The Parental Brain in Humans

Chapter 8 reviews the human parental brain. Most functional magnetic resonance imaging research has examined the maternal brain, with some research on the paternal brain. Although woman show allomaternal behavior, defensive neural circuits may depress maternal responsiveness under certain conditions. The subcortical circuits associated with human maternal behavior match those in nonhuman mammals and include medial preoptic area, mesolimbic dopamine, amygdala, and oxytocin neural systems. Interacting with these subcortical circuits are cortical regions, including dorsomedial prefrontal cortex and anterior insula, that are involved in maternal cognitions, empathy, emotions, and emotion regulation. The medial prefrontal cortex connects some of these cortical regions with the subcortical circuitry so that maternal cognitions and emotions can be translated into appropriate maternal behavior. The poor maternal behavior associated with postpartum depression may result from dysfunctions within these circuits, and alterations in corticotropin-releasing factor and OT may be involved.

The Relationship Between Challenging Behaviour, Cognitions and Stress in Mothers of Individuals with Intellectual Disabilities

Background: Cognitions are starting to receive more prominence as important when examining a number of factors including the topography of challenging behaviour. This study examined the relationships between maternal stress, challenging behaviour (aggressive and self-injurious behaviours) and parental cognitions and specifically whether maternal cognitions mediated the effect of challenging behaviour on parenting stress. Method: 46 mothers of children and young adults with ID completed questionnaires regarding their child's challenging behaviour, maternal cognitions and stress. Results: Significant correlations were found between challenging behaviour and maternal stress. The overall mediation models for aggression and self-injurious behaviour were significant. The Challenging Behaviour Perception Questionnaire: Consequences client subscale was the only independent significant mediator for both behaviours. Conclusions: Cognitions do play an important part in mediating the relationship between challenging behaviour and stress. Further research is needed to examine the similarities and differences between the mediation models for aggression and self-injurious behaviour.

Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: a randomised controlled trial and economic analysis

BackgroundCognitive–behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder.ObjectivesThis study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated.DesignParticipants were randomised to receive (i) child cognitive–behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive–behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother–child interactions (MCIs) (CCBT + MCI).SettingA NHS university clinic in Berkshire, UK.ParticipantsTwo hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder.InterventionsAll families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact.Main outcome measuresPrimary clinical outcomes were the child’s primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost–utility analysis framework with associated uncertainty.ResultsMCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62,p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67,p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59,p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53,p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%.ConclusionsGood outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group.Trial registrationCurrent Controlled Trials ISRCTN19762288.FundingThis trial was funded by the Medical Research Council (MRC) and Berkshire Healthcare Foundation Trust and managed by the National Institute for Health Research (NIHR) on behalf of the MRC–NIHR partnership (09/800/17) and will be published in full inHealth Technology Assessment; Vol. 19, No. 38.