Do dyadic interventions impact biomarkers of child health? A state-of-the-science narrative review

BACKGROUND

Early life adversity is related to numerous poor health outcomes in childhood; however, dyadic interventions that promote sensitive and responsive caregiving may protect children from the negative consequences of such exposures. To date, quasi-experimental and randomized controlled trials (RCTs) have examined the impact of dyadic interventions on a range of individual biomarkers in children, which may elucidate the relation between early stress exposure and transdiagnostic risk factors for prospective poor health. However, the content of interventions, analytic strategies, and findings vary widely across studies, obscuring key themes in the science and hindering policy and research efforts.

METHODS

We use a narrative approach to review findings from methodologically rigorous (predominantly RCT) studies of dyadic interventions' impacts on different biomarkers in children, including indicators of the hypothalamic-pituitary-adrenal (HPA) axis, parasympathetic (PNS) and sympathetic nervous systems (SNS), brain development, inflammation, and intracellular DNA processes. We contribute to this important area of inquiry through integrating findings across biological systems and identifying contextual and mechanistic factors to depict the current state of the field.

RESULTS

Evidence suggests dyadic interventions improved PNS functioning and advanced brain maturation. Some studies indicated interventions reduced hair cortisol concentrations, systemic inflammation, and resulted in differences in DNA methylation patterns. Findings did not support main effect-level change in salivary measures of HPA axis activity, SNS activity, or telomere length. Importantly, reviewed studies indicated significant heterogeneity in effects across biological systems, underscoring the importance of contextual factors (e.g., adversity subtype and severity) as potential moderators of effects. Further, findings suggested enhanced parenting behaviors may be a mechanism through which dyadic interventions operate on biomarkers.

CONCLUSIONS

We close with future policy and research directions, emphasizing the promise of biologically-informed dyadic interventions for understanding and ameliorating the effects of early adversity on transdiagnostic biomarkers of health.

Parenting Practices May Buffer the Impact of Adversity on Epigenetic Age Acceleration Among Young Children With Developmental Delays

This study examined whether children exposed to adversity would exhibit lower epigenetic age acceleration in the context of improved parenting. Children with developmental delays and externalizing behavior problems (N = 62; Mage = 36.26 months; 70.97% boys, 29.03% girls; 71% Latinx, 22.6% Black) were drawn from a larger randomized controlled trial (RCT), which randomized them to receive Internet-delivered parent-child interaction therapy (iPCIT; n = 30) or community referrals as usual (RAU; n = 32). Epigenetic age acceleration was estimated with the pediatric buccal epigenetic clock, using saliva. Adversity was assessed using parent, family, and neighborhood-level cumulative-risk indicators. Adversity interacted with Time 2 (T2) observations of positive and negative-parenting practices to predict epigenetic age acceleration 1.5 years later, regardless of treatment assignment. Children exposed to more adversity displayed lower epigenetic age acceleration when parents evidenced increased positive (b = -0.15, p = .001) and decreased negative (b = -0.12, p = .01) parenting practices.

The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training

Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.

The Enduring Importance of Parenting: Caregiving Quality and Fear-Potentiated Startle in Emerging Adults With a Child Maltreatment History

Background: The transition to adulthood is a period of increased risk for emergent psychopathology; emerging adults with a childhood maltreatment history are at risk for poor outcomes. Method: Using a multi-measure, transdisciplinary, cross-sectional design, this study tested whether participant-reported positive parenting, a potential resilience-promoting factor, moderated the association between clinician-rated PTSD symptom severity and a transdiagnostic maladjustment biomarker, fear-potentiated startle (FPS), in a sample of 66 emerging adults (Myears = 18.83, SD = 0.89) with a maltreatment history. We hypothesized that characteristics of effective parenting would moderate the relation between PTSD symptoms and FPS. Results: Results indicated that elevated PTSD, as measured by the CAPS, was associated with a more severe startle reaction. The magnitude of the increase in startle reactivity was moderated by parenting such that those with more positive parenting (Accepting [relative to rejecting]: b = -0.42, p < .001; Psychologically-controlling [relative to autonomy-promoting]: b = 2.96, p = .004) had significantly less reactivity across the task at higher levels of PTSD symptoms. Conclusions: Emerging adults with childhood maltreatment histories, high levels of PTSD symptoms, and who perceive present-day high-quality caregiver support may cope better with novel stressors relative to youth lacking that support, potentially translating to better psychological outcomes.

Does Parenting Explain the Link Between Cumulative SES Risk and Child Problems in the Context of Parental Depression?

The accumulation of socioeconomic stressors, such as being a single parent and having a limited income, is associated with childhood maladjustment and prospective poor health. Evidence suggests both positive and negative parenting strategies (e.g., warmth and praise; criticism and neglect) may account for the relationship between socioeconomic adversity and child outcomes. However, despite the common co-occurrence of parental depression and socioeconomic stress, models of cumulative socioeconomic risk and parenting have yet to be tested in parents who are also coping with depression. In a sample of children whose parents have a history of depression, this study extends findings from a previous report (i.e., Sullivan et al. in J Fam Psychol 33:883-893, 2019) to test whether behavioral observations of parenting account for the association between a cumulative risk index of socioeconomic stress and child psychological problems in the same sample of 179 children (M_age = 11.46 years, SD_age = 2.00) of parents with depression. Both positive and negative parenting accounted for the relationship between socioeconomic risk and both child- and parent-reported externalizing problems, whereas no evidence emerged for parenting accounting for the relation between cumulative risk and internalizing problems. This study highlights the central role socioeconomic stress plays in child maladjustment among parents coping with depression, as well as how parenting may be a critical mechanism linking socioeconomic stress and child externalizing problems.

COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions

The SARS-COV-2 (COVID-19) pandemic and associated social distancing guidelines have accelerated the telehealth transition in mental health. For those providing Behavioral Parent Training (BPT), this transition has called for moving sessions that are traditionally clinic-based, active, and directive to engaging, supporting, and treating families of children with behavior disorders remotely in their homes. Whereas many difficulties accompany this transition, the lessons learned during the current public health crisis have the potential to transform BPT service delivery on a large scale in ways that address many of its long-standing limitations. We describe both challenges and opportunities and consider the possibilities inherent in a large scale BPT service delivery model capable of increasing the reach and impact of evidence-based treatment for all families.

The Longitudinal Influence of Caregiver Dispositional Mindful Attention on Mindful Parenting, Parenting Practices, and Youth Psychopathology

Objectives

Although much research examining youth psychopathology from an ecological family systems theoretical framework has highlighted negative or pathological parental characteristics, it is important to identify and explore beneficial parent characteristics, such as mindful attention and awareness, that may be related to youth mental health. Dispositional mindfulness has been related, in cross-sectional research, to higher levels of mindful parenting, which impacts positive and negative parenting and, in turn, offspring internalizing and externalizing symptoms. The current study expands this work by examining associations among caregiver dispositional mindful attention, mindful parenting, parenting behaviors, and youth psychopathology in a short-term longitudinal model and by testing potential moderators.

Methods

A sample of 564 parents (60% mothers) of children between the ages of 3 and 17 reported on their dispositional mindful attention, mindful parenting, positive and negative parenting practices, and their youth's internalizing and externalizing symptoms at 4 time points over a 12-month period.

Results

The structural equation model indicated that higher levels of baseline caregiver dispositional mindful attention were related to higher levels of mindful parenting at 4 months. Higher levels of mindful parenting were associated with higher levels of positive parenting and lower levels of negative parenting practices at 8 months. Finally, lower levels of negative parenting practices were related to lower levels of internalizing and externalizing symptoms at 12 months. Moderator analyses suggested that all prospective associations in the model were equivalent for mothers and fathers, boys and girls, and children and adolescents.

Conclusions

Findings shed light on the importance of considering caregiver dispositional mindful attention as it relates to parenting behaviors and youth mental health.

Child Hostility toward a Parent with a History of Depression and Family Functioning

Family dysfunction has been associated with both child externalizing problems, including hostility, and parent depression or depressive symptoms. Research investigating child hostility directed toward a parent with a history of depression is absent, yet it may be associated with especially high levels of family dysfunction. The current study aimed to assess (1) the relation between observed child hostility, measured by the Iowa Family Interaction Rating Scale, toward such a parent and child-reported family dysfunction, using the Family Assessment Device, and (2) whether current parent depressive symptoms, measured by the Beck Depression Inventory-II, moderated this association. We hypothesized that child hostility would negatively relate to family functioning, even after controlling for parent depressive symptoms, and that parent depressive symptoms would moderate this association in that high levels of such symptoms would strengthen the negative relation between child hostility and family functioning. To address these hypotheses, hierarchical regression and moderation analyses were conducted in SPSS. Results indicated that higher levels of child hostility related to a more dysfunctional family environment. Furthermore, although speculative as the interaction of child hostility toward a parent and parent depressive symptoms only approached conventional levels of significance, low levels of both constructs may protect against family dysfunction. Findings from this study may inform new methods of family intervention and prevention, as well as ways of identifying families most at risk for dysfunction.

Clinical features of scrupulosity: Associated symptoms and comorbidity

OBJECTIVE

Scrupulosity is a manifestation of obsessive-compulsive disorder (OCD) characterized by religious or moral core fears. Clinicians often struggle to treat scrupulosity, which may be associated with several features known to predict poor treatment outcome. The purpose of this study was to examine these features in participants with scrupulous OCD, contamination OCD, and healthy controls.

METHOD

A total of 68 participants (57.4% women, age_mean  = 34.01) completed diagnostic interviews, and measures of symptoms and quality-of-life.

RESULTS

Relative to comparison groups, scrupulous participants had higher rates of obsessive-compulsive personality disorder, more severe schizotypal symptoms, and more severe symptoms of depression. In addition, OCD severity was strongly associated with poor insight in the scrupulous group. Both OCD groups reported poorer quality of life than did healthy controls.

CONCLUSIONS

Clinicians working with scrupulous individuals may enhance the efficacy of treatment in this challenging population by assessing carefully for these features, and incorporating treatment elements that address them.

Does interparental conflict decrease following changes in observed parenting from a preventive intervention program?

Interparental conflict, which is common among families where a parent has a history of Major Depressive Disorder, is associated with deficits in parenting. Models of family functioning propose that interparental conflict and parenting behaviors are transactional in nature. Given the interdependent nature of family systems, increases in positive parenting practices may lead to subsequent decreases in interparental conflict. The current study was a secondary analysis of data from a preventive intervention to improve parenting, child coping skills, and child behavior in families with a history of parental depression. We hypothesized that increases in positive parenting strategies would be associated with decreases in interparental conflict 12 months later. Results supported the study hypothesis. Findings underscored the interdependent nature of parent-child and parent-parent subsystems.

Parental perceptions of technology and technology-focused parenting: Associations with youth screen time

In the present study we propose a model linking parental perceptions of technology to technology-related parenting strategies to youth screen time, and, finally, to internalizing and externalizing problem behaviors. Participants were 615 parents drawn from three community samples of families with children across three developmental stages: young childhood, middle childhood, and adolescence. The model was tested at each stage with the strongest support emerging in the young childhood sample. One component of parental perceptions of technology, perceived efficacy, was related to technology-related parenting strategies across developmental stages. However, the association of these strategies to child screen time and, in turn, problem behaviors, diminished as children increased in age. Implications for intervention are considered.