Protective parenting: neurobiological and behavioral dimensions

A Psychometric Evaluation of the Tend-and-Befriend Questionnaire

In response to Cannon's widely accepted fight-or-flight system, Taylor et al. proposed the tend-and-befriend hypothesis to better capture variance in women's stress response behaviors. The Tend-and-Befriend Questionnaire (TBQ) measures self-reported individual differences in the use of fight, flight, tend, and befriend. Several studies have used this scale to evaluate sex differences in these behaviors, yet it has not yet been rigorously evaluated. Using three samples (N = 1094), we first explore the factor structure of the TBQ to produce and validate a revised measure, the TBQ-Short Form (TBQ-SF). Next, we evaluate the claim that women use tend-and-befriend more than men. Results indicated that the TBQ-SF provided both reliable subscales and largely acceptable model fit, yet the factor structure and validity varied across the three samples. While men do report more fighting than women, both men and women report use tending and befriending more than fighting or fleeing. Finally, other variables-namely attachment-capture more variance in TBQ-SF factors than sex. While the TBQ-SF does capture differences in stress reactions (fight, flight, tend/befriend), we suggest that the scale is most reliable in measuring overall stress reactivity. Therefore, future research should aim to construct a better scale specific to tend-and-befriend using alternative methodologies.

Parents' experiences of psychotherapeutic support on the neonatal unit: A mixed methods systematic review to inform intervention development for a multicultural population

BACKGROUND

Parents of infants admitted to neonatal intensive care require support to minimize the impact on their mental health and to encourage engagement with their infants to support infant neurodevelopment. Many interventions aim to address this need, but there is a lack of research considering the accessibility of these for a multicultural population.

AIM

To systematically identify sources of psychotherapeutic support available for parents with infants admitted to neonatal care (NNU, neonatal intensive care unit [NICU] and special care units), assess their accessibility and acceptability and identify challenges and facilitators.

STUDY DESIGN

Six electronic databases with no restrictions on language or date were used to identify relevant studies following Preferred Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Publications were included in the review if they reviewed parent experience of an intervention actively in place to support parent experience during the neonatal unit stay. Any studies where the intervention's primary aim was infant focused, such as developmental care, were excluded. All publications were quality-assessed using quality appraisal tools appropriate for their design type. Data were extracted line by line using Sekhon et al.'s theoretical acceptability framework and questionnaire.

RESULTS

A total of 3309 studies were found, of which 36 studies met the inclusion criteria. Included studies were published worldwide between 2000 and 2023 and explored 15 different interventions. Challenges for parental engagement were due to preconceived ideas about intervention requirements and parents' ability to participate in them. Timely information and providers' experience in delivering the intervention were reported to support engagement and as being valuable for enhancing participant knowledge. The emotional content of interventions was found to be challenging by parents across most studies. This was prominent in interventions designed to be carried out in a group format and where keepsakes were created. However, the value of these interventions was in reducing parents' feelings of isolation through increased social support and providing a starting point for conversations with wider family and friends about the family's neonatal experience. Participant demographics were poorly reported, with only two studies taking into consideration the ethicality of the intervention.

CONCLUSION

Poor reporting of participant demographics, and a focus on mothers as participants, means findings are not transferrable to the wider population of parents in neonatal units. Future studies should consider how to ensure that research and interventions are accessible to multicultural populations to improve the understanding of the acceptability of interventions. Better knowledge of neonates and the NNU setting amongst intervention providers could increase the accessibility of psychotherapeutic support for parents. Training for providers on how to manage sensitive conversations may also be beneficial to support parents during interventions.

RELEVANCE TO CLINICAL PRACTICE

The impact of neonatal admission on parental mental health is increasingly recognized and reported. Interventions have been developed to reduce the negative impact on the mental health of parents. There continue to be significant health inequalities as a result of many services not taking into account the acceptability and accessibility of interventions in this setting for their multicultural populations. This review highlights the need for better reporting of participant demographics in research and the inclusion of those seldom heard to ensure interventions are culturally, religiously and linguistically appropriate for multicultural populations.

Parental protection in fathers with negative caregiving experiences: Heightened amygdala reactivity to infant threatening situations

Parental protection is an important, yet understudied, aspect of parenting behavior. Predictors of the quality of protection and potential underlying neural mechanisms are still unknown. In this study, we examined whether negative caregiving experiences in fathers' own childhood are related to protective behavior and neural reactivity to infant threatening situations. Paternal protective behavior was measured with self- and partner-reported protective behavior and behavioral observations in an experimental set-up (auditory startling task) in 121 first-time fathers (mean age child = 19.35 weeks, SD = 11.27). Neural activation during exposure to videos of infant-threatening (vs. neutral) situations was measured with functional magnetic resonance imaging (fMRI). We found a significant and positive association between negative caregiving experiences and amygdala reactivity to infant-threatening situations. A history of negative caregiving experiences was not significantly related to reported or observed paternal protective behavior. Our findings suggest that fathers with negative caregiving experiences show emotional hyperreactivity to cues of infant threat.

Is paternal oxytocin an oxymoron? Oxytocin, vasopressin, testosterone, oestradiol and cortisol in emerging fatherhood

How do hormonal levels in men change from pregnancy to after the birth of their firstborn child, and what is the role of oxytocin, alone or in interplay with other hormones, in explaining variance in their parenting quality? We explored in 73 first-time fathers the development of five hormones that have been suggested to play a role in parenting: oxytocin (OT), vasopressin (AVP), testosterone (T), oestradiol (E2) and cortisol (Cort). In an extended group of fathers (N = 152) we examined associations with fathers' behaviour with their 2-month-old infants. OT and E2 showed stability from the prenatal to the postnatal assessments, whereas AVP and T decreased significantly, and Cort decreased marginally. OT on its own or in interplay with other hormones was not related to paternal sensitivity. Using an exploratory approach, the interaction between T and E2 emerged as relevant for fathers' sensitive parenting. Among fathers with high E2, high T was associated with lower sensitivity. Although we did not find evidence for the importance of OT as stand-alone hormone or in interplay with other hormones in this important phase in men's lives, the interaction between T and E2 in explaining variation in paternal behaviour is a promising hypothesis for further research. This article is part of the theme issue 'Interplays between oxytocin and other neuromodulators in shaping complex social behaviours'.

Portuguese parental beliefs and attitudes towards vaccination

Introduction

Portugal has one of the highest vaccine coverage rates among European countries, associated with excellent vaccine convenience and confidence levels. Considering both the high rate of pediatric vaccination in Portugal and the excellent indicators of vaccine convenience established, an analysis of confidence and complacency indicators could help understand this positive example. This study aimed to characterize parental beliefs according to the intention to vaccinate a next child and identify cognitive and demographic predictors of that intention in a Portuguese sample.

Methods

We measured perceptions of vaccines’ safety and efficacy, perceptions of the severity of vaccine-preventable diseases, beliefs related to conspiracy theories, attitudes towards immunization requirements, perceptions of social norms as predictors of the intention to vaccinate a subsequent child. We also inquired if parents had previously refused a recommended vaccine. The authors disseminated the questionnaire online to reach a diverse population of parents of 0–12 years old children. The final sample included 1,118 parents, 96.9% reported their intention to vaccinate the next child, and 3.6% had previously refused a vaccine. Two additional open-ended questions regarding motives to vaccinate or refuse a future baby's vaccination were answered by 886 parents.

Results

All the evaluated parental cognitive dimensions were significantly different between the group of parents who would vaccinate a next child and those who expressed the intention not to vaccinate. Beliefs about the safety and efficacy of vaccines and having fewer children were significant predictors of that intention.

Conclusion

The vast majority of parents reported attitudes and beliefs favorable to pediatric vaccination with high consistency in all cognitive dimensions assessed. Concerns regarding pediatric vaccines’ safety need to be sensitively and actively addressed by health providers to maintain excellent vaccination coverage rates.

Exploring the hormonal and neural correlates of paternal protective behavior to their infants

Infant protection is an important but largely neglected aspect of parental care. Available theory and research suggest that endocrine levels and neural responses might be biological correlates of protective behavior. However, no research to date examined associations between these neurobiological and behavioral aspects. This study, preregistered on https://osf.io/2acxd, explored the psychobiology of paternal protection in 77 new fathers by combining neural responses to infant-threatening situations, self-reported protective behavior, behavioral observations in a newly developed experimental set-up (Auditory Startling Task), and measurements of testosterone and vasopressin. fMRI analyses validated the role of several brain networks in the processing of infant-threatening situations and indicated replicable findings with the infant-threat paradigm. We found little overlap between observed and reported protective behavior. Robust associations between endocrine levels, neural responses, and paternal protective behavior were absent.

Exploring the neural basis for paternal protection: an investigation of the neural response to infants in danger

Perceiving potential threat to an infant and responding to it is crucial for offspring survival and parent–child bonding. Using a combination of functional magnetic resonance imaging and multi-informant reports, this longitudinal study explores the neural basis for paternal responses to threat to infants pre-natally (N = 21) and early post-natally (n = 17). Participants viewed videos showing an infant in danger and matched control videos, while instructed to imagine that the infant was their own or someone else’s. Effects were found for infant-threatening vs neutral situations in the amygdala (region-of-interest analyses) and in clusters spanning cortical and subcortical areas (whole-brain analyses). An interaction effect revealed increased activation for own (vs unknown) infants in threatening (vs neutral) situations in bilateral motor areas, possibly indicating preparation for action. Post-natal activation patterns were similar; however, in part of the superior frontal gyrus the distinction between threat to own and unknown infant faded. Fathers showing more protective behavior in daily life recruited part of the frontal pole more when confronted with threat to their own vs an unknown infant. This exploratory study is the first to describe neural mechanisms involved in paternal protection and provides a basis for future work on fathers’ protective parenting.

How Well Do Couples Care When They Are Expecting Their First Child? Family and Dyadic Predictors of Parental Sensitivity in Expectant Couples

Belsky's Process Model points to family-of-origin (especially experiences of mistreatment in childhood) as well as personality and marital relations as determinants of parenting quality, including parental sensitive responsiveness. Parental sensitivity might be intuitively developed during pregnancy and affects perinatal mental health. However, there is a lack of studies investigating effects of family-of-origin and relationship perceptions on expectant couples' parental sensitive responsiveness. The aim of the presented study was to test mediation and moderation effects of perceived partner's empathic concern and retrospectively assessed abuse experienced in childhood on sensitive parental responsiveness operationalized as caretaking behaviors and emotional reactions to a crying life-like doll. One hundred eleven expectant couples (N = 222; age: M _women = 28.4 years, SD = 3.03; age: M _men = 29.2 years, SD = 3.31; relationship duration: M _years = 6.8, SD = 3.43; gestational week: M = 31.3, SD = 4.58) assessed the extent to which they experienced physical and emotional abuse from their parents in childhood and rated their current partner's empathic concern. In the experimental procedure, couples reacted to a crying life-like doll and were assessed by trained psychologists using the modified Ainsworth Sensitivity Scale to measure couples' sensitive responsiveness. The results confirmed a significant mediational effect of perceived women's (and not men's) empathic concern for the relationship between the reported experience of abuse in family-of-origin by expectant fathers (and not mothers) and couples' sensitivity. Support and interventions regarding couples' empathy and parenting competence can be offered to both mothers and fathers to identify those who are at risk of low parental sensitivity.

Vasopressin Differentially Affects Handgrip Force of Expectant Fathers in Reaction to Own and Unknown Infant Faces

The underlying mechanisms of paternal responses to infant signals are poorly understood. Vasopressin has previously been proposed to affect these responses. Using a double-blind, placebo-controlled, within-subject design (N = 25 expectant fathers), we examined the effect of vasopressin administration on the use of excessive handgrip force during exposure to infant crying versus matched control sounds, while participants saw morphed images representing their own infant versus an unknown infant. We found that, compared to placebo, AVP administration elicited more excessive force while viewing an unknown infant image compared to viewing the image representing one’s own infant, while the reverse was true under placebo. The results are discussed in light of vasopressin’s role in parenting and parental protection among human fathers.

Bridges across the intergenerational transmission of attachment gap

Attachment is transmitted from one generation to the next. Adult attachment has been shown to predict the security or insecurity of children's attachment relationship with their parents. In search for the mechanism of intergenerational transmission of attachment sensitive parenting has been the main focus of research during the past four decades. Meta-analytic work confirmed the role of sensitive parenting, but a large explanatory gap remains to be explained. Parental mentalization has not yet fulfilled its promise as a bridge across the transmission gap. Here we suggest a model of intergenerational transmission that includes context and differential susceptibility, and we argue that the concept of parenting should be broadened to include autonomy support, limit-setting, protective parenting, parental warmth, and repair of mismatches.

Oxytocin and Human Sensitive and Protective Parenting

In this chapter we review the evidence for the role of oxytocin in parenting, and discuss some crucial but outstanding questions. This is not meant to be a comprehensive review of all studies on oxytocin and parenting in general. Instead, special attention will be paid to a dimension of parenting that has been largely neglected in behavioral and neurobiological research on parental caregiving, namely protection. Parental protection has received considerable attention in animal research but, despite its evolutionary importance, not in studies on humans. It is argued that oxytocin may have specific significance for the protective dimension of parenting. The effects of exogenous oxytocin may be dependent not only on contextual factors, but also on personal characteristics, most notably gender, on endogenous levels of oxytocin, and on early childhood experiences. Examining the contextual, personal, hormonal, neural, genetic, and behavioral mechanisms of protective parenting in tandem is essential for the development of a comprehensive theory of protective parenting, and for the identification of "biomarkers" for insensitive and unprotective parenting that should be taken into account in preventive parenting interventions.

Adapting to the changing needs of adolescents: parenting practices and challenges to sensitive attunement

Changes in adolescents' motivations and capabilities pose unique challenges to parents who play a continuing role in ensuring the youth's safety and well-being. We describe sensitively attuned parenting as an optimal response to this challenge and summarize practices of positive engagement, supervision/guidance and open communication that support sensitive attunement and facilitate the continuing development of the adolescent's self-confidence, autonomous decision-making, and communication skills. We then consider factors that require parents to adapt their practices to the particular needs and developmental level of the adolescent. Individual differences that may challenge parent's effectiveness in implementing these practices include: biological vulnerabilities, differential sensitivity to parenting, relationship history and temperament. Clinical interventions that seek to improve parenting offer an opportunity to test sensitive attunement as a mechanism for reducing adolescents' symptoms and problem behaviors.