Long-term effects of a preventive intervention on multiple components of adolescents' emotional insecurity.

A gap in research on family interventions is the understanding of long-term effects on hypothesized mechanisms of effect regarding children's processes of responding to family stressors. This study assessed the long-term effects of an intervention designed to improve interparental and family conflict resolution on adolescents' emotional insecurity about interparental conflict. Emotional insecurity about interparental conflict has long been linked with adolescents' risk for adjustment problems. These findings have motivated the development of several family-based preventive interventions, one of which is the focus of this study. A community sample of 225 adolescents and their parents participated in an RCT-based study of an intervention designed to reduce adolescent's emotional insecurity about interparental conflict. The intervention's effect on patterns of change in adolescents', mothers', and fathers' reports of the three components of adolescents' emotional insecurity (emotional reactivity, behavioral dysregulation, and cognitive representations) from posttest through the 3-year follow-up were examined using multilevel modeling. Results suggested that the intervention predicted immediate (pre to posttest) and long-term linear decreases in emotional reactivity, as well as long-term quadratic change in behavioral dysregulation. These findings support the beneficial effects of a brief intervention on multiple components of emotional security. The results also underscore the importance of considering the potential of long-term (including nonlinear) patterns of change that may occur as a function of family-based interventions, as well as that the impact of family-based interventions may vary as a function of reporter and component of emotional insecurity.

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.

Social media and ADHD: implications for clinical assessment and treatment.

The interaction between social media use and mental health is complicated. The mental health information shared on these platforms is frequently of poor quality but has the potential to exert powerful influence on users. Social media trend peaks in some mental disorders have led to increases in illness behaviour through social contagion. There has been a marked upsurge in online interest in attention deficit hyperactivity disorder (ADHD) over the last number of years, which has been particularly noticeable since the onset of the COVID-19 pandemic. The exponential increase in online ADHD interest has the potential to contribute to overloading mental health services with referrals. Mental health professionals and organisations need to consider strategies to ensure that quality health information is disseminated to younger audiences.

Postpartum romantic attachment and constructiveness: The protective effects of a conflict communication intervention for parents' relationship functioning over one year.

Parent relationship functioning has a well-documented influence on children's early socioemotional development as early as infancy. Postpartum parenting is also a critically vulnerable period for relationships and often results in relationship decline. We investigated the effects of a rigorous, psycho-educational conflict communication intervention for supporting parents' relationship functioning in terms of self-reported romantic attachment and observed conflict constructiveness. Using latent growth curve models, we evaluated the change in romantic attachment and constructiveness among 202 mother-father couples from 6 to 18 months postpartum. We further tested a comparison of the effects of the Conflict Intervention (CI) versus the control group and the Conflict Intervention paired with an additional parent sensitivity intervention (anyCI) versus the control group. Results indicated romantic attachment and observed constructiveness decreased over the 1-year period; this decline was partially mitigated for fathers participating in the intervention(s), wherein fathers who received the Conflict Intervention showed less decline in observed conflict constructiveness over time. Moreover, compared with those in the control condition, mothers who received the Conflict Intervention reported lower attachment security at 18 months postpartum. These results underscore the importance of including perspectives from both mothers and fathers when investigating intervention effects and considering the impact of combining interventions for parents. RESEARCH HIGHLIGHTS: A randomized control trial of a conflict intervention including mothers and fathers demonstrates protective effects for fathers' constructiveness between 6 and 18 months postpartum but was not protective for mothers. Parenting experience, whether parents were transitioning to parenthood or had older children, did not significantly predict romantic attachment or behavioral constructiveness trajectories. Interparental romantic attachment and constructiveness declined only slightly postpartum. Effects of the intervention were reduced when the intervention was combined with a second intervention.

Timing is everything: Developmental changes in the associations between intergroup contact and bias.

Identifying developmental patterns in intergroup contact and its relation with bias is crucial for improving prevention strategies around intergroup relations. This study applied time-varying effects modeling (TVEM) to examine age-based changes in relations between contact and bias in a divided community that included 667 youth (M age = 15.74, SD = 1.97) from Belfast, Northern Ireland, a conflict-affected setting. The results suggest no change in the relation between contact frequency and bias; however, the relation between contact quality and bias increases from ages 10-14 and then levels off. Differences between Catholics, the historic minority group, and Protestants, the historic majority group, also emerged. The article concludes with implications for future research and interventions for youth growing up amid conflict.

A Developmental Psychopathology Perspective on Political Violence and Youth Adjustment.

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Infant externalizing behavior and parent depressive symptoms: Prospective predictors of parental pandemic related distress.

Understanding predictors and effects of the COVID-19 Pandemic is a top-priority in research endeavors. The impact of COVID-19 on all components of family life and mental health cannot be overstated. This study emphasizes the need to investigate predictors of parents' responses to disaster by conceptualizing the depth of the impact of the pandemic using Bronfenbrenner's Bioecological Systems Model. We evaluate parents of infants as the center of the microsystem and discuss the importance of parents' responses to the pandemic for children's development. Specifically, utilizing a prospective design involving a sample of 105 infant-mother-father triads, we test the predictive effects of mothers' and fathers' mental health and infant externalizing behavior assessed prior to the pandemic when infants were 16-months on later pandemic related distress (PRD) approximately 1 year later. Results indicate that for both mothers and fathers, more depressive symptoms during their child's infancy predicted more PRD. Although mothers' reports of more child externalizing behavior significantly predicted more PRD, fathers' reports of externalizing were strongly, positively correlated with their concurrent depressive symptoms but not directly related to PRD. We demonstrate the importance of pre-existing mental health and parents' perceptions of their children's behavior as early as 16 months, in coping with disaster.

Latent classes in preschoolers' internal working models of attachment and emotional security: Roles of family risk.

Children's relationships inform their internal working models (IWMs) of the world around them. Attachment and emotional security theory (EST) emphasize the importance of parent-child and interparental relationships, respectively, for IWM. The current study examined (a) data-driven classes in child attachment and emotional security IWM, (b) associations between IWM classes and demographic variables, maltreatment, intimate partner violence (IPV), and maternal depressive symptoms, and (c) consistency in attachment and emotional security IWM classes, including as a function of maltreatment, IPV, and maternal depressive symptoms. Participants were 234 preschool-aged children (n = 152 experienced maltreatment and n = 82 had not experienced maltreatment) and their mothers. Children participated in a narrative-based assessment of IWM. Mothers reported demographics, IPV, and maternal depressive symptoms. Latent class analyses revealed three attachment IWM classes and three emotional security IWM classes. Maltreatment was associated with lower likelihood of being in the secure attachment class and elevated likelihood of being in the insecure dysregulated attachment class. Inconsistencies in classification across attachment and emotional security IWM classes were related to maltreatment, IPV, and maternal depressive symptoms. The current study juxtaposes attachment and EST and provides insight into impacts of family adversity on children's IWM across different family relationships.

Randomized preventive intervention for families: Adolescents' emotional insecurity and attachment to fathers.

The family communication project was a randomized preventive intervention designed to support families by improving interparental conflict behavior and the parent-child relationship, with the ultimate goal of decreasing emotional insecurity in the interparental relationship. Evidence for programs that may benefit father-adolescent attachment and adolescents' emotional insecurity in the marital context is a gap in the literature. According to the fathering vulnerability hypothesis, father-child attachment security might be expected to especially benefit from improvements in interparental conflict behavior. The present study evaluated whether there were any indirect effects of this intervention on emotional insecurity via attachment with each parent, with a particular interest in the role of father-child attachment. Cross-lagged panel models revealed that the parent-adolescent (PA) treatment condition predicted significantly decreased emotional insecurity at 6 months through posttest attachment to fathers, relative to the control and parent-only conditions. Mother-adolescent attachment was improved in the PA condition at posttest but was not a significant mediator of subsequent adolescent emotional insecurity. Thus, the intervention's effects on father-adolescent attachment plays an important role in explaining the long-term effects of the intervention on emotional insecurity about the interparental relationship. Results also call attention to the value of including adolescents in interventions to improve interparental conflict and parent-child relationships. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Long-term interparental conflict behavior and knowledge change after a brief family intervention.

To address a gap in the translational research on marital and family conflict intervention, we used a series of multilevel models to examine how interparental constructive conflict behavior, conflict resolution, and conflict knowledge improved up to 3 years postintervention in the Family Communication Project (FCP). The FCP was an experimental, longitudinal intervention focused on family conflict, communication, and adolescent adjustment. Participants consisted of adolescents and their two primary caregivers (N = 225 families). Each family was randomly assigned to one of two treatment groups (parent-adolescent or parent only) or two control groups (self-study or no treatment). Relative to controls, who showed no statistically significant improvement in conflict behavior, resolution, or knowledge, parents in the two-treatment conditions showed improvement in a nonlinear fashion. Modeled with piece-wise slopes, average change trajectories showed statistically significant increases from pretest to posttest, followed by declines but overall significant sustained growth by 3 years. Baseline marital hostility moderated this change, whereby couples who had higher levels of baseline marital hostility responded more favorably to treatment, but also declined more rapidly. Fathers in the study were shown to have stronger long-term treatment effects for conflict knowledge relative to mothers, and higher marital adjustment among fathers at baseline predicted less decline in dyadic conflict resolution after the intervention. The results highlight how examining within-family changes over time and between-family differences in change trajectories can contribute to practical insights about when and for whom interventions are most effective. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Preventing Mental Health Problems in Children After High Conflict Parental Separation/Divorce Study: An Optimization Randomized Controlled Trial Protocol.

Parental divorce is a childhood stressor that affects approximately 1.1 million children in the U.S. annually. The children at greatest risk for deleterious mental health consequences are those exposed to high interparental conflict (IPC) following the separation/divorce. Research shows that children's emotional security and coping efficacy mediate the impact of IPC on their mental health. Interventions targeting their adaptive coping in response to IPC events may bolster their emotional security and coping efficacy. However, existing coping interventions have not been tested with children exposed to high post-separation/divorce IPC, nor has any study assessed the effects of individual intervention components on children's coping with IPC and their mental health. This intensive longitudinal intervention study examines the mechanisms through which coping intervention components impact children's responses to interactions in interparental relationships. A 23 factorial experiment will assess whether, and to what extent, three candidate intervention components demonstrate main and interactive effects on children's coping and mental health. Children aged 9-12 (target N = 144) will be randomly assigned to one of eight combinations of three components with two levels each: (1) reappraisal (present vs. absent), (2) distraction (present vs. absent), (3) relaxation (present vs. absent). The primary outcomes are child-report emotional security and coping efficacy at one-month post-intervention. Secondary outcomes include internalizing and externalizing problems at the three-month follow-up. Based on data from this optimization phase RCT, intervention components will be selected to comprise a multi-component intervention and assessed for effectiveness in a subsequent evaluation phase RCT.

Examining the efficacy of prenatal intervention in reducing IPV revictimization and improving maternal mental health: A quasirandomized controlled trial of the Pregnant Moms' Empowerment Program (PMEP).

OBJECTIVE: The present study was a quasirandomized trial of the Pregnant Moms' Empowerment Program (PMEP) that examined the effects of the program on women's intimate partner violence (IPV) revictimization, depression, posttraumatic stress, and resilience. It was hypothesized that treatment would be associated with improvements across all of the indicated dimensions and that those women completing the module on violence and mental health would have particularly strong improvements. METHOD: Women who were currently pregnant, IPV-exposed, and at least 16 years of age were recruited and assigned to either a treatment or control condition. Participants (N = 137) completed four assessments (pretest [T1], posttest [T2], 3-months postpartum [T3], and 12-months postpartum [T4]). The key outcomes assessed included IPV (Revised Conflict Tactics Scales), depressed mood (Center for Epidemiological Studies Depression Scale), posttraumatic stress (PTSD Checklist for DSM-5), and resilience (Connor-Davidson Resilience Scale). RESULTS: Results of multilevel models examining IPV revictimization indicated that treatment was associated with significantly fewer experiences of physical assault and sexual coercion at all follow-up interviews (T2, T3, and T4) and fewer IPV-related injuries at T3 and T4. In addition, treatment exposure was associated with statistically and clinically significant improvement in depression at T2 and T4. The intervention had limited efficacy in increasing women's self-reported resilience or in reducing symptoms of posttraumatic stress. CONCLUSIONS: Together, these data suggest that PMEP is a promising evidence-based intervention for pregnant, IPV-exposed women, and that the effects-particularly for IPV and depression-are likely to be sustained over time. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trust, Forgiveness, and Peace: The Influence of Adolescent Social Identity in a Setting of Intergroup Conflict.

Following the signing of peace agreements, post-accord societies often remain deeply divided across group lines. There is a need to identify antecedents of youth's support for peace and establish more constructive intergroup relations. This article explored the effect of out-group trust, intergroup forgiveness and social identity on support for the peace process among youth from the historic majority and minorities communities in Belfast, Northern Ireland. The sample comprised of 667 adolescents (49% male; M=15.74, SD=1.99 years old) across two time points. Results from the structural equation model suggested that out-group trust was related to intergroup forgiveness over time, while forgiveness related to later support for the peace process. Strength of in-group social identity differentially moderated how out-group trust and intergroup forgiveness relate to later support for peace among youth from the conflict-related groups (i.e., Protestants and Catholics). Implications for consolidating peace in Northern Ireland are discussed, which may be relevant to other settings affected by intergroup conflict.

Supporting Youth and Families in Gaza: A Randomized Controlled Trial of a Family-Based Intervention Program.

Background: A total of 450 million children are now living in active conflict zones. The negative consequences for children are significant and long lasting. In response to the urgent need for sustainable interventions for children and families, the current study evaluated a brief (12 hr, 8 session) family-based coping and support program, Promoting Positive Family Futures (PPFF), in Gaza. Methods: Families (n = 68, mother/father/adolescent triads) were randomized into the PPFF intervention or another lengthier (50 hr, 25 session) locally well-established psychosocial support program (treatment as usual; TAU). Results: Improvements were found for both conditions for paternal and maternal depression, emotion regulation using cognitive reappraisal, family-wide emotional security, and adolescent adjustment. Effect sizes were medium to large (d = 0.35-1.27). Fathers in the PPFF condition reported lower depression and higher emotion regulation using cognitive reappraisal at post-test than did fathers in the TAU condition. Mothers in the PPFF condition reported higher levels of emotion regulation using cognitive reappraisal at post-test than did mothers in the TAU condition. PPFF was also indirectly associated with improved depression at post-test for both mothers and fathers via improvements in emotion regulation using cognitive reappraisal and with adolescent adjustment at six months via improvements in maternal emotion regulation using cognitive reappraisal. Conclusions: These findings suggest that the PPFF intervention has many benefits comparable with a longer and locally well-established program. PPFF was also associated with unique positive implications for family-wide adjustment over time. Support was also identified for transdiagnostic processes of improvement associated with the PPPF intervention consistent with the theoretical models informing the approach.

Age as a Dynamic Moderator of Relations between Exposure to Political Conflict and Mental Health in Belfast, Northern Ireland.

Identifying how, when, and under what conditions exposure to political conflict is associated with youth mental health problems is critical to developing programming to help youth exposed to various forms of political violence. The current study uses Time Varying Effects Modeling (TVEM) to examine how relations between exposure to ethno-politically motivated antisocial behavior and mental health problems change as a function of age in a sample of youth from Belfast, Northern Ireland. Young people (N = 583, Mage 16.51 wave 1, 17.23 wave 2) self-reported their exposure to sectarian antisocial behavior, nonsectarian antisocial behavior, and mental health problems as part of a longitudinal study of youth across multiple neighborhoods in Belfast. The results suggest mental health problems and associations with exposure to sectarian antisocial behavior change in nonlinear patterns throughout adolescence, with the strongest links between exposure to political conflict and mental health between ages 16 and 19. Significant relations between nonsectarian antisocial behavior and mental health problems were not indicated for the full sample but the results suggested a relation emerged in later adolescence for Protestant youth, the historical majority group. The value of this exploratory approach to examining relations between key context and psychological variables for youth in contexts of political tension and violence is discussed.

A Prospective Longitudinal Study of Mother-Child Attachment and Externalizing Trajectories in Boys and Girls.

In clinically referred children, boys and those with disorganized mother-child attachments tend to show the most maladaptive externalizing trajectories; however, additional research is necessary to test whether these findings hold in a community sample. Therefore, 235 community children (106 boys) were followed from ages 6 to 15 years across six time points. Multiple-group linear growth curves with mother-child attachment as a time-invariant covariate were fit to the data to explore externalizing trajectories for boys and girls. Results showed that boys had higher initial externalizing levels than girls, and children generally experienced a decline in symptoms over time. No significant trajectory differences were found for girls, and boys with different attachment classifications did not differ on their initial externalizing levels; however, boys with avoidant attachments (with resistant attachments trending) experienced a steeper decline in externalizing symptoms longitudinally. Implications for intervention and prevention are discussed.

Longitudinal Effects of Reminiscing and Emotion Training on Child Maladjustment in the Context of Maltreatment and Maternal Depressive Symptoms.

Exposure to child maltreatment and maternal depression are significant risk factors for the development of psychopathology. Difficulties in caregiving, including poor emotion socialization behavior, may mediate these associations. Thus, enhancing supportive parent emotion socialization may be a key transdiagnostic target for preventive interventions designed for these families. Reminiscing and Emotion Training (RET) is a brief relational intervention designed to improve maternal emotion socialization behavior by enhancing maltreating mothers' sensitive guidance during reminiscing with their young children. This study evaluated associations between maltreatment, maternal depressive symptoms, and the RET intervention with changes in children's maladjustment across one year following the intervention, and examined the extent to which intervention-related improvement in maternal emotion socialization mediated change in children's maladjustment. Participants were 242 children (aged 36 to 86 months) and their mothers from maltreating (66%) and nonmaltreating (34%) families. Results indicated that RET intervention-related improvement in maternal sensitive guidance mediated the effects of RET on reduced child maladjustment among maltreated children one year later. By comparison, poor sensitive guidance mediated the effects of maltreatment on higher child maladjustment among families that did not receive the RET intervention. Direct effects of maternal depressive symptoms on child maladjustment were also observed. This suggests RET is effective in facilitating emotional and behavioral adjustment in maltreated children by improving maltreating mothers' emotional socialization behaviors.

Typologies of daily relationship quality in marital and parent-child subsystems: Implications for child adjustment.

The ways in which marital relationships (MR) affect parent-child relationships (PCR) vary from day-to-day and differ from one family to another. The day-to-day fluctuations of MR-PCR associations and the between-family differences, however, have been largely overlooked in the literature. Using daily diary data from 152 mother-father couples (with a 7- to 17-year-old child) across three consecutive years, we identified typologies based on parents' daily relational dynamics and examined the association between family typologies and child adjustment. State space grids of daily relationship quality (i.e., MR and PCR) were constructed for each parent at each wave of assessment. Grid-sequence analysis was subsequently conducted to identify multiple family typologies, including cohesive, fluctuating cohesive, spillover, compensatory, and moderate relationship typologies. Some typologies changed over the years and differed for fathers and mothers (e.g., the compensatory typology). Child adjustment problems were the highest in children from families with poor MR and PCR quality (i.e., the spillover typology). Overall, our results evince the heterogeneous nature of family relationship dynamics and the developmental implications of these typologies. For practitioners and therapists who work with families, our findings highlight the value of improving marital and parent-child relationship quality in promoting positive child outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bidirectional effects between maternal mental health and adolescent internalizing problems across six years in Northern Ireland.

Background: Emerging evidence indicates the existence of bidirectional relations between mothers' mental health and adolescent adjustment, but few studies have examined these relations in contexts of high environmental adversity, including economic deprivation and political violence. Given other empirical connections between political violence and adolescent adjustment problems, the impact of child adjustment problems on maternal mental health may be exacerbated in contexts of sectarian violence. Methods: Addressing this gap, latent change score modeling was used to examine interrelations between trajectories of maternal mental health and adolescent internalizing symptoms over time in communities afflicted by political conflict. Over six years, 999 adolescent-mother dyads participated in a longitudinal study in Belfast, Northern Ireland. Six-hundred ninety-five families were originally recruited in year 1, with 304 recruited to supplement the sample in year 3; the largest available sample for a given year was 760 dyads. Models including maternal mental health, adolescent internalizing symptomatology, and political violence (i.e., sectarian antisocial behavior) as a time-varying covariate were tested. Results: Results demonstrated that for both mothers and adolescents in a dyadic pairing, higher rates of symptomology in one member of the dyad were related to symptoms observed in the other member. Results also suggest that political violence and factors related to social deprivation increased symptoms across the dyad. Conclusion: This study advances understanding of the bidirectional impact between maternal mental health and adolescent internalizing over time in contexts of political violence.

Practice variation in the diagnosis of acute rejection among pediatric heart transplant centers: An analysis of the pediatric heart transplant society (PHTS) registry.

BACKGROUND: Freedom from rejection in pediatric heart transplant recipients is highly variable across centers. This study aimed to assess the center variation in methods used to diagnose rejection in the first-year post-transplant and determine the impact of this variation on patient outcomes. METHODS: The PHTS registry was queried for all rejection episodes in the first-year post-transplant (2010-2019). The primary method for rejection diagnosis was determined for each event as surveillance biopsy, echo diagnosis, or clinical. The percentage of first-year rejection events diagnosed by surveillance biopsy was used to approximate the surveillance strategy across centers. Methods of rejection diagnosis were described and patient outcomes were assessed based on surveillance biopsy utilization among centers. RESULTS: A total of 3985 patients from 56 centers were included. Of this group, 873 (22%) developed rejection within the first-year post-transplant. Surveillance biopsy was the most common method of rejection diagnosis (71.7%), but practices were highly variable across centers. The majority (73.6%) of first rejection events occurred within 3-months of transplantation. Diagnosis modality in the first-year was not independently associated with freedom from rejection, freedom from rejection with hemodynamic compromise, or overall graft survival. CONCLUSIONS: Rejection in the first-year after pediatric heart transplant occurs in 22% of patients and most commonly in the first 3 months post-transplant. Significant variation exists across centers in the methods used to diagnose rejection in pediatric heart transplant recipients, however, these variable strategies are not independently associated with freedom from rejection, rejection with hemodynamic compromise, or overall graft survival.