Impact of Well-being Interventions for Siblings of Children and Young People with a Chronic Physical or Mental Health Condition: A Systematic Review and Meta-Analysis

Siblings of children and young people with a chronic illness are at increased risk of poor psychological functioning. A number of studies have attempted to implement and evaluate interventions targeting the psychological well-being of this at-risk group. This systematic review summarises the evidence regarding psychological functioning of siblings following an intervention targeting their well-being. The meta-analysis considered behaviour and knowledge, two of the most frequently studied outcomes. The following databases were used: PsycINFO, EMBASE, CINAHL, PubMed, Scopus and Web of Science. Seventeen studies were eligible to be included in the systematic review and eight in the meta-analysis. Results from the systematic review reflected the inconsistency of intervention evaluations in this area with a high level of heterogeneity and a total of 23 outcomes considered across the 17 included studies. The meta-analysis estimated effect sizes using a standardised mean difference (SMD) approach. Pre-post analysis suggested significant improvement in behavioural outcomes and knowledge of their sibling’s health conditions with a SMD of ? 0.44 [95% CI (? 0.6, ? 0.29); p = 0.000] and 0.69 [(95% CI = 0.42, 0.96); p = 0.000], respectively. The SMD was not significant for behavioural outcomes when considering treatment–control studies. In conclusion, the findings suggest interventions for well-being have a positive effect on the psychological functioning of siblings of children and young people with a chronic illness, but their specificity needs to be established. There is a need for further, more methodologically robust research in this area.     

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children,Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients’ specific needs.     

Foster Families: A Systematic Review of Intention and Retention Factors

Background: Compared to residential care, family foster care is the preferable type of alternative care for neglected or abused children as it provides a familiar context that supports children’s developmental needs. New foster families are needed to care for these children. Objective: This systematic review aims to provide a critical analysis of the literature, identifying factors that explain the intention to become and to continue as a foster family. This review was performed following the PRISMA checklist and guidelines, through a search conducted in the following databases (no restrictions were made): PsycArticles, PsycInfo, Psychology and Behavioral Sciences Collection, Academic Search Complete, ERIC, Scopus, and Web of Science. Study eligibility: The review includes empirical quantitative and/or qualitative studies in English, Portuguese, and Spanish, with community and/or foster parents’ samples and explores the factors for becoming and/or retention of foster parents. Results: Forty-nine studies were included. The results revealed that the intention to become a foster parent is largely influenced by motivational factors, personal and family characteristics, individual values and beliefs, social context influences, and perceived familiarity with the child protection system. The retention of foster families is closely related to factors within the child protection system, personal or family characteristics, foster child characteristics, and placement challenges. The relationship with agencies and professional support stands out as the most important factors. Limitations and Implications: This review did not include studies focused on children with specific needs and characteristics, and future research should consider the particular challenges of fostering this group. Practice implications of these findings for the recruitment, selection, and retention of foster families will be discussed.

     

Transactional Paths Between Children and Parents in Pediatric Asthma: Associations Between Family Relationships and Adaptation

The particular challenges posed by pediatric asthma may have a negative impact on the adaptation of children and their parents. From a transactional approach it is important to examine how reciprocal links between children and parents contribute to explain their adaptation and under which conditions these associations occur. This cross-sectional study aimed at examining the direct and indirect links between children’s and parents’ perceptions of family relationships and adaptation, separately (within-subjects) and across participants (cross-lagged effects), and the role of asthma severity in moderating these associations. The sample comprised 257 children with asthma, aged between 8 and 18 years-old, and one of their parents. Both family members completed self-reported questionnaires on family relationships (cohesion and expressiveness) and adaptation indicators (quality of life and psychological functioning). Physicians assessed asthma severity. Structural Equation Modeling was used to test within-subjects and cross-lagged paths between children’s and parents’ family relationships and adaptation. The model explained 47 % of children’s and 30 % of parents’ adaptation: family relationships were positively associated with adaptation, directly for children and parents, and indirectly across family members. Asthma severity moderated the association between family relationships and health-related quality of life for children: stronger associations were observed in the presence of persistent asthma. These results highlight the need of including psychological interventions in pediatric healthcare focused on family relationships as potential targets for improving children’s and parents’ quality of life and psychological functioning, and identified the children with persistent asthma as a group that would most benefit from family-based interventions.     

Negative and Positive Emotion Responses to Daily School Problems: Links to Internalizing and Externalizing Symptoms

Examining emotion reactivity and recovery following minor problems in daily life can deepen our understanding of how stress affects child mental health. This study assessed children’s immediate and delayed emotion responses to daily problems at school, and examined their correlations with psychological symptoms. On 5 consecutive weekdays, 83 fifth graders (M = 10.91 years, SD = 0.53, 51% female) completed brief diary forms 5 times per day, providing repeated ratings of school problems and emotions. They also completed a one-time questionnaire about symptoms of depression, and parents and teachers rated child internalizing and externalizing problems. Using multilevel modeling techniques, we assessed within-person daily associations between school problems and negative and positive emotion at school and again at bedtime. On days when children experienced more school problems, they reported more negative emotion and less positive emotion at school, and at bedtime. There were reliable individual differences in emotion reactivity and recovery. Individual-level indices of emotion responses derived from multilevel models were correlated with child psychological symptoms. Children who showed more negative emotion reactivity reported more depressive symptoms. Multiple informants described fewer internalizing problems among children who showed better recovery by bedtime, even after controlling for children’s average levels of exposure to school problems. Diary methods can extend our understanding of the links between daily stress, emotions and child mental health. Recovery following stressful events may be an important target of research and intervention for child internalizing problems.     

The Role of Family Income Dynamics in Predicting Trajectories of Internalizing and Externalizing Problems

Economic disparities in children’s behavioral functioning have been observed in prior research. Yet, studies have ignored important perspectives from developmental psychopathology and have not delineated how aspects of income dynamics (i.e., cumulative family income versus income volatility) differentially relate to behavior problems. To address these limitations, the current study examined how both cumulative income and income volatility predict trajectories of children’s internalizing and externalizing problems from kindergarten through fifth grade in a nationally representative sample of 10,900 children (51.4 % male). Results showed four distinct trajectories of internalizing problems and five distinct externalizing trajectories. Family income dynamics were related to trajectory group membership. Specifically, increased cumulative income decreased risk of membership in mid-increasing and mid-stable internalizing groups, and children whose families experienced multiple waves of income loss were 2.4 times as likely to be in the mid-increasing group instead of the low-stable group. With respect to externalizing, higher cumulative income increased the likelihood of belonging in the group exhibiting stably low externalizing problems. Experiencing income loss increased the risk of belonging in the trajectory group exhibiting chronically high externalizing behaviors. These results enhance our knowledge of the role of family income in the development of behavior problems.     

Psychological MaltreatmentL

SUMMARY

Current issues regarding the definition of psychological maltreatment and its impact on children are discussed. The argument is made that psychological maltreatment can be understood as parenting and socialization practices that leave a child's basic psychological needs unmet, and that children exposed to interparental violence should be viewed as victims of psychological maltreatment. A needs analysis based on developmental theory and research is presented as a context within which to view psychological maltreatment. Using that conceptualization, research findings concerning the behavioral, cognitive, and social-emotional difficulties of children exposed to marital violence are examined. Based on this developmental analysis, recommendations are made regarding research that is needed in the areas of these children and psychological maltreatment.     

Program Components of Psychosocial Interventions in Foster and Kinship Care: A Systematic Review

Foster children frequently experience early trauma that significantly impacts their neurobiological, psychological and social development. This systematic review examines the comparative effectiveness of foster and kinship care interventions. It examines the components within each intervention, exploring their potential to benefit child and carer well-being, particularly focussing on child behaviour problems, and relational functioning. Systematic searches of electronic databases included PsycINFO, MEDLINE, Web of Science Core Collection, the Cochrane Collaborations Register of Controlled Trials (CENTRAL) and Scopus to identify randomised or quasi-randomised trials of psychosocial foster/kinship care interventions, published between 1990 and 2016. Seventeen studies describing 14 interventions were included. Eleven studies reported comparative benefit compared to control. Overall, effective interventions had clearly defined aims, targeted specific domains and developmental stages, provided coaching or role play, and were developed to ameliorate the effects of maltreatment and relationship disruption. Interventions effective in reducing behaviour problems included consistent discipline and positive reinforcement components, trauma psychoeducation, problem-solving and parent-related components. Interventions effective in improving parent–child relationships included components focussed on developing empathic, sensitive and attuned parental responses to children’s needs. Given the prevalence of both behaviour problems and relational difficulties in foster families, targeting these needs is essential. However, interventions have tended to measure outcomes in either behavioural or relational terms. A more coordinated and collaborative research approach would provide a better understanding of the association between parent–child relationships and child behaviour problems. This would allow us to develop, deliver and evaluate programs that combine these components more effectively. Protocol Registration Number: PROSPERO CRD42016048411.     

Improving Parental Competencies: Subjectively Perceived Usefulness of a Parent Training Matters

As parental competencies are of importance for the development of children, these competencies are often fostered in parent training programs. Research suggests that a lack of fit between training contents and parental perceptions and expectations might result in a lower effectiveness of a parent training. Consequently, parents’ subjective perceptions of trainings should be in the focus of research on the effects of parent trainings. The present study evaluated the effectiveness of a parent training (MonteBaRo-Training) and analyzed pre-post-test changes. Parents who participated in the program (N = 117) and a waiting list control group (N = 88) were surveyed about children’s behavior problems, parenting sense of competence and dysfunctional parenting at two measurement occasions. Results indicated that the training was effective in improving parenting sense of competence, the perceptions of child problem behavior and dysfunctional parenting. Subjectively perceived usefulness of the training was associated with a change in children’s behavior problems and the parenting sense of competence after the completion of the course.     

Maternal Incarceration,Children’s Psychological Adjustment,and the Mediating Role of Emotion Regulation

Children who live in the context of maternal incarceration (MI) are exposed to both general environmental risk and incarceration-specific risk increasing the probability of their developing externalizing and internalizing behaviors problems. Little research has examined the socio-emotional mechanisms that account for the psychological effects of MI. This research examined children’s anger and sadness regulation as mediators between environmental and incarceration-specific risk and psychological functioning. Participants were 117 children (60% Black; 52% boys; M age = 9.85 years, SD = 1.65 years), their incarcerated mother, and current caregiver. All informants completed questionnaires assessing children’s anger and sadness regulation as well as externalizing and internalizing behaviors. Mothers and caregivers provided information concerning children’s exposure to environmental risk and all three reporters provided information on incarceration-specific risk experiences (ISRE). Structural equation modeling was used to test indirect effects of risk variables (ISRE, environmental) on psychological functioning (externalizing, internalizing behaviors) via emotion regulation (anger, sadness). Gender, age, and race were covariates. The analyses revealed significant indirect effects of incarceration-specific risk on both externalizing and internalizing behavior problems via anger regulation but not via sadness regulation. The findings highlight the centrality of emotion regulation as a mechanism that helps explain the negative psychological outcomes experienced by children exposed to ISRE with implications for preventive interventions.     

Imbalances and Impairments in Mental State Talk of Children with Internalizing and Externalizing Problems

ABSTRACT

The aims of this study were to investigate the associations between impairments and imbalances in children’s mental state talk, attachment security and abuse/neglect experiences, and to study how much of the variance in internalizing and externalizing problems was explained by mentalization problems. The sample included 100 Turkish children (M Age = 7.00 (SD = 2.01), 38% girls) referred to a outpatient psychotherapy clinic. Children were administered an attachment-based story stem task in order to code attachment security and different categories of mental state talk, including the extent of their direction (self vs other), balance, and appropriateness. Parents and teachers filled out socio-behavioral function scales. Findings indicated a significant positive association between externalizing problems and impaired mentalization. Internalizing problems were associated with mentalizing the other at the expense of one’s own mental states and underusing emotions. Attachment insecurity and adverse experiences were associated with mentalization impairments and imbalances. Finally, underuse of emotions and self-focused mental state talk predicted internalizing problems and impaired mental state talk predicted externalizing problems at trend level of significance. Qualitative analyses supported the results, which suggest that whereas children with externalizing problems suffer from severe mentalization deficits, children with internalizing problems undermentalize about themselves and emotions.     

Basic need satisfaction in the parental relationship offsets millennials’ worries about the transition to college

ABSTRACT

Students’ worries about transitioning to college are correlated with long-term reduced psychological well-being, so we investigated how psychological need satisfaction might mitigate millennials’ worries about college. As parents can support or undermine their children’s basic needs, we also examined the influence of autonomy-supportive and helicopter parenting during the transition. Additionally, we compared these outcomes between first- and continuing-generation students. Incoming college students (N = 355) completed measures of parental relationship need satisfaction, parental involvement, worries about college, and family achievement guilt. Higher need satisfaction in the parental relationship was associated with reduced worries and feelings of achievement guilt for both first- and continuing-generation students. Autonomy-supportive parenting moderated the relationship between autonomy and millennials’ worries about college. Helicopter parenting did not moderate any of the relationships examined in this study but was positively associated with students’ transition worries and achievement guilt. We discuss these findings in the context of self-determination theory.     

Psychological Adjustment,Social Responsiveness and Parental Distress in an Italian Sample of Siblings of Children with High-Functioning Autism Spectrum Disorder

The psychosocial adjustment of siblings of children with autism spectrum disorder (ASD) is a relatively recent field of study, but results in literature are often inconsistent, and studies specifically focused on samples of siblings of children with high-functioning ASD are very few. This paper analyzes the level of social impairment (index of broader autism phenotype), the risk of internalizing and externalizing problems (index of psychological adjustment) and the parenting distress in an Italian sample of siblings of children with high-functioning ASD (n = 26). The presence of risk factors (birth order, sex and number of siblings in the family) and the role of the siblings’ age are also explored. The data were collected through self-report instruments administered to parents. The results do not show higher average risk levels for psychosocial adjustment problems, even though a minority of the cases is at risk for social impairments (7.7 %), internalizing (23.1 %), externalizing (3.8 %) and total difficulties (11.5 %) and for distress in the parent–child system (15 %). Distress in the parent-sibling system seems to be modulated by the sibling’s features and to be higher when the sibling is older than the child with ASD. Additionally, a link between difficulties in psychological adjustment and broader autism phenotype is suggested.     

Moral Injury,Spiritual Care and the Role of Chaplains: An Exploratory Scoping Review of Literature and Resources

This scoping review considered the role of chaplains with regard to ‘moral injury’. Moral injury is gaining increasing notoriety. This is due to greater recognition that trauma (in its various forms) can cause much deeper inflictions and afflictions than just physiological or psychological harm, for there may also be wounds affecting the ‘soul’ that are far more difficult to heal—if at all. As part of a larger research program exploring moral injury, a scoping review of literature and other resources was implemented utilising Arksey and O’Malley’s scoping method (Int J Soc Res Methodol 8(1):19–32, 2005) to focus upon moral injury, spirituality (including religion) and chaplaincy. Of the total number of articles and/or resources noting the term ‘moral injury’ in relation to spiritual/religious issues (n = 482), the results revealed 60 resources that specifically noted moral injury and chaplains (or other similar bestowed title). The majority of these resources were clearly positive about the role (or the potential role) of chaplains with regard to mental health issues and/or moral injury. The World Health Organization International Classification of Diseases: Australian Modification of Health Interventions to the International Statistical Classification of Diseases and related Health problems (10th revision, vol 3—WHO ICD-10-AM, Geneva, 2002), was utilised as a coding framework to classify and identify distinct chaplaincy roles and interventions with regard to assisting people with moral injury. Several recommendations are made concerning moral injury and chaplaincy, most particularly the need for greater research to be conducted.     

Associations Between Fathers’ and Mothers’ Psychopathology Symptoms,Parental Emotion Socialization,and Preschoolers’ Social-Emotional Development

In this study we tested whether the relation between fathers’ and mothers’ psychopathology symptoms and child social-emotional development was mediated by parents’ use of emotion talk about negative emotions in a sample of 241 two-parent families. Parents’ internalizing and externalizing problems were measured with the Adult Self Report and parental emotion talk was observed while they discussed a picture book with their children (child age: 3 years). Children’s parent-reported internalizing and externalizing problems and observed prosocial behaviors were assessed at the age of 3 years and again 12 months later. We found that mothers’ use of emotion talk partially mediated the positive association between fathers’ internalizing problems and child internalizing problems. Fathers’ internalizing problems predicted more elaborative mother–child discussions about negative emotions, which in turn predicted more internalizing problems in children a year later. Mothers’ externalizing problems directly predicted more internalizing and externalizing problems in children. These findings emphasize the importance of examining the consequences of parental psychological difficulties for child development from a family-wide perspective.     

Maternal sensitivity in responding during play and children’s pre-mathematical skills: a longitudinal study from infancy to preschool age

This longitudinal study explored how mothers’ sensitivity in responding to their child’s cognitive and emotional needs in infancy and toddlerhood predicts children’s pre-mathematical skills at early preschool age. The sample consisted of 65 mother–child dyads (N = 130 individuals) videotaped during joint play at ages 1;0 and 2;0. The children’s pre-mathematical skills were tested at age 3;0. The path analyses showed that, in infancy, mothers’ autonomy support and scaffolding are more strongly related than emotional support to children’s later performance on spatial and numerical tasks. The findings are discussed in relation to how maternal sensitivity in responding fosters children’s pre-mathematical development in an optimal way.     

A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care

Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.     

Personal narratives about states of suffering and wellbeing: Children's conceptualization in terms of physical and psychological domain

The aim was to investigate how children conceptualize personal events of positive and negative valences pertaining to the physical and psychological domains. Five‐ to 9‐year‐olds narrated events referring to suffering states (Study 1, n = 112) and to suffering and wellbeing states (Study 2, n = 118). Analysis of the narratives revealed differences between the two states, with higher focus on events pertaining to a physical domain for suffering and to psychological domain for wellbeing; however, older children were more oriented toward psychological than physical events for both valences. Children showed higher tendency to produce causes compared to consequences, with younger children finding it difficult to introduce physical causes. Psychological suffering narratives revealed a richer psychological lexicon and more instances of domain coexistence. Asymmetry in the representation of different state valences and domains indicates multifaceted and developing conceptualization. Copyright © 2010 John Wiley & Sons, Ltd.     

Dynamics of identity development and separation–individuation in parent–child relationships during adolescence and emerging adulthood – A conceptual integration

Identity development and separation–individuation in parent–child relationships are widely perceived as related tasks of psychosocial maturation. However, a dynamic, developmental perspective that explains how intra-personal change in identity evolves from transactions between parents and children is not sufficiently represented in the literature. In this article, a selective literature review of psychological approaches to identity development and separation–individuation is presented with a focus on how the role of parents has been covered by approaches to identity development and on how general mechanisms of identity change could be filled with content by processes of separation–individuation. Afterwards, dynamics of identity development and separation–individuation are integrated based on the conceptualization of parents and children as two interrelated identity systems. Specifically, it is illustrated how interpersonal differences in long-term related changes in identity formation, identity evaluation, autonomy, and separateness and attachment between parents and children, could be explained by parent–child transactions in the transition between childhood and adolescence and between adolescence and emerging adulthood. Finally, implications of an integrative perspective for future empirical research are discussed.     

Possible competences to be aimed at in ethics education – Ethical competences highlighted in educational research journals

Abstract

The aim of this article is to present varieties of ethical competence that are highlighted in ethics and moral education research articles, and to discuss them in the light of competences stressed in the Swedish curriculum, understood as an example of ethics education in compulsory school. The material consists of 1,940 educational research articles published between 2000 and 2015, and the method of analysis is inductive, focusing on ethical competence. One finding is the similarity between the study’s tentative formulation of identified ethical competences in four categories, and Rest’s understanding of acting morally, captured in the four components: sensitivity, judgement, motivation and implementation. Based on the analysis of the articles, broader understandings of these focuses are developed, and later discussed in relation to Swedish ethics education, characterised as both a conservative and liberal values education. The analyses and comparison show the importance of the components of moral sensitivity and moral implementation and their relative absence in the Swedish curriculum, but also how moral judgement must include a competence to evaluate moral motivations, where empirically testable reasons are also central. Moreover, the risk of neglecting contextual, situational and knowledge-related aspects of ethical competence is highlighted.