The Generation R Study Behavioral and cognitive research in a prospective cohort study from fetal life

onwardsNicole Lucassen

Child and Adolescent Psychiatry, Sophia Children’s Hospital, Erasmus MC, www.generationr.nl

Generation R study (Rotterdam, the Netherlands)

Prospective cohort design From early fetal life Recruited from midwifery practices and hospitals Urban, multi-ethnic population 9.778 mothers and their unborn child 65.8% of their partners participated

Design Generation R

Generation R

Prospective cohort study from fetal life until

young adulthood. Primary research areas:

1) Behavioral and cognitive development

2) Growth and physical development

3) Diseases in childhood

4) Health(care) for pregnant women and children

Ethnicity Generation R children

Based on classification according to the CBS, 2004. Missing: 12%

Dutch, other European

58%

Others9%Cape Verdian

4%

Dutch Antilles4%

Turkish9%

Moroccan7%

Surinamese8%

Detailed measures in the Focus Cohort Homogeneous group: both parents and

grandparents are born in the Netherlands Children born between Feb, 2003 – Aug, 2005 1.232 families; 64,9% of fathers participated

Design Generation R:Focus Cohort

Data collection flowchart

12 weeks 20 weeks 30 weeks birth 2 months 6 months 12/14 months 18 months 24 months 3 yrs 4yrs

Fetal Ultrasound

Additional UltrasoundMeasures

Psychiatric Interview

Question naire 7

Question naire 10

Question naire 11

Questionaire 6

Neuromotor assessmentHome observation

Research Center visit 1e.g. Brain ultrasound

Research Center visit 2Neuromotor assessment

Research Center visit 3e.g. Strange Situation

Research Center visit 5e.g. Executive Functioning

Fetal UltrasoundBlood

Fetal UltrasoundUrine

Questionnaire 12

Questionnaire 14

FatherQuestionnaire

 Assessments in Generation R Cohort 

 

Questionnaire 1

Question naire 3

Question naire 4

Cord bloodBirth weightComplications

FatherQuestionnaire

Home Visit father-child interaction, discipline

GenerationR @ age 5 Research center visit

Observational research Generation R Focus Cohort

14 months lab visit: parent-infant attachment, psychophysiological

measurements (blood sampling, cortisol)

(primary caregiver requested to participate: 760 mothers, 115 fathers)

3 year lab visit: parent-child interaction, parental disciplinary strategies,

child’s compliance, emotion recognition, moral development

(primary caregiver requested to participate: 753 mothers, 107 fathers)

4 year home visit: father-child interaction, parental disciplinary

strategies, child’s compliance, cognitive development, moral development,

mother-child interaction

(752 families)

“Does the father matter?”

The influence of paternal psychopathology and father-child interaction on behavior problems in

preschool children

Family systems theory

Family systems theory describes the family as a

network of interconnected relationships in which the

whole is greater than the sum of its parts.

Accordingly, understanding a particular individual

within the family is not fully possible without

considering the network of relationships in which

that individual is embedded.

Family systems theory

Examples:

• Parental depression

• Parental sensitivity

Family systems theory: example depression

Parental depression: lack of research on the role of

one parent’s depression in the other parent’s

depression

Family systems theory: example depression

• Paternal depression magnifies children’s risk for developing psychopathology when co-occurring with maternal depression (e.g. Marchand & Hock, 1998)

• Nondepressed fathers are not a buffer for the

effects of maternal depression, even if fathers spend high amounts of time interacting with their

children (Mezulis et al., 2004)

Family systems theory: example sensitivity

Sensitivity is defined as the ability to respond

appropriately and promptly to the signals of the

infant

(Ainsworth, Blehar, Waters, & Wall, 1978)

Family systems theory: example sensitivity

Volling et al. (2002): no consistency in mothers’ and fathers’ sensitivity

• Mothers are more sensitive with their infants than fathers

Family systems theory: example sensitivity

Braungart-Rieker et al. (1999): modest to moderate

correlations in sensitivity to their infants.

Possible explanations:

• Parents hold same value systems with regard to responding sensitively

• One parent models sensitive caregiving to the other parent

(Fox et al., 1991)

My research questions

• Is paternal psychopathology related to behavior problems in young children?

• Does negative father-child interaction increase the risk of behavioral problems in the child?

• Can positive father-child interaction or paternal non-depression moderate the effect of maternal psychopathology on behavioral problems in children?

• What factors predict fathers’ sensitivity and what is the association between fathers’ sensitivity and mothers’ sensitivity at the age of four?

Method

• Generation R Focus Cohort

• Information folder at age of 4 years

• Appointment home visit when child is

4 years; 2 months

• The main focus is on participation of father!

• In case of divorce/split-up: biological father as well as stepfather is recruited

Information folder for participants

15 students conducting the home visits

Response rate

• Home visits performed: 752

September 2007 – December 2009

• Response rate: 76% of all eligible participants at the start

• Top 3 reasons not to participate: 1. Not interested; 2. No time; 3. Moved outside the country / inaccessible

4-year home visit: overview of 10 tasks

Task 1 & 2: father-child interaction

Task 3 & 4: father-child interaction/parenting

Task 5 & 8: development of conscience

Task 6: development of working memory

Task 7: development of sustained attention

Task 9 & 10: mother-child interaction

Total duration of home visit: 1,5 hours

Parent-child interaction

Teaching Tasks:

Tasks that require interaction between child

and parent in a problem solving task

(Erickson, Sroufe & Egeland, 1985)

Parent-child interaction: Etch-a-Sketch

Parent-child interaction: Etch-a-Sketch

Parent-child interaction: Tower building

Parent-child interaction: Tower building

Parental sensitivity

Supportive Presence reflects the extent to which

the parent expresses positive regard and emotional

and instructional support of the child

Intrusiveness refers to the degree to which the

parent lacks respect for the child’s autonomy

Parent-child interaction (Etch a Sketch)

Insert scene: father-child interaction

Paternal sensitivity: Supportive Presence

1. Father completely fails to be supportive to the child, either being aloof and unavailable or being hostile toward the child

2. Father provides very little emotional support to the child

3. Father gives some support, but it is sporadic and poorly timed to the child’s needs

4. This father does a respectable job of being available when his child needs support

5. Father provides good support, reassurance and confidence in the child’s ability, but he falters in this at times when the child especially could use more support

6. Father establishes himself as supportive and encouraging toward the child but has some lapses

7. Father skillfully provides support throughout the session

Parental sensitivity: Intrusiveness

1. The father allows the child sufficient time to explore and examine the environment, tools and parts

2. The father generally intervenes appropriately but he may show subtle signs of being intrusive

3. The father allows some time for exploration but steps in before the child seems to require help a few times

4. There is a feeling of some intrusiveness that is easily or clearly picked up by the coders, but it is not pervasive

5. There are clear signs that the father does not respect the child’s needs and interests

6. There are clear incidents of intrusiveness through out the session

7. This father is highly intrusive. His agenda clearly has precedence over the child’s wishes

Parent-child interaction (Etch a Sketch)

Insert scene: mother-child interaction

Paternal sensitivity: Supportive Presence

1. Mother completely fails to be supportive to the child, either being aloof and unavailable or being hostile toward the child

2. Mother provides very little emotional support to the child

3. Mother gives some support, but it is sporadic and poorly timed to the child’s needs

4. This mother does a respectable job of being available when her child needs support

5. Mother provides good support, reassurance and confidence in the child’s ability, but she falters in this at times when the child especially could use more support

6. Mother establishes herself as supportive and encouraging toward the child but has some lapses

7. Mother skillfully provides support throughout the session

Parental sensitivity: Intrusiveness

1. The mother allows the child sufficient time to explore and examine the environment, tools and parts

2. The mother generally intervenes appropriately but she may show subtle signs of being intrusive

3. The mother allows some time for exploration but steps in before the child seems to require help a few times

4. There is a feeling of some intrusiveness that is easily or clearly picked up by the coders, but it is not pervasive

5. There are clear signs that the mother does not respect the child’s needs and interests

6. There are clear incidents of intrusiveness through out the session

7. This mother is highly intrusive. Her agenda clearly has precedence over the child’s wishes

With special thanks to all the participants of the

Generation R study and to my supervisors:

Mijke P. van den Berg

Henning Tiemeier

Frank C. Verhulst

Marinus H. van IJzendoorn (Leiden University)

Marian J. Bakermans-Kranenburg (Leiden University)