthropometrics ● Maternal & Paternal DNA (once)

  36. Much of what a pregnant woman encounters in her daily life-the air she breaths, the food and drink she consumes, the chemicals she’s exposed to, even the emotions she feels-is shared in some fashion with her fetus. The fetus incorporates these offerings into its own body and makes them part of its flesh and blood. Annie Murphy Paul www.CHILDstudies.ca

  37. Protective factor? Outcome Stress & distress During pregnancy www.CHILDstudies.ca

  38. Does maternal child interaction quality operate to help the growing infant cope with stress before they are physiologically mature? Can mci overcome the effects of exposure to prenatal stress & distress? www.CHILDstudies.ca

  39. Next Steps: EMERGING THINKINGAttachment as a marker of relationship quality www.CHILDstudies.ca

  40. Assessment Intervention Outcome Resiliency Risk Factors Protective Factors -Infant/child characteristics (e.g. temperament, chronic conditions) -Parental health (e.g. depression, chronic health conditions) -Adolescent parenting -Low education -Poverty -Lack of maternal support -Intimate partner violence Cognitive Development High-Quality Parent- Infant/Child Interaction Behavioural Development Social Support Figure 1. Clinical Model of Parent-Child Interaction (adapted from Letourneau, 1997).

  41. Intervention Evaluation/Outcomes Assessment Risk Factors Protective Factors Resiliency Cognitive Ability Language Ability Toxic Stress: -Parental depression -Family violence -Addictions High-Quality Parent- Infant Interaction Attachment Security Social-emotional development Today’s thinking… Social Support Physical health -stress reactivity -immune health Reflective Function

  42. Not what I mean by “attachment”

  43. Secure attachment Sensitivity and parental availability are key determinants of secure attachment (Cassidy & Shaver, 1999; Trapolini et al., 2007)

  44. There is no such thing as a baby—Winnicott

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