Parenting stress and child behavior problems: a transactional relationship across time

The relationship between children's food allergies and family mealtimes: A systematic review

Food allergy prevalence is increasing among children; however, it is not clear how children's food allergy status impacts family mealtimes. This study's purpose was to systematically synthesize research regarding the relationship between children's food allergies, parental meal-centered stress, and family mealtime dynamics. Data sources for this study include peer-reviewed, English language sources from CINAHL, MEDLINE, APA PsycInfo, Web of Science, and Google Scholar. Five keyword categories (child, food allergies, meal preparation, stress, and family) were utilized to identify sources regarding how food allergies of children (from birth-12 years) relate to family mealtime dynamics or parental meal-centered stress. All 13 identified studies determined that pediatric food allergies relate to either increased parental stress, meal preparation issues, mealtime problems, or changes to family meals. Studies also indicate that meal preparation takes longer, requires more vigilance, and is more stressful due to children's food allergies. Limitations include that most studies were cross-sectional and based on maternal self-report. Children's food allergies are associated with parental meal-centered stress and mealtime issues. However, there is a need for research to account for specific changes to family mealtime dynamics and parent feeding behaviors so that pediatric health care professionals can alleviate parental meal-centered stress and provide guidance towards optimal feeding behaviors.

Neighborhood collective efficacy reduces child maltreatment through decreasing parenting stress: A longitudinal path model

BACKGROUND

Neighborhoods and families are crucial contexts for child maltreatment, yet research into mechanisms of neighborhood effects on child maltreatment remains limited.

OBJECTIVE

This study examined longitudinal associations between neighborhood collective efficacy, maternal parenting stress, and child maltreatment.

PARTICIPANTS AND SETTING

The study drew data from the Future of Families and Child Wellbeing Study (FFCWS). Participants included 2890 mothers who were interviewed when their children were born and at ages 3, 5, 9, and 15.

METHODS

A longitudinal path model was utilized to analyze direct and indirect effects of neighborhood collective efficacy on child maltreatment via parenting stress.

RESULTS

Neighborhood collective efficacy and parenting stress demonstrated temporal stability over time (ages 3 to 15). Child maltreatment had carry-over effects during childhood (ages 3 to 9) but not into adolescence (age 15). Higher parenting stress in earlier years was associated with increased child maltreatment in childhood (ages 3 to 9), but not in adolescence (age 15). Neighborhood collective efficacy was associated with reduced parenting stress over time. In early childhood (ages 3 to 9), neighborhood collective efficacy protected against child maltreatment through larger direct effects than indirect effects via reduced parenting stress. In later years (ages 5 to 15), however, neighborhood collective efficacy had neither direct nor indirect effects on childhood maltreatment.

CONCLUSIONS

Findings highlight early, targeted prevention and intervention strategies for child maltreatment. Programs aimed at reducing parenting stress, increasing community-based child protection practices, and strengthening neighborhood closeness could mitigate child maltreatment.

Parent-infant interaction in the context of emerging neurodiversities: Neurofibromatosis 1 and elevated likelihood of ADHD

Neurofibromatosis 1 (NF1) and attention-deficit hyperactivity disorder (ADHD) are distinct conditions with similarities in developmental course. Research suggests that neurodivergent processes in both conditions begin in the first year, altering infant behaviour and how parents respond, over time reducing social-communicative opportunities for social brain development. This study aimed to investigate parent-infant interactions in both groups relative to typically developing infants (TD) at 10 and 14 months. We hypothesised that the infants with NF1 and infants at elevated likelihood of ADHD (EL-ADHD) would show less attentiveness to their parent and less mutual parent-infant interaction relative to TD controls, that attentiveness-to-parent would be particularly low in infants with NF1, and that liveliness and negative affect would be higher in infants with EL-ADHD. Parents and their infants with NF1, EL-ADHD and TD were videotaped during free play interactions and coded using validated rating scales. The two non-TD groups differed in their interactive patterns from the TD group and each other in ways somewhat consistent with the early behaviours that characterise each group. The NF1 group showed relatively less mutual interactions than the EL-ADHD group, and less parental sensitive responsiveness and parental directiveness than the TD group, while EL-ADHD infants were livelier and showed less negative affect relative to the other groups. Most main effects persisted over time. While longer-term follow-up in larger samples is needed, our findings highlight how children with neurodevelopmental conditions that are not primarily characterised by social communication difficulties may nonetheless come to have distinct social experiences in the first year of life.

Surviving the storm: exploring gender-based burnout in Lebanon during the COVID-19 pandemic

Background

COVID-19 has worsened burnout, marked by exhaustion, cynicism, and reduced professional efficacy. In Lebanon, economic collapse, political instability, the Beirut Port explosion, and social unrest have compounded this, with limited gender-specific data. This study evaluates burnout levels in Lebanese women and men during COVID-19, exploring gender differences and related factors, including burnout mitigation strategies.

Methods

A cross-sectional survey included 423 adult participants aged 18 or older from Lebanon, recruited via online snowball sampling during July 2021 to August 2022. Utilizing the Maslach Burnout Inventory-General Survey (MBI-GS), participants reported exhaustion (≥ 12), cynicism (≥ 11), and low professional efficacy (≤ 21). Burnout was defined as exhaustion with either cynicism or low efficacy. The survey gathered demographic, family, and professional data, stressors, and burnout mitigation strategies. Analyses were gender-stratified, using descriptive statistics and Pearson's chi-squared test. Bivariate associations between burnout indicators and sample characteristics were tested using Pearson's chi-square. Odds ratios (OR) and adjusted ORs for burnout were estimated via logistic regressions.

Results

Lebanese women experienced higher rates of burnout compared to men during the pandemic, with significant differences observed in emotional exhaustion (p = 0.006). Factors associated with burnout varied between genders, with women more likely to exhibit exhaustion when residing in the Beqaa, Mount or North Lebanon governorates, being single, having children aged 10-15 years, and most interestingly when lacking support from their boss/institution. Stressors such as the Lebanese economic crisis and the Beirut Port Explosion were significantly linked to burnout in both genders, with the economic crisis particularly associated with higher levels of exhaustion in men (p = 0.011) and cynicism in both genders (p = 0.001 for men, p = 0.039 for women). Coping strategies, including COVID-19 precautions, social activities, and religious practices, were effective in reducing burnout among both women and men who experienced burnout (p = 0.039 and 0.03, respectively).

Conclusion

The study contributes to public health efforts, emphasizing the importance of recognizing gender dimensions in addressing burnout during the pandemic, designing targeted interventions and fostering supportive, inclusive environments for collective resilience namely for women at the workplace.

Association among parents' stress recovery experiences, parenting practices, and children's behavioral problems: a cross-sectional study

BACKGROUND

Parents can experience much stress from parenting, work, and household responsibilities. Parents' stress recovery experiences, or their lack thereof, can affect parenting practices and influence children's behavioral problems, which may thereby lead to difficulties for children later in life. Therefore, the relationships among these three factors deserve consideration. This study tested a model of the mediating role of parenting practices in the relationship between parents' stress recovery experiences and children's behavioral problems.

METHODS

Parents (N = 1,112) of 14-year-old children in the third year of junior high school in Japan completed a questionnaire, yielding 583 valid responses. To accurately determine the relationship among parents' stress recovery experiences, parenting practices, and children's behavioral problems, parents of children diagnosed with developmental disabilities and parents who did not respond to the required items in the questionnaire were excluded from the analysis. As a result, 536 of the 583 (89.0%) parents met the inclusion criteria. We conducted a path analysis, following the hypothesis that parents' stress recovery experiences, via their parenting practices, are associated with children's behavioral problems.

RESULTS

The path analysis results indicated that parents' stress recovery experiences of relaxation and mastery were positively associated with positive nurturing attitudes, whereas mastery and control were negatively associated with negative nurturing attitudes. Furthermore, positive nurturing attitudes were negatively associated with externalizing and internalizing problem behaviors, whereas negative nurturing attitudes were positively associated with externalizing and internalizing problem behaviors. In other words, the hypothesis that parents' stress recovery experiences of relaxation, mastery, and control reduce children's behavioral problems via promoting nurturing parental attitudes was supported.

CONCLUSIONS

The results indicate that the higher the level of parents' stress recovery experiences, the lower the level of reported children's behavioral problems. Parents' stress recovery experiences correlated with parenting practices, which partially mediated the relationship of the parents' stress recovery with children's behavioral problems. The suggestion is that increasing parents' stress recovery experiences, improving parenting practices and related behaviors, and strengthening the parent-child relationship are important measures that can be mutually beneficial for parents, children, and the overall family relationship.

Collateral effects of Coping Power on caregiver symptoms of depression and long-term changes in child behavior

A large body of research demonstrates positive impacts of the Coping Power Program as a preventive intervention for youth behavioral outcomes, but potential collateral effects for caregivers is less known. The current study examined whether the youth-focused Coping Power Program can have a secondary impact on caregiver self-reported symptoms of depression and in turn result in longer-term impacts on child disruptive behavior problems including aggression, conduct problems and hyperactivity. Data from 360 youth/caregiver pairs across 8 waves of data (grades 4 through 10) were analyzed. We used two methodological approaches to (a) assess indirect effects in the presence of potential bidirectionality using timepoint-to-timepoint dynamic effects under Autoregressive Latent Trajectory modeling and (b) estimate scale scores in the presence of measurement non-invariance. Results showed that individually delivered Coping Power (ICP) produced greater direct effects on conduct problems and indirect effects on general externalizing and hyperactivity (through reductions in caregiver self-reported symptoms of depression), compared to group Coping Power (GCP). In comparison to GCP, ICP produced similar direct effects on reductions in caregiver depression. Child-focused prevention interventions can have an indirect impact on caregiver depression, which later shows improvements in longer-term reductions for child disruptive problems.

Smoking to your kids gain? Childhood exposure to parental smoking and obesity

We empirically investigate the link between parental smoking during childhood or adolescence and the probability of adult obesity. Utilizing data from Household, Income and Labour Dynamics Survey for Australia spanning 2006-2021, our analysis reveals that individuals who were exposed to parental smoking during their childhood exhibit a 4.7 percentage point higher likelihood of being obese in later stages of life. Several robustness checks indicate that the results can be suggestive of a causal relationship. Our findings indicate that health, social capital, and personality traits act as significant pathways through which early exposure to parental smoking during childhood raises the risk of adult obesity. The implications of our findings are significant for early-life interventions aimed at addressing obesity stemming from exposure to passive smoking.

Executive function is associated with behaviour problems in children and adolescents with cerebral palsy and intellectual disability

BACKGROUND

Children and adolescents with cerebral palsy (CP) commonly have behaviour problems. The present study aimed to determine which of the most common clinical features experienced by children and adolescents with CP and intellectual disability are associated with behaviour problems.

METHOD

We investigated 11 possible associated variables including epilepsy, visual and hearing impairments, motor difficulties, communication and speech difficulties, pain, sleep disturbance, executive function (EF) deficits, type of CP, and parent stress. Thirty-eight parents or guardians of children aged 6 to 17 years with CP and intellectual disability (parent informed) completed proxy and self-report standardised questionnaires.

RESULTS

EF deficits and parent stress were significantly associated with behavioural problems.

CONCLUSION

For children and adolescents with CP and intellectual disability, the present study suggests close attention should be placed on specific clinical features including EF deficits and parent stress when considering variables associated with behaviour problems.

Childhood poverty, social support, immigration background and adolescent health and life satisfaction: A population-based longitudinal study

OBJECTIVES

This study examined whether poverty (neighborhood and household) was associated with future health or life satisfaction outcomes and whether the association operated through social support (adult support at home, adult support at school, peer belonging), or differed by the immigration background (nonimmigrant family or immigrant family) of the family.

METHODS

This study utilized a retrospective, longitudinal, population-based cohort that included self-reported survey data from the Middle Years Development Instrument (MDI) completed by children at age 9 and age 12, linked to administrative records. Participants included 5906 children in British Columbia, Canada. Neighborhood and household poverty were observed at age 8. Social support from adults and peers was self-reported at age 9. Outcomes (overall health; life satisfaction) were self-reported at age 12. Adjusted multi-level multiple linear regression analyses and parallel mediation analyses were utilized. The interaction between poverty exposure and immigration background was also examined.

RESULTS

Exposure to either poverty type was associated with lower levels of life satisfaction and overall health at age 12, though household poverty appeared to be associated with lower outcomes in comparison to neighborhood poverty. The indirect effects of poverty on outcomes appeared to operate primarily through adult support at home and peer belonging. Children in immigrant families had a larger negative association between neighborhood poverty and life satisfaction.

CONCLUSIONS

Household poverty had a larger negative association to outcomes in comparison to neighborhood poverty. The association of poverty to outcomes differed by immigration background and operated partially through adult support at home and peer belonging.

Child Well-Being, Family Functioning, and Contextual Strain: A Study of Multi-Assisted Low-Income Families

OBJECTIVES

This study aimed to examine the effects of poverty on child well-being and family functioning among low-income families. Specifically, it explored the role of parental stress, family dynamics, and contextual strain on children's behavioral and emotional outcomes. Using a sample of families receiving welfare support, the research sought to assess the impact of conditional cash transfer programs and the involvement of Child Protective Services on child development and family well-being.

METHODS

This cross-sectional study involved 99 children aged 8-12 from low-income, welfare-assisted families recruited from the Porto Metropolitan Area. Parental stress, parenting attitudes, family functioning, and child outcomes were assessed using standardized questionnaires. Families with and without Child Protective Services involvement were compared, and a cumulative index of contextual strain was developed to measure the multidimensional impact of stressors on child outcomes.

RESULTS

The results revealed that 53% of children exhibited clinical or borderline internalizing behaviors, 47% showed externalizing behaviors, and 39% experienced low psychological well-being. High levels of parental stress, low parenting competence, and significant contextual strain were associated with poorer child outcomes. Families involved with Child Protective Services showed no significant differences in parent or family characteristics, but children from these families exhibited fewer behavioral problems.

CONCLUSIONS

The study highlights the pervasive impact of poverty and contextual strain on child development, emphasizing the need for more comprehensive interventions. Family functioning and parental stress are critical factors influencing child well-being, pointing to the importance of addressing these areas through targeted welfare and support programs to reduce the intergenerational transmission of poverty and improve child outcomes.

Parenting stress and child behavior problems: Developmental psychopathology perspectives

The growing base of research on parenting stress and its relation to child behavior problems has largely paralleled the emergence of developmental psychopathology as a field of inquiry. Specifically, the focus on mechanism rather than main effects has begun to elevate explanatory models in the connection between parenting stress and a variety of adverse child and parent conditions. Still, work on parenting stress is limited by conceptual confusion, the absence of attention to developmental differentiation, a focus on child-specific rather than system influences. Recent research on these parenting stress issues is briefly reviewed, highlighting studies that have illustrated developmental psychopathology perspectives. A conceptual model is offered to illustrate the complex recursive nature of connections between parenting stress, parenting behavior, parent well-being, and children's adjustment, and I make a case for the adoption of a more systemic perspective to influence the next generation of developmental psychopathology research on parenting stress.

Does early skin-to-skin contact have a long-term effect on the emotional and behavioral development of very preterm infants?

Introduction

Premature birth may impair a sensitive, responsive, enjoyable, and regulating parenting style, potentially leading to behavioral, cognitive, and emotional deficits in children. Additionally, the emotional bond between the parent and infant may be disturbed due to the restrictions and difficulties at the neonatal intensive care unit (NICU), further negatively impacting child development. Skin-to-skin contact (SSC) directly after birth is strongly recommended also for preterm or low birth weight infants since there is high-certainty evidence that SSC has positive effects on neonatal and maternal health as well as on the quality of the parent-child relationship. The aim of this study was to examine the effect of skin-to-skin contact immediately after childbirth on the development of emotional and behavioral problems in children born preterm entering school.

Methods

This study is part of a randomized controlled delivery room skin-to-skin study (Deisy Study). A total of 33 children (aged 6-8 years) were assessed at school start. The German version of the CBCL/6-18R was used to evaluate the presence of behavior problems.

Results

The perceived parental stress 6 months after discharge was the variable that most contributed to the variance explanation. SSC immediately after childbirth was not significant in the prediction of emotional and behavioral problems at school start.

Limitations

The study was conducted in a small study group. Partners' variables were not included. Information regarding sociodemographic variables and bonding quality was collected 6 months (corrected age) after birth. The measurement of children's behavioral problems is not objective and corresponds to the parents' perception.

Clinical Trial Registration

https://clinicaltrials.gov, deisy study NCT01959737, deisy follow up NCT03366285.

A systematic review and meta-analysis of the effectiveness of interventions targeting the parent-child relationship in families of children with an intellectual disability

BACKGROUND

The review aimed to investigate the effectiveness of parent-child relationship interventions for families of children with intellectual disability up to 12 years old.

METHODS

Quasi-experimental or randomised controlled trials (RCTs) of interventions targeting the parent-child relationship where ≥50% of children had an intellectual disability were included. Meta-analyses of parent-child relationship outcomes and child outcomes used standardised mean difference as the effect size.

RESULTS

Twenty-seven papers were included (N = 1325). Parent-child relationship outcomes improved significantly (n = 1325; g = 1.08, 95% CI: 0.64, 1.52) with a large effect size that was robust to sensitivity analyses. Child developmental outcomes improved significantly (n = 1082; g = 0.65, 95% CI: 0.23, 1.07), and indicated a large effect size for child socialisation and communication.

CONCLUSIONS

Findings suggest that interventions targeting parent-child relationship quality are associated with substantial improvements in parent-child relationship and may improve child outcomes related to socialisation and communication.

Child's Externalizing and Internalizing Problems and Caregiver Strain: Mediation of Child's Executive Functions

The aim of the study is to explore the role of child's executive functions in the relation between child's externalizing and internalizing problems and caregiver strain in early school age children. The caregiver strain refers to providing nurture and care for a dependent family member. A sample includes 175 caregiver-child dyads and 36 school teachers. Participants completed the Family Strain Index which measures caregiver strain or burden (caregivers), the Strengths and Difficulties Questionnaire which measures child's externalizing and internalizing problems (teachers), and behavioral tasks that measure executive functions (children). Using structural equation modelling, the analysis resulted in a full mediation of the child's externalizing problems on the caregiver strain by child's executive functions. However, the association of child's internalizing problems with caregiver strain has not been confirmed. These results indicate that better child's executive functions buffer the negative effect of child's externalizing problems on caregiver perceived burden. Based on these results, we can suggest that interventions should be focused on programmes to improve the child's executive functions in the family and educational context, along with caregiver training aimed at providing emotional and social support, or individual therapy.

Arabic validation of the parental stress scale (PSS) in a population-based sample of Lebanese parents

BACKGROUND

Parental stress significantly impacts the well-being of families, and necessitates culturally sensitive tools for its assessment. The Parental Stress Scale, widely used in diverse cultural settings, lacks a validated Arabic version suitable for the Lebanese context, where unique sociopolitical and economic factors might influence parental stress differently. This study aimed to translate, culturally adapt, and validate the scale in Arabic among a Lebanese sample.

METHODS

Following the Snowball sampling method, participants (n = 502) were adult Lebanese parents who answered demographic questions and completed the Arabic version of the Parental Stress Scale and the Depression, Anxiety, and Stress Scale-8.

RESULTS

Confirmatory Factor Analysis showed a two-factor model of the Parental Stress Scale (CFI = 0.956). We found adequate composite reliability for both the 'Parental Stress' (ω = 0.91/α = 0.91) and 'Parental satisfaction' (ω = 0.94/α = 0.94) subscales. Convergent validity and concurrent validity were demonstrated through positive correlations with measures of depression, anxiety and stress. Our translation of the scale was shown to be invariant across sexes, with fathers scoring significantly higher than mothers.

CONCLUSION

Our validated Arabic version of the Parental Stress Scale offers a culturally sensitive instrument for assessing parental stress in Lebanon. This tool enables healthcare providers and researchers to identify stressors affecting Lebanese families, facilitating the development of targeted interventions to support parental mental health.

Relationships Between Family Sense of Coherence, Coping and Role Performance in Parents of Children with Disabilities: Structural Equation Modeling

This descriptive study was designed with a clear focus: to use structural equation modeling to determine the intricate relationships between family sense of coherence, coping, and role performance in parents of children with disabilities. The study was conducted with a sample of 185 parents of children receiving special education at the primary school level in a province in Türkiye. Data was collected using a parent introduction form, the Family Sense of Coherence Scale-short form (FSOC-S), the Family Role Performance (FRP) scale, and the Revised-COPE Scale (R-COPE). The effect of FSOC-S on FRP and R-COPE was statistically significant. The effect of FRP on R-COPE was statistically significant. Moreover, FSOC-S predicted 22.4% of FRP, while FSOC-S and FRP predicted 17.1% of R-COPE. The study's findings underscore the urgent need for interventions to improve the family's sense of coherence and positive coping attitudes. These interventions are crucial for parents to effectively manage the challenges they face while caring for a child with a disability. The study also highlights the significant role of positive coping attitudes and family sense of coherence in enhancing role performance in parents of children with disabilities.

A Longitudinal Study of Aggression in People with Autism and Other Neurodevelopmental Disabilities

Aggression is common in autism and neurodevelopmental disorders, but longitudinal research on aggression is lacking. We longitudinally tracked aggression in 254 individuals from toddlerhood to emerging adulthood. Our sample included participants with a range of cognitive abilities, with 39.9% classified as more-cognitively-abled (MCA; IQ ≥ 70) and 60.1% as less-cognitively-abled (LCA; IQ < 70). Aggression Composite scores were derived from data from the autism diagnostic observation schedule, autism diagnostic interview-revised, and child behavior checklist at ages 2, 9, and 18. Fifty-four percent, 69%, and 42% of the sample showed aggression in toddlerhood, school age, and emerging adulthood, respectively. LCA individuals had higher rates of aggression in school age (80%) and emerging adulthood (58%) compared to MCA individuals (48 and 22%, respectively). Longitudinal aggression profiles revealed distinct patterns of change over time: 31% displayed persistent aggression, 25% increased, 23% decreased, and 13% never displayed aggression. Higher autism symptoms, lower VIQ, NVIQ, and less-developed adaptive skills correlated with more aggression cross-sectionally. Nonverbal IQ and repetitive behaviors related to aggression longitudinally: people in decreasing or absent profiles had higher NVIQ and fewer RRBs than those with persistent or increasing profiles. Participants with aggression at 9 were four times likelier to exhibit aggression at 18. Aggression is common in autism and NDDs, peaking around age 9, and declining in emerging adulthood. Patterns of change varied widely, with evidence that higher NVIQ and fewer RRBs may be protective. Findings have implications for clinical practices, highlighting important developmental periods and high-risk subgroups.

Psychometric properties of the Parenting Stress Index-Short Form in a Peruvian sample

BACKGROUND

The stress experienced by parents in fulfilling their parental role has consequences for couple dynamics, parent-child interactions, and the mental health of parents. However, studies on the psychometric properties of the PSI-SF, particularly among Latin American parents, are scarce. Therefore, this study aims to evaluate the psychometric properties of the Spanish version of the Parenting Stress Index-Short Form (PSI-SF).

METHODS

The participants were Peruvian mothers and fathers with children in early childhood and primary education, with a mean age of 34.4 years (SD = 6.8). The sample was obtained in two phases: 130 participants for the Exploratory Factor Analysis (EFA) and 791 participants for the Confirmatory Factor Analysis (CFA).

RESULTS

The study results show a modified three-factor structure of the PSI-SF scale, with adequate fit indices (GFI = .99, AGFI = .99, SRMR = .024, CFI = .98, TLI = .98, RMSEA = .074) and loadings above 0.40. Additionally, the three factors of the scale demonstrated high reliability, with Cronbach's alpha and McDonald's omega values for Parental Distress (α = .94; ω = .95), Parent-Child Dysfunctional Interaction (α = .97; ω = .97), and Difficult Child (α = .94; ω = .94). The scale was also found to be invariant with respect to gender.

CONCLUSION

In conclusion, the study results suggest that the modified PSI-SF has adequate psychometric properties and is invariant for assessing parental stress in Peruvian fathers and mothers with children in early childhood and primary education.

ProVIA-Kids - outcomes of an uncontrolled study on smartphone-based behaviour analysis for challenging behaviour in children with intellectual and developmental disabilities or autism spectrum disorder

Introduction

Challenging behaviour (CB) is a common issue among children with autism spectrum disorder or intellectual and developmental disability. Mental health applications are low-threshold cost-effective tools to address the lack of resources for caregivers. This pre-post study evaluated the feasibility and preliminary effectiveness of the smartphone app ProVIA-Kids using algorithm-based behaviour analysis to identify causes of CB and provide individualized practical guidance to manage and prevent CB.

Methods

A total of 18 caregivers (M = 38.9 ± 5.0) of children with a diagnosis of autism spectrum disorder (44%), intellectual and developmental disabilities (33%) or both (22%) aged 4-11 years (M = 7.6 ± 1.8) were included. Assessments were performed before and after an 8-week intervention period. The primary outcome was the change in parental stress. Caregiver stress experience due to CB was also rated daily via ecological momentary assessments within the app. Secondary outcomes included the intensity of the child's CB, dysfunctional parenting, feelings of parental competency as well as caregivers' mood (rated daily in the app) and feedback on the app collected via the Mobile Application Rating Scale.

Results

We observed increases in parental stress in terms of conscious feelings of incompetence. However, we also saw improvements in parental stress experience due to CB and overreactive parenting, and descriptive improvements in CB intensity and caregiver mood.

Discussion

ProVIA-Kids pioneers behaviour analysis in a digital and automated format, with participants reporting high acceptance. Pilot results highlight the potential of the ProVIA-Kids app to positively influence child behaviour and caregiver mental health over a longer intervention period.

Registration

The study was registered at https://www.drks.de (ID = DRKS00029039) on May 31, 2022.

Cumulative childhood interpersonal trauma and parental stress: The role of partner support

Parents who have experienced cumulative childhood interpersonal trauma (CCIT, i.e., an accumulation of different types of abuse) tend to experience higher parental stress following the birth of a child. As CCIT is associated with lower levels of partner support, which is linked to increased parental stress, partner support could explain the link between CCIT and parental stress. Yet, these variables have never been studied using a dyadic approach. This study examined the role of received and provided partner support in the association between CCIT and parental stress. A randomly selected sample of 1119 couples with infants completed online questionnaires assessing CCIT, partner support, and parental stress. An actor-partner interdependence model path analysis showed that both parents' CCIT were associated with increased paternal stress through fathers' lower received and provided support, and with increased maternal stress through mothers' received and provided support. Overall, the findings highlight the significance of examining the interdependence between both parents' experience and the role of partner support as a key factor explaining the link between CCIT and parental stress, thereby emphasizing its importance as an intervention target.

Cognitive-Based Interventions for Improving Psychological Health and Well-Being for Parents of Children with Developmental Disabilities: A Systematic Review and Meta-analysis

This review aims to systematically summarize existing evidence to determine the effectiveness of cognitive-based interventions (CBIs) on psychological health and well-being among parents of children with developmental disabilities (DD). Six databases were searched to identify eligible randomized controlled trials (RCTs) from their inception to April 2023. The revised Cochrane Risk of Bias tool for RCTs was applied to assess the risk of bias and the certainty of evidence was evaluated using the Grading of Recommendation, Assessment, Development and Evaluation. Meta-analyses were conducted using a random-effects model. Twenty-five RCTs involving 1915 participants were identified. The results indicated that CBIs reduced parental stress levels (Hedges' g = - 0.69), depressive symptoms (g = - 0.95), anxiety levels (g = - 0.78), and parental distress (g = - 0.29), and improved parental well-being (g = 0.62) and parent‒child relationships (g = 0.43) postintervention compared with the active/inactive control groups. Subgroup analysis of the effectiveness of interventions using mindfulness-based interventions and cognitive behavioural therapy showed positive effects. The favourable intervention duration and participant targets were also identified in this review. Furthermore, the effects of CBIs were impacted by the different types of DD among the children. This review highlighted the positive effects of CBIs on parental stress levels, depressive symptoms, anxiety levels, parental distress levels, parental well-being levels, and parent‒child relationships. Future well-designed RCTs are needed to further investigate the effects of MBIs and CBT interventions on children with DD and their parents, as well as the factors and mechanisms of action affecting the efficacy of these interventions.

Feasibility study of a parent-driven intervention for youth with Down syndrome

BACKGROUND

Children with Down syndrome present with behavioural and emotional difficulties, including noncompliance, rule-breaking, emotion dysregulation and delays in executive functioning. Few behavioural interventions have been designed specifically for children with Down syndrome. The Research Units in Behavioral Intervention (RUBI) Parent Training for Disruptive Behaviors is a structured empirically supported parent training programme developed for caregivers of children with autism. This feasibility trial explored the feasibility and acceptability of an abbreviated RUBI intervention with caregivers of children with Down syndrome and identified promising outcome measures to target in future larger clinical trials.

METHOD

A double-blind randomised feasibility pilot clinical trial allocated participants to a behavioural intervention (BEH) or educational (EDU) group. BEH and EDU consisted of five individual sessions over the course of 5 to 8 weeks. Measures were administered to 20 caregivers and their youth with Down syndrome at three time points.

RESULTS

Both BEH and EDU were rated as feasible with high parental adherence and acceptable with high treatment satisfaction. Both BEH and EDU demonstrated decreased externalising behaviours, irritability and hyperactivity and improved behavioural regulation in executive functioning over time. No impact was noted on caregiver functioning.

CONCLUSION

The feasibility trial has strong findings regarding feasibility and satisfaction and has promising findings regarding the selection of measures for future trials testing an adapted RUBI programme and an education programme to reduce behavioural challenges in children with Down syndrome. Larger scale clinical trials are needed to confirm promising findings of these feasible treatments.

Perinatal intimate partner violence among teen mothers and children's attachment disorders in Rwanda: potential mediating factors

Background: The alarming prevalence of teen mothers' exposure to perinatal intimate partner violence (IPV, 8.3-67%) and attachment disorders (ADs) among their children is a global concern, especially in sub-Saharan Africa with high teenage pregnancy rates. This study, therefore, aimed to examine the link between teen IPV and AD in their offspring. We sought also to explore the mediating roles of postpartum depression symptoms, maternal sensitivity, parenting stress, and perceived social support in the relationship between perinatal IPV and children's ADs.Method: This cross-sectional study selected a random sample of 309 teen mothers from Nyanza district. This sample size was determined using Yamane's formula, with random sampling. Various instruments were used for data collection, including questionnaires on intimate partner violence, social support, maternal sensitivity, postpartum depression symptoms and parenting stress and early trauma-related disorders. The data was analysed using SPSS, with mediation analyses performed using the PROCESS macro (version 4.1).Results: IPV was found to be significantly associated with attachment disorders. Simple mediation models showed that parenting stress completely mediated these relationships, while postpartum depression, perceived social support, and maternal sensitivity partially mediated the relationship between IPV and children's ADs. In parallel mediation model, the combined roles of all mediators fully mediated the associations between IPV and ADs.Conclusion: These findings offer valuable insights in designing or strengthening the appropriate interventions to prevent and mitigate the perinatal intimate partner violence and its detrimental impact on children's attachment disorders. Combating intimate partner violence in post-conflict situations is challenging in teen mothers, however, our results suggest that efforts to address maternal mental health and parenting practices may protect children from attachment disorders.

Disruptive mood dysregulation disorder, parental stress, and attachment styles

Disruptive mood dysregulation disorder (DMDD) is a relatively new diagnostic entity concerning children with chronic irritability and severe anger outbursts. Currently, there is limited knowledge about the parental factors associated with the disorder. The aim of this study was to compare stress levels and attachment styles in parents of children with DMDD with those of parents of children with other diagnoses. Our sample consisted of 218 children (6-12 years, M age = 9.68 years) referred to child mental health outpatient clinics. Clinicians used a standardized semi-structured diagnostic interview to identify diagnoses. Parental stress levels and attachment styles were assessed using parent reports. We found that parents of children with DMDD experience significantly higher levels of parenting stress related to factors in the child than parents of children with other diagnoses. Furthermore, parents of children with DMDD show a higher association with insecure adult attachment styles than parents of children without DMDD. Finally, an adult preoccupied-ambivalent attachment style explains the variability in parental stress in the DMDD group to a large degree. We discuss how parental stress and an insecure attachment style can be associated with negative parenting practices. An implication from this study could be that treatment results might be improved by involving parents more in treatment programs for children with DMDD.

Pre-existing parental stress and youth internalizing symptoms predict parent-reported COVID-related stress in military families

Understanding the extent to which youth and families experienced COVID-related stress requires accounting for prior levels of stress and other associated factors. This is especially important for military families, which experience unique stressors and may be reluctant to seek outside help. In this prospective study, we examined the role of pre-pandemic family factors in predicting parent and youth stress during the COVID-19 pandemic. Participants were 234 families with at least one active-duty parent and a 3rd or 5th-grade child. Findings revealed that preexisting factors predicted youth and family COVID-related stress. Specifically, heightened pre-pandemic parental stress and youth internalizing symptoms were significant predictors of COVID-related stress. Implications for mental health professionals and other organizations supporting military parents and families during the COVID-19 pandemic as well as other times of upheaval are discussed.

Parent-Child Interactions May Help to Explain Relations Between Parent Characteristics and Clinically Observed Child Autistic Behaviours

The importance of supporting parent-child interactions has been noted in the context of prodromal autism, but little consideration has been given to the possible contributing role of parental characteristics, such as psychological distress. This cross-sectional study tested models in which parent-child interaction variables mediated relations between parent characteristics and child autistic behaviour in a sample of families whose infant demonstrated early signs of autism (N = 103). The findings suggest that associations between parent characteristics (psychological distress; aloofness) and child autistic behaviours may be mediated by the child's inattentiveness or negative affect during interactions. These findings have important implications in developing and implementing interventions in infancy which target the synchrony of parent-child interaction with the goal to support children's social communication development.

Relationship between Emotional Support for Parents and Autistic Children's Participation in Social and Physical Activities

The purpose of this study was to determine if parents receiving emotional support is positively correlated with children's participation in physical and social activities and if such a correlation exists between parental emotional support in children labeled as autistic. Data were drawn from 30,501 children aged 6 to 17 years in the 2020 National Survey of Children's Health database and analyzed using a retrospective cross-sectional approach based on multivariate linear regression models. Results showed parental emotional support was statistically significantly correlated with children's physical and social activity in the total sample but was not significant for the emotional support of parents with autistic children. The findings suggest that other issues must be considered as contributing factors for parents of autistic children in relation to social and physical activity participation.

Psychological wellbeing in parents of children with Down syndrome: A systematic review and meta-analysis

We report a review examining the psychological wellbeing of parents of children with Down syndrome (DS) relative to that of parents of typically developing (TD) children. A systematic search identified 57 relevant studies, which were synthesised meta-analytically. Relative to their counterparts with TD children, mothers and fathers of children with DS reported higher levels of parenting stress (mothers: g = 0.57, 95% CI [0.33, 0.81]; fathers: g = 0.40, [0.24, 0.56]), depressive symptoms (mothers: g = 0.42, [0.23, 0.61]; fathers: g = 0.25, [0.02, 0.48]) and psychological distress (mothers: g = 0.45, [0.30, 0.60]; fathers: g = 0.63, [0.26, 0.99]). Small effects were found for anxiety for mothers (g = 0.16, [0.03, 0.29]), with no differences for fathers (g = 0.03, [-0.25, 0.32]). No group differences were found for positive impact of parenting (mothers: g = -0.09, [-0.25, 0.07]; fathers: g = -0.04, [-0.30, 0.22]), while evidence concerning other positive wellbeing outcomes was limited. No significant moderating effects of child age range, country income level, or group differences in parental education level were identified, but limited subgroup analyses were possible. Raising a child with DS may be associated with elevated stress, depressive symptoms, and psychological distress for mothers and fathers. However, levels of parenting reward appear equivalent to those experienced by parents raising TD children.

Parenting children with disabilities in Sweden: a cluster-analysis of parenting stress and sufficiency of informal and formal support

Objective

To investigate patterns of parenting stress and access to sufficient informal and formal support among parents of children with disabilities. To explore whether child cognitive level, conduct problems and the need of language interpretation in contacts between parents and professionals are associated with patterns of parenting stress and support.

Method

Parents (N = 140) of children with disabilities in Sweden completed a questionnaire about parenting stress and support. Patterns of three variables-parenting stress and access to sufficient informal and formal support-were investigated using cluster analysis. The relationship of child cognitive level, level of conduct problems and of language interpretation needs between parents and professionals to cluster membership was explored using multinomial logistic regression.

Results

Five different clusters of parenting stress and support emerged. Parents in cluster 1 had lower than sample mean ratings on all three variables. Cluster 2 had elevated parenting stress, cluster 3 had elevated insufficient informal support and cluster 4 had elevated insufficient formal support. Cluster 5 had elevated ratings on all three variables. Greater child cognitive difficulties increased the likelihood of parent membership in cluster 2 (elevated stress), cluster 3 (elevated insufficient informal support), or cluster 5 (elevated ratings on all variables). Child conduct problems increased the likelihood of membership in cluster 2 (elevated stress) or cluster 5 (elevated ratings on all variables). No relationship between language interpretation needs and cluster membership was found.

Conclusions

Patterns of parenting stress and sufficiency of support, and their associations with child characteristics, vary substantially. However, families of children with conduct problems experiencing elevated parenting stress in combination with insufficient informal and formal support, may be particularly vulnerable. The results of the current study highlight the clinical importance of exploring and identifying individual parenting stressors and perceived levels of support, to be able to adapt services to better suit a variety of needs, and thus promote equitable care.

Delivery and Impact of Foster Parent Training: Similarities and Differences for Relative and Non-Relative Foster Parents

Literature on the delivery and impact of foster parent training, such as the Nurturing Parenting Program (NPP), is sparse, particularly for relative foster parents. This study investigates (a) how NPP referral, initiation, and completion rates vary between relative and non-relative foster parents, (b) reasons for not initiating NPP, and (c) changes in parenting attitudes and behaviors for relative and non-relative foster parents after participating in NPP. The study analyzed data from the Illinois Birth to Three (IB3) study for 722 relative and 397 non-relative foster parents of children ages three and younger. Relative and non-relative foster parents had similar NPP referral and initiation rates, but relatives had significantly lower completion rates. Content analysis of case notes for 498 cases showed that relative foster parents more frequently noted barriers (e.g., childcare, transportation) to NPP initiation. Among NPP completers, both groups reported similar levels of improvements in parenting attitudes and behaviors at the end of NPP, but a pattern of lower scores was observed for relative foster parents. The findings suggest a need for more support for foster parents, particularly relative foster parents.

COVID-19 Stress and Child Behavior: Examining Discrimination and Social Support in Racially Diverse ECHO Cohorts

OBJECTIVE

To examine the additive or moderating influences of caregiver COVID-19-related stress, social support, and discrimination on children's behavior problems across racially diverse populations.

METHOD

In this Environmental influences on Child Health Outcomes (ECHO) cohort study (N = 1,999 caregiver/child pairs), we operationalized caregiver COVID-19-related stress in 2 ways: first, as the number of stressors (eg, financial concerns, social distancing); and second, as the level of pandemic-related traumatic stress symptoms reported via questionnaires administered between April 2020 and August 2022. At the same assessment visit, caregivers also reported their current levels of discrimination, and a subsample (n = 968) reported their emotional and instrumental support. Either concurrently or at a later assessment visit, caregivers reported on their children's internalizing and externalizing behavior problems using the Child Behavior Checklist for Ages 6-18 (CBCL/6-18).

RESULTS

Multivariable analyses controlling for maternal education, marital status, child age, and child sex revealed that COVID-19-related stress (caregiver stressors and symptoms) and discrimination were positively associated, and that perceived support was negatively associated with child internalizing and externalizing behavior problems. Unexpectedly, neither emotional nor instrumental support attenuated the relationship between caregiver COVID-19-related stressors nor traumatic stress symptoms and child behavior problems. In the subset of Black American participants, caregiver perceived discrimination moderated the relationship between caregiver COVID-19 traumatic stress symptoms and child internalizing problems, such that the association was stronger at higher levels of discrimination.

CONCLUSION

Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes.

Role of child demographic, executive functions, and behavioral challenges on feelings about parenting among parents of youth with Down syndrome

BACKGROUND

Living with a child with Down syndrome (DS) influences the entire family, including caregivers.

AIMS

This study examined positive and negative caregiver feelings about parenting youth with DS and to what extent children's demographic, cognitive, behavioral characteristics, and co-occurring medical conditions are associated with those parental feelings. Specifically, the mediatory role of child behavioral challenges on the relationship between child executive functioning (EF) and parent feelings about parenting a child with DS was examined in a mediation analysis model.

METHODS AND PROCEDURES

Parents of 113 youth with DS aged 6 to 17 year rated their positive and negative feelings about parenting, and their child's behavioral challenges and EF.

OUTCOMES AND RESULTS

Externalizing and Internalizing behavioral challenges and emotional and behavioral regulations of EF were significantly associated with positive and negative parent feelings. Child behavioral challenges fully mediated the relationship between child EF and caregiver feelings about parenting, after controlling for identified covariates of child demographics.

CONCLUSIONS AND IMPLICATIONS

Findings have implications for understanding the role of EF, through its impact on behavioral challenges, on the feelings of caregivers about parenting a child with DS. These findings play a role in understanding outcomes of interventions targeted at EF and behavioral challenges, in the context of other child variables.

The Influence of Gifted Children's Stress Management on Parental Stress Levels

This study explores the associations between gifted children's stress management and parental stress level. A sample of 78 primary school children and their 76 parents took part in this study. Children were screened for intelligence and emotional quotients, while parents were tested for stress levels. Results show that the more children are aware of their stress-management skills, the less parents are stressed out. Moreover, the intelligence quotient is not significant in mediating this association, supporting the idea that it is not an a priori protective factor from a developmental perspective. The study findings suggest that when a child is equipped with the skills to handle stress by harnessing their emotional intelligence, it can have a beneficial effect on the entire family's well-being. Given that these skills can be developed, and the significant positive influence they have on a child's growth and adaptation, it is essential to offer specialized educational programs to gifted children. These programs should aim to enhance their emotional skills, which, in turn, can indirectly bolster the psychological health of the family unit as a whole.

Parent Stress and Observed Parenting in a Parent-Child Interaction Task in a Predominantly Minority and Low-Income Sample

High stress in parents may affect parenting and subsequent child socioemotional and behavioral development. Previous evidence suggests that highly stressed parents are more likely to engage in negative parenting, which is less structured and more punitive. However, the effects of life stress versus parent specific stress on parent-child interactions in early childhood has not been well studied, especially in minority and low-income samples. Thus, the current study assessed the relationship between perceived life stress, parenting-related stress, and observed parenting responses to young children during a structured, mildly challenging parent-child task. Predominantly minority and low-income parents and their children (2-5 years old; 54 dyads) completed the Perceived Stress Scale, the Parenting Stress Inventory, and participated in a structured 5-minute interaction task, the Toy-Wait Task (TWT), that was video-taped and coded by blind raters. The coding utilized a standardized system with good reliability assessing 1) Affect (parent and child positive and negative affect, shared positive affect), 2) Positive Parenting Behaviors (warmth, structured good involvement, listening/engagement), and 3) Negative Parenting Behaviors (reactivity, judgment, critical parenting). Significant associations were found between perceived life stress and parenting stress, (r (54) = 0.61, p<.01). Parents with higher perceived life stress scores showed more negative affect (r=0.291, p<.05) and lower involvement with the child (r=-0.367, p<.05), while parenting specific stress did not yield significant effects (p's > 0.05). Findings suggest that interventions that reduce stress in minority and low-income parents of young children may also improve parenting of young children with potential impact on decreasing child psychopathology risk.

The dynamic nature of parenting practices: a qualitative enquiry of parenting adolescents during COVID-19

Introduction

Parenting practices are known to be dynamic, evolving in response to various factors such as societal changes, cultural norms, and individual circumstances. Understanding the dynamic nature of parenting is essential for comprehending its influence on children's development. This study aimed to explore the adaptive nature of parenting practices amidst the backdrop of the COVID-19 pandemic, a global event that provided a unique context for examining these dynamics.

Methods

In-depth semi-structured qualitative interviews were conducted with six heterogeneous couples who were parenting at least one adolescent during the pandemic. Attride-Sterling's thematic network analysis was employed to analyze the interview data.

Results

Five global themes emerged from the data, namely, change in parenting style due to stressors, paternal versus maternal style of parenting, intergenerational transmission of parenting practices, child-centric parenting practices, positive parenting practices and evolving parent-child relationship during COVID-19.

Discussion

The findings highlight the tendency of parents to adapt their parenting styles to meet the evolving needs of their children. Understanding these dynamics is crucial for supporting families during times of crisis. Future research should explore the long-term effects of these changes and effective strategies for promoting positive parent-child relationships.

Acceptance and Commitment Therapy for Anger, Irritability, and Aggression in Children, Adolescents, and Young Adults: A Systematic Review of Intervention Studies

The onset of childhood disruptive behaviors is one of the most common presenting difficulties to clinics worldwide. Acceptance and commitment therapy (ACT) has shown to be effective in the reduction of anger and aggression among adults, however to date there has been no systematic review that has examined the effectiveness of ACT in addressing anger and aggression among children, adolescents, and young adults. The current systematic review aimed to evaluate the methodological standing and effectiveness of the peer-reviewed literature of ACT on anger and aggression for this population. PsycINFO, PubMed, and MEDLINE databases were searched systematically in June 2022 to identify studies in English published on the use of ACT for anger and aggression in children, adolescents, and young adults. Seven studies met the inclusion criteria with a combined sample of 305 participants across the interventions. The most common outcome measures used were self-report ratings of anger among participants. Studies were characterized by poor methodological rigor and findings were mixed as regards the effectiveness of ACT in addressing anger and aggression in this population. Some evidence suggests that group ACT may be effective in reducing self-report measures of anger, but no firm conclusions can be drawn from the extant literature due to the heterogeneous nature of the studies, and limited information about ACT protocols and treatment delivery. Further higher-powered studies comparing ACT to treatment as usual or waitlist are needed to clarify what ACT may add as a treatment to anger and aggression in this population.

The effectiveness of parent-Child observation in parent-Mediated programmes for children with developmental disabilities and externalizing disorders: A systematic review and meta-analysis

This systematic review evaluated the treatment effects of communication-focused parent-mediated interventions (CF-PMT), a form of intervention that involves therapists observing parent-child interactions and giving feedback to parents on how they can practice positive parenting strategies to prevent or reduce externalizing behaviours in children with developmental disabilities. A literature search was conducted on three electronic databases. To be included in the review, studies had to: evaluate CF-PMT where therapists give feedback after observing parent-child interactions; examine changes in externalizing behaviours amongst children with any forms of developmental disability; and adopt a randomised controlled trial study design. Fifteen studies met eligible criteria for the literature review, of those, 13 studies had available data on changes in the primary (child externalizing behaviours) and secondary outcomes (parental stress, child linguistic abilities and child social responsiveness). We found significant treatment effects for CF-PMT in reducing child externalizing behaviours (d = -.60) but not for any of the secondary outcomes. A sensitivity analysis showed a small but significant treatment effect for parental stress (d = -.18). Considerable bias was observed due to the lack of available information reported by studies on aspects measured by the Mixed Methods Appraisal Tool. Overall, we found evidence to support the benefits of complex interventions which incorporate direct parent-child observations and feedback to improve behavioural outcomes amongst children with developmental disabilities.

The change of psychosocial stress factors in families with infants and toddlers during the COVID-19 pandemic. A longitudinal perspective on the CoronabaBY study from Germany

Background

Over nearly three years, the COVID-19 pandemic has had a lasting impact on people's lives and mental health worldwide with its far-reaching restrictions and concerns about infections and other personal consequences. Families were particularly affected and showed increased stress and psychological problems. Long-term effects cannot be ruled out. So far, data on young families are sparse. The present longitudinal analysis (n = 932) of the CoronabaBY study investigated the development of parenting stress, parental affective symptoms, and child's mental health in young families with children aged 0-3 years in Germany as well as potential influencing factors.

Methods

The observational study includes two measurement points over the course of the pandemic (baseline and follow-up). Data was collected by app using standardized questionnaires.

Results

N = 932 participants, mainly mothers (94.7%) born in Germany (93.1%) with higher education (61.3% with at least high school diploma) and a comfortable financial situation participated in the longitudinal study. Children were on average 14.7 months old at baseline (SD: 12, range: 1-39 months). While the proportion of parents who perceived the pandemic as stressful decreased significantly from baseline (60%) to follow-up (52.3%), the proportion with parenting stress increased significantly (from 40.1% to 45.4%). Both parental and child mental health problems remained constant over time, with infants crying/feeding/sleeping problems ranging above pre-pandemic comparative data. Most predictive for high parenting stress at follow-up was high parenting stress at baseline. This was also true for parental affective symptoms (depression/anxiety) and child mental health problems.

Conclusions

Despite faded pandemic restrictions, parents remained burdened. Support services do not appear to have been sufficient to help families out of their stressful situation. Our results indicate a need for action regarding low-threshold services that effectively reach affected families.

Trial registration

The study was pre-registered in OSF (https://osf.io/search/?q=tksh5&page=1).

Parental Responsivity and Child Communication During Mother-Child and Father-Child Interactions in Fragile X Syndrome

PURPOSE

Past research shows that parentally responsive behavior toward the child positively influences language development in both neurotypical children and children with intellectual and developmental disabilities, including those with fragile X syndrome (FXS); however, most studies have focused exclusively on the mother-child relationship. The current study examined relationships between parent behavior (i.e., responsivity and behavior management) and child language performance in both mother-child and father-child interactions, as well as relationships between child characteristics and both parent behavior and child language.

METHOD

Participants were 23 families of young boys with FXS between 3 and 7 years of age. Mothers and fathers independently completed questionnaires assessing child characteristics and separately engaged in 12-min play-based interactions with their child via telehealth. One parent also completed a comprehensive interview assessing child adaptive behavior. Video recordings of the parent-child interactions were transcribed and coded for parent and child behavior, and measures of parent and child language were obtained from the transcripts.

RESULTS

Mothers and fathers used similar rates of responsive behaviors during parent-child interactions, and parental responsivity was positively associated with some aspects of child language performance (i.e., talkativeness and lexical diversity). Parental behavior, however, was not associated with syntactic complexity. Older children and children with higher levels of adaptive behavior had parents who used higher rates of responsive behaviors. Fathers used higher rates of behavior management strategies compared to mothers, and this type of parent behavior was not associated with child language.

CONCLUSION

Overall, this study provides evidence that interventions focused on increasing parental responsiveness would be beneficial for families of children with FXS and that these interventions should be delivered early given the association between responsivity and child age.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25229939.

Child characteristics associated with child quality of life and parenting stress in Angelman syndrome

BACKGROUND

Angelman syndrome (AS) is a rare neurodevelopmental disorder characterised by severe intellectual disability, movement disorder, epilepsy, sleeping problems, and behavioural issues. Little is known on child health-related quality of life (HRQoL) in AS. AS family studies have reported elevated parenting stress and a high impact of the child's syndrome on the parent. It is unclear which factors influence child HRQoL and parenting stress/impact in AS.

METHODS

We collected data prospectively through standardised clinical assessments of children with AS at the ENCORE Expertise centre for Angelman Syndrome at the Erasmus MC Sophia Children's Hospital. A linear regression analysis was conducted for the following outcome variables: (1) child HRQoL (Infant and Toddler Quality of Life Questionnaire); (2) the impact of the child's syndrome on the parent (Infant and Toddler Quality of Life Questionnaire); and (3) parenting stress (Parenting Stress Index). Predictor variables were child genotype, epilepsy, sleeping problems (Sleep Disturbance Scale for Children), cognitive developmental level (Bayley Cognition Scale), autistic features (Autism Diagnostic Observation Schedule) and emotional/behavioural problems (Child Behaviour Checklist). Covariates were sex, age and socio-economic status.

RESULTS

The study sample consisted of 73 children with AS, mean age = 9.1 years, range = 2-18 years. Emotional/behavioural problems were the strongest significant predictor of lowered child HRQoL. Internalising problems were driving this effect. In addition, having the deletion genotype and higher age was related to lower child HRQoL. Sleeping problems were related to a higher impact of the child's syndrome on the parent. Finally, emotional/behavioural problems were associated with higher parenting stress. Cognitive developmental level, autistic features and epilepsy were not a significant predictor of child HRQoL and parenting stress/impact.

CONCLUSIONS

These results suggest that interventions aimed at increasing child HRQoL and decreasing parenting stress/impact in AS should focus on child emotional/behavioural problems and sleeping problems, using a family-centred approach.

Pediatrician and parental evaluation of child neurodevelopment at 2 years of age

BACKGROUND

The early identification of infants with a risk for neurodevelopmental disorders in the first few years of life is essential for better developmental outcomes. Screenings should be carried out by combining the family pediatricians' and parents' perspectives, the two fundamental sources of information on children's health. The present study has three aims: (a) to test the feasibility of parent-report instruments to detect warning signs in their children's development; (b) to ascertain whether there is an agreement between the family pediatricians' (FP) clinical judgments of warning signs and the parental perceptions; (c) to determine whether there is a link between parents' distress and child development.

METHODS

Within the NASCITA birth cohort, in addition to the family pediatrician's clinical evaluation with routine tools, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) was completed by parents to assess the child's language, social skills, behavior, and sensory areas. Parents were also asked to complete the Parenting Stress Index, Short Form (PSI-SF) to verify the magnitude of stress in the parent-child system. Univariate and multivariate analyses were performed to evaluate the association between child and parental characteristics and the presence of warning signs.

RESULTS

The follow-up assessment was completed for 435 infants: 69 (15.8%) presented warning signs: 43 in the pediatrician's assessment and 36 in the M-CHAT-R (10 in both). A total of 16 children (14 with warning signs) received a diagnosis after a specialist evaluation. Being male (OR 2.46, 95%CI: 1.23-4.91) and having sleep disorders (OR 2.43, 95% CI 1.17-5.04) was associated with a greater likelihood of warning signs in the multivariate analysis, while reading aloud was a protective factor (not exposed versus exposed (OR = 3.14; 95% CI 1.60-6.17). For 73 children (18.4%), at least one parent tested positive for PSI-SF. An increased prevalence of parental distress was observed in children with warning signs (OR 2.36, 95% CI 1.27-4.37).

CONCLUSIONS

Integrating physician and parental perspectives during well-child visits and in clinical practice appears feasible and can improve the identification of children at risk of developmental disorders.

Economic impacts of the COVID-19 pandemic on families of children with autism and other developmental disabilities

Background

To control the spread of the coronavirus disease (COVID-19), many jurisdictions throughout the world enacted public health measures that had vast socio-economic implications. In emergency situations, families of children with developmental disabilities (DDs), including autism, may experience increased difficulty accessing therapies, economic hardship, and caregiver stress, with the potential to exacerbate autism symptoms. Yet, limited research exists on the economic impacts of the COVID-19 pandemic on families of children with autism or another DD compared to families of children from the general population.

Objectives

To assess impact of the COVID-19 pandemic related to parental employment and economic difficulties in families of children with autism, another DD, and in the general population, considering potential modification by socioeconomic disadvantage before the pandemic and levels of child behavioral and emotional problems.

Methods

The Study to Explore Early Development (SEED) is a multi-site, multi-phase, case-control study of young children with autism or another DD as compared to a population comparison group (POP). During January-July 2021, a COVID-19 Impact Assessment Questionnaire was sent to eligible participants (n=1,789) who had enrolled in SEED Phase 3 from September 2017-March 2020. Parents completed a questionnaire on impacts of the pandemic in 2020 and completed the Child Behavior Checklist (CBCL) to measure behavioral and emotional health of their child during this time. Multiple logistic regression models were built for employment reduction, increased remote work, difficulty paying bills, or fear of losing their home. Covariates include group status (autism, DD, POP), household income at enrollment, child's race and ethnicity, and binary CBCL Total Problems T-score (<60 vs. ≥60). Unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.

Results

The study included 274 children with autism, 368 children with another DD, and 385 POP children. The mean age of 6.1 years (standard deviation, 0.8) at the COVID-19 Impact Assessment did not differ between study groups. Parents of children with autism were less likely to transition to remote work (aOR [95% CI] = 0.6 [0.4, 1.0]) and more likely to report difficulty paying bills during the pandemic (1.8 [1.2, 2.9]) relative to parents of POP children. Lower income was associated with greater employment reduction, difficulty paying bills, and fear of losing their home, but inversely associated with transitioning to remote work. Parents of non-Hispanic (NH) Black children experienced greater employment reduction compared to parents of NH White children (1.9 [1.1, 3.0]). Parents from racial and ethnic minority groups were more likely to experience difficulty paying bills and fear losing their home, relative to NH White parents. Caregivers of children with CBCL scores in the clinical range were more likely to fear losing their home (2.1 [1.3, 3.4]).

Conclusion

These findings suggest that families of children with autism, families of lower socio-economic status, and families of racial and ethnic minority groups experienced fewer work flexibilities and greater financial distress during the pandemic. Future research can be used to assess if these impacts are sustained over time.

Parenting stress in parents with and without a mental illness and its relationship to psychopathology in children: a multimodal examination

Objective

Children of parents with a mental illness are at heightened risk to develop a mental illness themselves due to genetics and environmental factors. Although parenting stress (PS) is known to be associated with increased psychopathology in parents and children, there is no study investigating PS multimodally in a sample of parents with a mental illness. This study aims to compare PS of parents with and without a mental illness and further to examine the relationship between PS and psychopathology of children.

Methods

Participants were parents with a mental illness and parents without a mental illness and their children aged four to sixteen years. We assessed PS multimodally using a questionnaire, parents' evaluation of children's behavior (relational schemas) and psychophysiological arousal of parents during free speech task.

Results

Self-reported PS was increased, and evaluation of children's behavior was more negative and less positive in parents with a mental illness compared to parents without a mental illness. Children's psychopathology was associated with self-reported PS and relational schemas of parents. Regarding psychophysiological arousal, parents with a mental illness showed reduced reactivity in heart rate from baseline to free speech task in comparison to parents without a mental illness.

Conclusions

Our findings highlight the importance of implementing intervention programs to reduce PS for parents and children. In particular, parents with a mental illness might benefit from specific intervention programs in order to interrupt the transgenerational transmission of mental disorders.

Mother and child mental health over time in children with Autism and/or ADHD in the Longitudinal Study of Australian Children

This study utilised a longitudinal population-based study to explore mother and child mental health trajectories over time from child age 0 to 14 years, between children with ASD, ADHD, or ASD + ADHD. It explored whether a bidirectional relationship between mother psychological distress and child emotional and behavioural problems (EBPs) existed. The birth cohort from the Longitudinal Study of Australian Children was used. Child EBPs were assessed using the Strengths and Difficulties Questionnaire; and mother emotional distress using the Kessler K6. Generalised estimating equations and structured equation modelling was used to understand changes over time, differences between groups and bidirectional relationships. As expected, children with ASD, ADHD or ASD + ADHD had higher EBPs than children without, and their mothers had higher levels of psychological distress across most time points, but with differing trajectories. Mothers of children with ASD (with or without ADHD) showed increasing psychological distress over time, while mothers of children with ADHD had reducing distress. The bidirectional relationship between mother and child mental health found in children without diagnoses was only partially present in children with ASD/ADHD. Findings highlight support needs and discuss implications for transactional models of parent/child emotional problems in children with neurodevelopmental disorders.

A Longitudinal Study of Maternal Postnatal Bonding and Psychosocial Factors that Contribute to Social-Emotional Development

In this longitudinal study, we examined how maternal bonding and psycho-social factors are associated with social-emotional problems in two-year-old children. Our data came from a birth cohort from which data were collected at four timepoints: prenatally during the third trimester, and postnatally at 3, 8 and 24 months. The participants were 1,667 mothers, of which 943 (56.6%) returned the questionnaire at each timepoint of the longitudinal study. The Children's social-emotional problems were examined using the Brief Infant-Toddler Social and Emotional Assessment. According to linear regression analysis, maternal bonding difficulties at three and eight months, maternal expectations of the unborn baby during pregnancy, and maternal relationships within and outside the family were related to social-emotional problems in children of two years of age. The results highlight the importance of screening mothers who already prenatally have bonding problems or mothers who have bonding problems postnatally to provide effective and targeted intervention support.

Stress, Eating Behavior and Adverse Health in Parents of Young Children with Autism Spectrum Disorder

Mothers of children with Autism Spectrum Disorder (ASD) often experience chronic stress and are at risk for adverse health. However, little is known about fathers, especially when their child is in early childhood. Parenting stress, eating behavior and physical health was evaluated in mothers (n = 48) and fathers (n = 43) of young children (3-7 years) with ASD by questionnaires and physical measurements. Mother's prevalence rates of obesity (39.1%), abdominal obesity (59.6%) and metabolic syndrome (21.6%) were higher than the norm. In fathers, the prevalence rate of clinical parenting stress (33%) was higher than the norm. Parenting stress was positively related to disinhibited eating in mothers, not in fathers. It is crucial to monitor stress and health of parents of children with ASD.

Caregiving Stress Experienced by Parents of Adult Children with Intellectual Disabilities During COVID-19 in Korea

Many of community supports and resources were shattered in the COVID-19 pandemic, leaving parents to navigate caring for their adult child with intellectual disabilities with little support. This study explored caregiving stress experienced by parents of adult children with intellectual disabilities during the COVID-19 pandemic in Korea. In-depth interviews were conducted with 19 parents of an adult child with intellectual disabilities. Thematic analysis yielded two themes: caregiving burden and deteriorating health. Parents bore the brunt of the caregiving burden, spending much of their time helping their adult child with daily activities and managing their challenging behaviors, leaving the caregivers struggling physically and mentally. The heightened caregiver burden and associated deteriorating health among these parents raise serious concerns, indicating a need for immediate support to alleviate these issues and help parents navigate caring for their adult child with intellectual disabilities during the COVID-19 pandemic.

Follow-up care and support to parents of premature children: Multidisciplinary versus regular follow-up care

BACKGROUND

Preterm care involves clinical measures almost exclusively aimed at keeping the preterm alive and ready for discharge from hospital. Children are then enrolled in clinical follow-up care after this stressful period, but mental or specialised care for parents and child is often not embedded in the routine of a neonatal hospital ward and the family is then dependent on institutions for mental health or child health clinics, that is, regular care that is regionally scattered. This study aimed to investigate experiences of parents with regular care and compare them with parents visiting a fixed, specialised, multidisciplinary institute, outside the hospital walls, for preterm follow-up care.

METHODS

A survey was conducted among 56 parents (regular follow-up care N = 26; multidisciplinary follow-up care N = 30) of children born prematurely. The survey consisted out of items like parents' experiences with follow-up care, like the organisation of care, supportive care, environmental support and experienced stress.

RESULTS

Parents receiving multidisciplinary follow-up care reported higher levels of satisfaction with organisation of care (F = 5.45; p = 0.023) and supportive care (F = 11.69; p = 0.001) than parents receiving regular follow-up care. Also, it was found that the extent of support from the social environment alleviated stress but only in parents receiving regular follow-up care (ß = -0.47; p = 0.016).

CONCLUSIONS

The current study findings indicate that experience with follow-up care is valued higher when receiving multidisciplinary care than regular care, and the degree in environmental support alleviates stress in parents receiving regular care.

Depression During the Postpartum Period and Impacts on Parent-Child Relationships: A Narrative Review

Although controversy exists around labels for postpartum depression (PPD), focusing efforts on terms distracts the research community from better understanding the impact of depression on parent-infant relationships. The purpose of this article is to provide a narrative review of research related to how depression experienced in the postpartum period impacts parent-infant relationships. Our review indicates that PPD is pervasive, symptoms often appear during pregnancy, and it has the potential to negatively impact parent-infant relationships. Based on the recent review of literature, intervention efforts should focus on identification and treatment of PPD as early as possible to mitigate detrimental long-term impacts on parent-child relationships.

Associations between media exposure and mental health among children and parents after the Great East Japan Earthquake

Background: Exposure to natural disaster media coverage is associated with mental health problems, but its long-term impacts are still unclear. Also, no study has analysed the psychological impact of exposure to natural disaster media coverage among children who are generally sensitive to threatening events.Objective: We aimed to examine how television images of victims after the 2011 Great East Japan Earthquake were associated with mental health among children and their parents.Methods: In 2012, questionnaires for sociodemographic factors were distributed to 2053 families. Parents who provided written consent were contacted in 2013 and invited to provide information on mental health problems (outcome) and retrospectively provide information on television watching at the time of the earthquake (exposure). We used data from 159 parents who completed the survey as the final sample. We used a dichotomous variable to evaluate exposure to media coverage. Multivariable regression was used to examine the association between exposure to television images of victims and mental health, adjusting for potential confounders. Bias-corrected and accelerated bootstrap confidence intervals (CIs) were used.Results: Exposure to television images of victims was significantly associated with worse psychopathology among children (β, 1.51; 95% CI, 0.07-2.96) and greater psychological distress among their parents (β, 1.49; 95% CI, 0.28-2.70). Child psychopathology and parental psychological distress were significantly correlated (r = 0.36, p < .001).Conclusions: Exposure to television images of disaster victims may produce long-term impacts on mental health among children and their parents. To reduce the likelihood of mental health problems associated with disasters, clinicians may recommend reducing exposure to television images of victims.