Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

Overt and covert antisocial behavior: Child and family characteristics among psychiatric inpatient children

The present study examined child and family characteristics associated with overt and covert antisocial child behaviors. Child psychiatric inpatients (N=258, ages 6–13) were identified as high in overt and/or covert antisocial behaviors (e.g., aggression and stealing, respectively) based on a structured parent interview measuring antisocial behavior. Children were classified into four groups derived from the factorial combination of level of overt (high vs. low) and covert (high vs. low) antisocial behaviors. Analyses were made of the children's reactions to hostile and anger-provoking situations, deviant and prosocial child behaviors at home and at school, and family structure and organization. Children higher in overt antisocial behaviors were more negative, resentful, and irritable in their reactions to hostile situations and more aggressive at school. They came from families with significantly greater conflict and less independence among family members. Children higher in covert antisocial behavior participated in fewer social activities and were higher in anxiety; their families showed significantly lower family cohesion and organization and less of an emphasis on moral-religious values. The results suggest reliable differences in child and family functioning as a function of patterns of overt and covert antisocial behavior.     

青少年的学校适应问题：家庭亲密度、家庭道德情绪和责任感的作用

随机选取某市三所普通中小学四、六、八、十年级的755名青少年为被试,使用自评和他评问卷探讨家庭亲密度、家庭道德情绪和责任感与青少年学校适应之间的关系。结果显示：（1）青少年家庭亲密度、责任感与学校适应问题存在性别差异,女生家庭亲密度和责任感高于男生,外化和学业问题少于男生;家庭亲密度、道德情绪和责任感随年龄增长呈下降趋势;（2）家庭亲密度正向预测道德情绪和责任感,直接和间接负向预测青少年学校适应问题。（3）责任感负向预测学校适应问题,并在家庭亲密度和学校适应问题之间起部分中介作用;结构方程模型各指标的拟合效果较好。家庭亲密度、责任感是学校适应问题的良好预测指标。     

Family Functioning,Parental Psychological Distress and Child Behaviours: Evidence from the Victorian Child Health and Wellbeing Study

We examined, using data from the 2006 Victorian Child Health and Wellbeing Study (VCHWS), whether family functioning is associated with parental psychological distress and children's behavioural difficulties. The VCHWS was a statewide cross‐sectional telephone survey to 5,000 randomly selected primary caregivers of 0‐ to 12‐year‐old children between October 2005 and March 2006. Only parents or guardians of children aged 4–12 years (n = 3,370) were included in this study. After adjusting for sociodemographic variables and ethnicity, parents or guardians scoring higher on the family functioning scale (i.e., from poorly functioning households) were at greater risk of psychological distress and had children with lower levels of prosocial behaviour and higher levels of behavioural difficulties relative to those from healthily functioning households. Mental health prevention programmes addressing child mental and conduct problems should consider the family environment and target those families functioning poorly.     

Family characteristics as mediators of the influence of problem drinking and multiple risk status on child mental health

Structural equation modeling was used to test a theoretical model in which family cohesion and family reframing coping were hypothesized as mediators between family drinking problems, multiple risk factors, negative life events, and child mental health (conduct disorder, depression, anxiety) in two-parent families. Family cohesion mediated the relationships of family drinking problems and negative life events to child conduct disorder and depression. Negative life events mediated the relationships of family drinking problems and family multiple risk to child conduct disorder. Family reframing coping did not function as a mediator nor was it related to child mental health when other factors were considered simultaneously. Results indicate that increasing family cohesion and reducing sources of stress within the family (negative life events) represent promising areas for interventions for children with problem-drinking parents. Work on this study was funded in part by the National Institute for Mental Health Grant 2-P50-MH39246-06 to support a Preventive Intervention Research Center. The authors gratefully acknowledge contributions made by Rita Shell, Marcia Michaels, Joanne Gersten, George Knight, and Carolyn Berg.     

Predictors of Psychosocial and Cognitive Adaptation in Children with Sickle Cell Syndromes

Examined the role of socioecological factors (family functioning and socioeconomic variables) in predicting behavioral and cognitive adaptation in children with sickle cell syndromes (SCD). Participants included 74 African American children and adolescents with SCD and their primary caretakers. Outcomes included internalizing and externalizing behavior symptoms, as rated by caretakers, as well as intellectual abilities and academic achievement, as assessed by individually administered standardized instruments. Family functioning consisted of both caretaker adjustment and family environment (i.e., family adaptability and cohesion). Hierarchical multiple regression analyses revealed that caretaker psychological adjustment predicted externalizing behaviors, while family environment (i.e., adaptability and cohesion) predicted neither behavioral nor cognitive functioning. Socioeconomic variables alone predicted intellectual abilities and academic achievement and also contributed to the prediction of child behavioral adaptation. Results are discussed in terms of relevant sociocultural issues and implications for family-level prevention and intervention.     

The Relation Between Parental Mental Illness and Adolescent Mental Health: The Role of Family Factors

Children of parents with a mental illness are often found to be at high risk of developing psychological problems themselves. Little is known about the role of family factors in the relation between parental and adolescent mental health. The current study focused on parent–child interaction and family environment. This cross-sectional questionnaire study included 124 families with a mentally ill parent and 127 families without a mentally ill parent who at the time of the study had children aged 11–16 years old. Parents completed questionnaires about their mental health, parent–child interaction (i.e., parental monitoring and parental support), and family environment (i.e., cohesion, expressiveness, and conflict). Adolescents reported their internalizing and externalizing problems. Path analyses were used to examine the direct associations between parental mental illness and adolescent problems as well as the indirect relations via parent–child interaction and family environment. The results showed that interaction between parents with a mental illness and their child was significantly worse compared to parents without a mental illness. The family environment of parents with mental illness was also more negative. Mentally ill parents monitored their adolescents less, which in turn related to more externalizing problems of the adolescents. No factors mediated the relation between parental mental health and adolescent internalizing problems. Moreover, no direct effects of parental support, family cohesion, and family expressiveness with externalizing problems were found. These findings imply that parental monitoring should get a specific focus of attention in existing interventions designed to prevent adolescents with a mentally ill parent from developing problems.     

Interparental conflict and adolescent emotional security across family structures

This study investigated whether interparental conflict was differentially related to forms of emotional security (i.e., family, interparental, parent–child) and whether forms of emotional security were differentially associated with mental health problems for adolescents in married versus divorced/separated families. Participants were 1032 adolescents (ages 10–15; 51% male, 49% female; 82% non-Hispanic White, 9% Black/African American, 5% Hispanic, 2% Asian or Pacific Islander, 2% Native American) recruited from a public school in a middle-class suburb of a United States metropolitan area. We used multiple group multivariate path analysis to assess (1) associations between interparental conflict and multiple measures of emotional insecurity (i.e., family, interparental, and parent–child), (2) associations between measures of emotional insecurity and internalizing and externalizing problems, and (3) moderation effects of parent–child relationships. The patterns of association were similar across family structures. A high-quality parent–child relationship did not mitigate the harmful effects of interparental conflict on emotional insecurity or mental health problems. Findings suggest that regardless of family structure, emotional security across multiple family systems may be a critical target for intervention to prevent youth mental health problems, in addition to interventions that reduce conflict and improve parent–child relationships.     

Siblings of children with mental retardation: Family characteristics and adjustment

Siblings of children with mental retardation may be at greater risk for adjustment problems because of family stress related to the needs of the child with mental retardation. Family dimensions were investigated to determine their relationship to sibling adjustment. Adjustment of 12 siblings of children with mental retardation was examined in relationship to family dimensions. These relationships were compared to those for children from families without a disabled child. For both groups, self concept was positively associated with family cohesion, and social competence was positively associated with family promotion of independence. For only the siblings of the mentally retarded children, family conflict was inversely related to social competence, and family organization was positively related to sibling self concept. Our results suggest that family conflict and disorganization appear to have a more negative effect in families with a child with mental retardation.     

Child Personality as Moderator of Outcome in a School‐based Intervention for Preventing Externalising Behaviour

Studying moderators of intervention effects is essential to elucidate what works for whom. The present study investigated whether child personality moderates short‐term and follow‐up effects of an individualised preventive school‐based intervention for children with externalising behaviour. The sample consisted of 48 schools, with 264 fourth‐grade children displaying externalising behaviour (M_age = 10.2 years), randomly assigned to the intervention (n = 191) or no intervention control (n = 73) condition. Teachers and children reported at pretest, posttest and follow‐up test about reactive and proactive aggression. Child personality was assessed by teachers at pretest. Child conscientiousness moderated short‐term intervention effects, indicating that more organised and planful children benefited more from the intervention. Child extraversion moderated both short‐term and follow‐up intervention effects, with low extraverted children showing larger effects. These results affirm the importance of including personality as moderator of intervention effects in future studies, as interventions adapted to specific child traits might yield larger effects. Copyright © 2012 John Wiley & Sons, Ltd.     

An ecological approach to child and family clinical and counseling psychology

The ecological model of child and family clinical and counseling psychology considers mental health service delivery within a health maintenance framework, approaching the complexity of children's behavior in a systematic and organized fashion using science-based intervention practices. The service delivery framework integrates assessment, intervention, and motivation at all phases of an intervention. Assessments enhance the participants' and professionals' appraisal, which in turn impact motivation to change. Interventions are sensitive to assessment-based targets and participant motivation. A menu of interventions range from assessment, feedback, and brief interventions to more extensive mental health services, potentially integrated with other community agencies and school settings. The ecological model suggests revisions in the conceptualization of child and adolescent psychopathology, training for mental health professionals, and strategies for the design and testing of interventions. In general, a reformulation of mental heath services for children and families within an ecological framework enhances the potential for integrating science and practice.     

Social anxiety disorder in children and youth: A research update on aetiological factors

Social Anxiety Disorder (SAD) is a heterogeneous and distressing problem for many children and youth. This review focuses on the etiology and maintenance of SAD, and examines research findings in several key areas of investigation: genetic or hereditary factors (twin and family studies), temperament characteristics (behavioural inhibition), and parent–child interactions (attachment, parenting styles). It is concluded that genetic influences, behavioural inhibition, and parent–child interactions play significant and interactive roles in the development and maintenance of SAD. Other influences such as peer relationships, social skills deficits, and traumatic experiences are also acknowledged. Ultimately, an understanding of such pathways should facilitate effective early screening and intervention of children at risk for severe social anxiety.     

Bidirectional Spillover in the Family across the Transition to Parenthood

Although family systems theory posits reciprocal causality between subsystems of the family, such as intimate partner violence exacerbating harsh parenting and vice versa, longitudinal studies with cross‐lagged models have been used infrequently to test these principles. As guided by the spillover model, this study examined bidirectional associations between couple dysfunction, parent–child aggression risk, and child functioning across the transition to parenthood to determine whether and how disruptions in one subsystem relate to problems in other family subsystems. Participants were 201 first‐time mothers and 151 fathers from a diverse community sample, evaluated during pregnancy, and reassessed two more times through their child's first 18 months of life. Individual and dyadic path model results indicate bidirectional spillover effects between parent–child aggression risk and child functioning for both mothers and fathers, and spillover from parent–child aggression risk to couple dysfunction for mothers but not fathers. However, limited spillover effects were identified between couple functioning and child adjustment, in contrast to previous work. Findings suggest that spillover can happen reciprocally and early in the family, supporting transactional models of behavior and highlighting the need for early family level intervention.     

Improving Couples’ Relationship Functioning Leads to Improved Coparenting: A Randomized Controlled Trial With Rural African American Couples

Family-centered prevention programs for couples with children are being increasingly disseminated, with the hope that improving couples’ romantic relationships will lead to other benefits for families. To date, however, it is unclear whether these interventions do in fact yield these benefits. The current study addressed this gap by examining whether postintervention improvements in couples’ relationship functioning following family-centered prevention predicted longer-term change in coparenting, and whether postintervention improvements in coparenting predicted longer-term change in relationship functioning. We used four waves of data collected over 2 years from 346 rural African American couples with an early adolescent child who participated in a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, an intervention designed to promote strong couple, coparenting, and parent–child relationships in two-parent African American families. Results indicated that ProSAAF had significant short-term positive effects on both romantic relationship functioning and coparenting and that these effects did not differ in magnitude. Over time, however, only romantic relationship functioning postintervention was positively associated with long-term changes in coparenting; coparenting postintervention was not associated with long-term changes in relationship functioning and this association was significantly weaker than the other pathway. These findings support a key premise underlying relationship enhancement programs for parents, indicating that improving couples’ romantic relationship functioning can have longer-term benefits for the coparenting relationship as well. Further research examining long-term parent, child, and family outcomes following family-centered prevention for couples and the mechanisms of change underlying these outcomes is needed.     

A Kid-Friendly Tool to Assess Rumination in Children and Early Adolescents: Relationships with Mother Psychopathology and Family Functioning

The early identification of ruminative processes in children and early adolescents is particularly important to prevent the development of a stable ruminative style in later stages of development. The present study first aimed at validating a child-friendly tool, Kid Rumination Interview (KRI), to be used in a sample aged 7–12 years (n?=?100; 50% females). Second, we hypothesized that maternal depression, family functioning and participants’ emotion regulation skills would be associated with children’ levels of rumination. Factor analysis on KRI scores yielded two main factors: personal life-related rumination and school-related rumination. Older and female participants showed higher tendencies to ruminate about school issues compared to their younger and male counterparts. A low-to-moderate correlation emerged between school-related rumination and child/early adolescent’s emotion regulation capacities. Mothers’ depressive rumination and mothers’ depressive symptoms were positively associated with children/early adolescents’ rumination about personal life and rumination about school issues. Conversely, an adequate and positive family functioning was negatively correlated with both school-related rumination and rumination about personal life. Hierarchical regression analyses pointed to a crucial role of maternal rumination and familiar rigidity in both types of rumination. Personal life-related rumination was also specifically predicted by maternal depression and family enmeshment, whereas school-related rumination was significantly associated with children/early adolescents’ emotional control and gender. Overall, the KRI appears as a promising tool to assess rumination in children/early adolescents. Results suggests partially different pathways to specific forms of ruminative thoughts.     

Family Cohesion and Adaptation in Pediatric Chronic Conditions: The Missing Link of the Family’s Condition Management

The quality of family functioning has been considered an important predictor of adaptation in children with chronic conditions and their parents. Previous research suggests that beyond general family functioning, the specific experience of the family’s condition management is paramount for understanding family members’ adaptation. This study’s first goal was to compare family functioning and parents’ and children’s adaptation outcomes across four chronic conditions: asthma, diabetes, epilepsy, and obesity. Secondly, we explored the mediating role of family life difficulties and parental mutuality, as two potential paths through which family cohesion is linked to family members’ adaptation. A total of 263 parents of children (3–19 years old) with asthma (n = 77), obesity (n = 79), epilepsy (n = 52) and diabetes (n = 55) completed self-report measures of family cohesion, family life difficulty, parental mutuality, anxiety and depressive symptoms, and their children’s health-related quality of life (HrQoL). The results showed that families of children with diabetes, obesity, and epilepsy were at higher risk of experiencing family difficulties and children’s deteriorated HrQoL when compared to families of children with asthma. With regard to the links among study variables, although family cohesion had both a direct and indirect relationship with parental depressive symptoms, its links with parental anxiety symptoms and children’s HrQoL were only indirect, through family life difficulty. These associations were consistent across the four clinical groups. These findings emphasize the relevance of family-centered interventions aimed at promoting family cohesion, parents’ mutuality, and effective coping with the demands of pediatric chronic conditions.     

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.     

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.     

The contribution of parenting practices in a risk and resiliency model of children's adjustment

A risk and resiliency model of children's adjustment was evaluated, with a focus on the relationship of parenting practices to risk and protective factors. Risk factors included family stress, family conflict, parent psychopathology and low socio‐economic status. Protective factors included family cohesion, family social support and family moral– religious orientation. The research hypothesis was that parenting practices would have a direct effect on child outcomes, as well as a moderating effect on the relationship between risk and protective factors and child outcomes. Three different outcomes were utilized: disruptive behaviour disorders, adaptive emotional functioning and school achievement. Participants were 80 children aged 6–12 years and their mothers. Hierarchical regression analyses suggested that the combination of family risk and protection and parenting practices was highly predictive of child functioning for both disruptive externalizing behaviours and positive emotional adaptation. It was found that negative family factors were more highly associated with negative child outcomes, whereas positive family factors were more highly associated with positive child outcomes. Family risk factors and poor parenting primarily accounted for the variance in externalizing child behaviours. Alternately, family protective factors and positive parenting primarily accounted for the variance in child adaptive behaviours. Parenting practices had a direct effect on child outcomes, but was not a strong moderator of the relationship between risk and protection factors and child outcomes.     

The Relationship Between Male-Perpetrated Interparental Aggression,Paternal Characteristics,and Child Psychosocial Functioning

It is well established that children in homes where interparental violence is present are at increased risk for psychosocial (i.e., internalizing, externalizing, and attention) difficulties. However, previous studies have provided a limited view on the variety of factors that commonly co-occur in these environments (e.g., other characteristics of the parents and family) and how they may collectively impact children. Knowing this information could have implications for parental interventions aimed at preventing the continuation or initiation of psychosocial problems in children. Thus, the present study simultaneously examined the association between father-perpetrated interparental aggression, father characteristics, and child psychosocial functioning in a sample of 145 men arrested for domestic violence. Results showed that of all the variables examined, paternal antisocial personality traits and interpersonal hostility were uniquely associated with overall child psychosocial impairment, externalizing problems, and attention problems. Implications for intervention programs are discussed.