Pediatric irritability is prevalent and impairing, yet little is known about its pathophysiology and treatment. In this article, we build on our and others' previous work to posit core mechanisms of ...irritability operating across the brain, behavior, and environment. Specifically, we propose proximal processes that surround the symptomatology of irritability and are potential targets for an exposure-based cognitive-behavioral therapy (CBT) for irritability that our group has developed. The heart of this model focuses on neurocognitive processes: youth's encoding of nonreward and threat stimuli, which involves prediction error signaling in the brain, and cognitive control in the context of frustration. Alterations in these processes are theorized to be central to chronic, severe irritability. Environmental responses to youth's symptom expression are also examined. Exposure-based CBT for irritability utilizes controlled, in vivo exposure to nonreward and threat stimuli with the aim to engage cognitive control and target top-down regulation of frustration. This intervention integrates selected parent management training techniques to target symptom reinforcement processes. Continued pathophysiological and treatment studies of irritability will not only refine our emerging understanding of the phenotype, but also inform broader questions on the brain and behavioral mechanisms of CBT efficacy.
•We propose mechanisms of pediatric irritability across the brain, behavior, and environment.•Key neurocognitive processes include prediction error and cognitive control.•These may be targets for exposure-based cognitive-behavioral therapy (CBT) for irritability.•Exposure-based CBT for irritability is currently being tested in a clinical trial.•This research may inform understanding of the brain and behavior mechanisms of CBT.
The transition to parenthood introduces changes in various life domains. In this paper, we examined whether and to what degree the transition to parenthood is related to changes in the importance of ...major life goals. To do this, we examined the rank-order stability, ipsative stability, and mean-level change in six life goal domains (achievement, power, variation, affiliation, altruism, and intimacy) in a sample of 248 parents and 294 individuals in a romantic relationship without children across two time points. Overall, we found high rank-order (variable-oriented) and ipsative (person-oriented) stability, and little evidence for mean-level changes in the importance of life goals across the transition to parenthood. However, we found several selection effects suggesting that women without children tended to endorse agentic life goals (variation and achievement) more than mothers did. Generally, our findings underline the overall stability of life goals and their role as guiding principles in life.
The World Health Organization-Caregiver Skills Training Program, a parent-mediated early intervention facilitated by non-specialist providers piloted in urban India was evaluated using mixed-methods ...for feasibility and effects on child and caregiver outcomes. Caregivers (n = 22) of children (2–9 years) with social-communication delays participated in a single-group pre-post study. High rates of caregiver attendance, improved caregiver fidelity, and facilitator competency suggested program feasibility. Caregivers voiced acceptability of various intervention-components. The intervention was associated with improved caregiver-reported skills and knowledge (p < 0.00), reduction in stress (p = 0.03), improved child developmental outcomes on communication and social interaction (p < 0.00), and adaptive behaviors (p < 0.00). Challenges about logistics and availability of time were highlighted. Implications of results in resource-poor settings and recommendations for future feasibility trials are discussed.
The transition to parenthood is consistently associated with declines in physical activity. In particular, working parents are at risk for inactivity, but research exploring physical activity ...barriers and facilitators in this population has been scarce. The purpose of this study was to qualitatively examine perceptions of physical activity among working parents.
Working mothers (n = 13) and fathers (n = 12) were recruited to participate in one of four focus group sessions and discuss physical activity barriers and facilitators. Data were analyzed using immersion/crystallization in NVivo 10.
Major themes for barriers included family responsibilities, guilt, lack of support, scheduling constraints, and work. Major themes for facilitators included being active with children or during children's activities, being a role model for children, making time/prioritizing, benefits to health and family, and having support available. Several gender differences emerged within each theme, but overall both mothers and fathers reported their priorities had shifted to focus on family after becoming parents, and those who were fitting in physical activity had developed strategies that allowed them to balance their household and occupational responsibilities.
The results of this study suggest working mothers and fathers report similar physical activity barriers and facilitators and would benefit from interventions that teach strategies for overcoming barriers and prioritizing physical activity amidst the demands of parenthood. Future interventions might consider targeting mothers and fathers in tandem to create an optimally supportive environment in the home.
To determine the effect of the Early Start Denver Model (ESDM) for treatment of young children with autism on health care service use and costs.
We used data from a randomized trial that tested the ...efficacy of the ESDM, which is based on developmental and applied behavioral analytic principles and delivered by trained therapists and parents, for 2 years. Parents were interviewed about their children's service use every 6 months from the onset of the intervention to follow-up (age 6 years). The sample for this study consisted of 39 children with autism who participated in the original randomized trial at age 18 to 30 months, and were also assessed at age 6 years. Of this sample, 21 children were in the ESDM group, and 18 children were in the community care (COM) group. Reported services were categorized and costed by applying unit hourly costs. Annualized service use and costs during the intervention and post intervention for the two study arms were compared.
During the intervention, children who received the ESDM had average annualized total health-related costs that were higher by about $14,000 than those of children who received community-based treatment. The higher cost of ESDM was partially offset during the intervention period because children in the ESDM group used less applied behavior analysis (ABA)/early intensive behavioral intervention (EIBI) and speech therapy services than children in the comparison group. In the postintervention period, compared with children who had earlier received treatment as usual in community settings, children in the ESDM group used less ABA/EIBI, occupational/physical therapy, and speech therapy services, resulting in significant cost savings in the amount of about $19,000 per year per child.
Costs associated with ESDM treatment were fully offset within a few years after the intervention because of reductions in other service use and associated costs.
Early Characteristics of Autism; http://clinicaltrials.gov/; NCT0009415.
This paper explores how the new family forms have been taken into account in the reshaping of the French family policy. Three recent reforms are examined through the analytical frame of familialism ...which was one of three drivers of the family policy when it was set up in the mid-20th century. Familialism allows for a consideration of both moral, social and gender order that is on families. Firstly, change in the family law is explored in order to assess how new family life arrangements are institutionalized. Secondly, family policy responses to the new social risks resulting from change in the family life course are explored. Then policy responses to change in the gender order within the family are examined. Difficulties in implementing the policy change are discussed, highlighting the obstacles encountered by the current government as well as the gap between the objectives and their implementation.
Le trope prometteur de la technologie devient le corrélat de l’identité, à même de modifier la biologie du corps de l’homme. Valeurs et pratiques humaines sont impactées jusqu’à la définition même de ...l’humain. Cet article négocie et critique les possibilités matérielles et symboliques de l’utérus artificiel ( ua ). Il s’agit d’une ethnofiction qui propose une réflexion prospective sur les enjeux de société d’une telle révision de modèles de parentés (en tant que système de croyances). Au cœur de la définition de l’espèce, l’ ua parachèverait de dissocier sexualité et reproduction ; enfin, de façon complémentaire à d’autres technologies de la reproduction, modifierait en profondeur le projet d’enfantement en proposant à chacun un désir d’enfant.
What is it to be “an ideal parent”? Does the answer differ across countries and social classes? To answer these questions in a way that minimizes bias and ethnocentrism, we used open-ended questions ...to explore ideal-parent beliefs among 8,357 mothers and 3,517 fathers from 37 countries. Leximancer Semantic Network Analysis was utilized to first determine parenting culture zones (i.e., countries with shared ideal-parent beliefs) and then extract the predominant themes and concepts in each culture zone. The results yielded specific types of ideal-parent beliefs in five parenting culture zones: being “responsible and children/family-focused” for Asian parents, being “responsible and proper demeanor-focused” for African parents, and being “loving and responsible” for Hispanic-Italian parents. Although the most important themes and concepts were the same in the final two zones—being “loving and patient,” there were subtle differences: English-speaking, European Union, and Russian parents emphasized “being caring,” while French-speaking parents valued “listening” or being “present.” Ideal-parent beliefs also differed by education levels within culture zones, but no general pattern was discerned across culture zones. These findings suggest that the country in which parents were born cannot fully explain their differences in ideal-parent beliefs and that differences arising from social class or education level cannot be dismissed. Future research should consider how these differences affect the validity of the measurements in question and how they can be incorporated into parenting intervention research within and across cultures.
Parents who confidently reject vaccines and other forms of medical intervention often seek out pediatric care, medical treatments, and prescription medications for their children in ways that seem to ...contradict these views. Drawing on in-depth interviews with 34 parents who rejected some or all vaccines for their children, this article examines the strategies they use to pharmaceutically manage their children’s health, even when espousing a larger rejection of pharmaceutical interventions like childhood vaccines. Rather than treating decision-making as solely an internal process, this article shows how medication use results from individual, interactional, and institutional contexts, with different mechanisms of encouragement and enforcement. Using three illustrative cases, I show how parents manage ambivalence, which allows them to accept medication for their children as a tool to be deployed as deemed necessary in particular contexts while at the same time communicating their rejection of it. I conclude with suggestions for how to engage parents around healthcare decision-making.
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