The effects of early positive parenting and developmental delay status on child emotion dysregulation

The Emotion Dysregulation Inventory-Young Child: Psychometric Properties and Item Response Theory Calibration in 2- to 5-Year-Olds

OBJECTIVE

The Emotion Dysregulation Inventory (EDI) was designed and validated to quantify emotion dysregulation (ED) in children aged 6+ years. The purpose of this study was to adapt the EDI for use in young children (EDI-YC).

METHOD

Caregivers of 2,139 young children (aged 2-5 years) completed 48 candidate EDI-YC items. Factor and item response theory (IRT) analyses were conducted separately for clinical (neurodevelopmental disabilities; N = 1,369) and general population (N = 768) samples. The best-performing items across both samples were selected. Computerized adaptive testing simulations were used to develop a short-form version. Concurrent calibrations and convergent/criterion validity analyses were performed.

RESULTS

The final calibrated item banks included 22 items: 15 items for Reactivity, characterized by rapidly escalating, intense, and labile negative affect, and difficulty down-regulating that affect; and 7 items for Dysphoria, characterized primarily by poor up-regulation of positive emotion, as well an item each on sadness and unease. The final items did not show differential item functioning based on age, sex, developmental status, or clinical status. IRT co-calibration of the EDI-YC Reactivity with psychometrically robust measures of anger/irritability and self-regulation demonstrated its superiority in assessing emotion dysregulation in as few as 7 items. EDI-YC validity was supported by expert review and its association with related constructs (eg, anxiety, depression, aggression, temper loss).

CONCLUSION

The EDI-YC captures a broad range of emotion dysregulation severity with a high degree of precision in early childhood. It is suitable for use in all children aged 2 to 5 years, regardless of developmental concerns, and would be an ideal broadband screener for emotional/behavioral problems during well-child checks and to support early childhood irritability and emotion regulation research.

Short-term effects of the "I Spy Feelings" program on emotion regulation in 5- to 6-year-old children

Introduction

Mental health difficulties in early childhood can have a debilitating and ongoing impact throughout an individual's life; emotion regulation can serve as a protective factor. Therefore, evidence-based prevention programs that teach children effective skills and strategies for emotion regulation are needed.

Methods

As part of the Aussie Optimism pilot study evaluating the "I Spy Feelings" program, this study aims to assess the short-term effects of the program on emotion regulation in pre-primary aged children after 2 months via a longitudinal cluster randomized controlled trial. Participants included parents (N = 73) of 5- to 6-year-old children attending four different Catholic primary schools. Children from two of the schools were allocated to the intervention group where they participated in the program (N = 33), while children from the other two schools were allocated to the control group where they did not (N = 40). At each time point, all parents completed abridged Children's Emotional Management Scales measuring how well parents believe their child is able to cope with anger, sadness and worry.

Results

A significant intervention effect 2 months after intervention was found for the outcome of anger coping such that parents whose children were in the intervention group reported significantly greater improvement in their children's ability to cope with anger compared to parents whose children were in the control group. No significant effect was found for the outcome of sadness, and results for the worry subscale were inconclusive due to unacceptable internal consistency.

Discussion

The present study provides insight into the benefit of programs designed to enhance the emotion regulation skills of very young children. Further follow-up is needed to assess whether the "I Spy Feelings" program has lasting effects.

Mother-infant interaction and maternal postnatal psychological distress are associated with negative emotional reactivity among infants and toddlers- A FinnBrain Birth Cohort study

Studies have reported mixed findings regarding the effects of mother-infant interaction and maternal distress on children's negative emotional reactivity. In the current study (N = 134 and 107), we examined the effects of maternal Emotional Availability (sensitivity, structuring, non-intrusiveness and non-hostility) and maternal psychological distress on negative reactivity among children in the FinnBrain birth cohort study. In addition, the possible moderating effect of mother-infant interaction on the associations between maternal psychological distress and children's negative reactivity was examined. We used questionnaires to asses maternal psychological distress, observations of mother-infant interaction and observations as well maternal reports of child temperament to overcome the key limitations of many studies relying on single-method assessments. Our results showed that higher maternal sensitivity and structuring at 8 months of child's age were associated with lower mother-reported negative reactivity among children at 24 months. Higher maternal postnatal distress associated with higher parent-reported negative reactivity in children at 12 and 24 months of age when the effects of prenatal distress and the quality of mother-infant interaction were controlled for. Mother-infant interaction and maternal psychological distress did not associate with observations of child negative reactivity. We found no moderation effects of mother-infant interaction regarding the associations between maternal distress and children's negative emotional reactivity. Our findings reflect the importance of developing interventions to reduce the maternal distress symptoms while enhancing maternal sensitivity and structuring to prevent the possible harmful effects of these on child negative reactivity.

Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting

As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3-6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother-child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes.

Telehealth Treatment of Behavior Problems in Young Children With Developmental Delay: A Randomized Clinical Trial

Importance

Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD.

Objective

To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD.

Design, Setting, and Participants

A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories.

Interventions

Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU).

Main Outcomes and Measures

Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups.

Results

The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).

Conclusions and Relevance

Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families.

Trial Registration

ClinicalTrials.gov Identifier: NCT03260816.

The role of parental playfulness as a moderator reducing child behavioural problems among children with intellectual disability in Israel

BACKGROUND

Playfulness is well known to be vital for child development. However, not much is known regarding parental playfulness. We set out to investigate the role of parental playfulness in children with intellectual disabilities (ID) and typical development (TD) living in Israel. Specifically, we examined 1) differences in parental playfulness between groups and 2) parental playfulness as a moderator in the link between developmental status and behavioural problems (BP).

METHOD

One hundred forty-two families living in Israel and their children (48 % with ID) aged 4-7 years participated in the study. Parent-child play interaction was videotaped and coded for parental playfulness. Parents reported on child BP using the CBCL questionnaire.

RESULTS

Parents in the ID group showed lower levels of playfulness compared to parents in the TD group. Father's playfulness acted as a moderator in the link between developmental status and child BP.

CONCLUSIONS

These results highlight the unique role of father's playfulness in the developmental status of a child diagnosed with ID.

Parenting behaviors of mothers and fathers of young children with intellectual disability evaluated in a natural context

The aims of this study were to analyze the interactions of mothers and fathers with their children with intellectual disabilities, focusing on certain parental behaviors previously identified as promoting child development, and to explore the relations between parenting and some sociodemographic variables. A sample of 87 pairs of mothers and fathers of the same children were recruited from Early Intervention Centers. The children (58 male and 29 female) were aged 20–47 months. Most of the families (92%) were from the province of Barcelona (Spain), and the remaining 8% were from the other provinces of Catalonia (Spain). Parenting behaviors, divided into four domains (Affection, Responsiveness, Encouragement, and Teaching) were assessed from self-recorded videotapes, in accordance with the validated Spanish version of the PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). Parents were administered a sociodemographic questionnaire. The results revealed strong similarities between mothers’ and fathers’ parental behaviors. Mothers and fathers were more likely to engage in affectionate behavior than in teaching behavior. Only maternal teaching presented a significant positive relation to the child’s age. With respect to the child’s gender, no differences were observed in mothers’ parenting. Conversely, fathers scored significantly higher in Responsiveness, Encouragement and Teaching (and had higher total parenting scores) when interacting with boys. The severity of the child’s ID had a statistically significant effect only on fathers’ Teaching, which showed lower mean scores in the severe ID group than in the moderate and mild ID groups. Teaching also presented a significant positive relation to mother’s age, but father’s age was not related to any parenting domain. Mothers with a higher educational level scored significantly higher in Encouragement and Teaching, and the fathers’ educational level was not significantly related to any parenting domain. Mothers’ and fathers’ Teaching, and fathers’ Responsiveness, Encouragement and total parenting scores, presented a significant positive relation to family income. Finally, mothers spent more time in childcare activities than fathers, particularly on workdays. Our main conclusion is that mothers and fathers show very similar strengths and weaknesses when interacting with their children with intellectual disabilities during play.

Examining Facets of Mindfulness in the Relationship Between Invalidating Childhood Environments and Emotion Regulation

Research has shown that growing up in an environment in which emotions are invalidated (i.e., ignored or responded to negatively) by parents is associated with later difficulties regulating emotions. Meanwhile, dispositional mindfulness has been shown to engender a greater capacity for emotion regulation, through use of adaptive strategies like cognitive reframing and minimizing use of maladaptive strategies like expressive suppression. The current study aimed to explore the role of invalidating childhood environments on use of cognitive reappraisal and expressive suppression as emotion regulation skills and to investigate the role of mindfulness in this relationship. Participants were recruited via Amazon Mechanical Turk (n = 1094, M_age = 58.3% women) and completed self-report measures assessing perceptions of maternal invalidation, mindfulness, and emotion regulation. Results demonstrated that the mindfulness facets of describing, non-judging, and non-reactivity partially mediated the relationship between perception of maternal invalidation and expressive suppression. Awareness and non-reactivity were found to mediate the relationship between perception of maternal invalidation and cognitive reappraisal. Clinical implications are discussed.

Building Resilience Against the Sequelae of Adverse Childhood Experiences: Rise Up, Change Your Life, and Reform Health Care

A reformed approach to health care tackles health at its roots. Adverse childhood experiences (ACEs) in those exposed to them may contribute significantly to the root causes of many diseases of lifestyle. ACEs are traumatic experiences, such as physical and emotional abuse and exposure to risky family environments. In 1998, a ground-breaking study found that nearly 70% of Americans experience at least 1 ACE in their lifetime, and graded exposure is associated with the presence of mental health disorders, heart disease, cancer, and other chronic diseases. Over the past 20 years, evidence has demonstrated further disease risk, outcomes, and epigenetic underpinnings in children and adults with ACEs. Building resilience-the capacity to adapt in healthy ways to traumatic experiences-through lifestyle modification offers potential to combat the negative health effects associated with ACEs. Emerging research demonstrates resilience is cultivated through individual skills (emotional intelligence, coping, and fostering healthy lifestyle choices), and nurturing supportive relationships. Being mindful of the impact and prevalence of ACEs and diversity of individuals' experiences in society will help build resilience and combat the root cause of chronic disease. This review aims to cultivate that awareness and will discuss 3 objectives: to discuss the effects and hypothesized pathophysiological underpinnings of traumatic experiences in childhood on health and wellbeing throughout life, to present ways we can promote resilience in our daily lives and patient encounters, and to demonstrate how advocacy for the reduction of ACEs and promotion of resilient, trauma-informed environments are fundamental to health care reform.

Maternal Depression and Stress in the Neonatal Intensive Care Unit: Associations With Mother-Child Interactions at Age 5 Years

OBJECTIVE

Previous studies suggest that maternal postpartum mental health issues may have an impact on parenting and child development in preterm infants, but have often not measured symptomatology in the neonatal intensive care unit (NICU) or followed families through early childhood. This study examines how maternal depressive symptoms and stress in the NICU are related to parenting behaviors at age 5 years, in mothers of children born very preterm (at ≤30 weeks' gestation).

METHOD

This longitudinal study followed a diverse sample of 74 very preterm children and their mothers. Maternal depression and stress were assessed in the NICU. At age 5, mother-child dyads were observed and coded for maternal intrusiveness, negativity, sensitivity, and positivity. Other covariates, including maternal and child intelligence, maternal education, income-to-needs ratio, maternal depression at age 5 years, and child sex were included in multivariate analyses.

RESULTS

The interaction between maternal NICU stress and NICU depression for intrusiveness and negativity indicates that greater NICU depression was associated with more intrusiveness under medium or high levels of NICU stress, and more negativity under high levels of NICU stress. Furthermore, greater NICU depression was associated with less sensitivity, over and above other covariates.

CONCLUSION

Findings suggest that early maternal peripartum depression and stress in the NICU can have lasting impacts on multiple parenting behaviors, highlighting the need for screening and targeted interventions in the NICU.

Developmental Patterns of Child Emotion Dysregulation as Predicted by Serotonin Transporter Genotype and Parenting

Individual differences in emotion regulation are central to social, academic, occupational, and psychological development, and emotion dysregulation (ED) in childhood is a risk factor for numerous developmental outcomes. The present study aimed to (a) describe the developmental trajectory of ED across early childhood (3-6 years) and (b) examine its sensitivity to youth serotonin transporter genotype, positive and negative parenting behaviors, and their interaction. Participants were 99 families in the Collaborative Family Study, a longitudinal study of children with or without developmental delays. Child ED and early parenting were coded from parent-child interactions. To examine serotonin transporter genotype as a moderator between parenting and child emotion dysregulation (ED), children with the homozygous short (SS) genotype were compared to children with the homozygous long (LL) or heterozygous (SL) genotype. We used latent growth curve modeling (LGCM) to model yearly change in ED from child age 3 to 6 years. LGCM revealed that ED decreased overall across early childhood. In addition, we observed separate Genotype × Positive and Genotype × Negative parenting behavior interactions in predictions of ED growth curves. Children with the SL/LL genotype had ED trajectories that were minimally related to positive and negative parenting behavior, whereas ED decreased more precipitously among children with the SS genotype when exposed to low negative parenting or high positive parenting. These findings provide evidence for Gene × Environment interactions (G×Es) in the development of ED in a manner that is conceptually consistent with vantage sensitivity, and they improve inferences afforded by prospective designs.