Reciprocity among maternal distress, child behavior, and parenting: transactional processes and early childhood risk

Measurement issues in longitudinal studies of mental health problems in children with neurodevelopmental disorders

PURPOSE

To develop and test an approach for assessing the risk of bias in four measurement-related domains key to the study of mental health problem trajectories in children with neurodevelopmental disorders (NDD): (1) conceptual overlap between mental health problems and NDD diagnostic criteria, (2) over-reliance on a single informant, (3) unwarranted omission of the child's perspective, and (4) the use of instruments not designed for or adapted to the population.

METHODS

Building upon a previous systematic review, this study established supplementary criteria for assessing the risk of bias domains. Following this, the criteria were applied to measures used in 49 longitudinal studies of mental health problems in children with NDD.

RESULTS

The general risk of bias across domains was rated as high in 57.1% of the 49 included studies. The highest risk of bias was seen in domain four (rated as high in 87.8% of studies) and the lowest in domain three (24.5%).

CONCLUSIONS

The risk of bias items enhance our understanding of the quality of the evidence about mental health problem trajectories in children with NDD. The methodological quality of future research can be increased by selecting conceptually clear scales developed for the population - preferably in the form of cognitively accessible self-report scales - and adopting a multi-informant approach.

Parent-focused online video intervention for promoting parenting sense of competence: a randomized controlled trial

BACKGROUND

Apart from child behavioral problems which were ameliorated by increasing parenting skills, parental well-being is one of the important components for development of parenting sense of competence (PSOC), which subsequently affects parenting style and child outcomes. This randomized controlled trial study aims to determine whether a brief asynchronous parent-focused online video intervention (POVI) that was easily accessible would be effective in increasing PSOC and parental well-being.

METHODS

One hundred and twenty parents, with a poor Thai Mental Health Indicators-15 score or mild-moderate depression/anxiety, of children aged 3-10 years, were randomized into two parallel groups, intervention and control groups (1:1). The intervention group received six online, weekly, parent-focused sessions. Parent and child outcomes were measured at baseline, 6, and 10 weeks. The Generalized Estimating Equations model was used for the analysis.

RESULTS

At 10 weeks, the intervention group reported a higher PSOC (p = 0.005), particularly on the parenting satisfaction subscale, and mental health indicator. Both groups experienced reduced depression and anxiety from baseline, and child behaviors remained unchanged.

CONCLUSIONS

POVI improved PSOC and parental well-being among parents with mild to moderate mental health problems. POVI may be used as a primary tool to promote parental well-being in general pediatric practice.

IMPACT

This study demonstrates the efficacy of a parent-focused online video intervention (POVI) in enhancing parenting sense of competence and parental well-being. It addresses the gap in interventions that focus primarily on parental well-being, particularly for those who face mild to moderate mental health challenges. The findings contribute valuable insights for healthcare professionals, highlighting the potential of POVI, an easy-to-access and less time-consuming intervention, as a primary tool to promote parental well-being in general pediatric practice settings.

A longitudinal path model examining the transactional nature of parenting and child externalizing behaviors in a large, sociodemographically diverse sample

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

Maternal Adversity and Epigenetic Age Acceleration Predict Heightened Emotional Reactivity in Offspring: Implications for Intergenerational Transmission of Risk

Black American women are disproportionately exposed to adversities that may have an intergenerational impact on mental health. The present study examined whether maternal exposure to adversity and epigenetic age acceleration (EAA; a biomarker of stress exposure) predicts the socioemotional health of her offspring. During pregnancy, 180 Black American women self-reported experiences of childhood adversity and marginalization-related adversity (i.e., racial discrimination and gendered racial stress) and provided a blood sample for epigenetic assessment. At a three-year follow-up visit, women reported their offspring's emotional reactivity (an early indicator of psychopathology) via the CBCL/1.5-5. After adjusting for maternal education and offspring sex, results indicated that greater maternal experiences of childhood trauma (β = 0.21, SE(β) = 0.01; p = 0.01) and racial discrimination (β = 0.14, SE(β) = 0.07; p = 0.049) predicted greater offspring emotional reactivity, as did maternal EAA (β = 0.17, SE(β) = 0.09, p = 0.046). Our findings suggest that maternal EAA could serve as an early biomarker for intergenerational risk conferred by maternal adversity, and that 'maternal adversity' must be defined more broadly to include social marginalization, particularly for Black Americans.

Impact of preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in preschool children

BACKGROUND

Internalizing problems are common in young children, often persist into adulthood, and increase the likelihood for subsequent psychiatric disorders. Problematic attachment, parental mental health problems, and stress are risk factors for the development of internalizing problems. COVID-19 lockdown measures have resulted in additional parental burden and especially their impact on preschool children has rarely been investigated as of now. The current study examined the impact of sustained preschool attendance, parental stress, and parental mental health on internalizing and externalizing problems during COVID-19 lockdown measures in a sample of preschool children in Germany.

METHODS AND FINDINGS

N = 128 parents of preschool children filled out a one-time online survey about children's internalizing problems, externalizing problems, and attachment for three time points: before a nation-wide lockdown (T1), during the most difficult time of the lockdown (T2) and after the lockdown (T3). Additionally, parents answered questions about their own depressive and anxious symptomatology for the three time points and parental stress for T1 and T2. Linear-mixed effect models were computed to predict children's internalizing / externalizing behavior. Preschool children showed a significant increase in internalizing and externalizing problems over time, highest at T2 with small decreases at T3. Parental depressive and anxious symptomatology increased significantly from T1 to T2, but also remained high at T3. Parental stress levels were comparable to community samples at T1, but attained average values reported for at-risk families at T2. Linear-mixed effect models identified higher parental stress, parental anxiety, attachment problems, parental education, and less preschool attendance as significant predictors for internalizing and externalizing problems in preschoolers with more specific associations shown in separate models. A limitation is the retrospective assessment for the times T1 and T2.

CONCLUSIONS

Preschool children's mental health is strongly and negatively influenced by the ongoing COVID-19 pandemic and its lockdown measures. Sustained preschool attendance may serve as a protective factor.

Emotional availability in mothers and their children with spinal muscular atrophy type 1 who require augmentative and alternative communication: a mixed-methods pilot study

Emotional availability in parent-child interactions fosters children's socioemotional development. Little is known about the emotional availability of parents and children with profound motor disabilities and complex communication needs or the contributions of augmentative and alternative communication (AAC) to emotional availability. To begin addressing these gaps, this pilot study focused on three mothers and their children with spinal muscular atrophy Type 1 who could not speak and required AAC. The study used a mixed-methods design. Mother-child interactions were rated using the Emotional Availability Scales. Semi-structured in-depth interviews with the mothers were qualitatively analyzed. Emotional availability in mother-child dyads was adequate. In the interviews, mothers addressed significant challenges but described mainly typical parent-child relationships and adaptive child and mother coping attributable to the use of AAC. Results suggest that emotional availability is possible and can be facilitated by AAC, even with children with profound motor disabilities and limited ability to communicate needs and desires. The findings highlight the importance of targeting children's socioemotional needs and parent-child emotional availability in AAC interventions with families of children with profound motor disabilities.

Implementing mental health interventions within a national nurse home visiting program: A mixed-methods evaluation

BACKGROUND

Up to half of low-income mothers experience symptoms of depression and anxiety that affect their well-being and increase their children's risk for behavioral and emotional problems. To address this problem, an engaged research/practice planning team designed the Mental Health Innovation (MHI), a multicomponent implementation strategy that integrates evidence-based mental health interventions within the national Nurse-Family Partnership (NFP). The MHI includes four implementation strategies: online training modules, clinical resources, team meeting modules, and virtual consultation.

METHODS

A convergent, mixed methods observational design was applied to evaluate implementation outcomes, guided by the RE-AIM framework. We operationalized Reach as the number and demographics of women enrolled in NFP agencies exposed to MHI strategies. Adoption was operationalized as the number and proportion of nurses and supervisors who used MHI implementation strategies. For implementation, we assessed multilevel stakeholders' perceptions of strategy acceptability and feasibility. Data were pulled from NFP's national data management systems and collected through focus groups and surveys. Quantitative data were analyzed using counts and summary statistics. Qualitative themes were generated through content analysis.

RESULTS

The MHI reached agencies serving 51,534 low-income mothers (31.2% African American and 30.0% Latina). Adoption rates varied across implementation strategies. Between 60% and 76% of NFP nurses (N = 2,100) completed each online module. Between 27% and 51% of nurse supervisors (n = 125) reported using each team meeting module. Of 110 teams invited to participate in virtual consultation, 40.9% (n = 45) participated. Mothers served by agencies participating in virtual consultation differed significantly from those who did not, with lower percentages of African American and Latina. Qualitative themes suggest that MHI strategies were generally viewed as acceptable; perceptions of feasibility varied across strategies.

CONCLUSIONS

This study identified both strengths and opportunities for improvement. Further evaluation is needed to assess the MHI's effectiveness in improving mothers' mental health.

Longitudinal Coupling of Depression in Parent-Adolescent Dyads: Within- and Between-Dyad Effects Over Time

The present work evaluated reciprocal, within-dyad associations between parent-adolescent depressive symptoms across two independent samples (N=327 and N=435 dyads, respectively; approximately 85% biological mothers) assessed every three months for two (Study 1) to three (Study 2) years. Results of random intercept cross-lagged panel models converged to support positive contemporaneous patterns of co-fluctuation in parent and adolescent depression, such that within-person deviations in parental depression were associated with same direction within-person deviations in adolescent depression at the same timepoint. In contrast, within-person fluctuations in parent depression did not predict prospective within-person fluctuations in adolescent depression, or vice versa, across the follow-up period. Results held across boys and girls, as well as dyads with and without a parental history of depressive disorder. Overall, findings advance knowledge by demonstrating that, after accounting for between-person/dyad variance, parent and adolescent depression demonstrate contemporaneous co-fluctuations, but do not demonstrate within-dyad reciprocity over time.

Maternal caregiver's typologies and internalized behaviors in African American adolescents living in urban public housing

AIMS

This study explores how variations in maternal caregiver types may be associated with adolescents' internalized behaviors (i.e., depressive symptoms) and resources (i.e., attitudes toward delinquent behaviors and efficacious beliefs).

METHOD

Using a sample of 375 African American youth from public housing in three large US cities, we used Latent Profile Analysis to identify various maternal caregiver classes. Multinomial logistic regression analyses were conducted to assess whether youth can be correctly classified into maternal caregiver classes based on their internalized behaviors.

RESULTS

Three maternal caregiver classes were identified. Results suggest youth living with high encouragement and high (supervision) maternal caregivers were associated with more conventional attitudes, higher self-efficacy, and lower depressive symptoms.

CONCLUSION

Findings highlight how maternal caregivers can influence the internalizing behaviors of African American youth in US public housing. Individual, community, and system-level interventions can be leveraged to support the impact of these maternal caregivers.

Transactional Associations Between Parent and Late Adolescent Internalizing Symptoms During the COVID-19 Pandemic: The Moderating Role of Avoidant Coping

Extensive research has demonstrated the transactional nature of parent-child psychopathology, with limited studies examining these effects during late adolescence and none, to our knowledge, longitudinally during the COVID-19 pandemic. The current study examined the cross-lagged effects of parent and adolescent internalizing symptoms during the COVID-19 pandemic and the moderating role of avoidant coping. A sample of 291 adolescents (Age_mean = 18.27; 53% female; 61% White) and their parents rated their own anxiety and depressive symptoms and coping during the first two months following stay-at-home orders during the COVID-19 pandemic. Parent internalizing symptoms at the first assessment predicted adolescent internalizing symptoms at the second assessment. Adolescent avoidant coping style moderated this effect of parent internalizing symptoms on adolescent internalizing symptoms in the subsequent month, such that parent internalizing symptoms predicted child internalizing symptoms only among adolescents with moderate to high rates of avoidant coping. Follow-up analyses indicated different patterns when examining depressive and anxiety symptoms separately. The results highlight complex family dynamics between adolescents and their parents and begin to differentiate how individual characteristics impact the response to a significant life event such as the COVID-19 pandemic.

Bidirectional Relations between Parent Warmth and Criticism and the Symptoms and Behavior Problems of Children with Autism

Family research in the field of ASD has focused on describing the impact of child challenges on parents, usually mothers, and given little attention to the ways in which mothers and fathers reciprocally influence the development of the child with ASD. The current study examined the direction of effects between the emotional quality of the mother-child and father-child relationships and the child's severity of ASD symptoms and emotional and behavioral problems across three time points spanning 2 years. Using parent Five Minute Speech Samples and teacher ratings of the severity of the child's ASD symptoms and emotional and behavioral problems, four cross-lagged structural equation models were employed to test bidirectional effects between parent warmth and criticism and child ASD symptoms and emotional and behavioral problems across three waves of data (approximately 12 months apart) in 159 families who had a child with ASD (initially aged 6 to 13 years). Mothers and fathers had an average age of 39.53 (SD=5.55) and 41.66 years (SD=6.19). Children with ASD were predominately male (86.2%) and white, non-Hispanic (76.7%). Crossed-lagged model results indicated bidirectional effects for both mothers and fathers. Warmth in the mother-child relationship and father-child relationship impacted child functioning at earlier time points. In the opposite direction, child functioning impacted father warmth and mother criticism at later time points. Findings indicate that the emotional quality of the parent-child relationships are bidirectionally related to the symptoms and emotional and behavioral problems of children with ASD. Important implications for supporting families are discussed.

Polymorbidity of developmental disabilities: Additive effects on child psychosocial functioning and parental distress

BACKGROUND

While parents of children with developmental disabilities show greater parenting burden and distress compared with their counterparts, little is known about to what extent developmental polymorbidity in children escalates and magnifies the risk of parental distress.

AIMS

This study investigated the co-occurrence of developmental disabilities among a sample of elementary school children and examined its additive effects on child psychosocial functioning and parental distress.

METHODS AND PROCEDURES

A cross-sectional survey among 710 parents of elementary school children in Hong Kong included measures of child psychosocial functioning and parental stress. Structural equation modeling was used to test a hypothesized model in which child psychosocial functioning mediates the effect of developmental polymorbidity on parental distress.

OUTCOMES AND RESULTS

About one-fourth of the participants reported their children having two or more developmental disabilities. The number of developmental disabilities was positively related to the severity of emotional and behavioral problems in children, which in turn explained general and parenting distress in parents.

CONCLUSIONS AND IMPLICATIONS

Given the heightened vulnerability to distress among parents of children with multiple developmental disabilities, psychological care should particularly target this population. Early identification and intervention strategies are also needed to detect children with multiple co-occurring developmental disabilities, which could potentially alleviate their emotional and behavioral problems and lessen the parenting burden.

Non-native language proficiency may influence the responsiveness of bilingual parents towards young children with autism: A short report

BACKGROUND AND AIMS

Although bilingualism is a common worldwide phenomenon, limited research has considered the experiences of children with autism growing up in bilingual environments. Here, we investigated the potential influence of parental bilingualism, and native vs. non-native language use, on responsiveness to children's communication attempts during parent-child interactions where the child had autism. Specifically, we investigated the amount of parent responses to child verbal communication (frequency) and the promptness of these responses (temporal synchrony).

METHODS

Participants were 22 monolingual and 20 bilingual parents and their children with autism aged 2-6 years, recruited from a multicultural, metropolitan city where English is the dominant language. Extending from our previous report on this sample, we identified the frequency and temporal synchrony of parent responses from filmed 10-minute free-play sessions. Monolingual parents were videoed during one free-play session in English. Bilingual parents were videoed during two free-play sessions; one in their native language and one in English. We compared the frequency and temporal synchrony of parental responses across monolingual and bilingual parent groups and, for bilingual parents, across native vs. non-native (English) language interaction samples. Finally, we examined how other measures of bilingual parents' non-native language proficiency were associated with interaction responsiveness measures.

RESULTS

When using their native language, bilingual parents demonstrated reduced frequency of responsiveness (even when controlling for opportunities provided by the child) and less temporal synchrony to child communication compared to English-speaking monolingual parents. Bilingual parents were also less frequently responsive (but not less temporally synchronous) during their native- compared to during their non-native (English) language interactions. Moreover, for bilingual parents, more frequent responsiveness to child communication bids when interacting in non-native English was associated with greater assessed English vocabulary knowledge.

CONCLUSIONS

In this sample, use of non-native English did not appear to adversely affect how often, or how quickly, bilingual parents responded to their children's verbal communication bids. However, nor did we find evidence of a native-language advantage. Rather, during English-language interactions, when these bilingual parents were responsive towards their children, this was on par with rates and timing of responsiveness shown by English-speaking monolinguals. This may partly be explained by bilinguals' non-native language proficiency, and habitual use/personal dominance patterns.

IMPLICATIONS

These data suggest no definitive drawback of non-native language use for synchronous responsiveness by bilingual parents interacting with young children with autism. However, our data also serve to highlight the complex, multifaceted nature of adult bilingualism, and indicate the need for more research - with large, well-characterised samples - to permit strong conclusions concerning how parental language-use choices may influence children's natural learning environments, including in the context of autism and developmental language impairments.

An investigation into maternal use of telegraphic input to children with Down syndrome

Maternal input influences language development in children with Down syndrome (DS) and typical development (TD). Telegraphic input, or simplified input violating English grammatical rules, is controversial in speech-language pathology, yet no research to date has investigated whether mothers of children with DS use telegraphic input. This study investigated the quality of linguistic input to children with DS compared to age-matched children with TD, and the relationship between maternal input and child language abilities. Mothers of children with DS simplified their input in multiple ways, by using a lower lexical diversity, shorter utterances, and more telegraphic input compared to mothers of children with TD. Telegraphic input was not significantly correlated with other aspects of maternal input or child language abilities. Since children with DS demonstrate specific deficits in grammatical compared to lexical abilities, future work should investigate the long-term influence of maternal telegraphic input on language development in children with DS.

Medicaid Instability and Mental Health of Teen Parent Families

This study examines the effect of inconsistent Medicaid coverage on parenting stress, maternal depression, and child behavior in a sample of teen mothers and their children. The majority (54%) of mothers experienced inconsistent coverage. After 24 months, mothers experiencing inconsistent coverage had significantly higher parenting stress and depressive symptoms, and their children had more internalizing behaviors than families with consistent Medicaid. These differences existed despite no initial differences and controlling for numerous covariates. Policies and practices that stabilize Medicaid coverage for teen parent families may reduce unnecessary stress, depressive symptoms, and early childhood behavior problems.

Maternal Anxiety, Parenting Stress, and Preschoolers' Behavior Problems: The Role of Child Self-Regulation

OBJECTIVE

Maternal anxiety is a well-known risk factor for early childhood behavior problems. In this study, we explore (1) whether parenting stress mediates this relation and also (2) whether child factors, namely self-regulation, modify the influence of maternal well-being on child externalizing and internalizing problems at 4 years of age.

METHOD

Mothers taking part in the Growing Up in Singapore Towards Healthy Outcomes cohort completed the Spielberger State-Trait Anxiety Inventory when their children were 24 months of age. At 42 months of age, children performed a self-regulation task (n = 391), and mothers completed the Parenting Stress Index. When children were 48 months old, both parents completed the Child Behavior Checklist.

RESULTS

As predicted, parenting stress mediated the relation between maternal trait anxiety and child externalizing and internalizing problems. This mediating effect was further moderated by child self-regulation. The indirect effect of maternal trait anxiety through parenting stress on child externalizing problems was stronger among children with low self-regulation.

CONCLUSION

Parenting stress is an additional pathway connecting maternal trait anxiety and children's externalizing and internalizing behavior problems. The risk for child externalizing problems conveyed by elevated maternal trait anxiety and parenting stress may be buffered by better self-regulation in 4-year-olds. These results suggest that interventions that include decreasing parenting stress and enhancing child self-regulation may be important to limiting the transgenerational impact of maternal trait anxiety.

Maternal distress across the postnatal period is associated with infant secretory immunoglobulin A

Employing a longitudinal design, relationships between maternal distress (i.e., perceived stress, negative affect, depressive symptomology), and infant secretory immunoglobulin A (sIgA) across the peripartum period were examined in 51 mother-infant dyads. Indices of maternal distress were assessed at four time periods: third trimester of pregnancy and 1, 3, and 6 months postpartum. Infant saliva samples were collected at each of the three time points in the postpartum period to assess sIgA levels. No relationships were found between prenatal maternal distress and infant sIgA. Results indicated that during the postnatal period, higher concurrent maternal distress was associated with reduced infant sIgA. Maternal distress did not prospectively predict infant sIgA. These findings advance our understanding of the social-context of infant development, highlighting the significance of maternal regulation of infant immunity.

A Randomized Control Trial Evaluating an Online Mindful Parenting Training for Mothers With Elevated Parental Stress

Objectives

The prevalence of maternal stress in early years of parenting can negatively impact child development. Therefore, there is a need for an early intervention that is easily accessible and low in costs. The current study examined the effectiveness of an 8-session online mindful parenting training for mothers with elevated levels of parental stress.

Methods

A total of 76 mothers were randomized into an intervention (n = 43) or a waitlist control group (n = 33). The intervention group completed pretest assessment prior to the online intervention. Participants completed a post intervention assessment after the 10 weeks intervention and a follow-up assessment 10 weeks later. The waitlist group completed waitlist assessment, followed by a 10-week waitlist period. After these 10 weeks, a pretest assessment took place, after which the waitlist group participants also started the intervention, followed by the posttest assessment. Participating mothers completed questionnaires on parental stress (parent-child interaction problems, parenting problems, parental role restriction) and other maternal (over-reactive parenting discipline, self-compassion, symptoms of depression and anxiety) and child outcomes (aggressive behavior and emotional reactivity) while the non-participating parents (father or another mother) were asked to also report on child outcomes.

Results

The online mindful parenting intervention was shown to be significantly more effective at a 95% level than a waitlist period with regard to over-reactive parenting discipline and symptoms of depression and anxiety (small and medium effect sizes), and significantly more effective at a 90% level with regard to self-compassion, and mother-rated child aggressive behavior and child emotional reactivity (small effect sizes). The primary outcome, parental stress, was found to have a 95% significant within-group effect only for the subscale parental role restriction (delayed small effect size improvement at follow-up). No significant improvements on child outcomes were found for the non-participating parent.

Conclusion

To conclude, the results provide first evidence that an online mindful parenting training may be an easily accessible and valuable intervention for mothers with elevated levels of parental stress.

Maternal Responsiveness to Gestures in Children With Down Syndrome

PURPOSE

This study compared gesture use in young children with Down syndrome (DS) and typical development (TD) as well as how mothers respond to child gestures based on child age and diagnosis.

METHOD

Twenty-two mother-child dyads with DS and 22 mother-child dyads with TD participated. The child participants were between 22 and 63 months and were matched on chronological age. We coded child gesture use and whether mothers recoded child gestures (i.e., provided a verbal translation) during naturalistic interactions.

RESULTS

The children with DS used more gestures than peers with TD. After controlling for expressive language ability, the two groups were not significantly different on child gesture use. Regardless of child diagnosis, mothers recoded approximately the same percentage of child gestures. There was a significant interaction between child diagnosis and child age when predicting the percentage of maternal gesture recodes; mothers of children with DS did not demonstrate differences in the percentage of maternal gesture recodes based on child age, but there was a negative relationship between the percentage of maternal gesture recodes and child age for the children with TD.

CONCLUSIONS

Young children with DS gesture more than chronological age-matched children with TD, therefore providing numerous opportunities for caregivers to recode child gestures and support language development. Early intervention should focus on increasing parent responsiveness to child gestures earlier in life in order to provide additional word-learning opportunities for children with DS.

Relations Among Maternal Life Satisfaction, Shared Activities, and Child Well-Being

Maternal well-being is assumed to be associated with well-being of individual family members, optimal parenting practices, and positive developmental outcomes for children. The objective of this study was to examine the interplay between maternal well-being, parent-child activities, and the well-being of 5- to 7-year-old children. In a sample of N = 291 mother-child dyads, maternal life satisfaction, the frequency of shared parent-child activities, as well as children's self-regulation, prosocial behavior, and receptive vocabulary were assessed using several methods. Data were collected in a special study of the Socio-Economic Panel Study (SOEP), a representative longitudinal survey of private households in Germany. Using structural equation modeling, significant positive direct and indirect relations between maternal life satisfaction, frequency of shared parent-child activities, children's self-regulation, prosocial behavior, and receptive vocabulary were found. The more satisfied the mother was, the more she shared activities with her child and the more the child acted prosocially. Furthermore, the higher the frequency of shared parent-child activities, the higher the child scored in all three analyzed indicators of children's well-being: self-regulation, prosocial behavior, and receptive vocabulary. The current study supports the assumption of maternal well-being as the basis of positive parenting practices and child well-being.

Child internalizing problems and mother-child discrepancies in maternal rejection: Evidence for bidirectional associations

We investigated the bidirectional associations between mother-child discrepancies in their perceptions of maternal rejection and children's internalizing problems over 10 years from pre/early adolescence to early adulthood. Mothers' reports of rejection and involvement in the parent-child relationship, the children's perception of the mother's rejection, and children's self-report of internalizing problems were collected from a sample of 360 low-income ethnically diverse urban mother-child dyads at three time points (T1, T2, and T3) with 5-year intervals. Children were on average 12.6 years old at T1 (54% girls). Using a series of nested path analyses, we found that mother-child discrepancies while reporting maternal rejection at T1 were predictive of lower ratings of maternal involvement at T2 (β = -.14), which predicted higher levels of internalizing problems at T3 (β = -.16). The presence of mother's affective disorder was related to T1 mother-child discrepancies (β = .14). Regarding bidirectional associations, children's internalizing problems predicted maternal involvement across all time points, whereas T2 maternal involvement predicted T3 child internalizing problems. Discrepancies showed small associations with child internalizing problems both concurrently and over time. The findings highlight the importance of early discrepancies in the perception of maternal rejection for child internalizing symptoms. (PsycINFO Database Record

Recognizing Maternal Depressive Symptoms: An Opportunity to Improve Outcomes in Early Intervention Programs

Objective A higher rate of depressive symptoms is found among mothers of children with disabilities compared to other parents. However, there is a lack of study of mothers with children <3 years of age participating in Early Intervention (EI) programs. This study aims to more fully describe the extent of mood disorders in these mothers including estimated prevalence, severity and factors associated with maternal mental health, using gold standard clinical diagnostic and symptom measures, and test models associating depressive symptoms with contextual factors and child behavior. Methods A cross-sectional study was conducted with 106 women who had at least one child enrolled in EI. Mothers were interviewed and completed reliable, valid measures to evaluate mental health, health status, family conflict, parent-child interaction, self-efficacy, social support, child behavioral problems, hardship, endangerment, and child disability. Descriptive statistics and multivariate analyses were performed. Results We found 8 % of participants met all criteria for a Major Depressive Episode (MDE) with 44 % of the sample reporting a past episode and 43 % endorsing recurrent episodes. Using the CES-D to assess depressive symptom severity approximately 34 % of mothers screened in a clinically significant range. Using linear regression to predict severity of current depressive symptoms demonstrated that current depression severity was primarily predicted by poorer maternal health status, lower self-efficacy and past MDE (p < 0.05). Conclusions for practice A brief assessment of maternal mood, health and self-efficacy are important factors to assess when evaluating how to support mothers of children in EI.

Agreement and Disagreement on Emotional and Behavioral Problems in a Sample of Preschool-Age Children

The present study aimed to identify predictors of agreement and disagreement concerning emotional and behavioral problems reported by the mothers and teachers of preschool-aged children. Participants included 172 (89 boys) children, their mothers, and their preschool teachers. Mothers were asked to complete the Child Behavior Checklist for Ages 1½-5 (CBCL 1½-5), the Brief Symptom Inventory (BSI), and a sociodemographic questionnaire, and were observed engaging in an interactive task with their child. Preschool teachers completed the Caregiver Teacher Report Form for Ages 1½-5 (CTRF). The results show low cross-informant agreement. None of the studied variables predicted cross-informant agreement; however, maternal psychopathology and the presence of an assistant in the classroom were predictors of disagreement between mothers and teachers. Although these results highlight the influence of maternal and school context variables on the disagreement among informants’ reports on the emotional and behavioral problems of preschool-aged children, additional research in this field is needed.

The relationships between father involvement and parental acceptance on the psychological adjustment of children and adolescents: The moderating effects of clinical status

This study analyzes how a child's clinical condition modifies the relationship of father involvement, parental (fathers and mothers) acceptance and the child´s psychological adjustment, including the internalizing and externalizing problems. The cohort studied was composed of 226 subjects (61.94% males) with a mean age of 14.08 years, of which 113 children were from an incidental clinical sample and 113 from the general population. Both groups were matched by sex, age and family status, and the data show that the same structure of parent-child relationships that predict the child´s psychological adjustment can be accepted for both the clinical and non-clinical groups of children. However, the intensity of the relationships between the variables father involvement, parental acceptance and the child´s outcomes differed in function of the child's clinical status. Specifically, in the clinically-referred sample compared to non-clinical sample father involvement had a stronger effect on the children´s internalizing (but not the externalizing) problems and on their global psychological adjustment via their perceived maternal acceptance. The role of father involvement in the family relationships of clinical children is discussed. This study provides important evidence to support the need for enhanced paternal participation in the intervention programs for families.

Engaging national and regional partners to accelerate broad-scale implementation of nurse-developed interventions

Only a small proportion of research-tested interventions translate into broad-scale implementation in real world practice, and when they do, it often takes many years. Partnering with national and regional organizations is one strategies that researchers may apply to speed the translation of interventions into real-world practice. Through these partnerships, researchers can promote and distribute interventions to the audiences they want their interventions to reach. In this paper, we describe five nurse scientists' programs of research and their partnerships with networks of national, regional, and local organizations, including their initial formative work, activities to engage multi-level network partners, and lessons learned about partnership approaches to speeding broad-scale implementation.

Maternal psychological distress and child decision-making

BACKGROUND

There is much research to suggest that maternal psychological distress is associated with many adverse outcomes in children. This study examined, for the first time, if it is related to children's affective decision-making.

METHODS

Using data from 12,080 families of the Millennium Cohort Study, we modelled the effect of trajectories of maternal psychological distress in early-to-middle childhood (3-11 years) on child affective decision-making, measured with a gambling task at age 11.

RESULTS

Latent class analysis showed four longitudinal types of maternal psychological distress (chronically high, consistently low, moderate-accelerating and moderate-decelerating). Maternal distress typology predicted decision-making but only in girls. Specifically, compared to girls growing up in families with never-distressed mothers, those exposed to chronically high maternal psychological distress showed more risk-taking, bet more and exhibited poorer risk-adjustment, even after correction for confounding. Most of these effects on girls' decision-making were not robust to additional controls for concurrent internalising and externalising problems, but chronically high maternal psychological distress was associated positively with risk-taking even after this adjustment. Importantly, this association was similar for those who had reached puberty and those who had not.

LIMITATIONS

Given the study design, causality cannot be inferred. Therefore, we cannot propose that treating chronic maternal psychological distress will reduce decision-making pathology in young females.

CONCLUSIONS

Our study suggests that young daughters of chronically distressed mothers tend to be particularly reckless decision-makers.

The association between parental mental health and behavioral disorders in pre-school children

Background and Aim

Behavioral disorders among children reflect psychological problems of parents, as mental illness of either parent would increase the likelihood of mental disorder in the child. In view of the negative relationship between parents’ and children’s illness, the current study intended to determine the correlation between mental health of parents and behavioral disorders of pre-school children.

Methods

The present descriptive-correlational research studied 80 children registered at pre-school centers in Pardis Township, Tehran, Iran during 2014–2015 using convenience sampling. The research tools included General Health Questionnaire (GHQ) and Preschool Behavior Questionnaire (PBQ). The resulted data were analyzed using Pearson Product-moment Correlation Coefficient and regression analysis in SPSS 21.

Results

The research results showed that there was a significant positive correlation between all dimensions of mental health of parents with general behavioral disorders (p<0.001). The results of the regression analysis showed that parents’ depression was the first and the only predictive variable of behavioral disorders in children with 26.8% predictive strength.

Conclusion

Given the strong relationship between children’s behavioral disorders and parents’ general health, and the significant role of parents’ depression in children’s behavioral disorders, it seems necessary to take measures to decrease the impact of parents’ disorders on children.

Early Childhood Precursors and School age Correlates of Different Internalising Problem Trajectories Among Young Children

It is unclear why trajectories of internalising problems vary between groups of young children. This is the first attempt in the United Kingdom to identify and explain different trajectories of internalising problems from 46 to 94 months. Using both mother- and child-reported data from the large Growing Up in Scotland (GUS) birth cohort (N = 2901; male N = 1497, female N = 1404), we applied growth mixture modelling and multivariable multinomial regression models. Three trajectories were identified: low-stable, high-decreasing and medium-increasing. There were no gender differences in trajectory shape, membership, or importance of covariates. Children from both elevated trajectories shared several early risk factors (low income, poor maternal mental health, poor partner relationship, pre-school behaviour problems) and school-age covariates (low mother-child warmth and initial school maladjustment) and reported fewer supportive friendships at 94 months. However, there were also differences in covariates between the two elevated trajectories. Minority ethnic status and pre-school conduct problems were more strongly associated with the high-decreasing trajectory; and covariates measured after school entry (behaviour problems, mother-child conflict and school maladjustment) with the medium-increasing trajectory. This suggests a greater burden of early risk for the high-decreasing trajectory, and that children with moderate early problem levels were more vulnerable to influences after school transition. Our findings largely support the sparse existing international evidence and are strengthened by the use of child-reported data. They highlight the need to identify protective factors for children with moderate, as well as high, levels of internalising problems at pre-school age, but suggest different approaches may be required.

Family Interactions and Developmental Risk Associated With Early Cognitive Delay: Influences on Children's Behavioral Competence

Family interactions can be important contributors to the development of child psychopathology, yet the mechanisms of influence are understudied, particularly for populations at risk. This prospective longitudinal study addresses differences in whole family interactions in 194 families of young children with and without early-identified developmental risk associated with cognitive delay. The influence of family interactions on children's later externalizing behaviors, internalizing behaviors, and social skills was examined, and developmental risk was tested as a potential moderator of these relations. Results indicated that the presence of cognitive developmental risk was linked to higher levels of family control than in families of typically developing children, but groups did not differ on dimensions of cohesion, warmth, organization, or conflict. Observed cohesion and organization were associated with better social skills for all children, regardless of risk status. Significant interactions emerged, indicating that higher levels of conflict and control were associated with higher levels of behavior problems, but only for families of typically developing children. These findings underscore the importance of family-level assessment in understanding the development of children's behavior and suggest the need for deeper analysis of the nuances of family process over time.

Associations between maternal and paternal depressive symptoms and early child behavior problems: Testing a mutually adjusted prospective longitudinal model

BACKGROUND

While there is substantial empirical work on maternal depression, less is known about how mothers' and fathers' depressive symptoms compare in their association with child behavior problems in early childhood. In particular, few studies have examined unique relationships in the postpartum period by controlling for the other parent, or looked at longitudinal change in either parent's depressive symptoms across the first living years as a predictor of child problems.

METHODS

We examined depressive symptoms in parents at 6, 12, 24, 36 and 48 months following childbirth, and child behavior problems at 48 months. Linear growth curve analysis was used to model parents' initial levels and changes in symptoms across time and their associations with child outcomes.

RESULTS

Mothers' depressive symptoms at 6 months predicted behavior problems at 48 months for all syndrome scales, while fathers' did not. Estimates for mothers' symptoms were significantly stronger on all subscales. Change in fathers' depressive symptoms over time was a significantly larger predictor of child aggressive behavior than corresponding change in mothers'. No interaction effects between parents' symptoms on behavior problems appeared, and few child gender differences.

LIMITATIONS

Child behavior was assessed once precluding tests for bidirectional effects. We only looked at linear change in parental symptoms.

CONCLUSIONS

Mothers' postpartum depressive symptoms are a stronger predictor for early child behavior problems than fathers'. Change in fathers' depressive symptoms across this developmental period was uniquely and strongly associated with child aggressive problems, and should therefore be addressed in future research and clinical practice.

Early identification of social-emotional problems: Applicability of the Infant-Toddler Social Emotional Assessment (ITSEA) at its lower age limit

ITSEA is an often recommended tool for assessment of social-emotional problems and competence delays in children aged 12-36 months, but concerns have been raised about low variability and age-inappropriate questions for children as young as 12 months. This study explored ITSEA's (1) psychometric properties, (2) properties concerning the detection of clinically significant problems and competence delays and (3) discriminant validity at 12 months. A total of 102 children with high versus low risk scores on marker measures of developmental status and parenting stress obtained at 6 months, were selected from a longitudinal population-based study to participate in the present study. Risk status was operationalized as Bayley III Screening Test (Bayley, 2005a. Bayley scales of infant and toddler development: Screening test manual (3rd ed.). San Antonio, TX: Pearson) Composite Subscale scores and Parenting Stress Index total score (PSI, 3rd edition, Abidin, 1995. Parenting Stress Index. Professional manual. (3rd ed.). Odessa, FL: Psychological Assessment Resources). At 12 months, ITSEA was administered to parents as a structured interview to identify guidance needs and to collect qualitative information about the items, and the assessment of developmental level and parenting stress was repeated. All ITSEA domains and subscales were found to be relevant. However, nearly all respondents needed guidance. Moreover, there were substantial floor/ceiling effects on subscale level and one item had to be discarded. ITSEA was used in combination with the Bayley-III Screener and PSI to detect cases with clinically significant scores, with ITSEA making a unique contribution to case detection. Dysregulation problems were the most frequently detected, and the differences between high-risk and low-risk group children and gender differences indicated adequate discriminant validity. The results suggest that ITSEA may be meaningfully applied even among children as young as 12 months.

The role of co-parenting alliance as a mediator between trait anxiety, family system maladjustment, and parenting stress in a sample of non-clinical Italian parents

This study investigated the role of co-parenting alliance in mediating the influence of parents’ trait anxiety on family system maladjustment and parenting stress. A sample of 1606 Italian parents (803 mothers and 803 fathers) of children aged one to 13 years completed measures of trait anxiety (State Trait Anxiety Inventory—Y), co-parenting alliance (Parenting Alliance Measure), family system maladjustment (Family Assessment Measure—III), and parenting stress (Parenting Stress Inventory—Short Form). These variables were investigated together comparing two structural equations model-fitting including both partners. A model for both mothers and fathers was empirically devised as a series of associations between parent trait anxiety (independent variable), family system maladjustment and parenting stress (dependent variables), mediated by co-parenting alliance, with the insertion of cross predictions between mothers and fathers and correlations between dependent variables for both parents. Results indicated that the relation between mothers and fathers’ trait anxiety, family system maladjustment and parenting stress was mediated by the level of co-parenting alliance. Understanding the role of couples’ co-parenting alliance could be useful during the family assessment and/or treatment, since it is an efficient and effective tool to improve the family system maladjustment and stress.

Wait until your father gets home? Mother's and fathers' spanking and development of child aggression

This study examined whether fathers' and mothers' spanking contributed to development of child aggression in the first 5 years of life. We selected parents (N =1,298) who were married or cohabiting across all waves of data collection. Cross-lagged path models examined fathers', mothers', and both parents' within-time and longitudinal associations between spanking and child aggression when the child was 1, 3, and 5 years of age. Results indicated that mothers spanked more than fathers. When examining fathers only, fathers' spanking was not associated with subsequent child aggression. When examining both parents concurrently, only mothers' spanking was predictive of subsequent child aggression. We found no evidence of multiplicative effects when testing interactions examining whether frequent spanking by either fathers or mothers was predictive of increases in children's aggression. This study suggests that the processes linking spanking to child aggression differ for mothers and fathers.

Transactional Patterns of Maternal Depressive Symptoms and Mother-Child Mutual Negativity in an Adoption Sample

Transactional models of analysis can examine both moment-to-moment interactions within a dyad and dyadic patterns of influence across time. This study used data from a prospective adoption study to test a transactional model of parental depressive symptoms and mutual negativity between mother and child over time, utilizing contingency analysis of second-by-second behavioral data. To consider both genetic and environmental influences on mutual negativity, depressive symptoms were examined in both adoptive and birth mothers. Adoptive mother depressive symptoms at 9 months increased the likelihood that, at 18 months, children reacted negatively to their mothers' negative behavior, which in turn predicted higher levels of adoptive mother depressive symptoms at 27 months, suggesting that over time, mothers' depressive symptoms influence and are influenced by moment-to-moment mutual negativity with their toddlers. Birth mother depressive symptoms moderated the association between mutual negativity at 18 months and adoptive mother depressive symptoms at 27 months, suggesting a child-driven contribution to maternal depressive symptoms that can be measured by a genetic sensitivity.