Faculty Bibliography

Mental health is a low priority in most countries around the world. Minimal research and resources have been invested in mental health at the national level. As a result, WHO has developed the Assessment Instrument for Mental Health Systems (WHO-AIMS) to encourage countries to gather data and to re-evaluate their national mental health policy. This paper demonstrates the utility and limitations of WHO-AIMS by applying the model to four countries with different cultures, political histories and public health policies: Iraq, Japan, the Philippines and The former Yugoslav Republic of Macedonia. WHO-AIMS provides a useful model for analysing six domains: policy and legislative framework; mental health services; mental health in primary care; human resources; education of the public at large; and monitoring and research. This is especially important since most countries do not have experts in mental health policy or resources to design their own evaluation tools for mental health systems. Furthermore, WHO-AIMS provides a standardized database for cross-country comparisons. However, limitations of the instrument include the neglect of the politics of mental health policy development, underestimation of the role of culture in mental health care utilization, and questionable measurement validity

This article presents long-term effects of a preventive intervention for young children at high risk for antisocial behavior. Ninety-two children (M age = 4 years) were randomly assigned to an 8-month family intervention or no-intervention control condition and assessed 4 times over a 24-month period. Intent-to-treat analyses revealed significant intervention effects on observed child physical aggression, and significant intervention effects found at the end of the program were maintained at follow-up for responsive parenting, harsh parenting and stimulation for learning. Parent ratings of child aggression did not show significant effects of intervention

This study evaluated the utility of the social competence scale (SCS)-parent version, a measure of social competence developed for children of elementary school age, for use with preschool-age children. Data were derived from two samples of preschoolers: a community sample assessed at enrollment to pre-kindergarten programs and a high-risk sample of children at familial risk for conduct problems participating in a preventive intervention trial. Using data from both samples, we assessed the factor structure, internal consistency, and stability of the SCS, and whether the SCS discriminated the high-risk sample from the community sample. Results support the utility and construct validity of the SCS for use in preschoolers. The total SCS scale was relatively stable over 24 months during the preschool period and was correlated with other measures of social competence, parent ratings of emotion regulation, lability and behavior problems, and tests of child cognitive ability

CONTEXT: Salivary cortisol levels during social challenge relate to adaptive functioning in children and adults. Low cortisol levels have been related to conduct problems and antisocial behavior. Although studies in rodents implicate early-life social experience in cortisol regulation, no studies with humans have examined the effects of an experimentally manipulated early-life social experience on cortisol regulation. OBJECTIVE: To examine the effects of experimental manipulations of social experience on cortisol response to a social challenge in preschoolers at risk for antisocial behavior. DESIGN: Randomized controlled trial. SETTING: Department of Child and Adolescent Psychiatry, New York University School of Medicine. PARTICIPANTS: Ninety-two preschool-age siblings of youths adjudicated for delinquent acts. Intervention Family-based intervention included 22 weekly group sessions for parents and preschoolers and 10 biweekly home visits conducted during a 6- to 8-month period. MAIN OUTCOME MEASURES: Salivary cortisol levels before and after a social challenge (entry into an unfamiliar peer group). RESULTS: Relative to controls, children in the intervention condition had increased cortisol levels in anticipation of the peer social challenge. Increases were relative to both preintervention cortisol levels during the challenge and cortisol levels in the home, which were not altered by the intervention. CONCLUSIONS: A family-based preventive intervention for children at high risk for antisocial behavior alters stress response in anticipation of a peer social challenge. The experimentally induced change in cortisol levels parallels patterns found in normally developing, low-risk children

This study explored the factor structure and developmental trajectory of effortful control (EC), its relations with child adjustment, and the moderating role of age and gender in 75 4- to 6-year-old children at risk for psychopathology. Confirmatory factor analyses revealed two subcomponents of effortful control: Suppress/Initiate (the ability to inhibit a dominant response while initiating a new response) and Motor Control (inhibiting fine and gross motor activity). EC performance improved with age, and both subcomponents were associated with greater social competence at all ages. Associations with internalizing problems were moderated by child age such that greater EC was linked to fewer problems at age 4 but did not relate to problems at ages 5 or 6

We examined mother-child (M-C) conflict behavior during the toddler years. The nature of M-C conflict behaviors, whether conflict behavior differed by context, and factors that were associated with conflict interactions were examined. We used data collected as part of the National Evaluation of the Healthy Steps for Young Children Program. 378 M-C dyads participated in this study. Videotaped observational data at 16-18 months were used to code conflict behaviors using an event recording method. Results showed that M-C conflict were more likely to be initiated by the mothers and that conflict interactions were influenced by context of interaction, family, maternal, and child temperamental factors. In this study, we provide a foundation for understanding parent-child conflict interaction prior to age two. (journal abstract)

This study examined the relationship between early maternal knowledge of child development and later quality of parenting behaviors. Differences by race/ethnic group were also examined. Mother-infant dyads (N = 378) participated in the study. Mothers completed the Knowledge of Infant Development Inventory (KIDI) when the infant was 2-4 months, and mother-toddler dyads were videotaped in their homes at 16-18 months. The Home Observation for Measurement of the Environment Inventory (HOME), Parent/Caregiver Involvement Scale (P/CIS), and Nursing Child Assessment by Satellite Training (NCAST) were used to measure quality of mother-toddler interaction. A series of hierarchical multiple regression analyses was conducted controlling for confounding demographic variables. Results revealed no significant main effect of maternal correct estimation of child development on quality of parenting, but there was a significant main effect of maternal underestimation of child development on quality of parenting during a teaching task. There was also a significant interaction of maternal knowledge and race in relation to quality of parenting behavior. Implications for generalizability and interventions are discussed. (C) 2004 Elsevier Inc. All rights reserved

We examined the relation of the relatively new parent-to-infant Postnatal Attachment Questionnaire (PAQ) and the Attachment Q-Set (AQS) in mothers and fathers of 12-month-old infants. The PAQ represents the affective component and the AQS the behavioural component of caregiver - infant attachment. The PAQ has to do with the feelings of the parents towards the infant, whereas the AQS is concerned with the infant's and parents' behaviour vis-a-vis each other. Fifty-nine mothers and 38 fathers of 59 infants ( 31 girls, 28 boys) completed the PAQ and the AQS when their infants were between the ages of 11 and 15 months. The results of multiple regression analyses indicate that the PAQ of both mothers and fathers, as a whole, is significantly related to the AQS. Also, interaction effects revealed that, for fathers of daughters, the relation between the PAQ and the AQS is positive, such that more pleasure in interacting was associated with more secure attachments; whereas for fathers of sons, the relation between the AQS and the absence of hostility PAQ subscale is significant and positive, with less hostility relating to more secure attachments. These findings lend support for the notion that parental feelings are one important correlate of infant secure-base behaviour

The Healthy Steps for Young Children Program (HS) is designed to provide support for new parents through the pediatrician's office. We present findings of the effect of HS on the quality of mother-child interaction, security of attachment, and child behaviour using observational data from two of the HS sites that utilized a randomized treatment design. Results indicated that mothers participating in Healthy Steps were more likely to interact sensitively and appropriately than mothers in the comparison group at the second assessment point (age 34-37 months) but not at the first assessment point (age 16-18 months). There were no differences in child outcomes at either time point when the cross-sectional data were analyzed. However, the results of the longitudinal analysis (which included families who participated in the home observations at both Time 1 and Time 2) indicated that Healthy Steps participation was associated with greater security of attachment and fewer child behaviour problems. (C) 2004 Elsevier Inc. All rights reserved