One or many? Which and how many parenting variables should be targeted in interventions to reduce children's externalizing behavior?

Mothers' Emotion Regulation and Negative Affect in Infants: The Role of Self-Efficacy and Knowledge of Parenting Practices

Early in development, children rely heavily on caregivers for assistance with the regulation of negative emotion. As such, it is important to understand parent characteristics that influence caregiver ability to attenuate infant negative affect and mediating factors by which this process may unfold. This study examined the relationship between parental emotional regulation strategies (ERs) and infants' negative affect and tested the mediating effects of parenting self-efficacy and knowledge of this association. Results indicated that higher maternal reappraisal was related to higher maternal self-efficacy whereas higher maternal suppression was related to lower knowledge of parenting practices. Maternal suppression was negatively related to infant frustration; maternal self-efficacy was positively related to infant falling reactivity and negatively related to sadness. There was a significant indirect effect between maternal reappraisal and infant falling reactivity through maternal self-efficacy. The mediation result suggests that mothers with higher use of reappraisal show higher self-efficacy and have infants with higher falling reactivity. Maternal knowledge about parenting practices was related to lower infant fear. Maternal knowledge of parenting practices did not mediate any associations between maternal emotion regulation strategies and infant negative affect. These findings contribute to the understanding early protective parenting mechanisms for supporting the external regulation of negative affect in infants and also in designing and implementing preventive parenting programs focused on the emotional needs of parents and children.

Parent Emotion Socialization and Positive Emotions in Child and Adolescent Clinical Samples: A Systematic Review and Call to Action

The majority of the emotion socialization behaviors (ESB) literature has focused on community samples and socialization of negative emotions. However, it is becoming increasingly apparent that ESB are also critical in setting the foundations for the healthy development of positive emotions, with implications for developmental psychopathology. We conducted a systematic review of research examining parent ESB and youth positive emotions in clinical child and adolescent samples. A literature search was conducted in March 2021, resulting in 563 abstracts being reviewed. Two reviewers independently screened the titles and abstracts to identify relevant papers, with 53 articles being reviewed in full. Seven articles (four cross-sectional and correlational, three intervention) were included in the current review, of which one was with an internalizing sample, three were with an externalizing sample, and three were with a neurodevelopmental disorder sample. Results varied regarding the role of parent ESB in youth positive emotions across clinical populations. In correlational studies, minimal evidence was found for the association between parent ESB and youth positive emotions, but across the three intervention studies, there was evidence that both parent ESB and children's positive emotions can be improved through intervention. We present a preliminary model of relations between youth psychopathology, parent ESB, and child positive emotions, with consideration of potential moderators of links between ESB and positive emotions. Finally, we discuss limitations of the existing body of research, and offer specific recommendations for future research directions.

Parental Self-efficacy and Health-related Outcomes Among Children with Hirschsprung Disease: A Cross-sectional Study

PURPOSE

Little attention has been put to parental self-efficacy (PSE) on the home care management and its impact on the health-related outcome in children with Hirschsprung disease (HD) after surgery. The purpose of this study was to investigate the association between PSE and post-operative outcome and quality of life (QoL) in children with HD.

DESIGN AND METHODS

This study adopted a cross-sectional study design. Children diagnosed with HD who had surgery during 2015 and 2018, and their parents were included. Parental self-efficacy, children's post-operative fecal continence and QoL were evaluated with validated questionnaires; post-operative readmission and adverse events were extracted from electronic medical record system.

RESULTS

Of the eligible families, 69.6% (96/138) responded to the follow-up. The median children's age at surgery and current age were 16 (interquartile range: 10-32) and 45 (interquartile range: 39.7-57) months, respectively. The mean PSE score is 8.78 points, with the lowest score in the bowel habit training dimension (7.88 ± 2.28), followed by getting social support dimension (8.07 ± 2.64). Multivariable linear regression showed that PSE was associated with fecal continence (β = 0.043, 95% CI 0.013-0.072), pediatric QoL total score (β = 0.210, 95% CI 0.011-0.409) and social score (β = 0.273, 95% CI 0.022-0.525). No associations were observed between PSE and weight z-score, height z-score, readmission or adverse events.

CONCLUSIONS

PSE is correlated with fecal continence and QoL of children with HD.

PRACTICE IMPLICATIONS

PSE should be considered when designing a parental education program, with the focus on bowel habit training and getting social support.

Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis

Purpose

The purpose of this paper is to examine the prevalence of posttraumatic stress symptoms (PTSS) in adults and children who were exposed to applied behavior analysis (ABA) autism early childhood intervention. Using an online questionnaire to survey autistic adults and caregivers of autistic children, the author collected data from 460 respondents on demographics, intervention types, and current pathological behaviors with symptom severity scales. This study noted PTSS in nearly half of ABA-exposed participants, while non-exposed controls had a 72 percent chance of being asymptomatic. ABA satisfaction ratings for caregivers averaged neutral or mild satisfaction. In contrast, adult satisfaction with ABA was lower on average and also tended to take on either extremely low or extremely high ratings. Exposure to ABA predicted a higher rate and more severe PTSS in participants, but the duration of exposure did not affect satisfaction with the intervention in caregivers.

Design/methodology/approach

Participants were recruited for an online survey through social media networks, adult gatherings, social skills groups, and autism support groups nationwide. Adult inclusion criteria consisted of autism – diagnosed or self-diagnosed – and an age of 18 or older. A total of 460 respondents, consisting of autistic adults and caregivers of autistic children, completed an online survey. The caregiver entries (n=217) concerned 79 percent male children, 21 percent female children (male to female 3.80:1), and one MtF transgender child, ages 1-38, with an average age at diagnosis of 4.69 years. The adult entries (n=243) concerned 30 percent males, 55 percent females (male to female 0.55:1), and 14 percent other gender, ages 18-73, with an average age at diagnosis of 25.38 years.

Findings

Nearly half (46 percent) of the ABA-exposed respondents met the diagnostic threshold for PTSD, and extreme levels of severity were recorded in 47 percent of the affected subgroup. Respondents of all ages who were exposed to ABA were 86 percent more likely to meet the PTSD criteria than respondents who were not exposed to ABA. Adults and children both had increased chances (41 and 130 percent, respectively) of meeting the PTSD criteria if they were exposed to ABA. Both adults and children without ABA exposure had a 72 percent chance of reporting no PTSS (see Figure 1). At the time of the study, 41 percent of the caregivers reported using ABA-based interventions.

Originality/value

The majority of adult respondents were female, raising questions about the population of online autistic survey respondents. Further, the high numbers of reported gender other than male or female in the adult respondents, as well as at least on MtF child from the caregiver respondents indicates that future studies should consider these intersections. These accompanied significant discrepancies in reporting bias between caregivers and ABA-exposed individuals, which highlight the need for the inclusion of the adult autistic voice in future intervention design. Based on the findings, the author predicts that nearly half of ABA-exposed autistic children will be expected to meet the PTSD criteria four weeks after commencing the intervention; if ABA intervention persists, there will tend to be an increase in parent satisfaction despite no decrease in PTSS severity.