Inter-rater reliability and acceptance of the structured diagnostic interview for regulatory problems in infancy

Background: Regulatory problems such as excessive crying, sleeping–and feeding difficulties in infancy are some of the earliest precursors of later mental health difficulties emerging throughout the lifespan. In the present study, the inter-rater reliability and acceptance of a structured computer-assisted diagnostic interview for regulatory problems (Baby-DIPS) was investigated. Methods: Using a community sample, 132 mothers of infants aged between 3 and 18 months (mean age = 10 months) were interviewed with the Baby-DIPS regarding current and former (combined = lifetime) regulatory problems. Severity of the symptoms was also rated. The interviews were conducted face-to-face at a psychology department at the university (51.5 %), the mother’s home (23.5 %), or via telephone (25.0 %). Inter-rater reliability was assessed with Cohen’s kappa (k). A sample of 48 mothers and their interviewers filled in acceptance questionnaires after the interview. Results: Good to excellent inter-rater reliability on the levels of current and lifetime regulatory problems (k = 0.77–0.98) were found. High inter-rater agreement was also found for ratings of severity (ICC = 0.86–0.97). Participants and interviewers’ overall acceptance ratings of the computer-assisted interview were favourable. Acceptance scores did not differ between interviews that revealed one or more clinically relevant regulatory problem(s) compared to those that revealed no regulatory problems. Conclusions: The Baby-DIPS was found to be a reliable instrument for the assessment of current and lifetime problems in crying and sleeping behaviours. The computer-assisted version of the Baby-DIPS was well accepted by interviewers and mothers. The Baby-DIPS appears to be well-suited for research and clinical use to identify infant regulatory problems

Kindliche Verhaltensauffälligkeiten im ersten Lebensjahr und mütterliche Belastung in der Zeit der COVID-19-Pandemie

Theoretischer Hintergrund: Die COVID-19-Pandemie stellte in vielen Bereichen eine Belastung für Familien dar, insbesondere durch die einschneidenden Beschränkungen zu Beginn. Fragestellung: Wie wirkte sich dies auf die Belastung von Müttern mit Kindern im ersten Lebensjahr und auf die kindliche Verhaltensregulation aus? Methode: In einer Online-Befragung schätzten 577 Mütter das Schrei-‍, Schlaf- und Fütter-/Essverhalten ihrer Kinder (M = 7.3; 0 – 12 Mon., SD = 3.25) und ihre eigene Belastung ein, zudem Stresserleben, depressive Symptomatik, Partnerschaftszufriedenheit und Bonding. Ergebnisse: Schlafprobleme traten bei 21.7 %, schwer tröstbares und häufiges Schreien bei 12.3 % und exzessives Schreien bei 1.6 % der Kinder auf. Mindestens jede fünfte Mutter fühlte sich durch Schreien oder Schlafprobleme belastet. Mehr Stress, beeinträchtigtes Bonding und weniger Partnerschaftszufriedenheit erklärten 17 – 21 % der Varianz der mütterlichen Belastung durch Schrei- und Schlafverhalten. In der Zeit der stärksten Beschränkungen zeigte sich signifikant mehr Belastung in der Gruppe von Müttern, die von vermehrtem Schreien und verlängerter Einschlaflatenz berichteten, sowie mit mindestens einem weiteren Kind im Haushalt (MANOVA). Diskussion und Schlussfolgerung: Pandemiebedingt belastend für Mütter im ersten Jahr scheinen eingeschränkter Zugang zum Versorgungssystem, die Betreuung von mehr als einem Kind sowie das Alter des Kindes zu sein, während eine gute Beziehung zum Kind (Bonding) und/oder zum Partner (Partnerschaftszufriedenheit) abmildernd wirken.Theoretical background: The COVID-19 pandemic placed a burden on families in several respects, particularly because of the severe confinement imposed at its beginning. The confinement in spring 2020 led to social disruption and a reduction of supportive structures. In the first year of an infant’s life, the psychological well-being of a mother–child dyad is particularly susceptible to external stressful changes. Research question: How did the restrictions from the pandemic affect families with children in the first year of the infant’s life, particularly infant regulatory problems and related maternal stress? Methods: In an online survey, N = 577 mothers reported on their infants’ behavior (0 – 12 months of age, M = 7.3 months, SD = 3.3) regarding their crying, sleeping, and feeding/eating behavior as well as the respective distress experienced during the restrictions. Measures of current maternal well-being included overall perceived stress, depressivity, relationship satisfaction, and maternal bonding. Frequency/duration of infantile crying, sleep latency as well as night awakenings and feeding/eating problems were surveyed following clinical criteria (DC: 0 – 5) and percentile scores, respectively. The association of infant behavior and maternal distress was examined using linear regression and MANOVA. Results: Overall, at least one in five mothers felt burdened by her child’s regulatory problems during the time of severe restrictions. More than one in four mothers reported being highly or very highly distressed by her child’s crying. Sleeping problems, such as prolonged sleep latency (> 90th percentile) or several nightly awakenings, were reported for 21.7 % of the children. Difficulty to console and frequent crying were reported for 12.3 % and excessive crying for 1.6 % of the children. Higher levels of stress as well as increased impairment in maternal bonding and less relationship satisfaction explained 17 – 21 % of the variance of maternal distress from crying and sleeping problems. Significantly more distress was evident in the group of mothers who reported increased crying and prolonged latency to fall asleep (> 45 min) and with more than one child in the household during the period of most severe restrictions (MANOVA). A lack of medical, psychotherapeutic, and other means of care was reported by nearly a quarter of the respondents and was the only restriction that was significantly related to the perception of more stressful child behavior. Discussion and conclusion: Pandemic-related stressors for first-year mothers appear to be enhanced by limited access to the care system, caring for more than one child, the increasing age of the child, while a good relationship with the child (bonding) and/or partner (relationship) satisfaction provide buffers

Attention placebo control in randomized controlled trials of psychosocial interventions

Attention placebo control (APC) is considered a highly valid control condition when conducting trials of social interventions. Unfortunately, an appropriate APC condition is rarely used. This letter discusses the tension between methodological and ethical requirements of an APC group in psychosocial interventions based on our experiences with a randomized controlled efficacy study of a parent training program. To prevent negative side effects and high drop-out rates, feasible and accepted attention control conditions are discussed. The paradigms of placebo research must be adapted to the special challenges of psychosocial intervention research

Beyond the technique of calming methods: the role of parent-child relationship and self-regulation skills on infant regulation in early childhood (BECALM)

This anonymous online survey explores the association between parental calming methods on infant behavior (crying, sleeping). Additionally, the moderating role of family relationships (parent-infant bonding, stress coping within the partner-relationship) as well as parental self-regulation skills and beliefs about behavior regulation, is examined

The relevance of infant outcome measures

Problems in infant mental health such as the ability to experience, regulate, and express emotional states is expressed in behavioral problems like excessive crying, feeding, and sleeping problems. Parenting programs are popular but their effectiveness on infant mental health remains uncertain. Possibly, because recent studies have focused only on parental and parent–child measures while they miss to assess infant behavioral measures. The goal of this pilot study is to fill in this gap by assessing infantile behavioral measures. We investigated the acceptance and first indicators of efficacy of the universal group parenting training Baby Triple P (BTP) compared to a care as usual (CAU) control condition focusing on early behavioral problems. In all, 49 couples were randomly allocated to receive either eight BTP sessions before birth and per telephone after birth or to take part in CAU. Infant behavior was assessed with a diary and a structured diagnostic interview. Parental self-report measures of partnership quality and parental competence were assessed before birth, 10 weeks after birth and at 6-month follow-up. Since the parent training was conducted before the birth of the child, the child’s mental health could not be assessed before the parent training. Thus, for this variable no within measurement (pre–post) could be carried out and intention-to-treat analysis was not possible. However, a between group analysis comparing BTP against CAU took place to assess effectiveness of BTP on children’s mental health. Mothers and fathers rated the program as feasible and relevant. Results indicate significant group differences in crying behavior 6 months after birth to the benefit of the intervention group. No beneficial outcomes were found for feeding and sleeping problems in infants or partnership quality, parental sense of competence in parents. Due to an unrepresentative high level of education of the participating parents and the small sample size, these findings can be considered preliminary. Nevertheless, these results allow to further investigate the effectivity of BTP in large-scale clinical trials. Behavioral diaries or diagnostic interviews for early mental health problems should be routinely implemented in randomized controlled trials (RCTs) in order not to miss possible behavioral changes in infants

Parent-child diagnostic agreement on anxiety symptoms with a structured diagnostic interview for mental disorders in children

$\textbf {Objective:}$ In clinical structured diagnostic interviews, diagnoses based on parent and child reports have low to moderate agreement. The aims of the present study are (1) to examine diagnostic agreement on anxiety disorders between parents and children on the levels of current and lifetime diagnostic category and diagnoses focusing in particular on diagnostic criteria and (2) to identify parent- and child-related predictors for diagnostic agreement. $\textbf {Method:}$ The sample consisted of 166 parent-child dyads interviewed with the Structured Diagnostic Interview for Mental Disorders in Children (Kinder-DIPS, Schneider et al., 2009). The children (51.8% girls) were between the ages of 7 and 18 years ($\it M$ = 10.94; $\it SD$ = 2.22). $\textbf {Results:}$ Overall, parent-child agreement on the diagnostic category of anxiety disorder ($\it k$ = 0.21; $\it k$ = 0.22) and the specific anxiety diagnoses (base rate > 10%) of social phobia, specific phobia and separation anxiety disorder ($\it k$ = 0.24–0.52; $\it k$ = 0.19–0.43) and corresponding diagnostic criteria ($\it k$ = 0.22–0.67; $\it k$ = 0.24–0.41) were low to moderate with the highest agreement on separation anxiety disorder ($\it k$ > 0.43). Lower maternal depression, and higher social support reported by mother and father were associated with higher parent-child agreement. Maternal depression was indicated as the strongest predictor. Parental sense of competence, parental anxiety, the amount of parent-child interaction and the child’s age and gender had no predictive value. $\textbf {Conclusions:}$ Parent-child agreement can be expected to be higher on the level of anxiety criteria compared to specific anxiety diagnoses and diagnostic anxiety category. Psychological strains in the family-especially maternal depression and low social support-lower the parent-child agreement on anxiety symptoms. Child- and relation-related variables (age, gender, amount of time parent(s) and children interact) play no role in the prediction of low parent-child agreement

Inter-rater reliability and acceptance of the structured diagnostic interview for regulatory problems in infancy

$\textbf {Background:}$ Regulatory problems such as excessive crying, sleeping–and feeding difficulties in infancy are some of the earliest precursors of later mental health difficulties emerging throughout the lifespan. In the present study, the inter rater reliability and acceptance of a structured computer assisted diagnostic interview for regulatory problems (Baby DIPS) was investigated. $\textbf {Methods:}$ Using a community sample, 132 mothers of infants aged between 3 and 18 months (mean age = 10 months) were interviewed with the Baby DIPS regarding current and former (combined = lifetime) regulatory problems. Severity of the symptoms was also rated. The interviews were conducted face to face at a psychology department at the university (51.5 %), the mother’s home (23.5 %), or via telephone (25.0 %). Inter rater reliability was assessed with Cohen’s kappa $\textit {(k)}$. A sample of 48 mothers and their interviewers filled in acceptance questionnaires after the interview. $\textbf {Results:}$ Good to excellent inter rater reliability on the levels of current and lifetime regulatory problems ($\it k$ = 0.77–0.98) were found. High inter rater agreement was also found for ratings of severity ($\it ICC$ = 0.86–0.97). Participants and interviewers’ overall acceptance ratings of the computer assisted interview were favourable. Acceptance scores did not differ between interviews that revealed one or more clinically relevant regulatory problem(s) compared to those that revealed no regulatory problems. $\textbf {Conclusions:}$ The Baby DIPS was found to be a reliable instrument for the assessment of current and lifetime problems in crying and sleeping behaviours. The computer assisted version of the Baby DIPS was well accepted by interviewers and mothers. The Baby DIPS appears to be well suited for research and clinical use to identify infant regulatory problems