Caregiver Distress and Child Behavior Problems in Children with Developmental Delay from Predominantly Minoritized Backgrounds.

IMPORTANCE: Child behavior problems have been shown to contribute to caregiver distress and vice versa among youth with developmental delay (DD). However, studies have not examined these associations among children and caregivers from underrepresented ethnic/racial backgrounds. Furthermore, research has not explored how associations function differently following internet-delivered treatment or based on the level of acculturation and enculturation. OBJECTIVE: We examined bidirectional associations between caregiver distress (i.e. symptoms of depression, anxiety, and stress) and externalizing and internalizing behavior problems in 3- to 5-year-old children with DD from underrepresented ethnic/racial backgrounds. We also examined the impact of internet-delivered Parent-Child Interaction Therapy (iPCIT) and the moderating role of acculturation and enculturation on these bidirectional associations. METHOD: Children aging out of early intervention services (n = 150) and their primary caregiver were randomized to receive iPCIT or referrals as usual (RAU) in the community. RESULTS: Findings provide support for bidirectional associations between child internalizing behavior problems and caregiver depressive symptoms, although there were fewer significant associations among families randomized to iPCIT compared to RAU. Weaker associations were observed among families with higher levels of enculturation, whereas stronger associations were observed among families with higher levels of acculturation. CONCLUSIONS: Results highlight a sensitive period from age 3.5 to 4 years old for bidirectional associations between caregiver distress and child behavior problems and highlight the importance of addressing family cultural values during treatment. Findings also suggest the utility of internet-delivered behavioral parenting interventions in weakening the effect of child behavior problems on caregiver distress and vice versa.

A Pilot Trial of a Home-Based Parenting Intervention for High-Risk Infants: Effects on and Moderating Role of Effortful Control.

Despite the important developmental outcomes associated with effortful control (EC), there is limited research demonstrating the efficacy of early interventions for improving EC and assessing the extent to which a child's level of baseline EC impacts the outcome of intervention on externalizing problems. This study aims to fill these gaps in the literature by assessing the efficacy of the Infant Behavior Program (IBP), a parenting intervention for infants with elevated levels of behavior problems, in improving infant EC and the moderating effect of baseline infant EC on intervention outcomes. Participants included 60 high-risk 12- to 15-month-old infants and their mothers. Families were randomized to receive the IBP or standard pediatric primary care. Parent-report measures of infant behavior and compliance were examined at baseline, post-intervention, and 3- and 6-month follow-up assessments. Results showed infants who received the IBP displayed significantly higher levels of EC at the post-intervention assessment compared to infants in the control group. Additionally, moderation analyses showed initial levels of EC moderated the effect of the IBP on externalizing problems and compliance, such that infants with higher levels of baseline EC displayed greater decreases in externalizing problems at post-intervention and greater increases in compliance at the 6-month follow-up. While these findings did not survive a false discovery rate correction, they offer preliminary support for the efficacy of the IBP in improving infants' EC and highlight the importance of considering EC as a factor associated with early intervention outcomes for externalizing problems.

Pathways from maternal shyness to adolescent social anxiety.

BACKGROUND: Social anxiety is amongst the most prevalent adolescent mental health problems; however, it is often unrecognized due to its comorbidity with other anxiety problems such as generalized anxiety. Thus, understanding the unique developmental pathways to social anxiety is critical for improving its prevention. We examined the pathway from maternal shyness, when children were 4 years old, to adolescents' social anxiety at age 15 through social wariness at age 7. We hypothesized that childhood social wariness would mediate the association between maternal shyness and social anxiety in adolescence. METHODS: Participants (N = 291; 54% female) were followed from early childhood to adolescence. Mothers reported on their own shyness when children were 4 years old. Social wariness toward unfamiliar peers was observed in the laboratory at ages 4 and 7. Adolescent social anxiety and generalized anxiety were assessed via self-report, parent-report, and clinical diagnoses at age 15. RESULTS: Maternal shyness was positively associated with adolescent social anxiety but not generalized anxiety at age 15. Higher levels of maternal shyness at age 4 predicted greater social wariness at age 7, which in turn predicted greater social anxiety but not generalized anxiety at age 15. Social wariness at age 7 partially mediated the association between maternal shyness and adolescent social anxiety. CONCLUSIONS: This study identifies a unique developmental pathway from maternal shyness to adolescent social anxiety. Findings suggest that childhood social wariness connects maternal shyness to adolescent social anxiety.

Editorial: Treatment of Early Childhood Callous-Unemotional Traits: What Do We Know and Where Do We Go from Here?

Callous-unemotional (CU) traits, characterized by lack of remorse, guilt, or empathy, are represented in DSM-5 under the limited prosocial emotions specifier for conduct disorder. Research suggests that some interventions for conduct problems are less effective for children with higher levels of CU traits,1 and few interventions have been shown to reduce CU traits. Specifically, behavioral parenting interventions, evidence-based treatments for conduct problems, have been shown to be less effective for children with higher levels of CU traits.2 Although research suggests high comorbidity of internalizing and externalizing problems in early childhood,3 no prior studies examined the effect of CU traits on the treatment of childhood internalizing problems. Donohue et al.4 addressed this significant gap in the literature by evaluating the efficacy of Parent-Child Interaction Therapy-Emotion Development (PCIT-ED) in the treatment of preschoolers with major depressive disorder (MDD) and oppositional defiant disorder (ODD) and the moderating role of child CU traits on treatment outcomes. In this editorial, we discuss the contributions and limitations of the article by Donohue et al.4 and provide recommendations for future research to advance the field.