Parenting behaviors of mothers with posttraumatic stress: The roles of cortisol reactivity and negative emotion

Understanding and supporting parenting in parents seeking PTSD treatment: a qualitative study

Background: Parental post-traumatic stress disorder (PTSD) can impact parenting and child psychosocial wellbeing. Complementing trauma-focused psychotherapy with parenting interventions can thus have important preventive value. Understanding parents' lived experiences is necessary to tailor such interventions to their needs.Objective: This study addressed the question: how can preventive parenting support be shaped to the needs of parents entering specialized psychotherapy for PTSD? To answer this question, we investigated parenting challenges, parent-child communication about PTSD, strengths, and social support experiences of parents with PTSD.Method: The sample included 14 parents seeking PTSD treatment at a tertiary mental healthcare institution, while parenting children aged 4-17. Data were collected using semi-structured interviews and analysed using reflexive thematic analysis.Results: On the one hand, parental dysregulation (e.g. exploding or shutting down) was an important challenge. On the other hand, parents' attempts to remain regulated (e.g. through overcontrol and overprotectiveness) also affected family life. When talking to their child about PTSD, parents were guided by what they considered beneficial for the child to know. An important strength was that parents tried to remain attuned to the child's needs, regardless of their own struggles. Parents also described experiences that could be understood as post-traumatic growth through parenting. Generally, parents experienced a lack of social support.Conclusion: Our findings illustrate that parents entering PTSD treatment are highly motivated to do what is best for their child. Based on parents' lived experiences, preventive parenting interventions should address the impacts of both dysregulation and overcontrolling regulation attempts. Another important goal is reducing feelings of incompetence. Integrating the parenting role in psychotherapy for PTSD could also be beneficial. For example, setting parenting-related therapy goals can be motivating. Furthermore, parent-child interactions can be a mirror that reflects the parents' inner state: considering these interactions can help recognize changes in symptomatology.

Child Maltreatment and Harsh Parenting: The Role of Maternal Chronic Relational Strains

While prior research indicates that parents who were maltreated as children are more likely to engage in negative parenting behaviors, less is known about how mothers' social relationships may influence these practices. Yet parenting behaviors are influenced not only by the individual characteristics of the parent and child, but also by the social context that exists around the parent-child dyad. The aim of the current cross-sectional study was to test a model examining the effect of mothers' exposure to child maltreatment on harsh parenting practices, as observed in the lab, and the mediating role of strain in mothers' relationships. Seventy-eight mother-child dyads, with children ranging from 18- to 36-months old, were recruited from the community; mothers completed self-report measures of childhood trauma and relational strains, and were observed during a stressful parent-child interaction in the lab. Results indicated that higher child maltreatment was associated with harsher parenting, indirectly via greater chronic relational strains. These findings contribute important knowledge on how mothers' trauma history may influence their current social context to affect parenting behavior. Therapeutic approaches focused on alleviating maternal relational strains, including interventions that target other important people in a mother's circle, may yield more parenting benefits than parent training without a systemic approach.

The Efficacy of Relationship Education for Improving Children's Outcomes: A Multi-Informant, Multi-Method Study

Although relationship education (RE) programs aim to improve parents' communication with one another with the hope that it will enhance children's mental health, few studies have investigated if such spillover actually occurs. Therefore, drawing from a sample of 431 families from the Supporting Healthy Marriage Project, the present study examined the relations between parental participation in a RE program and children's subsequent distress, as well as mechanisms that may explain these effects. Using a multi-informant (focal child and parents) and multi-method (self-report and observational assessments) longitudinal design, the current study examined whether randomization into RE programming predicted children's exposure and emotional reactivity to interparental conflict and if decreases in parents' negative communication mediated these effects. Results based on mothers' reports indicated that when parents received RE, children's exposure to conflict decreased. However, these findings were not corroborated by fathers or children. There were also no differences in children's emotional reactivity across conditions, and observable communication did not mediate the relation between randomization into RE and children's outcomes. Together, there was minimal evidence for the efficacy of RE on children's functioning. Results underscore the importance of evaluating multiple family members' perspectives and highlight the need for future work to consider these pathways in samples experiencing greater distress.

Stress and emotion recognition predict the relationship between a history of maltreatment and sensitive parenting behaviors: A moderated-moderation

Our study proposes to examine how stress and emotion recognition interact with a history of maltreatment to influence sensitive parenting behaviors. A sample of 58 mothers and their children aged between 2 and 5 years old were recruited. Parents' history of maltreatment was measured using the Child Trauma Questionnaire. An emotion recognition task was performed. Mothers identified the dominant emotion in morphed facial emotion expressions in children. Mothers and children interacted for 15 minutes. Salivary cortisol levels of mothers were collected before and after the interaction. Maternal sensitive behaviors were coded during the interaction using the Coding Interactive Behavior scheme. Results indicate that the severity of childhood maltreatment is related to less sensitive behaviors for mothers with average to good abilities in emotion recognition and lower to average increases in cortisol levels following an interaction with their children. For mothers with higher cortisol levels, there is no association between a history of maltreatment and sensitive behaviors, indicating that higher stress reactivity could act as a protective factor. Our study highlights the complex interaction between individual characteristics and environmental factors when it comes to parenting. These results argue for targeted interventions that address personal trauma.

Harsh parenting among veterans: parents' military-related PTSD, mentalization, and pre-military trauma

Objectives

Veteran parents experiencing posttraumatic stress disorder (PTSD) may resort to harsh parenting. The indirect pathway from parental military-related PTSD to harsh parenting, and the moderating role of parents' pre-military trauma histories, has been less explored. Informed by mentalization theory, as well as trauma-sensitive and posttraumatic growth perspectives, we aim to explore the associations between veteran parents' military-related PTSD, mentalization, harsh parenting, and prior trauma before military service.

Methods

Data were collected from an online research panel of 509 veteran parents with children under 10. We employed Structural Equation Models to test indirect and moderating effects.

Results

We identified an indirect effect of parental pre-mentalization from military PTSD to harsh parenting [corporal punishment: b = 0.35, p < 0.001, 95% CI (0.23, 0.46); psychological aggression: b = 0.14, p < 0.001, 95% CI (0.09, 0.19)]. Multi-group analysis on four parent groups (parents with only pre-military physical trauma, parents with only pre-military psychological trauma, parents with both pre-military physical and psychological trauma, and parents with no pre-military physical or psychological trauma) highlighted differences in these associations, particularly between parents with only pre-military physical trauma and those without any physical and psychological trauma. The military-related PTSD effects on psychological aggression, corporal punishment, and pre-mentalization were all significantly higher for parents without pre-military physical and psychological trauma.

Conclusion

Modifying parents' interpretation of their child's mental states can potentially counteract the effects of veterans' military PTSD on harsh parenting. Family-based programs should be created considering veteran parents' pre-military trauma histories.

Towards a more comprehensive understanding of PTSD and parenting

BACKGROUND

The impact of post-traumatic stress disorder (PTSD) on parenting and the parent-child relationship has been well-documented in the scientific literature. However, some conceptual and methodological challenges within this research field remain.

PROCEDURE

We reflect on a number of challenges that we identified while examining the literature in preparation of an individual participant data meta-analysis on the relationships between PTSD and parenting.

FINDINGS

We address 1) the presence of 'trauma-islands'; 2) the need for transdiagnostic theoretical frameworks for mechanisms between PTSD and parenting; 3) the lack of developmental perspectives; 4) the overuse of self-reported retrospective measures; 5) the need to study more diverse samples and cultural contexts; and 6) the lack of research on resilience and post-traumatic growth in parenting. Based on these reflections, we offer suggestions on strategies for responding to these challenges through: 1) welcoming open science; 2) working towards shared theoretical frameworks; 3) doing more longitudinal research 4) expanding the methodological palette; 5) centering lived experience; and 6) taking systemic inequality into account.

CONCLUSION

With this commentary, we aim to open a discussion on next steps towards a more comprehensive understanding of the association between PTSD and parenting, and inspire collaborative research.

Study protocol: development and randomized controlled trial of a preventive blended care parenting intervention for parents with PTSD

BACKGROUND

Children of parents with post-traumatic stress disorder (PTSD) are at increased risk of adverse psychological outcomes. An important risk mechanism is impaired parental functioning, including negative parenting behavior, perceived incompetence, and lack of social support. Several parenting interventions for trauma-exposed parents and parents with psychiatric disorders exist, but none have specifically targeted parents with PTSD. Our objective is to evaluate the effectiveness of a blended care preventive parenting intervention for parents with PTSD.

METHODS

The intervention was adapted from an existing online intervention, KopOpOuders Self-Help. In co-creation with parents with PTSD and partners, the intervention was adapted into KopOpOuders-PTSD, by adding PTSD-specific content and three in-person-sessions with a mental health prevention professional. Effectiveness will be tested in a randomized controlled trial among N = 142 parents being treated for PTSD at Arkin Mental Health Care (control condition: treatment as usual, n = 71; intervention condition: treatment as usual + intervention, n = 71). Online questionnaires at pretest, posttest, and three-month follow-up and ecological momentary assessment at pretest and posttest will be used. Intervention effects on primary (parenting behavior) and secondary outcomes (perceived parenting competence, parental social support, parenting stress, child overall psychological problems and PTSD symptoms) will be analyzed using generalized linear mixed modeling. We will also analyze possible moderation effects of parental PTSD symptoms at pretest on primary and secondary outcomes.

DISCUSSION

This study protocol describes the randomized controlled trial of KopOpOuders-PTSD, a blended care preventive parenting intervention for parents with PTSD. Findings can contribute to understanding of the effectiveness of parenting support in clinical practice for PTSD.

TRIAL REGISTRATION

This protocol (Version 1) was registered on 11-02-2022 at ClinicalTrials.gov under identification number NCT05237999.

Mindful Parenting Mediated Between Mothers’ Perceived Stress During COVID-19 and Child Adjustment

Objectives

Maternal stress is associated with a myriad of maladjusted outcomes among children. To identify the role of mindful parenting between mothers’ stress and child adjustment during the COVID-19 pandemic, this study tested competing hypotheses with mothers’ mindful parenting as a mediator versus a moderator.

Methods

A total of 172 Chinese mothers of preschool-aged children participated in this study. Participants completed a self-report measure of stress during COVID-19 and mindful parenting, as well as a mother-report measure of children’s prosocial behavior, internalizing problems, and externalizing problems. Structural equation models were conducted to examine the mediation versus moderation effects of mindful parenting between mothers’ stress during COVID-19 and child adjustment, after controlling for family income, children’s age, sex, and adjustment at baseline.

Results

Findings indicated that mindful parenting mediated the link between mothers’ stress during COVID-19 and child adjustment, including internalizing problems, externalizing problems, and prosocial behavior. A test of competing hypothesis showed that mindful parenting did not moderate between mothers’ stress during COVID-19 and child adjustment.

Conclusions

This study revealed the mediating effects of mindful parenting between mothers’ perceived stress during COVID-19 and child adjustment. The findings inform researchers and practitioners about mindful parenting as a potential mechanism between maternal stress and child adjustment during the pandemic.

Maternal stress and mental health before pregnancy and offspring diurnal cortisol in early childhood

The current study investigates whether prepregnancy maternal posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and stress predict children's cortisol diurnal slopes and cortisol awakening responses (CARs) adjusting for relevant variables. Mothers were enrolled after delivering a baby and followed through their subsequent pregnancy with 5 years of longitudinal data on their subsequent child. This prospective design allowed assessment of PTSD symptoms, depressive symptoms, and perceived stress prior to pregnancy. Children provided three saliva samples per day on three consecutive days at two timepoints in early childhood (M age = 3.7 years, SD = 0.38; M age = 5.04 years, SD = 0.43). Mothers' PTSD symptoms prior to pregnancy were significantly associated with flatter child diurnal cortisol slopes at 4 and 5 years, but not with child CAR. Findings at the age of 4 years, but not 5 years, remained statistically significant after adjustment for maternal socioeconomic status, race/ethnicity, child age, and other covariates. In contrast, maternal prepregnancy depressive symptoms and perceived stress did not significantly predict cortisol slopes or CAR. Results suggest that maternal prepregnancy PTSD symptoms may contribute to variation in early childhood physiology. This study extends earlier work demonstrating risk of adverse outcomes among children whose mothers experienced trauma but associations cannot be disentangled from effects of prenatal mental health of mothers on children's early childhood.

The Ecology of Youth Psychological Wellbeing in the COVID-19 Pandemic

The consequences of profound disruption to everyday life caused by the COVID-19 pandemic will only emerge over time. Guided by ecological systems (Pitchik et al., 2021) and developmental psychopathology (Masten & Cicchetti, 2010) frameworks, I review evidence that points to parents at home with children as particularly vulnerable to increased psychological difficulties, particularly in contexts of poverty. Resultant compromised parenting may reduce children's opportunities for the kinds of everyday interactions that promote cognitive and socioemotional development and expose them to increases in coercive, avoidant, and other problematic caregiving behaviours. I discuss three evidence-based strategies that parents could adopt to buffer their child's mental health: building positive discipline strategies, talking with the child about the pandemic and its consequences, and conversing about the past. I conclude, however, that approaches to supporting parents and their children at this time must also address multisystem factors that compromise caregivers' ability to provide nurturing care.

Associations Between Maternal Post-traumatic Stress Disorder and Traumatic Events With Child Psychopathology: Results From a Prospective Longitudinal Study

Introduction: Exposure to interpersonal violence (IPV) can lead to post-traumatic stress disorder (PTSD) in mothers, and in turn adversely affect the mother-child relationship during early development, as well as the mental health of their children. Our objectives are to assess: (1) the association of maternal IPV-PTSD to child psychopathology, (2) the association of maternal IPV independently of PTSD to child psychopathology, and (3) the relationship between child exposure to violence to the psychopathology of these children. Methods: We used data from the longitudinal Geneva Early Childhood Stress Project. The sample included 64 children [mean age at Phase 1 = 2.4 (1.0-3.7) years] of mothers with or without IPV-PTSD. Data on mothers was collected during Phase 1, using the Clinical Administered PTSD Scale (CAPS), the Brief Physical and Sexual Abuse Questionnaire (BPSAQ) and the Conflict Tactics Scale (CTS2). Modules of a semi-structured diagnostic interview, and the Violence Exposure Scale were used to collect information on child at Phase 2, when children were older [mean age = 7.02 (4.7-10)]. Results: A higher CAPS score in mothers when children were toddler-age was associated with an increased risk of symptoms of attention deficit/hyperactivity disorder (ADHD; β = 0.33, p = 0.014) and PTSD in school-age children. The association between maternal IPV-PTSD and child PTSD (β = 0.48, p < 0.001) symptoms remained significant after adjustment for potential confounders. Among children, exposure to violence was associated with an increased risk of symptoms of generalized anxiety (β = 0.37, p = 0.006), major depressive (β = 0.24, p = 0.039), ADHD (β = 0.27, p = 0.040), PTSD (β = 0.52, p < 0.001), conduct (β = 0.58, p = 0.003) and oppositional defiant (β = 0.34, p = 0.032) disorders. Conclusion: Our longitudinal findings suggest that maternal IPV-PTSD during the period of child development exert an influence on the development of psychopathology in school-aged children. Mothers' IPV was associated with child psychopathology, independently of PTSD. Child lifetime exposure to violence had an additional impact on the development of psychopathology. Careful evaluation of maternal life-events is essential during early childhood to reduce the risk for the development of child psychopathology. Early efforts to curb exposure to violence in children and early intervention are both needed to reduce further risk for intergenerational transmission of trauma, violence, and related psychopathology.