Improved Perceptions of Emotion Regulation and Reflective Functioning in Parents: Two Additional Positive Outcomes of Parent-Child Interaction Therapy

Parent Emotion Regulation, Mindful Parenting, and Youth Attachment: Direct and Indirect Associations with Internalizing and Externalizing Problems

The direct associations between two dimensions of parent emotion regulation within the parent-youth relationship (dysregulation; suppression), mindful parenting, and youth internalizing and externalizing problems were examined among 759 parents of youth with significant behavioural or emotional problems. The indirect associations of parent emotion regulation and mindful parenting with youth functioning through youth attachment anxiety and avoidance were also investigated. Parent dysregulation was associated with internalizing symptoms both directly and through attachment anxiety, and with externalizing symptoms directly and through attachment anxiety and avoidance. Parent suppression was associated with internalizing symptoms through attachment anxiety, and with externalizing symptoms through attachment anxiety and avoidance. Mindful parenting was associated with lower internalizing symptoms through attachment anxiety and with lower externalizing symptoms through attachment anxiety and avoidance. Emotion regulation within parent-child relationships and mindful parenting may be critical components of parenting programs aimed at promoting youth attachment security and mental health.

Coherence of Parental Representations Following Therapy for Autistic Children

Autistic children experience high rates of mental health challenges, and links have been found between child mental health and the parent-child relationship. As parents of autistic children are often actively involved in their child's treatment, it is important to consider aspects of the parent-child relationship within this context. The present study investigated changes in a component of the parent-child relationship, the coherence of parental representations, following participation in a 10-week cognitive behavioural therapy intervention designed to address autistic children's mental health challenges. Relationships were examined between coherence and child characteristics (i.e., autism symptoms, mental health), and associations with child treatment outcomes (i.e., mental health). Participants included 81 children (89% boys) aged 8 to 13 years and their parents (85% mothers) aged 35 to 54 years. Baseline levels of coherence were related to children's mental health symptoms but not autism symptoms. Although there were no significant changes in overall coherence across therapy, subscale-level improvements (i.e., concern, acceptance) emerged. Changes in coherence across therapy were linked with children's post-intervention behavioural symptoms and were approaching significance for internalizing problems, but were not associated with externalizing problems. It is critical to investigate factors that shape the coherence of parents' representations of their children, as this may provide insight into potential targets for intervention. Ascertaining whether participation in therapy improves parental coherence, and consequently child treatment outcomes, can advocate for parent-involved therapy, which will ultimately benefit the well-being of autistic children.

Testing reciprocal associations between child anxiety and parenting across early interventions for inhibited preschoolers

BACKGROUND

Given the robust evidence base for the efficacy of evidence-based treatments targeting youth anxiety, researchers have advanced beyond efficacy outcome analysis to identify mechanisms of change and treatment directionality. Grounded in developmental transactional models, interventions for young children at risk for anxiety by virtue of behaviorally inhibited temperament often target parenting and child factors implicated in the early emergence and maintenance of anxiety. In particular, overcontrolling parenting moderates risk for anxiety among highly inhibited children, just as child inhibition has been shown to elicit overcontrolling parenting. Although longitudinal research has elucidated the temporal unfolding of factors that interact to place inhibited children at risk for anxiety, reciprocal transactions between these child and parent factors in the context of early interventions remain unknown.

METHOD

This study addresses these gaps by examining mechanisms of change and treatment directionality (i.e., parent-to-child vs. child-to-parent influences) within a randomized controlled trial comparing two interventions for inhibited preschoolers (N = 151): the multicomponent Turtle Program ('Turtle') and the parent-only Cool Little Kids program ('CLK'). Reciprocal relations between parent-reported child anxiety, observed parenting, and parent-reported accommodation of child anxiety were examined across four timepoints: pre-, mid-, and post-treatment, and one-year follow-up (NCT02308826).

RESULTS

Hypotheses were tested via latent curve models with structured residuals (LCM-SR) and latent change score (LCS) models. LCM-SR results were consistent with the child-to-parent influences found in previous research on cognitive behavioral therapy (CBT) for older anxious youth, but only emerged in Turtle. LCS analyses revealed bidirectional effects of changes in parent accommodation and child anxiety during and after intervention, but only in Turtle.

CONCLUSION

Our findings coincide with developmental transactional models, suggesting that the development of child anxiety may result from child-to-parent influences rather than the reverse, and highlight the importance of targeting parent and child factors simultaneously in early interventions for young, inhibited children.

Applying the Theoretical Domains Framework to Develop an Intervention to 'Re-implement' Parent-Child Interaction Therapy (PCIT)

Parent-Child Interaction Therapy (PCIT) is an empirically supported treatment for childhood conduct problems, with increasing numbers of clinicians being trained in Aotearoa/New Zealand. However, ensuring sustained delivery of effective treatments by trained clinicians in routine care environments is notoriously challenging. The aims of this qualitative study were to (1) systematically examine and prioritise PCIT implementation barriers and facilitators, and (2) develop a well specified and theory-driven 're-implementation' intervention to support already-trained clinicians to resume or increase their implementation of PCIT. To triangulate and refine existing understanding of PCIT implementation determinants from an earlier cross-sectional survey, we integrated previously unanalysed qualitative survey data (54 respondents; response rate 60%) with qualitative data from six new focus groups with 15 PCIT-trained clinicians and managers in Aotearoa/New Zealand. We deductively coded data, using a directed content analysis process and the Theoretical Domains Framework, resulting in the identification of salient theoretical domains and belief statements within these. We then used the Theory and Techniques Tool to identify behaviour change techniques, possible intervention components, and their hypothesised mechanisms of action. Eight of the 14 theoretical domains were identified as influential on PCIT-trained clinician implementation behaviour (Knowledge; Social/Professional Role and Identity; Beliefs about Capabilities; Beliefs about Consequences; Memory, Attention and Decision Processes; Environmental Context and Resources; Social Influences; Emotion). Two of these appeared to be particularly salient: (1) 'Environmental Context and Resources', specifically lacking suitable PCIT equipment, with (lack of) access to a well-equipped clinic room appearing to influence implementation behaviour in several ways. (2) 'Social/Professional Role and Identity', with beliefs relating to a perception that colleagues view time-out as harmful to children, concerns that internationally-developed PCIT is not suitable for non-Māori clinicians to deliver to Indigenous Māori families, and clinicians feeling obligated yet isolated in their advocacy for PCIT delivery. In conclusion, where initial implementation has stalled or languished, re-implementation may be possible, and makes good sense, both fiscally and practically. This study suggests that re-implementation of PCIT in Aotearoa/New Zealand may be facilitated by intervention components such as ensuring access to a colleague or co-worker who is supportive of PCIT delivery, access to suitable equipment (particularly a time-out room), and targeted additional training for clinicians relating to the safety of time-out for children. The feasibility and acceptability of these intervention components will be tested in a future clinical trial.

Functional integration of anterior insula related to meaning in life and loneliness

BACKGROUND

Meaning in life (MIL), defined as people's feelings of life's meaningfulness, plays a vital role in buffering loneliness - an important indicator of depression and other psychological disorders. Considerable evidence shows that MIL arises from widely distributed brain activity; however, how such activity is functionally integrated and how it influences loneliness is still understudied.

METHODS

We here examined how the functional integration of brain regions is related to individual MIL based on resting-state functional magnetic resonance imaging data from the Human Connectome Project (N = 970).

RESULTS

We found that the global brain connectivity (GBC) of the right anterior insula (rAI) can significantly predict individual MIL. Moreover, mediation analyses were conducted to investigate how the brain influences loneliness with MIL's mediation, which revealed that MIL fully mediates the effect of this hub on loneliness.

CONCLUSIONS

These findings suggest that the rAI is a key hub for MIL and loneliness. Its functional integration can be used as a biomarker to predict individual MIL and loneliness.

Evidence-Based Treatment in Practice: PCIT Research on Addressing Individual Differences and Diversity Through the Lens of 20 Years of Service

Parent-Child Interaction Therapy (PCIT) is an intensive parent support program for caregivers and their children who exhibit difficult-to-manage disruptive behaviors. After more than four decades of research supporting its efficacy for reducing children's disruptive behaviors and improving parent-child relationships, PCIT has become one of the most popular and widely disseminated parenting support programs in the world. The evidence for the efficacy of PCIT can be found in many reviews of randomized clinical trials and other rigorous studies. To add to those reviews, our aim was to provide practical guidance on how PCIT can be part of an evidence-based program for families that depends on practitioner expertise, as well as attention to families' diverse needs. To do this, we describe the evolution of PCIT as practiced in a university-community partnership that has continued for over 20 years, alongside a narrative description of selected and recent findings on PCIT and its use in specific client presentations across four themes. These themes include studies of 1) whether the standard manualized form of PCIT is efficacious across a selection of diverse family situations and child diagnoses, 2) the mechanisms of change that explain why some parents and some children might benefit more or less from PCIT, 3) whether treatment content modifications make PCIT more feasible to implement or acceptable to some families, at the same time as achieving the same or better outcomes, and 4) whether PCIT with structural modifications to the delivery, such as online or intensive delivery, yields similar outcomes as standard PCIT. Finally, we discuss how these directions in research have influenced research and practice, and end with a summary of how the growing attention on parent and child emotion regulation and parents' responses to (and coaching of) their children's emotions has become important to PCIT theory and our practice.

Protocol for a randomised pilot study of a novel Parent-Child Interaction Therapy (PCIT) 're-implementation' intervention

BACKGROUND

Despite a number of clinicians having been trained in Parent-Child Interaction Therapy (PCIT) in Aotearoa/New Zealand, few are regularly delivering the treatment, with barriers to use including a lack of suitable equipment and lack of professional support. This pragmatic, parallel-arm, randomised, controlled pilot trial includes PCIT-trained clinicians who are not delivering, or only rarely utilising, this effective treatment. The study aims to assess the feasibility, acceptability and cultural responsivity of study methods and intervention components and to collect variance data on the proposed future primary outcome variable, in preparation for a future, larger trial.

METHODS

The trial will compare a novel 're-implementation' intervention with a refresher training and problem-solving control. Intervention components have been systematically developed to address barriers and facilitators to clinician use of PCIT using implementation theory, and a draft logic model with hypothesised mechanisms of action, derived from a series of preliminary studies. The intervention includes complimentary access to necessary equipment for PCIT implementation (audio-visual equipment, a 'pop-up' time-out space, toys), a mobile senior PCIT co-worker and an optional weekly PCIT consultation group, for a 6-month period. Outcomes will include the feasibility of recruitment and trial procedures; acceptability of the intervention package and data collection methods to clinicians; and clinician adoption of PCIT.

DISCUSSION

Relatively little research attention has been directed at interventions to resurrect stalled implementation efforts. Results from this pragmatic pilot RCT will refine and shape knowledge relating to what it might take to embed the ongoing delivery of PCIT in community settings, providing more children and families with access to this effective treatment.

TRIAL REGISTRATION

ANZCTR, ACTRN12622001022752, registered on July 21, 2022.

Conceptualizing the Role of Parent and Child Emotion Regulation in the Treatment of Early-Onset Behavior Disorders: Theory, Research, and Future Directions

Behavior disorders (BDs) are common and costly, making prevention and early-intervention a clinical and public health imperative. Behavioral Parent Training (BPT) is the standard of care for early-onset (3-8 years old) BDs, yet effect sizes vary and wane with time suggesting the role of underlying factors accounting for variability in outcomes. The literature on emotion regulation (ER), which has been proposed as one such underlying factor, is reviewed here, including a brief overview of ER, theory and research linking ER, externalizing symptoms, and/or BDs, and still largely preliminary work exploring the role of parent and child ER in BPT outcomes. Research to date provides clues regarding the interrelationship of ER, BDs, and BPT; yet, determining whether adaptations to BPT targeting ER are necessary or useful, for whom such adaptations would be most important, and how those adaptations would be implemented requires addressing mixed findings and methodological limitations. To guide such work, we propose a conceptual model elucidating how standard BPT may impact ER and processes linked to ER, which we believe will be useful in organizing and advancing both basic and applied research in future work.

How the home learning environment contributes to children's social-emotional competence: A moderated mediation model

Introduction

The home learning environment is the earliest contact learning environment in early childhood development, which plays an important role in the development of children's social-emotional competence. However, previous studies have not clarified the precise mechanisms by which the home learning environment influences children's social-emotional competence. Therefore, the purpose of the study is to explore the relationship between the home learning environment and its intrinsic structure (i.e. structural family characteristics, parental beliefs and interests, and the educational processes) and children's social-emotional competence, and whether gender plays a moderating role in the relationship.

Method

The study randomly selected a sample of 443 children from 14 kindergartens in western China. The Home Learning Environment Questionnaire and the Chinese Inventory of Children's Social-emotional competence scale were used to investigate the home learning environment and social-emotional competence of these children.

Results

(1) Structural family characteristics and parental beliefs and interests both had a significant positive predictive effect on children's social-emotional competence. (2) The educational processes fully mediate between structural family characteristics, parental beliefs and interests, and children's social-emotional competence. (3) Gender moderated the effect of the home learning environment on children's social-emotional competence. Gender moderates not only the indirect effects between parental beliefs and interests and children's social-emotional competence, but also the indirect effects between structural family characteristics and children's social-emotional competence. At the same time, gender also moderated the direct effects between parental beliefs and interests and children's social-emotional competence.

Discussion

The results emphasize the crucial role of the home learning environment in the development of children's early social-emotional competence. Therefore, parents should pay attention to the home learning environment and improve their ability to create a home learning environment that promotes the positive development of children's social-emotional competence.

The Impact of Maternal Depression on Internet-Parent–Child Interaction Therapy for Child Attention-Deficit/Hyperactivity Disorder: A Case Study

Conduct disorders and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid, with an estimated prevalence rate of 51.5% for children between 2–17 years of age (Centers for Disease Control and Prevention, 2020). Parent–Child Interaction Therapy (PCIT) is an empirically supported behavioral parent training program for children with disruptive behavior. PCIT research consistently demonstrates decreases in disruptive behaviors and increases in positive parenting strategies among families of young children with ADHD; however, PCIT has yet to become widely recognized as a treatment for ADHD. This case study presents the treatment of a 6-year-old boy with ADHD and severe behavior problems. The case was further impacted by the single mother’s depressive symptoms and internet delivery of PCIT during the COVID-19 pandemic. Findings from this case report documented an improvement in disruptive child behaviors and emotion regulation and increased positivity during parent–child interactions, despite worsening maternal depressive symptoms. This case study highlights the utility of PCIT to improve child disruptive behaviors and ADHD symptoms in the midst of several complicating factors.

Parents' reflective functioning and their agreement on treatment goals in attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This study examined the trajectories of parents' reflective functioning over the course of individual preparatory sessions with the therapist in attachment-based family therapy (ABFT) for Israeli sexual minority young adults and their nonaccepting parents, and whether such reflective functioning was associated with parents' agreement on the goals for subsequent conjoint corrective attachment sessions. Three parents with good agreement on treatment goals were compared to three parents with poor agreement on treatment goals. Parents' in-session reflectivity regarding their child's experience of nonacceptance, and regarding the quality of their relationship with their child, was observationally measured at the session level. Reflective functioning increased over time among those parents who reported good agreement with the treatment goals. There were no changes in parents' reflective functioning in the poor agreement group. Findings suggest the potential importance of facilitating parents' reflective functioning in ABFT, before conducting conjoint corrective attachment sessions. Research and clinical implications are discussed.

[Formula: see text]Parental interaction style, child engagement, and emerging executive function in fetal alcohol spectrum disorders (FASD)

Children with fetal alcohol spectrum disorders (FASD) are known to experience cognitive and neurobehavioral difficulties, including in areas of executive function and social skills development. Interventions for these challenges have focused on a number of areas, including parent-based training. Despite the general consensus that specific parenting styles consistent with an "authoritative" - warm but firm - parenting approach may influence behavioral self-regulation, it is not known what specific parental interaction styles are associated with child engagement and emerging executive function in this population. The current study used an observation-based behavioral coding scheme during parent-child play interactions and associated parent report-based executive function measures in children with FASD. Here, we demonstrate that parental interaction styles with increased responsive/child-oriented behavior and parental affect are associated with higher levels of child play engagement, while parental interaction that has increased achievement-orientation is associated with higher levels of emerging executive function in children with FASD. These findings help inform future studies on behavioral targets in parent-based training programs and highlight the importance of considering certain parental interaction styles during parent-child play.

Unique Contributions of Maternal Prenatal and Postnatal Emotion Dysregulation on Infant Respiratory Sinus Arrhythmia

Prenatal intrauterine exposures and postnatal caregiving environments may both shape the development of infant parasympathetic nervous system (PNS) activity. However, the relative contributions of prenatal and postnatal influences on infant respiratory sinus arrhythmia (RSA)-an index of PNS functioning-are relatively unknown. We examined whether prenatal and postnatal maternal emotion dysregulation, a transdiagnostic construct that spans mental health diagnoses, were independently related to infant RSA trajectories during a social stressor, the still-face paradigm. Our sample included 104 mothers and their 7-month-old infants. Maternal emotion dysregulation was measured with the Difficulties in Emotion Regulation Scale during the 3rd trimester of pregnancy and again at a 7-month postpartum laboratory visit. Infant RSA was recorded during the still-face paradigm. Only postnatal maternal emotion dysregulation was associated with infant RSA. Specifically, high postnatal emotion dysregulation was associated with a blunted (i.e., dampened reactivity and recovery) infant RSA response profile. Infant sex did not moderate the associations between maternal emotion dysregulation and infant RSA. Findings suggest that postnatal interventions to promote effective maternal emotion regulation may reduce risk for infants' dysregulated psychophysiological stress responses.

A Cohort Study on the Effect of Parental Mind-Mindedness in Parent-Child Interaction Therapy

Parent-child interaction therapy (PCIT) is a short-term, evidence-based intervention for caregivers with children aged between 2 and 7 who exhibit behavioral problems. PCIT is effective, but has a high attrition rate ranging from 27% to 69%. We hypothesize that a low level of parental mind-mindedness-the parent's propensity to treat the child as an intentional agent with its own thoughts and emotions-might contribute to premature attrition or cause families to profit less from treatment. To test these hypotheses, we performed a retrospective cohort study in a time-limited, home-based PCIT sample (n = 19) and in a clinic-based PCIT sample (n = 25), to investigate whether parents with a medium-high level of mind-mindedness differ from parents with a medium-low level of mind-mindedness in the outcome measures of PCIT (child's behavioral problems, parenting skills and stress and mothers' anxious and depressed symptoms). Furthermore, we examined if mind-mindedness was related to attrition and (for clinic-based PCIT only) number of sessions. Repeated measures ANOVA showed that mothers with a medium-high level of mind-mindedness displayed more improvement in two parenting skills benefiting a positive parent-child interaction. Furthermore, we found a group effect of mind-mindedness in the PCIT-home sample, with mothers with a medium-high level of mind-mindedness showing better results on most outcome measures. Our findings suggest that adding a mind-mindedness improving intervention prior to or during PCIT could benefit mothers with a medium to low level of mind-mindedness.

The Circle of Security Parenting Program (COS-P): A Randomized Controlled Trial of a Low Intensity, Individualized Attachment-Based Program With at-Risk Caregivers

The Circle of Security-Parenting Intervention (COS-P; Cooper et al., 2009) is a psychoeducational program for caregivers of young children that has been widely disseminated. The program is founded in attachment theory and relies on computer-delivered content and parent reflection and discussion to teach concepts of safety and security to promote better caregiver-child relationships and child wellbeing. The present study is a randomized controlled trial of COS-P, individually delivered to 85 Australian caregivers (51 COS-P, 34 waitlist control) who reported parenting distress and child disruptive behaviors. Caregivers completed a baseline assessment and repeated the assessment after completion of COS-P or 8 weeks on the waitlist. Caregivers completed surveys to report child symptoms, and parenting stress, anxious and avoidant attachment, reflective functioning, parenting practices, and depressive symptoms. No differences in COS-P vs. waitlist participants were found at baseline. Analyses of complete data (35 COS-P, 25-26 waitlist) revealed a greater decline in caregivers' attachment anxiety and negative parenting relative to waitlist, but only attachment anxiety in intent-to-treat analyses. Other improvements were found, but these extended to both the COS-P and waitlist conditions and did not differ between conditions. Overall, effects of COS-P were small and rarely significant, suggesting the need to consider alternative programs that have evidence of effectiveness when providing services to at-risk families.

Understanding Children's Emotions: Differences in Mothers With a History of Childhood Maltreatment

Experiencing maltreatment in childhood can have a lasting impact on how individuals identify and understand emotions in others. Research in this area has not examined parents' understanding of children's emotions, although emotion processing deficits may be one mechanism linking childhood maltreatment to subsequent parenting problems. In a matched case-control design, we test whether mothers with (n = 50) and without (n = 96) childhood maltreatment differ in their understanding of children's emotions on self-report measures and computer-based tasks. Compared to the control group, mothers who experienced maltreatment labeled more children with sad or angry emotions when given limited facial information and made different interpersonal inferences about children they labeled angry. They also reported more subjective difficulty interpreting emotions in unknown children and their own child. Results provide further evidence of emotion processing biases associated with childhood maltreatment. Interventions aimed at improving parental emotion understanding and mentalization may be particularly useful for mothers with a history of childhood maltreatment.

Emotional Regulation in Mothers and Fathers and Relations to Aggression in Hong Kong Preschool Children

This study explored the associations among emotional regulation in mothers and fathers and preschool children's physical and relational aggression using a Hong Kong Chinese sample. This study also explored whether child gender would moderate the association between parental emotional regulation strategies and children's physical and relational aggression. Participants were 168 children aged 4-6 years. Parents reported on their own emotional regulation approaches and kindergarten class teachers rated children's aggression 6 months later. Path analyses showed that higher levels of reappraisal and lower levels of suppression by mothers was associated with higher levels of child relational aggression. There were no significant associations among fathers' emotional regulation and children's aggression. Results from multi-group analysis showed that there were no significant moderation of the associations by child gender. Results highlight the importance of mothers' emotional regulation in child aggression and suggest that the maladaptive consequences of emotional suppression are culturally relative.

Barriers to Clinician Implementation of Parent-Child Interaction Therapy (PCIT) in New Zealand and Australia: What Role for Time-Out?

BACKGROUND

Parent-Child Interaction Therapy (PCIT) is an effective parent training approach for a commonly occurring and disabling condition, namely conduct problems in young children. Yet, despite ongoing efforts to train clinicians in PCIT, the intervention is not widely available in New Zealand and Australia.

METHODS

We undertook a cross-sectional online survey of clinicians in New Zealand and Australia who had completed at least the 40-h initial PCIT training, to understand the barriers they encountered in their implementation efforts, and the extent to which attitudes toward time-out influenced implementation. The overall response rate was 47.5% (NZ: 60%; Australia: 31.4%).

RESULTS

Responses suggested that participants generally viewed PCIT as both acceptable and effective. Australian participants reported seeing significantly more clients for PCIT per week than those in NZ (Medians 0 and 2, respectively; χ2(1) = 14.08, p < 0.001) and tended to view PCIT as more effective in treating disruptive and oppositional behaviour (95% CI: -0.70, -0.13, p = 0.005). Participants currently seeing PCIT clients described it as more enjoyable to implement than those not using PCIT (95% CI: -0.85, -0.10, p = 0.01). Thirty-eight percent of participants indicated that they adapt or tailor the standardised protocol, primarily by adding in content relating to emotion regulation, and removing content relating to time-out. Participants generally felt that they had fewer skills, less knowledge, and less confidence relating to the Parent-Directed Interaction phase of PCIT (which involves time-out), compared with the Child-Directed Interaction phase.

CONCLUSION

While we had hypothesised that time-out represented an intra-intervention component that detracted from implementation success, results suggested that clinician concern over the use of time-out was present but not prominent. Rather, the lack of access to suitable equipment (i.e., one-way mirror and ear-piece) and difficulties associated with clients attending clinic-based sessions were barriers most commonly reported by clinicians. We suggest that future research might consider whether and how PCIT might be "re-implemented" by already-trained clinicians, moving beyond simply training more clinicians in the approach.

Does maternal inhibitory control mediate effects of a parenting intervention on maternal sensitive discipline? Evidence from a randomized-controlled trial

The quality of parenting greatly impacts child development, highlighting the importance of support programs that effectively improve parenting. Studies on successful intervention programs define their efficacy by gains in parenting and/or child development. However, much remains unknown about the internal processes that explain how parenting interventions bring about their effects. The aims of the current randomized-controlled study were to test whether the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) improved maternal inhibitory control (1) and whether inhibitory control mediated any effects of VIPP-SD on maternal sensitive discipline (2). In total, 66 mothers of whom a random 33% received the VIPP-SD and the others a "dummy" intervention participated in pre- and post-intervention assessments. Sensitive discipline was observed during a semi-structured limit-setting situation and inhibitory control was measured using a stop-signal task. Contrary to expectations, inhibitory control improved over time in the control group and sensitive discipline did not show the expected increase in the intervention group. Results did not support mediation. We suggest that the intervention may have induced cognitive restructuring of parenting schemas, delaying improvements in post-intervention inhibitory control and sensitive discipline. Factors that may be involved in parents' susceptibility to interventions require attention in future work.

Parent emotional regulation: A meta-analytic review of its association with parenting and child adjustment

We conducted a meta-analytic review of 53 studies published between 2000 and 2020 to quantify associations of parents’ emotion regulation with parenting behavior and children’s emotion regulation and internalizing and externalizing symptoms. Twelve meta-analyses, which included between 4 to 22 effect sizes ( N from 345 to 3609), were conducted to summarize associations of parent emotion regulation with positive or negative parenting behaviors and child outcomes of emotion regulation, difficulties in emotion regulation, internalizing symptoms, or externalizing behavior. Given the range of behavioral parent emotion regulation measures used across studies, effect sizes for parent emotion regulation strategy use ( skill) were analyzed separately from effect sizes for parents’ difficulties with emotion regulation. Summary effect sizes ranged from |.08| to |.28| for relations of parent emotion regulation skill with parenting behaviors and children’s adjustment. Summary effect sizes ranged from |.03| to |.42| for relations of parent emotion regulation difficulties with parenting behaviors and children’s adjustment. In general, parents with better emotion regulation skill or fewer difficulties are higher in positive parenting behaviors and have children with better emotion regulation and fewer internalizing symptoms. Evidence was less clear-cut for child externalizing behaviors. Significant effect size heterogeneity was observed in most analyses, and study characteristics (measures, child age, parent gender, sampling, and region where the study was conducted) were examined as moderators. Measures used, child age, and participant risk status moderated effect size in some analyses.

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent-child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children's mental health research, services, and policy are discussed.

Emotion-focused parenting interventions for prevention and treatment of child and adolescent mental health problems: a review of recent literature

PURPOSE OF REVIEW

To review recent studies on emotion-focused parenting interventions to provide clinicians with knowledge about how these approaches might be used in prevention and treatment of mental health difficulties for children, adolescents and their families.

RECENT FINDINGS

A number of emotion-focused parent interventions are reported in the literature, including emotion coaching/communication parenting programs, emotion-focused family therapy, attachment-focused parenting interventions (including those that address parental reflective functioning/mentalization), mindfulness parenting programs and behavioral programs with added emotion components. All target emotions or emotional communication to assist parents and children understand and work through emotional experiences so they are less likely to impede healthy functioning. These interventions target four main domains: exploring family of origin or early attachment/relational experiences with emotion, targeting parents' own emotion awareness and regulation, shifting parents responses to or communication with their children when emotions occur, and promoting parents' skills for assisting children to regulate emotions and behavior. This review from the last 18 months found 50 studies that evaluated programs addressing these domains.

SUMMARY

Whilst the dominant approach in evidence-based parenting programs has been teaching behavioral strategies, it has been recognized that a focus on emotion-related processes is important. This is especially when working to improve the attachment relationship or when parents and children experience emotion dysregulation. This review demonstrates extensive evidence to support emotion-focused parenting interventions.

Exploring Children's Creative Self-Efficacy Affected by After-School Program and Parent-Child Relationships

This study aimed to verify the relationship among children’s creative self-efficacy, parenting style, parent–child relationship, and after-school program. Judgmental sampling was used for subject selection from Taiwan. There are 550 valid participants composed of elementary school to junior high school students; their data were put into the statistical process. The multiple regression analysis was applied in this study. The survey tool was developed based on literature review and related articles. Research result supported the idea that the after-school program was the most significant variable that affected the student’s creative self-efficacy. The “punitive discipline” and “autonomy support” of parenting style can affect positive parent–child relationships as well as students’ creative self-efficacy. Evidence supported the notion that “negative parent–child relationships” will not motivate students’ creative self-efficacy. Besides, the after-school program plays an important role in the students’ creative self-efficacy independently.

Mothers' self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers' physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants' behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.

Does your child need therapy? Maternal reflective functioning and perceived need for and use of child mental health treatment

Interventions to improve reflective functioning (RF) are being delivered to parents of children with mental health needs, yet whether this population differs in RF is unknown. We examine if mothers with varying levels of child mental health (CMH) treatment need and use differ in RF in a community sample of 212 mothers. Participants completed measures of general RF, parental RF, children's symptoms, perceived treatment need, treatment utilization, and perceptions of treatment efficacy at baseline and one year later. Low maternal RF was associated with elevated child symptoms, and a greater perceived need for treatment. Among mothers who believed their child needed services, those with low general RF were less likely to be utilizing services at baseline and in the next year. Mothers with lower parental RF also believed that CMH treatment was less effective. Findings support the use of RF-based interventions with parents identified because of their child's mental health.