Theoretical models of affectionate versus affectionless control in anxious families: a critical examination based on observations of parent-child interactions

Elucidating the Roles of Maternal Overcontrol and Warmth in the Development of Childhood Anxiety and Depression: A Moderated Mediation Framework

Studies have linked childhood anxiety and depression with parenting characterized by high control and low warmth. However, few studies have examined how control and warmth may work together to influence internalizing symptoms in children. Therefore, the goal of this study was to examine the moderating effect of warmth on the relationship between overcontrol and anxiety and depressive symptoms, as well as whether negative thoughts serve as a mediator of these pathways. A total of 182 fourth and fifth grade children completed measures of maternal parenting behavior, negative thoughts, and anxiety and depressive symptoms. Results showed an interaction between overcontrol and warmth for depressive but not anxiety symptoms. Furthermore, low warmth increased the strength of the mediating relationship between overcontrol and depression via thoughts of personal failure. Findings may signal a need for early interventions to address parenting behaviors, such as controlling behaviors, in parents of children at risk for internalizing difficulties.

Maternal Depression and Mother-Child Oxytocin Synchrony in Youth with Anxiety Disorders

The neuropeptide oxytocin (OT) plays a central role in the regulation of affiliative bonds and anxiety. However, the degree to which its levels are synchronized between interaction partners has not yet been assessed. Physiological synchrony assessed using other peripheral measures (e.g., heart rate, etc.) has been tied to positive outcomes for the individual and the dyad. The present study examined OT synchrony in the context of child anxiety and maternal depression by examining mother-child dyads. Mothers and their children with anxiety disorders participated in a behavioral interaction task. Changes in OT levels and mother-child OT synchrony before and after the interaction, as well as their moderation by maternal depression, were assessed. Ninety-eight youth with anxiety disorders (ages 10 to 17) and their mothers underwent psychiatric evaluation, and mothers rated their own depressive symptoms and their children's behavior problems. Salivary OT was assayed from mother and child before and after the task. Behavioral coding showed that interactions were characterized by high behavioral synchrony between mothers and their children, and both individuals displayed higher levels of positive vs. negative affect during the interactions. Mothers and their children also showed decreases in OT levels after the interaction. As hypothesized, OT synchrony increased following the task, but only dyads in which mothers showed high levels of depressive symptoms showed this increase. As hypothesized, lower levels of OT-synchrony were associated with higher levels of child internalizing symptoms. The findings suggest that positive interactions may be beneficial for youth with anxiety disorders with mothers with depression.

Association Between Obsessive-Compulsive Symptom Dimensions in Mothers and Psychopathology in Their Children

Background: The non-clinical presentation of obsessive-compulsive symptoms (OCS) in women may impact not only their daily lives and well-being but also increase the risk for emotional and behavioral problems in their children. This study aims to investigate the OCS dimension distribution in a large sample of mothers from a cohort of school age children and the association between these OCS dimensions with their own psychopathology, and with the presence of OCS and other psychopathology in their children. Method: Our final sample consisted of 2,511 mother-children dyads recruited from the elementary schools of two large cities. Throughout multiple regression analysis, we examined the correlations between demographic and clinical variables of mothers assessed by the Mini International Psychiatric Interview (MINI) and the Dimensional Yale-Brown Obsessive-Compulsive Scale-Short Version (DY-BOCS-SV) with children's psychopathology status reported by the Child Behavior Checklist (CBCL). Results: The overall prevalence of mothers who reported experiencing at least one OCS was 40% (N = 1,004). "Aggression/violence" was the most frequent symptom dimension (32.2%), followed by the "symmetry/ordering" (16.4%) and the "sexual/religious" dimensions (13.8%). There was a significant correlation between the presence of OCS and maternal psychopathology in general (p < 0.001, r = 0.397). Not only the presence but also the severity of the mother's OCS were strongly correlated to the total (p < 0.001), internalizing (p < 0.001), externalizing (p < 0.001), and OCS subscale scores (p < 0.001) on the CBCL. Conclusion: OCS dimensions are highly prevalent in women. Presence and severity of maternal OCS are related to children's psychopathology and behavioral problems.

Mothers With Postpartum Psychiatric Disorders: Proposal for an Adapted Method to Assess Maternal Sensitivity in Interaction With the Child

About 15% of mothers suffer from postpartum psychiatric disorders, such as depression, anxiety, or psychosis. Numerous studies have shown maternal caregiving behavior to be negatively affected under these circumstances. The current study sets out to shed light on specific caregiving behaviors of affected mothers in the context of parental mental illness at an early stage. There are several methods to assess maternal caregiving behavior in terms of sensitivity. However, all of them have limitations regarding the peculiarities of mothers with postpartum disorders, that is, changes in affect regulation, and the early onset of the disorder postpartum. With the current study, we provide an adapted method to assess maternal sensitivity based on methods recently approved in attachment research. Two groups of mothers, who were either healthy or had different postpartum disorders, were recorded on video during interactions with their infants. Behaviors were rated regarding responsiveness, promptness, appropriateness, intrusiveness, and positive and negative affect. A first analysis revealed an increased number of deficits on all subscales in mothers with postpartum psychiatric disorders as compared to healthy mothers. Depressive mothers with a single diagnosis had lower scores in responsiveness, promptness, and appropriateness and higher scores on intrusiveness as compared to those in healthy mothers. Here, maternal behavior appears more parent-centered, whereas affect seemed to be relatively unharmed. Moreover, as compared to healthy mothers, mothers with comorbid depression and anxiety symptomatology achieved lower scores on responsiveness, appropriateness, and positive affect and higher scores on intrusiveness and negative affect. It is suggested, that increased deficits are related to the severity of illness in mothers with comorbidities. Results on promptness indicate that these mothers are still capable of maintaining higher vigilance to infant cues. Variance in maternal behavior was relatively high in clinical mothers, showing that some of them are well capable of behaving in a sensitive manner toward their child. One strength of our adapted method is that particular aspects of sensitive parent-child interactions are assessed separately. This may shed light on specific behavior patterns of different postpartum psychiatric disorders, which may in turn relate to specific child outcomes. The manual is open for usage, while reliability testing is required.

Parental overcontrol x OPRM1 genotype interaction predicts school-aged children's sympathetic nervous system activation in response to performance challenge

Parental overcontrol (OC), the excessive regulation of a child's behavior, cognition, and emotion, is associated with the development of child anxiety. While studies have shown that genetic factors may increase sensitivity to stress, genetic vulnerability to parental OC has not been examined in anxiety etiology. A functional polymorphism in the mu opioid receptor OPRM1 (A118G, rs1799971) has been shown to impact stress reactivity. Using a community sample of children (N = 85, 9-12 years old), we examined the main and interactive effects of maternal OC and child OPRM1 genotype in predicting children's sympathetic nervous system reactivity during a performance stressor. Neither OC nor genotype predicted children's electrodermal activity (EDA); however, the interaction between OC and child genotype significantly predicted stress reactivity, as indexed by EDA, during the challenging task. Among children with the minor G-allele, higher maternal OC was associated with higher reactivity. In A homozygotes, maternal OC was not associated with EDA, suggesting a diathesis-stress pattern of gene x environment interaction. We discuss implications for anxiety etiology and intervention.

Perceived Peer Victimization Predicts Anxiety Outcomes in a Prevention Program for Offspring of Anxious Parents

Offspring of anxious parents are at heightened risk for developing anxiety disorders. Preventive interventions for these youths are promising but not universally effective, creating a need to identify outcome predictors. Peer experiences (e.g., peer victimization, social support) are associated with youth anxiety trajectories but have been relatively unexplored in this context. Thus, this study tested whether peer experiences predicted anxiety-related outcomes in families participating in a randomized controlled trial of a child anxiety prevention program for families with a clinically anxious parent. Parental anxiety severity was also examined as a moderator of relations between peer experiences and subsequent child anxiety. Participants were 121 families (child M age = 8.69, 55.90% girls). Hierarchical logistic and linear regressions were used to test whether baseline peer-related factors predicted increased anxiety symptom severity and anxiety disorder onset over 12 months. Youths reporting greater perceived peer victimization at baseline were more likely to develop an anxiety disorder and had more severe anxiety symptoms 12 months later. Lower social support from classmates also predicted increased anxiety severity, but this effect became nonsignificant after accounting for peer victimization. Further, parental anxiety severity moderated the peer victimization-child anxiety severity link: Higher child-reported peer victimization predicted increased anxiety in offspring of highly and moderately anxious but not low anxious parents. Children's reports of peer victimization appear important for understanding which youth may not respond to preventive interventions in high-risk families-especially for children with more severely anxious parents. Implications for the focus of selective anxiety prevention programs are discussed.

Perceived Control, Family Environment, and the Etiology of Child Anxiety-Revisited

In 1998, Chorpita, Brown, and Barlow published a now seminal study in Behavior Therapy examining the development of anxiety in children and adolescents using Barlow's 1988 model of the development of anxiety in adults. Mindful of developmental considerations, parental control and children's perceptions of control were considered key factors in this revised model. Since that study, mixed support has accumulated for the role of control, both parental control and children's perceptions of that control, in the development of childhood anxiety. As a result, the measurement of these constructs has been critically examined and refined in recent years and encouraging findings have been obtained. Unfortunately, however, the Chorpita and colleagues study as well as the studies that have followed have used cross-sectional designs and the directionality of effects has not been clearly established. Longitudinal studies are required. Here, we present a qualitative review of these developments and provide directions for future research.

Differential parenting and risk for psychopathology: a monozygotic twin difference approach

PURPOSE

Consistent and non-specific associations have been found between parenting style and major depression, anxiety disorders, and externalizing behavior. Although often considered part of twins' shared environment, parenting can also be conceptualized as non-shared environment. Non-shared environmental influences have important effects on development but are difficult to test and sort out because of the possible confounding effects of gene-environment interactions and evocative gene-environment correlations. The monozygotic (MZ) differences approach is one way to analytically investigate non-shared environment.

METHODS

The aim of the present study is to use the MZ differences approach to investigate the relationship between differential parenting among 1303 twin pairs (mean age 36.69 ± 8.56) and differences in total symptom counts of major depression (MD), generalized anxiety disorder (GAD), conduct disorder (CD), and anti-social behavior (ASB) during adulthood.

RESULTS

Although effect sizes tended to be small, a number of results were significantly different from zero. Perceived differences in parental coldness was positively associated with internalizing disorders. Differences in protectiveness were negatively associated with MD, GAD, and ASB. Differences in authoritarianism were positively associated with MD and CD, but negatively associated with ASB.

CONCLUSIONS

Perceived differences in parenting style are associated with differences in MD, GAD, CD, and ASB outcomes in a sample of MZ twins. Despite the lack of a basis for making causal inferences about parenting style and psychopathology, these results are suggestive of such a relationship and show that non-shared environmental influence of parenting does in some cases significantly predict adult psychopathology.

Examining Parenting in the Neighborhood Context: A Review

Positive parenting behavior is a robust predictor of child and adolescent psychosocial adjustment; however, contextual factors that relate to parenting itself are not well understood. This limited understanding is, in part, related to the fact that although theories have been put forth to explain the link between ecological context and parenting, there has been little integration of key concepts across these theories or empirical examination to determine their soundness. This review aims to begin to fill this gap by focusing on one contextual influence on parenting in particular, neighborhood context. Specifically, this review utilizes three constructs to provide a framework for integrating and organizing the literature on parenting within the neighborhood context: Danger (capturing crime and concerns for safety), Disadvantage (assessing the absence of institutional and economic resources), and Disengagement (noting the absence of positive social processes in the community). Findings from this review suggest evidence for an association between neighborhood context and positive parenting. Yet these results appear to vary, at least to some extent, depending on which neighborhood construct is examined, the way positive parenting is assessed, and specific sample demographics, including family income and youth gender and age. Findings from this review not only summarize the research to date on neighborhood and parenting, but provide a foundation for future basic and applied work in this area.

Examining Parenting in the Neighborhood Context: A Review

Positive parenting behavior is a robust predictor of child and adolescent psychosocial adjustment; however, contextual factors that relate to parenting itself are not well understood. This limited understanding is, in part, related to the fact that although theories have been put forth to explain the link between ecological context and parenting, there has been little integration of key concepts across these theories or empirical examination to determine their soundness. This review aims to begin to fill this gap by focusing on one contextual influence on parenting in particular, neighborhood context. Specifically, this review utilizes three constructs to provide a framework for integrating and organizing the literature on parenting within the neighborhood context: Danger (capturing crime and concerns for safety), Disadvantage (assessing the absence of institutional and economic resources), and Disengagement (noting the absence of positive social processes in the community). Findings from this review suggest evidence for an association between neighborhood context and positive parenting. Yet these results appear to vary, at least to some extent, depending on which neighborhood construct is examined, the way positive parenting is assessed, and specific sample demographics, including family income and youth gender and age. Findings from this review not only summarize the research to date on neighborhood and parenting, but provide a foundation for future basic and applied work in this area.

Does Harm Avoidance mediate effects of recollected parental bonding on mental distress in adulthood?

BACKGROUND

Adverse early life conditions such as perceived low quality of parental bonding increase vulnerability to stress and psychopathology in adulthood. However, the mechanisms by which perceptions of parental bonding translate into vulnerability are unclear and remain sparsely investigated in healthy populations. We proposed a model, in which the personality trait Harm Avoidance would mediate effects of recollected parental bonding during the first sixteen years of life on measures of perceived stress and mental distress severity in adulthood.

METHOD

Five-hundred-eighteen adults (65.1 % women), aged 18-53years, completed questionnaires of parental bonding, perceived stress, trait Harm Avoidance, and severity of mental distress. Direct and indirect effects mediated through trait Harm Avoidance were examined in a structural equation model.

RESULTS

Under the causal assumptions of our proposed model, indirect effects of trait Harm Avoidance mediated the relationship between parental overprotection and severity of mental distress, while significantly attenuating the direct effects of parental care on severity of mental distress. Moreover, indirect effects of trait Harm Avoidance significantly attenuated the direct effects of parental overprotection and care on perceived stress.

CONCLUSION

In this large sample of mentally healthy adults, recollected parental bonding was significantly associated with levels of perceived stress and severity of mental distress. The results from our proposed model further suggest that trait Harm Avoidance may be a developmental link, by which the quality of recollected parental bonding in childhood translates into adult vulnerability to stress and mental distress.

Child anxiety and parenting in England and Italy: the moderating role of maternal warmth

BACKGROUND

Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross-cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted.

METHODS

A sample of 8- to 10-year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent-Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video-recorded blindly rated mother-child interaction tasks, the 'belt-buckling tasks and the 'etch-a-sketch', providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection.

RESULTS

There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self-reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety.

CONCLUSIONS

Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.

Parenting and risk for mood, anxiety and substance use disorders: a study in population-based male twins

BACKGROUND

Previous studies consistently identified a relationship between parenting behavior and psychopathology. In this study, we extended prior analyses performed in female twins to a large sample of twins from male-male pairs.

METHODS

We used interview data on 2,609 adult male twins from a population-based twin registry. We examined the association between three retrospectively reported parenting dimensions (coldness, protectiveness, and authoritarianism) and lifetime history of seven common psychiatric and substance use disorders. Using univariate structural equation modeling, we also examined the influence of the genetic and environmental factors on parenting.

RESULTS

Examined individually, coldness was consistently associated with risk for a broad range of adult psychopathology. Averaged odds of psychiatric disorders associated with parenting were increased between 26 and 36 %. When the three parenting dimensions were examined together, coldness remained significant for major depression, phobia, and generalized anxiety disorder. Controlling for other disorders, the associations between the parenting dimensions and psychopathology were non-specific. Twin fitting model demonstrated that modest heritability accounted for parenting, whereas most variance resulted from the non-shared environment.

CONCLUSIONS

Based on our current and prior findings, there is broad similarity in the impact of parenting on adult psychopathology between men and women.

Intergenerational transmission of educational attainment: Three levels of parent-child communication as mediators

Although the intergenerational transmission of educational attainment has been confirmed by many researchers, its mechanism still remains controversial. Parent-child communication has been regarded as one of the important mediators. The present study primarily aimed to examine the potentially mediating role of parent-child communication in the transmission of educational attainment, based on a sample of 366 Chinese fifth and sixth graders. Parent-child communication was measured against the three levels of the parents' communication ability, the quality of the father-child and mother-child communications, and the relation between the two dyadic communications. The results duplicated the positive effect of parents' educational attainment on children's academic achievement. Moreover, it was found that parents' communication ability alone played a mediating role, and that the three levels of parent-child communication constructed a "mediator chain" between the parents' educational attainment and the children's academic achievement. Finally, the intergenerational transmission of educational attainment in China and the mediating role of the three levels of parent-child communication were discussed.

Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework

Anxiety disorders represent a common but often debilitating form of psychopathology in both children and adults. While there is a growing understanding of the etiology and maintenance of these disorders across various research domains, only recently have integrative accounts been proposed. While classical attachment history has been a traditional core construct in psychological models of anxiety, contemporary attachment theory has the potential to integrate neurobiological and behavioral findings within a multidisciplinary developmental framework. The current paper proposes a modern attachment theory-based developmental model grounded in relevant literature from multiple disciplines including social neuroscience, genetics, neuroendocrinology, and the study of family factors involved in the development of anxiety disorders. Recent accounts of stress regulation have highlighted the interplay between stress, anxiety, and activation of the attachment system. This interplay directly affects the development of social-cognitive and mentalizing capacities that are acquired in the interpersonal context of early attachment relationships. Early attachment experiences are conceptualized as the key organizer of a complex interplay between genetic, environmental, and epigenetic contributions to the development of anxiety disorders - a multifactorial etiology resulting from dysfunctional co-regulation of fear and stress states. These risk-conferring processes are characterized by hyperactivation strategies in the face of anxiety. The cumulative allostatic load and subsequent "wear and tear" effects associated with hyperactivation strategies converge on the neural pathways of anxiety and stress. Attachment experiences further influence the development of anxiety as potential moderators of risk factors, differentially impacting on genetic vulnerability and relevant neurobiological pathways. Implications for further research and potential treatments are outlined.

Trajectories of anxiety in a population sample of children: clarifying the role of children's behavioral characteristics and maternal parenting

This study pursued three goals. The first goal was to explore children's trajectories of anxiety from age 6 to 12 using a representative community sample. The second goal was to assess the link between certain behavioral characteristics assessed in kindergarten (i.e., inattention, hyperactivity, aggressiveness, and low prosociality) and these trajectories. The third goal was to determine whether certain aspects of maternal parenting (i.e., warmth and discipline) could moderate the association between these characteristics and the trajectories of anxiety. A population sample of 2,000 children (1,001 boys, 999 girls) participated in this longitudinal study. Developmental trajectory analyses allowed us to identify four trajectory groups: low, low-increasing, high-declining, and high anxiety groups. Moreover, multinomial logistic regressions revealed a profile of children at risk of developing high anxiety symptoms (i.e., high group), characterized by sociofamily adversity, inattention, and low prosociality in the classroom. Hyperactivity was also found in this profile, but only for children exposed to a mother who showed little affective warmth. Finally, mothers' high level of discipline increased the odds of belonging to the high anxiety group. The results are discussed in relation to studies examining the association among anxiety, behavioral characteristics, and parenting during childhood.

A preliminary investigation of the impact of maternal obsessive-compulsive disorder and panic disorder on parenting and children

Although there is evidence for the intergenerational transmission of anxiety disorders, there is little research in relation to specific parental disorders. This study evaluated three groups of mothers with at least one child aged 7-14, defined in terms of maternal obsessive-compulsive disorder (OCD; n=23), panic disorder (n=18), and healthy controls (n=20). Parental perceptions and symptomatology, general and disorder-specific child symptoms and mother-child interactions were investigated using self-report, informant report and independent assessment. Mothers with OCD and panic disorder expressed high levels of concern about the impact of their anxiety disorder on their parenting. Group differences in terms of child anxiety were subtle rather than clinically significant. In interactions, anxious mothers were less warm and promoting of psychological autonomy than healthy controls, and they exhibited elevated expressed emotion. Overall, the results suggested a mix of effects including trans-diagnostic and disorder-specific issues. Implications for future research are discussed.

The development of anxiety disorders in childhood: an integrative review

We present an integrative review of the development of child anxiety, drawing on a number of strands of research. Family aggregation and genetic studies indicate raised vulnerability to anxiety in offspring of adults with the disorder (e.g. the temperamental style of behavioural inhibition, or information processing biases). Environmental factors are also important; these include adverse life events and exposure to negative information or modelling. Parents are likely to be key, although not unique, sources of such influences, particularly if they are anxious themselves. Some parenting behaviours associated with child anxiety, such as overprotection, may be elicited by child characteristics, especially in the context of parental anxiety, and these may serve to maintain child disorder. Emerging evidence emphasizes the importance of taking the nature of child and parental anxiety into account, of constructing assessments and interventions that are both disorder specific, and of considering bidirectional influences.

Effect of maternal panic disorder on mother-child interaction and relation to child anxiety and child self-efficacy

To determine whether mothers with panic disorder with or without agoraphobia interacted differently with their children than normal control mothers, 86 mothers and their adolescents (aged between 13 and 23 years) were observed during a structured play situation. Maternal as well as adolescent anxiety status was assessed according to a structured diagnostic interview. Results showed that mothers with panic disorder/agoraphobia showed more verbal control, were more criticizing and less sensitive during mother-child interaction than mothers without current mental disorders. Moreover, more conflicts were observed between mother and child dyadic interactions when the mother suffered from panic disorder. The comparison of parenting behaviors among anxious and non-anxious children did not reveal any significant differences. These findings support an association between parental over-control and rejection and maternal but not child anxiety and suggest that particularly mother anxiety status is an important determinant of parenting behavior. Finally, an association was found between children's perceived self-efficacy, parental control and child anxiety symptoms.