Parental stress and mental health outcomes following very preterm birth: A systematic review of recent findings

BACKGROUND

In recent years, there has been a wide array of research studies published on parental mental health and stress following very preterm birth. This review aims at reviewing the prevalence and risk factors of long-term parental depression, anxiety, post-traumatic stress symptoms and parenting stress following very preterm birth.

METHODS

We searched PubMed, PsychINFO and Web of Science for descriptive, cross-sectional and longitudinal studies published between January 2013 and August 2022.

RESULTS

45 studies met our inclusion criteria. In the first two years, depression, anxiety, post-traumatic stress symptoms and parenting stress were present in ∼20 % of mothers of extreme and very low birth weight (E/VLBW) infants. Long-term psychological distress symptoms could be observed, although few studies have focused on symptoms into school age and longer. Fathers of VLBW infants might experience more psychological distress as well, however, they were only included in ten studies. We found that parental distress is more common when the co-parent is struggling with mental health symptoms. Many risk factors were identified such as social risk, history of mental illness, interpersonal factors (i.e. social support) and child-related factors (i.e. intraventricular hemorrhage, disability, use of medical equipment at home).

LIMITATIONS

Several studies have methodological issues, such as a lack of control of known confounders and there is a large variety of measures employed.

CONCLUSION

Important risk factors for stress and mental health symptoms were identified. More evidence is needed to determine if long-term symptoms persist into school age. Research should focus on taking a family-based approach in order to identify preventive strategies and resilience factors in parents of VLBW infants.

The bidirectional temporal relationship between parenting stress and child maltreatment: A cross-lagged study based on intervention and cohort data

BACKGROUND

Parenting stress has long been proposed as a major risk factor for child maltreatment. However, there is a lack of evidence from existing studies on the temporal sequence to establish a causal relationship. This study aims to examine bidirectional temporal relationships between parenting stress and child maltreatment.

METHODS

Longitudinal data from two different sources were analysed: a pre-post study of an online parenting programme conducted across six countries - the ePLH Evaluation Study, and a prospective cohort study in the United States - LONGSCAN. Cross-lagged panel model on parenting stress and child maltreatment was used in each dataset.

RESULTS

Based on repeatedly measured data of 484 caregivers in the ePLH study across five time points (every two weeks), we found that parenting stress at an earlier time point predicted later child maltreatment (IRR = 1.14, 95 % CI: 1.10,1.18). In addition, the occurrence of child maltreatment was associated with higher subsequent short-term parenting stress (IRR = 1.04, 95 % CI: 1.01,1.08) and thus could form a vicious circle. In the LONGSCAN analysis with 772 caregivers who were followed up from child age of 6 to child age of 16, we also found parenting stress at an earlier time point predicted later child maltreatment (β = 0.11, 95 % CI: 0.01,0.20), but did not observe an association between child maltreatment and subsequent long-term parenting stress.

LIMITATIONS

Potential information bias on the measurements.

CONCLUSIONS

This study provides evidence for a bidirectional temporal relationship between parenting stress and child maltreatment, which should be considered in parenting intervention programmes.

Greater mobile device-prompted phone pickups are associated with daily parent stress

AIM

No studies have examined notifications as they relate to parent stress. We aimed to examine associations between objective daily mobile device notifications and pickups with daily parenting stress.

METHODS

This was a within- and between-subjects, cross-sectional study that took place from 2020 to 2021. The study occurred during the coronavirus disease of 2019 pandemic. Data were collected in a low-contact home visit. This study included 62 parents of 62 children aged 48-71 months. Parents downloaded a passive sensing app on their Android mobile devices collecting data on duration, device notifications and device pickups. Parents completed an end-of-day stress survey for 4 days. We used random effects models to examine the variation of daily stress with smartphone duration, notification frequency, pickup frequency and device-initiated pickups, adjusting for covariates.

RESULTS

Parents were on average 37.3 years old (SD ± 5.7) and were predominantly mothers (82.3%). On average, parents received 293 daily notifications and picked up their phones 93 times. Duration of smartphone use and notification frequency were not associated with daily stress. Device-initiated pickups were associated with daily parent stress.

CONCLUSION

When notifications prompted parents to pick up their phones more often, parents experienced greater stress.

The Chinese Parenting Stress Scale for Preschoolers' Parents: Development and Initial Validation

Parenting stress is the experience of discomfort or distress that results from the demands associated with the role of parenting. Although there are numerous parenting stress scales, relatively few scales have been developed with consideration of the Chinese cultural context. This study aimed to develop and validate the Chinese Parenting Stress Scale (CPSS) with a multidimensional and hierarchical structure for Mainland Chinese preschoolers' parents (N = 1,427, Mage = 35.63 years, SD = 4.69). In Study 1, a theoretical model and an initial 118 items were developed, drawing on prior research and existing measures of parenting stress. Exploratory factor analysis yielded 15 first-order factors with 60 items. In Study 2, confirmatory factor analyses supported a higher order solution consisting of 15 first-order factors covering four domains: Child Development (12 items), Difficult Child (16 items), Parent-Child Interaction (12 items), and Parent's Readjustment to Life (20 items). Measurement invariance indicated no gender differences between parents for the scale scores. The convergent, discriminant, and criteria validity of the CPSS scores was supported by its association with related variables in the expected directions. Moreover, the CPSS scores added significant incremental variance in predicting somatization, anxiety, and child's emotional symptoms more so than the Parenting Stress Index-Short Form-15. The CPSS total and subscale scores all had acceptable Cronbach's αs in both samples. The overall findings support the CPSS as a psychometrically sound tool.

Comparative effects of mindfulness-based stress reduction and psychoeducational support on parenting stress in families of autistic preschoolers

LAY ABSTRACT

Parents of autistic children often experience high levels of parenting stress, which can have negative mental and physical effects on both the parent and child. This study tested the efficacy of mindfulness-based stress reduction in reducing parenting stress in parents of preschool-aged autistic children compared to a psychoeducation and support intervention. We assessed parenting stress before and after the interventions and at 6- and 12-month follow-up. Both interventions significantly decreased parenting stress, but mindfulness-based stress reduction reduced stress more than did psychoeducation and support, with the strongest effect observed 1 year later. This suggests that the stress-reducing benefits of mindfulness-based stress reduction persist and may increase over time.

Mothers and fathers show different neural synchrony with their children during shared experiences

Parent-child shared experiences has an important influence on social development in children although contributions of mothers and fathers may differ. Neural synchronicity occurs between mothers and fathers and their children during social interactions but it is unclear whether they differ in this respect. We used data from simultaneous fNIRS hyperscanning in mothers (n = 33) and fathers (n = 29) and their children (3-4 years) to determine different patterns and strengths of neural synchronization in the frontal cortex during co-viewing of videos or free-play. Mothers showed greater synchrony with child than fathers during passive viewing of videos and the synchronization was positively associated with video complexity and negatively associated with parental stress. During play interactions, mothers showed more controlling behaviors over their child and greater evidence for joint gaze and joint imitation play with child whereas fathers spent more time gazing at other things. In addition, different aspects of child communication promoted neural synchrony between mothers and fathers and child during active play interactions. Overall, our findings indicate greater neural and behavioral synchrony between mothers than fathers and young children during passive or active shared experiences, although for both it was weakened by parental distress and child difficulty.

Parenting stress in parents with and without a mental illness and its relationship to psychopathology in children: a multimodal examination

Objective

Children of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children.

Methods

Participants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents' evaluation of children's behavior (relational schemas) and psychophysiological arousal of parents during free speech task.

Results

Self-reported PS was increased, and evaluation of children's behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children's psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness.

Conclusions

Our findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.

The Family-Check-Up® Autism Implementation Research (FAIR) Study: protocol for a study evaluating the effectiveness and implementation of a family-centered intervention within a Canadian autism service setting

Introduction

Prevalence rates of emotional and behavior problems (EBP) in autistic children and youth are high (40-70%), and often cause severe and chronic impairment. Furthermore, autistic children are also more likely to experience family "social-ecological" adversity compared to neurotypically developing peers, including social isolation, child maltreatment, caregiver mental illness, and socioeconomic risk. These family stressors increase the risk of co-occurring EBP among autistic children and can often impede access to evidence-based care, thus amplifying long-term health inequities for autistic children and their caregivers. In the current autism services landscape, there are few scalable, evidence-based programs that adequately address these needs. The Family Check-Up (FCU®) is a brief, strength-based, and tailored family-centered intervention that supports positive parenting and explicitly assesses the social determinants of child and family mental health within an ecological framework. Studies have demonstrated long-term positive child and caregiver outcomes in other populations, but the FCU® has not been evaluated in families of autistic children and youth. Therefore, we aimed to evaluate FCU® implementation within an established, publicly funded Autism Program in Ontario, Canada, with delivery by autism therapists, to demonstrate sustainable effectiveness within real-world settings.

Methods

In this study, we outline the protocol for a hybrid implementation-effectiveness approach with two key components: (1) A parallel-arm randomized controlled trial of N = 80 autistic children/youth (ages 6-17 years) and high levels of EBP and their caregivers. Primary and secondary outcomes include child EBP, and caregiver well-being and parenting. (2) A mixed methods implementation study, to describe facilitators and barriers to implementation of the FCU® within an autism service setting.

Discussion

Scalable, ecologically focused family-centered interventions offer promise as key components of a public health framework aimed at reducing mental health inequities among autistic children, youth, and their caregivers. Results of this study will inform further program refinement and scale-up.

Corrigendum: Longitudinal relations between parenting stress and child internalizing and externalizing behaviors: testing within-person changes, bidirectionality and mediating mechanisms

[This corrects the article DOI: 10.3389/fnbeh.2022.942363.].

Cognitive behavioral stress management for parents: Prevention and reduction of parental burnout

Context

Parental burnout increases the risk of deleterious consequences on parents', couples', and children's physical and mental health.

Methods

The current study (N = 134) aimed to assess the effectiveness of a Cognitive Behavioural Stress Management (CBSM) group programme in terms of parental burnout reduction. In total 67 parents attended the 8-week CBSM intervention groups, and another 67 parents were assigned to the waiting-list control group. We compared the effectiveness of the CBSM intervention with a waiting-list control group directly after the end of the programme and at three-months follow-up.

Results

The results showed that compared to the control group the CBSM programme contributed to the reduction of parental burnout symptoms with statistically significant and small effect size. Moreover, the contrast analyses showed that the reduction in parental burnout severity was maintained at 3 month-follow-up. The reduction in parental burnout scores was mediated by the decrease in stress and the increase in unconditional self-kindness.

Conclusions

These results highlight the potential benefits of the CBSM programme for parental burnout prevention and reduction.

Translation and validation of the Chinese version of the maternal postpartum stress scale

OBJECTIVE

To translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women.

METHODS

A total of 406 postpartum women were recruited from six hospitals in Nantong, Jiangsu Province, China. Cronbach's α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale-21 anxiety dimension, and Perceived Stress Scale were used as calibration scales to measure the correlation of MPSS. All data were analyzed using SPSS 25.0 and Amos 24.0.

RESULTS

The Cronbach's α co-efficient of the Chinese version of MPSS and its three dimensions were 0.940 and 0.882-0.911, respectively. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The scale's content validity index was 0.926. Three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ2/Df = 2.167, comparative fit index = 0.918, Tucker-Lewis index = 0.907, incremental fit index = 0.919, and root mean square error of approximation = 0.075).

CONCLUSION

The translated Chinese version of MPSS had suitable reliability and validity in assessing postpartum stress in Chinese women. The translated scale can also help with the early identification of postpartum stress and provide a scientific basis for the formulation of early personalized intervention measures. Overall, the scale has certain clinical value and practical significance for enhancing the physical and mental health of postpartum women. However, future studies including large, diverse populations are warranted.

The effect of perceived social support on postpartum stress: the mediating roles of marital satisfaction and maternal postnatal attachment

BACKGROUND

Multiple factors may be responsible for the development of postpartum stress, including perceived social support, marital satisfaction, and maternal postnatal attachment. However, the underlying mediation mechanisms remain unclear. This study examined the complex relationships between perceived social support and postpartum stress among Chinese women.

METHODS

A convenience sample comprising 406 postpartum women was recruited from six hospitals in Nantong, Jiangsu Province, China. The participants completed general survey questionnaires and were evaluated using the Maternal Postpartum Stress Scale, the Perceived Social Support Scale, the Maternal Postnatal Attachment Scale, and the Marital Satisfaction Scale. Furthermore, we evaluated the relationship between postpartum stress and the various influencing factors by performing a multiple linear regression analysis. The potential mediating roles of marital satisfaction and maternal and infant attachment in the association between perceived social support and postpartum stress were explored by performing a mediation analysis.

RESULTS

According to the multivariate regression analysis, perceived social support, marital satisfaction, and maternal postnatal attachment contributed to postpartum stress levels (P < 0.05). The mediation analysis revealed that marital satisfaction and maternal postnatal attachment played parallel mediating roles in the association between perceived social support and postpartum stress, and the mediating effect of marital satisfaction was - 0.1125 (95% confidence interval [CI]: -0.1784 to -0.0520), accounting for 33.20% of the total effect, and the mediating effect of maternal postnatal attachment was - 0.0847 (95% CI: -0.1304 to -0.0438), accounting for 25.00% of the total effect.

CONCLUSION

Our study revealed that perceived social support could influence postpartum stress not only through direct effect (41.80% of the total effect), but also through the indirect effect (mediation effect) of marital satisfaction and maternal postnatal attachment (58.20% of the total effect), suggesting that improving postpartum women's social support, enhancing maternal and infant attachment, and improving their marital satisfaction could help lower postpartum stress.

Meta-Analyses of the Relationships between Family Systems Practices, Parents' Psychological Health, and Parenting Quality

(1) Background: Family systems theories include assertations that both personal and environmental factors are determinants of parents' psychological health, well-being, and parenting quality. Applied family systems theories focus on determinants that can be operationalized as intervention practices. The analyses described in this paper focused on the direct and indirect effects of four family systems practices (family needs, resources, supports, and strengths), parents' psychological health (depression, well-being, etc.), and parenting quality (parenting beliefs, involvement, and practices) in families of children with identified disabilities, medical conditions, or at-risk conditions for poor outcomes; (2) Methods: Data from previously completed meta-analyses of the relationships between family systems practices and parents' psychological health outcomes and parenting quality outcomes were reanalyzed. Next, a meta-analysis of the relationships between parents' psychological health and parenting quality was completed to identify which predictors were related to which parenting quality outcomes. Both main effects and mediated effects were examined; (3) Results: The four family systems practices were each related to six different psychological health measures and three parenting quality measures. The six different parental psychological health measures were also related to the three parenting quality measures. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health; (4) Conclusions: The effects of family systems practices and parents' psychological health on parenting quality were primarily direct and independent. The relationships between family systems practices and parenting quality were partially mediated by parents' psychological health. Future research should focus on the identification of other mediator variables found to be important for explaining the indirect effects of family systems practices measures on parenting beliefs, behavior, and practices.

Initial psychometric properties of the Parental Stress Scale examined using a sample of Russian mothers

Parental stress is defined as a personal response to stressors associated with being a parent. In recent studies, parental stress has been viewed as a component of normative parenting. The purpose of this study was to collect initial evidence of the construct validity and reliability of the Russian version of the 18-item Parental Stress Scale (PSS) using a sample of mothers of Russian primary school students. The results are the first wave of a longitudinal study. Mothers (n = 900) of fourth-grade students participated in the study and filled out an online survey. The exploratory and confirmatory factor analyses of the PSS on the Russian mothers indicated two factors: parental stress and parental satisfaction, with good estimates of reliability. The PERMA-Profiler questionnaire was used to examine the convergent and divergent validity of the PSS. The results revealed significant correlations between parental stress and satisfaction and different aspects of well-being among the respondents. The initial investigation of this Russian adaptation of the PSS provides evidence of its reliability and validity. Despite the limitations and the need for further research, this version of the PSS can be recommended for use in studies on modern parenting as well as in psychological support, education, and development of programs promoting positive parent-child relationships by targeting parental needs.

Changes in children's attachment security to mother and father after the birth of a sibling: Risk and resilience in the family

Changes in children's attachment security to mother and father were examined for 230 firstborn children (M = 31.17 months), their mothers and fathers participating in a longitudinal investigation starting in the last trimester of the mothers' pregnancy and 1, 4, 8, and 12 months after the birth of an infant sibling. Both parents completed the Attachment Q-set at prenatal, 4, and 12 months. Growth mixture models revealed four latent classes in which children's attachments were (a) both secure with a modest decline to both parents (68.3%); (b) more secure with father than mother with a steep decline for both (12.6%); (c) both insecure with no change (10%); and (d) more secure with mother than father with a modest increase for both (9.1%). Multi-group latent growth curve analyses revealed that parenting and coparenting differed across families. Children had lower externalizing behavior problems in families with two secure attachments than in families with one secure attachment, either to mother or to father, who, in turn, had fewer problems than children with two insecure attachments. Findings underscore the strengths of a family systems framework to understand attachment relationships with multiple caregivers and the family risks and protective factors that covary with children's behavioral adjustment after the birth of a sibling.

Parental Stress and Chinese American Preschoolers' Adjustment: The Mediating Role of Parenting

Family contexts, such as parental stress and parenting practices, play critical roles in preschoolers' adjustment. However, these processes have been understudied in Chinese American families. The present study examined the associations between Chinese American mothers' experiences of two types of stress (i.e., general/contextual stress and parenting stress) and their preschoolers' socio-emotional and behavioral adjustment problems; in addition, the mediating roles of maternal psychologically controlling parenting and maternal warmth in these associations were assessed. Participants included 207 first-generation Chinese American mothers (Mage = 37.78 years, SDage = 4.36) and their 3- to 6-year-old children (Mage = 4.50 years, SDage = 0.90; 52% boys). Mothers reported on their levels of stress, psychologically controlling parenting, and warmth practices; teachers reported on child adjustment in the school setting. The results revealed that higher levels of general/contextual stress and parenting stress were each uniquely associated with more maternal psychologically controlling parenting practices, which in turn was associated with fewer socio-emotional and behavioral adjustment problems in children. Our findings can inform parenting intervention programs designed to improve Chinese American preschoolers' adjustment.

Parenting stress and FASD: A scoping review

BACKGROUND

Fetal alcohol spectrum disorder (FASD) is a complex neurodevelopmental disorder that may arise following prenatal exposure to alcohol. Children with FASD tend to experience a diverse set of physical, social, cognitive, and behavioral symptoms. Caregivers of these children likely experience elevated levels of parenting stress; however, research in this area is still in its infancy.

AIM

The present study sought to more fully understand the current state of the literature on parenting stress experienced by caregivers of children with FASD.

METHOD

Databases including PsycInfo, Scopus, PsycArticles, and Google Scholar were searched for records meeting our inclusion criteria.

RESULTS AND CONCLUSION

15 studies were deemed eligible for this review. This literature suggests that caregivers of children with FASD experience heightened levels of parenting stress. Child factors, especially child behavior and executive functioning difficulties are associated with Child Domain stress, while parent factors are associated with Parent Domain stress. Gaps were identified in child and caregiver mental health issues, as well as placement information.

Developmental trajectories of children’s sibling jealousy after the birth of a sibling: Strict parental control, parenting stress and parental depression as pre-birth predictors

This longitudinal research identified the developmental trajectories of sibling jealousy in firstborn children (M age = 49.9 months; 55% boys) among 107 Chinese families from 1 to 12 months after the birth of a younger sibling. Four sibling jealousy trajectories were identified: (a) low-increasing, (b) middle-stable, (c) high-stable, and (d) sharp-increasing. Trajectory group membership varied as a function of pre-birth parental factors including strict parental control (i.e., tiger parenting), parenting stress, and parental depression. These results highlight the benefit of examining the development of sibling jealousy over the transition to siblinghood and the importance to recognize pre-birth parental characteristics, especially paternal factors, as determinants when identifying children who may be at greater risk of adjustment difficulties following the birth of a younger sibling.

Developmental Precursors of Primary and Secondary Callous-Unemotional Traits in Youth

There is growing evidence of diverse etiological pathways to the development of callous-unemotional (CU) traits, known as primary and secondary CU variants. The purpose of the present study was to extend previous cross-sectional research and examine theoretical predictors of CU variants prospectively from childhood to adolescence. Participants included high-risk control and normative samples from the Fast Track project (N = 754, male = 58%, Black = 46%). Using structural equation modelling, primary CU traits, identified in early adolescence, were associated with higher levels of childhood emotion regulation and lower levels of prosocial behavior. Secondary CU traits were associated with lower levels of childhood emotion regulation and low parental warmth, but not prosocial behaviour. Neither CU variant was related to harsh parenting. Parental warmth moderated emotion regulation and prosocial behavior on secondary CU traits. Results were not moderated by sex. A greater understanding of theoretical developmental precursors of CU variants may better guide intervention efforts.

Sibling Support and Perceived Daily Hassles in Latino and Non-Latino Families of Children with DD

Parents of children with developmental delay (DD) report significantly higher levels of parenting stress compared to parents of children with typical development. There is a heightened need for social support among families of children with DD. Siblings play an important role in these contexts as a supportive resource and primary stress buffer. Little to no research has examined how these stress and supportive processes may differ among Latino and non-Latino parents. The current study examined the relation between sibling support and parents' perceived daily hassles between Latino and non-Latino parents of children with DD (N = 146; 65% Latino; mean parent age = 37.39 years; mean child age = 49.63 months; SD = 7.9). Latinos reported significantly greater use of sibling support and lower perceived daily hassles compared to non-Latino counterparts. In the combined sample, greater sibling support was significantly correlated with lower daily hassles. When examined separately in Latino and non-Latino groups, this correlation only remained significant among Latinos. The interaction between ethnicity and sibling support on perceived daily hassles was approaching significance, such that Latinos who reported high levels of sibling support reported lower perceived daily hassles. Findings emphasize the universal importance of familial support systems for the well-being of parents of children with DD and point to the possible protective role of Latino cultural factors that influence the degree to which these supports are employed. Results may inform culturally sensitive adaptations to parenting interventions for Latino families that harness sibling support to target and buffer parenting stress.

Examination of physical activity development in early childhood: protocol for a longitudinal cohort study of mother-toddler dyads

BACKGROUND

Physical activity (PA) development in toddlers (age 1 and 2 years) is not well understood, partly because of a lack of analytic tools for accelerometer-based data processing that can accurately evaluate PA among toddlers. This has led to a knowledge gap regarding how parenting practices around PA, mothers' PA level, mothers' parenting stress, and child developmental and behavioral problems influence PA development in early childhood.

METHODS

The Child and Mother Physical Activity Study is a longitudinal study to observe PA development in toddlerhood and examine the influence of personal and parental characteristics on PA development. The study is designed to refine and validate an accelerometer-based machine learning algorithm for toddler activity recognition (Aim 1), apply the algorithm to compare the trajectories of toddler PA levels in males and females age 1-3 years (Aim 2), and explore the association between gross motor development and PA development in toddlerhood, as well as how parenting practices around PA, mothers' PA, mothers' parenting stress, and child developmental and behavioral problems are associated with toddlerhood PA development (Exploratory Aims 3a-c).

DISCUSSION

This study will be one of the first to use longitudinal data to validate a machine learning activity recognition algorithm and apply the algorithm to quantify free-living ambulatory movement in toddlers. The study findings will help fill a significant methodological gap in toddler PA measurement and expand the body of knowledge on the factors influencing early childhood PA development.

Longitudinal associations between parent, child, family factors and dyssomnias in children from birth to 8 years: The CIKEO study

BACKGROUND

Dyssomnias, are the most common parent-reported sleep complaints in young children. The present study investigated the prevalence, one-year development (incidence and persistence) of dyssomnia in early childhood, and the parent, child, and family factors associated with dyssomnia.

METHODS

Longitudinal data of 700 children aged 0-8, gathered in the CIKEO cohort study in the Netherlands were analyzed. Dyssomnias were defined as the presence of night awakenings ≥3 times per night or sleep-onset latency of >30 min. Least absolute shrinkage and selection operator (LASSO) was used to identify the parental, child, and family factors associated with the incidence and persistence of dyssomnias in children.

RESULTS

The mean age of the children (47 % girls) was 3.2 ± 1.9 years at baseline and 4.4 ± 1.8 years at follow-up. The prevalence of dyssomnias was 13.3 % and 15.4 % at baseline and follow-up, respectively. The incidence and persistence rates of dyssomnias at follow-up were 12.0 % and 37.6 %, respectively. New incidence of insomnia was associated with being a girl, having medical conditions, experiencing stressful life events, and lower parenting self-efficacy at baseline (P < 0.05). Higher levels of parental psychological distress were associated with the persistence of dyssomnias in children (P < 0.05).

CONCLUSIONS

Dyssomnias are common with a moderate persistent rate in young children. Several parental, child, and family factors in relation to the incidence and persistence of dyssomnias were identified. Preventive programs and interventions targeting modifiable factors, particularly parental psychological distress, parenting self-efficacy, and resilience to stressful life events, might benefit child sleep.

Examining the Contributions of Parents' Daily Hassles and Parenting Approaches to Children's Behavior Problems during the COVID-19 Pandemic

The present study was designed to examine the direct and indirect contributions of parenting daily hassles and approaches to children's externalizing and internalizing behavior problems during the COVID-19 pandemic. The sample for this study was 338 preschool children (53.6% girls, M_age = 56.33 months, SD = 15.14) and their parents in Turkey. Parents reported their daily hassles, parenting approaches, and children's behavior problems. Findings from the structural equation model showed that higher levels of parenting daily hassles predicted higher levels of externalizing and internalizing behavior problems. In addition, we found an indirect effect of daily hassles on children's internalizing behaviors via positive parenting. Further, there was an indirect path from parenting daily hassles to children's externalizing behaviors through the negative parenting approach. Results are discussed in the context of the COVID-19 pandemic.

Families with young children during the COVID-19 pandemic-The importance of family type, perceived partnership roles, parental stress, and social support for changes in the home learning environment during lockdown

Beginning in March 2020, the lockdown precipitated by the COVID-19 pandemic resulted in many challenges, especially for families with young children. Many children had little or no access to institutional education. Therefore, they were even more dependent on their parents providing them with home learning activities (HLA) to support their development. We examined the adaptability of families with regard to changes in parents' provision of HLA in traditional two-parent families, single parent families, and large families compared to before the lockdown. We focused on family resources, such as a supportive distribution of roles within the partnership, or social support, as predicting factors of adaptability in N = 8,513 families with children aged 18-69 months. In addition, we considered parental stress as a further influencing factor. The cross-sectional data depicts families from a nationwide online survey, which we conducted during spring 2020 in Germany. We found that (a) all three family types offered their children more learning activities at home, albeit with slight differences between the families. However, (b) we identified differences in the factors influencing families' adaptability: Across all family types, we found slight to medium negative relations between adaptability and parental stress. The relations were most evident in large families. Furthermore, social support exhibits somewhat positive relations to the adaptability of large families. For adaptability in single-parent families, gender differences were initially evident. Among single fathers, the change in parental HLA was stronger than among single mothers. However, this relation disappeared when we took parental stress and social support into account. For traditional two-parent families and single parents, our analyses revealed (c) barely significant relations between the investigated predictors and changes in HLA during lockdown. Overall, our study confirms that high stress limits the adaptability of providing HLA in families and that social support mitigates negative relations between stress and the provision of HLA, especially in large families. In order to develop effective and needs-based family support programs, it is therefore important to help parents cope with stress and provide them with low-threshold social support. The extent to which these services need to be adapted to different family types must be surveyed in more depth.

Parental stress and life satisfaction: A comparative study of social services users and nonusers from a gender perspective

The psychometric properties of the Spanish version of the Parental Stress Scale (PSS) scale have not been verified on the Spanish population. Similarly, the literature on gender differences and parental stress is inconclusive, and there is little evidence of their relationship with life satisfaction. To analyze the psychometric properties of the Spanish version of the PSS scale, (2) to examine possible gender differences, and (3) to study the relationship between parental stress (PS) and parental rewards (PR) and satisfaction with life (SWL) attending to the possible moderating effect of gender. These objectives were examined in samples comprising Social Services Users (SSU) (N = 525; 78.3% female; Mage  = 38.3) and non-SSU users (N = 421; 41.1% male; Mage  = 37.08). A CFA corroborated a two-factor structure: PS and PR. In the SSU sample, mothers showed higher PS and lower PR. However, PR was also higher in mothers from the non-SSU sample compared to fathers. PR and PS were directly related to SWL in the SSU sample. However, gender moderated the relationship between PR and SWL in the non-SSU sample in the case of mothers. The results are discussed considering gender roles and the characteristics of both samples.

Parental stress during the COVID-19 pandemic: A one-year follow-up

OBJECTIVE

This two-wave longitudinal study aimed at increasing knowledge about levels of parental stressors and rewards among mothers and fathers of children aged 1-18 during the first year of the COVID-19 pandemic in Norway.

BACKGROUND

The COVID-19 pandemic and infection-control measures have caused changes to family life. Managing homeschooling or caring for younger children while working from home may have posed significant strain on parental stress, negatively impacting the quality of parent-child relationships and parents' sensitivity to their children's needs.

METHOD

We employed data collected in April 2020 and April 2021 from the longitudinal population-based survey in Bergen/Norway (Bergen in ChangE-study). 7424 parents participated (58.6% mothers and 41.5% fathers).

RESULTS

The overall levels of parental stressors and rewards did not change significantly. Over the two time points, the factors associated with decreased parental stressors were being male, aged 40-49 years, having a relatively high income, and reporting initial difficulties with closed kindergartens or schools. For parents aged 18-29 years, the level of parental stressors increased.

CONCLUSION

The study suggests that the overall levels of parental stress remained unchanged during the first year of the pandemic. Even so, the study also uncovered that younger parents represented a vulnerable subgroup.

IMPLICATIONS

To prevent detrimental consequences in the wake of the pandemic, it could be important to increase awareness and competence among professional staff in kindergartens, primary schools, and child health clinics targeting young parents and their children.

Examining the Directionality of the Relationship Between Maternal Warmth and Early School-Age Anxiety

Maternal warmth has been identified as a contributing factor to the development of child anxiety; however, no studies to date have examined observed maternal warmth longitudinally in this relationship. The present study addressed this knowledge gap by examining the simultaneous development of maternal warmth and child anxiety over time (between-person effects using latent growth curve modeling) and the directionality of associations (within-person effects using autoregressive latent trajectory modeling). Participants included 753 mothers and children. Between-person effects indicated that lower initial levels of anxiety were related to greater levels of maternal warmth over time. Within-person effects showed that maternal warmth in grade 1 predicted subsequent decreases in child anxiety in grade 2 (i.e., a parent effect). Present findings demonstrate the importance of maternal warmth in the early school-age years for decreasing subsequent child anxiety.

Longitudinal Associations between Parental Warmth, Harsh Discipline, Child Emotion Regulation, and ODD Dimensions

Research has yet to investigate the mediating role of emotion regulation in the relation between parental warmth and harsh discipline with oppositional defiant disorder (ODD). Further, few studies have investigated ODD as both a unitary construct and as three distinct dimensions (anger, defiance, spitefulness). Thus, the present study aimed to investigate child emotion regulation (grade 2) as a mediator of the relation between parental warmth and harsh discipline (kindergarten, grade 1, grade 2) and ODD and its dimensions (grade 3). Participants included the high-risk and normative samples from the Fast Track project (N = 753, male = 58 %, Black = 46 %). Constructs were assessed using observation and parent and teacher reports. Although results demonstrated an absence of indirect effects, emotion regulation was negatively associated with overall ODD and anger and defiance, but not spitefulness. Findings illustrate how increased attention toward the study of ODD as distinct dimensions contributes to our ability to parse out heterogeneity among children with the disorder.

"At Least Somebody Sees You as a Hero": Fatherhood Stress and Well-Being in Ghana

Fathers' mental health and behaviors influence child development and partner well-being, yet paternal stress and well-being are frequently overlooked; especially in non-Western settings. The aim of this mixed-methods study was to quantitatively assess the impact of parenting stress on fathers' overall well-being in Ghana, West Africa; while qualitatively delving into their lived experiences as fathers. We used a qual/quant mixed-methods approach in this study. The study was conducted in three distinct locations in Ghana (a) Ada, a rural community on the Southeastern coast; (b) Kumasi, an urban setting in upper Southern Ghana; and (c) Sunyani, a peri-urban setting in West-central Ghana. Paternal stress was measured with the Aggravation in Parenting Scale (APS) and well-being was assessed using the Secure Flourishing Index (SFI). Textual data from focus group interviews were sorted using inductive coding and aggregated into overarching themes. Thirty-eight Ghanaian fathers ages 21 to 74 years participated in the study, average age 43 (±12.12 SD), median 39.5. Correlation analyses showed a strong, negative association between paternal stress and well-being (R = -0.63; p < .0001), which was supported in linear regression models (β = -1.04; 95% CI: -1.62, -0.45; p<.0001). Emergent themes of fatherhood stress included financial (employment, food, education, and health care), social (norms and expectations), and psychological (mental work, discipline, relationships, and coping strategies) stressors. A fourth overarching theme of pride and joy in parenting permeated the interviews. Ghanaian fathers with higher parenting stress experience lower overall well-being. Identified stressors could guide interventions that bolster the well-being of fathers and their families.

Parental Stress Assessment with the Parenting Stress Index (PSI): A Systematic Review of Its Psychometric Properties

Parental stress is a construct related to people's perception of difficulties and feelings of not being able to cope with the demands of parenting. This construct is often experienced as a negative or aversive response to parental obligations, and the available evidence also suggests that excessive parenting stress reduces the use of positive parenting behaviors and are related to dysfunctional parenting. Different instruments exist to assess parental stress. This article is part of a project to translate and adapt the Parenting Stress Index (PSI), fourth edition, in its two forms (full and short). The aim of this research is to identify the psychometric indicators obtained by this instrument and to review the evidence they can provide.

METHOD

Following the PRISMA guide (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), the studies related to the PSI were identified in different databases (ERIC, PsycArticles, PubMed, Scopus and Web of Science).

RESULTS

The screening process resulted in 16 articles; four have analyzed the psychometric properties of the PSI-4 and the rest have studied the PSI-3. Although version 4 was published in 2012, the studies are scarce. However, they follow the line noted in the previous short version, a high internal consistency and a factor structure of three factors.

CONCLUSIONS

The difficulties of working with a measurement instrument with 101 items means that the full version of the PSI has been little studied, except in translation and linguistic adaptation studies.

Associations of parenting daily hassles with parents' mental health during the COVID-19 school closure

RATIONALE

Parenting is a demanding task associated with parents' mental health, which is likely exacerbated by the COVID-19 pandemic lockdown. The present study investigated daily parenting hassles and their effects on parents' mental health during this period.

METHODS

A total of 7314 parents with children aged 3-14 years old completed a sociodemographic questionnaire and reported on their perceived daily parenting hassles, mental health, family support, and co-parenting during the COVID-19 school closure.

RESULTS

Most parents (73.4%) showed different degrees of daily hassles, and a relatively higher prevalence of depression (18.7%), anxiety (22.4%), and stress (12.1%) were found. Motherhood, parents' younger ages, lower education parents, job loss, and having younger children, boys, and multiple children were associated with elevated daily parenting hassles and mental health issues. Importantly, daily parenting hassles were uniquely associated with mental health problems after controlling for various sociodemographic characteristics, family support, and co-parenting. Furthermore, family support and co-parenting can attenuate daily parenting hassles, which, in turn, protect parents' mental health.

CONCLUSIONS

The findings of the present study underscore the critical need to consider daily parenting hassles and their effects on the mental health of parents during the COVID-19 lockdown. The present study also outlines potential factors (family support and co-parenting) that attenuate parents' daily parenting hassles and protect their mental health during the COVID-19 lockdown.

The Lockdown Impact on the Relations between Portuguese Parents and Their 1- to 3-Year-Old Children during the COVID-19 Pandemic

Many countries have applied mandatory confinement measures in response to the COVID-19 pandemic, such as school and kindergarten closures, which confined families to their homes. The study concerns the impacts of the first COVID-19 lockdown on the relationships between Portuguese parents and their children, in a non-clinical population composed of fathers and mothers of children between the ages of 12 months and 3 years and 364 days. An online questionnaire (set by the research team) and the Parenting Daily Hassles Scale (PDHS) concerning the confinement period were applied between 17 June and 29 July 2020. To assess the impacts of the lockdown, outcomes regarding the impacts perceived by the parents, the potential regression in the development of children, and the willingness to promote changes in family routines in the future, were considered. Of the total sample (n = 1885), 95.4% of the parents (n = 1798) said that, after confinement, the relationship with their children had improved or remained similar to the pre-confinement period; 97.3% (n = 1835) noticed positive changes in the development of their children, and 63.7% (n = 1200) noted that the relationships with their children during the confinement period would lead to some changes in family routines in the future. Multivariate regression analyses showed that most of the sociodemographic variables chosen were not associated with the outcomes. However, significant levels of pressure over parenting and parental overload (reported by high scores in the PDHS intensity and frequency scales), challenging behaviors of the children, and the impacts they had on parental tasks had negative influences on the studied outcomes. On the contrary, the number of adults living with their children, the perceptions regarding the development of their children, and sharing new experiences with them were significant factors for positively-perceived impacts on the relationships between them or in the desire to bring about changes in family routines in the future. The impacts of the lockdown on the relationships between parents and children aged between 1 and 3 years old were more dependent on relational aspects and on the parents’ sense of competence in exercising parental functions. We conclude that, despite the increased demands imposed by the lockdown, nearly all of the parents evaluated the quality of the relationship with their children as positive after this period.

Frontal Alpha Asymmetry in Response to Stressor Moderates the Relation Between Parenting Hassles and Child Externalizing Problems

Inequitable urban environments are associated with toxic stress and altered neural social stress processing that threatens the development of self-regulation. Some children in these environments struggle with early onset externalizing problems that are associated with a variety of negative long-term outcomes. While previous research has linked parenting daily hassles to child externalizing problems, the role of frontal alpha asymmetry (FAA) as a potential modifier of this relationship has scarcely been explored. The present study examined mother-child dyads, most of whom were living in low socioeconomic status households in an urban environment and self-identified as members of racial minority groups. Analyses focused on frustration task electroencephalography (EEG) data from 67 children (mean age = 59.0 months, SD = 2.6). Mothers reported the frequency of their daily parenting hassles and their child's externalizing problems. Frustration task FAA moderated the relationship between parenting daily hassles and child externalizing problems, but resting FAA did not. More specifically, children with left frontal asymmetry had more externalizing problems as their mothers perceived more hassles in their parenting role, but parenting hassles and externalizing problems were not associated among children with right frontal asymmetry. These findings lend support to the motivational direction hypothesis and capability model of FAA. More generally, this study reveals how individual differences in lateralization of cortical activity in response to a stressor may confer differential susceptibility to child behavioral problems with approach motivation (i.e., left frontal asymmetry) predicting externalizing problems under conditions of parental stress.

Is the Predisposition to Have More Children Beneficial among Parents with Only One Child? Evidence from Spanish Parents

The fertility deficit in many European countries is related to a low rate of second births. Understanding the factors associated with the predisposition of one-child parents to have more children could contribute to the search for solutions to this social problem. Although previous evidence highlights the role of employment and social factors, psychological factors have been poorly investigated. This study examines the relationship between different psychosocial factors (rumination, personality, life satisfaction, perfectionism, social support, parental stress, guilt linked to work–family conflict, age and child temperament) and parents’ predisposition to have more children. The sample consisted of 96 one-child Spanish parents whose child was in early childhood education (59.3% women; M_age = 37.41). The results show that one-child parents with the predisposition to have more children, compared to those without a predisposition to have more children, showed higher levels of life satisfaction, extroversion and adaptive perfectionism but lower levels of rumination and parental stress. The social implications of these findings and how they may affect parenting today are discussed.

Symptoms of Pediatric Feeding Disorders Among Individuals with 3q29 Deletion Syndrome: A Case-Control Study

OBJECTIVE

The goal of this study was to evaluate symptoms of pediatric feeding disorder in a sample of individuals with 3q29 deletion syndrome (3q29Del). Previous research has found that individuals with 3q29Del may experience elevated feeding concerns in early childhood; however, the specificity of these feeding concerns is not well understood.

METHODS

We compared individuals with 3q29Del (N = 83) with controls (N = 59) using an 11-item survey that assessed commonly reported symptoms associated with pediatric feeding disorders. An exploratory analysis also examined individuals with 3q29Del with and without a comorbid global developmental delay (GDD) or an autism spectrum disorder diagnosis.

RESULTS

Caregivers of 3q29Del cases reported higher incidences of feeding concerns on 10 of the 11 items included in the survey. This included statistically significant differences in food refusal behaviors, rejection of 1 or more food groups, and a history of failure to thrive. Parents of children with comorbid GDD were more likely to report concerns regarding food selectivity and problem behaviors during mealtime.

CONCLUSION

The results suggest individuals with 3q29Del experience increased symptoms of pediatric feeding disorder that may require targeted evaluation and intervention for optimal outcomes. Future research should include a more thorough multidisciplinary evaluation to further elucidate symptom severity and optimal treatment strategies.

Measurement instruments for parental stress in the postpartum period: A scoping review

Background

Parenting stress is a particular type of stress that is conceptualized as a negative psychological response to the numerous obligations associated with raising children. Despite a considerable increase in research on parenting stress, little attention has been given to the ways parenting stress are measured.

Objectives

This scoping review aimed to provide an overview of available instruments measuring parental stress and to describe their psychometric properties.

Methods

We conducted a scoping review in accordance with international guidelines for scoping reviews. The main search strategy was searches in seven electronic databases. Pairs of reviewers selected relevant studies based on predetermined inclusion and exclusion criteria. Studies had to report one or more psychometric properties of an instrument measuring stress in parents with children 0–12 months. For each included study, we collected information relevant to the review question, guided by the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN). Finally, we collated, summarized, and reported the findings descriptively.

Results

From 2164 unique record, 64 studies from 24 countries were included. They described 15 instruments, of which four were generic and eleven parental-specific self-administered instruments. Only two studies examined parental stress among fathers. Eleven of the studies were validation studies, but they only described seven of the 15 instruments. Internal consistency was the only information provided by 73.4% of the included studies. None of the instruments had information on all measurement properties as per the COSMIN criteria, and there was no information about measurement error, responsiveness, or interpretability for any of the 15 instruments.

Discussion

There are presently 15 instruments with some associated psychometric information being used to measure parental stress among parents with young children, but the amount of information on the instruments’ psychometric properties is slight. There is a need for further research.

How the Emotional Environment Shapes the Emotional Life of the Child

Emotion understanding facilitates the development of healthy social interactions. To develop emotion knowledge, infants and young children must learn to make inferences about people's dynamically changing facial and vocal expressions in the context of their everyday lives. Given that emotional information varies so widely, the emotional input that children receive might particularly shape their emotion understanding over time. This review explores how variation in children's received emotional input shapes their emotion understanding and their emotional behavior over the course of development. Variation in emotional input from caregivers shapes individual differences in infants' emotion perception and understanding, as well as older children's emotional behavior. Finally, this work can inform policy and focus interventions designed to help infants and young children with social-emotional development.

Mexican-Origin Adolescent Mothers' Beliefs and Practices Concerning Children's School Readiness

Parents' academic socialization of their young children is a critical yet understudied area, especially in the context of vulnerable parent-child dyads. The current longitudinal study examined factors that informed mothers' beliefs and practices concerning children's kindergarten readiness in a sample of 204 Mexican-origin adolescent mothers (M age = 19.94). Adolescent mothers' individual characteristics and assets (i.e., parental self-efficacy, educational attainment, educational utility beliefs, knowledge of child development) and sources of stress (i.e., economic hardship, coparenting conflict) were related to the importance they placed on children's social-emotional and academic readiness for kindergarten, their provision of cognitive stimulation and emotional support to their children in the home, and their enjoyment of literacy activities with their child. Moreover, adolescents' perception of parenting daily hassles emerged as a mediator in this process. Findings underscore the importance of considering Mexican-origin adolescent mothers' strengths and assets along with their unique contextual stressors as they relate to beliefs and practices that could have implications for their children's school success.

A 1-year longitudinal study of the stress, sleep, and parenting of mothers of toddlers

OBJECTIVES

The present study, building on cross-sectional research showing links between mothers' sleep, stress, and parenting, used a longitudinal design to consider (1) the temporal direction of links between mothers' sleep and stress, (2) whether mother sleep deficits predict change in parenting across time, and (3) whether mother sleep deficits mediate the inverse association between stress and positive parenting.

DESIGN

The study used repeated measures of stress, mother sleep, and positive parenting at toddler ages 30, 36, and 42 months.

SETTING

Data were collected at 2 sites, one in the Midwest and one in the East.

PARTICIPANTS

Four hundred thirteen mother-toddler pairs were followed. Mothers were mostly married, college educated, and middle class, but there was also considerable variability between families.

MEASUREMENTS

Stress was measured via parenting hassles, CHAOS, and role overload scales. Mother sleep was measured via actigraphy. Positive parenting was observed during the bedtime routine and rated using the HOME scale and other items.

RESULTS

Mother stress and sleep were inextricably linked across toddlerhood, and worse sleep was predictive of less observed positive parenting, even when controlling for prior levels of stress and parenting.

CONCLUSIONS

Improving mothers' sleep may be important in efforts to improve their parenting.

Parenting Stress and Child Externalizing and Internalizing Problems Among Low-Income Families: Exploring Transactional Associations

Although the association between parenting stress and child behavioral outcomes is well established (Deater-Deckard, Clin Psychol 5:314-332, 1998), longitudinal research examining the direction of these effects is limited. This study examined transactional associations between parenting stress and child externalizing and internalizing behaviors among 1209 low-income female caregivers (M_age = 34.51) with children in early childhood or early adolescence (i.e., either 2- to 5-years-olds or 9- to 15-year-olds at Time 1) across a 6 year time span using three time points. Parent-driven associations between parenting stress and child internalizing problems for the early childhood group were found. In the early adolescent group, transactional and child-driven associations were found between parenting stress and child externalizing problems, but only child-driven associations for internalizing problems. Thus, transactional associations were only supported for the early adolescent group. These findings suggest developmental differences in how parenting stress and child behavioral problems are linked among low-income families. Clinical implications are discussed.

Maternal Parenting Stress, Disengagement Strategies for Managing Parenting Stress, and Hazardous Alcohol Use among Mothers of Adolescents

Objective: According to the reward- stress dysregulation model of addiction and parenting, parenting stress may play a critical role in the etiology and maintenance of substance misuse. To date, limited work has examined how parenting stress may relate to hazardous alcohol use among mothers of adolescents. The present study examined if parenting stress interacted with maternal stress responses (i.e., disengagement coping, involuntary disengagement stress responses) in relation to maternal hazardous alcohol use. Method: Two hundred and fifty-three mothers (n = 147 hazardous alcohol users; 58% of the sample) of adolescents between the ages of 12 and 16 years participated in the current study. Mothers were recruited using Qualtrics panel services. Mothers reported on their parenting stress, strategies for managing parenting stress, and use of alcohol. Mothers also reported basic demographic information (Mage = 41.10 years, 86.6% identified as white, 81.1% of mothers were married). Interaction analyses were used to test hypotheses. Results: Maternal parenting stress interacted with maternal involuntary disengagement stress responses in relation to maternal hazardous alcohol use, such that at average and high levels of disengagement stress responses, parenting stress was associated with hazardous alcohol use. These results were robust to covariates (i.e., family income, maternal anxiety symptoms, maternal depressive symptoms, general levels of maternal stress, maternal cigarette use). Maternal disengagement coping strategies were not related to maternal hazardous alcohol use. Conclusion: Results suggest that parenting stress and involuntary disengagement stress responses may be associated with hazardous alcohol use among mothers of adolescents.

Children born to women in opioid maintenance treatment: A longitudinal study of child behavioral problems and parenting stress

In the wake of the "opioid epidemic", there is considerable concern regarding potential harmful long-term effects of prenatal opioid exposure. Opioid misuse and addiction confer increased exposure to lifestyle stressors and health burdens. Accordingly, it is challenging to disentangle effects of prenatal opioid exposure per se from factors related to maternal stress. In this study, we followed 36 women enrolled in comprehensive opioid maintenance treatment (OMT) program and their children alongside 36 age-matched mother-child dyads from a community sample (COMP) from pregnancy until child-age 8 years. Across five sessions, we used a battery of well-established questionnaires to investigate trajectories of parenting stress and mental health symptoms as well as child behavior problems. The 8-year retention was relatively high (OMT: 72%, COMP: 67%), and the OMT sample remarkably stable and well-functioning, with minimal concomitant illicit drug use. Mixed effects regressions showed significantly different trajectories of child behavior problems (F = 3.8, p = 0.024) and parenting stress (F = 3.1, p = 0.016) in the two groups. Differences in experienced stress were largely explained by more distress specifically related to the parenting role in the OMT group (F = 9.7, p = 0.003). The OMT sample also reported higher psychological distress (F = 15.6, p < 0.001) than the comparison group, but notably few participants presented with problems that warranted clinical intervention. The results underscore the benefits of tailored follow-up of children prenatally exposed to opioids and their families beyond infancy and toddlerhood. Long-term direct effects of prenatal opioid exposure on behavior problems are likely modest, given an otherwise stable caregiving environment conducive to healthy development.

Acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) delivered via eLearning, videoconferencing, and in-person hybrid modalities in Hong Kong

BACKGROUND

Local children with developmental disabilities were deprived of learning opportunities due to recent social and health incidents, resulting in elevating challenging behaviors and familial conflicts. This study explored the acceptability and feasibility of the World Health Organization's Caregiver Skills Training Programme (WHO CST) in alternative delivery modes under new normal and post COVID-19 period.

METHOD

CST was delivered via eLearning (EL), videoconferencing (VC), and in-person hybrid (IP) modes to 34 parent-child dyads, being randomly assigned to modes of asynchronous non-interfering EL (n = 9), synchronous with online coaching VC (n = 7), synchronous with in-person coaching IP (n = 9) and Wait-list Control WLC (n = 9). Data from two standardized scales of General Health Questionnaire (GHQ-12) and Strengths and Difficulties Questionnaire (SDQ), and Post-session and Home Visit Feedback Form by Caregivers that included both structured and open-ended questions were collected before and after intervention. Both quantitative and qualitative approaches were used in studying the collected data.

RESULTS

High levels of acceptability and feasibility of the training programme were supported by ratings on comprehensiveness and relevance, agreement with their personal values, duration, and usefulness. IP and VC groups yielded more positive changes than EL and WLC groups with 3, 16, 13, and -3% in General Health Questionnaire (GHQ-12), -13, -15, -6 and 0% in Difficulties-total, and 36.5, 35.5, 5.8 and 2.4% in Prosocial Scale at Strengths and Difficulties Questionnaire (SDQ) for EL, VC, IP, and WLC groups respectively from baseline to 12 weeks after intervention. Results from two standardized scales echoed with qualitative observations that the programme helped improve caregivers' well-being, child's communication, and behaviors across intervention groups.

CONCLUSIONS

Current findings revealed that CST delivered in three alternative modes were acceptable and feasible, and yielded positive impacts toward both caregivers and children. In-person coaching, and skill-practicing sessions were effective in mitigating child's challenging behaviors while personal interaction, either face-to-face or virtual, is a significant factor in uplifting caregivers' well-being, whereas the self-learning model was appreciated by the busy caregivers. In clinical practice, needs and goals of families and the constraints of remote interventions at the settings should be balanced.

Association between Second-Time Mother's Prenatal Depression and Firstborn's Behaviour Problems: The Mediation Role of Parenting Daily Hassles

Background: With the relaxation of birth control policy in China in recent years, second-time mothers’ mental health has raised concerns. However, the impact of firstborn children’s behaviour problems on second-time mothers’ prenatal depression in families transitioning to siblinghood has received little attention from family psychologists. Aims: This research aims to investigate whether firstborn children’s behaviour problems affect second-time mothers’ prenatal depression and the mediation role of daily parenting hassles, i.e., minor stressors associated with parenting, on this relationship. Methods: Data about second-time mothers’ prenatal depression, parenting daily hassles, and firstborn children’s behaviour problems were collected from 105 families transitioning to two children families using mother-reported questionnaires. Regressions were used to analyze the data. Results: About half of the mothers in the sample have depressive symptoms. Firstborns’ behaviour problems did not have a direct effect on the mother’s prenatal depression, but the problems did have an indirect effect via parenting daily hassles. The mothers’ age was significantly associated with prenatal depression. Conclusions: The mediation role of parenting daily hassles in the association with firstborn’s behaviour problems and mother’s prenatal depression suggests the need for support that reduce the levels of daily parenting hassles from firstborn children.

Using e-diaries to investigate ADHD - State-of-the-art and the promising feature of just-in-time-adaptive interventions

Attention-deficit/hyperactive disorder (ADHD) is characterized by symptoms which are dynamic in nature: states of hyperactivity, inattention and impulsivity as core symptoms, and emotion dysregulation as associated feature. Although tremendous work has been done to investigate between-subject differences (how patients with ADHD differ from healthy controls or patients with other disorders), little is known about the relationship between symptoms with triggers and contexts, that may allow us to better understand their causes and consequences. Understanding the temporal associations between symptoms and environmental triggers in an ecologically valid manner may be the basis to developing just-in-time adaptive interventions. Fortunately, recent years have seen advances in methodology, hardware and innovative statistical approaches to study dynamic processes in daily life. In this narrative review, we provide a description of the methodology (ambulatory assessment), summarize the existing literature in ADHD, and discuss future prospects for these methods, namely mobile sensing to assess contextual information, real-time analyses and just-in-time adaptive interventions.

Maternal feeding stress during mealtimes as a mediator between child food fussiness and maladaptive feeding behaviors among mothers of preschoolers

Parenting stress has been linked to maladaptive feeding behaviors and adverse child outcomes. Maternal stress that is specific to child feeding during mealtimes has not been previously explored. We sought to examine our hypothesis that maternal feeding stress during mealtimes (MFS-mealtimes) mediates the association of child food fussiness and concern about child's diet with maladaptive feeding behaviors. Mothers (n = 100) were recruited through different preschoolers around the city of Jeddah, Saudi Arabia. Participants completed an online questionnaire, which included a newly developed MFS-mealtimes index (Cronbach's α = 0.89), the Child Feeding Questionnaire- Arabic (CFQ-A), and the child food fussiness scale. We conducted path analysis to test our hypothesis, and we used bivariate analyses to inform our path model. Mean child age was 4.76 years (SD = 0.62), and 62% of children were female. Mean maternal age was 33.9 years (SD = 5.83). Results from path analysis showed that concern about child's diet and child food fussiness were each associated with higher MFS-mealtimes (B = 0.11, 95% confidence interval (CI) = 0.01, 0.20, p < 0.05, and B = 0.29, 95% CI = 0.05, 0.53, p < 0.01, respectively). MFS-mealtimes was in turn associated with higher pressure to eat (B = 0.45, 95% CI = 0.18, 0.71, p < 0.05). Goodness of fit indices showed good model fit (p > X² = 0.83, SRMR = 0.005, and CFI = 1.00). Our findings suggest a novel approach for promoting a favorable mealtime environment. Parenting stress reduction interventions have been shown to be successful in reducing stress levels and may be utilized for minimizing feeding stress during mealtimes. Mothers of picky eaters may be specifically targeted for intervention programs. Long term consequences of excessive MFS-mealtimes, as well as variations between cultures need further evaluation.

Understanding at-the-moment stress for parents during COVID-19 stay-at-home restrictions

RATIONALE

In spring 2020, many states in the United States enacted stay-at-home orders to limit the spread of COVID-19 and lessen effects on hospitals and health care workers. This required parents to act in new roles without much support. Although studies have asked parents about stress before and during the pandemic, none have examined how stress may have fluctuated throughout the day and the characteristics related to those daily changes.

OBJECTIVE

Our study assesses how time-varying (e.g., presence of a focal child) and day-varying (e.g., weekend vs. weekday) factors were related to parents' level of stress.

METHODS

We use Ecological Momentary Assessment to examine stress three times a day (10 a.m., 3 p.m., and 9 p.m.) for 14 days. We include two different dates hypothesized to be related to parents' stress levels: (1) when Ohio announced schools would go virtual for the rest of the academic year and (2) when most retail businesses were allowed to re-open. Our sample of 332 individuals, recruited via Facebook, Craigslist, and word of mouth, completed 13,360 of these brief surveys during April-May 2020. Data were analyzed using generalized ordered logit models.

RESULTS

Parents report lower levels of stress when completing the 9 p.m. survey, but higher levels when they were at work, during weekdays (compared to weekends) or when they were with the focal child. COVID-19 milestone dates were not related to stress levels.

CONCLUSIONS

Parents need some form of respite (e.g. child care, child-only activities) to reduce stress, especially during the week when parents are juggling their outside employment and their child(ren)'s schooling. Providing parents with skills and tools to identify and reduce stress, such as apps monitoring heart rate or providing deep breathing techniques, may be one way of helping parents cope with extremely stressful situations.

A Pilot Study of Younger Sibling Adaptation: Contributions of Individual Variables, Daily Stress, Interparental Conflict and Older Sibling's Variables

Older siblings are powerful socialization agents, playing a significant role in the sociocognitive, social, and emotional development of their younger siblings. However, there are few clues about the variables that explain younger sibling's adaptation. The objective of this pilot study was to identify the determinants of younger siblings' adaptation and to analyze the role played by personal, sibling, family and older siblings' variables using 50 dyads of siblings aged between 7 and 18 years. The variables considered were the sibling relationships and the maladaptation of older siblings, and individual (sex, number of siblings, extroversion, and agreeableness) and contextual variables (interparental conflict, daily stress) were controlled. Hierarchical multiple regressions provided evidence in favor of the model that analyzed the younger siblings' maladaptation to school, showing positive associations both with the older siblings' level of school maladaptation and with sibling conflict. In addition, the study highlighted the relevance of the trait of agreeableness and of family stress in the adaptation of younger siblings.

Mothers' Parenting Stress and Neighborhood Characteristics in Early Childhood (Ages 0-4)

Neighborhood characteristics are important when raising children. Traditional approaches to parental stress research have focused on the impacts of daily hassles and how individual factors, such as children’s temperament, family resources, and social support from friends and family reduce or exacerbate parental stress. There have been few studies on neighborhood characteristics and parental stress, and even fewer studies have examined the association longitudinally. The goal of the present study was to explore the association between mothers’ parental stress and neighborhood characteristics longitudinally across early childhood (ages 0–4). Using the 2008–2012 Panel Study on Korean Children, we followed 1536 mothers. The results showed that mothers’ parenting stress was highest when children were aged two to three, and neighborhood characteristics had significant associations with parenting stress. The study indicated that mothers who reported that their neighborhoods had sufficient childcare facilities, were convenient to access public recreational and cultural facilities, and those who reported that their neighborhoods were good places to raise children, exhibited significantly lower levels of parenting stress. Further, the effects of neighborhoods on mothers’ parenting stress were greatest when children were aged one and four. Hence, such findings should be incorporated when designing and developing communities.