Pre-COVID respiratory sinus arrhythmia moderates associations between COVID-19 stress and child externalizing behaviors: Testing neurobiological stress theories

Exposure to stress related to the COVID-19 pandemic contributes to psychopathology risk, yet not all children are negatively impacted. The current study examined a parasympathetic biomarker of stress sensitivity, respiratory sinus arrhythmia (RSA), as a moderator of the effects of exposure to pandemic stress on child internalizing and externalizing behaviors in a sample of children experiencing economic marginalization. Three to five years pre-pandemic, when children were preschool-aged, RSA during baseline and a challenging parent-child interaction were collected. Mid-pandemic, between November 2020 and March 2021, children's exposure to pandemic stress and internalizing and externalizing behaviors were collected. Results demonstrated that children who, pre-pandemic, demonstrated blunted parasympathetic reactivity (i.e., no change in RSA relative to baseline) during the dyadic challenge exhibited elevated risk for externalizing behaviors mid-pandemic. Further, this risk was greatest for children exposed to high and moderate levels of pandemic stress. Consistent with diathesis stress and polyvagal frameworks, these conditional effects suggest that blunted parasympathetic reactivity in response to stress in early childhood may escalate the development of externalizing behaviors following stress exposure at school age.

The Protective Effects of Parent-Child Emotion Dialogues for Preschoolers Exposed to Intimate Partner Violence

Exposure to intimate partner violence (IPV) during early childhood is associated with self-regulation difficulties. Caregivers can facilitate children's self-regulation through emotion-focused conversations about past experiences, buffering downstream effects. However, caregivers experiencing violence may avoid distressing emotions activated by such conversations. This paper explores two different models of relational stress responses, one involving indirect effects (i.e. spillover effects) and the other moderation (i.e. buffering effects). Mothers (n = 117), oversampled for violence exposure, self-reported on IPV and participated in an emotional reminiscing task with children (aged 3-5 years); narratives were coded for maternal sensitive guidance. Maternal sensitive guidance was related to children's self-regulation. Sensitive guidance did not have indirect effects in the association between IPV exposure and children's self-regulation, but did buffer the association between physical IPV and self-regulation; this pattern did not hold for psychological IPV. Results suggest sensitive guidance during reminiscing may promote self-regulation in contexts of high IPV.

Harnessing Virtual Mom Power: Process and Outcomes of a Pilot Telehealth Adaptation of a Multifamily, Attachment-Based Intervention

Objective

The COVID-19 pandemic and mitigation strategies amplified racial and income-based health disparities, profoundly shifted family life, and altered delivery systems for support services. We report pilot data from a telehealth adaptation of Mom Power, an evidence-based, attachment-informed multifamily preventive intervention (clinicaltrials.gov: de-identified).

Method

Virtual Mom Power (VMP), adapted for economically marginalized, predominantly Black mothers and their young children (n = 9) was implemented in New Orleans, an early COVID-19 hotspot with an entrenched history of structural racism and trauma. We outline our approach to adaptation of curriculum and service delivery, using a trauma-informed lens.

Results

Maternal reports of maternal and child functioning from pre to post were consistent with improvements in maternal depressive and posttraumatic stress symptoms and child competence, comparable to outcomes from in-person trials. Feasibility and acceptability data were strong.

Discussion

Preliminary results and reflections on process suggest that telehealth service delivery of a multifamily preventive intervention, with attention to decreasing barriers to online access and consideration of culture and context, facilitated engagement while maintaining fidelity and effects on intervention targets. Future research using larger samples, randomized controlled design, and multi-method assessment should continue to guide dissemination of reflective, group-based telehealth parenting programs.

Parental Emotion Regulation and Mentalization in Families of Children With ADHD

Objective: The aim of this study is to examine the role of parental emotion regulation (ER) and parental mentalization as possible contributors to hostile and coercive parenting in families of children with ADHD. Method: Seventy-four Israeli families (64 mothers and 48 fathers) seeking parent training for child ADHD completed measures during the intake session. Measures included parental ER; parental mentalization; hostile, coercive, and submissive parenting; and child symptoms. Results: Findings suggested a relationship between parental ER and coercive parenting independent of child age, symptom level, and parental mentalization. Parental mentalization appeared to buffer against hostility specifically among parents with low ER capacities. Patterns were parallel for mothers and fathers. Conclusion: Study findings highlight the importance of evaluating and addressing parental ER in interventions attempting to reduce coercive parenting. The findings also highlight the potential role of parental mentalization as a protective mechanism against hostile parenting in families of children with ADHD.

Linking preschoolers' parasympathetic activity to maternal early adversity and child behavior: An intergenerational perspective

Increasing evidence suggests intergenerational effects of maternal early adversity on offspring self-regulation. Prior work has demonstrated associations between maternal adverse childhood experiences (ACEs) and infant respiratory sinus arrhythmia (RSA), a parasympathetic biomarker associated with emotional and behavioral self-regulation. The present study examined these associations and additional potential pathways including children's violence exposure and maternal psychopathology among 123 biological mother-child dyads. Families were low-income and oversampled for violence exposure; children were 3-5 years old. RSA was examined during dyadic interaction using latent growth curve modeling (LGCM). On average, females exhibited greater RSA reactivity. Greater RSA withdrawal across the interaction was associated with greater child negative affect during the interaction, linking RSA reactivity to concurrent child behavior. Consistent with previous findings among infants, high maternal ACEs were associated with lower child RSA at task initiation but not with RSA reactivity across the interaction. Findings suggest that the association between high maternal ACEs and a lower set point for offspring RSA persists into the early childhood period, beyond the influence of maternal psychopathology and children's own violence exposure. These data provide further evidence for the biological embedding of maternal early adversity across generations as well as for the relevance of RSA to child behavioral regulation.

Family social support buffers the intergenerational association of maternal adverse childhood experiences and preschoolers' externalizing behavior

Despite previous work demonstrating that an accumulation of maternal adverse childhood experiences (ACEs) is associated with negative health outcomes across generations, few studies have investigated protective factors beyond the parent-child dyad in the intergenerational transmission of adversity. The current study extends previous findings by examining maternal family social support as a culturally relevant buffer in the association between mothers' ACEs and her children's behavior problems in early childhood. Participants included 121 African American mothers and their preschool-aged children experiencing high sociodemographic risk. Mothers completed questionnaires on ACEs, perceived family social support, children's violence exposure and behavior problems as well as relevant demographics. Maternal family social support moderated the relation between maternal ACEs and children's externalizing behaviors (b = -.14, p < .01), such that children of mothers who reported high ACEs and also moderate to high family social support did not show elevated externalizing behaviors; this pattern was not observed for internalizing behaviors (b = -.06, p = .06). Additionally, the intergenerational buffering effects of family social support were observed above and beyond mothers' psychopathology and children's exposure to violence. These results have implications for culturally relevant prevention and intervention efforts supporting African American mothers with young children that reflect resiliency in the face of disparities across generations. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Emotion Regulation and Parent Distress: Getting at the Heart of Sensitive Parenting among Parents of Preschool Children Experiencing High Sociodemographic Risk

OBJECTIVES

Sensitive parenting requires modulation of emotions in order to effectively organize and orient behavioral responses. There is considerable evidence that psychological distress can impair sensitive parenting practices, and also that psychological distress is associated with deficits in emotion regulation capacities. The negative effect that psychological distress has on parents' emotion regulation capacities may be a mechanistic pathway through which psychological distress impacts parenting, as dysregulated emotions may be more proximal to parenting behaviors than distress itself; however, this specific link between psychological distress, emotion regulation, and parenting is not often examined in parenting models.

METHODS

The current study tested these relations in a high sociodemographic risk community-sample, oversampled for violence exposure, of caregivers of preschoolers. Caregivers self-reported on their psychological distress and emotion regulation difficulties. Parent sensitivity was assessed via observations of parent-child interactions.

RESULTS

Results indicated that difficulties in emotion regulation were a mediator for the relation between parents' psychological distress and sensitive parenting behaviors. Difficulties in emotion regulation predicted decreased sensitivity above and beyond the effect of psychological distress.

CONCLUSIONS

These findings emphasize the importance of regulation of emotional reactions in order to orient and engage in sensitive parenting behaviors. Additionally, they suggest clinically that supporting parents' emotion regulation capacities specifically may promote more sensitive parenting in contexts of parental psychological distress.

Caregiver Self-Reports and Reporting of Their Preschoolers' Trauma Exposure: Discordance Across Assessment Methods

Nearly half of preschool-aged children from low-income families in the United States have been exposed to potentially traumatic events (PTEs), yet few are identified or receive trauma-focused mental health care. Given the critical need to accurately and efficiently identify PTE-exposed individuals, the current study examined discordant caregiver self-reporting of PTE exposure and caregiver reporting of child PTE exposure across two assessment methods: checklist and interview. Research has demonstrated significant cross-method discrepancies among adults reporting stressful life experiences, but examinations of caregiver reporting for their young children have not been conducted. Further, given their possible impact on reporting patterns, caregiver and child characteristics were examined in relation to discordant caregiver reporting by trauma type. Participants were 64 low-income, racially and ethnically diverse caregivers and their preschool-aged children from a Northeastern US city. Caregivers reported self and child PTE exposure via checklist and semi-structured interview. Cross-method discordance for caregiver and child exposure by trauma type ranged from 10.9% to 46.9% (Cohen's kappa =.06-.70). Caregiver race and education were associated with discordant reporting, as were caregiver and child psychopathology. Lower levels of caregiver psychopathology were associated with discordant caregiver reporting of their own exposure, whereas higher levels were associated with discordant caregiver reporting of child exposure. Discordant caregiver reporting of PTE exposure varies by assessment format and trauma type and is differentially related to caregiver demographics and caregiver and child psychopathology. Associations between assessment methods, individual characteristics, and reporting should be considered when assessing PTE exposure to support service engagement and targeted treatment.

Parental insightfulness and parenting behavior: a two-dimensional analysis of parent contributions to child cognitive outcomes

Utilizing a two-dimensional model of parenting emphasizing both (1) proximity seeking and (2) exploration, consistent with a conceptual framework rooted in attachment theory, the relations between parental insightfulness, observed parenting, and child cognitive outcomes were investigated in a low-income sample of 64 of caregivers and their young 3-5-year-old children. Specifically, observed parental sensitivity (proximity seeking) and intrusiveness (exploration) and parental insightfulness assessed dimensionally to capture Positive Insight and Focus on Child were examined in relation to child cognitive outcomes. Parental intrusiveness was negatively correlated with cognitive performance; however, parental sensitivity was not associated with child cognitive outcomes. Parents' capacity to remain child-focused during the Insightfulness Assessment was negatively correlated with observed intrusiveness and was associated with child cognitive performance. These results suggest unique contributions of dimensions of parental insightfulness and parenting behaviors to child cognitive outcomes - specifically, parents' capacity to remain focused on children's experience during the Insightfulness Assessment and nonintrusive parenting behavior, which may reflect strategies to support children's exploration.

Impact of Physical Abuse on Internalizing Behavior Across Generations

This study investigated the multigenerational impact of mothers' own exposure to physical maltreatment on internalizing symptoms in her child after accounting for her parenting practices, depression, and the child's own exposure to stressful life events. Children (n = 101, ages 5-16), predominantly African American, were recruited into this cross sectional study using ethnographic mapping and targeted sampling for high-risk neighborhoods. Mothers reported retrospectively on their own exposure to physical maltreatment in childhood, their parenting practices, as well as current depressive symptoms. Maternal report of her child's exposure to stressful life events and child behavior was also collected. Maternal childhood exposure to physical maltreatment was significantly associated with her child's internalizing symptoms (p = .004); this effect remained after accounting for child sex, maternal depressive symptoms, harsh parenting practices, and the child's own exposure to stressful life events. Formal tests of mediation through these pathways were non-significant. Findings suggest mothers' experience of childhood maltreatment contributes uniquely to children's internalizing symptoms, potentially through previously uncharacterized pathways. Examination of additional behavioral, psychosocial and biological pathways may help better describe the multi-generational effects of child maltreatment.

A Pilot Study Examining the Effectiveness of the PEERS Program on Social Skills and Anxiety in Adolescents with Autism Spectrum Disorder

The Program for the Evaluation of the Enrichment of Relational Skills (PEERS), a social skills intervention for high functioning adolescents with autism spectrum disorder (ASD), has been proven efficacious in randomized control trials. However, the effectiveness of the PEERS program in community settings has not been studied. The present small-scale pilot study examined the effectiveness of the PEERS program in a community setting. Five adolescents and their caregivers participated in the PEERS intervention. Results indicated that the adolescents showed significant improvement in their social engagement, social cognition, social communication, social motivation, and knowledge of PEERS skills and concepts from pre- to post-intervention. Furthermore, adolescents showed significant reductions in their internalizing and autistic symptoms from pre- to post-intervention. The findings from this small-scale pilot study support the effectiveness of the PEERS program in community-based settings.

Sex Differences in the Contribution of Respiratory Sinus Arrhythmia and Trauma to Children's Psychopathology

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co-contribution of exposure to potentially traumatic events (PTEs), baseline RSA, and RSA withdrawal to internalizing and externalizing behavior in a sample of primarily African American youth (n = 92) recruited using neighborhood mapping techniques from communities high in epidemiological indicators of adversity. Exposure to PTEs was associated with lower baseline RSA. Complex interactions were observed between sex of the child, baseline RSA and RSA withdrawal, and PTE exposure predicting to internalizing behaviors. Among girls with high (4+) levels of PTEs, high baseline RSA and RSA withdrawal predicted higher internalizing; for RSA withdrawal only, the inverse was observed for girls with low PTE exposure, for whom high RSA withdrawal predicted lower internalizing. No associations were observed from RSA to externalizing, or among boys to internalizing. Findings are consistent with distinct patterns among primarily African American samples and suggest the need for sex-specific conceptualizations of the link between environmental adversity, physiological reactivity, and internalizing behaviors.

Violence in context: Embracing an ecological approach to violent media exposure

This commentary expands on Anderson, Bushman, Donnerstein, Hummer, and Warburton's agenda for minimizing the impacts of violent media exposure (VME) on youth aggression. We argue that in order to effectively intervene in the development of aggression and other maladaptive traits, researchers and policymakers should take an ecological, developmental psychopathology approach to understanding children's exposure to VME within developmental, relational, environmental, and cultural contexts. Such a framework holds the most promise for identifying at-risk groups, establishing targets of intervention, and testing mechanisms of change.

Age and Adaptive Functioning in Children and Adolescents with ASD: The Effects of Intellectual Functioning and ASD Symptom Severity

The present study examined the moderating effects of intellectual functioning and ASD symptom severity on the relation between age and adaptive functioning in 220 youth with autism spectrum disorder (ASD). Regression analysis indicated that intellectual functioning and ASD symptom severity moderated the relation between age and adaptive functioning. For younger children with lower intellectual functioning, higher ASD symptom severity was associated with better adaptive functioning than that of those with lower ASD symptom severity. Similarly, for older children with higher intellectual functioning, higher ASD symptom severity was associated with better adaptive functioning than that of those with lower ASD symptom severity. Analyses by subscales suggest that this pattern is driven by the Conceptual subscale. Clinical and research implications are discussed.

"Am I Doing the Right Thing?": Pathways to Parenting a Gender Variant Child

Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, "what is the experience of parents who raise a GV or transgender child?" Eight mothers and three fathers of GV male and female children (ages 5-13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.

Caregiver insightfulness and young children's violence exposure: testing a relational model of risk and resilience

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children's exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children's behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence.

Widening the circle of security: a quasi-experimental evaluation of attachment-based professional development for family child care providers

This pilot program evaluation was undertaken to examine the effectiveness of an attachment-based, group professional-development experience, Circle of Security-Parenting, on family childcare (FCC) providers' psychological resources and self-efficacy in managing children's challenging behaviors and supporting children's socioemotional development. Licensed FCC providers with children actively in their care (n = 34) self-selected into the program, offered in English and Spanish through a regional support network for FCC providers; a comparison group of providers was recruited from the state database of licensed providers (n = 17). A significant Time × Group interaction was observed for self-efficacy in managing challenging behaviors, F(1, 46) = 30.59, p = .000, partial η(2) = .40, with participating providers' mean self-efficacy scores increasing, p = .000, d = .78, while comparison providers' decreased, p = .003, d = 1.40. Mean depressive symptoms decreased over time for both groups whereas job stress-related resources were stable over time in both groups. Patterns of association were found between providers' self-report of difficulties considering children's mental states and depressive symptoms, job stress resources, and self-efficacy. Limitations and implications for future research are reviewed, including the impact of conducting this work within an organized support network for FCC providers.

Growth trajectories of early aggression, overactivity, and inattention: Relations to second-grade reading

The link between behavior problems and low academic achievement is well established, but few studies have examined longitudinal relations between early externalizing behaviors before school entry and low academic achievement following transition to formal schooling. Early inattention has been particularly overlooked, despite strong associations between inattention and reading difficulties later in development. Trajectories of infant and toddler aggression, overactivity, and inattention, developed from parent reports about 1- to 3-year-old children, were examined as predictors of direct assessments of 2nd-grade reading in an at-risk epidemiological study subsample (N = 359). Reports of inattentive and overactive behaviors at ages 1-3 years and changes in inattention through toddlerhood predicted reading achievement in 2nd grade. A parallel process model suggested that the effects of early inattention on reading appear to be most robust. Findings underscore the contribution of social-emotional development to school readiness and the importance of early identification of children with externalizing problems, as early interventions designed to reduce externalizing problems may improve later reading skills.

Preschool children's observed disruptive behavior: variations across sex, interactional context, and disruptive psychopathology

Sex differences in disruptive behavior and sensitivity to social context are documented, but the intersection between them is rarely examined empirically. This report focuses on sex differences in observed disruptive behavior across interactional contexts and diagnostic status. Preschoolers (n = 327) were classified as nondisruptive (51%), clinically at risk (26%), and disruptive (23%) using parent and teacher reports on developmentally validated measures of disruptive behavior and impairment. Observed disruptive behavior was measured with the Disruptive Behavior Diagnostic Observation Schedule, a developmentally sensitive observational paradigm characterizing variation in preschoolers' disruptive behavior across two interactional contexts (parent and examiner). Repeated measures analyses of variance revealed a three-way interaction of child sex by diagnostic status by interactional context (F = 9.81, p < .001). Disruptive boys were the only subgroup whose behavior was not sensitive to interactional context: They displayed comparable levels of disruptive behavior with parents and examiners. In contrast, disruptive girls demonstrated the strongest context effect of any group. Specifically, with the examiner, disruptive girls' behavior was comparable to nondisruptive boys (though still more elevated than nondisruptive girls). However, in interactions with their mothers, disruptive girls displayed the highest rates of disruptive behavior of any subgroup in any context, although the difference between disruptive boys and disruptive girls in this context was not statistically significant. Findings suggest the importance of sex-specific conceptualizations of disruptive behavior in young children that take patterns across social contexts into account.

Prevalence of DSM-IV disorder in a representative, healthy birth cohort at school entry: sociodemographic risks and social adaptation

OBJECTIVE

The aims of this paper are as follows: to present past-year prevalence data for DSM-IV disorders in the early elementary school years; to examine the impact of impairment criteria on prevalence estimates; to examine the relation of sociodemographic and psychosocial risk factors to disorders; and to explore associations between "internalizing" and "externalizing" disorders and social competence and family burden as further validation of the impairing nature of these disorders.

METHOD

As part of a longitudinal representative population study of children born healthy between July 1995 and September 1997 in the New Haven-Meriden Standard Metropolitan Statistical Area of the 1990 Census (n = 1,329), parents of a subsample enriched for child psychopathology (n = 442; 77.6% response rate, 69.5% of eligible sample) were interviewed in the child's kindergarten or first-grade year with the Diagnostic Interview Schedule for Children, Version IV (DISC-IV). Parents were surveyed about sociodemographic and psychosocial characteristics, and both parents and teachers were surveyed about social competence.

RESULTS

Approximately one in five (21.6 %) children met criteria for psychiatric disorder(s) with impairment. Sociodemographic and psychosocial correlates included persistent poverty beginning in early childhood, limited parental education, low family expressiveness, stressful life events, and violence exposure. Finally, diagnostic status was significantly associated with poorer social competence and family burden.

CONCLUSIONS

That approximately one in five children evidenced a psychiatric disorder with impairment during the transition to formal schooling highlights the importance of integrating psychiatric epidemiological and developmental approaches to inform conversations about school readiness and intervention planning.

Stability and individual change in depressive symptoms among mothers raising young children with ASD: maternal and child correlates

Mothers raising children with Autism Spectrum Disorders (ASD) evidence elevated depressive symptoms, but symptom stability has not been examined. Mothers (N=143) of toddlers with ASD (77% boys) were enrolled and assessed when their children were 18 to 33 months old and followed annually for 2 years. Multilevel modeling revealed no significant change in group depressive symptom level, which was in the moderately elevated range (Intercept=13.67; SE=.96). In contrast, there was significant individual variation in change over time. Child problem behaviors and delayed competence, maternal anxiety symptoms and angry/hostile mood, low parenting efficacy and social supports, and coping styles were associated with depression severity. Only maternal anxiety and parenting efficacy predicted individual change. Many mothers do not appear to adapt, supporting the need for early intervention for maternal well-being.