Early Childhood Externalising Behaviour Problems: Child, Parenting, and Family-related Predictors Over Time

Clinical, socio-demographic, and parental correlates of early autism traits in a community cohort of toddlers

Identifying factors linked to autism traits in the general population may improve our understanding of the mechanisms underlying divergent neurodevelopment. In this study we assess whether factors increasing the likelihood of childhood autism are related to early autistic trait emergence, or if other exposures are more important. We used data from 536 toddlers from London (UK), collected at birth (gestational age at birth, sex, maternal body mass index, age, parental education, parental language, parental history of neurodevelopmental conditions) and at 18 months (parents cohabiting, measures of socio-economic deprivation, measures of maternal parenting style, and a measure of maternal depression). Autism traits were assessed using the Quantitative Checklist for Autism in Toddlers (Q-CHAT) at 18 months. A multivariable model explained 20% of Q-CHAT variance, with four individually significant variables (two measures of parenting style and two measures of socio-economic deprivation). In order to address variable collinearity we used principal component analysis, finding that a component which was positively correlated with Q-CHAT was also correlated to measures of parenting style and socio-economic deprivation. Our results show that parenting style and socio-economic deprivation correlate with the emergence of autism traits at age 18 months as measured with the Q-CHAT in a community sample.

Mediation of Parental Aggravation in the Association Between ADHD Severity and Electronic Media Use: A National Survey of Children's Health Study

OBJECTIVE

To determine whether the association between ADHD severity and electronic media use was mediated by parental aggravation.

METHODS

This was a retrospective analysis from the 2016 to 2017 National Survey of Children's Health (NSCH) involving children ages of 3 to 17 years with parent-reported ADHD (n = 5,930). Path analyses were used to model the relationships between ADHD severity with parental aggravation (PA) as a mediator, and electronic device (ED) and television (TV) use as outcomes, controlling for covariates.

RESULTS

Parental aggravation mediated the relationship between ADHD severity and ED use and TV use (indirect effects: β = .02, p < .001; β = .01, p = .004). When stratified by age, the mediation effect between ADHD and ED use remained significant for adolescents and school-age children, and mediation between ADHD and TV use remained significant only for adolescents.

CONCLUSION

These findings suggest a need to develop targeted interventions to address PA and manage excessive electronic media use in children with moderate/severe ADHD.

Association between maternal employment and the child´s mental health: a systematic review with meta-analysis

The recent rise in maternal workforce participation has led to more research regarding the role of maternal employment for (early) childhood mental health. This systematic review with meta-analysis covers new evidence on the association of both variables. A systematic literature search was conducted. Studies had to compare children 0-7 years of age on the basis of their mothers' employment status, working amount, employment duration, i.e., how long the mother had been back at work after birth, or timing of return to work. Child mental health was operationalized as behavior problems and prosocial behavior. Narrative and meta-analytic syntheses of evidence were conducted. Maternal employment was associated with more conduct problems but less internalizing behavior problems and anxious/depressed behavior in children; full-time employment was linked to more externalizing behavior problems and more hyperactivity/inattention. Longer employment duration was related to less (internalizing) behavior problems and more prosocial behavior but also more externalizing behavior problems. Narrative syntheses indicated early maternal return to work to be associated with more child externalizing behavior problems and less prosocial behavior. Whether maternal employment is associated with child mental health strongly depends on both variables' operationalization. Especially part-time employment, longer employment duration, and return to work only after the first year postpartum may be beneficial for child mental health. Practical implications pertain to an expanded offer of family leave and the endorsement of maternal employment after the first year postpartum. Here, factors that may buffer the negative associations with full-time employment warrant consideration.

Building a Predictive Model of Social-Emotional Adjustment: Exploring the Relationship between Parenting Self-Efficacy, Parenting Behaviour and Psychological Distress in Mothers of Young Children in Ireland

The purpose of this study was to generate greater understanding of social-emotional difficulties in infants and toddlers in an Irish context. This study compared rates of reported social-emotional difficulties in young children in clinical and non-clinical samples and probed a predictive model of social-emotional adjustment. Data were collected from a cross-sectional sample of 72 mothers of young children aged between 12 and 48 months. Mothers were recruited from waiting lists for child Early Intervention services (clinical sample) and community mother-toddler groups (non-clinical sample). Mothers completed a questionnaire battery which assessed parenting self-efficacy, parenting behaviour, psychological distress and child social-emotional adjustment. The results indicated that 55.5% of young children in the clinical sample and 15% in the non-clinical sample had significant social-emotional problems. Similarly, 55.5% of young children in the clinical sample and 30% in the non-clinical sample had significant delays in the acquisition of social-emotional competencies. Two hierarchical multiple regressions were carried out with social-emotional problems and social-emotional competencies as the respective criterion variables. Clinical or non-clinical group membership, parenting satisfaction and maternal psychological distress were found to be significant predictors of child social-emotional problems in a model which explained 59% of the variance. Task-specific self-efficacy was the only significant predictor of child social-emotional competencies in a model which explained 21% of the variance. The significant rates of social-emotional problems in young children in the current study and the potential negative impact on child health and wellbeing, suggest that the early assessment of social-emotional adjustment should be incorporated into routine clinical assessment for young children. For services to effectively meet the needs of children with social-emotional difficulties and their families, consideration of maternal factors is also necessary.

Infant screen media usage and social-emotional functioning

There has been little research on whether and how screen media usage affects social-emotional (SE) function prior to two years of age, even though early SE development is understood to be nurtured through interpersonal experience, mainly withthe primary caregiver. This study sought to characterise infant screen media usage and understand how it may link with concurrent SE function by testing associated effects on reducing parent-infant interaction and of parent psychological factors. Questionnaire responses from 327 UK-based parents of infants aged 6-24 months showed diverse usage in the amount of time spent on screen media ('screen time') and amount of parental involvement (co-sharing and co-referencing). Infants with possible SE delay experienced more screen time than those at low risk. The study tested three mediation models and found support for the displacement and not distancing hypothesis based on this community sample. While screen time predicted both SE competence and SE problems, reduced parent-infant play partially mediated the effect on SE competence. Parent depressed mood was positively linked with infant SE problems, but there was little evidence that increased screen time mediated this effect. Also, parent reflective function and attitudes toward parent-infant play were unrelated to screen time. Though longitudinal study is warranted, the findings implicate screen media usage as potentially directly and indirectly relevant when addressing infant mental health.

The mental health of immigrant mother's offspring in Taiwan: A national epidemiological study

BACKGROUND/PURPOSE

With globalization, transnational marriages become more and more common in the world. The mental health of the offspring of immigrants is a significant public health issue. The present study aimed to investigate whether children of immigrant mothers demonstrate more emotional and behavioral problems than those of native mothers in Taiwan.

METHODS

In a sample of 6242 children in grade 3, grade 5, and grade 7 from a national epidemiological study of child mental disorders, 617 (9.9%) children were born by immigrant mothers (Chinese, Vietnam, Indonesia, and other countries) and 5625 children by Taiwanese parents. The children reported on Achenbach Youth Self-report, and their parents reported about them on the Child Behavior Checklist, Parental Bonding Inventory, and Family APGAR for assessing emotional and behavioral problems, mother's parenting style, and perceived family support.

RESULTS

Compared with children of native mothers, children of immigrant mothers reported themselves and were reported by their parents to have more externalizing and internalizing problems. However, after considering the effects of sociodemographics, parenting style, and family function, only significant differences in externalizing problems between children with native or immigrant mothers were found.

CONCLUSION

Our findings indicate that right parenting style and family support; may offset emotional and behavioral problems in children of immigrant mothers, and suggest that improving maternal parenting and family function is beneficial to child development, regardless of immigrant or native mothers.

A Randomized Control Trial Evaluating an Online Mindful Parenting Training for Mothers With Elevated Parental Stress

Objectives

The prevalence of maternal stress in early years of parenting can negatively impact child development. Therefore, there is a need for an early intervention that is easily accessible and low in costs. The current study examined the effectiveness of an 8-session online mindful parenting training for mothers with elevated levels of parental stress.

Methods

A total of 76 mothers were randomized into an intervention (n = 43) or a waitlist control group (n = 33). The intervention group completed pretest assessment prior to the online intervention. Participants completed a post intervention assessment after the 10 weeks intervention and a follow-up assessment 10 weeks later. The waitlist group completed waitlist assessment, followed by a 10-week waitlist period. After these 10 weeks, a pretest assessment took place, after which the waitlist group participants also started the intervention, followed by the posttest assessment. Participating mothers completed questionnaires on parental stress (parent-child interaction problems, parenting problems, parental role restriction) and other maternal (over-reactive parenting discipline, self-compassion, symptoms of depression and anxiety) and child outcomes (aggressive behavior and emotional reactivity) while the non-participating parents (father or another mother) were asked to also report on child outcomes.

Results

The online mindful parenting intervention was shown to be significantly more effective at a 95% level than a waitlist period with regard to over-reactive parenting discipline and symptoms of depression and anxiety (small and medium effect sizes), and significantly more effective at a 90% level with regard to self-compassion, and mother-rated child aggressive behavior and child emotional reactivity (small effect sizes). The primary outcome, parental stress, was found to have a 95% significant within-group effect only for the subscale parental role restriction (delayed small effect size improvement at follow-up). No significant improvements on child outcomes were found for the non-participating parent.

Conclusion

To conclude, the results provide first evidence that an online mindful parenting training may be an easily accessible and valuable intervention for mothers with elevated levels of parental stress.

Parental Depression, Overreactive Parenting, and Early Childhood Externalizing Problems: Moderation by Social Support

This study used a large (N = 519), longitudinal sample of adoptive families to test overreactive parenting as a mediator of associations between parental depressive symptoms and early childhood externalizing, and parents' social support satisfaction as a moderator. Maternal parenting (18 months) mediated the association between maternal depressive symptoms (9 months) and child externalizing problems (27 months). Paternal parenting was not a significant mediator. Unexpectedly, we found a cross-over effect for the moderating role of social support satisfaction, such that partners' social support satisfaction reduced the strength of the association between each parent's own depressive symptoms and overreactive parenting. Results point to the importance of accounting for broader family context in predicting early childhood parenting and child outcomes.

Effects of a mindfulness-based intervention (MYmind) for children with ADHD and their parents: protocol for a randomised controlled trial

INTRODUCTION

Mindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design.

METHODS AND ANALYSIS

This study will adopt a randomised controlled trial design including 140 children aged 8-12 years with ADHD together with one of their parents (n=140). These families will be randomised into intervention group (n=70) who will be offered the MYmind programme delivered by trained healthcare professionals, and an active control group (n=70) who will be offered the CBT programme. The intervention includes 8 weekly 90 min group sessions for children with ADHD (aged 8-12 years) and their respective parents. The primary and secondary outcomes will include children's attention, ADHD-related symptoms, behaviours, executive function and mindfulness levels measured by validated objective measures and parent's reported instruments. Parents' parental stress, parenting styles, ADHD related symptoms, well-being, rumination level and mindfulness levels will also be measured. Analysis is by intention to treat. The effects of intervention will be evaluated by comparing outcomes between the two arms, as well as comparing outcomes within subject through comparing measurements at baseline (T0), immediately after the 8 week intervention (T1) and at 3 (T2) and 6 (T3) months postintervention.

ETHICS AND DISSEMINATION

Ethics approval has been granted by the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (The Joint CUHK-NTEC CREC). Participants will be required to sign informed consent form from both parents and children. Findings will be reported in conferences and peer-reviewed publications in accordance with recommendations of Consolidated Standards of Reporting Trials.

TRIAL REGISTRATION NUMBER

ChiCTR1800014741; Pre-results.

Child Temperamental Flexibility Moderates the Relation between Positive Parenting and Adolescent Adjustment

Temperamental flexibility and lower positive parenting are associated with internalizing and externalizing problems; however, youth varying in flexibility may be differentially affected by positive parenting in the prediction of symptoms. We examined whether children's flexibility moderated prospective relations between maternal and paternal positive parenting and youth internalizing and externalizing symptoms during adolescence. Participants (N =775, 71% male) and their caregivers completed measures when youth were 10-12 and 12-14 years old. Father positive parenting interacted with child flexibility to predict father-reported internalizing and externalizing problems. Consistent with the diathesis-stress model, children lower in flexibility experienced greater symptoms than children higher in flexibility in lower positive parenting contexts. Among children lower in flexibility, lower paternal positive parenting was associated with greater internalizing and externalizing symptoms compared to higher paternal positive parenting. However, among youth higher in flexibility, symptom levels were similar regardless of whether youth experienced lower or higher paternal positive parenting.

Toddlers' Differential Susceptibility to the Effects of Coparenting on Social-Emotional Adjustment

The present study tested whether infants high in negative affectivity are differentially susceptible to observed coparenting behavior in relation to their subsequent social-emotional development. Data came from a longitudinal study of 182 U.S. dual-earner, primiparous couples and their infant children. At 9-months postpartum, child negative affectivity was reported by mothers and fathers and supportive and undermining coparenting behavior were assessed from mother-father-infant observations. At 27-months mothers reported on toddlers' externalizing behavior and dysregulation using a clinical assessment tool designed to identify competencies and areas of concern in toddlers' social-emotional development. Hierarchical regression analyses revealed partial support for the differential susceptibility hypothesis. Specifically, infants high in negative affectivity had lower levels of dysregulation when embedded in a more supportive coparenting context, and higher levels of dysregulation when embedded in a less supportive coparenting context. In contrast, supportive coparenting behavior was not relevant for the dysregulation of infants initially low in negative affectivity.

Child-evoked maternal negativity from 9 to 27 months: Evidence of gene-environment correlation and its moderation by marital distress

Past research has documented pervasive genetic influences on emotional and behavioral disturbance across the life span and on liability to adult psychiatric disorder. Increasingly, interest is turning to mechanisms of gene-environment interplay in attempting to understand the earliest manifestations of genetic risk. We report findings from a prospective adoption study, which aimed to test the role of evocative gene-environment correlation in early development. Included in the study were 561 infants adopted at birth and studied between 9 and 27 months, along with their adoptive parents and birth mothers. Birth mother psychiatric diagnoses and symptoms scales were used as indicators of genetic influence, and multiple self-report measures were used to index adoptive mother parental negativity. We hypothesized that birth mother psychopathology would be associated with greater adoptive parent negativity and that such evocative effects would be amplified under conditions of high adoptive family adversity. The findings suggested that genetic factors associated with birth mother externalizing psychopathology may evoke negative reactions in adoptive mothers in the first year of life, but only when the adoptive family environment is characterized by marital problems. Maternal negativity mediated the effects of genetic risk on child adjustment at 27 months. The results underscore the importance of genetically influenced evocative processes in early development.

Culture, parenting, and child behavioral problems: a comparative study of cross-cultural immigrant families and native-born families in Taiwan

Little is known about the interplay of cultural, parenting, and sociodemographic/socioeconomic factors on children's behavioral problems, especially within culturally mixed families in Chinese society. This study compares the presence of behavioral problems between children from families with an immigrant mother and those from native-born families in a randomly selected sample of 957 children aged 6 to 12 years from three counties in central Taiwan. Behavioral problems were assessed using the Child Behavior Checklist completed by parents and the Teacher's Report Form. Parenting styles were assessed using the Parental Bonding Instrument completed by children. Children of immigrant mothers had higher scores for all behavioral syndromes based on the parent's report. However, in the teacher's report a difference was only observed for withdrawn/depressed syndrome. Children of immigrant mothers were more likely, and children with high paternal care were less likely, to have internalizing and total problems in the parent's report. For the teacher's report, only high education in fathers was associated with decreased internalizing and total problems in children. These findings suggest that children growing up in a cross-cultural environment with an immigrant mother, as opposed to a native-born Taiwanese family environment, are more likely to have higher internalizing problems and total behavioral problem scores, due to a number of cultural, parenting, and sociodemographic factors. Children's behaviors appear to be more influenced by fathers' than mothers' parenting styles, regardless of family type. The study findings imply that unequal health and social conditions exist between cross-cultural and native-born families.

Exploring the impact of parental psychopathology and emotion regulation on evidence-based parenting interventions: a transdiagnostic approach to improving treatment effectiveness

Parenting interventions, particularly those categorized as parent management training (PMT), have a large evidence base supporting their effectiveness with most families who present for treatment of childhood behavior problems. However, data suggest that PMTs are not effective at treating all families who seek services. Parental psychopathology has been identified as one important factor moderating their effectiveness, yet few PMTs pay explicit attention to the role of parental psychopathology in treatment. Given growing support for a transdiagnostic model of psychopathology, which posits that disruptions in emotions and emotion regulation (ER) may underlie various forms of psychopathology, one way to address the impact of parental psychopathology on PMT may be by targeting parental ER. This paper will review the available literature on PMT and parental psychopathology, as well as existing evidence on relations between ER and both parental psychopathology and parenting behaviors. The limited research on PMTs that include explicitly parent-focused components will be reviewed, and suggestions for augmenting existing PMT curricula by including intervention around parental ER will be presented.

Parent Predictors of Changes in Child Behavior Problems

The present study examined whether ineffective discipline, single parent status, social support, parent involvement, and parent depression predicted changes in preschoolers' (N = 129) behavior problems. This study also evaluated whether child sex and ethnicity moderated the relationships between these variables and changes in problem behavior. Parents completed questionnaires at the beginning of the study, and parent, teacher, and observational ratings of children's behavior problems were collected twice during the school year. Parents' own social support predicted improvement for boys and parent depression was associated with worsening symptoms for girls. Single parenthood and parent involvement predicted changes in behavior problems for the sample as a whole. Several significant ethnic differences emerged, highlighting the importance of considering cultural context in studies of parenting and child externalizing behavior.

The role of caregiver contingent responsiveness in promoting compliance in young children

The purpose of this study was to examine relations between parents' contingent responding and the behavior of their young children, in the context of other relevant parenting behaviors. Parents were observed interacting with their 3-6 year-old children during two laboratory tasks. Parent responses to child bids were classified into four mutually exclusive categories: contingent responses, non-contingent non-negative responses, negative responses, and no response. Hierarchical regression analyses were used to examine relations between contingent responsiveness and child compliance, after accounting for the quality of parent directives and parent negativity. Contingent responsiveness was uniquely associated with greater child compliance for mothers during both tasks and for fathers during one task. An interaction effect was found, indicating that fathers' responsiveness during the second task was associated with greater child compliance in older, but not younger, children. Implications for clinical practice and future research directions are discussed.

The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents

This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8-12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child's ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.

Mindful Parenting in Mental Health Care

Mindfulness is a form of meditation based on the Buddhist tradition, which has been used over the last two decades to successfully treat a multitude of mental health problems. Bringing mindfulness into parenting ("mindful parenting") is one of the applications of mindfulness. Mindful parenting interventions are increasingly being used to help prevent and treat mental disorders in children, parenting problems, and prevent intergenerational transmission of mental disorders from parents to children. However, to date, few studies have examined the hypothesized mechanisms of change brought about by mindful parenting. We discuss six possible mechanisms through which mindful parenting may bring about change in parent-child interactions in the context of child and parent mental health problems. These mechanisms are hypothesized to be mediated by the effects of mindfulness on parental attention by: (1) reducing parental stress and resulting parental reactivity; (2) reducing parental preoccupation resulting from parental and/or child psychopathology; (3) improving parental executive functioning in impulsive parents; (4) breaking the cycle of intergenerational transmission of dysfunctional parenting schemas and habits; (5) increasing self-nourishing attention; and (6) improving marital functioning and co-parenting. We review research that has applied mindful parenting in mental health settings, with a focus on evidence for these six mechanisms. Finally, we discuss directions for future research into mindful parenting and the crucial questions that this research should strive to answer.

Child and Informant Influences on Behavioral Ratings of Preschool Children

This study investigated relations among teacher, parent, and observer behavioral ratings of 3- and 4-year-old children using intraclass correlations and ANOVA. Comparisons within and across children from middle- (N =166; Mean age 54.25 months, SD = 8.74) and low-income (N =199; Mean age 51.21 months, SD = 7.22) backgrounds revealed significant agreement between the raters but also considerable differences in both ranking and absolute scores between raters. Teachers and parents consistently rated children from low-income classrooms as having more behavioral problems and fewer prosocial behaviors. Results are conceptualized with respect to how differential expectations, comparison groups, and types of interaction with children can affect the evaluation of child behavior. Results point to the need for multiple sources of evaluation when assessing a child for behavioral difficulties, particularly in children from lower income backgrounds.

Externalizing disorders: cluster 5 of the proposed meta-structure for DSM-V and ICD-11

BACKGROUND

The extant major psychiatric classifications DSM-IV and ICD-10 are purportedly atheoretical and largely descriptive. Although this achieves good reliability, the validity of a medical diagnosis is greatly enhanced by an understanding of the etiology. In an attempt to group mental disorders on the basis of etiology, five clusters have been proposed. We consider the validity of the fifth cluster, externalizing disorders, within this proposal.

METHOD

We reviewed the literature in relation to 11 validating criteria proposed by the Study Group of the DSM-V Task Force, in terms of the extent to which these criteria support the idea of a coherent externalizing spectrum of disorders.

RESULTS

This cluster distinguishes itself by the central role of disinhibitory personality in mental disorders spread throughout sections of the current classifications, including substance dependence, antisocial personality disorder and conduct disorder. Shared biomarkers, co-morbidity and course offer additional evidence for a valid cluster of externalizing disorders.

CONCLUSION

Externalizing disorders meet many of the salient criteria proposed by the Study Group of the DSM-V Task Force to suggest a classification cluster.

Policy aspects and nursing care of families with parents who are sexual minorities

Families in which parents are lesbian, gay, bisexual, or transgender are more diverse than they are similar. This article reviews current literature to identify fundamental issues facing families that include sexual minority parents and their children. The unique nursing needs of families with gay, lesbian, transgender, or bisexual parents are critically examined for direct relevance to family nursing practice. Nurses and other health care professionals can incorporate current knowledge of unique child developmental, parenting, and legal issues into their work with these families. Nursing assessment and policies that consider the unique needs of these families will be addressed.