Caregiver stress and cultural identity in families of preschoolers with developmental delay and behavioral problems

Psychometric Evaluation of the Abbreviated Multidimensional Acculturation Scale (AMAS) in a Treatment-Seeking Sample of First-Generation Immigrant Caregivers

The unique needs of first-generation immigrants and their families have not been prioritized in mental healthcare. Cultural tailoring of child services requires valid, reliable, and efficient assessments of family cultural identity. The Abbreviated Multidimension Acculturation Scale (AMAS) is a self-report of acculturation and enculturation that has been evaluated in community, but not clinical, samples. We offer the first AMAS psychometric evaluation in a treatment-seeking sample of first-generation immigrant caregivers presenting for children's mental healthcare (N = 219). Analyses examined the internal consistency, concurrent validity, and factor structures of the long-form AMAS (42 items, six subscales), AMAS-10 (10 items, four subscales), and AMAS-14 (14 items, six subscales). Findings provide support for the AMAS-10 and AMAS-14, but not the full-length AMAS, in the present sample. Given urgent needs for culturally responsive care for first-generation populations, the AMAS-10 and AMAS-14 can be used in clinical settings to support cultural assessment, case conceptualization, and treatment planning.

The effectiveness of therapist-led family-centered language intervention for children with language delay

Background

China's language therapist shortage and intergenerational caregiving trends underscore the need for family-based language training, yet such interventions are underutilized and family roles undervalued. This study aims to investigate the effect of a therapist-led family-centered intervention on children with language delay.

Methods

The study comprised 134 children, comprising 59 girls and 75 boys, aged between 2 and 5 years (39.92±10.23 months) who presented with language delay. These participants were selected from the pediatric rehabilitation ward of the Second Affiliated Hospital of Army Medical University from July 2021 and July 2023. They were divided into a control group (n=70) receiving language therapy led by a language therapist, and an observation group (n=64) receiving therapist-led family-centered language intervention in conjunction with the treatment provided to the control group. Demographic characteristics were analyzed. The Gesell and Sign-significant (S-S) were used for assessments before and after the intervention.

Results

No significant demographic differences were found between the groups. Both groups demonstrated significant improvements in language development following a 3-month intervention as assessed by the Gesell assessment. The control group showed an increase from 52.97±4.79 to 65.97±3.48 (P<0.001), while the observation group improved from 53.53±4.06 to 71.98±4.51 (P<0.001). Additionally, prior to the intervention, differences were observed between the control group and the observation group in S-S assessments, particularly in symbolic form and instructional content (P=0.04 and P<0.001) as well as foundational research topics (P=0.04 and P<0.001). Following the intervention, the observation group demonstrated more significant advancements in language development compared to control group as evidenced by higher Gesell scores (18.45±5.72 vs. 13.00±6.16, P<0.001), S-S assessments in symbolic form and instructional content (1.11±1.55 vs. 0.53±1.57, P=0.03), and foundational research topics (1.42±1.88 vs. 0.64±2.14, P=0.02). Based on the Gesell assessment, there was a significant improvement in personal-social skills for both groups of children following intervention (all P<0.05), with the observation group demonstrating a more pronounced enhancement compared to the control group (4.73±4.07 vs. 2.20±3.68, P<0.001).

Conclusions

Therapist-led family-centered interventions enhance language development, with parents playing a significant role in mitigating skip-generation caregiving and fostering greater parent-child interactions.

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

Importance

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

Objective

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

Design, Setting, and Participants

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

Interventions

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

Main Outcomes and Measures

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

Results

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

Conclusions and Relevance

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

Trial Registration

ClinicalTrials.gov Identifier: NCT03260816.

Social Support and Parenting Stress in Hispanic Parents of Children with Autism Spectrum Disorder

The purpose of this integrative review is to synthesize the literature examining the relationship between parenting stress and social support in Hispanic parents of children with autism spectrum disorder (ASD). A database search of studies that evaluated parenting stress and social support in this population was conducted. Fourteen studies met inclusion criteria. Despite high stress levels, both informal and formal social supports improved parenting stress among Hispanic families. Few studies evaluated culturally sensitive social support interventions. With the increasing prevalence of ASD, the development of culturally sensitive social support interventions is necessary to promote the well-being of Hispanic families.

Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents

PURPOSE OF REVIEW

To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations.

RECENT FINDINGS

Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports.

SUMMARY

Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.