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

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

• Nicole Lucassen
• Child and Adolescent Psychiatry, Sophia
  Childrens Hospital, Erasmus MC,
  www.generationr.nl

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Generation R study (Rotterdam, the Netherlands)
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Design Generation R

• 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

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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

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Ethnicity Generation R children
Based on classification according to the CBS,
2004. Missing 12
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Design Generation RFocus Cohort

• 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

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Data collection flowchart
 Assessments in Generation R Cohort
Cord blood Birth weight Complications
Fetal Ultrasound Blood
Fetal Ultrasound
Neuromotor assessment Home observation
Fetal Ultrasound Urine
Father Questionnaire
Father Questionnaire
Question naire 7
Question naire 10
Question naire 11
Questio naire 6
Question naire 12
Question naire 14
Question naire 1
Question naire 3
Question naire 4
GenerationR _at_ age 5 Research center visit
12 weeks 20 weeks 30 weeks birth 2 months 6
months 12/14 months 18 months 24 months 3 yrs
4yrs
Home Visit father-child interaction, discipline
Additional Ultrasound Measures
Research Center visit 1 e.g. Brain ultra sound
Research Center visit 2 Neuromotor assessment
Research Center visit 3 e.g. Strange Situation
Research Center visit 5 e.g. Executive Functioning
Psychiatric Interview
 
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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,
• childs compliance, emotion recognition, moral
  development
• (primary caregiver requested to participate 753
  mothers, 107 fathers)
• 4 year home visit father-child interaction,
  parental disciplinary
• strategies, childs compliance, cognitive
  development, moral development,
• mother-child interaction
• (752 families)

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Does the father matter?

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

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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.

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Family systems theory

• Examples
• Parental depression
• Parental sensitivity

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Family systems theory example depression

• Parental depression lack of research on the role
  of
• one parents depression in the other parents
• depression

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Family systems theory example depression

• Paternal depression magnifies childrens 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)

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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)

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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

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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)

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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?

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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

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Information folder for participants
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15 students conducting the home visits

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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

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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

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Parent-child interaction

• Teaching Tasks
• Tasks that require interaction between child
• and parent in a problem solving task
• (Erickson, Sroufe Egeland, 1985)

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Parent-child interaction Etch-a-Sketch

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Parent-child interaction Etch-a-Sketch

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Parent-child interaction Tower building
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Parent-child interaction Tower building
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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 childs autonomy

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Parent-child interaction (Etch a Sketch)

• Insert scene father-child interaction

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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 childs 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 childs 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

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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 childs 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 childs wishes

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Parent-child interaction (Etch a Sketch)

• Insert scene mother-child interaction

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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 childs 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 childs 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

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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 childs 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 childs wishes

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• 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)