Parental use of ‘cry it out’ in infants: no adverse effects on attachment and behavioural development at 18 months

Background Leaving infant to cry it out has been the subject of discussion among researchers and parents. Nevertheless, there is paucity of empirical research investigating the association between leaving infant to cry it out and consequent crying duration and frequency, mother–infant attachment and behavioural development. Methods The sample with complete longitudinal data comprised 178 infants and their caretakers. Parental use of ‘leaving infant to cry out’ and cry duration were assessed with maternal report at term, 3, 6 and 18 months, and frequency of crying was assessed at term, 3 and 18 months of age. Attachment was measured at 18 months using the strange situation procedure. Behavioural development of the infant was assessed with two observational measures and a parent‐report questionnaire at 18 months. Results The use of ‘leaving infant to crying’ was rare at term and increased over the next 18 months. ‘Leaving infants to cry it out’ at term was associated with a decrease in crying frequency at 3 months. Furthermore, leaving infants to cry it out a few times at term and often at 3 months was associated with shorter fuss/cry duration at 18 months of age. No adverse impacts of leaving infants to cry it out in the first 6 months on infant–mother attachment and behavioural development at 18 months were found. Conclusions Contemporary practice of some parents in the United Kingdom to occasionally or often ‘leaving infant to cry it out’ during the first 6 months was not associated with adverse behavioural development and attachment at 18 months. Increased use of ‘leaving to cry it out’ with age may indicate differential responding by parents related to infant self‐regulation

Infant regulatory problems : neurodevelopmental vulnerability and sensitive parenting

Infant regulatory problems (crying, sleeping, feeding) are a common concern for parents and practitioners. Although there is now good evidence of the long-term adverse influences of infant regulatory problems on mental health, in particular if they co-occur together (multiple regulatory problems), important gaps remain regarding the precursors of regulatory problems. In particular, it is unclear whether and how sensitive parenting and/or neurodevelopmental vulnerability are involved in the development of multiple regulatory problems. Furthermore, do regulatory problems impair the development of the infants’ relationship to their mothers, i.e. attachment? This thesis explores neurodevelopmental vulnerability and sensitive parenting as precursors of multiple regulatory problems, and whether multiple regulatory problems increase the likelihood of insecure and/or disorganised attachment. The thesis consists of four studies and uses preterm birth as a natural model to assess neurodevelopmental vulnerability due to the interruption caused by preterm birth on the key processes of brain development. Study 1, a meta-analysis, explored the relationship between neurodevelopmental vulnerability and maternal sensitivity by comparing maternal sensitivity in preterm and full-term infants. Findings indicate that having an infant with neurodevelopmental vulnerability does not alter mothers’ sensitive parenting. In Study 2, using the Growth of at risk Infants (GAIN) study, the effect of neurodevelopmental vulnerability on regulatory problems across the first 18 months was investigated. Very preterm/very low birth weight infants experienced more multiple regulatory problems at term and 18 months compared to full-term infants. In Study 3, the longitudinal relationship between neurodevelopmental vulnerability, maternal sensitivity and multiple regulatory problems across infancy was explored allowing for reciprocal associations between maternal sensitivity and multiple regulatory problems across infancy. Both maternal sensitivity and multiple regulatory problems were moderately persistent from term to 18 months. Consistent with our previous findings, it was revealed that neurodevelopmental vulnerability had an enduring impact on multiple regulatory problems. On the other hand, maternal sensitivity at term had only a short-term negative impact on multiple regulatory problems at 3 months. No evidence for a reciprocal influence of maternal sensitivity and multiple regulatory problems was found. Finally, Study 4 examined whether early multiple regulatory problems at 3 and 6 months increase the likelihood of insecure and/or disorganised attachment. Findings revealed that multiple regulatory problems as early as 3 months increased the risk of both insecure and in particular, disorganised attachment at 18 months. In conclusion, neurodevelopmental vulnerability increases the risk of multiple regulatory problems, which are moderately persistent across the first 18 months of life. Furthermore, multiple regulatory problems do not impair maternal sensitivity but have adverse effects on the infants’ relationship with their mothers by increasing the risk of insecure and disorganised attachment. Clinicians should be aware that multiple regulatory problems are a significant potential risk factor for poorer infant-mother relationship

Commentary: Response to commentary by Davis and Kramer

Davis and Kramer (2021) in their commentary on our study (Bilgin & Wolke, 2020) state that we ‘argue that leaving an infant to “cry it out”, rather than responding to the child’s cries, had no adverse effects on mother‐infant attachment at 18 months’ (Davis & Kramer, 2021, p. 1). Instead, we wrote that ‘contemporary practice by some parents to occasionally or often “leaving infant to cry it out” during the first 6 months was not associated with adverse behavioural development and attachment at 18 months’ (p. 8). Based on the empirical findings of our observation study, we suggested that ‘increased use of “leaving to cry it out” with age may indicate differential responding by mothers to aid the development of infant self‐regulation’ (p. 8). Indeed, in an editorial of our study, the joint editor of this journal concluded that ‘Bilgin and Wolke responsibly conclude that there is little reason to make definitive pronouncements to parents of young infants about how much to let them cry it out, given that both the attachment theory (responding promptly early promotes security) and learning theory (ignoring crying prevents dependency) formulations were unsupported by their findings’ (Zeanah, 2020, p. 1172)

Systematic review and meta-analysis : fussing and crying durations and prevalence of colic in infants

Objective To determine the mean duration of fussing and crying and prevalence of colic using modified Wessel criteria in infants in the first 3 months of life. Study design A systematic literature search was performed using the databases Medline, PsycINFO, and Embase. The major outcome measure was mean total fuss/cry duration during 24 hours at ages 1-2 weeks (11 samples), 3-4 weeks (6 samples), 5-6 weeks (28 samples), 8-9 weeks (9 samples), and 10-12 weeks (12 samples). Results Of 5687 articles reviewed, 28 diary studies (33 samples) were suitable for inclusion in meta-analysis; these studies included 8690 infants. No statistical evidence for a universal crying peak at 6 weeks of age across studies was found. Rather, the mean fuss/cry duration across studies was stable at 117-133 minutes (SDs: 66-70) in the first 6 weeks and dropped to a mean of 68 minutes (SD: 46.2) by 10-12 weeks of age. Colic was much more frequent in the first 6 weeks (17%-25%) compared with 11% by 8-9 weeks of age and 0.6% by 10-12 weeks of age, according to modified Wessel criteria and lowest in Denmark and Japan. Conclusions The duration of fussing/crying drops significantly after 8-9 weeks of age, with colic as defined by modified Wessel criteria being rare in infants older than 9 weeks. Colic or excessive fuss/cry may be more accurately identified by defining fuss/cry above the 90th percentile in the chart provided based on the review

Longitudinal associations between justice sensitivity, nonsuicidal self-injury, substance use, and victimization by peers

Justice sensitivity (JS), the tendency to perceive and negatively respond to alleged injustice, has been associated with a range of internalizing and externalizing problems and peer victimization; however, it remains unclear if it has an association with self-victimization. Participants (N = 769) reported on their JS longitudinally at 9–19 (T1), 11–21 (T2), and 14–22 years of age (T3). They further reported on nonsuicidal self-injury (NSSI) and illegal substance use as indicators of self-victimization as well as victimization by peers at T2 and T3. A cross-lagged latent model revealed that victim JS at T1 was positively associated with NSSI, substance use, and peer victimization at T2, and victim JS at T2 was positively associated with substance use at T3. Higher observer JS at T2 predicted higher illegal substance use at T3 and higher illegal substance use at T2 predicted higher observer JS at T3. Finally, higher peer victimization at T2 predicted less perpetrator JS at T3 in the total group. Multigroup models further revealed sex-specific effects. Our findings highlight that being sensitive to injustice, particularly the tendency to feel unfairly treated or being taken advantage of, contributes to individuals’ vulnerability to both engaging in behaviors reflecting self-victimization and being a target of peer victimization, which in turn have influences on JS

The prevalence of personality disorders in the community: a global systematic review and meta-analysis

Background Personality disorders are now internationally recognised as a mental health priority. Nevertheless, there are no systematic reviews examining the global prevalence of personality disorders. Aims To calculate the worldwide prevalence of personality disorders and examine whether rates vary between high and low and middle-income countries (LAMICs). Method We systematically searched PsycINFO, MEDLINE, EMBASE and PubMed from 1980 to May 2018 to identify articles reporting personality disorder prevalence rates in community populations (PROSPERO registration number: CRD42017065094). Results Forty-six studies (from 21 different countries spanning six continents) satisfied inclusion criteria. The worldwide pooled prevalence of any personality disorder was 7.8 % (95% Confidence Intervals: 6.1-9.5). Rates were greater in high income (9.6%; 95% CI: 7.9-11.3%) compared with LAMI (4.3%; 95% CI =2.6-6.1%) countries. In univariate meta-regressions, significant heterogeneity was partly attributable to study design (two-stage versus one-stage assessment), county income (high versus LAMI) and interview administration (clinician versus trained graduate). In multiple meta-regression analysis, study design remained a significant predictor of heterogeneity. Global rates of Cluster-A, B and C personality disorders were 3.8 % (3.2, 4.4%), 2.8% (1.6, 3.7%) and 5.0% (4.2, 5.9%). Conclusions Personality disorders are prevalent globally. Nevertheless, pooled prevalence rates should be interpreted with caution due to high levels of heterogeneity. More large-scale studies with standardised methodologies are now needed to increase our understanding of population needs and regional variations

Changes in emotional problems, hyperactivity and conduct problems in moderate to late preterm children and adolescents born between 1958 and 2002 in the United Kingdom

Background Preterm birth is a risk factor for the development of emotional and behavioural problems in childhood and adolescence. Given the substantial improvements in neonatal care across decades, it has been expected that the difference in emotional problems, hyperactivity, and conduct problems between moderate to late preterm (MLPT) and full term (FT) children and adolescents have declined in recent years. Methods Data from four UK population-based studies were used: The National Child Development Study (NCDS; 1958), the British Cohort Study (BCS70; 1970), the Avon Longitudinal Study of Parents and Children (ALSPAC, 1991?1992) and the Millennium Cohort Study (MCS; 2000?2002). Emotional problems, hyperactivity and conduct problems were assessed with mother-reports in early childhood (5?7 years), late childhood (10?11 years) and adolescence (14?16 years). Furthermore, emotional problems were self-reported in adolescence in BCS70, ALSPAC and MCS. Results In the most recent cohort, the MLPT group had higher mother-reported emotional problems than those born FT in late childhood and adolescence, whereas there were no differences in self-reported emotional problems in adolescence. Regarding mother-reported hyperactivity symptoms, the MLPT group had higher scores than the FT group in the two most recent cohorts in late childhood and in the most recent cohort in adolescence. Regarding mother-reported conduct problems, MLPT children had significantly higher scores than the FT children in the oldest and in the most recent cohort in late childhood. On the other hand, in adolescence, MLPT children had significantly lower scores in conduct problems in comparison to FT children in the cohort born in 1991?1992. Conclusions Mother-reported emotional problems and hyperactivity symptoms of those born MLPT have increased from the birth years 1958 to 2000?2002 during late childhood and adolescence, whereas self-reported emotional problems were similar in MLPT and FT groups during adolescence from 1970 to 2000?2002. Findings are less consistent regarding conduct problems. The current findings highlight the importance of raising the awareness of teachers about the association between MLPT birth and behavioural and emotional problems in late childhood and adolescence to prevent the long-term negative outcomes associated with the sequalae of MLPT birth.Peer reviewe

Preschool Mathematics and Literacy Skills and Educational Attainment in Adolescents Born Preterm and Full Term

Objectives: To test whether preschool academic skills were associated with educational attainment in adolescence and whether associations differed between individuals born preterm and at full term. Study design: This prospective cohort study comprised 6924 individuals, including n = 444 (6.4%) adolescents born preterm ( .05). Higher preschool academic skill scores in mathematics were associated with greater odds of attaining GCSE Mathematics and preschool literacy skills were associated with GCSE English. Adolescents born preterm with higher preschool mathematics (OR: 1.51, CI: 1.14, 2.00) and literacy skills (OR: 1.57, CI: 1.10, 2.25) were more likely to attain GCSEs in the respective subject than their term-born counterparts with equal levels of preschool skills. Conclusions: Preschool academic skills in mathematics and literacy are associated with educational attainment of preterm and term-born individuals in adolescence. Children born prematurely may benefit more from preschool mathematics and literacy skills for academic and educational success into adolescence than term-born individuals

Parents’ life satisfaction prior to and following preterm birth

The current study tested whether the reported lower wellbeing of parents after preterm birth, relative to term birth, is a continuation of a pre-existing difference before pregnancy. Parents from Germany (the German Socio-Economic Panel Study, N = 10,649) and the United Kingdom (British Household Panel Study and Understanding Society, N = 11,012) reported their new-born’s birthweight and gestational age, subsequently categorised as very preterm or very low birthweight (VP/VLBW, < 32 weeks or < 1500 g), moderately/late preterm or low birthweight (MLP/LBW, ≥ 32 weeks and < 37 weeks/≥ 1500 g and < 2500 g), or term-born (≥ 37 weeks and ≥ 2500 g). Mixed models were used to analyse life satisfaction, an aspect of wellbeing, at four assessments-two years and six months before birth and six months and two years afterwards. Two years before birth, satisfaction of prospective term-born, MLP/LBW, or VP/VLBW mothers did not significantly differ. However, mothers of VP/VLBWs had lower satisfaction relative to mothers of term-borns at both assessments post-birth. Among fathers, satisfaction levels were similarly equivalent two years before birth. Subsequently, fathers of VP/VLBWs temporarily differed in satisfaction six months post-birth relative to fathers of term-borns. Results indicate that parents’ lower life satisfaction after VP/VLBW birth is not a continuation of pre-existing life satisfaction differences