Changes in self-reported and observed parenting following a randomized control trial of parent-child interaction therapy for the treatment of preschool depression

Preschool Mood Disorders: A Review of the Literature from 2017 to 2024

Depression symptoms that onset during early childhood are increasingly recognized as a significant public health concern. A proliferation of research over the last 2 decades has identified preschool depression as a diagnostic reality that is associated with a severe and persistent course of depression throughout the lifespan. The current review summarizes the research on preschool depression from the last 7 years (2017-2024), with a particular focus on the assessment of, factors and outcomes associated with, neurobiological underpinnings of, and treatments for preschool depression. We also discuss potential avenues of inquiry that further elucidate the nature of preschool depression.

Early Emotion Development Intervention Improves Mental Health Outcomes in Low-Income, High-Risk Community Children

Children living in poverty and facing related forms of adversity are at higher risk for experiencing concurrent and later psychopathology. Although negative psychological outcomes can be improved by enhancing sensitive and responsive caregiving early in development, interventions targeting the caregiver-child dyad are not readily accessible. The present study investigated the feasibility and effectiveness of delivering a shortened eight-session form of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) in-person or remotely as an early intervention for 3-6-year-old children (N = 62) at elevated risk for psychopathology who were growing up in low-income communities. Caregiver-child dyads were randomized to eight-sessions of PCIT-ED or online parenting education. Relative to parenting education, children receiving PCIT-ED exhibited lower externalizing symptoms and functional impairment and more positive peer relationships following the intervention. Findings support the effectiveness of this shortened form of PCIT-ED, delivered in-person or remotely, as an early intervention to improve symptoms of psychopathology and functioning in high-risk children living in poverty.Trial registration Clinicaltrials.gov; NCT04399629.

Observations of Positive Parenting from Online Parent-Child Interactions at Age 1

Objective

Brief, reliable, and cost-effective methods to assess parenting are critical for advancing parenting research.

Design

We adapted the Three Bags task and Parent Child Interaction Rating System (PCIRS) for rating online visits with 219 parent-child dyads (White, n = 104 [47.5%], Black, n = 115 [52.5%]) and combined the video data with survey data collected during pregnancy and when children were aged 1.

Results

The PCIRS codes of positive regard, stimulation of child cognitive development, and sensitivity showed high reliability across the three parent-child interaction tasks. A latent positive parenting factor combining ratings across codes and tasks showed good model fit, which was similar regardless of parent self-identified race or ethnicity, age, socioeconomic disadvantage, marital/partnered status, and parity, as well as methodological factors relevant to the online video assessment method (e.g., phone vs. laptop/tablet). In support of construct validity, observed positive parenting was related to parent-reported positive parenting and child socioemotional development. Finally, parent reports of supportive relationships in pregnancy, but not neighborhood safety or pandemic worries, were prospectively related to higher positive parenting observed at age 1. With the exception of older parental age and married/partnered status, no other parent, child, sociodemographic, or methodological variables were related to higher overall video exclusions across tasks.

Conclusions

PCIRS may provide a reliable approach to rate positive parenting at age 1, providing future avenues for developing more ecologically valid assessments and implementing interventions through online encounters that may be more acceptable, accessible, or preferred among parents of young children.

Novel mechanism-based treatments for pediatric anxiety and depressive disorders

Pediatric anxiety and depressive disorders are common, can be highly impairing, and can persist despite the best available treatments. Here, we review research into novel treatments for childhood anxiety and depressive disorders designed to target underlying cognitive, emotional, and neural circuit mechanisms. We highlight three novel treatments lying along a continuum relating to clinical impact of the disorder and the intensity of clinical management required. We review cognitive training, which involves the lowest risk and may be applicable for problems with mild to moderate impact; psychotherapy, which includes a higher level of clinical involvement and may be sufficient for problems with moderate impact; and brain stimulation, which has the highest potential risks and is therefore most appropriate for problems with high impact. For each treatment, we review the specific underlying cognitive, emotional, and brain circuit mechanisms that are being targeted, whether treatments modify those underlying mechanisms, and efficacy in reducing symptoms. We conclude by highlighting future directions, including the importance of work that leverages developmental windows of high brain plasticity to time interventions to the specific epochs in childhood that have the largest and most enduring life-long impact.

A Dynamic Systems Analysis of Dyadic Flexibility and Shared Affect in Preschoolers with and Without Major Depressive Disorder

Preschool onset Major Depressive Disorder (PO-MDD) is a severe disorder often leading to chronic impairment and poor outcomes across development. Recent work suggests that the caregiver-child relationship may contribute to PO-MDD symptoms partially through disrupted caregiver-child interactions. The current study uses a dynamic systems approach to investigate whether co-regulation patterns in a dyad with a child experiencing PO-MDD differ from dyads with a child without the disorder. Preschoolers between the ages of 3-7 years-old (N = 215; M(SD) = 5.22(1.06); 35% girls; 77% white) were recruited for a randomized controlled trial of an adapted version of parent-child interaction therapy. An additional sample (N = 50; M(SD) = 5.17(.84)' 34% girls; 76% white) was recruited as a control group. Dyads completed two interactive tasks and affect was coded throughout the interaction. State Space Grids (SSG) were used to derive measures of dyadic affective flexibility (i.e., affective variability in dyadic interactions) and shared affect. PO-MDD dyads did not differ from controls in dyadic affective flexibility. However, there were significant differences in shared positive and neutral affect. PO-MDD dyads spent less time and had fewer instances of shared positive affect and spent more time and had more instances of shared neutral affect than the community control group. These comparisons survived multiple comparisons correction. There were no differences for shared negative affect. Findings suggest that children experiencing PO-MDD have differing dyadic affective experiences with their caregivers than healthy developing children, which may be a mechanism through which depressive states are reinforced and could be targeted for treatment.

Preliminary perceived intervention changes and engagement in an evidence-based program targeted at behavioral inhibition during early childhood, delivered in-person and online

Introduction

Behavioral inhibition during early childhood is one of the strongest risk factors for the development of later anxiety disorders. Recently developed in-person interventions that target both young children who are highly inhibited and their parents (e.g., the Turtle Program), have decreased children's anxiety and have increased social participation in the peer group. However, researchers have yet to examine the effects of intervention mode of delivery. In the present study, we compared the pre-to post-intervention changes in child and parenting functioning of families participating in the Turtle Program, delivered in-person and online with those changes made in families allocated to a waiting-list condition; compared session attendance, homework completion and satisfaction with the intervention outcomes of families involved in the Turtle Program, delivered in-person and online; and explored the predictive role of parenting and child factors in session attendance, homework completion and satisfaction with the outcomes of families involved in the Turtle Program, depending on the mode of delivery (in-person vs. online).

Method

Fifty-seven parents of highly inhibited preschoolers (3-5 years), with no diagnosis of selective mutism or developmental disorders, who were randomly allocated to waiting-list (n = 20), Turtle Program delivered in-person (n = 17) and online (n = 20) conditions completed the Portuguese versions of the Behavioral Inhibition Questionnaire, the Preschool Anxiety Scale, the Social Behavior and Competence Scale, the Modified Child-Rearing Practices Questionnaire at pre- and post-intervention assessment. Parents also completed the Preschool Shyness Study Satisfaction Survey at post-intervention assessment.

Results

Independent of intervention mode of delivery, generalized equation estimates revealed a reduction in children's total anxiety symptoms and an improvement in parental nurturing behaviors. Child anxiety and social competence at pre-assessment were the most prominent predictors of session attendance and satisfaction with post-intervention child and parenting outcomes.

Discussion

Overall, this study showed that parents in both intervention conditions perceived comparable positive changes in child functioning from pre- to post-intervention assessment and similar levels of session attendance, homework completion, and satisfaction. Significantly, however, perceived satisfaction with post-intervention child and parenting outcomes was higher, when children were reported to display higher SEL skills at baseline, independent of the intervention mode of delivery.

Scientific collaborations and research trends in Parent-Child Interaction Therapy: a bibliometric analysis

Parent-child interaction therapy (PCIT) is considered to be an effective intervention for children aged 2-7 years with conduct problems. PCIT research has been conducted for approximately 50 years; however, an analysis of general research patterns has not been published. In this context, the present study outlines a bibliometric analysis of scientific collaborations, prevalence across locations on the basis of countries and organizations, leading researchers, and trends within PCIT research. Findings demonstrate that PCIT is an area in which international scientific collaborations are intense and current, and collaborations continue to be formed around the world. Additionally, results indicate that dissemination of intercultural PCIT adaptations are continuous.

Children's Maternal Representations Moderate the Efficacy of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) Treatment For Preschool Depression

A randomized controlled trial (RCT) demonstrated that a novel psychotherapy, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), effectively treats preschool-onset depression. However, little is known about which children benefit most from PCIT-ED. As positive parent-level factors are associated with lesser depressive symptoms, this study explored the potential moderating role of positive parenting relationships on PCIT-ED efficacy. This study examined mothers and their children aged 3-6 (N = 185) who participated in the PCIT-ED RCT. Children were randomized to immediate PCIT-ED treatment (n = 94) or a waitlist control condition (n = 91) that received treatment after 18 weeks. Prior to treatment, children completed a narrative story completion task that was videotaped and coded for children's positive and negative representations of their mothers. Parent-child interaction tasks were also completed pre-treatment and videotaped and coded to measure observed parenting. Odds of MDD diagnosis post-treatment were predicted by the interaction of children's negative maternal representations and treatment group (Estimate = -.68; SE = .27; [Formula: see text] = 6.45; p = .01) and the interaction of children's relatively more positive than negative maternal representations and treatment group (Estimate = .30; SE = .13; [Formula: see text] = 5.27; p = .02). Observed parenting measures did not significantly predict odds of MDD diagnosis. Thus, PCIT-ED predicted loss of MDD diagnosis for children who displayed maternal representations that were less negative, and relatively more positive than negative. Results suggest that children with relatively more positive maternal representations may be more likely to benefit from PCIT-ED, whereas children with more negative maternal representations may need targeted work to decrease negative maternal perceptions before initiating PCIT-ED in order for treatment to be most effective.

Trauma-Directed Interaction (TDI): An Adaptation to Parent-Child Interaction Therapy for Families with a History of Trauma

Parent-Child Interaction Therapy (PCIT) is one of the strongest evidence-based treatments available for young children and their families. Research has supported the use of PCIT for children with a history of trauma; however, the treatment does not directly address trauma in the child. PCIT is a dyadic treatment; yet, the impact of the carer’s trauma on the carer-child relationship is not assessed or incorporated into treatment. For these reasons, therapists, families, agencies, and funders tend to view PCIT as a trauma treatment with skepticism. PCIT therapists who currently address trauma within the intervention do so without a standardized approach. Trauma-Directed Interaction (TDI) is an adaptation developed to directly address these concerns. TDI maintains the key elements and theoretical underpinnings of PCIT while adding sessions to cover psychoeducation about trauma, carer response to a child’s trauma reactions (SAFE skills), and coping skills to aid both the child and the carer to manage trauma activators (COPE skills). The TDI module creates a consistent strategy for PCIT therapists to address trauma, thus allowing research and replication which will advance the dual fields of PCIT and family trauma. The theoretical conceptualization of TDI is presented along with next steps in its evaluation.