Parental Stress and Children’s Social and Behavioral Outcomes: The Role of Abuse Potential over Time

Parental stress is a well-established risk factor for adverse child outcomes, including the development of aggression, externalizing behavior problems, and anxiety, as well as compromised emotional coping, impaired social cognition, and diminished treatment response. Abuse potential represents a mechanism by which parental stress may impact child social competence and behavior; evidence links parental stress to abuse potential, and abuse potential to a range of negative child social competence and behavioral outcomes. The current study assessed relationships between parental stress, abuse potential, and child social and behavioral outcomes over time. Parents of children ages 2–6 years (N?=?610, 44% girls) reported on perceived parental stress and attitudes towards abuse and neglect, as well as child social competence and behavior problems, before and after a caregiver-directed, community-based intervention. Changes in parental stress, abuse potential, and child social and behavioral outcomes were examined using panel analyses, while controlling for intervention effects and demographic variables. Parental stress predicted child social competence, anxiety/withdrawal, and anger/aggression over time; while the links between stress and anxiety/withdrawal, and stress and social competence, were mediated by child abuse potential, the link between stress and anger/aggression was not mediated by child abuse potential. Findings suggest that abuse potential represents a mechanism by which parental stress and child social and behavioral outcomes are linked. Further, screening for child social competence deficits may identify children at risk for abuse, as well as parents in need of services to reduce stress.     

Trajectories of Social Anxiety in Children: Influence of Child Cortisol Reactivity and Parental Social Anxiety

Few studies have examined the interactive effect of intra- and extra-individual vulnerability factors on the trajectory of social anxiety in children. In this study, we examined the joint influence of familial vulnerability (i.e., parental social anxiety) and child biological stress vulnerability (i.e., cortisol reactivity) on trajectories of social anxiety. Children (N?=?112 (57 males), M _age?=?8.14 years, S.D. = 2.25) were followed over three visits spanning approximately three years. Parental social anxiety was assessed using the Social Phobia and Anxiety Inventory, children’s behavior and salivary cortisol reactivity were measured in response to a speech task, and children’s social anxiety was assessed at all three visits using the Screen for Child Related Emotional Disorders (SCARED; Parent-report). A growth curve analysis was used to examine trajectories of child social anxiety as predicted by children’s cortisol reactivity and parental social anxiety, adjusting for covariates. We found a significant interaction between parental social anxiety and child cortisol reactivity in predicting child social anxiety across time. Having a socially anxious parent coupled with heightened cortisol reactivity predicted the highest levels of child social anxiety, with scores that remained above clinically significant levels for social anxiety across all visits. Children with familial risk for social anxiety and who also exhibit high stress-reactivity appear to be at risk for persistent, clinically significant social anxiety. This highlights the importance of considering the interaction between both biological and contextual factors when considering the development, maintenance, and treatment of social anxiety in children across time.     

Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya

Youth mental health interventions in low-resource communities may benefit from including empirically supported elements, using stigma-free content, and using trained lay-providers. We developed and evaluated such an intervention, targeting adolescent depression and anxiety in Kenya, where mental health care is limited by social stigma and a paucity of providers. Kenyan adolescents (N = 51, ages 14–17, 60.78% female) from a school in an urban slum in Nairobi with self-reported moderate-to-severe symptoms of depression or anxiety were randomized to the 4-week “Shamiri” (“thrive”) group intervention or a study skills control intervention of equal duration. The Shamiri intervention included growth mindset, gratitude, and value affirmation exercises. The content was delivered by recent high school graduates (ages 17–21, 60% male) trained as lay-providers. Participants met in school once-a-week in groups of 9–12 youths (average group size 10). Compared to the study-skills control, Shamiri produced greater reductions in adolescent depression symptoms (p = .038; d = .32) and anxiety symptoms (p = .039; d = .54) from baseline to 4-week follow-up, and greater improvements in academic performance (p = .034; d = .32) from the school-term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p = .028, d = .71). This appears to be the first report that a brief, lay-provider delivered, community-based intervention may reduce internalizing symptoms and improve academic outcomes in high-symptom adolescents in Sub-Saharan Africa. Larger replications with extended follow-ups will help gauge the strength and durability of these effects.     

A Pilot Feasibility Open Trial of an Interpretation Bias Intervention for Parents of Anxious Children

Interpretation bias is a transdiagnostic mechanism underlying anxiety. Theoretical models highlight the role of parental interpretation bias in predicting and maintaining child anxiety. However, very few studies have examined parent interpretation bias as a treatment target. The current pilot study tested the feasibility and acceptability of an interpretation bias intervention delivered by a smartphone app, called HabitWorks, in parents of anxious children who self-reported at least mild symptoms of anxiety and negative interpretation bias.Parents of anxious youth (ages 8 to 16) were recruited from the waitlists of three child anxiety clinics. They were asked to complete interpretation modification exercises via the HabitWorks app 3 times per week for 1 month. Participants completed assessments at pre- and post-intervention and 1-month follow-up to assess changes in interpretation bias, anxiety symptoms, and overall perceptions of HabitWorks.Participants (N = 14) (M_age = 44.36; 14.29% men, 85.71% women) completed an average of 13.29 exercises out of the 12 prescribed. Acceptability ratings were high. Interpretation bias, as measured by an assessment version of the intervention exercise, significantly improved from pre- to posttreatment, and these improvements were maintained at the 1-month follow-up. Anxiety symptoms significantly improved from the “mild” severity range to the “none to minimal” range.In this pilot feasibility study in parents of anxious youth, HabitWorks was a feasible and acceptable low-intensity intervention. These preliminary results support a future controlled trial of HabitWorks for parents. Future studies are also needed to test whether targeting interpretation bias in parents has downstream effects on maladaptive parent behaviors and ultimately, child interpretation bias and anxiety.     

Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.     

Effect of Make Parenting a Pleasure on Parenting Skills and Parental Depression

Abstract

This paper explores a feasibility trial examining the effects of the Make Parenting A Pleasure (MPAP), a 12-week parent training program designed to promote family resilience by strengthening the following factors: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence in children. Fifty-nine (59) participants were assigned to either a treatment group (n?=?32) or a waitlist control group (n?=?27). Results showed that participants in the MPAP treatment group demonstrated an increase in parenting skills and child development knowledge as well as a decrease in parental depression when compared to waitlist control group participants. Results emphasize the importance of promoting resiliency by supporting parents through direct instruction and skill development.     

Anxiety Symptoms in African American Children: Relations with Ethnic Pride,Anxiety Sensitivity,and Parenting

This cross-sectional study examined the relations among children’s ethnic pride, perceived parenting behavior (i.e., parental control, parental acceptance), anxiety sensitivity, and child anxiety symptoms (i.e., physical symptoms, social anxiety symptoms, separation anxiety symptoms, and harm avoidance symptoms) in 266 African American school children (M = 9.98 years old; 55% girls). Structural equation modeling results indicated that high ethnic pride was associated with high parental acceptance. High perceived parental acceptance, in turn, was related to children reporting low levels of social anxiety symptoms and high levels of harm avoidance. In addition, high parental control was related to high anxiety sensitivity. Anxiety sensitivity partially mediated the relation between parental control and separation anxiety symptoms, such that parental control was both directly and indirectly related to separation anxiety symptoms. Parental control was indirectly related to physical symptoms, social anxiety symptoms, and harm avoidance symptoms through its direct link to anxiety sensitivity. The study’s results increment knowledge about factors influencing specific dimensions of anxiety in African American children.     

Emotional,cognitive, and social functioning in children and early adolescents living in post-armed conflict: Testing mediating mechanisms

This study examined whether, and to which extent, the associations between conflict intensity and children's and early adolescents' functioning problems were mediated through parental harsh discipline in a post-armed conflict setting. Data from 9623 Iraqi mothers and their children who participated in UNICEF MICS showed that the associations between conflict intensity, parental discipline and child functioning were similar for children and early adolescents. Higher conflict intensity was indirectly associated with increased anxiety and depression, greater learning and cognitive difficulties, and greater social and behavioural problems through parental harsh discipline. The proportion mediated effect sizes emphasised the importance of parent-focused interventions in improving child and adolescent functioning outcomes in conflict-affected populations.     

The Circle of Security Parenting Program (COS-P): A Randomized Controlled Trial of a Low Intensity,Individualized Attachment-Based Program With at-Risk Caregivers

The Circle of Security–Parenting Intervention (COS-P; Cooper et al., 2009) is a psychoeducational program for caregivers of young children that has been widely disseminated. The program is founded in attachment theory and relies on computer-delivered content and parent reflection and discussion to teach concepts of safety and security to promote better caregiver-child relationships and child wellbeing. The present study is a randomized controlled trial of COS-P, individually delivered to 85 Australian caregivers (51 COS-P, 34 waitlist control) who reported parenting distress and child disruptive behaviors. Caregivers completed a baseline assessment and repeated the assessment after completion of COS-P or 8 weeks on the waitlist. Caregivers completed surveys to report child symptoms, and parenting stress, anxious and avoidant attachment, reflective functioning, parenting practices, and depressive symptoms. No differences in COS-P vs. waitlist participants were found at baseline. Analyses of complete data (35 COS-P, 25-26 waitlist) revealed a greater decline in caregivers’ attachment anxiety and negative parenting relative to waitlist, but only attachment anxiety in intent-to-treat analyses. Other improvements were found, but these extended to both the COS-P and waitlist conditions and did not differ between conditions. Overall, effects of COS-P were small and rarely significant, suggesting the need to consider alternative programs that have evidence of effectiveness when providing services to at-risk families.     

Parental fear of negative child evaluation in child social anxiety

Parental anxiety has been linked to child anxiety in various studies. However, specific mechanisms responsible for this relationship in the context of child social anxiety are still largely unknown. A potential mediator between parental and child social anxiety may be parental fear of negative child evaluation (FNCE). To investigate this concept, we collected self-reported data from families with 9- to 16-year old children in a non-clinical sample (458 mother-child dyads and 336 father-child dyads). While both paternal and maternal FNCE predicted child social anxiety, only maternal FNCE mediated the association between maternal and child social anxiety. Maternal report of FNCE was also found to mediate the association between maternal social anxiety and general childhood emotional problems but not externalising problems. Overall, this study is the first to identify a mediator variable that may explain the association between mother and child social anxiety in school-age children. The results shed new light on the mechanisms by which fear and anxiety may be transmitted across generations.     

Maternal Intrusiveness,Family Financial Means,and Anxiety Across Childhood in a Large Multiphase Sample of Community Youth

Intrusive parenting has been positively associated with child anxiety, although examinations of this relationship to date have been largely confined to middle to upper middle class families and have rarely used longitudinal designs. With several leading interventions for child anxiety emphasizing the reduction of parental intrusiveness, it is critical to determine whether the links between parental intrusiveness and child anxiety broadly apply to families of all financial means, and whether parental intrusiveness prospectively predicts the development of child anxiety. This study employed latent growth curve analysis to evaluate the interactive effects of maternal intrusiveness and financial means on the developmental trajectory of child anxiety from 1st grade to age 15 in 1,121 children (50.7 % male) and their parents from the NICHD SECCYD. The overall model was found to provide good fit, revealing that early maternal intrusiveness and financial means did not impact individual trajectories of change in child anxiety, which were stable from 1st to 5th grade, and then decrease from 5th grade to age 15. Cross-sectional analyses also examined whether family financial means moderated contemporaneous relationships between maternal intrusiveness and child anxiety in 3rd and 5th grades. The relationship between maternal intrusiveness and child anxiety was moderated by family financial means for 1st graders, with stronger links found among children of lower family financial means, but not for 3rd and 5th graders. Neither maternal intrusiveness nor financial means in 1st grade predicted subsequent changes in anxiety across childhood. Findings help elucidate for whom and when maternal intrusiveness has the greatest link with child anxiety and can inform targeted treatment efforts.     

School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial

Anxiety disorders are one of the most prevalent diagnoses in youth, often resulting in impaired social and school functioning. Research on treatments for youth anxiety is primarily based in traditional clinical settings. However, integrating youth psychotherapies into the school environment improves access to evidence-based care. The present study is a pilot, randomized waitlist-controlled trial of a school-based, group Acceptance and Commitment Therapy–based (ACT) intervention for adolescents with anxiety. Students at two separate schools (N = 26) with elevated anxiety were randomized to a 12-week waitlist or to immediate treatment. Participants in the immediate treatment condition reported statistically significant decreases in anxiety and class absences at posttreatment and follow-up compared to the waitlist group. No statistically significant differences were found between groups for depression, psychological flexibility, positive mental health, and student well-being. However, medium within-condition effect sizes were seen in the treatment group for all outcomes. Participants reported the treatment as favorable with good acceptance ratings. Overall, this study supports ACT as a viable intervention for schools and other clinical settings providing services to adolescents with anxiety.     

Relationships between restrictive mother-child interactions and anxiety of the child

Abstract

The “two-process model” postulates that there are specific associations between patterns of parental child-rearing styles and the development of the child's anxiety and coping dispositions. Besides parameters of parental feedback to the child, this model considers support and restriction to be the central dimensions of child-rearing behavior. The present study aims at assessing behavioral indicators for restriction. For this purpose, the working and intervention behavior of 47 mothers and their ten- to 13-year-old children was observed and registered during a 15-minute period of common problem-solving (putting together a difficult puzzle-like cube). In order to register processes of problem-oriented cooperation between mother and child, transitional probabilities between defined state and event classes were analyzed. Based on the theoretical definition of the child-rearing style “restrictio”, hypotheses concerning the significance of variable transitional probabilities are formulated and tested regarding their correspondence with anxiety-related characteristics of the child.     

Child Perceptions of Parental Care and Overprotection in Children with Cancer and Healthy Children

The primary aims of this study were to: (a) examine child perceptions of overprotection; and (b) explore how these perceptions relate to child health and adjustment. Children with a prior diagnosis of cancer (n = 205) and children without a history of serious illness (n = 76) reported on parental overprotective and caring behaviors. Children with cancer were recruited from one of four strata based on the elapsed time since their cancer diagnosis (1–6 months; 6–24 months; 2–5 years; >5 years) Children also reported on symptoms of depression, anxiety, and posttraumatic stress. Children with cancer did not differ from healthy children in their perceptions of parental care or overprotection. Child distress was more strongly related to perceptions of care and overprotection than child’s health status. Children with cancer do not report their parents approach to care and protection differently than children without a cancer history. These findings mirror prior research examining parental perceptions of overprotection and suggest that, despite the challenges of parenting a child with serious illness, parental protection is not significantly altered.     

Influence of Parenting Factors on Childhood Social Anxiety: Direct Observation of Parental Warmth and Control

The purpose of the present study is to determine the association of parenting behaviors and social anxiety in children. Three parental factors—including parental socialization, control, and warmth—were investigated in a sample of 31 two-parent families. Rather than solely relying upon retrospective questionnaires, this study incorporated direct observation and a Daily Activity Log to assess the qualities of social interaction. Moderate associations between parental control and child anxiety symptoms were found, with no support for the association between parental warmth and child anxiety. More specifically, maternal overprotection and observed negative commands related to child social anxiety, and paternal overprotection related to child general anxiety. Several gender differences were found regarding the impact of parent behaviors on child anxiety. Implications, limitations, and future directions are discussed.     

Perceived Parental Control and Parent–Child Relational Qualities in Chinese Adolescents in Hong Kong

Chinese secondary school students (N = 3,017) were asked to respond to instruments that measure subjective evaluation of parental behavioral control (indexed by parental knowledge, expectation, monitoring, discipline, and demandingness, as well as Chinese parental control attributes), parental psychological control, and parent–child relational qualities (satisfaction with parental control, child's readiness to communicate with the parents, and perceived mutual trust). Results showed that Chinese adolescents perceived their fathers and mothers to be different in terms of the above indicators, and they suggest that the notion of “strict father, kind mother” in traditional Chinese culture has changed to “strict mother, kind father” in contemporary Chinese culture. Results also showed significant main effects of the child (boys vs. girls) and interaction effects of parents and gender of the child. Finally, parental educational levels were positively related to perceived parental control processes and parent–child relational qualities.     

An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia

There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with “small” to “very large” effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.     

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.     

Fathers’ Challenging Parenting Behavior Prevents Social Anxiety Development in Their 4-Year-Old Children: A Longitudinal Observational Study

Recent models on parenting propose different roles for fathers and mothers in the development of child anxiety. Specifically, it is suggested that fathers’ challenging parenting behavior, in which the child is playfully encouraged to push her limits, buffers against child anxiety. In this longitudinal study, we explored whether the effect of challenging parenting on children’s social anxiety differed between fathers and mothers. Fathers and mothers from 94 families were separately observed with their two children (44 % girls), aged 2 and 4 years at Time 1, in three structured situations involving one puzzle task and two games. Overinvolved and challenging parenting behavior were coded. Child social anxiety was measured by observing the child’s response to a stranger at Time 1, and half a year later at Time 2, and by parental ratings. In line with predictions, father’s challenging parenting behavior predicted less subsequent observed social anxiety of the 4-year-old child. Mothers’ challenging behavior, however, predicted more observed social anxiety of the 4-year-old. Parents’ overinvolvement at Time 1 did not predict change in observed social anxiety of the 4-year-old child. For the 2-year-old child, maternal and paternal parenting behavior did not predict subsequent social anxiety, but early social anxiety marginally did. Parent-rated social anxiety was predicted by previous parental ratings of social anxiety, and not by parenting behavior. Challenging parenting behavior appears to have favorable effects on observed 4-year-old’s social anxiety when displayed by the father. Challenging parenting behavior emerges as an important focus for future research and interventions.