Child-Focused Cognitive Behavioral Therapy for Pediatric Abdominal Pain Disorders Reduces Caregiver Anxiety in Randomized Clinical Trial.

Pediatric functional abdominal pain disorders (FAPD) are associated with elevated anxiety in youth and their caregivers, both contributing to an adverse impact on functioning in youth with FAPD. While a CBT approach (ie, Aim to Decrease Anxiety and Pain Treatment [ADAPT]) is known to improve health outcomes for youth, it is unknown if child-focused treatment improves caregiver anxiety. This secondary analysis of a larger randomized clinical trial examined if child-focused CBT (ADAPT) for pain and anxiety also impacts caregiver anxiety and explored the relation between caregiver anxiety and child symptoms (ie, pain, disability, anxiety) after treatment. A total of 79 caregiver-child dyads were randomized to ADAPT plus treatment as usual (TAU) or TAU only. Caregiver anxiety and child outcomes (pain, disability, anxiety) were assessed at baseline and approximately 8 weeks later. Caregivers of children who completed ADAPT+TAU demonstrated lower anxiety compared to those who only received TAU. Moreover, regardless of treatment assignment, caregivers with greater anxiety had children who reported more pain and anxiety, but not functional disability at post-assessment. Results suggest a brief, child-focused intervention targeting pain and anxiety may also improve caregiver anxiety. As such, suggestions to improve future treatments are offered. PERSPECTIVE: Caregiver anxiety symptoms diminished after their child with functional abdominal pain completed a course of child-focused CBT targeting pain and anxiety. Further, caregiver anxiety was related to child-reported symptoms (pain and anxiety) after treatment. Therefore, improved caregiver mental health via a child-focused CBT may also improve pediatric outcomes.

Maternal Accuracy for Children's Fearful Distress in Toddlerhood and Kindergarten: Moderation of a Serial Indirect Effect by Toddler Fearful Temperament.

OBJECTIVE: Drawing on existing literature concerning the interrelations among toddler fearful temperament, maternal protective parenting, and maternal cognitions, the current study sought to test how mothers' abilities to predict their children's distress expressions and behaviors in future novel situations ("maternal accuracy"), may be maintained from toddlerhood to children's kindergarten year. DESIGN: A sample of 93 mother-child dyads completed laboratory assessments at child age 2 and were invited back for two laboratory visits during children's kindergarten year. Fearful temperament, age 2 maternal accuracy, and protective behavior were measured observationally at age 2, and children's social withdrawal and kindergarten maternal accuracy were measured observationally at the follow-up kindergarten visits. RESULTS: We tested a moderated serial mediation model. For highly fearful children only, maternal accuracy may be maintained because it relates to protective parenting, which predicts children's social withdrawal, which feeds back into maternal accuracy. CONCLUSIONS: Maternal accuracy may be maintained across early childhood through the interactions mothers have with their temperamentally fearful children. Given concurrent measurement of some of the variables, the role of maternal cognitions like maternal accuracy should be replicated and then further considered for inclusion in theories and studies of transactional influences between parents and children on development.

The Influence of Caregiver Distress and Child Anxiety in Predicting Child Somatization in Youth with Functional Abdominal Pain Disorders.

Pediatric functional abdominal pain disorders (FAPD) are associated with adverse outcomes including increased somatization (e.g., heightened physiological sensations that include gastroenterological and non-gastroenterological symptoms) and increased functional disability. Caregiver distress and child anxiety are separately associated with the adverse outcomes of pediatric FAPD. However, the cumulative role of caregiver (i.e., stress, anxiety, and depression) and child psychological functioning (anxiety) in relation to adverse outcomes associated with FAPD, and particularly somatization, is unclear. Thus, the present investigation sought to examine the role of caregiver distress and child anxiety in relation to pain-related functioning (i.e., somatization, pain intensity, functional disability) in youth with FAPD. Data were gathered as part of a larger study examining a psychological treatment for youth with FAPD. Participants (ages 9-14) with FAPD completed measures of child anxiety, pain, and pain-related functioning. Caregivers completed a measure of caregiver distress (e.g., stress, anxiety, depressive symptoms). Pearson correlations revealed significant positive associations between child anxiety and child functional disability. Additionally, caregiver anxiety, child anxiety, and child somatization were all significantly and positively correlated with one another. Therefore, we assessed whether child anxiety may potentially mediate the relationship between caregiver anxiety and child somatization in this cross-sectional study. The indirect association between caregiver anxiety and child somatization via child anxiety was not significant. Future research including longitudinal designs to further understand the relationship between caregiver anxiety, child anxiety, and child pain-related functioning, would enhance understanding of how these potentially modifiable psychological factors may impact adverse outcomes of FAPD.

The Relation between Specific Parenting Behaviors and Toddlers' Early Anxious Behaviors is Moderated by Toddler Cortisol Reactivity.

Differential susceptibility theory posits that neurobiological reactivity (e.g., cortisol levels) should be considered as an individual index of susceptibility to both positive and negative environments. The current investigation separately examines cortisol reactivity and total concentration in toddlerhood as moderators of the longitudinal relation between maternal protection and encouragement of independence and increases or decreases in observed anxious behaviors, respectively. A total of 119 mother-toddler dyads participated in a laboratory visit when toddlers were 12- to 18-months-old. Mothers reported on their parenting behaviors and toddlers participated in a novelty episode from which their anxious behaviors were coded. Toddlers provided three saliva samples, yielding measures of cortisol reactivity and total cortisol concentration. One year later, dyads returned to the laboratory where toddlers participated in another novelty episode to observationally assess anxious behaviors. Results revealed that maternal protection tended to relate to greater increases in anxious behaviors one year later only for toddlers who displayed high cortisol reactivity. Cortisol reactivity also moderated the relation between maternal encouragement of independence and change in toddler anxious behaviors, with this parenting behavior relating to greater decreases in anxious behaviors only for toddlers with high cortisol reactivity. Results examining total cortisol concentration as a moderator were not significant. Results suggest the importance of considering toddler cortisol reactivity a context of susceptibility when examining the longitudinal relation between parenting behaviors and the development of anxious behaviors in toddlerhood.

Mother-Toddler Cortisol Synchrony Moderates Risk of Early Internalizing Symptoms.

Cortisol synchrony is the degree to which mother-toddler cortisol levels are mutually regulated within a dyad. Synchrony's impact on toddler development is not well understood, so this study investigated how synchronous cortisol levels (reactivity and total concentration) in mother-toddler dyads moderates the association between risk factors (i.e., maternal worry, toddler inhibition) and early internalizing symptoms. Seventy mothers and their 2-year-old toddlers provided interpretable saliva samples. Behavioral observations were made to assess the toddler's temperament at age 2, and mothers reported on their toddler's internalizing symptoms when toddlers were 2- and 3-years-old. Results suggest that mother-toddler synchrony in total cortisol concentration moderates the relation between risk factors and internalizing symptoms. Specifically, toddler inhibition and maternal worry were less associated with concurrent toddler internalizing symptoms when dyads demonstrated greater cortisol synchrony in total concentration. Further, synchrony in total cortisol levels marginally moderated the association between toddler inhibition and future internalizing symptoms, such that inhibited toddlers were less likely to demonstrate internalizing symptoms at age 3 when dyads demonstrated more cortisol synchrony. This suggests that cortisol synchrony may serve as an advantageous context that reduces the risk of developing of internalizing symptoms and augments the field's understanding of the implications of shared physiological responses within mother-toddler dyads.

Paternal Anxiety in Relation to Toddler Anxiety: The Mediating Role of Maternal Behavior.

Despite robust investigations examining the impact of maternal anxiety and parenting behaviors and child anxiety risk, less is understood about the impact of paternal anxiety and parenting behaviors on child anxiety risk, particularly within the broader family context. An Actor Partner Interdependence Model (APIM) was used to examine whether paternal anxiety longitudinally predicted child anxiety risk indirectly through maternal and paternal parenting behaviors, while controlling for maternal anxiety. Both fathers and mothers of 12- to 30-month-olds (n = 94) provided self-report of their anxiety and parenting behaviors. Child inhibited temperament (i.e., anxiety risk) was coded. Two APIMs separately considering encouragement of independence and overprotection were examined. These models revealed no direct relation between parent and child anxiety while controlling for parenting behaviors. Models did suggest that paternal anxiety is indirectly linked with future child anxiety through lower maternal encouragement of independence, but not through maternal overprotection or paternal parenting behaviors.

Maternal anxiety and physiological reactivity as mechanisms to explain overprotective primiparous parenting behaviors.

In this study, we sought to determine whether the affective and physiological experience of primiparous, or first-time, motherhood is distinct from multiparous motherhood, how the child's level of inhibited temperament impacts it, and if such a temperament results in overprotective parenting behaviors. A total of 117 mothers and their 24-month-old toddlers participated in novelty tasks designed to elicit parenting behaviors and toddler's typical fear reactions. Mothers also completed a battery of questionnaires. Results suggest that primiparous mothers experienced more worry, which was associated with increased overprotective parenting behaviors. Primiparous mothers also demonstrated greater physiological (i.e., cortisol) reactivity while watching their first-born children interact with novel stimuli, but how this related to overprotective parenting was dependent on the child's level of inhibition. Specifically, primiparous mothers displayed more cortisol reactivity with their uninhibited toddlers, which indirectly linked parity to less overprotective parenting behaviors. Primiparous mothers of highly inhibited toddlers displayed greater overprotective parenting behaviors, independent of maternal cortisol reactivity. The results indicate that the transition to motherhood is a unique experience associated with greater worry and physiological reactivity and is meaningfully influenced by the toddler's temperament. Distinctions in both observed and self-reported overprotective parenting are evident through considering the dynamic interaction of these various aspects. (PsycINFO Database Record

Correlates and consequences of toddler cortisol reactivity to fear.

Cortisol reactivity to fear-eliciting stimuli during toddlerhood may represent an indicator of risk for anxiety spectrum problems and other maladjustment. Thus, it is important to understand factors that may contribute to cortisol reactivity as well as those that determine its predictive relation to early emerging anxiety. In this vein, the current study investigated maternal comforting behaviors, both solicited and unsolicited by the toddler, as correlates of cortisol reactivity at 2years of age. Furthermore, we investigated maternal comforting behaviors and behavioral indicators of fear in both a low-threat and a high-threat context as moderators of the relation between cortisol reactivity at age 2 and change in anxiety from age 2 to age 3. The sample comprised 99 2-year-old toddlers and their mothers. Toddlers provided saliva samples at baseline and after a fear-eliciting stimulus that were assayed for cortisol. Mothers were observed for comforting behavior while interacting with their toddlers in laboratory tasks and completed questionnaires about their toddlers' anxiety. Results indicated that unsolicited (spontaneous) comforting behavior related to toddler cortisol reactivity above and beyond solicited comforting and the level of fear toddlers displayed in the same task. Moreover, fear in a low-threat context, but not in a high-threat context, moderated the relation between cortisol reactivity and change in anxiety, such that cortisol reactivity had a positive relation to anxiety at extreme levels of low-threat fear. Results suggest the importance of considering the caregiving environment and context-specific fear in understanding the nature of cortisol reactivity during the toddler years.

Current Themes in Understanding Children's Emotion Regulation as Developing from within the Parent-Child Relationship.

A large existing literature has established that children's emotion regulation (ER) behaviors and capacities emerge from within the parent-child relationship. This review identified very recently published studies that exemplify contemporary themes in this area of research. Specifically, new research suggests that the influence of fathers, above and beyond that of mothers, becomes more pronounced across development. Further, culture influences how parents socialize emotion and how specific parenting behaviors relate to children's developing ER. Lastly, studies find child-elicited effects, such that children's ER predicts parents' emotion socialization and other relevant behaviors. We suggest several future directions, including understanding the nature of situations that elicit ER patterns, as well as both expanding upon and integrating the areas highlighted in the review.