Behavioral Parent Training in Infancy: What About the Parent-Infant Relationship?

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.

Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.

The Efficacy of Parent Training Interventions with Parents of Children with Developmental Disabilities

Parenting children with developmental disabilities (DD) can be generally characterized by a considerable psychological burden. The effects on parental and familial psychological well-being and, consequently, on children's developmental outcomes should not be underestimated, especially in early childhood. The current review aims to advance our understanding of the key factors (e.g., formats, sample characteristics, research design) that characterize parent training interventions, and that could be related to their outcomes, to guide researchers and clinical practitioners to develop and provide efficient programs. Studies were identified via an Internet search from three electronic databases, following PRIMSA guidelines. Studies published until November 2021 were taken into account. The initial search yielded a total of 2475 studies. Among them, 101 studies were fully reviewed. Finally, ten of the studies, which met all the inclusion criteria, formed the basis for this review. Participants' characteristics, main features of the interventions (i.e., study design, structure, and contents), outcome variables and treatment efficacy were deeply examined and discussed. Key factors of parent training interventions with parents of children affected by DD are enlightened, to guide researchers and clinicians in the design and implementation of tailored specific programs, aimed to sustain parenting and foster children's developmental outcomes, from early stages of life.

Impact of a Behavioral Parenting Intervention in Infancy on Maternal Emotion Socialization

Research has demonstrated the effect of parent emotion socialization on later child emotion development and behavior. Given these findings, the goal of the present study was to examine the effect of an early parenting intervention on a component of emotion socialization: parent emotion talk. We also examined the indirect effect of behaviorally-based parenting skills on the relation between the intervention and parent emotion talk. Participants were 58 mothers and their 12- to 15-month-old infant. Families were randomly assigned to standard pediatric primary care or a brief in-home intervention targeting parenting skills to promote positive infant behavior. Families completed assessments at baseline, post-intervention, and a 3-month follow-up. Assessments included a 10-min infant-led play task, which was coded for parent emotion talk. Results demonstrated a significant effect of the intervention on parent emotion talk. Specifically, mothers in the intervention group displayed a higher frequency of parent emotion talk at post-intervention. Indirect effects of behaviorally-based parenting skills were significant, demonstrating that increases in behaviorally-based parenting skills at the post-intervention led to increases in parent emotion talk at the follow-up. Findings highlight the effect of a brief, home-based behavioral parenting intervention with infants on maternal emotion socialization.

Global Workforce Development in Father Engagement Competencies for Family-Based Interventions Using an Online Training Program: A Mixed-Method Feasibility Study

Global access to practitioner training in the clinical engagement of fathers in family-based interventions is limited. The current study evaluated the feasibility of training practitioners in Canada and UK using online training developed in Australia by examining improvements in practitioner confidence and competence in father engagement, training satisfaction, qualitative feedback, and benchmarking results to those from an Australian sample. Practitioners were recruited to participate in a 2-h online training program through health services and charity organisations. The online program required practitioners to watch a video and complete self-reflection exercises in a digital workbook. Pre- and post-training measures were collected immediately before and after the online training program. The results indicated significantly large improvements in self-reported confidence and competence in engaging fathers following training, with levels of improvement similar to those found in Australia. Training satisfaction was high and qualitative feedback suggested providing local resources and increasing representation of social diversity could improve training relevance in local contexts. The findings suggest online training in father engagement can contribute to global workforce development in improving practitioners' skills in engaging fathers in family-based interventions.

Impact of Parenting Intervention on Observed Aggressive Behaviors in At-Risk Infants

Aggressive behaviors in early childhood persist through childhood and adolescence and result in negative outcomes. However, studies assessing aggressive behaviors in early childhood have focused primarily on parent report. Additionally, the effects of parenting interventions and associated parenting skills on early observed aggression have not been examined. In the present study, we examined the direct effect of a brief, in-home adaptation of Parent-Child Interaction Therapy, the Infant Behavior Program (IBP), on observed frequency of aggressive behaviors and global ratings of aggression in infants ages 12 to 15 months. Additionally, we examined behaviorally-based parenting skills as a mechanism by which the IBP impacted observed infant aggressive behaviors. Sixty infants with elevated levels of behavior problems were randomized to receive the IBP or standard pediatric primary care. Infants receiving the IBP demonstrated a significant decrease in the observed frequency of aggressive behaviors during infant-led play across a 3-month follow-up. Furthermore, the intervention led to decreases in parental use of don't skills (i.e., directive and negative parent statements), which, in turn, led to decreases in the frequency of observed aggressive behaviors at a 3-month follow-up. However, effects were not maintained at a 6-month follow-up. Results provide preliminary evidence for the efficacy of a brief parenting intervention on reducing the frequency of infant aggressive behaviors, including the indirect effect of the IBP on the frequency of aggressive behaviors through reductions in parenting skills. The study highlights the importance of targeting negative parenting practices to decrease subsequent aggressive behaviors in early childhood.

The pursuit of social acceptance: aberrant conformity in social anxiety disorder

The defining pathological features of social anxiety disorder primarily concern the social landscape, yet few empirical studies have examined the potentially aberrant behavioral and neural patterns in this population using socially interactive paradigms. We addressed this issue by investigating the behavioral and neural patterns associated with social conformity in patients with social anxiety disorder. We recorded event-related potentials when healthy subjects (n = 19), and patients with social anxiety disorder (n = 20) made attractiveness judgements of unfamiliar others, while at the same time, being exposed to congruent/incongruent peer ratings. Afterwards, participants were asked to rerate the same faces without the presence of peer ratings. When compared with healthy controls, social anxiety disorder patients exhibited more positive attitudes to unfamiliar others and conformed more with peers-higher feedback. These behavioral effects were in parallel with neural responses associated with social conflict in the N400 signal, showing higher conformity to peers-higher feedback compared with peers-lower or peers-agree feedback among social anxiety disorder patients. Our findings provide evidence on the behavioral and neural patterns of social anxiety disorder during social interactions, and support the hypothesis that individuals with social anxiety disorder are more motivated to pursue social acceptance and possibly avoid social rejection.

Changes in parental prosody mediate effect of parent-training intervention on infant language production

OBJECTIVE

Parent-training interventions to reduce behavior problems in young children typically coach parents on the content of their speech, but rarely assess parents' prosody during parent-child interactions. Infant-directed speech helps shape the parent-infant relationship and promote language development, which predicts adaptive behavioral outcomes in children. The current study examined (a) the effect of a parent-training intervention on parents' vocal cues in interactions with their infant and (b) whether parental prosody mediated the impact of the intervention on infant language production.

METHOD

Sixty families with 12- to 15-month-old infants (47% female; 95% of Hispanic/Latino ethnicity) participated in the Infant Behavior Program (IBP), a brief home-based adaptation of Parent-Child Interaction Therapy, or received standard pediatric care. Speech analysis was performed on mothers' (n = 40) utterances during infant-led play pre- and postintervention. Infants' number of utterances spoken during play was assessed at pre- and postintervention, and at 3- and 6-month follow-ups.

RESULTS

Mothers who received the IBP spoke with greater pitch range and slower tempo postintervention, when controlling for baseline prosody. Change in these vocal cues, which are typical of infant-directed speech, mediated the effect of the intervention on infants' word production after 6 months.

CONCLUSIONS

Interventions targeting the content of parents' speech during parent-infant interactions may lead to changes in parental prosody, which may be beneficial for infants' language development. Impaired linguistic abilities in infancy are strongly associated with behavior problems in later childhood; thus, these findings highlight a potential mechanism for intervention efficacy in promoting positive socioemotional and behavioral outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families

In the U.S., there is a growing Latino population, in which parents primarily speak Spanish to their children. Despite the evidence that language preference is associated with level of acculturation and influences parenting practices in these families, no study has compared how Spanish-and English-speaking Latino families acquire and utilize the skills taught during parent-training programs such as Parent-Child Interaction Therapy (PCIT). Twenty-seven mother-infant Latino dyads received a home-based adaptation of the Child-Directed Interaction (CDI) phase of PCIT as part of a larger randomized control trial. Most infants were male (63%), and their average age was 13.7 months (SD = 1.43). Most families (52%) lived below the poverty line. The Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III) was employed to evaluate PCIT skills at baseline and post-treatment, as well as at 3- and 6-month follow-up, assessments. We conducted multiple linear regression analyses among Spanish-speaking (55%) and English-speaking (45%) families to examine differences in acquisition and utilization of do and don't skills at each assessment while controlling for mother's education. Results yielded no group differences in the acquisition rate of do or don't skills at any time point. However, Spanish-speaking mothers used significantly more don't skills than English-speaking mothers at each assessment. Specifically, Spanish-speaking families used significantly more commands at baseline, post-treatment, and the 6-month followup assessments, as well as more questions at post-treatment and at the 6-month follow-up assessments. These findings highlight the importance of addressing cultural values such as respeto to ensure culturally robust parent-training programs for Latino families.