Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD,Predominantly Inattentive Presentation

We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.     

You are Such a Bad Child! Appraisals as Mechanisms of Parental Negative and Positive Affect

Although parent cognitions are considered important predictors that determine specific emotional reactions and parental practices, models on the cognitive strategies for regulating parental distress or positive emotions are not well developed. Our aim was to investigate the nature of cognitions involved in parental distress and satisfaction, in terms of their specificity (parental or general) and their processing levels (inferential or evaluative cognitions). We hypothesized that parent's specific evaluative cognitions will mediate the impact of more general and inferential cognitive structures on their affective reactions. We used bootstrapping procedures in order to test the mediation models proposed. Results obtained show indeed that rather specific evaluative parental cognitions are mediating the relationship between general cognitions and parental distress. In terms of the cognitive processing levels, it seems that when parents hold both low self-efficacy and parental negative global evaluations for the self/child, this adds significantly to their distress.     

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.     

Evaluating the Effectiveness of a Group CBT for Parents of ADHD Children

Improvements in parenting skills do not necessarily lead to improvements in child and parent outcomes for children with attention deficit and hyperactivity disorder (ADHD). Cognitive factors such as parental cognitions and parenting self-efficacy may influence such outcomes. Clinical research on the effects of cognitive-behaviour therapy (CBT) on parental cognitions, parenting self-efficacy and mental health in Chinese parents of children with ADHD is lacking. This quasi-experimental study intended to assess the effects of a culturally attuned group CBT treatment on the mental health and quality of life of Chinese parents aged 26–58 years, with children with ADHD in Hong Kong. Participants in the experimental group received group CBT and standard treatment and their counterparts in the control group received standard treatment. Primary outcome variables of mental health and quality of life and process variables including parenting stress, parenting efficacy and dysfunctional attitudes were measured at baseline, post-treatment and 3-month follow-up. Data were analysed using 2?×?3 ANCOVAs, Cohen’s d statistics and multiple mediation analyses. Group by time interactions were found for most outcome variables. Effect size statistics indicated that group CBT had small to moderate effects on most outcome variables at post-treatment and follow-up assessments. The effect of CBT on mental health was mediated by the reduction in parenting stress and the effect of CBT on quality of life was mediated by the reductions in parenting stress and dysfunctional attitudes. Given its potential benefit, it is worth considering incorporating this group CBT programme into interventions for Chinese parents with ADHD children.     

Separation anxiety in first-time mothers: infant behavioral reactivity and maternal parenting self-efficacy as contributors

This short-term longitudinal study examined the contribution of infant behavioral reactivity and maternal parenting self-efficacy to first-time mothers’ (total n = 32) separation anxiety. Infants’ behavioral reactivity indexed by gaze and facial affect were observed in the conditions of routine play and maternal still face at 3 months. Mothers reported their self-perceived parenting efficacy at 3 months and separation anxiety at 6 months. Results revealed that infants’ frequent gazing at their mother, greater negative affect, and less positive affect observed during the still face, but not during the routine play, contributed to heightened maternal separation anxiety. In addition to a direct link between low maternal parenting self-efficacy and high maternal separation anxiety, maternal parenting self-efficacy buffered against the impact of infant negative reactivity on maternal separation anxiety. The role of infant reactivity and maternal self-efficacy in parenting was discussed.     

Alcohol-specific parenting,adolescent alcohol use and the mediating effect of adolescent alcohol-related cognitions

Objectives : Previous research indicated that alcohol-specific parenting is an important precursor of adolescent alcohol use, but failed to define the underlying mechanism. Based on social cognitive theory, alcohol-related cognitions such as alcohol refusal self-efficacy and alcohol-related expectancies were hypothesised to mediate this link.

Design : A cross-sectional survey included 1349 mothers and their sixth grade (11–12?years old) adolescent offspring. Structural equation modelling was employed to test the association between alcohol-specific parenting and adolescent alcohol use, mediated by adolescent alcohol-related cognitions.

Main outcome measures : Adolescent alcohol use, drinking refusal self-efficacy and alcohol expectancies.

Results : The associations between frequency of communication, maternal alcohol use and adolescent alcohol use were mediated by negative alcohol-related expectancies. The associations between quality of communication, rules and disclosure and adolescent alcohol use were mediated by self-efficacy.

Conclusions : The present study provides a first indication that the underlying mechanism of the association between the most important alcohol-specific parenting practices and adolescent alcohol use can be contributed to the mediating effect of alcohol-refusal self-efficacy.     

Perceived Parenting Style of Fathers and Iranian Adolescents' Self-efficacy: The Moderating Role of Gender and Education

The authors examined the moderating role of adolescent's gender and father's education on the associations between perceived paternal parenting styles and self-efficacy in a socioeconomical diverse sample of Iranian ado-lescents (n = 382). Results revealed that paternal authoritative parenting was significantly and positively related to self-efficacy. Interestingly, a significant and positive relation was also found between paternal authoritarian parenting and self-efficacy. This finding might have been the result of the fact that this study was conducted as part of a collectivist culture. In addition, the results indicated that boys who perceived their fathers as highly authoritative indicated higher self-efficacy than girls did. Furthermore, the findings demonstrated that higher educational levels attenuate the negative impact of the permissive parenting style on self-efficacy. The present findings underscore the need to focus on the role of gender and father's education when assessing the link between parenting style and adolescents' self-efficacy.     

A Model of Intention to Participate in Parenting Interventions: The Role of Parent Cognitions and Behaviors

A wide range of factors, from perceived child behavior problems to sociocultural factors, have been identified as impacting the engagement of parents in parenting interventions. However, parents’ cognitions and behaviors have not been evaluated sufficiently to understand their role in initial parental engagement. The current study aimed to examine why some parents are more likely to want to participate in parenting programs and how their cognitions and behaviors are related to their intention to participate in future parenting interventions. We tested the hypothesised model of parental factors on intention to participate using structural equation modelling (SEM) in AMOS. This study (N = 6,733) analyzed existing data from the International Parenting Survey (IPS), a web-based tool developed to collect information about parents’ views on family and parenting at a population level in several countries. Results showed that parents’ coercive parenting, parental consistency, positive encouragement, relationship with their child, parental self-efficacy, psychological distress, and help-seeking behaviors were significantly related to their intention to participate in future parenting interventions. The structural model of parents’ cognitions and behaviors explained 16% of the variance in intention to participate. Although the current model explained a small but significant percentage of the variance, it expands existing understanding regarding parental cognitions and behaviors and their relationship to intention. Implications for further research and engagement practice are discussed.     

A Pilot Randomized Trial of an Online Parenting Skills Program for Pediatric Traumatic Brain Injury: Improvements in Parenting and Child Behavior

This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n = 20) or access to Internet resources on managing brain injury (n = 17). Parent–child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.     

Cognitive Mediators of Treatment for Social Anxiety Disorder: Comparing Acceptance and Commitment Therapy and Cognitive-Behavioral Therapy

Objective

To assess the relationship between session-by-session mediators and treatment outcomes in traditional cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) for social anxiety disorder.

Method

Session-by-session changes in negative cognitions (a theorized mediator of CBT) and experiential avoidance (a theorized mediator of ACT) were assessed in 50 adult outpatients randomized to CBT (n = 25) or ACT (n = 25) for DSM-IV social anxiety disorder.

Results

Multilevel modeling analyses revealed significant nonlinear decreases in the proposed mediators in both treatments, with ACT showing steeper decline than CBT at the beginning of treatment and CBT showing steeper decline than ACT at the end of treatment. Curvature (or the nonlinear effect) of experiential avoidance during treatment significantly mediated posttreatment social anxiety symptoms and anhedonic depression in ACT, but not in CBT, with steeper decline of the Acceptance and Action Questionnaire at the beginning of treatment predicting fewer symptoms in ACT only. Curvature of negative cognitions during both treatments predicted outcome, with steeper decline of negative cognitions at the beginning of treatment predicting lower posttreatment social anxiety and depressive symptoms.

Conclusions

Rate of change in negative cognitions at the beginning of treatment is an important predictor of change across both ACT and CBT, whereas rate of change in experiential avoidance at the beginning of treatment is a mechanism specific to ACT.     

A cross-cultural investigation of cognitions and depressive symptoms in adolescents

Adolescents (N=2,272) from Hong Kong and the United States provided information regarding their depressive symptoms, cognitions (self-efficacy, negative cognitive errors, and hopelessness), and stressful events between 2 surveys 6 months apart. Depressive symptoms and hopelessness were higher, and self-efficacy and negative cognitive errors were lower in Hong Kong than in the United States. Cognitions were associated with concurrent depressive symptoms and predicted depressive symptoms 6 months later in both cultures. The "reverse" model was also supported with more variance predicted by depressive symptoms to later cognitions than from cognitions to depressive symptoms. There was some support for the hypothesis that self-efficacy is less salient in collective compared with individualistic cultures. These findings extend cognitive theories of depression to a non-Western culture.     

More than Just the Breadwinner: The Effects of Fathers' Parenting Stress on Children's Language and Cognitive Development

Despite numerous studies on parenting stress suggesting negative influences on parent–child interactions and children's development, the majority of these studies focus on mothers' parenting stress with little or no acknowledgement of fathers. Using data from the National Early Head Start Research and Evaluation Project, this study examined (i) the effects of fathers' parenting stress during toddlerhood on children's language and cognitive outcomes when children are 3 years old (ii) whether the effects of fathers' parenting stress on children's language and cognitive development vary by child gender? Results from mixed linear models showed fathers' parenting stress predicted children's lower cognitive scores, but there were no gender differences in the effects of fathers' parenting stress on children's cognitive outcomes. In the language domain, boys, not girls, were found to be more susceptible to the effects of fathers' parenting stress. These findings indicated that fathers, in addition to mothers, should be included in early parenting research and interventions. Copyright © 2016 John Wiley & Sons, Ltd.     

Relationships among Negative Emotionality,Responsive Parenting and Early Socio‐cognitive Development in Korean Children

The present study examined the interplay among negative emotionality, responsive parenting and socio‐cognitive developmental outcomes (i.e., communication, personal‐social and problem‐solving outcomes) in about 1620 Korean children using three waves of longitudinal data spanning the first 2 years of their life. Results from the Structural Equation Modeling (SEM) demonstrated that there were moderate to low degrees of stability in negative emotionality, responsive parenting and socio‐cognitive developmental outcomes from infancy to toddlerhood. Evidence for reciprocity in the parent–child relationship was found; responsive parenting predicted higher levels of subsequent child communication (in infancy and toddlerhood), and infants' higher problem‐solving ability predicted higher responsive parenting in toddlerhood. Overall, the cross‐age associations among the variables were similar between boys and girls, but some different patterns were observed: when controlling for family contextual factors and the within‐time correlations, negative emotionality at an earlier point significantly predicted lower responsive parenting at a later point and vice versa only in girls during infancy, but neither in boys nor in toddlerhood. The implications of these findings are discussed. Copyright © 2016 John Wiley & Sons, Ltd.     

Promoting Positive Relationship Between Parents and Grandparents: A Randomized Controlled Trial of Group Triple P Plus Compassion in Vietnam

In Vietnamese culture, grandparents are significantly involved in the upbringing of grandchildren. This involvement of grandparents entails lots of ambiguities and challenges. Boundaries between parents and grandparents are often unclear, and communication can be restricted due to power differentials, leading to inconsistent discipline. This study seeks to evaluate the efficacy of the Group Triple P–Positive Parenting Program plus Building Coparenting Alliance—a compassion-focused module to promote the parent-grandparents relationship. One hundred Vietnamese parents whose parents or parent in-laws provided care for their children were randomly assigned to either an intervention condition (n = 50) or a waitlist control condition (n = 50). Both groups were assessed at three time-points (pre-intervention, post-intervention, and 6-month follow-up). The short-term intervention effects were found across domains, including co-parenting conflict, parents' self-compassion, dysfunctional parenting, parenting self-efficacy, parental adjustment, child behavioral problems and child prosocial behaviors. Intervention effects on co-parenting conflict, parenting behaviors, and the child's prosocial behaviors were maintained at a 6-month follow-up. This study demonstrates the efficacy of Triple P plus compassion in promoting co-parenting relationships between parents and grandparents, enhancing parenting practice and child outcomes in Vietnamese families.     

Relations of Parenting and Negative Life Events to Cognitive Diatheses for Depression in Children

In a sample of 299 children (grades 2, 4, and 6), we examined parenting and negative life events as predictors of depressive cognitions, specifically low self-perceived competence, depressive cognitive schemas, and depressogenic attributional style. We also examined developmental trends in these relations. Children completed measures of parenting, negative life events, and depressive cognitions. Parents also completed measures of parenting and negative life events. Consistent with our hypotheses, negative parenting and negative life events corresponded with higher levels of depressive cognitions, whereas positive parenting corresponded with lower levels of depressive cognitions. The relations between negative parenting and negative automatic thoughts were stronger for older children. Theoretical and practical implications are discussed.     

The Effects of the <Emphasis Type="Italic">Nobody’s Perfect</Emphasis> Program on Parenting Resourcefulness and Competency

We conducted an evaluation of Nobody’s Perfect Program involving 71 participants from Peterborough County, Canada. Prior to the program, parents completed demographic information, along with self-report measures assessing the types of interactions with their children, parent resourcefulness, knowledge and use of resources, parent competency and self-efficacy, which were completed again after the program and at a two month follow-up testing. In comparison to parents not earning certificates, parents earning certificates were younger and more likely to have completed previous parenting programs. As well, parents earning certificates demonstrated and maintained an increase in parenting resourcefulness, warm/positive parent-child interactions, sense of parenting competency and satisfaction, and use of community resources. The more sessions parents attended, the better their parenting resourcefulness and warm/positive parent-child interactions on completion and at follow-up, and the less their angry and punitive parenting at follow-up. Parents who had attended parenting programs before had higher parenting resourcefulness scores at entry. They left the program with increased levels of parenting resourcefulness, better parent-child interactions, and more effective child management skills. A number of recommendations are suggested to help facilitators of the program enhance service delivery and improve parental outcomes.     

Family-level factors of early childhood development: Evidence from rural China

Family-level factors that characterize the home environment are critical inputs to early language and cognitive development, and potential mechanisms for improving developmental outcomes in vulnerable populations. Many studies conducted in high-income and Western settings highlight stimulating parenting, the home language environment, and parental self-efficacy as possible mechanisms of early development, though less is known about how these family-level factors impact child development in low- or middle-income settings. Even less is known about these family-level factors and early childhood development in rural China, where rates of cognitive and language delay in children aged 0–3 years are as high as 45% and 46%, respectively. Using data collected from 77 rural households with children aged 18–24 months in Southwestern China, this study examines the associations between stimulating parenting, the home language environment, and parental self-efficacy, and early cognitive and language development. The results indicate that stimulating parenting was significantly associated with cognitive, language, and overall development; the home language environment was only significantly associated with language development; and parental self-efficacy was not significantly associated with any developmental outcomes. The implications of such findings reveal mechanisms for supporting healthy child development in rural China.     

Parent Accommodation Contemporaneously Mediates the Association Between Youth Irritability and Youth Anxiety Treatment Outcome

Research documents that child and adolescent (youth) irritability and anxiety have high co-occurrence, and anxious-irritable presentations are associated with greater impairment than anxious nonirritable presentations. This study examines the association between irritability and youth anxiety treatment outcome and tests a conceptual model of the associations among youth irritability, parent accommodation, and youth anxiety severity following cognitive behavioral treatment (CBT). Participants were N = 128 clinic-referred youths ages 6 to 17 years (M = 9.76 years; 57% female) who met criteria for primary anxiety disorder diagnoses and completed a 12- to 14-week CBT anxiety protocol. Parent- and youth-report on youth irritability, parent accommodation of their child’s anxiety, and youth anxiety severity were assessed pretreatment and posttreatment. Using parent-report, youth irritability at pretreatment was associated with high parent accommodation of youth anxiety and high youth anxiety severity at posttreatment. The association between irritability and youth anxiety outcome was mediated contemporaneously by parent accommodation at posttreatment. These findings show that parent accommodation of their anxious-irritable children’s anxiety may account for high youth anxiety severity following treatment. Developing strategies to target irritability in anxious youth and/or reduce parent accommodation in the presence of youth irritability represent important directions for future research.     

Callous-Unemotional Traits and Effortful Control Mediate the Effect of Parenting Intervention on Preschool Conduct Problems

Parenting intervention (PI) is an effective treatment for children’s conduct problems (CP) that has been shown to be mediated by improved parenting practices and parenting self-efficacy. Recently, Hitkashrut’s randomized controlled trial demonstrated that ineffective parenting (IP) mediated effects on callous-unemotional (CU) traits and effortful control (EC), while controlling for more general treatment effects on CP. These temperament and personality-based features predict the formation of early-onset antisocial trajectories with poor long-term prognosis. The objective of this study was to use Hitkashrut’s 3-wave dataset to test posttreatment EC and CU mediation of treatment effect on 1-year follow-up CP, and to determine whether mediation by each child-level potential mediator remains significant when tested concurrently with the parenting mediator. Parents of 209 3–5 year-old preschoolers (163 boys; 46 girls), with subclinical-clinical range CP were assigned to 14-session co-parent training groups (n?=?140 couples), or to minimal intervention control groups (n?=?69 couples). Assessments were based on both parents’ questionnaires. An intent-to-treat analysis showed that EC and CU traits simultaneously mediated treatment effects on CP in one EC/CU mediational model. The concurrent testing of child- and parent-level mediators showed mediation by IP and CU traits in the CU/IP model, and IP mediation in the EC/IP model. Similar results were obtained in mediational analyses that controlled for the shared variance between the mediators and CP at T2. Overall, the findings support an intervention model of coaching parents of high-CP children to promote moral self-regulatory competencies while concurrently applying behavioral methods that directly target CP.     

Parenting Sensitivity,Parental Depression and Child Health: The Mediational Role of Parental Self-Efficacy

This paper discusses the theoretical role of parental self-efficacy, or parents' beliefs in their competence and effectiveness in the parental role, as a mediator of relations between parent–child risk and parental sensitivity. Evidence is marshalled from studies of parenting in the contexts of maternal depression and child health risk to support the premise that parent–child characteristics affect parental sensitivity indirectly via their more direct impact on parental feelings of efficacy, and that parenting efficacy represents the ‘final common pathway’ in the prediction of parenting sensitivity. Also considered in this working model are specific social-contextual factors as independent contributors to parenting efficacy and as possible moderators of relations between parent–child characteristics and self-efficacy. Implications for intervention are discussed. © 1996 John Wiley & Sons, Ltd.