Dale M. Stack

OBJECTIVES: To report the 3-year follow-up results of the “Caring Intensively” study, which examined children’s psychological and behavioral responses after PICU hospitalization. DESIGN: Prospective mixed methods, concurrent triangulation design. In the quantitative arm, study group (SG) and comparison group (CG) children and their parents were administered a battery of measures assessing psychological and behavioral outcomes, and telephone survey data were collected 6 weeks, 6 months, 1, 2, and 3 years post-discharge. In the qualitative arm, SG interviews were conducted 1 and 3 years post-discharge. Recruitment 2014–2018, with follow-up completed 2021. SETTING: SG recruited from PICUs of three Canadian quaternary care pediatric hospitals; CG from two hospitals’ ear, nose, and throat (ENT) day surgery units. PATIENTS: Age (3–12 yr) and gender-matched PICU children (SG, 158) or day surgery ENT children (CG, 169) and their parents were recruited; 62% of families completed the study (SG, 97; CG, 106). Selected SG families were interviewed at year 1 (17 families, 30 participants) and year 3 (14 families, 27 participants). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: No group differences on primary or secondary outcomes. Both groups reported emotional and behavioral changes in children via telephone survey; however, group findings diverged on their nature and attribution. SG parents attributed changes primarily to PICU hospitalization; CG parents attributed changes to other life events. At year 3, 40.3% of SG parents still reported negative emotional and behavioral changes in children suggesting a chronic trajectory of recovery. Qualitative interview findings converged with SG survey responses, reflecting the adaptive and relational challenges confronting children and families. CONCLUSIONS: This study highlights children’s emotional and behavioral responses over the 3 years post-PICU and the need to study child recovery within the family. These findings contribute to our understanding of the nature and duration of trajectories of recovery and emphasize the importance of providing clinical follow-up and prioritizing family-identified outcomes in future research.

Governments around the world are pressed to invest in postsecondary education. However, little research exists to document whether large-scale educational reforms aimed at increasing rates of postsecondary attendance benefit youth’s developmental outcomes. This study tested whether an educational reform occurring in Québec, Canada, in the 1960s increased educational levels, and whether it benefitted some youth more than others. In the 1970’s, 4109 low-income youth (50% females) aged 7–13 years old were recruited at Time 1 from first, fourth, and seventh grade classes (M_age = 10.6, SD = 2.5). Socio-behavioral characteristics and academic skills at Time 1 were examined as predictors of educational attainment at Time 2, three decades later, on 3883 of the same participants. Multinomial logistic regressions were used to examine the likelihood of youth obtaining a diploma from the newly created, accessible, and affordable colleges (“cégeps”). Low-educated groups (high school dropouts and high school graduates) presented a higher early risk profile than did college graduates. Interactions revealed that social withdrawal protected youth from disadvantaged neighborhoods, helping them graduate from college. Likeability helped academically weaker girls go beyond college and access university, and helped academically competent boys graduate from college. Aggressive behavior decreased the odds of university attendance for academically competent boys. Policies promoting higher education for disadvantaged youth should be supplemented with early interventions integrating academic and socio-behavioral objectives.

Adaptive emotion regulation begins with infants operating jointly with their parents to regulate their emotions, which fosters the development of independent regulation. Little is known about when or how this transition occurs, or the impact of factors such as parental availability or premature birth status. The current study examined the use of self‐soothing, attentional distraction, and dyadic regulation in full‐term and healthy very‐low‐birthweight (VLBW) preterm infant‐mother dyads at 5 ½, 12, and 18 months of age. At 5 ½ months, dyads participated in the Still‐Face procedure. At 12 and 18 months, dyads participated in two free‐play interactions, a puzzle task, and an interference task. Emotion regulation behaviors were coded using two systematic, observational systems. Results indicated that infants used less self‐soothing and attentional distraction and more dyadic regulation as they aged. Increased use of self‐soothing at earlier ages predicted increased use of dyadic regulation at subsequent ages. Toddlers used more independent, attention‐seeking, and escape behavior during periods of maternal unavailability. There were no significant differences between full‐term and VLBW/preterm toddlers’ emotion regulation behaviors. Results from the current study contribute to the understanding of normative development of emotion regulation and the risk associated with prematurity.

Few studies have examined the longitudinal impact of birth status on the infant-mother relationship and on children’s socio-emotional development. In the present study we investigated developmental patterns of such relationships (using the Emotional Availability (EA) Scales) in fullterm and VLBW/PT infants from infancy to emerging school age. Our objectives were to: (a) model the developmental trajectories of EA dimensions (maternal sensitivity, structuring, nonhostility; child responsiveness, involvement) in a VLBW/PT and fullterm sample, (b) identify potential effects of VLBW/PT status on these trajectories, and (c) determine whether the effects of VLBW/PT status on children’s socio-emotional development (child EA) remained after accounting for the effect of maternal EA. Child-mother dyads (n=109) were observed in home-based interactions (face-to-face and free play) when children were 6, 12, 18 and 57-months-old in fullterm (37-41 weeks, >2500g; n=48) and healthy VLBW/PT (26-32 weeks gestation, birth weight 800-1500g, corrected for gestational age; n=61) children. Developmental trajectories of maternal and child EA were assessed using multilevel growth modeling in Mplus. Results indicated that, even after controlling for maternal EA, there was a persistent negative effect of VLBW/PT birth status on child EA trajectories. Both initially and over time, VLBW/PT infants lagged behind their fullterm counterparts on levels of responsiveness and involvement with mothers. There was also a persistent positive effect of maternal EA (sensitivity and structuring) on child EA trajectories. Higher average levels of maternal sensitivity and structuring across time were also associated with higher and persistent levels of child responsiveness and involvement of their mothers. Importantly, results held after modeling both effects together, and after controlling for maternal education and child gender. Our results have implications for VLBW/PT children’s development, the parent-child relationship, and integrating family level factors and relationship dimensions in early prevention and intervention programs.

The purpose of the present study was to investigate the communicative functions of mutual touch during mother-infant interactions and their relation with infants’ affect and the quality of the mother-infant relationship. The two normal periods of the Still-Face procedure were examined for mothers and their 5½-month-old full-term (n=40) and very low-birthweight/preterm (VLBW/preterm; n=40) infants. The Functions of Mother-Infant Mutual Touch Scale was used to code the function of each mutual touch. Results indicated that full-term infant-mother dyads spent significantly more time engaged in playful and regulatory mutual touch compared to VLBW/preterm infant-mother dyads who spent significantly more time engaged in attention-centered, unbalanced, and guided mutual touch. Infant smiling was found to significantly co-occur with playful mutual touch for both the full-term and VLBW/preterm infants, while fretting co-occurred with unbalanced mutual touch for VLBW/preterm infants. Higher levels of maternal sensitivity and regulatory mutual touch were associated for full-term dyads, while lower levels of maternal sensitivity were associated with unbalanced mutual touch for VLBW/preterm dyads. Results from this study enable a more comprehensive understanding of the functions of mutual touching, and suggest key differences in which mutual touching behaviours are organized with infants’ affect and relationship dimensions between mothers and their infants.