1. The Generation R Study Behavioral and cognitive research in a prospective cohort study from fetal life onwards Nicole Lucassen Child and Adolescent Psychiatry, Sophia Children’s Hospital, Erasmus MC, www.generationr.nl

2. Generation R study (Rotterdam, the Netherlands)

3.  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

4. 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

5. Ethnicity Generation R children Based on classification according to the CBS, 2004. Missing: 12%

6.  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

7. 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 Ultrasound Measures Psychiatric Interview Question naire 7 Question naire 10 Question naire 11 Questio naire 6 Neuromotor assessment Home observation 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 Fetal Ultrasound Blood Fetal Ultrasound Urine Question naire 12 Question naire 14 Father Questionnaire Assessments in Generation R Cohort Question naire 1 Question naire 3 Question naire 4 Cord blood Birth weight Complications Father Questionnaire Home Visit father-child interaction, discipline GenerationR @ age 5 Research center visit

8. 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)

9. “Does the father matter?” The influence of paternal psychopathology and father- child interaction on behavior problems in preschool children

10. 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.

11. Family systems theory Examples: Parental depression Parental sensitivity

12. Family systems theory: example depression Parental depression: lack of research on the role of one parent’s depression in the other parent’s depression

13. 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)

14. 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)

15. 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

16. 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)

17. 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?

18. 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

19. Information folder for participants

20. 15 students conducting the home visits

21. 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

22. 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

23. Parent-child interaction Teaching Tasks: Tasks that require interaction between child and parent in a problem solving task (Erickson, Sroufe & Egeland, 1985)

24. Parent-child interaction: Etch-a-Sketch

26. Parent-child interaction: Tower building

28. 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

29. Parent-child interaction (Etch a Sketch) Insert scene: father-child interaction

30. 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

31. 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

32. Parent-child interaction (Etch a Sketch) Insert scene: mother-child interaction

33. 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

34. 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

35. 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)