Parent-Child Play and the Emergence of Externalizing and Internalizing Behavior Problems in Childhood: A Systematic Review

Where Is the Parent's Voice? A Meta-Synthesis of Parental Experiences of Video Feedback Parenting Interventions

Video-aided feedback (VF) is a well-evidenced intervention technique to enhance the relationship between a parent and their young child. While parental acceptability is foundational to engagement and intervention efficacy, the parent's perspective is only now emerging as a valued consideration when evaluating VF-based interventions. This systematic review metasynthesised qualitative research on the experiences of primary caregivers with a young child (primarily 0-30 months) of participating in a VF parenting intervention. A search of nine databases yielded 17 studies (10 published since 2020) involving parents who had participated in range of VF-focussed programmes. Thematic synthesis identified six themes: (1) Getting past the fear and discomfort: Being 'good enough' and 'doing the right thing'; (2) The power of video: "I had never really noticed that before‟ (with two subthemes: video as validation and for seeing child behavioural intentionality; video as an agent for change); (3) The practitioner's skill and role in creating a safe space; (4) The approach was too intangible, inflexible, positive, unclear; (5) When the intervention is over: Positive change and generalisation; (6) Parental engagement and involvement: Barriers and enhancements. While most parents reported experiencing a range of interpersonal and intrapersonal benefits from taking part in a VF parenting intervention, having to overcome initial strong negative and uncomfortable feelings were an important part of the journey. Some parents could not see the value of the approach or did not perceive the intervention to meet their needs. Insights into parental experience are complementary to outcome-based evaluations. However, biased design (e.g., only one study included intervention non-completers) and variable study quality need addressing in future studies. Implications for practice are discussed.

Mother-Infant Interaction and Maternal Postnatal Psychological Distress Associate with Child's Social-Emotional Development During Early Childhood: A FinnBrain Birth Cohort Study

We studied the effects of mother-infant interaction and maternal pre- and postnatal psychological distress on children's social-emotional problems and competences, as well as whether interaction quality moderates the association between distress and children's outcomes. Maternal pre- and postnatal psychological distress were measured using the SCL and EPDS questionnaires, whereas mother-infant interaction was measured when the child was 8 months old using the EA Scales. Children's social-emotional development was measured using the BITSEA questionnaire at 2 years old and using the SDQ questionnaire at 4 years old, where higher maternal structuring was associated with fewer social-emotional problems in children and higher maternal sensitivity was associated with greater social-emotional competence in children at 2 years old. Further, higher postnatal distress was found associated with greater social-emotional problems at 2 years old, though neither these effects nor moderating effects at 4 years old were observed after multiple-comparison corrections. Our findings support direct associations of both mother-infant interaction and maternal postnatal psychological distress with children's social-emotional development during toddlerhood.

Mediating effects of parent-child dysfunctional interactions in the relationship between parenting distress and social-emotional problems and competencies

This study investigated the association between parenting distress and four variables of young children's social-emotional problems and competencies: externalizing, internalizing, and dysregulation problems, and social-emotional competencies, and whether parent-child dysfunctional interactions mediated these associations. Participants were Chinese toddlers (N = 711) aged 24-36 months in family (44.3%) and center-based (55.7%) care. The results from structural equation modeling showed that parent-child dysfunctional interactions fully mediated the relationship between parenting distress and externalizing, and dysregulation problems, and social-emotional competencies, while partially mediated in the internalizing problems for both groups. Furthermore, multi-group SEM models showed the direct and indirect pathways differed between two groups. The research concludes that parent-child interaction plays a crucial role in mediating the relationship between parenting distress and young children's social-emotional problems and competencies. For families' choice of childcare, this study suggests early center-based services provided for toddlers exposed to family risk characteristics such as parents' poor mental health, and more importantly, low levels of parent-child interactions.

Types of On-Screen Content and Mental Health in Kindergarten Children

Importance

Excessive screen time has been associated with a higher risk for mental health problems, but whether the associations differ by screen content types is unclear.

Objective

To examine the allocation of and longitudinal changes in screen exposure across different content types and to explore their associations with mental health in children aged 3 to 6 years.

Design, Setting, and Participants

This cohort study used 3-wave, lagged generalized estimating equation models to analyze data from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool (SCHEDULE-P) study in Shanghai, China. The cohort was a representative sample of kindergarten children. Data were collected between November 2016 and May 2019 when children were aged 3 to 4 years (wave 1), 4 to 5 years (wave 2), and 5 to 6 years (wave 3). Data analysis was performed between June 2022 and May 2023.

Exposure

Screen exposure (total daily time and time with each type of content, including educational programs, entertainment programs, non-child-directed programs, electronic games, and social media) was collected when children were aged 3, 5, and 6 years.

Main Outcomes and Measures

Mental health of children at age 3, 5, and 6 years was reported by parents using the Strengths and Difficulties Questionnaire.

Results

Of the 15 965 children included in the representative sample, 8270 were males (51.7%) and the mean (SD) age at wave 1 was 3.73 (0.30) years. As children developed from ages 3 to 6 years, the proportion of screen exposure to educational programs (≤1 hour per day: 45.0% [95% CI, 43.5%-46.5%] to 26.8% [95% CI, 25.3%-28.3%]) and entertainment programs (≤1 hour per day: 44.4% [95% CI, 42.8%-45.9%] to 32.1% [95% CI, 30.4%-33.9%]) decreased, whereas exposure to social media increased (≤1 hour per day: 1.5% [95% CI, 1.2%-1.9%] to 27.1% [95% CI, 25.5%-28.7%]). The associations between on-screen content and mental health varied. For a given total screen time, a higher proportion of screen exposure to educational programs was associated with a lower risk for mental health problems (adjusted odds ratio [AOR], 0.73; 95% CI, 0.60-0.90), whereas non-child-directed programs were associated with a higher risk for such problems (AOR, 2.82; 95% CI, 1.91-4.18). Regardless of the content, total screen time was consistently associated with mental health problems.

Conclusions and relevance

Results of this study indicated that both total screen time and different types of content were associated with mental health problems in children aged 3 to 6 years. Limiting children's screen time, prioritizing educational programs, and avoiding non-child-directed programs are recommended.

The Quality of Mother-Child Feeding Interactions Predicts Psychopathological Symptoms in Offspring and Mothers Seven Years Later: A Longitudinal Study on the General Population

The increased risk of internalizing and externalizing symptoms in children has been observed in the presence of maternal psychopathology. This study aimed to investigate a potential pathway involving the quality of early interactions between mothers and their children. A sample of 150 mother-child dyads underwent assessment when the children were 3 years old and around the age of 10. Video recordings of feeding exchanges between mothers and children were analyzed to evaluate the quality of mother-child interactions. Maternal psychopathology and child internalizing and externalizing symptoms were measured through self-report and report-form measures completed by mothers. The quality of mother-child feeding interactions at three years of age significantly differentiated (p < 0.001), eight years later, between mothers at high and low psychopathological risk and between children exhibiting clinical and subclinical internalizing symptoms. Clinically relevant child symptoms were notably more prevalent when the mother-child interaction quality at three years of age was maladaptive, particularly in the context of concurrent high maternal psychopathological risk. The study findings underscore the importance of focusing on the early quality of mother-child feeding interactions to identify potential situations of maternal and child clinical risk for the development of psychopathological symptoms and to guide preemptive measures and policies.

A Comprehensive Analysis of the Relationship between Play Performance and Psychosocial Problems in School-Aged Children

During childhood, play contributes to the physical, emotional, cognitive and social development of infants and children and may enhance future mental health. The aim of this study was to examine the relationship between play performance factors and psychosocial problems in school-aged children. A total of 142 typical Spanish children aged 5 to 9 years were included. Play performance was measured with the My Child’s Play questionnaire, while the Strengths and Difficulties Questionnaire was used to evaluate internalizing and externalizing problems. The findings showed that personal, environmental and activity factors of play performance were associated with psychosocial problems and prosocial behavior in children. Moreover, children with high psychosocial difficulties reported significantly poorer play performance. As executive functioning during play was the factor that was most strongly associated with internalizing and externalizing psychosocial difficulties, it is possible that executive functions have a decisive role on both social cognition and self-regulation during play performance.