Jana Kreppner

This article explores the stability and impact of birth country and heritage interest among international adoptees from adolescence to adulthood, using data from the English and Romanian Adoptees (ERA) study. While adolescence is often seen as key for ethnic identity development, adulthood may also offer opportunities for reflection and integration. We examined interest in Romania at ages 15 and 23, and its links to earlier neurodevelopmental difficulties, behavioural engagement (e.g., visiting Romania, contact with biological relatives), and adult wellbeing. Four main findings emerged: first, interest in Romania was generally stable – 49% showed persistently low interest, 11% persistently high, 23% increased, and 17% decreased; second, higher interest was linked to visiting Romania and contact with biological relatives, especially mothers and siblings; third, greater interest was associated with fewer childhood attention-deficit/hyperactivity disorder (ADHD) symptoms, but not with other deprivation-related issues or institutional deprivation duration; and fourth, higher interest was associated with fewer emotional problems in adulthood, though not differences in self-esteem or functional outcomes. These findings suggest heritage interest may support mental health in adulthood for some adoptees. Adoption support should encourage heritage engagement and tailor interventions to individual neurodevelopmental profiles, promoting identity exploration across the lifespan.

Background: Paternal perinatal mental health influences subsequent child development, yet is under-investigated. This study aims to examine the impact of different timings of paternal perinatal anxiety (prenatal-only, postnatal-only, and both pre-and postnatally) on children’s subsequent emotional and behavioral difficulties. Method: We used data from the Avon Longitudinal Study of Parents and Children and tested the prospective associations between anxiety in fathers and adverse mental health outcomes in children at 3 years, 6 months and 7 years, 7 months. Results: Children whose fathers were anxious in the perinatal period were at higher risk of subsequent adverse outcomes, compared to children whose fathers were not anxious perinatally. At 3 years, 6 months, the highest risk group was the one with fathers anxious prenatally-only; compared to children with non-anxious fathers, children in the prenatal-only group were significantly more likely to present mental health difficulties, measured by total problems (unadjOR = 1.82, 95%CI [1.28, 2.53]). At 7 years, 7 months, children exposed to paternal anxiety both pre- and postnatally were at higher risk of any psychiatric disorder (unadjOR = 2.35, 95%CI [1.60, 3.37]) compared to the non-anxious group. Conclusions: Paternal perinatal anxiety is a risk factor for child adverse outcomes, even after accounting for maternal mental health, child temperament, and sociodemographic factors, and should not be overlooked in research and clinical practice.

Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants’ recruitment and the app’s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients’ data. Parents’ and clinicians’ feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0

Inclusive education for children with attention deficit hyperactivity disorder (ADHD) presents challenges for school staff and professional development is lacking. Training is not always available when needed, strategies suggested by external experts can be impractical and staff lack autonomy in choosing the best way of being resourced. Additionally, the experience and knowledge of the range of school staff is not utilised. A collaborative working group of school staff and a researcher explored an alternative method of ADHD resourcing. Co‐construction of knowledge defines how the group discursively identified actionable knowledge from the different perspectives and knowledge brought by individual group members. A systemic framework was used to critically reflect on the collaboration. The framework enabled reflection on four areas to understand how and why the collaboration led to a published web‐based school staff ADHD resource. Firstly, starting conditions and assumptions were considered to identify and articulate the rationale for the resource. Secondly, the context and system dynamics enabled consideration of the socio‐cultural and political landscape of the project and the impact of COVID‐19. Thirdly, the different voices of participants and power dynamics were reflected on. Finally, emergence was a frame in which to elucidate knowledge production and changes in practice. The collaborative working group addressed the research–practice gap and the need for diversity of voices to be heard across the school. Knowledge co‐construction positions staff as knowledge bearers and, together with different forms of knowledge, they can be empowered to create new, contextualised evidence‐based knowledge.

BACKGROUND The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants’ recruitment and the app’s usability. OBJECTIVE This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. METHODS myHealthE was adapted to screen patients’ data. Parents’ and clinicians’ feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. RESULTS Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. CONCLUSIONS Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. INTERNATIONAL REGISTERED REPORT RR2-10.1186/s40814-021-00959-0

Background: Perfectionism is an important feature of adult psychopathology. In the absence of a prior review of the role of perfectionism in perinatal psychopathology, we aimed to ascertain whether perfectionism was associated with symptoms of maternal perinatal depression and anxiety. Method: We followed PRISMA guidance (PROSPERO: 42019143369), estimated weighted effect sizes and tested possible moderators: timing (pre or post‐ natal), scales used to measure constructs, infant gender, temperament and age; and rated study quality. Results: Fourteen studies met eligibility criteria. Perfectionism as a whole, and the perfectionistic concerns dimension, were moderately correlated with common maternal perinatal mental health difficulties r = .32 (95% Confidence Interval = 0.23 to 0.42). In sub‐group analyses, perfectionistic concerns were associated with depression ( r = .35, 95% CI = 0.26–0.43). We found no evidence of significant moderation of associations. Limitations: Included studies had methodological and conceptual limitations. All studies examined depression and two examined anxieties; all examined perfectionistic concerns and four examined perfectionist strivings. Conclusions: Perfectionism, namely perfectionistic concerns, is potentially associated with common maternal perinatal mental health problems. While further research is warranted, identification of perfectionism in the perinatal period may help focus resources for intervention, reducing the prevalence of perinatal mental health difficulties.