The relation of maternal sensitivity to children's internalizing and externalizing problems within the context of maternal depressive symptoms

Maternal alcohol dependence symptoms, maternal insensitivity to children's distress, and young children's blunted emotional reactivity

Maternal insensitivity to children's emotional distress (e.g., expressions of sadness or fearfulness) is one mechanism through which maternal alcohol dependence may increase children's risk for psychopathology. Although emotion dysregulation is consistently associated with psychopathology, it remains unclear how or why alcohol dependence's effects on caregiving responses to children's distress may impact children's emotion regulation over time, particularly in ways that may engender risks for psychopathology. This study examined longitudinal associations between lifetime maternal alcohol dependence symptoms, mothers' insensitivity to children's emotional distress cues, and children's emotional reactivity among 201 mother-child dyads (Mchild age = 2.14 years; 56% Black; 11% Latino). Structural equation modeling analyses revealed a significant mediational pathway such that maternal alcohol dependence predicted increases in mothers' insensitivity to children's emotional distress across a one-year period (β = .16, p = .013), which subsequently predicted decreases in children's emotional reactivity one year later (β = -.29, p = .009). Results suggest that mothers with alcohol dependence symptoms may struggle to sensitively respond to children's emotional distress, which may prompt children to suppress or hide their emotions as an adaptive, protective strategy. The potential developmental benefits and consequences of early, protective expressive suppression strategies are discussed via developmental psychopathology frameworks.

Protective factors enhancing resilience in children of parents with a mental illness: a systematic review

Objectives

A systematic review was conducted to (1) investigate protective factors enhancing resilience in children of parents with a mental illness (COPMI), and (2) examine theoretical and methodological issues in the existing literature.

Method

Following guidelines for systematic reviews, searches were performed using Web of Science, Pubmed and Embase. After screening 5,073 articles 37 fulfilled inclusion criteria and were extracted for review. Results of the present review indicate that there are several ways to help build resilience in COPMI. More specifically, five protective factors emerged from the reviewed literature: Information, Support, Family functioning and Connectedness, Child coping, and Parenting.

Discussion

Research on protective factors in children confronted with parental mental illness is still scarce and for some factors no clear conclusions can be drawn based on the available evidence. To further our understanding of the building blocks and underlying mechanisms of resilience in COPMI, additional rigorously designed studies are needed.

The Differential Impact of Parenting on Adolescent Externalizing Behaviors in the Context of Maternal Stress

The effectiveness of parenting on child outcomes may be dependent on other contextual factors. To date, few studies have focused on the potential moderating effect of maternal stress on the relationship between parenting and youth externalizing behaviors. This study extends prior work by assessing how the relationship between parenting and youth outcomes varies by the presence of maternal stress, while focusing on the developmental period of adolescence and two dimensions of parenting, parental knowledge and maternal warmth. Data were collected from 278 Mother-adolescent dyads (M_{adolescent age} = 14.05; 53.2% females; 61.9% minority) on maternal stress, maternal warmth and parental knowledge, and youth aggression and delinquency. Multi-level regression models found significant two-way interactions between parental knowledge and maternal stress on aggression and between maternal warmth and maternal stress on both outcomes. Parental knowledge was associated with lower aggression in the context of high maternal stress, but warmth only attenuated the risk of youth outcomes among low maternal stress. This study highlights the importance of considering how contextual factors impact the relationship between parenting and youth externalizing behaviors.

The Influence of Socioeconomic Status (SES) and Processing Speed on the Psychological Adjustment and Wellbeing of Pediatric Brain Tumor Survivors

Simple Summary

Processing speed (PS) is one of the most impaired functions in pediatric brain tumor survivors (PBTSs) and it has been linked to difficulties in their psychological functioning, together with other non-insult-related risk factors, such as socio-economic status (SES). Given the psychological adjustment difficulties observed in PBTS, the aim of the current study was to explore the relationship between SES and psychological functioning, measured with the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire, and considering the contribution of PS as a mediator. The results demonstrated that the influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the SES–internalizing problems relationship but not on the SES–externalizing problems relationship. These findings suggest that PS may be a rehabilitation target to prevent psychological distress and should be addressed, especially for PBTSs who live in a disadvantaged situation.

Abstract

(1) Background: The relationship between processing speed (PS) and psychological adjustment in the healthy population is well established, as is that between low socio-economic status (SES) and psychological distress. While PS is one of the most impaired functions in pediatric brain tumor survivors (PBTSs), previous research has demonstrated that low SES may be a predictor of increased psychosocial risk in PBTSs. Given the psychological adjustment difficulties observed in PBTS, in the current study we aimed to explore the relationship between SES and psychological functioning, considering the contribution of PS as a mediator. (2) Methods: demographic and clinical data of 80 children (age range: 4–17 y.o.) were retrospectively collected. Psychological measures were the parent-compiled versions of the Child Behavioral Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ). Mediation analysis models were performed on psychological measures with and without the inclusion of covariates. (3) Results: The influence of SES on the CBCL total index was mediated by PS. Furthermore, PS was found to have a mediating effect on the relationship between SES and internalizing problems but not on the relationship between SES and externalizing problems. (4) Conclusions: The results suggest that PS may be a rehabilitation target for the prevention of psychological distress and should be addressed especially for PBTSs who live in a disadvantaged situation.

Long-Term Mental Health and Quality of Life Outcomes of Neonatal Insults in Kilifi, Kenya

We examined the mental health and quality of life (QoL) outcomes and their correlates of school-aged survivors of neonatal jaundice (NNJ), hypoxic-ischemic encephalopathy (HIE), and a comparison group. The Child Behavior Checklist and the Pediatric Quality of Life Inventory were administered to assess the mental health and QoL of 375 children (134 with NNJ, 107 with HIE, and 134 comparison group) aged 6 to 12 years [Median age 9 (interquartile range 7 to 11)]. The results showed that survivors of NNJ and HIE have mental health problems and QoL similar to the comparison group. Maternal mental health was the predominant covariate of mental health and QoL in survivors of NNJ and HIE. This result could indicate that mothers with mental health problems are more likely to have children with mental health issues, but also that caring for children with these adversities may affect mental health well-being of the caregivers. There is a need for early mental health screening and psychosocial intervention for caregivers and their children to enhance both their mental health and QoL.

Developmental pathways from maternal history of childhood maltreatment and maternal depression to toddler attachment and early childhood behavioral outcomes

The current study examined the development of toddler attachment and early childhood behavior among children of mothers with a history of childhood maltreatment and current major depressive disorder. Maternal depression, maternal sensitivity, and toddler attachment were assessed as mediators of the association between maternal history of childhood maltreatment and child internalizing and externalizing behavior. Participants were from a low-income, largely racial minority urban sample and included 123 mothers with (n = 69) and without (n = 54) major depressive disorder at baseline and their children assessed at 12, 26, and 36 months old. Findings suggest maternal depression and maternal sensitivity mediated the association between maternal history of childhood maltreatment and disorganized attachment. Maternal depression, but not disorganized attachment, mediated the association between maternal history of childhood maltreatment and child symptomatology. Results suggest that supporting mothers through depression and processing their adverse childhood experiences are critical in fostering positive child development.

Trajectories of mental health problems in children of parents with mental health problems: results of the BELLA study

Children of parents with mental health problems (CPM) have an increased risk for behavioral and psychological problems. This study investigated the age- and gender-specific course as well as predictors of mental health problems in CPM using the longitudinal data (baseline 1- and 2-year follow-ups) of a German general population sample from the BELLA study. Children and adolescents aged 11-17 years (at baseline) who had a parent with mental health problems (n = 325) were analyzed. The mental health problems of the children were assessed by the self-reported version of the strengths and difficulties questionnaire (SDQ). We used individual growth modeling to investigate the age- and gender-specific course, and the effects of risk as well as personal, familial and social protective factors on self-reported mental health problems in CPM. Additionally, data were examined differentiating internalizing and externalizing mental health problems in CPM. Results indicated that female compared to male CPM showed increasing mental health problems with increasing age. Mental health problems in CPM were associated with lower self-efficacy, worse family climate and less social competence over time. Internalizing problems were associated with lower self-efficacy, less social competence and more severe parental mental health problems. Externalizing problems were associated with lower self-efficacy, worse family climate and lower social competence. The main limitations of the study are the short time period (2 years) covered and the report of mental health problems by only one parent. Our findings should be considered in the development of treatment and prevention programs for mental health problems in CPM.

MATERNAL INTERACTION QUALITY MODERATES EFFECTS OF PRENATAL MATERNAL EMOTIONAL SYMPTOMS ON GIRLS' INTERNALIZING PROBLEMS

The role of mother-infant interaction quality is studied in the relation between prenatal maternal emotional symptoms and child behavioral problems. Healthy pregnant, Dutch women (N = 96, M = 31.6, SD = 3.3) were allocated to the "exposed group" (n = 46), consisting of mothers with high levels of prenatal feelings of anxiety and depression, or the "low-exposed group" (n = 50), consisting of mothers with normal levels of depressive or anxious symptoms during pregnancy. When the children (49 girls, 47 boys) were 23 to 60 months of age (M = 39.0, SD = 9.6), parents completed the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, ), and mother-child interaction quality during a home visit was rated using the Emotional Availability Scales. There were no differences in mother-child interaction quality between the prenatally exposed and low-exposed groups. Girls exposed to high prenatal emotional symptoms showed more internalizing problems, if maternal interaction quality was less optimal. No significant effects were found for boys.

Resilience in the Offspring of Depressed Mothers: Variation Across Risk, Domains, and Time

Considerable research has demonstrated that maternal depression is a significant risk factor for emotional and behavioral problems in children and adolescents (Goodman and Gotlib in Psychol Rev 106:458-490, 1999). It is important to note, however, that most children of depressed parents do not develop problems. This review will examine studies of resilience as they relate to the degree to which positive adjustment occurs across different levels of risk (i.e., severity and chronicity of depression as well as in context of multiple risk factors), domains of adjustment, and time. Understanding the phenomenon of resilience to depression is of critical importance to prevention and intervention experts because it may provide insight into processes that can be enhanced and targeted in prevention approaches among high-risk populations.

Escolares que Convivem com a Depressão Materna Recorrente: Diferenças entre os Sexos

Resumo Há divergências na literatura quanto às diferenças entre os sexos na associação entre depressão materna e desenvolvimento infantil. Neste estudo, compararam-se diferenças entre os sexos relativas ao comportamento e desempenho escolar de crianças que conviviam com a depressão materna, correlacionando tais desfechos. Participaram 40 díades mãe-criança, tendo as mães diagnóstico de Transtorno Depressivo Recorrente. As crianças, de sete a 12 anos, foram divididas em grupos por sexo. Foi realizada aplicação de entrevista diagnóstica, do Questionário de Capacidades e Dificuldades e do Teste de Desempenho Escolar. As meninas apresentaram mais sintomas emocionais comparadas aos meninos. Constataram-se associações significativas entre comportamento e desempenho escolar apenas para as meninas, sinalizando maior vulnerabilidade destas meninas.

Maternal sensitivity, infant limbic structure volume and functional connectivity: a preliminary study

Mechanisms underlying the profound parental effects on cognitive, emotional and social development in humans remain poorly understood. Studies with nonhuman models suggest variations in parental care affect the limbic system, influential to learning, autobiography and emotional regulation. In some research, nonoptimal care relates to decreases in neurogenesis, although other work suggests early-postnatal social adversity accelerates the maturation of limbic structures associated with emotional learning. We explored whether maternal sensitivity predicts human limbic system development and functional connectivity patterns in a small sample of human infants. When infants were 6 months of age, 20 mother-infant dyads attended a laboratory-based observational session and the infants underwent neuroimaging at the same age. After considering age at imaging, household income and postnatal maternal anxiety, regression analyses demonstrated significant indirect associations between maternal sensitivity and bilateral hippocampal volume at six months, with the majority of associations between sensitivity and the amygdala demonstrating similar indirect, but not significant results. Moreover, functional analyses revealed direct associations between maternal sensitivity and connectivity between the hippocampus and areas important for emotional regulation and socio-emotional functioning. Sensitivity additionally predicted indirect associations between limbic structures and regions related to autobiographical memory. Our volumetric results are consistent with research indicating accelerated limbic development in response to early social adversity, and in combination with our functional results, if replicated in a larger sample, may suggest that subtle, but important, variations in maternal care influence neuroanatomical trajectories important to future cognitive and emotional functioning.

Parenting as a Moderator of the Effects of Maternal Depressive Symptoms on Preadolescent Adjustment

The purpose of this study was to examine whether parenting moderated the association between maternal depressive symptoms and initial levels and growth of preadolescent internalizing and externalizing symptoms. This study used a community sample of preadolescent children (N = 214; 8-12 years old at Time 1), measuring maternal depressive symptoms and parenting at Time 1, and preadolescent internalizing and externalizing symptoms at each year for 3 years. After modeling latent growth curves of internalizing and externalizing symptoms, growth factors were conditioned on maternal depressive symptoms, positive (acceptance and consistent discipline) and negative (rejection and physical punishment) parenting, and the interactions of depression and parenting. Maternal rejection moderated the relation of maternal depression with internalizing symptoms, such that high rejection exacerbated the effects of maternal depressive symptoms on initial levels of preadolescent internalizing problems. There were no significant interactions predicting externalizing problems. The findings highlight how specific parenting behaviors may alter the way in which maternal depressive symptoms confer risk for behavior problems.

Video feedback compared to treatment as usual in families with parent-child interactions problems: a randomized controlled trial

BACKGROUND

For the first time to our knowledge, short- and long-term effects of a multi-site randomized-controlled trial (RCT) of video feedback of infant-parent interaction (VIPI) intervention in naturalistic settings are published. The intervention targets families with children younger than 2 years old and parent-child interactions problems. Outcome variables were 1) observed parent-child interactions and 2) parent-reported child social and emotional development. Between-group differences of the moderating effects of parental symptoms of depression, personality disorders traits, and demographic variables were investigated.

METHOD

The study had a parallel-group, consecutively randomized, single-blinded design; participants were recruited by health- and social workers. Seventy-five families received VIPI, and 57 families received treatment as usual (TAU). Videotapes of each parent-child interactions were obtained before treatment, right after treatment, and at a 6-month follow-up and coded according to Biringen's Emotional Availability Scales. Parental symptoms of depression and personality disorder traits were included as possible moderators.

RESULTS

Evidence of a short-term effect of VIPI treatment on parent-child interactions was established, especially among depressed parents and parents with problematic interactions-and, to some extent, among parents with dependent and paranoid personality disorder traits. A long-term positive effect of VIPI compared with TAU on child social/emotional development was also evident. In a secondary analysis, VIPI had a direct positive effect on the depressive symptoms of parents compared with TAU.

CONCLUSION

The findings of the study support the use of VIPI as an intervention in families with interaction difficulties.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN99793905.

The ecology of early childhood risk: a canonical correlation analysis of children's adjustment, family, and community context in a high-risk sample

The ecology of the emergence of psychopathology in early childhood is often approached by the analysis of a limited number of contextual risk factors. In the present study, we provide a comprehensive analysis of ecological risk by conducting a canonical correlation analysis of 13 risk factors at child age 2 and seven narrow-band scales of internalizing and externalizing problem behaviors at child age 4, using a sample of 364 geographically and ethnically diverse, disadvantaged primary caregivers, alternative caregivers, and preschool-age children. Participants were recruited from Special Supplemental Nutrition Program for Women, Infants, and Children sites and were screened for family risk. Canonical correlation analysis revealed that (1) a first latent combination of family and individual risks of caregivers predicted combinations of child emotional and behavioral problems, and that (2) a second latent combination of contextual and structural risks predicted child somatic complaints. Specifically, (1) the combination of chaotic home, conflict with child, parental depression, and parenting hassles predicted a co-occurrence of internalizing and externalizing behaviors, and (2) the combination of father absence, perceived discrimination, neighborhood danger, and fewer children living in the home predicted child somatic complaints. The research findings are discussed in terms of the development of psychopathology, as well as the potential prevention needs of families in high-risk contexts.

Treatment effectiveness of PMTO for children's behavior problems in Iceland: assessing parenting practices in a randomized controlled trial

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training - Oregon model (PMTO™), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre-post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.

Determinants of Change in Maternal Sensitivity: Contributions of Context, Temperament, and Developmental Risk

OBJECTIVE

Maternal sensitivity is a fundamental parenting construct and a determinant of positive child outcomes and healthy parent-child relationships. Few longitudinal studies have investigated determinants of sensitive parenting, particularly in a population of children at risk for developmental delay.

DESIGN

This study modeled trajectories of maternal sensitivity observed in two independent parenting contexts at child ages 3-, 4-, and 5-years. The sample included N = 247 mother-child dyads, with n = 110 children classified as at risk for developmental delays. Predictors included maternal distress, child anger proneness, and developmental risk status.

RESULTS

Maternal sensitivity changed during more demanding parenting tasks over the 3-year period but not during a low-demand task. Mothers of children with developmental risk, relative to mothers of typically developing children, and mothers of boys relative to mothers of girls, showed less sensitivity during more demanding parenting tasks.

CONCLUSIONS

Early developmental risk and child gender contribute to the nature of maternal sensitivity over time, but their contributions depend on the situational demands of the interaction. This contextualized view of sensitivity provides further evidence in support of parenting as a dynamic developmental process.