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Sullivan ADW, Roubinov D, Noroña-Zhou AN, Bush NR. Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review. Psychoneuroendocrinology 2024; 162:106949. [PMID: 38295654 DOI: 10.1016/j.psyneuen.2023.106949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/22/2023] [Accepted: 12/23/2023] [Indexed: 03/04/2024]
Abstract
BACKGROUND Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts. METHODS We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field. RESULTS Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers. CONCLUSIONS We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.
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Affiliation(s)
- Alexandra D W Sullivan
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA.
| | - Danielle Roubinov
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, University of North Carolina, Chapel Hill, USA
| | - Amanda N Noroña-Zhou
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, Center for Health and Community, Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Pediatrics, Division of Developmental Medicine, UCSF, USA.
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Blanchet BH, Hayes T, Gillenson C, Neuman K, Heymann P, Comer JS, Bagner DM. Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024:1-12. [PMID: 38512063 DOI: 10.1080/15374416.2024.2317409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
IMPORTANCE Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. OBJECTIVE We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent-Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. METHOD Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. RESULTS Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. CONCLUSIONS Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.
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Affiliation(s)
- Brynna H Blanchet
- Department of Psychology, Center for Children and Families, Florida International University
| | - Timothy Hayes
- Department of Psychology, Center for Children and Families, Florida International University
| | - Caroline Gillenson
- Department of Psychology, Center for Children and Families, Florida International University
| | - Keara Neuman
- Department of Psychology, Center for Children and Families, Florida International University
| | - Perrine Heymann
- Department of Psychology, Center for Children and Families, Florida International University
| | - Jonathan S Comer
- Department of Psychology, Center for Children and Families, Florida International University
| | - Daniel M Bagner
- Department of Psychology, Center for Children and Families, Florida International University
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Peskin A, Barth A, Andrew Rothenberg W, Turzi A, Formoso D, Garcia D, Jent J. New Therapy for a New Normal: Comparing Telehealth and in-Person Time-Limited Parent-Child Interaction Therapy. Behav Ther 2024; 55:106-121. [PMID: 38216225 DOI: 10.1016/j.beth.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 05/09/2023] [Accepted: 05/14/2023] [Indexed: 01/14/2024]
Abstract
Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (N = 380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.
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Matano M, Kurane K, Wakabayashi K, Yada Y, Kono Y, Tajima T, Osaka H, Monden Y. Efficacy of parent-child interaction therapy for children born premature. Pediatr Int 2024; 66:e15742. [PMID: 38409900 DOI: 10.1111/ped.15742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/12/2023] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Premature children are known to be at a high risk of developing behavioral problems. This study examined the effectiveness of parent-child interaction therapy (PCIT) in reducing behavioral problems in young children born premature. METHODS The study included 18 child-parent pairs with children born at less than 35 weeks of gestation (range: 23-34 weeks, median: 31.0 weeks) and aged 27-52 months (median: 38.0 months). They were assigned to either the PCIT group (n = 7) or the non-PCIT group (n = 11) based on maternal desire for treatment. The study was designed to examine the effects of PCIT. Specifically, the Eyberg Child Behavior Inventory (ECBI) intensity score, ECBI problem score, and Parenting Stress Index Short Form (PSI-SF) scores were compared before treatment and after 6 months. RESULTS In the PCIT group, the mean ECBI intensity score was 135.7 (SD = 13.5; T-score = 64) at baseline and 90.1 (SD = 15.5; T-score = 46) at post-assessment, the mean ECBI problem score was 9.8 (SD = 1.9; T-score = 54) at baseline and 4.4 (SD = 3.1; T-score = 44) at post-assessment, the mean PSI-SF total score was 60.1 (SD = 4.8; 95%tile) at baseline and 49.6 (SD = 5.6; 85%tile) at post-assessment, showing a significant improvement (ECBI intensity scores: p < 0.001, d = 2.03; ECBI problem scores: p < 0.001, d = 1.94; PSI-SF total scores: p = 0.004, d = 0.86). On the other hand, none of the scores showed significant change in the non-PCIT group. CONCLUSIONS The PCIT can be considered as a potential treatment option for behavioral problems in young children born premature.
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Affiliation(s)
- Miyuki Matano
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Koyuru Kurane
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Kei Wakabayashi
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Yukari Yada
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Yumi Kono
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Toshihiro Tajima
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
| | - Yukifumi Monden
- Department of Pediatrics, Jichi Medical University, Shimotsuke City, Tochigi, Japan
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Sullivan ADW, Bozack AK, Cardenas A, Comer JS, Bagner DM, Forehand R, Parent J. Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays. Psychol Sci 2023; 34:1173-1185. [PMID: 37733001 PMCID: PMC10626625 DOI: 10.1177/09567976231194221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/26/2023] [Indexed: 09/22/2023] Open
Abstract
This study examined whether children exposed to adversity would exhibit lower epigenetic age acceleration in the context of improved parenting. Children with developmental delays and externalizing behavior problems (N = 62; Mage = 36.26 months; 70.97% boys, 29.03% girls; 71% Latinx, 22.6% Black) were drawn from a larger randomized controlled trial (RCT), which randomized them to receive Internet-delivered parent-child interaction therapy (iPCIT; n = 30) or community referrals as usual (RAU; n = 32). Epigenetic age acceleration was estimated with the pediatric buccal epigenetic clock, using saliva. Adversity was assessed using parent, family, and neighborhood-level cumulative-risk indicators. Adversity interacted with Time 2 (T2) observations of positive and negative-parenting practices to predict epigenetic age acceleration 1.5 years later, regardless of treatment assignment. Children exposed to more adversity displayed lower epigenetic age acceleration when parents evidenced increased positive (b = -0.15, p = .001) and decreased negative (b = -0.12, p = .01) parenting practices.
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Affiliation(s)
- Alexandra D. W. Sullivan
- Department of Psychological Science, University of Vermont
- Department of Psychiatry, Center for Health and Community, University of California, San Francisco
| | - Anne K. Bozack
- Department of Epidemiology and Population Health, School of Medicine, Stanford University
| | - Andres Cardenas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University
- Department of Pediatrics, School of Medicine, Stanford University
| | - Jonathan S. Comer
- Department of Psychology and Center for Children and Families, Florida International University
| | - Daniel M. Bagner
- Department of Psychology and Center for Children and Families, Florida International University
| | - Rex Forehand
- Department of Psychological Science, University of Vermont
| | - Justin Parent
- Bradley-Hasbro Children’s Research Center, E. P. Bradley Hospital, Providence, RI
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University
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Rowe GM, Bagner DM, Lorenzo NE. Cumulative Risk and Externalizing Behaviors during Infancy in a Predominantly Latine Sample. Behav Sci (Basel) 2023; 13:bs13050363. [PMID: 37232600 DOI: 10.3390/bs13050363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/27/2023] Open
Abstract
Externalizing behavior problems are among the top mental health concerns in early childhood, and many parenting interventions have been developed to address this issue. To better understand predictors of parenting intervention outcomes in high-risk families, this secondary data analysis evaluated the moderating effect of cumulative risk on child externalizing behaviors, parenting skills, and intervention dropout after completion of a home-based adaptation of the child-directed interaction phase of parent-child interaction therapy (PCIT) called the Infant Behavior Program (IBP). The participants included 58 toddlers (53% male; average age of 13.5 months; and 95% Hispanic or Latine) who were part of a larger randomized control trial in which families were randomly assigned to receive the IBP or treatment as usual (TAU). Cumulative risk was found to moderate the effect of the intervention group on child externalizing behaviors such that the participants in the intervention group with higher cumulative risk scores had greater reductions in externalizing behaviors. A potential explanation for these unexpected findings may be that the obstacles to treatment that were previously imposed by comorbid risk factors (i.e., lack of transportation, time commitment, and language barriers) were adequately addressed such that the families who most needed the intervention were able to remain fully engaged.
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Affiliation(s)
- Greighson M Rowe
- Department of Psychology, American University, Washington, DC 20016, USA
| | - Daniel M Bagner
- Department of Psychology, Florida International University, Miami, FL 33199, USA
| | - Nicole E Lorenzo
- Department of Psychology, American University, Washington, DC 20016, USA
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Hofheimer JA, McGrath M, Musci R, Wu G, Polk S, Blackwell CK, Stroustrup A, Annett RD, Aschner J, Carter BS, Check J, Conradt E, Croen LA, Dunlop AL, Elliott AJ, Law A, Leve LD, Neiderhiser JM, O’Shea TM, Salisbury AL, Sathyanarayana S, Singh R, Smith LM, Aguiar A, Angal J, Carliner H, McEvoy C, Ondersma SJ, Lester B. Assessment of Psychosocial and Neonatal Risk Factors for Trajectories of Behavioral Dysregulation Among Young Children From 18 to 72 Months of Age. JAMA Netw Open 2023; 6:e2310059. [PMID: 37099294 PMCID: PMC10134008 DOI: 10.1001/jamanetworkopen.2023.10059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/10/2023] [Indexed: 04/27/2023] Open
Abstract
Importance Emotional and behavioral dysregulation during early childhood are associated with severe psychiatric, behavioral, and cognitive disorders through adulthood. Identifying the earliest antecedents of persisting emotional and behavioral dysregulation can inform risk detection practices and targeted interventions to promote adaptive developmental trajectories among at-risk children. Objective To characterize children's emotional and behavioral regulation trajectories and examine risk factors associated with persisting dysregulation across early childhood. Design, Setting, and Participants This cohort study examined data from 20 United States cohorts participating in Environmental influences on Child Health Outcomes, which included 3934 mother-child pairs (singleton births) from 1990 to 2019. Statistical analysis was performed from January to August 2022. Exposures Standardized self-reports and medical data ascertained maternal, child, and environmental characteristics, including prenatal substance exposures, preterm birth, and multiple psychosocial adversities. Main Outcomes and Measures Child Behavior Checklist caregiver reports at 18 to 72 months of age, with Dysregulation Profile (CBCL-DP = sum of anxiety/depression, attention, and aggression). Results The sample included 3934 mother-child pairs studied at 18 to 72 months. Among the mothers, 718 (18.7%) were Hispanic, 275 (7.2%) were non-Hispanic Asian, 1220 (31.8%) were non-Hispanic Black, 1412 (36.9%) were non-Hispanic White; 3501 (89.7%) were at least 21 years of age at delivery. Among the children, 2093 (53.2%) were male, 1178 of 2143 with Psychosocial Adversity Index [PAI] data (55.0%) experienced multiple psychosocial adversities, 1148 (29.2%) were exposed prenatally to at least 1 psychoactive substance, and 3066 (80.2%) were term-born (≥37 weeks' gestation). Growth mixture modeling characterized a 3-class CBCL-DP trajectory model: high and increasing (2.3% [n = 89]), borderline and stable (12.3% [n = 479]), and low and decreasing (85.6% [n = 3366]). Children in high and borderline dysregulation trajectories had more prevalent maternal psychological challenges (29.4%-50.0%). Multinomial logistic regression analyses indicated that children born preterm were more likely to be in the high dysregulation trajectory (adjusted odds ratio [aOR], 2.76; 95% CI, 2.08-3.65; P < .001) or borderline dysregulation trajectory (aOR, 1.36; 95% CI, 1.06-1.76; P = .02) vs low dysregulation trajectory. High vs low dysregulation trajectories were less prevalent for girls compared with boys (aOR, 0.60; 95% CI, 0.36-1.01; P = .05) and children with lower PAI (aOR, 1.94; 95% CI, 1.51-2.49; P < .001). Combined increases in PAI and prenatal substance exposures were associated with increased odds of high vs borderline dysregulation (aOR, 1.28; 95% CI, 1.08-1.53; P = .006) and decreased odds of low vs high dysregulation (aOR, 0.77; 95% CI, 0.64-0.92; P = .005). Conclusions and Relevance In this cohort study of behavioral dysregulation trajectories, associations were found with early risk factors. These findings may inform screening and diagnostic practices for addressing observed precursors of persisting dysregulation as they emerge among at-risk children.
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Affiliation(s)
- Julie A. Hofheimer
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
- Department of Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Guojing Wu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney K. Blackwell
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Annemarie Stroustrup
- Division of Neonatology, Department of Pediatrics, Cohen Children’s Medical Center at Northwell Health, New Hyde Park, New York
| | - Robert D. Annett
- Department of Pediatrics, University of New Mexico Health Sciences Center, Albuquerque
| | - Judy Aschner
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
- Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Brian S. Carter
- Department of Pediatrics, University of Missouri-Kansas City, Children’s Mercy Kansas City, Kansas City
| | - Jennifer Check
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Elisabeth Conradt
- Department of Psychiatry, Duke University School of Medicine, Durham, North Carolina
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Anne L. Dunlop
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Amy J. Elliott
- Avera Research Institute, Sioux Falls, South Dakota
- Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls
| | - Andrew Law
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leslie D. Leve
- Prevention Science Institute, University of Oregon, Eugene
| | | | - T. Michael O’Shea
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill
| | | | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle
| | - Rachana Singh
- Department of Pediatrics, Tufts University School of Medicine, Boston, Massachusetts
| | - Lynne M. Smith
- Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Andréa Aguiar
- Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana-Champaign
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana-Champaign
| | - Jyoti Angal
- Avera Research Institute, Sioux Falls, South Dakota
| | - Hannah Carliner
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Cindy McEvoy
- Department of Pediatrics, Oregon Health & Science University, Doernbecher Children’s Hospital, Portland
| | - Steven J. Ondersma
- Division of Public Health, Michigan State University, East Lansing
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Barry Lester
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Brown University Alpert School of Medicine, Providence
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Error in Text. JAMA Pediatr 2023; 177:323. [PMID: 36877221 PMCID: PMC9989897 DOI: 10.1001/jamapediatrics.2023.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
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