The LifeStories project: Empowering voices and avoiding harm-Ethics protocol of a long-term follow-up study of individuals placed in infant care institutions in Switzerland

Little empirical data exist to guide ethical decisions when conducting research with vulnerable populations. The current study assesses a protocol designed to mitigate risks in a population-based cohort of 246 individuals placed in care institutions as infants in a non-selective 60-year follow-up. In total, 116 (47%) individuals chose to participate, of whom 53 (55%) reported positive effects of participation such as the opportunity to fill some gaps in their life stories, to better deal with their past, and to understand previous family dynamics. Only three individuals (2.5%) explicitly reported negative short-term consequences such as feeling upset as a result of thinking about stressful times, but they nonetheless rated the usefulness of the study as high. For six participants (5%), psychological counseling sessions were initiated as a support measure. Our findings suggest that risk of harm can be managed with a rigorous ethics protocol when conducting research with a vulnerable cohort and therefore enable the voices of survivors to be heard. A step wise approach in which increasing amounts of information were presented at each step, clearly operationalized passive decline, and direct and consistent contact with highly trained staff were considered key to mitigating distress. Keywords: deprivation; ethics; institutionalization; long-term follow-up; vulnerable cohor

Developmental trajectories of children's playfulness in two- to six-year-olds

Even though playfulness has been found to be highly relevant to the development and wellbeing of young children, hardly any longitudinal findings are available on stability and changes in children's playfulness. This study examined developmental trajectories of children's playfulness in two- to six-year-olds over a two-year period and analyzed whether individual and family characteristics and transition to primary school explain these trajectories. The sample included 839 children (47.3% girls, MAge = 4.87 years, SDAge = 1.39) from 38 childcare centers and 47 kindergartens in Switzerland. Children's playfulness was assessed at three measurement time points at one-year intervals using the multidimensional Children's Playfulness Scale to gather parent and teacher reports. Second-order linear growth curve models showed significant interindividual differences in children's playfulness at initial baseline. These differences correlated with effects for age, migrant background, and maternal education. The growth-related processes varied depending on children's age, and the individual dimension of children's playfulness whether an increase, stability, or decline was observed. In particular, social components of playfulness were found to change. On average, children's playfulness increased in early years but decreased from school age onwards. However, closeness in parent–child relationships proved to be supportive of children's playfulness at all time points. The results indicate the significance of positive parenting to children's playfulness, but they also draw attention to how playful qualities can be maintained and more highly valued in the school environment. In general, the study can contribute to a better understanding of the construct of playfulness in childhood

Development and Health of Adults Formerly Placed in Infant Care Institutions – Study Protocol of the LifeStories Project

A growing volume of research from global data demonstrates that institutional care under conditions of deprivation is profoundly damaging to children, particularly during the critical early years of development. However, how these individuals develop over a life course remains unclear. This study uses data from a survey on the health and development of 420 children mostly under the age of three, placed in 12 infant care institutions between 1958 and 1961 in Zurich, Switzerland. The children exhibited significant delays in cognitive, social, and motor development in the first years of life. Moreover, a follow-up of a subsample of 143 children about 10 years later revealed persistent difficulties, including depression, school related-problems, and stereotypies. Between 2019 and 2021, these formerly institutionalized study participants were located through the Swiss population registry and invited to participate once again in the research project. Now in their early sixties, they are studied for their health, further development, and life-course trajectories. A mixed-methods approach using questionnaires, neuropsychological assessments, and narrative biographical interviews was implemented by a multidisciplinary team. Combining prospective and retrospective data with standardized quantitative and biographical qualitative data allows a rich reconstruction of life histories. The availability of a community sample from the same geographic location, the 1954–1961 cohort of the Zurich Longitudinal Studies, described in detail in a paper in this issue (Wehrle et al., 2020), enables comparison with an unaffected cohort. This article describes the study design and study participants in detail and discusses the potential and limitations of a comparison with a community sample. It outlines a set of challenges and solutions encountered in the process of a lifespan longitudinal study from early childhood into the cusp of old age with a potentially vulnerable sample and summarizes the lessons learned along the way

Are screen media the new pacifiers? : the role of parenting stress and parental attitudes for children's screen time in early childhood

Screen media are increasingly shaping our everyday lives, including those of young children. Among other reasons, parents might use screen media as a problem-oriented coping strategy to reduce parenting stress levels. Furthermore, parental attitudes towards children's screen media use have been shown to predict screen time in young children. The present study examines the intertwined roles of parenting stress and parental attitudes to children's screen time throughout early childhood. Parents of N = 462 children aged up to 3 years (M = 1.28, SD = 0.61; 50% female) participated in four assessments within 10 months. Parents reported their level of parenting stress, their attitudes toward young children's screen media use, and their child's screen time at each assessment. Across all measurement time points, results indicated that both parenting stress and positive parental attitudes are positively associated with children's screen time. Furthermore, parental attitudes were found to strengthen the link between stress and children's screen time at two of the four measurement time points. Recommendations for children's screen time should consider parental stress and suggest alternative strategies for coping with parenting stress

Burden of child maltreatment in China:A systematic review

Objective To estimate the health and economic burdens of child maltreatment in China. Methods We did a systematic review for studies on child maltreatment in China using PubMed, Embase, PsycInfo, CINAHL-EBSCO, ERIC and the Chinese National Knowledge Infrastructure databases. We did meta-analyses of studies that met inclusion criteria to estimate the prevalence of child neglect and child physical, emotional and sexual abuse. We used data from the 2010 global burden of disease estimates to calculate disability-adjusted life-years (DALYs) lost as a result of child maltreatment. Findings From 68 studies we estimated that 26.6% of children under 18 years of age have suffered physical abuse, 19.6% emotional abuse, 8.7% sexual abuse and 26.0% neglect. We estimate that emotional abuse in childhood accounts for 26.3% of the DALYs lost because of mental disorders and 18.0% of those lost because of self-harm. Physical abuse in childhood accounts for 12.2% of DALYs lost because of depression, 17.0% of those lost to anxiety, 20.7% of those lost to problem drinking, 18.8% of those lost to illicit drug use and 18.3% of those lost to self-harm. The consequences of physical abuse of children costs China an estimated 0.84% of its gross domestic product – i.e. 50 billion United States dollars – in 2010. The corresponding losses attributable to emotional and sexual abuse in childhood were 0.47% and 0.39% of the gross domestic product, respectively. Conclusion In China, child maltreatment is common and associated with large economic losses because many maltreated children suffer substantial psychological distress and might adopt behaviours that increase their risk of chronic disease

Dilemmas for international mobilization around child abuse and neglect.

Abstract The goal of this commentary is to articulate some issues and dilemmas raised by various efforts to mobilize international action around child abuse and neglect (CAN). We will start by proposing a typology of international mobilization strategies, noting that initiatives to promote CAN programming in new settings have tended to emphasize one of three vectors: governments, professionals, or international NGOs. There are pros and cons to each emphasis, which we discuss. We also review the debates around some of the following dilemmas: Should low-income countries be a top priority for CAN mobilization? Are there cultural and institutional capacities that need to be present in a country in order for CAN programs to work or be ethical? Are some CAN programs more likely to be internationally transferable than others and why so? Has the field adequately considered whether non-CAN programming (e.g., family planning) might actually be more effective at preventing maltreatment than CAN programming? Does the field give adequate acknowledgment that policies and practices emanating from high-resourced and Western countries may not always be the best to disseminate? Are we relying too much on a model of program transplantation over a model of local cultivation? Should we aim for modest rather than ambitious accomplishments in international mobilization? How much emphasis should be placed on the priority dissemination of evidence-based programming? We conclude with some suggestions in the service of clarifying these dilemmas and making some of these decisions more evidence based

Using participatory methods to develop and implement research on historical compulsory social measures and placements in Switzerland

Many of the child welfare policies and practices in Switzerland before the law reform of 1981 were rather invasive and were exercised under a legal context that sometimes threatened basic human rights. The inclusion of survivors of such measures in the research process has been vigorously requested in Switzerland. Therefore, four individuals who had been placed in institutions as children have been included in the process of preparing a recently initiated, 60-year follow-up study of individuals placed in infant care institutions in Switzerland in the late 1950s and early 1960s. Using focus interviews and “think-aloud” methods, the interviewees commented on two parts of the planned research process: (a) how to contact the cohort, and (b) finalising the assessment instruments. Data were analysed using qualitative content analysis. Interviewees felt their participation was a sign of recognition of their experience and expertise. Their input contributed to the research in a host of ways. For example, they helped to make documents more understandable, identified errors and redundancies, and pointed out wording that might cause insecurities or negative reactions. They also pointed to shortcomings in some of the items used in the assessment instruments. In addition, they made significant contributions regarding how best to approach and work with the cohort. This study shows that, when researching historical compulsory social measures, the inclusion of formerly institutionalised individuals in development and implementation is not only feasible, but is of significant benefit to the quality of the research

Development of Playfulness in Children with Low Executive Functions: The Role of Parental Playfulness and Parental Playtime with Their Child

Children with low executive functions (EFs) are described as having lower levels of playfulness, the quality of children’s play, compared to children with EFs within the normal range. However, how playfulness in children with low EFs develops over time remains unclear. Additionally, little is known about how parental playfulness and parental playtime with their child affect these developmental trajectories in children with low EFs. To address these research gaps, we measured playfulness in 62 children with low EFs and 62 children with EFs within the normal range aged 3 to 6 years at three time points over 2 years. We used the Children’s Playfulness Scale, which captures multi-informant perspectives from parents and teachers. Moreover, the parents of children with low EFs reported their own playfulness and their playtime with their children at T1. Repeated-measures hierarchical linear models indicated significantly lower levels of playfulness in the children with low EFs than in the controls, with no significant changes observed over 2 years in either group. In the children with low EFs, we found a significant positive relationship between parental playfulness at T1 and children’s playfulness 2 years later but a significant negative relationship between parental playtime at T1 and children’s playfulness 2 years later. These results prompt a broad discussion on potential implications for the enhancement of playfulness in children with low EFs within the family environment

Are screen media the new pacifiers? : the role of parenting stress and parental attitudes for children's screen time in early childhood

Screen media are increasingly shaping our everyday lives, including those of young children. Among other reasons, parents might use screen media as a problem-oriented coping strategy to reduce parenting stress levels. Furthermore, parental attitudes towards children's screen media use have been shown to predict screen time in young children. The present study examines the intertwined roles of parenting stress and parental attitudes to children's screen time throughout early childhood. Parents of N = 462 children aged up to 3 years (M = 1.28, SD = 0.61; 50% female) participated in four assessments within 10 months. Parents reported their level of parenting stress, their attitudes toward young children's screen media use, and their child's screen time at each assessment. Across all measurement time points, results indicated that both parenting stress and positive parental attitudes are positively associated with children's screen time. Furthermore, parental attitudes were found to strengthen the link between stress and children's screen time at two of the four measurement time points. Recommendations for children's screen time should consider parental stress and suggest alternative strategies for coping with parenting stress