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The COVID-19 Pandemic: Implications for Maternal Mental Health and Early Childhood Development [Editorial]

Kerker, Bonnie D; Willheim, Erica; Weis, J Rebecca
Women are particularly susceptible to mental health challenges during the perinatal period. With the onset of the COVID-19 pandemic in 2020, much concern was raised about the impact that the associated isolation, uncertainty, grief, loss and economic upheaval would have on mental health. Women experienced a disproportionate amount of environmental strain during this time, including economic stress and challenges associated with being essential workers; stressors were perhaps most prevalent in communities of color and immigrant groups. For women who were pregnant during the height of the pandemic, it is clear that stress, anxiety, and depression were increased due to changes in medical care and decreases in social support. Increased mental health challenges in the perinatal period have been shown to impact social-emotional, cognitive and behavioral health in infants and children, so the potential consequences of the COVID-19 era are great. This paper discusses these potential impacts and describes important pathways for future research.
PMID: 36646659
ISSN: 2168-6602
CID: 5410622

The Adaptation of a Postpartum Depression Prevention Evidence-Based Intervention in Family Homeless Shelters

Kerker, Bonnie D.; Milian, Jacqueline; Clark, Melissa R.; Weiss, Dara; Lewis, Kristen; Willheim, Erica
Evidence-based interventions (EBIs) are considered the gold standard but it is unclear if they are effective across settings. Reach Out and Stay Strong, Essentials for new Mothers (ROSE) has been shown to prevent postpartum depression in clinical settings, but has not been implemented or tested in homeless populations. We used the Exploration, Preparation, Implementation and Sustainment (EPIS) model overlaid with the Dynamic Adaptation Process (DAP) to adapt ROSE for implementation in a homeless shelter system in a large U.S. city, using feedback from both the organization and community. The adapted intervention was called Strong in Shelter (SIS). In this paper, we present 4 DAPS (April, 2018- December, 2020); the EPIS stages within each DAP are described. The Exploration Stage is centered around early and ongoing engagement with shelter providers and residents. The Preparation Stage includes adaptations based on learnings from the Exploration and the Implementation Stages from previous DAPs. The Implementation Stage highlights what we learned from implementation and both quantitative and qualitative feedback from shelter staff and residents. Following the DAP cycles, we created scalable plans in the Sustainment Stage. Thematic analysis was used to identify, analyze and report patterns within qualitative data, and descriptive analyses were conducted with quantitative data. Participant engagement and satisfaction were high and facilitators reported implementing SIS with fidelity to ROSE"™s core components. By engaging staff and the participants early and continually, and utilizing an iterative and flexible adaptation process, EBIs such as ROSE can be adapted and implemented with fidelity in new settings.
ISSN: 1062-1024
CID: 5662392

I'm Coming Home: Providing Parent Training to Support Inpatient Discharge Programs

Feder, Michael A; Brodman, Douglas M; Yang, Zi Chun; Ng, Vanessa YT; Glickman, Samantha; Smith, Jacquline; Baroni, Argelinda; Willheim, Erica; Verduin, Timothy L
ISSN: 1065-8025
CID: 5324962

Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology

Pointet Perizzolo, V C; Glaus, J; Stein, C R; Willheim, E; Vital, M; Arnautovic, E; Kaleka, K; Rusconi Serpa, S; Pons, F; Moser, Dominik A; Schechter, D S
Background:Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology. Methods:Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC). Results:We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS. Conclusion:These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.
PMID: 35111283
ISSN: 2000-8066
CID: 5153702

Negative and distorted attributions towards child, self, and primary attachment figure among posttraumatically stressed mothers: what changes with Clinician Assisted Videofeedback Exposure Sessions (CAVES)

Schechter, Daniel S; Moser, Dominik A; Reliford, Aaron; McCaw, Jaime E; Coates, Susan W; Turner, J Blake; Serpa, Sandra Rusconi; Willheim, Erica
This study found that within a non-referred community pediatrics clinic sample, the severity of mothers' trauma-related psychopathology, in particular, their interpersonal violence-related (IPV) posttraumatic stress, dissociative, and depressive symptoms predicted the degree of negativity of mothers' attributions towards their preschool age children, themselves, and their own primary attachment figure. Results also showed that mothers with IPV-related posttraumatic stress disorder (PTSD) as compared to non-PTSD controls showed a significantly greater degree of negativity of their attributions toward their child, themselves and their primary attachment figure during childhood. The study finally found a significant reduction in the degree of negativity of mothers' attributions only towards their child following a three-session evaluation-protocol that included a form of experimental intervention entitled the "Clinician Assisted Videofeedback Exposure Session(s)" (CAVES), for mothers with IPV-PTSD as compared to control-subjects.
PMID: 24553738
ISSN: 1573-3327
CID: 2736662

Dyadic psychotherapy with infants and young children: child-parent psychotherapy

Willheim, Erica
This article briefly reviews the historical and empiric foundations of dyadic psychotherapy, highlighting the evolution of the central tenet that very young children exist in a relational context. The target of therapeutic intervention must therefore be the caregiver-child relationship. General features of dyadic psychotherapy are discussed, as well as aspects that are unique to the treatment of very young children. An overview of the goals and intervention modalities of Child-Parent Psychotherapy is provided as an example of an evidence-based dyadic intervention that incorporates theoretical principles and techniques of psychodynamic psychotherapy.
PMID: 23538011
ISSN: 1558-0490
CID: 3089612

An fMRI study of the brain responses of traumatized mothers to viewing their toddlers during separation and play

Schechter, Daniel S; Moser, Dominik A; Wang, Zhishun; Marsh, Rachel; Hao, XueJun; Duan, Yunsuo; Yu, Shan; Gunter, Benjamin; Murphy, David; McCaw, Jaime; Kangarlu, Alayar; Willheim, Erica; Myers, Michael M; Hofer, Myron A; Peterson, Bradley S
This study tested whether mothers with interpersonal violence-related posttraumatic stress disorder (IPV-PTSD) vs healthy controls (HC) would show greater limbic and less frontocortical activity when viewing young children during separation compared to quiet play. Mothers of 20 children (12-42 months) participated: 11 IPV-PTSD mothers and 9 HC with no PTSD. During fMRI, mothers watched epochs of play and separation from their own and unfamiliar children. The study focused on comparison of PTSD mothers vs HC viewing children in separation vs play, and viewing own vs unfamiliar children in separation. Both groups showed distinct patterns of brain activation in response to viewing children in separation vs play. PTSD mothers showed greater limbic and less frontocortical activity (BA10) than HC. PTSD mothers also reported feeling more stressed than HC when watching own and unfamiliar children during separation. Their self-reported stress was associated with greater limbic and less frontocortical activity. Both groups also showed distinct patterns of brain activation in response to viewing their own vs unfamiliar children during separation. PTSD mothers' may not have access to frontocortical regulation of limbic response upon seeing own and unfamiliar children in separation. This converges with previously reported associations of maternal IPV-PTSD and atypical caregiving behavior following separation.
PMID: 22021653
ISSN: 1749-5024
CID: 2736732

The relationship of violent fathers, posttraumatically stressed mothers and symptomatic children in a preschool-age inner-city pediatrics clinic sample

Schechter, Daniel S; Willheim, Erica; McCaw, Jaime; Turner, J Blake; Myers, Michael M; Zeanah, Charles H
This study aims to understand if greater severity of maternal posttraumatic stress symptoms (PTSS), related to maternal report of interpersonal violence, mediates the effects of such violence on (a) child PTSS as well as on (b) child externalizing and internalizing symptoms. Study participants were mothers (N = 77) and children 18 to 48 months recruited from community pediatric clinics. Data were analyzed continuously via bivariate correlations and then multiple linear regression. Post hoc Sobel tests were performed to confirm mediation. Paternal violence accounted for 15% of the variance of child PTSS on the PCIP-OR (beta = .39, p
PMID: 22170456
ISSN: 1552-6518
CID: 2736722

Subjective and objective measures of parent-child relationship dysfunction, child separation distress, and joint attention

Schechter, Daniel S; Willheim, Erica; Hinojosa, Claudia; Scholfield-Kleinman, Kimberly; Turner, J Blake; McCaw, Jaime; Zeanah, Charles H; Myers, Michael M
The literature suggests an adverse impact of maternal stress related to interpersonal violence on parent-child interaction. The current study investigated associations between a mother's self-reported parent-child relationship dysfunction and what she does in response to her child's cues. It also examined whether maternal perception of parent-child dysfunctional interaction and child behavior when stressed by separation, along with maternal behavior in response to child distress, predicted impaired joint attention (JA) during play. Participant mothers (n = 74) and their children ages 12-48 months were recruited from community pediatrics clinics and completed two videotaped visits. After correlations, multiple linear regression was applied to find the best model fit that would predict outcomes of interest. We found that both maternal subjective report of self-reported parent-child relationship dysfunction and observed child separation distress together predicted atypical maternal behavior. Self-reported parent-child relationship dysfunction, observed atypical maternal behavior, and child separation distress combined significantly predicted less time spent in joint attention during play. Maternal posttraumatic stress predicted less maternal availability after separation stress. Clinicians should thus carefully assess and listen to parents' communication of disturbances in their relationship with their young child. Left untreated, parent-child relationship dysfunction may well lead to impairment in learning and social-emotional development.
PMID: 20557225
ISSN: 1943-281x
CID: 2736752

Is maternal PTSD associated with greater exposure of very young children to violent media?

Schechter, Daniel S; Gross, Anna; Willheim, Erica; McCaw, Jaime; Turner, J Blake; Myers, Michael M; Zeanah, Charles H; Gleason, Mary Margaret
This study examined media viewing by mothers with violence-related posttraumatic stress disorder (PTSD) and related media exposure of their preschool-age children. Mothers (N = 67) recruited from community pediatric clinics participated in a protocol involving a media-preference survey. Severity of maternal PTSD and dissociation were significantly associated with child exposure to violent media. Family poverty and maternal viewing behavior were also associated. Maternal viewing behavior mediated the effects specifically of maternal PTSD severity on child exposure. Clinicians should assess maternal and child media viewing practices in families with histories of violent trauma exposure and related psychopathology.
PMID: 19924819
ISSN: 1573-6598
CID: 2736762