Mothers whose infants varied in early biological characteristics (born at term, n ϭ 120; born at very low birth weight [VLBW], n ϭ 144) were randomized to a target group (n ϭ 133) or developmental feedback comparison group (n ϭ 131) to determine whether learning responsive behaviors would facilitate infant development. The target condition included videotaped examples, problem-solving activities, and mothers' critique of their own behaviors through video procedures across 10 home visits. All target versus comparison mothers showed greater increases across multiple responsiveness behaviors observed in 4 assessments conducted across 6 -13 months of age; changes in emotionally supportive behaviors were strongest for target mothers of infants born at VLBW. Increased maternal responsiveness facilitated greater growth in target infants' social, emotional, communication, and cognitive competence, supporting a causal role for responsiveness on infant development. Although benefits were generally comparable across risk groups, aspects of social and emotional skills showed greater change for those born at VLBW. Evidence for responsiveness as a multidimensional construct was provided as well as the importance of different aspects of responsiveness mediating the effect of the intervention on different infant skill domains.

The role of early versus ongoing maternal responsiveness in predicting cognitive and social development was examined in home visits for mothers, full-term children (n = 103), and medically low-risk (n = 102) and high-risk (n = 77) preterm children at 5 ages. There were 4 maternal clusters based on warm and contingent responsiveness behaviors observed early (at 6, 12, and 24 months) and late (at 3 and 4 years): high early, high late; high early, low late; low early, moderate late; and low early, low late. Children, especially preterm children, showed faster cognitive growth when mothers were consistently responsive. Social growth was similar in the consistently responsive (high-high) and the early-responsive inconsistent (high-low) clusters, but greater deceleration at 4 years among children with mothers in the inconsistent cluster refuted the notion of a unique role for early responsiveness. The importance of consistent responsiveness, defined by an affective-emotional construct, was evident even when a broader constellation of parenting behaviors was considered.

Importance There is limited information about the effect of erythropoietin or a high transfusion threshold in traumatic brain injury (TBI). Objective To compare the effects of erythropoietin and two transfusion thresholds (7 and 10 g/dl) on neurological recovery after TBI. Design Randomized trial using a factorial design to test: i.) whether erythropoietin would fail to improve favorable outcomes by 20%, and ii.) whether a transfusion threshold of >10 g/dl would increase favorable outcomes without increasing complications. Setting Neurosurgical intensive care units of two Houston level 1 trauma centers Participants Between May 2006 and August 2012, 200 patients with closed head injury who were unable to follow commands were enrolled within 6 hours of injury; 102 patients received erythropoetin and 98 received placebo. Erythropoetin or placebo was initially dosed daily for 3 days and then weekly for 2 more weeks (n=74) and then the 24h and 48h doses were dropped for the remainder (n=126). Ninety-nine and 101 patients were assigned to the 7g/dl and 10g/dl transfusion thresholds. Intervention Intravenous erythropoietin 500 IU/kg or saline per dose. Transfusion threshold maintained with packed red blood cell transfusion. Main Outcome Glasgow Outcome Scale dichotomized as favorable (good recovery and moderate disability) and unfavorable (severe disability, vegetative, or dead) at 6 months post-injury. Results There was no erythropoeitin-transfusion threshold interaction. Compared to placebo (favorable outcome rate: 34/89 [38.2%]; 95%CI=28.2-49.1%), both erythropoetin groups were futile (first dosing regimen: 17/35 [48.6%]; 95%CI=31.4-66.0%, p=0.13, and second dosing regimen: 17/57 [29.8%]; 95%CI=18.4-43.4%, p<0.001). Favorable outcome rates were 37/87 (42.5%) and 31/94 (33.0%) in the 7 and 10 g/dl threshold groups (95%CI for the difference = − 0.05 to 0.25, p=0.28). There was a higher incidence of thromboembolic events in the 10 g/dl threshold group (22/101 [21.8%] vs. 8/99 [8.1%], p=0.009). Conclusions and Relevance In patients with closed head injury, neither the administration of erythropoietin nor maintaining hemoglobin concentration > 10 g/dl resulted in improved neurological outcome at 6 months and the 10 g/dl threshold was associated with a higher incidence of adverse events.. These findings do not support either approach in this setting.

This study examined the optimal timing (infancy, toddler-preschool, or both) for facilitating responsive parenting and the intervention effects on maternal behaviors and child social and communication skills for children who vary in biological risk. The intervention during infancy, Playing and Learning Strategies (PALS I), showed strong changes in maternal affective-emotional and cognitively responsive behaviors and infants' development. However, it was hypothesized that a 2nd intervention dose in the toddler-preschool period was needed for optimal results. Families from the PALS I phase were rerandomized into either the PALS II, the toddler-preschool phase, or a Developmental Assessment Sessions condition, resulting in 4 groups. Facilitation of maternal warmth occurred best with the PALS I intervention, while cognitive responsive behaviors were best supported with the PALS II intervention. Behaviors that required responsiveness to the child's changing signals (contingent responsiveness, redirecting) required the intervention across both the early and later periods. Keywordsparenting; responsiveness; early intervention; child outcomes Responsive parenting described from different theoretical frameworks (e.g., attachment) emphasizes an affective-emotional style with positive affection and high levels of warmth and nurturance (Darling & Steinberg, 1993), responses that are contingently linked to children's signals, and acceptance of children as unique individuals (Ainsworth, Blehar, Waters, & Wall, 1978;Bornstein, 1985). From a sociocultural framework, the behaviors that fit into this style have been expanded to include cognitively responsive behaviors such as maintaining children's focus of interest (Akhtar, Dunham, & Dunham, 1991;Tomasello & Farrar, 1986) and the use of rich verbal input that is responsive to children's signals Tamis-LeMonda, Bornstein, & Baumwell, 2001 NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript parenting as critically important for its role in providing a strong foundation for children to develop optimally (Ainsworth et al., 1978;Bornstein, 1985). Through repeated experiences of responsive interactions with parents that incorporate these behaviors, children are thought to internalize and generalize their learning to new experiences (e.g., Ainsworth et al., 1978;Bornstein & Tamis-LeMonda, 1989;Grusec & Goodnow, 1994). It also has been documented that parents can be supported through interventions to increase this aspect of parenting that, in turn, has facilitated a range of children's outcomes (Juffer, Hoksbergen, Riksen-Walraven, & Kohnstamm, 1997;Landry, Smith, & Swank, 2006; Van Zeigl, Mesman, Van IJzendoorn, Bakermans-Kranenburg, & Juffer, 2006).What is less well understood is whether there are developmental periods during which the influence of this parenting style is particularly important or whether consistency in responsive parenting is needed. For example, some theories identify responsive parenting during infancy as most critical, while others d...

The present study examined whether parenting and child characteristics of 2- and 3 1/2-year-old children had common paths of influence on their 4 1/2-year independent cognitive and social functioning. Structural equation modeling was guided by hypotheses that assumed children's later independence is facilitated by specialized parental support in early social interactions. To address the importance of variability in early development for understanding children's later independence, we included 104 term and 185 preterm children, as they are known to differ in early skills. As predicted, mothers' maintaining of children's interests indirectly supported 4 1/2-year cognitive and social independence through a direct, positive influence on 2- and 3 1/2-year skills. Directiveness positively supported children's early cognitive and responsiveness skills but by 3 1/2 years, high levels of this behavior had a direct, negative influence on their cognitive and social independence at 4 1/2 years. Whereas high levels of maintaining interests across these ages support later independence, directiveness needs to decrease in relation to children's increasing competencies. Results support a theoretical framework that emphasizes the importance of the social context for understanding the origins of children's later independent functioning.