Background and aimsDespite the high prevalence and negative effects of hazardous substance use, few young adults enter treatment. Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, has proved efficacious in promoting treatment entry. The aim of the current trial was to compare the efficacy of CRAFT with an active control for parents of young adults (aged 18-24 years) with hazardous substance use.DesignThis was a randomized controlled superiority trial comparing CRAFT (n = 58) with an active control group receiving manualized counselling (n = 55), with outcome assessments at 6, 12 and 24 weeks (primary end-point). A sequential design with a stopping rule was added post recruitment commencement.SettingThe study took place in two outpatient clinics for young adults in Stockholm, Sweden, and subsequently via video-conference due to COVID-19.ParticipantsBetween October 2018 and May 2021, 113 participants (92% female) who were parents of young adults (87% male) were recruited. Recruitment was discontinued when 70% of the planned sample had been recruited, following an interim analysis of the primary outcome showing no difference between conditions.Intervention and comparatorParticipants were randomized (ratio 1 : 1) to eight manual-based individual CRAFT sessions or five individual manual-based counselling sessions + one voluntary psychoeducative group session, delivered over maximum 14 weeks.MeasurementsThe primary outcome measure was the rate of young adult entry in substance use treatment during the trial period (24 weeks).FindingsAt the 24 weeks follow-up, 19 (33%) of CRAFT participants and 17 (31%) of counselling participants had reported young adult treatment entry, with no difference between conditions (odds ratio CRAFT versus counselling 0.84, 95% confidence interval = 0.35; 1.99, P = 0.700). Both conditions reported clinically relevant reductions in young adult substance use, but no change in participants' levels of depression, anxiety or stress.ConclusionsThis trial showed no statistically significant evidence that Community Reinforcement and Family Training (CRAFT), a support programme for concerned significant others of people with substance use disorders, is more efficacious than manual-based counselling regarding treatment entry for young adults.

Objectives: To investigate associations between family structure, family complexity, and sleep in adolescence.

Background: Family structure may be associated with sleep patterns and sleep problems among adolescents. Yet, research documenting this association has not captured the complexity of modern families and used crude measures of sleep.

Method: The youth@hordaland study (N = 8833) of adolescents aged 16-19 conducted in 2012 in Norway provided a detailed assessment of family structure, family complexity (i.e., living with half-/stepsiblings), and multiple sleep parameters. Insomnia and delayed sleep-wake phase disorder (DSWPD) were defined in alignment with diagnostic criteria. Ordinary least squares and Poisson regression analyses were used to assess associations between family structure, family complexity, and sleep outcomes.

Results: Adolescents in joint physical custody (JPC) had more similar sleep parameters as peers in nuclear families than in single-and stepparent families. Adolescents in single- and stepparent families had a higher risk of short sleep duration on weekdays, long sleep onset latency, long wake after sleep onset, oversleeping, insomnia, and DSWPD than peers in nuclear families. Family complexity was also associated with a higher risk of sleep problems, but the risk attenuated when considered jointly with family structure. Socioeconomic status and depressive symptoms partly attenuated the differences between the groups.

Conclusion: Inequalities in sleep exist by family structure and, in part, family complexity. Despite alternating between two homes and often experiencing family complexity, sleep among adolescents in JPC was more similar to peers in nuclear families than in single- and stepparent families.

Aim: The aim of this study was to describe sociodemographic and family predictors for behavioural and emotional problems in pre-schoolers.

Methods: This was a cross-sectional study including 30,795 children in the Stockholm region whose parents had completed the Strength and Difficulties Questionnaire (SDQ) prior to a routine visit to a well-baby clinic at age 3 years. Multivariate logistic regression was used to analyse predictors for having a high total SDQ difficulties score.

Results: Young parental age and a low level of parental education predicted high total SDQ score in a stepwise pattern. Being a first-born child was associated with a high SDQ score with an adjusted odds ratio of 2.10 (95% C.I. 1.84-2.41), compared with having older siblings. A sole physical custody arrangement predicted a high total SDQ score after parental separation. The percentage of children with a high total SDQ score increased with the Care Need Index (CNI) of the well-baby clinic.

Conclusions: This study identified socioeconomic disadvantage and being the first-born child as the main predictors of poor mental health at age 3 years. Well-baby clinics with socioeconomically disadvantaged catchment areas should be provided with adequate resources and methods for equitable prevention.

Aim: Parental separation has been associated with poor mental health in children with better outcomes in children living in joint physical custody compared with those living with one parent after the separation. In this study, we investigated socioeconomic and relational predictors in early childhood of later parental separation and family arrangements thereafter. Methods: This study included 34 768 children from the Danish National Birth Cohort, who were living with both parents at the 6 months' data collection and followed up in 2010-2014 at age 11 years. Questionnaire data from the two data collections were linked with population registers in Statistics Denmark about parental income, education and psychiatric care and analysed in logistic regression models. Results: Socioeconomic indicators of the family and parental psychiatric disorders before birth of the child and family relationships in infancy predicted parental separation at age 11 year. For children with separated parents, a high family income and a high parental educational level were the main predictors of living in joint physical custody at the 11-year follow-up. Conclusion: Socioeconomic living conditions predict parental separation as well as living arrangements thereafter. Studies of consequences of living arrangements after parental separation should account for family factors preceding the separation.

Aim: This study compared mental health after parental separation in 7-year-old children living in joint physical custody with sole physical custody family arrangements.

Methods: The study population included 39 661 children from the Danish National Birth Cohort, living in a nuclear family at age 6 months. Child mental health was measured at age 7 years with maternal reports of the Strength and Difficulties Questionnaire (SDQ) operationalised as a high total score. Associations between living arrangements and mental health were analysed using logistic regression models, taking into account early childhood indicators of family relations, parental mental health and socioeconomic conditions.

Results: There were no statistically significant differences between the living arrangements after parental separation with joint physical custody having an odds ratio (OR) of 1.37 (95% CI 1.10–1.70), sole physical custody without a new partner OR 1.33 (95% CI 1.19–1.47) and OR 1.55 (95% CI 1.30–1.84) for sole physical custody with new partner, with children in a nuclear family as reference.

Conclusion: This study indicates that living arrangements after parental separation have a minimal influence on child mental health at age 7 years.

This study investigated mental health in schoolchildren in different living arrangements after parental separation. The study population included 31,519 children from the Danish National Birth Cohort, followed-up at age 11 in 2010-2014. Child mental health was measured with a maternal report of the Strength and Difficulties Questionnaire (SDQ). Associations between living arrangements and mental health were analyzed using logistic and linear regression models, taking into account early childhood indicators of the parents' relations, income, education and psychiatric care. At age 11, children living in a nuclear family had the lowest rate of total SDQ score, 8.9%. Of the children who had experienced parental separation, children in joint physical custody had the lowest adjusted odds ratio (OR)1.25 (95%-CI 1.09-1.44), for a high SDQ score relative to children living in a nuclear family, with adjusted ORs of 1.63 (1.42-1.86) and OR 1.72 (1.52-1.95) for sole physical custody arrangements with and without a new partner. An analysis of change in SDQ scores between ages 7 and 11 in children showed a similar pattern. This study indicates that joint physical custody is associated with slightly more favorable mental health in schoolchildren after parental separation than sole physical custody arrangements.

Aim The aim of this narrative review was to evaluate the evidence for interventions for children's secure attachment relationships and parents' caregiving sensitivity that could potentially be implemented in the context of a well-baby clinic. Methods Literature search on programmes for parental caregiving sensitivity and secure attachment for infants aged 0-24 months. Randomised controlled trials (RCTs) published 1995-2018 with interventions starting from one week postpartum, and with a maximum of 12 sessions (plus potential booster session) were included. Results We identified 25 studies, of which 22 studied effects of home-based programmes using video feedback techniques. Positive effects of these interventions in families at risk were found on parental caregiving sensitivity and to a lesser extent also on children's secure or disorganised attachment. The effects of two of these programmes were supported by several RCTs. Three intervention studies based on group and individual psychotherapy showed no significant positive effects. Most of the interventions targeted mothers only. Conclusions The review found some evidence for positive effects of selective interventions with video feedback techniques for children's secure attachment and strong evidence for positive effects on parental caregiving sensitivity. Important knowledge gaps were identified for universal interventions and interventions for fathers and parents with a non-Western background.

Aim: Joint physical custody, children spending equal time in each parents’ respective home after a parental divorce, is particularly common in Nordic compared with other Western countries. Older children have been shown to fare well in this practice but for young children there are few existing studies. The aim of this paper is to study psychological problems in 2- to 9-year-old Nordic children in different family forms. Methods: Total symptom score according to the Strengths and Difficulties Questionnaire as well as scores showing externalizing problems were compared among 152 children in joint physical custody, 303 in single care and 3207 in nuclear families through multiple linear regression analyses. Results: Children in single care had more psychological symptoms than those in joint physical custody (B = 1.08; 95% CI 0.48 to 1.67) and those in nuclear families had the least reported symptoms (B = −0.53; 95% CI −0.89 to −0.17). Externalizing problems were also lower in nuclear families (B = −0.28, 95% CI −0.52 to −0.04) compared with joint physical custody after adjusting for covariates. Conclusions: Young children with non-cohabiting parents suffered from more psychological problems than those in intact families. Children in joint physical custody had a lower total problem score than those in single care after adjusting for covariates. Longitudinal studies with information on family factors before the separation are needed to inform policy of young children’s post-separation living arrangements.

Joint physical custody (JPC) refers to a practice where children with separated parents share their time between the parents' respective homes. Studies on parents' views of JPC for young children are scarce. The aim of this interview study was to explore parents' perceptions on how they experience and practice equally shared JPC for their 1-4 year-olds in Sweden. Forty-six parents (18 fathers and 28 mothers) of 50 children (31 boys and 19 girls) under 5 years of age were interviewed. Parents were recruited through information in the media and represented a broad range of socioeconomic backgrounds, as well as both voluntary and court-ordered custody arrangements. The interviews were semi-structured and analyzed using systematic text condensation. Two themes emerged regarding the research question. In the first theme, Always free, never free, parents described their striving to coparent without a love relationship. While they appreciated the freedom of being a half-time parent, doing things one's own way, they felt constrained by the long-term commitment to live close to and keep discussing child rearing issues with the ex-partner. Good communication was key and lessened parent's feelings of being cut-off from half of the child's life. When JPC was ordered by court or conflicts were intense, parents tried to have less contact and worried when the children were in the other home. The second theme, Is it right, is it good?, included descriptions of how the parents monitored the child's responses to the living arrangement and made changes to optimize their adjustment. Adaptations included visits for the child with the other parent mid-week, shared meals or adapting schedules. In conclusion, these parents worked hard to make JPC work and cause minimal damage to their children. Most parents were pleased with the arrangements with the notable exception of couples experiencing ongoing conflict.

AimJoint physical custody (JPC), where children spend about equal time in both parent's homes after parental separation, is increasing. The suitability of this practice for preschool children, with a need for predictability and continuity, has been questioned.

MethodsIn this cross-sectional study, we used data on 3656 Swedish children aged three to five years living in intact families, JPC, mostly with one parent or single care. Linear regression analyses were conducted with the Strengths and Difficulties Questionnaire, completed by parents and preschool teachers, as the outcome measure.

ResultsChildren in JPC showed less psychological problems than those living mostly (adjusted B 1.81; 95% CI [0.66 to 2.95]) or only with one parent (adjusted B 1.94; 95% CI [0.75 to 3.13]), in parental reports. In preschool teacher reports, the adjusted Betas were 1.27, 95% CI [0.14 to 2.40] and 1.41, 95% CI [0.24 to 2.58], respectively. In parental reports, children in JPC and those in intact families had similar outcomes, while teachers reported lower unadjusted symptom scores for children in intact families.

ConclusionJoint physical custody arrangements were not associated with more psychological symptoms in children aged 3–5, but longitudinal studies are needed to account for potential preseparation differences.