Book reading styles in dual‐parent and single‐mother families

Background. Whereas many studies have investigated quantitative aspects of book reading (frequency), few have examined qualitative aspects, especially in very young children and through direct observations of shared reading. Aim. The purpose of this study was to determine possible differences in book‐reading styles between mothers and fathers and between mothers from single‐ and dual‐parent families. It also related types of parental verbalizations during book reading to children's reported language measures. Sample. Dual‐parent (29) and single‐parent (24) families were observed in shared book reading with their toddlers (15‐month‐olds) or young preschoolers (27‐month‐olds). Method. Parent–child dyads were videotaped while book reading. The initiator of each book‐reading episode was coded. Parents' verbalizations were exhaustively coded into 10 categories. Mothers completed the MacArthur Communicative Development Inventory, and the children were given the Bayley scales. Results. All parents differentiated their verbalizations according to the age rather than the gender of the child, but single mothers imitated female children more than males. Few differences in verbalizations were found between mothers and fathers or between mothers from single‐ and dual‐parent families. Fathers allowed younger children to initiate book‐reading episodes more than mothers. For both age groups of children, combined across families, verbalizations that related the book to the child's experience were correlated with reported language measures. Questions and imitations were related to language measures for the older age group. Conclusions. The important types of parental verbalizations during shared book reading for children's language acquisition are relating, questions and imitations.     

Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

Parents’ Reports of Children’s Internalizing Symptoms: Associations with Parents’ Mental Health Symptoms and Substance Use Disorder

This brief report examined the unique associations between parents’ ratings of child internalizing symptoms and their own depression and anxiety in families with parental substance use disorder (SUD). Further, we examined whether parental SUD (father only, mother only, both parents) was related to discrepancy in mothers’ and fathers’ reports of children’s internalizing symptoms. Participants were 97 triads (fathers, mothers) in which one or both parents met criteria for SUD. Polynomial regression analyses were conducted to examine whether father-mother reports of child internalizing symptoms had unique associations with parents’ own symptoms of depression and anxiety while controlling for child gender, child age, and SUD diagnoses. Controlling for fathers’ symptoms and other covariates, mothers experiencing more depression and anxiety symptoms reported more symptoms of child internalizing symptoms than did fathers. Mothers’ and fathers’ SUD was associated with higher anxiety symptoms among mothers after controlling for other variables. A second set of polynomial regressions examined whether father-mother reports of child internalizing symptoms had unique associations with parents’ SUD diagnoses while controlling for child gender and child age. After controlling for mothers’ symptoms and other covariates, parents’ reports of children’s internalizing symptoms were not significantly associated with either parent’s SUD or parental SUD interactions (i.e., both parents have SUD diagnoses). Taken together, mothers’ ratings of children’s internalizing symptoms may be accounted for, in part, by her reports of depression and anxiety symptoms.     

The effect of parental modeling of anxious behaviors and cognitions in school-aged children: An experimental pilot study

The current study tested: (1) the impact of parental modeling of anxious behaviors and cognitions on child anxiety level, anxious cognitions, desired avoidance, and objective performance using an experimental paradigm; and (2) whether the impact of parental modeling of anxious behaviors and cognitions differed by parent gender. Twenty-five parents (a random selection of 12 male and 13 female parents) participated with one of their children (ages 8-12 years; 56.0% male; 76.0% Caucasian). All children experienced two test conditions: an anxious condition in which their parent was trained to act anxiously before a planned spelling test and a non-anxious condition in which their parent was trained to act in a relaxed and confident manner before a planned spelling test. Results showed that, regardless of parent gender, children endorsed higher anxiety levels, anxious cognitions, and desired avoidance of the spelling test in the anxious relative to the non-anxious condition. Parental modeling of anxiety did not affect child spelling performance. Significant interaction effects indicated that fathers had a stronger impact on child anxiety level and cognitions than did mothers. Results highlight the importance of parental modeling and the potential role of both mothers and fathers in prevention and treatment for child anxiety.     

Associations of Parent–Child Anxious and Depressive Symptoms When a Caregiver Has a History of Depression

We examined the associations between parent and child anxious and depressive symptoms controlling for co-occurring symptoms in both. One hundred and four families participated, including 131 9–15 year old children considered at risk for anxiety and/or depression due to a history of depression in a parent. Parents and children completed questionnaires assessing depressive and anxious symptoms. Linear Mixed Models analyses controlling for the alternate parent and child symptoms indicated that both parent and child depressive symptoms and parent and child anxious symptoms were positively associated. Parental depressive symptoms were not positively associated with child anxious symptoms, and parental anxious symptoms were not positively associated with child depressive symptoms. The findings provide evidence for positive specific links between parent and child development of same-syndrome, but not cross-syndrome, symptoms when a caregiver has a history of depression.     

The Influence of Mothers' and Fathers' Parenting Stress and Depressive Symptoms on Own and Partner's Parent‐Child Communication

This study examines how parenting stress and depressive symptoms experienced by mothers and fathers influence their own (actor effects) and the partner's (partner effects) parent–child communication. Based on the Actor‐Partner Interdependence Model, data from 196 families were analyzed, with both parents rating their parenting stress and depressive feelings, and parents as well as children rating the open parent–child communication. Actor effects were found between parenting stress and open parent–child communication, whereas partner effects were prominent between depressive symptoms and open parent–child communication. The results provide no evidence for gender differences in the strength of the pathways to open parent–child communication. Our findings demonstrate the need to include both parents in studies on parent–child communication to enhance our understanding of the mutual influence among family members.     

The role of parental emotional distress in parent report of child anxiety

Evaluated the role of maternal and paternal emotional distress in parent report of anxiety in their child. Participants were 239 children (ages 7.5 to 15 years) diagnosed with a primary anxiety disorder and their parents (193 fathers, 238 mothers). Parents individually completed the State-Trait Anxiety Inventory, the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory for Children-Parent Version (a report of the child's anxiety). Children completed the State-Trait Anxiety Inventory for Children. Mothers and fathers reported more anxiety in their children than the children reported themselves. No significant relations were found between parental anxiety and parent report of child anxiety. When we examined girls only, both maternal and paternal BDI scores were significant predictors of parent report of the child's anxiety after we controlled for parental anxiety. Separate analyses by child age revealed that parent reports of child anxiety were more correlated with the self-reports of younger children. The implications of these findings are discussed.     

Effectiveness of an ACT‐based rehabilitation program for the treatment of chronic fatigue: Results from a 12‐months longitudinal study

Acceptance and Commitment Therapy (ACT) is potentially effective for treating chronic fatigue. Given the paucity of studies on this topic, we aimed to assess long‐term trajectories of primary (fatigue, quality of life and functional abilities) and secondary outcomes (anxious and depressive symptoms) of an ACT‐based rehabilitation program for patients with chronic fatigue. Further, we examined if changes in potential process variables (psychological inflexibility, metacognitive beliefs, and cognitive and behavioral responses to symptoms) during ACT predicted change in all outcomes across follow‐up. One‐hundred ninety‐five workers on sick leave (mean age: 43.61 ± 9.33 years; 80.5% females) with a diagnosis of chronic fatigue were enrolled in a manualized, 3.5‐week intensive return‐to‐work rehabilitation program based on ACT. All completed a battery of questionnaires at pre‐, post‐treatment, 6 and 12 months follow‐up. We found significant longitudinal changes in most primary and secondary outcomes from pre‐ up to 12 months follow‐up. All process variables significantly decreased from pre‐ up to 12 months follow‐up, and pre‐to‐post changes in fear avoidance beliefs were most often associated with a greater change in outcomes across follow‐up. Depressive symptomatology showed a similar trajectory of change to fatigue, meaning that scores were correlated at each time point and tended to converge over time. This suggests that both symptoms influence each other substantially over a year following the treatment. Concluding, results lend support to the effectiveness of an ACT‐based rehabilitation program for patients with chronic fatigue and provide preliminary evidence for the role of process variables and depressive symptomatology on subsequent change in outcomes.     

Symptoms of depression in Swedish fathers in the postnatal period and development of a screening tool

Methods for detecting depression in fathers after the birth of their child are scarce. The Edinburgh Postnatal Depression Scale (EPDS), used to screen mothers for postpartum depression (PPD), lacks somatization and externalizing items. This potentially decreases its sensitivity in detecting depression in fathers, as many men actually express depression with somatization or externalizing symptoms. The present study assessed depressive symptoms in fathers of children 0–18 months old, and evaluated whether addressing both typical depression and externalizing, so‐called “depressive equivalent” symptoms, might be more suitable for such assessment. The Beck Depression Inventory‐II (BDI‐II), EPDS, and Gotland Male Depression Scale (GMDS) were responded to by 447 Swedish fathers online. Among participants, 27% reported depressive symptoms above the BDI‐II cut‐off suggestive of depression. Most fathers reported both traditional and depressive equivalent symptoms and a subgroup expressed exclusively depressive equivalent symptoms. Consistently, a scale combining items from the EPDS and GMDS showed higher sensitivity than the EPDS alone in identifying fathers with elevated depressive symptoms, at equal levels of specificity. Our findings suggest that a combination of EPDS and depressive equivalent symptom items results in a more suitable instrument for screening for depression in fathers during the postnatal period.     

Parents as Partners: A U.K. Trial of a U.S. Couples‐Based Parenting Intervention For At‐Risk Low‐Income Families

Despite the well‐established links between couple relationship quality and healthy family functioning, and burgeoning evidence from the international intervention field, there is little or no evidence of the efficacy of couples‐based interventions from the United Kingdom (U.K.). This study explored whether the Parents as Partners (PasP) program, a group‐based intervention developed in the United States, brought about the same benefits in the U.K. The evaluation is based on 97 couples with children from communities with high levels of need, recruited to PasP because they are at high risk for parent and child psychopathology. Both mothers and fathers completed self‐report questionnaires assessing parents’ psychological distress, parenting stress, couple relationship quality and conflict, fathers’ involvement in child care and, importantly, children's adjustment. Multilevel modeling analysis comparing parents’ responses pre‐ and postintervention not only showed substantial improvements for both parents on multiple measures of couple relationship quality, but also improvements in parent and child psychopathology. Analyses also indicated most substantial benefits for couples displaying poorest functioning at baseline. The findings provide initial evidence for the successful implementation of PasP, an American‐origin program, in the U.K., and add support for the concept of the couple relationship as a resource by which to strengthen families.     

Trauma‐focused CBT with maltreated children: A clinic‐based evaluation of a new treatment manual

The effectiveness of a locally developed trauma‐focused cognitive behavioural therapy (TF‐CBT) program for maltreated children with post‐traumatic stress disorder (PTSD) was examined across different therapists in a child protection clinic setting. An earlier phase of the research piloting the program had provided promising results. This second phase involved two studies evaluating the completed TF‐CBT manual delivered by (a) the developer and (b) other therapists. A single‐case multiple‐baseline design was used to demonstrate the controlling effects of the treatment on PTSD symptoms and child coping. Eight 9–13‐year‐old abused children with PTSD were treated. Positive outcomes support the effectiveness of the TF‐CBT program delivered by both the developer and other therapists. The study design and methodology were robust enough to confirm empirically the clinically beneficial effects and potential for this new program. It was also apparent, however, from study limitations, including missing data for some patients, that there are a number of challenges in carrying out such research in a busy child protection service setting with multiply‐abused patients. This paper considers implications and ways forward for engaging in empirically supported practice as well as future development and research.     

Changes in maternal expressed emotion toward clinically anxious children following cognitive behavioral therapy

The aim of this study was to determine whether maternal expressed emotion (criticism and emotional overinvolvement) decreased across treatment for childhood anxiety. Mothers of 48 clinically anxious children (aged 6-14 years) were rated on levels of criticism (CRIT) and emotional overinvolvement (EOI), as measured by a Five Minute Speech Sample (FMSS) from mothers, prior to and following cognitive behavioral therapy (CBT) for their children’s anxiety. Results showed a significant decrease in the proportion of mothers who expressed high levels of criticism and emotional overinvolvement from pretreatment to posttreatment. This finding suggests that interventions aimed at reducing symptoms of child anxiety can also result in a decrease of maternal expressed emotion (criticism and emotional overinvolvement).     

The Effects of Parental Depressive Symptoms,Appraisals, and Physical Punishment on Later Child Externalizing Behavior

Examined a cognitive-behavioral pathway by which depressive symptoms in mothers and fathers increase risk for later child externalizing problem behavior via parents’ appraisals of child behavior and physical discipline. Participants were 245 children (118 girls) at risk for school-age conduct problems, and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 5 ½ years old at Time 2 (T2). At T1, mothers and fathers reported their depressive symptoms, perceptions of their child’s reciprocal affection and responsiveness, frequency of physical punishment, and child externalizing problems. Mothers, fathers, and teachers provided ratings of externalizing behavior at T2. Structural equation modeling revealed that parents’ negative attributions mediated positive relations between their depressive symptoms and frequency of physical punishment for both fathers and mothers. More frequent physical punishment, in turn, predicted increased child externalizing behavior at T2. In future research, transactional mechanisms underlying effects of clinical depression on child conduct problems should be explored at multiple stages of development. For parents showing depressive symptoms, restructuring distorted perceptions about their children’s behavior may be an important component of intervention programs.     

Children’s Perspectives of an Enhanced Cognitive-Behavioral Treatment for Child–Parent Dyads With Anxiety Disorders

Prior research has extensively evaluated the efficacy of cognitive-behavioral therapy (CBT) for child anxiety disorders—however, few studies have investigated anxious children’s perspectives and experiences of participating in CBT. This qualitative study explored children’s acceptability of a newly developed enhanced CBT intervention, designed specifically for the treatment of anxiety disorders in children with a clinically anxious parent. The study also explored children’s perceptions and experiences of individual (child only) and joint observational (child–parent) exposure activities that were key to the intervention. Ten children (age range 6–11, M = 8.5 years) and their mothers (age range 34–45, M = 39.5 years) completed in-depth semistructured interviews to investigate child participants’ anticipated and experiential acceptability of the enhanced CBT intervention. Thematic analysis revealed seven major themes broadly reflecting the acceptability, appropriateness, and perceived benefit of the intervention elements, with particular value credited to exposure tasks and the dyadic nature of the intervention. Findings suggest that future experimental evaluation of the enhanced intervention is warranted. Further, the study highlights that CBT for child anxiety disorders, where exposure work is a feature, is acceptable and perceived to be effective by its intended treatment recipients. Trial prospectively registered, preresults, ANZCTR1261900033410.     

The impact of mothers' trait anxiety on their expectations of approach‐avoidance behaviour in anxious and non‐anxious children

This study investigated estimates of approach and avoidance behaviour in clinically anxious and non‐anxious children, and whether mothers' expectations of their children's avoidance differed as a function of high trait anxiety (HTA) versus low trait anxiety (LTA). Participants were 62 clinically anxious and 60 non‐anxious children aged 7–12 years and their mothers. Estimates of avoidance were obtained using an analogue task in which children and mothers were given threat and pleasant information about two novel animals and were asked to estimate children's avoidance of the threat animal's habitat when the threat animal was present (threat condition) and absent (safe condition) from the habitat and when its presence was uncertain (ambiguous condition). Contrary to expectation, anxious children did not differ from controls in estimates of avoidance in any condition. However, relative to HTA mothers of anxious children and LTA mothers of non‐anxious children, HTA mothers estimated greater approach behaviour by their non‐anxious children in the threat condition. Findings suggest that mothers' expectations of children's approach‐avoidance behaviour is influenced by both maternal and child factors.     

Brief Cognitive-Behavioral Therapy for Anxious Youth: Feasibility and Initial Outcomes

We developed and evaluated a brief (8-session) version of cognitive-behavioral therapy (BCBT) for anxiety disorders in youth ages 6 to 13. This report describes the design and development of the BCBT program and intervention materials (therapist treatment manual and child treatment workbook) and an initial evaluation of child treatment outcomes. Twenty-six children who met diagnostic criteria for a principal anxiety diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia were enrolled. Results suggest that BCBT is a feasible, acceptable, and beneficial treatment for anxious youth. Future research is needed to examine the relative efficacy of BCBT and CBT for child anxiety in a randomized controlled trial.     

A Comparison of Interactions Among Children,Parents, and Therapists in Cognitive Behavior Therapy for Anxiety Disorders in Australia and Japan

Despite growing attention to the efficacy of culturally adapted cognitive-behavioral treatment (CBT) programs for children and adolescents, there is still little empirical and practical information available to therapists who adapt original treatment protocols to suit clients of a specific culture. The current study aimed to compare therapeutic interactions across CBT treatment delivered with two different cultural groups. We developed an observational coding system to examine behaviors exhibited by child, parent, and therapist during CBT sessions conducted in Australia and Japan for children with anxiety disorders. Our results demonstrated significant differences between the two countries with respect to the treatment readiness of children, the proportion of talking during the sessions by parents and children, therapists’ laughter, length of silence during the first session, and parent indices of accommodation. In terms of transitions over time (i.e., first to last CBT session), parents in both countries tended to talk more during the last CBT session, whereas only Australian therapists talked less over time. The proportion of silence decreased over time during the Japanese sessions, and the amount of interruptions by parents increased over time for Australian sessions. Finally, our exploratory analyses demonstrated that a number of behavioral observations were correlated with anxiety treatment outcome at posttreatment. This study suggests that interactions between a child, parent, and therapist during CBT sessions may be affected by the culture in which the CBT session occurs, which could have implications for culturally adapted CBT programs.     

Observed Mother– and Father–Child Interaction Differences in Families with Medically Assisted Reproduction‐Conceived Twins and Singletons

Increased medically assisted reproduction (MAR) use to treat infertility has resulted in a growing twin birth rate. Little is known about parent–child relationships for twin relative to singleton children in middle childhood. This study fills this gap by examining parent–child relationships in 57 families with eighty 6‐ to 12‐year‐old MAR twin and singleton children using observational data (warm and supportive communication, control, and hostility). Nested ANCOVAs indicate that while mothers exhibit similar interactional behaviors toward twins and singletons, fathers have less optimum behaviors toward twins relative to singletons. Twins displayed less engaged behavior with mothers and fathers relative to singletons. Given the vitality of parent–child relationships for family and child adjustment, future studies should examine determinants and outcomes of twin–singleton relationship differences to bolster twins’ and their families’ functioning.