The Parenting Anxious Kids Ratings Scale-Parent Report (PAKRS-PR): Initial Scale Development and Psychometric Properties

Emotion Regulation, Parenting, and Psychopathology: A Systematic Review

The presence of a parental mental disorder can lead to adverse outcomes for children. Difficulties in emotion regulation are observed across a range of mental health problems and may play a crucial role in this context. Following PRISMA guidelines, we systematically searched Medline, PsycINFO, Embase, and Web of Science for studies examining the association between emotion regulation in parents with psychopathology at a clinical or subclinical level and their parenting. The protocol was registered with the PROSPERO international prospective register of systematic reviews (CRD42021224954; January 2021). A total of 23 studies were included in the qualitative synthesis. Emotion regulation was predominantly assessed using self-report on the general ability (e.g., Difficulties in Emotion Regulation Scale). The assessment of parenting encompassed a broad range of aspects and operationalizations. Across psychopathology in parents, several aspects of difficulties in emotion regulation were associated with unfavorable emotion socialization, more negative parenting, and partially with less positive parenting. Slightly different effects were observed for posttraumatic stress disorder and anxiety disorders. For parents with depressive disorders, specific emotion regulation strategies (suppression, reappraisal) seem to buffer against negative parenting. Since the majority of studies refer only to mothers, generalization to fathers is limited. Furthermore, conclusions are limited due to study heterogeneity and lack of prospective studies. Nevertheless, findings suggest that interventions should target the improvement of emotion regulation in parents with psychopathology.

Sleep Disturbances in Pediatric Body-Focused Repetitive Behaviors: A Preliminary Investigation

Body-focused repetitive behaviors (BFRBs) are repeated actions to one's body resulting in physical damage. Limited research has examined sleep, a known factor in psychological health, within the context of pediatric BFRBs. The current study sought to explore the connection between disordered sleep and BFRBs in a community sample. Aim 1 of the study was to determine the predictive power of group membership [control group (no BFRB symptoms reported), subthreshold BFRB group (mild BFRB symptoms reported; severity score of 2 or less out of 9), and those with symptoms characteristic of BFRBs (more than mild BFRB symptoms reported; severity score of 3 or higher out of 9)] for level of sleep disturbance. A hierarchical regression revealed that there was a significant effect of group membership after controlling for anxiety (F (3, 410) = 152.976, p < .001). Aim 2 of the study was to test whether there was a relationship between sleep disturbance and BFRB severity. The hierarchical regression revealed that at Step 1, anxiety accounted for 23.1% of the variance in BFRB severity (β = 0.48, t = 8.87, p < 0.001). At Step 2, sleep disturbance total score accounted for an additional 7.2% of the variance, suggesting this variable makes a unique contribution to overall BFRB severity (SDSC: β = 0.40, t = 5.18, p < 0.001). The findings of this study suggest that sleep could be a clinical factor to consider when conceptualizing a child with BFRBs.

Youth Anxiety: The Moderating Effects of Accommodation and Emotional Warmth

Parental accommodation (i.e., modifying behavior to reduce child distress) is among the most empirically supported anxiety enhancing parenting practices; while emotional warmth (i.e., support and affection) has demonstrated a less clear link to anxiety. The current study aims to explore the interactive nature of emotional warmth within the context of accommodation. We hypothesized that accommodation would moderate the relationship between emotional warmth and anxiety. The sample included parents of youth (N = 526) ages 7-17. A simple moderation analysis was conducted. Accommodation significantly moderated the relationship [B = 0.03, C.I. (0.01, 0.05), p = 0.01]. Additional variance was accounted for by adding the interaction term to the model (R² = 0.47, p < 0.001). At high levels of accommodation, emotional warmth significantly predicted child anxiety symptoms. This study affirms that emotional warmth is significantly related to anxiety in the context of high accommodation. Future work ought to build upon these findings to explore these relationships. Limitations of the study include sampling and parent-report data.

Family Accommodation Scale for Sensory Over-Responsivity: A Measure Development Study

Family accommodation refers to the attempt of family members (most often parents) to prevent their child's distress related to psychopathology. Family accommodation can limit meaningful participation in personal and social routines and activities. Accommodation has been studied extensively in the context of childhood anxiety and has been linked to greater impairment, and poor intervention outcomes. Like anxiety, sensory over-responsivity (SOR) symptoms are associated with heightened distress and thus, may also be accommodated by family members. The current study describes the validation of a new pediatric family accommodation scale for SOR. Parents of 301 children ages 3-13 years completed an online survey, of which 48 had medical or developmental conditions. The survey included the Child Sensory Profile 2 and the newly developed family accommodation scale for sensory over-responsivity (FASENS). Three Sensory Profile 2 scores were analyzed: SOR, sensory under-responsivity and sensory seeking. The FASENS consists of 18 items; 12 describing the frequency of accommodation behaviors and 6 describing the impact of the accommodation on the wellbeing of the family and the child. Results indicated that the FASENS has high internal consistency (α = 0.94) as well as a significant 3-factor confirmatory model fit: (1) accommodations (i.e., avoidance and changes), (2) family impact, and (3) child impact. FASENS scores significantly correlated with SOR symptoms (r = 0.52-0.60, p < 0.001). However, they also correlated with under-responsivity and seeking (r = 0.33-0.42, p < 0.001). Parents of children with health conditions reported significantly higher FASENS scores (p < 0.002), which corresponded with their child's significantly higher sensory scores (p < 0.001). Family accommodations for SOR occur to some extent in the general population, but their prevalence and impact are significantly greater when the child has a health condition, in addition to SOR. Additional research is needed to explore whether these accommodations are adaptive and whether families and children would benefit from learning to reduce them, as with anxiety.

Psychometric Properties of a Measure Assessing Anxiogenic Parenting Practices in Food Allergy

Aim

Pediatric food allergy represents a significant public health burden. In order to avoid allergen consumption, adequate management requires daily vigilance and involvement from parents, frequently leading to increased parental anxiety. While specific anxiogenic parenting practices (i.e., parenting behaviors which may aid in the development and/or exacerbation of childhood anxiety) have been documented within this population, to this point, these behaviors have not been systematically measured.

Objectives

The current study aimed to develop and examine a parent-report scale designed to measure anxiogenic parenting behaviors related to food allergy.

Methods

Participants included 177 parents of children with food allergy recruited online using Amazon Mechanical Turk (mTurk). An exploratory factor analysis was conducted to determine the factor structure of the newly developed scale. Subsequently, psychometric properties (e.g., construct validity) were examined via correlational analyses.

Results

Results indicated a 24-item, 3 factor (Factor 1: Involvement in Food Allergy; Factor 2: Worry about Food Allergy; Factor 3: Autonomy Promotion) scale, which accounted for 53.11% of the total variance. The Kaiser–Meyer–Olkin measure was acceptable, KMO = 0.872 and Bartlett’s test of sphericity indicated sufficient correlations between items (χ2 (378) = 2568.95). All subscales demonstrated strong internal consistency (Involvement in Food Allergy: α = .880; Worry about Food Allergy: α = .892; Autonomy Promotion α = .796) as well as convergent and discriminant validity.

Conclusions

Results support the overall psychometric properties of the scale. Interpretations, limitations, and future directions are discussed.

Development and validation of the Modeling of Parental Anxiety Questionnaire

Parental anxious modeling is assumed to be a risk factor for child anxiety. Until now there has been no self-assessment scale available that measures parental modeling of anxiety in a comprehensive way. Our aim with this study was to bridge this gap by developing the Modeling of Parental Anxiety Questionnaire (MPAQ). To do this, we generated an item pool containing 51 statements covering different aspects of parental modeling of anxious and non-anxious behaviors. A sample of Swedish parents (N = 1092) of children aged 4-12, answered an online survey comprising the generated item pool, the Parental Overprotection Scale (OP) and the PROMIS Anxiety short forms (the adult version and the parent proxy report scale). A factor analysis of the items of parental modeling indicated a structure with four separate factors. These factors formed the final four subscales of MPAQ; (1) being curios and content, (2) being on guard, (3) displaying anxiety and avoidance, and (4) displaying stress. The Cronbach's alpha coefficients of the subscale scores ranged from moderate to good. Linear regression analysis showed that the displaying anxiety and avoidance-subscale had the strongest association with child anxiety symptoms. These findings show that MPAQ demonstrates adequate psychometric properties and has potential for being used in research and clinical settings, for example to identify potential targets for parenting interventions and to measure mediation effects.

Exploring the Link Between Transdiagnostic Cognitive Risk Factors, Anxiogenic Parenting Behaviors, and Child Anxiety

Theoretical models suggest parent anxiety leads to increased anxiogenic parenting, an important etiological factor for child anxiety disorders. Evidence suggests that parents engage in anxiogenic parenting to reduce distress in response to their child's anxiety; however, further study of this mechanism is needed. Cognitive risk factors, including distress intolerance, anxiety sensitivity, emotion-related impulsivity, and repetitive negative thinking are promising to examine as they impact emotion regulation. This study examined whether an indirect association between parent anxiety and anxiogenic parenting via these risk factors exists, and if child anxiety moderated this effect. Findings demonstrated evidence for an indirect association via distress intolerance in mothers at high levels of child anxiety, but not low levels. An unmoderated indirect effect via emotion-related impulsivity was found. Anxiety sensitivity and repetitive negative thinking did not demonstrate significant indirect effects. These findings suggest distress intolerance and emotional-related impulsivity may be targets for parent-focused child anxiety treatments.

Clinical Update: The Role of Family Accommodation in Youth Anxiety Treatment Outcomes

Over the past several years, family accommodation (FA) has gained increasing recognition for its role in child and adolescent anxiety disorders. Recent clinical trials highlight the importance of assessing and addressing FA within the context of treatment, with findings showing that FA is a significant predictor of treatment success. This clinical update was prompted by such findings, and specifically findings from a study by Zilcha-Mano and colleagues (2020) which suggest that the level of agreement between child- and parent-reports of FA has differential effects on outcomes for child- and parent-based treatments. In this article we aim to provide (1) a brief overview of the research pointing to the reduction of FA as a critical ingredient of youth anxiety treatment, and (2) a summary and in-depth discussion of the study by Zilcha-Mano et al. (2020) that speaks to the potential importance of leveraging multi-informant reports of FA. With regard to the latter aim, we offer preliminary suggestions for how clinicians might incorporate measures of FA into their practice to maximize benefits for anxious youth and their families. We also offer suggestions for how future research can build on these novel findings, advance methods of FA assessment, and promote its clinical utility.

Using Evaluative Criteria to Review Youth Anxiety Measures, Part II: Parent-Report

This Evidence Base Update of parent-report measures of youth anxiety symptoms is a companion piece to our update on youth self-report anxiety symptom measures (Etkin et al., 2021). We rate the psychometric properties of the parent-report measures as Adequate, Good, or Excellent using criteria developed by Hunsley and Mash (2008) and Youngstrom et al. (2017). Our review reveals that the evidence base for parent-report measures is considerably less developed compared with the evidence base for youth self-report measures. Nevertheless, several measures, the parent-report Screen for Child Anxiety-Related Emotional Disorders, Multidimensional Anxiety Scale for Children, and Spence Children's Anxiety Scale, were found to have Good to Excellent psychometric properties. We conclude our review with suggestions about which parent-report youth anxiety measures are best suited to perform different assessment functions and directions for additional research to expand and strengthen the evidence base.

The Relationship of Family Accommodation with Pediatric Anxiety Severity: Meta-analytic Findings and Child, Family and Methodological Moderators

Given the importance of family accommodation for the course, treatment and prognosis of anxiety in pediatric populations, we conducted a meta-analysis to estimate the magnitude and potential moderators of the relationship between accommodation and anxiety severity. Study selection criteria were: (1) included quantitative measures of accommodation and anxiety severity, (2) sampled participants younger than 19 years, (3) a sample size greater than 10, (4) reported statistical data needed to compute effect sizes, and (4) be in English or Spanish. Search procedures included assessment of electronic databases, systematic reviews and empirical studies, and email inquiries. Effect size was Pearson correlation coefficient, assuming a random-effects model. Positive moderate association was observed for measures administered to parents. This was moderated by the percentage of children with separation anxiety and selective mutism. Global effect sizes were small for measures administered to children and when accommodation was reported by parents and anxiety by children. Implications for assessment and treatment are discussed.

Using Mechanical Turk to Study Parents and Children: An Examination of Data Quality and Representativeness

Objective: Mechanical Turk (MTurk) is a popular data collection tool that is increasingly used to study parents and children. We examined the quality of data obtained via MTurk, the representativeness of parents on MTurk, and whether the wording of MTurk recruitment materials is related to sample characteristics.Method: Participants were 650 parents with children aged 4 to 17 recruited for two separate studies (64.6% female, 83.8% Caucasian, mean age = 37.6 years). The Mental Health Survey (N = 322) recruitment materials described a study about mental health and the Health Survey (N = 328) materials only referenced health; both surveys restricted participation to parents in the United States (U.S.). Parents completed measures about demographics, mental health service seeking history, and parent and youth psychopathology.Results: Participants provided reliable responses on study measures, with low rates of missing data. Participants were more female, less racially/ethnically diverse, and more educated than the U.S. population, and also had more children per household. Over 40% of parents and 30% of children had previously received mental health services and many scored in the clinical range on measures of psychopathology. Contrary to hypotheses, mental health help seeking was higher in the Health Survey than the Mental Health survey.Conclusions: MTurk is a feasible method for child and adolescent clinical psychology research, although participants may not be fully demographically representative of the general population and could possibly be better considered an at-risk or clinical sample than a community sample.

Examining Differences in Parent Knowledge About Pediatric Food Allergies

Objective

Pediatric food allergy (FA) is a serious health condition that has become increasingly prevalent. Parents often play a primary role in assessing and managing risk for their child’s FAs, making it critical that they remain informed of the most recent guidelines for FA management. This study aimed to examine if diagnostic source (i.e., pediatrician vs. allergist) and child- and parent-level variables predicted parental FA knowledge using a comprehensive measure.

Methods

The Food Allergy Knowledge Test (FAKT) was administered to parents (N = 518) of children aged 3–17 years with (n = 349) and without (n = 169; i.e., control group) FAs using internet-sampling procedures. The sample was further partitioned into parents of children diagnosed by an allergist or a pediatrician, and control group parents who did or did not endorse knowing someone with an FA.

Results

Significant group differences were found with respect to the overall FAKT score and diagnostic source. Among the FA group, parental relationship to child, income, identification with a minority status, parental anxiety, and child possession of an emergency action plan were significant predictors of FAKT scores.

Conclusions

Knowledge of FA was poor across all groups. Education for caregivers both with and without food-allergic children is important to ensure FA safety in multiple settings. Future directions and limitations are discussed.

Parenting Styles and Internalizing Symptoms in Adolescence: A Systematic Literature Review

A growing body of recent research has identified associations between various parenting practices and styles and internalizing problems among adolescents. However, the reported findings are inconsistent and the studies in question have been conducted from different theoretical backgrounds. The aim of this systematic review was to synthesize the literature on the association of parental socialization styles with depression, anxiety, and suicidal ideation. To this end, we conducted a systematic search of the PsycInfo, Scopus, Pubmed, and Web of Science databases, covering literature published from 2010 to 2019. The search was restricted to peer-reviewed studies in English or Spanish. The results show that parental warmth, behavioural control, and autonomy granting are inversely related to internalizing symptoms in adolescents. Conversely, psychological control and harsh control by parents are positively associated with adolescent anxiety, depression, and suicidal ideation. Although the associated effect sizes are only small or moderate, the results suggest that these variables should be taken into account when designing programmes aimed at promoting parenting styles conducive to the wellbeing of adolescents.

Development and evaluation of the Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS): assessment of parental concordance with guidelines for the prevention of child anxiety and depression

BACKGROUND

Involving parents in the prevention of mental health problems in children is prudent given their fundamental role in supporting their child's development. However, few measures encapsulate the range of risk and protective factors for child anxiety and depression that parents can potentially modify. The Parenting to Reduce Child Anxiety and Depression Scale (PaRCADS) was developed as a criterion-referenced measure to assess parenting against a set of evidence-based parenting guidelines for the prevention of child anxiety and depressive disorders.

METHODS

In Study 1, 355 parents of children 8-11 years old across Australia completed the PaRCADS and measures of parenting, general family functioning, child anxiety and depressive symptoms, and parent and child health-related quality of life. Their children completed measures of parenting, anxiety and depressive symptoms, and health-related quality of life. In Study 2, six subject-experts independently evaluated the PaRCADS items for item-objective congruence and item-relevance. Item analysis was conducted by examining item-total point-biserial correlation, difficulty index, B-index, and expert-rated content validity indices. Reliability (or dependability) was assessed by agreement coefficients for single administration. Construct validity was examined by correlational analyses with other measures.

RESULTS

Four items were removed to yield a 79-item, 10-subscale PaRCADS. Reliability estimates for the subscale and total score range from .74 to .94. Convergent validity was indicated by moderate to strong correlations with other parenting and family functioning measures, and discriminant validity was supported by small to moderate correlations with a measure of parents' health-related quality of life. Higher scores on the PaRCADS were associated with fewer anxiety and depressive symptoms and better health-related quality of life in the child. PaRCADS total score was associated with parental age, parent reported child's history of mental health diagnosis and child's current mental health problem.

DISCUSSION

Results showed that the PaRCADS demonstrates adequate psychometric properties that provide initial support for its use as a measure of parenting risk and protective factors for child anxiety and depression. The scale may be used for intervention and evaluative purposes in preventive programs and research.

Examining the Relationship Between Anxiogenic Parenting Practices and Cognitive Flexibility in Youth

Cognitive flexibility (CF), a subdomain of executive functioning (EF), involves abilities such as set shifting and reversal learning. Some variability in CF is normative across youth due to the gradual refinement of broader EF along with the prefrontal cortex. Prior research has suggested that a supportive parenting environment contributes to strong EF, whereas harsh/controlling parenting is associated with deficits. The current investigation explores whether certain parenting practices (e.g., parental accommodation, over-involvement, modeling) are associated with such deficits. Anxiogenic parenting and CF were assessed in 112 youth aged 9 to 17 years, with results demonstrating that parenting practices were not predictive of CF in these youth. Age accounted for the majority of differences in set shifting performance, potentially emphasizing the influence of parenting at different stages of development. Accordingly, future research is necessary to determine the potential impact of anxiogenic parenting at specific points in the development of CF.