Effect of a parenting intervention on decreasing adolescents' behavioral problems via reduction in attachment insecurity: A longitudinal, multicenter, randomized controlled trial

A Pilot Study of an Attachment-Based Parenting Intervention for Parents of Adolescents in China: Translation, Modifications, and Preliminary Effectiveness

Adolescent mental health problems have increased internationally, and over one-quarter of Chinese adolescents-approximately 40 million teens-have reported significant mental health problems in recent years. This study tailored and evaluated the acceptance, uptake, and effectiveness of Connect, a brief manualized trauma-informed and attachment-based parenting program, for Mandarin-speaking families in Beijing, China. 30 parents (aged 36-50 years, Mage = 44.6, SD = 3.2; 83.3% mothers, 16.7% fathers) of youth aged 10-16 years (Mage = 13.4, SD = 1.5; 50.0% female) were enrolled in a single-arm pilot study with preprogram and postprogram assessments of youth mental health, parental functioning, and quality of parent-child relationships. Careful translation was necessary to retain program nuances and meaning, including references to Chinese idioms and poems to enhance cultural meaning. Program modifications included tailoring role plays to reflect culturally relevant domains of parent-youth conflict, direct prompting of parents in reflection exercises and discussions, and a deeper emphasis on empathy in parent-child relationships. These modifications enhanced rather than diminished core program fidelity within this cultural context. Program enrolment, attendance, retention, and parents' feedback revealed strong program acceptance and perceived cultural fit. Parents also reported significant reductions in youth internalizing and externalizing problems, youth-to-parent and parent-to-youth physical and psychological aggression, parent depressed mood, and parenting strain. The findings align with previous randomized clinical trials and implementation studies of Connect across diverse countries, contexts, and clinical populations. Replication is required with larger samples, randomized designs, and using parent and youth measures to sensitively capture the quality of parent-child relationships.

Parental attachment, attachment to friends, and well-being among Chilean adolescents and emerging adults

Adolescence and emerging adulthood are two life stages marked by notable cognitive and socioemotional changes. During both periods, friendships play an increasingly significant role and can significantly impact individuals positively or negatively. Despite the evolving nature of these relationships, parents remain crucial to the development of both adolescents and emerging adults, playing a key role in their well-being. This study aimed to investigate the mediating role of attachment to friends in the relationship between parental attachment and the well-being of Chilean adolescents and emerging adults. In a cross-sectional correlational study, 363 adolescents (48.2% female) aged 14 to 17 years (M = 15.33, SD = 0.95) and 199 emerging adults (67.8% female) aged 18 to 29 years (M = 22.42, SD = 2.53) completed the Inventory of Parent and Peer Attachment and the Pemberton Happiness Index Scale to assess general, eudaimonic, hedonic, and social well-being. Results of path analyses indicated that, for both adolescents and emerging adults, a more secure attachment to parents was directly associated with higher scores in all well-being dimensions. Additionally, more secure parental attachment was indirectly associated with better eudaimonic and social well-being through a more secure attachment to friends. These findings suggest that enhancing parental attachment could be a valuable focus in clinical interventions aimed at improving overall well-being in adolescents and emerging adults.

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

Parenting and Emotional and Behavioral Difficulties in a General Population Sample of Adolescents: The Mediating Role of Emotional Dysregulation

Research has shown that both parenting and emotional dysregulation are associated with mental health outcomes in youth. This cross-sectional research was developed to replicate these noted findings and explore the mediating role of emotional dysregulation to explain the relationship between parenting and emotional and behavioral difficulties (internalizing and externalizing problems) in adolescents. A total of 104 adolescents (61.5% females; M = 15.62 yrs., SD = 1.38) participated in the study. Participants completed the Parental Bonding Instrument (measuring care, promotion of autonomy, and overprotection) referring to both the mother and father, the Difficulties in Emotion Regulation Scale, and the Youth Self-Report. The results showed that difficulties in emotion regulation fully mediated the relationship between overprotection (in both parents) and low maternal care with internalizing problems, on the one hand, and the relationship between maternal overprotection and low care (in both parents) with externalizing problems, on the other hand. Furthermore, emotional dysregulation partially mediated the effect of paternal care on internalizing problems. These findings help to clarify one of the mechanisms through which parenting can affect mental health in youth. Theoretical and clinical implications are discussed.

"It opened a new door for me": A qualitative study of forcibly displaced parents' experiences of an attachment-based parenting program

The aim of the study was to explore forcibly displaced parents' experiences of how an online attachment-based parenting program (eConnect) impacted their relationships with their teens. Data was collected from four focus group discussions with 28 parents who participated in the eConnect program. Data was analyzed using network thematic analysis. A global theme emerged from the analysis: Strengthened Parent-Teen Relationships. Four underpinning organizing themes described the process through which the parent-teen relationship was strengthened: Knowledge Served as the Foundation for Change, Increased Parental Self-Efficacy, Improved Emotional Attunement Facilitates Dyadic Affect Regulation, and Shifted Power Dynamics and Emerging Mutual Parent-Teen Partnership. Findings suggest that eConnect is promising intervention for strengthening parent-teen relationships and supporting forcibly displaced families.

Disseminating online parenting resources through community-academic partnerships

This community-engaged study aimed to understand effective strategies for disseminating online parenting resources (OPRs) in schools. OPRs were disseminated through seven E-Parenting tips and eight Facebook posts. Facebook posts were viewed a total of 12,404 times, and each post reached an average of 505 people each month. Average engagement rate was 2.41% per post. E-Parenting tips yielded 1514 total clicks, and the average clicks per message was 216.29. E-Parenting tips related to internalizing problems (e.g., anxiety, depression) had a higher click rate than E-Parenting tips related to externalizing problems (e.g., oppositional behavior). OPRs disseminated through Facebook posts, and E-Parenting tips resulted in wide reach and engagement. Different media channels should be utilized to disseminate different OPRs to as many parents as possible.

Attachment and trauma-informed programme to support forcibly displaced parents of youth in Sweden: feasibility and preliminary outcomes of the eConnect Online programme

OBJECTIVES

To assess the feasibility, acceptability and the impact of an online parenting programme for forcibly displaced parents of adolescents.

DESIGN

The study was a single-arm feasibility study using pre-intervention post-intervention and follow-up assessments.

SETTING

Participants were recruited from municipality-based activities for refugee parents in a small city in the south of Sweden.

PARTICIPANTS

Participants were forcibly displaced parents (n=23; 47.8% maternal figures) of youth (n=23; 8-17 years old; 26.1% female) from Syria, Afghanistan and Somalia participating in an online parenting programme (eConnect).

INTERVENTION

eConnect is an attachment-based and trauma-informed parenting intervention and was delivered over the course of 10 weekly sessions.

PRIMARY AND SECONDARY OUTCOME MEASURES

Feasibility was assessed by programme enrolment, attendance, completion and acceptability of the online platform and cultural fit of the programme. Primary outcome measures were programme impact on youth mental health problems. Secondary outcome measures were programme impact on family functioning and parent-child attachment insecurity.

RESULTS

The eConnect programme was highly feasible in terms of overall enrolment (100%), attendance (89.6%) and retention rates (100%). The online platform was acceptable, with mixed feedback primarily related to the access and usage of technology. Cultural fit of the programme was acceptable. Youth mental health problems (η 2=0.29) and family functioning significantly improved (η 2=0.18) over the course of the programme. Unexpectedly, parent reports of youth attachment insecurity significantly worsened (η 2=0.16).

CONCLUSIONS

The findings suggest that the online delivery of Connect was a promising way to reduce barriers to service access and improve mental health problems and family functioning among forcibly displaced parents and their children during COVID-19. Future research is needed to explore the acceptability and impact of this programme post-COVID-19, and to develop culturally tailored and psychometrically sound measures for parent and youth reports of attachment.

Evidence Base Update of Psychosocial Treatments for Adolescents with Disruptive Behavior

OBJECTIVE

This article expands the review of psychosocial treatments for adolescents with disruptive behavior (DB), published previously by this journal. That earlier review focused on DB treatment studies published 1966-2014; the current paper updates the evidence base by incorporating DB treatment studies published 2014-2021.

METHOD

A literature search and screening process identified 63 new studies for inclusion in this updated review. The 63 new studies were combined with 86 studies from the prior review and evaluated using Journal of Clinical Child and Adolescent Psychology level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on the evidence.

RESULTS

In total, 3 well-established, 7 probably efficacious, and 10 possibly efficacious treatments for adolescents with DB were identified. Further, 52 treatments were classified as experimental and 22 treatments were determined to have questionable efficacy.

CONCLUSIONS

There continues to be a large body of literature building the evidence base for treatments of adolescent DB. With a few exceptions, treatments falling into the top three evidence levels utilized more than one theoretical approach, enhancing each treatment's ability to target DB from multiple angles. Key advances include broad representation of various demographic groups, countries of origin, treatment settings, and provider types in this body of research. Despite these advances, more research is needed to address key gaps in the field, including the need for more studies on treatments tailored to adolescents with DB who are not yet involved with the juvenile justice system.

Secure attachment predicts lower societal cost amongst severely antisocial adolescents

BACKGROUND

Social and economic costs associated with antisocial behaviour are well-established, but little is known about the potential costs savings/benefits of secure attachment in this high-risk group. We aimed to provide the first test of attachment quality as a distinct predictor of economic costs.

METHODS

111 adolescents (10-17 years of age, M = 15.0, SD = 1.6; 71% male) referred to young offender services due to high levels of antisocial behaviour were included. Costs were measured by detailed service-use interview, and attachment security to mother and father elicited through the Child Attachment Interview. The level of antisocial behaviour and callous-unemotional traits were assessed. Cost predictors were calculated using generalised linear models.

RESULTS

Mean 12-months service costs were £5,368 (sd 5,769) per adolescent, with justice system and educational service costs being the main components. After adjusting for covariates, economic costs were predicted by attachment quality to fathers, with a difference of £2,655 per year between those with secure (£3,338) versus insecure attachment (£5,993); significant cost effects were not found for attachment quality to mothers. Higher levels of callous-unemotional traits, lower verbal IQ, higher levels of antisocial behaviour, and older age were also significant cost predictors.

CONCLUSIONS

Secure attachment to fathers is a predictor of reduced public cost in adolescents with severe antisocial behaviour. This novel finding for severely antisocial youth extends previous findings in less antisocial children and underscores the public health and policy benefits of good caregiving quality and the value of population-level dissemination of evidence-based interventions that improve caregiving quality.

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.

eCONNECT Parent Group: An Online Attachment-Based Intervention to Reduce Attachment Insecurity, Behavioral Problems, and Emotional Dysregulation in Adolescence

During adolescence, a secure parent-adolescent relationship promotes youths' adjustment and psychological well-being. In this scenario, several studies have demonstrated the effectiveness of the CONNECT program, a 10-session, attachment-based parenting intervention that helps parents understand and reframe their parent-adolescent interactions, reducing adolescents' insecure attachment and behavioral problems. Furthermore, recent years have witnessed a significant increase in the implementation of effective online versions of psychological interventions, emphasizing the opportunity for more agile and easier dissemination of evidence-based protocols. Therefore, this study aims to identify changes in adolescents' attachment insecurity, behavioral problems, and parent-child affect regulation strategies, providing preliminary findings on an online, 10-session, attachment-based parenting intervention (eCONNECT). A total of 24 parents (20 mothers, 4 fathers; Mage = 49.33, SD = 5.32) of adolescents (Mage = 13.83 years, SD = 1.76, 45.8% girls) were assessed on their adolescents' attachment insecurity (avoidance and anxiety) and behavioral problems (externalizing and internalizing), and on their affect regulation strategies in the parent-child interaction (adaptive reflection, suppression, and affect dysregulation) at three time points: before intervention (t0), after intervention (t1), and at a 2-month follow-up (t2). Mixed-effects regression models highlighted a reduction in adolescents' internalizing problems (d = 0.11), externalizing problems (d = 0.29), and attachment avoidance (d = 0.26) after the intervention. Moreover, the reduction in externalizing problems and attachment avoidance remained stable at follow-up. Additionally, our findings highlighted a reduction in parent-child affect dysregulation. Results add preliminary evidence on the implementation suitability of an online attachment-based parenting intervention to change at-risk adolescents' developmental trajectories by reducing attachment insecurity, behavioral problems, and parent-child affect regulation.

Secure Attachment Relationships With Mothers, But Not Fathers, Moderate the Relation Between Attention-Deficit Hyperactivity Symptoms and Delinquency in Adolescents

OBJECTIVE

The primary aim of this study was to investigate whether secure parent-adolescent attachment relationships moderate the longitudinal relation between 9th grade (G9) ADHD symptoms and 12th grade (G12) delinquency within a community sample of adolescents.

METHOD

Participants included 335 9th graders, of whom 203 students completed measures again in 12th grade. Mothers reported on their adolescents' ADHD symptoms and aggressive behaviors, and adolescents completed measures of their own delinquency and their perceptions of their parent-child attachment relationships.

RESULTS

G9 ADHD symptoms predicted increases in G12 delinquent behaviors. Moderation effects were also found such that G9 ADHD symptoms predicted G12 delinquency for only those youth who had moderate or low levels of secure maternal attachment. Paternal secure attachment did not moderate the effects of G9 ADHD symptoms on G12 delinquency.

CONCLUSION

Findings underscore the importance of secure maternal attachment relationships in the development of delinquency among adolescents with ADHD symptoms.

Destructive interparental conflict affects Chinese children's emotional and behavioral problems: Indirect pathways via parent-child attachment and emotional insecurity

BACKGROUND

Previous studies have demonstrated that destructive interparental conflict (IPC) is closely related to the emergence of emotional and behavioral problems in adolescents. In addition, in the family system, such conflict also affects the patent-child attachment relationship and emotional insecurity of adolescents.

OBJECTIVES

This study mainly explores the relationship between destructive interparental conflict and adolescents' emotional and behavioral problems, focuses on the role of parent-child attachment and emotional insecurity, and analyzes whether this relationality plays multiple mediating roles in the influence of destructive interparental conflict on emotional and behavioral problems.

METHODS

Data for the study were obtained through a questionnaire survey conducted on 524 Chinese adolescents from primary and junior high school.

RESULTS

Structural equation modeling was conducted to test direct and indirect pathways between destructive interparental conflict and Chinese adolescents' emotional and behavioral problems. Destructive IPC negatively predicted parent-child attachment and parent-child attachment negatively predicted emotional and behavioral problems. Destructive Interparental conflict positively predicted emotional insecurity and emotional insecurity positively predicted emotional and behavioral problems.

DISCUSSION

The results show that: (1) Parent-child attachment negatively predicted emotional and behavioral problems, and emotional insecurity positively predicted the same. (2) Parent-child attachment and emotional insecurity act in a multiple mediating role between destructive IPC and adolescents' emotional and behavioral problems. (3) Parent-child attachment and emotional insecurity constitute two indirect pathways between destructive IPC and adolescents' emotional and behavioral problems, respectively.

CONCLUSION

Destructive IPC can adversely affect emotional and behavioral problems among adolescents; destructive IPC plays a damaging role in their emotional security and parent-child attachment, consequently effecting emotional and behavioral problems.