Relationships between Child Emotional and Behavioral Symptoms and Caregiver Strain and Parenting Stress

Development of the assessment for emotional and behavioral problems in school-aged children

BACKGROUND

Several assessments have been developed to assess school-aged children's emotional and behavioral problems (EBPs), but none based on the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision. This study aimed to develop the Assessment for Emotional and Behavioral Problems in School-aged children (AEBPS) fitting current knowledge of mental health disorders.

MATERIALS AND METHODS

This study included 2 phases. In Phase I, the assessment construct and its corresponding items were developed. In Phase II, the reliability and validity of the AEBPS were examined.

RESULTS

The AEBPS contains 120 items in five subscales. The psychometric results showed that the AEBPS subscales had high internal consistency (Cronbach's alpha = 0.83-0.97) and acceptable to good test-retest reliability (intra-class correlation coefficient = 0.65-0.93). The results of exploratory factor analysis showed that most items within each subscale of the AEBPS significantly contributed to their respective concepts. The AEBPS subscales had small to high correlations with the subscales of the Child Behavior Checklist (r = 0.37-0.87). The AEBPS had good discriminant validity to differentiate children with and without EBPs.

CONCLUSIONS

The newly-developed AEBPS fits the current knowledge of mental health diagnoses for assessing school-aged children's EBPs and has sound psychometric evidence. The AEBPS can be reliably and validly used in a variety of settings.

Telebehavioral Health for Caregivers of Children With Behavioral Health Needs to Address Caregiver Strain: Cohort Study

BACKGROUND

Behavioral health conditions among children have worsened over the past decade. Caregivers for children with behavioral health conditions are at risk for two types of caregiver strain: (1) an objective strain, that results directly from the child's condition and (2) subjective strain, that arises from the caregiver's feelings regarding these events.

OBJECTIVE

This study aimed to evaluate the impact of a technology-enabled pediatric and family behavioral health service on caregivers' strain among a commercially insured population. We also explore the common symptom clusters of caregiver strain to better understand the caregiver presentation to inform future care planning.

METHODS

We examined changes in caregiver strain using the Caregiver Strain Questionnaire-Short Form 7 over the course of their child's web-based behavioral health care between 2021 and 2023 using a pre-post study design. Common caregiver strain symptom clusters were identified using Ward hierarchical agglomerative clustering.

RESULTS

The majority of children were White 60.8% (1002/1647), female 53.6% (882/1647), and aged between 5 and 9 years (33.7%, 555/1647). Families fall broadly into 4 groups based on what drives caregiver strain the most, namely those experiencing (1) disrupted family relationships and time interruption, (2) missed work, (3) worried about their child's future and feeling tired and sad, and (4) financial strain. Caregiver strain, which was associated with the child's disease severity (P<.001), decreased significantly in all therapeutic groups.

CONCLUSIONS

Web-based family-oriented behavioral health care can improve caregiver strain and reduce family and time disruptions, missed work, and financial strain. Sources of caregiver strain vary and may be overlooked when relying on the conventional scoring of the Caregiver Strain Questionnaire-Short Form 7.

Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping

Parents of children with ADHD experience significantly more parenting stress in comparison to parents of typically developing children due to the emotional and behavioral difficulties related to ADHD. Additionally, approximately 30% of children with ADHD experience co-occurring anxiety. Parents of children with co-occurring anxiety and ADHD report increased stress due to role restriction and isolation compared to parents of children with ADHD alone. Poor emotional regulatory coping in children with ADHD has been linked to elevated negative affect and irritability, which also contributes to increased stress among parents. The present study examined the direct and indirect associations of child anxiety symptoms and emotional regulatory coping on elevated ADHD symptoms and parenting stress. Participants were 203 children aged 7-12-years-old and their parents. Parents completed a self-report measure of parenting stress and measures of their child's ADHD symptoms, anxiety, and emotional regulatory coping. Additionally, children completed self-report measures of emotional regulatory coping. Model testing indicated that the overall model demonstrated excellent fit to the data. Parameter testing supported an indirect effect of child ADHD symptoms on parenting stress through child anxiety symptoms and an indirect effect of child ADHD symptoms on parenting stress through child emotional regulatory coping. These results suggest that child anxiety and emotion dysregulation in children with ADHD have a negative impact on parental stress. The current study adds to the understanding of the important roles emotional regulatory coping and anxiety play in children with ADHD to contribute to increased parenting stress.

Dimensions of caregiver strain may partially mediate the relationship between youth symptomology and counseling utilization among Latinxs

Whether Latinx families use youth mental health services (MHS) depends on complex influences of barriers and facilitators within and outside of the home. This research sought to shed light on caregiver strain as part of the equation focused on parental identification and responses to youth mental health needs. We examined multiple dimensions of caregiver strain as potential mediators between youth mental health symptom severity and psychological counseling utilization. The present sample consisted of 598 Latinx caregivers to youths ages 6-18 who provided information on youth internalizing and externalizing problems, caregiver strain, and youth psychological counseling service utilization within the last year. Our findings suggest that youth symptom severity (internalizing and externalizing problems) was generally positively associated with dimensions of caregiver strain. Youth symptom severity through objective and subjective internalized strain pathways were associated with greater odds of youth MHS utilization. In contrast, youth symptom severity through subjective externalized strain reduced the odds that Latinx caregivers would report utilizing youth MHS. These models only partially mediated the relationship between youth problems and service use. Findings suggest that Latinx caregivers may navigate conflicting sources of strain related to their child's mental health problem severity in ways that may differentially impact the odds that they access youth MHS. Along with addressing structural and systemic barriers to care, utilization of psychological counseling services may also be improved through interventions that help Latinx caregivers view youth services as avenues for addressing caregiver strain and providing psychoeducation that frames externalized strain within a mental health lens.

Associations Among Autism Symptom Domains and Facets of Caregiver Strain

Parents of children with autism spectrum disorder (ASD) often experience elevated levels of caregiver strain (CGS). Few studies have examined the relationship between core ASD symptoms and each facet of CGS: objective, subjective internalized, and subjective externalized strain. The predictive effect of core and associated features of ASD on CGS facets were investigated, while also exploring the moderating effect of age. Atypical behaviors and behavior problems were the strongest predictors of all types of caregiver strain. For younger children, more repetitive behaviors predicted higher externalized strain, yet the opposite was true for parents of adolescents. Given that caregiver strain impacts parents' service utilization patterns, future research should focus on strategies to support parents in reducing caregiver strain.

Impact of the COVID-19 pandemic on perceived changes in responsibilities for adult caregivers who support children and youth in Ontario, Canada

BACKGROUND

The COVID-19 pandemic has created long-lasting changes in caregiving responsibilities, including but not limited to increased demands, loss of support, worsening mental and physical health, and increased financial worries. There is currently limited evidence regarding factors associated with perceived changes in caregiving responsibilities.

AIMS

This observational study aimed to investigate factors (sociodemographic characteristics of caregivers and mental health and/or addiction concerns of the caregiver and their youth) that predict perceived negative changes in caregiving responsibilities among adult caregivers (aged 18+ years) of children and youth (aged 0-25 years) in Ontario, Canada, during the COVID-19 pandemic.

METHOD

Data were collected from 1381 caregivers of children and youth between January and March of 2022 through a representative cross-sectional survey completed online. Logistic regression was conducted to determine predictors contributing to perceived negative changes in caregiving responsibilities.

RESULTS

Among the sociodemographic characteristics, only ethnicity significantly predicted outcome. Higher caregiver strain (odds ratio [OR] = 10.567, 95% CI = 6.614-16.882, P < 0.001), worsened personal mental health (OR = 1.945, 95% CI = 1.474-2.567, P < 0.001), a greater number of children/youth cared for per caregiver (OR = 1.368, 95% CI = 1.180-1.587, P < 0.001), dissatisfaction with the availability of social supports (OR = 1.768, 95% CI = 1.297-2.409, P < 0.001) and negative changes in mental well-being in at least one child/youth (OR = 2.277, 95% CI = 1.660-3.123, P < 0.001) predicted negative changes in caregiving responsibilities.

CONCLUSION

These results support further exploration of the implications of negative perceptions of caregiving responsibilities and what processes might be implemented to improve these perceptions and the outcomes.

Needs of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis

Objective

Access to wraparound care coordination within systems of care (SOC) is increasing nationwide for youth with emotional and behavioral disorders and their families. Though wraparound care coordination serves a broad population of youth who experience a variety of complex needs, less is known about the impact of wraparound services based on these specified needs. Using latent class analysis, the current study aimed to first identify classes of youth based on their presenting needs and then examine the impact of class membership on treatment experiences and outcomes at baseline and six-month follow-up.

Method

Caregiver-reported data from 1,243 youth enrolled in wraparound care coordination services within a statewide SOC were used. Latent class analysis was used to determine classes of youth needs and regression results examined whether baseline characteristics, child and family team meeting characteristics, mental health outcomes, and perceptions of care differed based on identified classes.

Results

Results revealed five distinct classes of youth needs: Behavioral Needs, ADHD-related Behavior Needs, Educational Needs, Mental Health Needs, and Multi-Needs. Overall participants saw improvement in all follow-up outcomes. Significant between-class differences were also found in all outcome categories measured.

Conclusion

The current results further solidify the benefits of comprehensive wraparound care within a SOC. Additionally, understanding youth's needs and their impact on treatment services allows for more targeted care for youth and their families.

Maternal hair cortisol predicts periodic and aperiodic infant frontal EEG activity longitudinally across infancy

Maternal stress is known to be an important factor in shaping child development, yet the complex pattern of associations between stress and infant brain development remains understudied. To better understand the nuanced relations between maternal stress and infant neurodevelopment, research investigating longitudinal relations between maternal chronic physiological stress and infant brain function is warranted. In this study, we leveraged longitudinal data to disentangle between- from within-person associations of maternal hair cortisol and frontal electroencephalography (EEG) power at three time points across infancy at 3, 9, and 15 months. We analyzed both aperiodic power spectral density (PSD) slope and traditional periodic frequency band activity. On the within-person level, maternal hair cortisol was associated with a flattening of frontal PSD slope and an increase in relative frontal beta. However, on the between-person level, higher maternal hair cortisol was associated with steeper frontal PSD slope, increased relative frontal theta, and decreased relative frontal beta. The within-person findings may reflect an adaptive neural response to relative shifts in maternal stress levels, while the between-person results demonstrate the potentially detrimental effects of chronically elevated maternal stress. This analysis offers a novel, quantitative insight into the relations between maternal physiological stress and infant cortical function.

X- vs. Y-Chromosome Influences on Human Behavior: A Deep Phenotypic Comparison of Psychopathology in XXY and XYY Syndromes

Do different genetic disorders impart different psychiatric risk profiles? This question has major implications for biological and translational aspects of psychiatry, but has been difficult to tackle given limited access to shared batteries of fine-grained clinical data across genetic disorders. Using a new suite of generalizable analytic approaches, we examine gold-standard diagnostic ratings, scores on 66 dimensional measures of psychopathology, and measures of cognition and functioning in two different sex chromosome aneuploidies (SCAs) - Klinefelter (XXY/KS) and XYY syndrome (n=102 and 64 vs. n=74 and 60 matched XY controls, total n=300). We focus on SCAs for their high collective prevalence, informativeness regarding differential X- vs. Y-chromosome effects, and potential relevance for normative sex differences. We show that XXY/KS elevates rates for most psychiatric diagnoses as previously reported for XYY, but disproportionately so for anxiety disorders. Fine-mapping across all 66 traits provides a detailed profile of psychopathology in XXY/KS which is strongly correlated with that of XYY (r=.75 across traits) and robust to ascertainment biases, but reveals: (i) a greater penetrance of XYY than KS/XXY for most traits except mood/anxiety problems, and (ii) a disproportionate impact of XYY vs. XXY/KS on social problems. XXY/KS and XXY showed a similar coupling of psychopathology with adaptive function and caregiver strain, but not IQ. This work provides new tools for deep-phenotypic comparisons of genetic disorders in psychiatry and uses these to detail unique and shared effects of the X- and Y-chromosome on human behavior.

Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis

Objective

Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up.

Method

Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined.

Results

Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up.

Conclusion

Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.

Parenting stress and children's trauma symptoms over the course of TF-CBT: Examining differences between relative and foster/adoptive caregivers

BACKGROUND

Through Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), the gold standard in children's trauma treatment, caregivers participate in sessions parallel to the child. However, much of the research examining the impact of this caregiver involvement has focused on biological or relative caregivers, despite the high prevalence of trauma and trauma symptoms among youth in foster care and high rates of parenting stress among foster/adoptive caregivers.

OBJECTIVE

The current study examined differences among relative and foster/adoptive caregivers' levels of parenting stress throughout the course of TF-CBT and how these differences were associated with child trauma symptoms throughout treatment.

PARTICIPANTS AND SETTING

Participants were 130 caregiver-child dyads (84 = foster/adoptive; 46 = biological/relative) who completed TF-CBT in either an academic-based clinic or an associated mental health agency. Providing clinicians were trained in TF-CBT, participated in case consultation, and received ongoing clinical supervision.

METHODS

Children and caregivers completed baseline measures prior to beginning treatment and termination measures at the completion of treatment.

RESULTS

Prior to treatment, foster/adoptive caregivers reported greater dysfunction in their parent-child interactions and relative caregivers reported greater personal stress. These differences were not seen at treatment termination, and significant reductions in child trauma symptoms and caregiver parenting stress were evidenced from pre to post treatment. Significant covariation between child trauma symptoms and relative caregiver parenting stress at termination was also found.

CONCLUSIONS

There were different profiles of parenting stress for relative versus foster/adoptive caregivers, but treatment completion attenuated group differences in parenting stress over the course of treatment.

Examining the influence of irritability and ADHD on domains of parenting stress

Parents of children with ADHD typically report higher levels of parenting stress than parents of typically developing children. Children with ADHD display developmentally inappropriate levels of hyperactivity, impulsivity, and inattention. Some children with ADHD are also prone to particularly high levels of tonic irritability that may explain some of the impairments typically found in ADHD. The present study sought to determine the unique impact of ADHD and tonic irritability on child-related parenting stress domains (e.g., difficult child, parent-child dysfunctional interactions). 145 mothers of children with and without ADHD aged 7-12 years participated in the current study. Mothers completed self-report measures of parenting stress as well as a diagnostic structured interview. Ecological momentary assessment (EMA) was used to assess tonic irritability in an ecological environment. Indirect effects models were specified using PROCESS Model 4. For the parent-child dysfunctional interaction domain, the data were best fit by a model specifying a significant total effect of ADHD that was fully accounted for by an indirect effect through irritability. For the difficult child domain, model testing indicated a significant total effect of ADHD that was partially accounted for by an indirect effect through irritability. The current study adds support to the growing body of literature acknowledging the role of tonic irritability in children with ADHD. Furthermore, the results provide novel insight in the complex relation of irritability, child ADHD, and domains of parenting stress.

Longitudinal Relationship between Children’s Emotion Dysregulation and Parent’s Negative Experience of the COVID-19 Lockdown in France

"Introduction: At the beginning of the COVID-19 pandemic, a lockdown was implemented in France, leading to profound changes in families’ life. Studies showed emotional and behavioral difficulties in children and adults during this period. However, few research has focused on the longitudinal interactions between children’s emotion regulation and parental emotional experience of the lockdown. Aim: This study aimed to examine the longitudinal bidirectional relationships between children’s emotion regulation and parental emotional experience of the lockdown. Method: One hundred and twenty parents of children aged 5 to 12 answered two online questionnaires, at the start of the first lockdown (Time 1), and one month later (Time 2). Emotional dysregulation in children and parental emotional experience of the lockdown were assessed. Results: The results of the autoregressive cross-lagged analyses revealed that children’s emotion regulation at Time 1 predicted lockdown-related parental emotional experience at Time 2, whereas lockdown-related parental emotional experience at Time 1 didn’t predict children’s emotion regulation at Time 2. Conclusion: This study suggested that parents of children with greater emotion regulation difficulties have had a worse emotional experience of the lockdown, without affecting the emotional regulation of children. Clinical implications and protective factors are discussed."

One Size Does Not Fit All: Discharge Teaching and Child Challenging Behaviors

This study compares quality of discharge teaching and care coordination for parents of children with challenging behaviors participating in a nursing implementation project, which used an interactive iPad application, to usual discharge care. Unlike parents in the larger quasi-experimental longitudinal project, parents of children with challenging behaviors receiving the discharge teaching application (n = 14) reported lower mean scores on the quality of discharge teaching scale-delivery subscale (M = 8.2, SD = 3.1) than parents receiving usual care (n = 11) (M = 9.6, SD = 4.7) and lower scores on the Care Transition Measure (M = 2.44, SD = 1.09) than parents receiving usual care (M = 3.02, SD = 0.37), with moderate to large effects (0.554-0.775). The discharge teaching approach was less effective with this subset, suggesting other approaches might be considered for this group of parents. Further study with a larger sample specific to parents of children with challenging behaviors is needed to assess their unique needs and to optimize their discharge experience.

Children aged 3-4 years were more likely to be given mobile devices for calming purposes if they had weaker overall executive functioning

AIM

Young children with weaker self-regulation use more digital media, but studies have been limited by parent-reported screen time measures. We examine associations between early childhood executive functioning and objective mobile device usage.

METHODS

The parents of 368 American children (51.6% male) aged 3-4 years of age completed standardised measures of executive functioning, parenting stress and household chaos. They provided mobile sampling data for 1 week in 2018-2019 and reported how often the children used mobile devices to calm themselves.

RESULTS

The children's mean age was about 3.8 years. A third of the children who were given devices to calm them down had weaker executive functioning in the overall and multivariable models, including working memory, planning and organisation. So did 39.7% of the children who used educational apps. Streaming videos, using age-inappropriate apps and using the mobile device for more than1 h per day were not associated with executive functioning levels. Parenting stress and household chaos did not moderate the associations.

CONCLUSION

This study confirms previous studies that suggesting that children with weaker overall executive functioning used devices more for calming purposes. It also raises questions about whether children with weaker executive functioning should use educational apps.

Mindfulness, Parental Attributions, and Parenting: the Moderating Role of Child Mental Health

Objectives

Research interest in mindfulness, the capacity for present-oriented, nonjudgmental attention and awareness, and its relation to parenting has been growing in recent years. However, factors facilitating the association between mindfulness and parenting are not yet well understood. In the present study, we examined whether parents’ biased causal thinking about children’s misbehaviors, i.e., parental attributions, may mediate the link between parents’ dispositional mindfulness and parenting. Given that parents of children with clinically elevated mental health difficulties tend to report more biased parental attributions, we further examined whether the proposed mediation may differ across parents of children with and without clinical diagnoses or referrals for mental health difficulties.

Methods

Parents (59.8% mothers) of 8- to 12-year-old children with (n = 157) and without (n = 99) clinical diagnoses or referrals for mental health difficulties participated in online surveys assessing their mindfulness, parental attributions, and negative parenting behaviors.

Results

More mindful parents reported less negative parenting, with the link significantly mediated by less biased parent-directed attributions, but not child-directed attributions. The mediating effect via parent-directed attributions was significantly moderated by the child’s clinical status: the effect was retained only for parents of children with clinical diagnoses or referrals for mental health difficulties. No significant moderation effect emerged for child-directed attributions.

Conclusions

The results provide initial support for the links among parents’ mindfulness, parental attributions, and parenting. The present findings suggest that parental mindfulness may be important for less biased parental attributions, with implications for parenting behaviors at least in the context of children’s mental health disorders.

Caregiver's Perspectives on the Healthcare Experiences of Children With Behaviour-Related Disorders

Objective: Social Pediatrics focuses on targeting and mitigating the effects of the social determinants of health on a child’s well-being and development. Negative health outcomes have been seen in children who have faced poverty, food insecurity, inadequate housing, and traumatic events. In particular, children who come from socioeconomically disadvantaged households are more likely to develop behavioural problems. The purpose of this study is to explore the experiences of caregivers for children with a behaviour-related disorder. This includes children affected by attention, academic, and social issues (e.g. attention-deficit hyperactivity disorder, autism spectrum disorder). This study will aim to understand the strengths, barriers, and social limitations to accessing and receiving care for children with behavioural disorders. 

Methods: A qualitative descriptive design was used to conduct three focus groups. Of the 64 caregivers contacted, a total of 13 participants agreed to be in the study. All focus groups were analyzed using inductive thematic analysis. 

Results: Preliminary findings suggest that caregivers value pediatricians who spend time, communicate, and make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge regarding services and programs available in their area. Three major themes emerged from this study including (1) timeliness to care, (2) advocacy, and (3) relationship building.

Conclusion: Findings suggested that caregivers valued pediatricians who spend time to make a human connection with their patients. Barriers included physician turnover, long wait times for referrals, and a lack of knowledge of available services. Caregivers who were young mothers felt an added layer of judgement when accessing the necessary care for their children. This study is important as it contributes to our knowledge on the role Social Pediatrics can play in the care of children with behaviour-related disorders. 

The longitudinal relationship between child emotional disorder and parental mental health in the British Child and Adolescent Mental Health surveys 1999 and 2004

BACKGROUND

Research suggests parental psychopathology has an adverse effect on child mental health. However, due to the interactional nature of parent-child relationships and with a high rate of emotional disorders reported in school-age children, it is important to know whether the effect is reciprocal.

METHODS

We explored the longitudinal relationship between child and parent mental health in the British Child and Adolescent Mental Health Surveys (N=7,100 child-parent dyads) and their three-year follow-ups. The Development and Well-Being Assessment with DSM-IV diagnostic criteria was used to measure child psychiatric diagnoses, while parental mental health was assessed using the General Health Questionnaire. Multivariable logistic regression was used to explore the longitudinal association between child emotional disorder and parent mental health.

RESULTS

Parents of children who had an emotional disorder at baseline were more likely to have poor mental health three years later compared with parents whose children had no psychiatric diagnosis (33.3% versus 16.7%; crude odds ratio=2.52; adjusted odds ratio=2.19, 95% CI=1.58 to 3.05, p<0.001). Children of parents with poor mental health at baseline were more likely to develop an emotional disorder three years later compared with children whose parents had good mental health (5.2% versus 2.5%; crude odds ratio=2.08; adjusted odds ratio=1.63, 95% CI=1.18 to 2.25, p=0.003).

LIMITATIONS

The findings of this research are limited by the survey data collected, the measures used and survey dropout.

CONCLUSIONS

We detected a bi-directional relationship between child and parent mental health, suggesting that effective intervention for one individual may benefit other family members.

Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11): A Validation Study

Caregiver strain is associated with caregiver and child well-being and clinical outcomes. The present study examined the psychometric properties of a revised 11-item measure of caregiver strain, the Caregiver Strain Questionnaire-Short Form 11 (CGSQ-SF11). In a sample of 962 caregivers, we found support for a three-factor model of the CGSQ-SF11, consisting of objective (e.g., financial impact), subjective internalized (e.g., sadness about the child's problems), and subjective externalized (e.g., anger directed toward the child) strain factors. Measurement invariance was supported across multiple demographic and clinical groups, and all three subscales displayed high internal consistency. Convergent validity was also supported through positive correlations with measures of child psychopathology symptoms and psychosocial impairment. Moreover, caregiver strain was associated with number of child disorders as well as breadth of child symptoms across both internalizing and externalizing domains. Findings provide initial validation of the CGSQ-SF11 as a comprehensive yet brief measure of caregiver strain.

Maternal Distress/Coping and Children's Adaptive Behaviors During the COVID-19 Lockdown: Mediation Through Children's Emotional Experience

The present study focused on the psychological impact that the lockdown due to coronavirus disease-19 (COVID-19) had on families in Italy. During the COVID-19 pandemic, the Italian government imposed a strict lockdown for all citizens. People were forced to stay at home, and the length of the lockdown was uncertain. Previous studies analyzed the impact of social distance measures on individuals' mental health, whereas few studies have examined the interplay between the adults' functioning, as parents, during this period and the association with the child's adjustment. The present study tested if maternal distress/coping predicts children's behaviors during the COVID-19 lockdown, hypothesizing a mediation effect via children's emotional experience. Participants were 144 mothers (M age = 39.3, 25-52, SD = 5.6) with children aged 5-10 years (M age = 7.54, SD = 1.6, 82 boys); mothers answered to an online survey. Results indicated that mothers with higher exposure to COVID-19 showed higher levels of distress and higher display of coping attitudes, even if in the structural equation modeling model, the COVID-19 exposure was not a predictor of mothers' distress. Compared with mothers with good coping skills, mothers with higher stress levels were more likely to attribute negative emotions to their children at the expense of their positive emotions. Moreover, children's emotions acted as mediators between maternal distress/coping and children's adaptive/maladaptive behaviors. In conclusion, it is important to support parents during pandemic emergence, by providing them with adequate information to manage the relationship with their children, to reduce their level of distress and to enhance their coping abilities.

Online parent programs for children's behavioral problems: a meta-analytic review

A recent increase in the development of online parent programs calls for the need to understand how effective these strategies are for improving children's mental health. We meta-analyzed the effects of online parent programs on children's behavioral problems. Moreover, we explored the combinations of program components to yield stronger program effects. Medline, PsycINFO, Web of Science, and the Cochrane Library were searched. We included peer-reviewed randomized studies evaluating the effect of an online parent program. Effect sizes (Hedges' g) were calculated from post intervention means and standard deviations. We used Qualitative Comparative Analysis (QCA) to identify pathways to effectiveness and individual content and delivery components that seem sufficient or necessary for yielding high effectiveness. Of 2941 articles, 12 articles with a total of 2025 participants met the inclusion criteria. Online parent programs have significant effects on children's behavioral problems (g =   - 0.32; 95% CI, - 0.47 to - 0.17), emotional problems (g =  - 0.22; 95% CI, - 0.31 to - 0.13), and parental mental health problems (g =  - 0.30; 95% CI, - 0.42 to - 0.17). In the QCA, sending parents reminders to work on the program was the only one sufficient component. In conclusion, online support programs reduce children's behavioral and emotional problems and improve parental mental health. Sending parents reminders to work on the program seems to contribute to high effectiveness. Review Registration This study was registered with PROSPERO, number CRD42017080051.

Conflict Resolution and Emotional Expression in Mother-Preadolescent Dyads: Longitudinal Associations with Children's Socioemotional Development

How youth learn to manage emotions during mother-child conflict influences their socioemotional development. Ninety-four mother-preadolescent (aged 9-13, 57.4% female) dyads were observed during conflict discussions and completed questionnaire measures at one prior time-point (Time 1; ages 6-10) and one subsequent time-point (Time 3; ages 11-16) to the observations (Time 2). The temporal associations between individuals' emotional expressions and their own and their partners' verbal conflict behaviors were observed. Mothers and preadolescents were more attacking and assertive when angry, and more conciliatory and avoidant when sad. Neutral affect predicted the most constructive behaviors, while positive affect promoted avoidance. The responses were similar following their partners' emotions. Maternal conflict-escalating responses to anger were associated with difficult characteristics in earlier childhood and socioemotional difficulties in adolescence. Maternal and child de-escalation following sadness predicted socioemotional adjustment in adolescence. These results demonstrate that conflict resolution between preadolescents and their mothers is influenced by the emotional climate of the interaction, and that the management of negative emotions within the dyad is tied to youth's socioemotional development.

Clinical Demonstration of the Potential of Parental Feedback in Reducing Deterioration During Group Psychotherapy With Children

In recent years, great efforts have been exerted to minimize the rates of deterioration in clinical practice, especially in child psychotherapy. The present study explored the potential effect of routine outcome monitoring (ROM) with parents as a preventive intervention to reduce deterioration in children. Twenty-five children receiving treatment for emotional problems were randomized to parent-based, ROM-assisted group psychotherapy or to treatment as usual (TAU). A mixed-methods approach was utilized, with the number of deteriorating cases compared at the group level and two case illustrations assessed at the individual level. At the group level, there were fewer cases of deterioration in child's anxiety, parental stress, and quality of parent's alliance in the ROM-assisted group, compared with TAU. Case studies illustrated how ROM can be used as a tool to communicate with parents to prevent deterioration. Routine outcome monitoring in child psychotherapy may thus benefit therapy process and outcome. Limitations and directions for future research are discussed.

Parenthood and Well-Being: A Decade in Review

Understanding social aspects of parental well-being is vital, because parents' welfare has implications not only for parents themselves but also for child development, fertility, and the overall health of a society. This article provides a critical review of scholarship on parenthood and well-being in advanced economies published from 2010 to 2019. It focuses on the role of social, economic, cultural, and institutional contexts of parenting in influencing adult well-being. We identify major themes, achievements, and challenges and organize the review around the demands-rewards perspective and two theoretical frameworks: the stress process model and life course perspectives. The analysis shows that rising economic insecurities and inequalities and a diffusion of intensive parenting ideology were major social contexts of parenting in the 2010s. Scholarship linking parenting contexts and parental well-being illuminated how stressors related to providing and caring for children could unjustly burden some parents, especially mothers, those with fewer socioeconomic resources, and those with marginalized statuses. In that vein, researchers continued to emphasize how stressors diverged by parents' socioeconomic status, gender, and partnership status, with new attention to strains experienced by racial/ethnic minority, immigrant, and LGBTQ parents. Scholars' comparisons of parents' positions in various countries expanded, enhancing knowledge regarding specific policy supports that allow parents to thrive. Articulating future research within a stress process model framework, we showed vibrant theoretical pathways, including conceptualizing potential parental social supports at multiple levels, attending to the intersection of multiple social locations of parents, and renewing attention to local contextual factors and parenting life stages.

Problem behavior in young children referred with language difficulties: Relations to language and intentional communication

BACKGROUND AND AIMS

This exploratory study aims to examine the relative contribution of language and intentional communication to internalizing and externalizing problem behavior.

METHODS

Twenty-nine Dutch-speaking children (age range 24-46 months) referred with language difficulties participated in this study. For the majority of children, these early language difficulties appeared to be part of a broader neurodevelopmental disorder, mainly autism spectrum disorder. Parent ratings on the Achenbach Child Behavior Checklist 1½-5 were predicted from children's language level and intentional communicative abilities, the latter being assessed by both parent report and direct observation. In all series of hierarchical regression analyses, chronological age and nonverbal mental age were included as covariates.

RESULTS

Parents commonly reported withdrawal, emotionally reactive behavior, attention problems, and aggressive behavior. Parent-rated intentional communication was the most important predictor of internalizing problem behavior and played an important role in the prediction of aggressive behavior as well. However, chronological age and/or nonverbal mental age also predicted parent-rated levels of externalizing problem behavior, especially attention problems.

CONCLUSIONS

The relation between language difficulties and problem behavior may be influenced by maturation and children's ability to communicate intentionally.Implications: Language proficiency should, therefore, be independently assessed from children's intentional communicative abilities which, in turn, may differ across contexts.

Finding confidence and inner trust as a parent: experiences of group-based compassion-focused therapy for the parents of adolescents with mental health problems

Purpose: Compassion-focused therapy (CFT) can alleviate the stress and challenges faced by the parents of adolescents with mental health (MH) problems. Although CFT interventions have shown promising results, few studies have examined its effectiveness in adolescent psychiatric settings. Therefore, this study examined the participant experiences of group-based CFT for the parents of adolescents with MH problems.Methods: The reflective lifeworld research (RLR) approach was used to conduct in-depth interviews with eleven parents, focusing on participant experiences of group-based CFT. Meaning-oriented data analysis was undertaken.Results: The essential meaning of the phenomenon of participating in group-based CFT was understood as finding confidence and inner trust as a parent, characterized by an understanding of one's own needs, which provided parents with the confidence to support their children. The phenomenon is further explicated with its three constituents: (a) taking care of oneself and one's child; (b) being open and sharing experiences; and (c) acceptance and hope for the future.Conclusions: The CFT intervention enabled parents to find their agency and strengthened their relationships with their children. The findings underscore the need to acknowledge the supportive role parents play in the recovery of children who receive psychiatric care.

Pain is a family matter: Quality of life in mothers and fathers of youth with chronic pain

BACKGROUND

Most research on family impacts of paediatric chronic pain has been conducted with mothers, and therefore, little is known about fathers' adjustment. However, it is well established that caring for a child with chronic pain takes a toll on caregiver well-being. Parents of children with chronic pain have been found to experience high levels of anxiety, depression, and parenting stress. As such, the goal of this study was to examine differences between mothers and fathers of youth with chronic pain, explore interaction effects between parent gender and child variables, and compare parents' scores to national norms.

METHODS

Participants included 160 matched mothers and fathers of youth with chronic pain participating in an interdisciplinary pain rehabilitation programme. At admission, parents completed the Center for Epidemiological Studies-Depression scale and SF-36 to assess depression and health-related quality of life. T tests and analysis of variance were used to explore differences between mothers and fathers and population norms.

RESULTS

Mothers reported experiencing significantly poorer functioning than did fathers in the domains of emotional role interference, social functioning, and vitality. Differences remained significant when controlling for other psychosocial variables using multiple regression. Child gender and depression level were found to be significant predictors of parent mental health, with mothers' mental health more negatively influenced by child depression. Additionally, mothers' scores in mental health domains were significantly lower than population norms.

CONCLUSIONS

These findings highlight the importance of identifying the ways in which chronic pain in youth may affect parents differently in order to enhance caregiver support and interventions.

Predictors of foster parents' stress and associations to sensitivity in the first year after placement

In Germany, almost 70 000 children are living in foster families (Statistisches Bundesamt, 2016). Many foster children show mental health problems as they were exposed to an accumulation of risk factors. Hence, foster parents are often faced with challenging parenting situations. The current study focuses on the predictors of foster parents' stress and examines longitudinally whether parenting stress is associated with foster parents' sensitivity. The sample consisted of 55 children (aged from 1 to 6 years) and their foster caregivers. Foster parents' sensitivity was observed during home visits. Caregiver reports were used to assess parenting stress (Parenting Stress Index) as well as foster children's externalizing behavior problems (Child Behavior Checklist). For main caregivers' stress at the beginning of placement, regression analyses revealed both, foster children's externalizing problems as well as partners' stress as predictive. For main caregivers' stress one year after, only initial parenting stress and partners' stress were predictive. Foster parents' sensitivity was correlated with their parenting stress one year after placement. Regression analyses revealed no longitudinal effects of initial parenting stress on overall sensitivity. However, supportive presence was predicted by initial supportive presence and by the interaction between parenting stress and children's externalizing problems at placement. The findings highlight the role of the partner in experiencing parenting stress when taking care of a foster child. Furthermore, they emphasize that foster parents who care for children with behavior problems need adequate support that can buffer initial parenting stress and thereby promote sensitive caregiving.

Learning About Parenting Together: A Programme to Support Parents with Inter-generational Concerns in Pune, India

Rapid developments in the last few decades have brought about dramatic changes in Indian social life, particularly affecting new middle-class families. Inter-generational conflicts, high academic pressures, and modern anxieties lead to stress both in parents and in children. There is a need for parenting programmes that respond to these specific concerns, in order to reduce parenting stress and improve family well-being. This study aimed to develop and evaluate a parenting programme in Pune, India, based on a ‘theory of change’. In this pilot programme, parents were encouraged to learn in a group format about fostering autonomy in children, promoting academic potential in a stress-free manner and remaining in connection with adolescents. Facilitated by a psychologist, parents participated in four sessions involving ‘creativity and play’, ‘self-awareness and bonding’, and ‘communication’. The intervention was based on validated psychotherapeutic approaches and parenting methods to support parents in their learning. Some 16 in-depth interviews were conducted with parents before and eight interviews after the intervention to understand their learning experiences. Additional feedback was gathered from observation notes and debriefings after each session. The results show that the attention for playful quality time helped parents to (re)gain a more creative and flexible attitude towards spending time with their children. Second, parents learned to reflect on their frameworks of meaning (rooted in their own upbringing), listen attentively and communicate more mindful with their children. Furthermore, this study shows that an activity-based approach, connecting parents in co-creating new parenting paradigms, while supporting them with stress-reducing tools, is a useful way of engaging this target group. The study concludes by offering new perspectives for counsellors working with families in countries undergoing rapid change.

Are Anxiety Disorders in Children and Adolescents Less Impairing Than ADHD and Autism Spectrum Disorders? Associations with Child Quality of Life and Parental Stress and Psychopathology

We compared clinically referred children with anxiety disorders (AD; n = 63) to children with autism spectrum disorder (ASD; n = 39), ADHD Combined (ADHD-C; n = 62), ADHD Predominantly Inattentive (ADHD-I; n = 64), and typically developing children (n = 42) on child quality of life (QOL), paternal and maternal psychopathology and parental stress. Diagnoses were based on DSM-IV-TR criteria. Multilevel analyses showed that QOL in AD was higher on school and social functioning, compared to respectively ADHD and ASD, and lower compared to normal controls on all five domains. Fathers reported their AD children higher QOL than mothers. Also, AD appeared to be associated with less parental stress and parental psychopathology than other child psychopathology. Therefore, parental factors may need to be considered more in treatment of children with ADHD/ASD than AD.

Impact of Psychosocial Environment on Young Children's Emotional and Behavioral Difficulties

Objective: The impact of maternal psychosocial stress on young children’s mental difficulties is unclear. This study investigated the joint effects of the socioeconomic status and parent-child relationships on emotional and behavioral difficulties in preschool children. Methods: The case-control study included 1416 mothers and their 4–6 year-old children pairs, living in Kaunas city, Lithuania. The parent-child relationships were measured using the Parent-Child Dysfunctional Interaction subscale. Children’s mental health difficulties were assessed by the Strengths and Difficulties Questionnaire. We used logistic regression models to indicate the strength of the associations. Results: Lower socioeconomic status women more often than higher ones reported pathological mother-child relations. Low education level was associated with statistically significant increase adjusted odds ratios for emotional symptoms and total behavioral difficulties. With reference to the group of better-educated mothers and normal mother-child relations, low education and pathological mother-child relations statistically significantly increased the risk of total difficulties in 4–6 year-old children; the adjusted odds ratios were 2.45; 95% CI 1.51–3.99. Conclusions: Pathological mother-child relations strengthened the effect of lower education on the increased risk of emotional and behavioral difficulties in preschool-age children. Measures oriented towards health behavior and psychosocial difficulties management may decrease children’s emotional and behavioral difficulties.

Assessment of Caregiver Inventory for Rett Syndrome

Rett syndrome (RTT) requires total caregiver attention and leads to potential difficulties throughout life. The Caregiver Burden Inventory, designed for Alzheimer disease, was modified to a RTT Caregiver Inventory Assessment (RTT CIA). Reliability and face, construct, and concurrent validity were assessed in caregivers of individuals with RTT. Chi square or Fisher's exact test for categorical variables and t tests or Wilcoxon two-sample tests for continuous variables were utilized. Survey completed by 198 caregivers; 70 caregivers completed follow-up assessment. Exploratory factor analysis revealed good agreement for physical burden, emotional burden, and social burden. Internal reliability was high (Cronbach's alpha 0.898). RTT CIA represents a reliable and valid measure, providing a needed metric of caregiver burden in this disorder.

The Simultaneous Effects of Socioeconomic Disadvantage and Child Health on Children's Cognitive Development

Family socioeconomic status (SES) and child health are so strongly related that scholars have speculated child health to be an important pathway through which a cycle of poverty is reproduced across generations. Despite increasing recognition that SES and health work reciprocally and dynamically over the life course to produce inequality, research has yet to address how these two pathways simultaneously shape children's development. Using longitudinal data from the Fragile Families and Child Wellbeing Study and marginal structural models, we ask three questions: (1) how does the reciprocal relationship between socioeconomic disadvantage and child health affect estimates of each circumstance on children's cognitive development?; (2) how do their respective effects vary with age?; and (3) do family SES and child health have differential effects on cognitive development across population subgroups? The results show that the negative effects of socioeconomic disadvantage and poor health are insensitive to their reciprocal relationships over time. We find divergent effects of socioeconomic disadvantage and poor health on children's cognitive trajectories, with a widening pattern for family SES effects and a leveling-off pattern for child health effects. Finally, the effects of socioeconomic disadvantage are similar across all racial/ethnic groups, while the effects of child health are largely driven by white children. We discuss theoretical and policy implications of these findings for future research.

Caring for the Caregiver: Supporting Families of Youth With Special Health Care Needs

Caregivers of youth with special health care needs (YSHCN) are a critical part of the health care team. It is important for pediatric providers to be cognizant of the burden and strain caregiving can create. This article will discuss the health, psychological, social, and financial effects of caregiving, as well as strategies to screen for caregiver strain among families of YSHCN. Caregivers of YSHCN, for example, are more likely to report poor health status and demonstrate higher rates of depression and anxiety. Numerous validated screens for caregiver strain have been developed to address the multi-faceted effects of caregiving. Finally, we will discuss strategies to alleviate caregiver strain among this vulnerable population. We will describe services pediatric providers can encourage caregivers to utilize, including financial support through Supplemental Security Income (SSI), benefits available through the Family Medical Leave Act (FMLA), and options for respite care. Addressing caregiver strain is an important aspect of maintaining a family centered approach to the care of YSHCN.

Long-Term Effects of Pre-Placement Risk Factors on Children's Psychological Symptoms and Parenting Stress Among Families Adopting Children From Foster Care

This exploratory longitudinal study examined behavioral outcomes and parenting stress among families with children adopted from foster care, taking into account environmental and biological risk factors. Child internalizing and externalizing problems and parenting stress were assessed in 82 adopted children and their families at 2 months post-placement, 12 months post-placement, and then yearly until 5 years post-placement. A history of abuse/neglect predicted significantly higher externalizing and internalizing problems at a borderline level of statistical significance. In the initial stages after placement, externalizing problems were significantly higher among children who were 4 years or older at placement versus those who were younger than 4, although differences were no longer significant 5 years post-placement. Statistical trends in parenting stress reflected reduced stress in the first 12 months followed by a plateau for parents who adopted older children and greater stress for parents who adopted younger children. Familiar limitations for observational cohort data apply. Nonetheless, the availability of longitudinal follow-up on a sizable sample of children adopted from foster care adds insight to the psychological dynamics for adoptive families and suggests that families of children adopted from the foster care system may have unique needs for ongoing support around behavioral issues.

Parenting Stress Among Caregivers of Children With Bipolar Spectrum Disorders

Caregivers of psychiatrically impaired children experience considerable parenting stress. However, no research has evaluated parenting stress within the context of pediatric bipolar spectrum disorders (BPSD). Thus, the aim of this investigation was to identify predictors and moderators of stress among caregivers in the Longitudinal Assessment of Manic Symptoms study. Participants included 640 children and their caregivers in the Longitudinal Assessment of Manic Symptoms cohort. Children had a mean age of 9.4 ± 1.9 years (68% male, 23% BPSD); parents had a mean age of 36.5 ± 8.3 years (84% mothers). Children with BPSD had more service utilization, psychiatric diagnoses, mood and anxiety symptoms, and functional impairment but fewer disruptive behavior disorders. Caregivers of children with BPSD were more likely than caregivers of children without BPSD to have a partner, elevated depressive symptoms, antisocial tendencies, and parenting stress (Cohen's d = .49). For the whole sample, higher child IQ, mania, anxiety, disruptive behavior, and caregiver depression predicted increased parenting stress; maternal conduct disorder predicted lower stress. Child anxiety and disruptive behavior were associated with elevated caregiver stress only for non-BPSD children. Caregivers of children with BPSD experience significant burden and thus require specialized, family-focused interventions. As stress was also elevated, to a lesser degree, among depressed caregivers of children with higher IQ, mania, anxiety, and disruptive behavior, these families may need additional supports as well. Although parents with conduct/antisocial problems evidenced lower stress, these difficulties should be monitored. Thus, parenting stress should be evaluated and addressed in the treatment of childhood mental health problems, especially BPSD.

Caregiving for youth with co-occurring developmental disabilities and behavioral health issues when caregivers face additional health-related stressors: Analysis of risk and protective factors from a national sample

BACKGROUND

Family caregivers of youth with DD and behavioral health issues experience the highest level of caregiving strain. Many must also deal with their own or another family member's chronic health condition, which may place them at additional risk for poor outcomes.

AIMS

(1) Provide a "snapshot" of DD family caregivers based on a national sample; (2) identify risk and protective factors among groups of DD caregivers with graduated levels of health-related stressors; (3) examine the impact of risk and protective factors on strain for DD caregivers.

METHODS AND PROCEDURES

We conducted a secondary analysis of data from N=600 DD caregivers recruited through sites across the United States. Risk and protective factors were compared among three groups of caregivers at study enrollment: (1) those focused on providing care for the target youth with DD, without additional health-related stressors with which to contend; (2) those contending with minor additional health-related stressors; and, (3) those contending with major additional health-related stressors. Predictors of caregiving strain at six months post-enrollment were identified.

RESULTS

52% of the overall sample was unemployed and 71% were living at or below poverty. Differences were found among groups on a variety of risk and protective factors. With some exceptions, predictors of caregiving strain were similar to non-DD populations.

CONCLUSIONS AND IMPLICATIONS

This study provides valuable information about a population of caregivers who are highly vulnerable to poor outcomes. Findings highlight the importance of considering the needs, strengths, and outcomes of family caregivers.

Factor Analysis of Therapist-Identified Treatment Targets in Community-Based Children's Mental Health

The present study used exploratory and confirmatory factor analyses to identify underlying latent factors affecting variation in community therapists' endorsement of treatment targets. As part of a statewide practice management program, therapist completed monthly reports of treatment targets (up to 10 per month) for a sample of youth (n = 790) receiving intensive in-home therapy. Nearly 75 % of youth were diagnosed with multiple co-occurring disorders. Five factors emerged: Disinhibition, Societal Rules Evasion, Social Engagement Deficits, Emotional Distress, and Management of Biodevelopmental Outcomes. Using logistic regression, primary diagnosis predicted therapist selection of Disinhibition and Emotional Distress targets. Client age predicted endorsement of Societal Rules Evasion targets. Practice-to-research implications are discussed.

Late preterm birth is a strong predictor of maternal stress later in life: Retrospective cohort study in school-aged children

AIM

The aim of this study was to compare the level of stress in mothers of school-aged children born late preterm and admitted to the intensive care unit (ICU) with the level of maternal stress if a child was born late preterm and not admitted to the ICU as well as if a full-term child was admitted to the ICU.

METHODS

In this retrospective cohort study the data were gathered via telephone interview with mothers. The Parenting Stress Index/Short Form was used to determine the level of stress in mothers. Background demographic characteristics, medically relevant variables, and the level of stress were tested using the chi-square test and Kruskal-Wallis test. Logistic regression was used in order to identify predictors of significant level of stress.

RESULTS

Mothers of late preterm born children who were admitted to the ICU, as well as mothers of late preterm children who were not admitted had higher level of stress compared to mothers of full-term children. Namely, mothers of late preterm born children admitted to the ICU had 18-fold increase in risk for significant level of total stress (OR = 18.09; 95% CI 8.55 to 38.26) while 24-fold greater risk was observed in mothers of late preterm children who were not admitted to the ICU (OR = 24.05; 95% CI 10.66 to 54.26) in comparison to mothers of full-term born children.

CONCLUSION

Results indicate that preterm birth and its complications are associated with a higher level of stress in mothers, that persists to school age.

The interplay between child and maternal health: reciprocal relationships and cumulative disadvantage during childhood and adolescence

While many studies use parental socioeconomic status and health to predict children's health, this study examines the interplay over time between child and maternal health across childhood and adolescence. Using data from women in the National Longitudinal Study of Youth 1979 cohort and their children (N = 2,225), autoregressive cross-lagged models demonstrate a reciprocal relationship between child activity limitations and maternal health limitations in direct effects of child activity limitations on maternal health limitations two years later and vice versa-net of a range of health-relevant time-varying and time-invariant covariates. Furthermore, there are indirect effects of child activity limitations on subsequent maternal health limitations and indirect effects of maternal health limitations on subsequent child activity limitations via intervening health statuses. This study examines how the interplay between child and maternal health unfolds over time and describes how these interdependent statuses jointly experience health disadvantages.