From correlates to causes: can quasi-experimental studies and statistical innovations bring us closer to identifying the causes of antisocial behavior?

Longitudinal, epidemiological studies have identified robust risk factors for youth antisocial behavior, including harsh and coercive discipline, maltreatment, smoking during pregnancy, divorce, teen parenthood, peer deviance, parental psychopathology, and social disadvantage. Nevertheless, because this literature is largely based on observational studies, it remains unclear whether these risk factors have truly causal effects. Identifying causal risk factors for antisocial behavior would be informative for intervention efforts and for studies that test whether individuals are differentially susceptible to risk exposures. In this article, we identify the challenges to causal inference posed by observational studies and describe quasi-experimental methods and statistical innovations that may move researchers beyond discussions of risk factors to allow for stronger causal inference. We then review studies that used these methods, and we evaluate whether robust risk factors identified from observational studies are likely to play a causal role in the emergence and development of youth antisocial behavior. There is evidence of causal effects for most of the risk factors we review. However, these effects are typically smaller than those reported in observational studies, suggesting that familial confounding, social selection, and misidentification might also explain some of the association between risk exposures and antisocial behavior. For some risk factors (e.g., smoking during pregnancy, parent alcohol problems), the evidence is weak that they have environmentally mediated effects on youth antisocial behavior. We discuss the implications of these findings for intervention efforts to reduce antisocial behavior and for basic research on the etiology and course of antisocial behavior.     

Novel Insights into Longstanding Theories of Bidirectional Parent–Child Influences: Introduction to the Special Section

Although bidirectional parent and child influences have been incorporated in theoretical models pertaining to the development of internalizing and externalizing behaviors in youth, studies have historically focused on the socializing influence that parents have on their children. This has left several important research questions unanswered about the nature of bidirectional parent-child relations across development, including how these bidirectional effects are related to different types of child and adolescent psychopathology. The goal of this special section is to examine some longstanding issues regarding the nature of bidirectional parent-child effects across time using a diverse array of longitudinal datasets. The results from these studies emphasize the importance of considering bidirectional effects in developmental psychopathology research, particularly the often overlooked influence that children and adolescents have on their parents' behavior and emotional well-being. Following these empirical articles, an expert in the field provides a scholarly commentary designed to outline the progress that has been made in understanding bidirectional parent-child effects across development as well as to propose fruitful areas for future research.     

The role of fathers in child and adolescent psychopathology: make room for daddy.

This review summarizes research concerning the relation between paternal factors and child and adolescent psychopathology. When compared with mothers, fathers continue to be dramatically underrepresented in developmental research on psychopathology. However, findings from studies of children of clinically referred fathers and nonreferred samples of children and their fathers indicate that there is substantial association between paternal characteristics and child and adolescent psychopathology. Findings from studies of fathers of clinically referred children are stronger for fathers' effects on children's externalizing than internalizing problems. In most cases the degree of risk associated with paternal psychopathology is comparable to that associated with maternal psychopathology. Evidence indicates that the presence of paternal psychopathology is a sufficient but not necessary condition for child or adolescent psychopathology.     

Focusing on the Positive: A Review of the Role of Child Positive Affect in Developmental Psychopathology

This review proposes a transactional model of child positive affect (PA) to reflect the ways that PA, in various contexts, may confer both risk and protection for psychosocial adjustment. Though research has largely explored the ways that low PA relates to maladjustment in youth, much less research has focused on the ways that PA can facilitate adjustment, particularly under conditions of risk. Yet, theory suggests that a greater emphasis on PA as a protective factor is an important endeavor in developmental psychopathology research; such conceptual issues are explored in this review. This review also seeks to spur a more nuanced approach to the study of child PA through the use of increased multi-method, longitudinal assessments as well as the consideration of contextual factors. Building upon this research base is important for aiding in the development of intervention and prevention efforts that attempt to promote positive psychosocial development and mitigate the course of psychopathology in youth at risk for PA difficulties.     

The Role of Temperament in the Etiology of Child Psychopathology

A substantial proportion of children and adolescents come to suffer from psychological disorders. This article focuses on the temperament factors that are involved in the pathogenesis of child psychopathology. It is argued that besides the reactive temperament factor of emotionality/neuroticism, the regulative process of effortful control also plays an important role in the etiology and maintenance of internalizing and externalizing problems in youths. More specifically, vulnerability to child psychopathology is determined by a temperament that is characterized by high levels of emotionality/neuroticism and low levels of effortful control. Models are hypothesized in which reactive and regulative temperament factors either have interactive or additive effects on the development of psychological disorders in children, and conceptualized in terms of a developmental psychopathology perspective. Directions for future research and clinical implications of this temperamental view on psychopathology are discussed.     

The psychotherapy of parenthood: towards a formulation and valuation of concurrent work with parents

This paper explores the process and value of concurrent work with parents when their child is being treated in individual psychotherapy. The position taken is that psychoanalytic understanding generally and the specific formulations presented in this paper have a broader applicability in other aspects and approaches in child and adolescent mental health practice. The central issues are the interweaving of knowledge of family processes, child development and psychopathology, and the uses that can be made of an understanding of transference and countertransference. A particular formulation is presented in relation to aspects of the work that constitute ‘child guidance’ and those that may be considered as ‘psychotherapeutic’ in relation to parental psychopathology. We have coined the term ‘the psychotherapy of parenthood’ to give this work the status it deserves and to define a boundary within which to explore the areas and levels of this complex work. Some practice and training implications are considered.     

Effects of A Parenting-Focused Mindfulness Intervention on Adolescent Substance Use and Psychopathology: A Randomized Controlled Trial

Substance use and psychopathology symptoms increase in adolescence. One key risk factor for these is high parent stress. Mindfulness interventions reduce stress in adults and may be useful to reduce parent stress and prevent substance use (SU) and psychopathology in adolescents. This study tested the feasibility and effects of a mindfulness intervention for parents on adolescent SU and psychopathology symptoms. Ninety-six mothers of 11–17 year olds were randomly assigned to a mindfulness intervention for parents (the Parenting Mindfully [PM] intervention) or a brief parent education [PE] control group. At pre-intervention, post-intervention, 6-month follow-up, and 1-year follow-up, adolescents reported on SU and mothers and adolescents reported on adolescent externalizing and internalizing symptoms. Primary intent to treat analyses found that the PM intervention prevented increases in adolescent SU over time, relative to the PE control group. The PM intervention also prevented increases in mother-reported externalizing symptoms over time relative to the PE control group. However, PM did not have a significant effect on internalizing symptoms. PM had an indirect effect on adolescent-reported externalizing symptoms through greater mother mindfulness levels at post-intervention, suggesting mother mindfulness as a potential intervention mechanism. Notably, while mothers reported high satisfaction with PM, intervention attendance was low (31% of mothers attended zero sessions). Secondary analyses with mothers who attended?>??=?50% of the interventions (n?=?48) found significant PM effects on externalizing symptoms, but not SU. Overall, findings support mindfulness training for parents as a promising intervention and future studies should work to promote accessibility for stressed parents.

Clinical Trials Identifier: NCT02038231; Date of Registration: January 13, 2014

     

Relations Between Emotion Regulation, Parenting, and Psychopathology in Young Maltreated Children in Out of Home Care

Young maltreated children, birth to three years, represent the age group with the highest rates of maltreatment in the United States (ACYF 2007). There are few studies to date that have investigated early childhood maltreatment and its effects on emotion regulatory processes and psychopathology. In response, the current investigation uses a dyadic assessment procedure to examine the relationship between parenting, emotion regulation, and symptoms of psychopathology among maltreating and non-maltreating parent–child interactions. The participants in this study were 123 children (66 maltreated and 57 nonmaltreated) from ages 1–3. Child and parent affect and child effortful control were observed during a parent–child interaction task. Symptoms of psychopathology were measured using the Child Behavior Checklist. The maltreated children exhibited more anger, more internalizing symptomatology, and less positive affect compared to non-maltreated children. Among maltreated children, emotion dysregulation was associated with internalizing symptomatology. Moreover, these data reveal parental positive affect was associated with lower child internalizing symptomatology and parental anger was associated with higher child internalizing symptomatology in the entire sample. This investigation offers evidence that emotion dysregulation subsequent to poor dyadic interactions is associated with early child maltreatment. These data suggest that maltreated children experience difficulties in emotion regulation which may be related to their higher levels of behavioral symptomatology.     

Childhood abuse as a possible locus for early intervention into problems of violence and psychopathology

Reviewed research on abuse in childhood. Physical abuse, sexual abuse, psychological abuse, as well as children witnessing parents abuse each other, were all found to be associated with later problems with violence and psychopathology. No causal conclusions could be drawn because of the correlational nature of the research. Also, research into possible interventions was reviewed. At least somewhat effective interventions for stopping abuse once it begins are available for all of the types of abuse. However, there are no data on the effects of these interventions on long-term problems of violence or psychopathology. It is recommended that psychopathologists and therapists collaborate in long-term studies which utilize intervention as a tool for experimentally investigating the relationships between childhood abuse and later problems of violence or psychopathology.     

Problematic Identity Processes: The Role of Identity Distress

This special issue of Identity: An International Journal of Theory and Research explores some of the anxiety, distress, and difficulties that may be encountered in the identity development process. Despite findings documenting the presence of identity distress in samples from a variety of settings and cultures, it has been slowly moving out of direct attention within the world of clinical psychology and psychiatry. This special issue expands on our understanding of identity distress in a number of ways. It adds to our knowledge of prevalence and severity, as well as its psychological correlates. It examines identity distress under the contexts of traumatic exposure and the refugee experience, and it offers some cross-national comparisons. Also offered is a developmental psychopathology perspective as a way to lay the groundwork for increased prevention and intervention work, and an example of such an intervention program for emerging adults. It is hoped that this special issue on identity distress will shine more light on this important, and possibly growing, yet understudied phenomenon, and will contribute toward expanding and enhancing efforts to foster positive youth development.     

Does a Booster Intervention Augment the Preventive Effects of an Abbreviated Version of the Coping Power Program for Aggressive Children?

Booster interventions have been presumed to be important methods for maintaining the effects of evidence-based programs for children with behavioral problems, but there has been remarkably little empirical attention to this assumption. The present study examines the effect of a child-oriented booster preventive intervention with children who had previously received an abbreviated version (24 child sessions, 10 parent sessions) of the Coping Power targeted prevention program. Two hundred and forty-one children (152 boys, 89 girls) were screened as having moderate to high levels of aggressive behavior in 4th grade, then half were randomly assigned to receive the abbreviated Coping Power program in 5th grade, and half of the preventive intervention children were then randomly assigned to a Booster condition in 6th grade. The Booster sessions consisted of brief monthly individual contacts, and were primarily with the children. Five assessments across 4 years were collected from teachers, providing a three-year follow-up for all children who participated in the project. Results indicated that the abbreviated Coping Power program (one-third shorter than the full intervention) had long-term effects in reducing children’s externalizing problem behaviors, proactive and reactive aggression, impulsivity traits and callous-unemotional traits. The Booster intervention did not augment these prevention effects. These findings indicate that a briefer and more readily disseminated form of an evidence-based targeted preventive intervention was effective. The findings have potential implications for policy and guidelines about possible intervention length and booster interventions.     

The Development of Latent Dimensions of Psychopathology across Early Childhood: Stability of Dimensions and Moderators of Change

Recent research has described the structure of psychopathology as including one general and multiple specific factors, and this structure has been found in samples across development. However, little work has examined whether this structure is consistent across time, particularly in young children, within the same sample. Further, few studies have examined factors that influence the magnitude of the stability of latent dimensions of psychopathology. In the present study, we examine these issues in a community sample of 545 children assessed at ages 3 and 6. In addition, we explored child temperament, parental history of psychopathology, and parenting behaviors as potential moderators of the longitudinal stability of latent dimensions of psychopathology. We found that the same bifactor model structure identified at age 3 provided an adequate fit to the data at age 6. Further, our model revealed significant homotypic stability of the general, internalizing, and externalizing specific factors. We also found evidence of differentiation of psychopathology over time with the general factor at age 3 predicting the externalizing factor at age 6. However, we failed to identify moderators of the longitudinal associations between psychopathology latent factors. Overall, our results bolster support for the bifactor structure of psychopathology, particularly in early childhood.     

Child maltreatment as a global phenomenon: From trauma to prevention

Past studies have clearly showed the negative impact of neglect and abuse on child development at both the psychological and neurobiological levels. To date, many studies have focused on identifying risk and protective factors occurring at all levels of the ecology. However, more distal‐level variables, such as culture and ethnicity, have not been studied as much as those of more proximal levels; yet studies in Western countries have consistently found an overrepresentation of child maltreatment reports among ethnic minority groups. In this commentary, we reflect on a series of articles examining maltreatment from a crosscultural perspective and using samples of diverse countries. Taken together, studies in this special section document the terrible fact that maltreatment is a global phenomenon. Through a summary of these studies’ main findings and concerns, we highlight four key points that we believe are important to consider for future research and intervention efforts.     

Mothers and Fathers in Family Cognitive-Behavioral Therapy for Anxious Youth

Cognitive-behavioral therapy (CBT) for anxiety disorders in youth has been evaluated in randomized clinical trials and found to be an efficacious treatment. Studies have investigated the effects of increased parental/family involvement in treatment. In the majority of these studies, however, parental involvement is synonymous with maternal involvement leaving the role of fathers unknown. Studies including parents in treatment have yet to examine the independent contribution of mothers and fathers to child outcome. We examined the relationship between both mother (n = 45) and father (n = 45) attendance and engagement in therapy sessions, maternal and paternal psychopathology, and child (n = 45) treatment outcome when parents were included in a Family CBT program for anxiety-disordered youth. Some indications were found for the notion that greater rates of mother and father attendance in session, as well as higher ratings of mother and father engagement in session, are associated with improved child outcome. Parental psychopathology was not associated with attendance, engagement, or child outcome. Recommendations for future research are offered.     

Effects of parent and child characteristics on participation and outcome of an individualized booster parent intervention for children with externalizing behaviour

In this study, we examined whether a booster parent training, offered after a cognitive behavioural child intervention, is effective in reduction of aggressive behaviour and changes in parenting. A second aim was to identify parent and child characteristics that influence parental participation. Children (73% boys, 40% immigrants, mean age = 10.1 (.53)) were randomly assigned to the child (n = 97 children) or child and parent intervention (n = 94 children) condition. Results of both intention-to-treat and completers only analyses indicated no extra effects of the parent intervention for the total group. Parents who participated (47%) did not differ from non-participants in demographic characteristics. However, mother's perceived level of child's aggression at the end of the child intervention was of significant meaning for the decision to participate in the parent intervention. Participation seemed to interrupt the development of more aggressive behaviour and less appropriate parenting skills for those children in highest need and resulted in increased maternal involvement.     

Resilience and Family Psychosocial Processes Among Children of Parents with Serious Mental Disorders

Resilience involves successful adaptation despite adverse circumstances, and is operationalized in this study as a multidimensional construct which consists of both positive and negative indicators of adaptation. Previous research has emphasized the importance of parental psychopathology in predicting child adaptation among children of parents with serious mental disorders. In contrast, we hypothesized five family psychosocial processes as common sequelae to serious parental mental disorder that are central to child adaptation beyond that predicted by parental psychiatric status. These are diminished family financial resources, social network constriction, impaired performance of parenting tasks, increased familial stress, and disruption of the parent-child bond. We examined the relationship of these processes to child adaptation independently through hierarchical regression analyses after taking into account parental psychiatric symptoms and functioning as well as the child's age and gender. One hundred seventy-seven children of mothers with serious mental disorder, ages 2–17 years old, were assessed on measures of adaptation. Results indicated that family psychosocial processes are a more consistent and powerful predictor of child adaptation than parental psychopathology. Results also indicated that, for these children, adaptation is predicted most consistently by parenting performance, and to lesser extents, by the parent-child bond and familial stress. We discuss our results in terms of their implications for theory and intervention with children of parents with serious mental disorders and for the study of resilience.     

Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety

Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children’s treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre- to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method—in-person CCBT versus parent-mediated bibliotherapy—influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.     

Family violence

Researchers and policymakers have begun to recognize the extent and severity of family violence in recent years, particularly its effects on children. Despite a flurry of research, however, there is much disagreement about the definition of violence, its development, the consequences for victims, and the most effective avenues for intervention. Similar conceptual, methodological, and practical problems are faced by those working in the areas of physical child abuse, child sex abuse, and child witnesses to spouse abuse. In further research on these complex problems, researchers are encouraged to use operational definitions that avoid terms like abuse and violence, to focus new efforts on emotional mediators of violent actions, to evaluate the effects of violence on the entire family system, and to redouble efforts to conduct systematic outcome research. Those professionals who are currently responsible for intervention are encouraged to use definitions of and responses to family violence that match those used for assaults between strangers.     

The development of antisocial behaviour patterns in childhood and adolescence

A developmental model of antisocial behaviour is presented in this paper. Arguments and evidence are presented for the position that although many factors such as parent criminality, social and economic disadvantage, child temperament, and marital discord systematically affect the development of antisocial child behaviour, their influence is mediated by the extent to which they disrupt day-to-day parenting practices. Particularly, it is argued that irritable, ineffective discipline and poor parental monitoring are the most proximal determinants of the early development and maintenance of antisocial behaviour. The implications of this model for prevention and intervention in child conduct problems are discussed, using examples of promising clinical work that focuses on direct parent training.