Parental expressions of love in Chinese American immigrant families: Implications for children's attachment security.

Harlow's seminal work on the nature of attachment focused on the importance of warm, responsive, and loving relationships in children's healthy development. While the need for love and care is arguably universal, the ways in which these emotions are expressed can vary across cultural contexts. We examined how Chinese American parents' expressions of love were associated with children's attachment security. A total of 110 Chinese American immigrant parent-child dyads (children 7-11 years old, 49% girls) participated in 3-min conversations in which parents were instructed to communicate love and care. Proposition-level analyses in speech (total 8825 propositions) identified three types of affection: training (guan and chiao shun); relational affection (qin); and validation (acceptance and encouragement of child's own expression of emotion, thoughts, and behaviors). Higher training was observed in parents with lower American orientation and lower income. Higher relational affection was observed in parents with lower income. Higher validation was observed in parents with higher income. Using path analyses, training and validation were found to be positively associated with children's attachment security beyond parenting styles. Effects of parents' relational affection were moderated by children's American orientation. Results demonstrate how immigrant parents draw on multiple cultural scripts to express love and care. These findings expand traditional concepts of parental love in immigrant families and illustrate how bicultural expressions of love can shape attachment security in middle childhood. A video abstract of this article can be viewed at https://youtu.be/HqUfIDxkFsE RESEARCH HIGHLIGHTS: Analyses of parent-child discussions identified three parental affection styles (i.e., training, relational affection, and validation) as expressions of love and care in Chinese American immigrant families. Training and validation were positively associated with children's attachment security. Relational affection was associated with lower attachment security for children with higher American cultural orientation, suggesting the effects of parent-child expressions of love are shaped by acculturation.

Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence.

OBJECTIVE: Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD: Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS: Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION: The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.

Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families.

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7-11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed.

Dynamic associations between emotion expressions and strategy use in Chinese American and Mexican American preschoolers.

Previous studies of emotion regulation in young children commonly used between-person approaches, which limit our understanding of dynamic and temporal relations between emotion expressions and strategy use. Further, previous work has mainly focused on temperamental reactivity among White children, and it is unclear whether these findings can generalize to children of Asian and Latinx origins. In the current study, we examined the within-person temporal associations between emotion expressions and strategy use among 3- to 5-year-old children in low-income Chinese American (CA) and Mexican American (MA) families. Children's emotion expressions (positive and negative) and strategy use (gaze aversion, self-soothing, fidgeting, and language) during an unfair social interaction task were coded by 10-s epoch. Executive functions were examined as between-person level predictors of strategy use. Multilevel modeling was conducted to examine whether positive and negative emotion expressions at one epoch (t-1) predicted strategy use at the following epoch (t). The results indicate that positive emotion expressions predicted an increase in fidgeting at the next epoch (ß = .34, p < .01). Executive functions were unrelated to strategy use. Cultural group differences were found: CA children displayed lower intensity of positive emotion and fewer strategy use compared with MA children. The present findings inform theories on the dynamics of emotion regulation in young children and have implications for interventions with underrepresented immigrant populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessing the hierarchy of personal values among adolescents: A comparison of rating scale and paired comparison methods.

INTRODUCTION: For assessing personal values, the rating scale method may not adequately reflect the hierarchical structure of personal values and tends to be influenced by response style bias. The paired comparison method is considered a promising alternative approach, because it engages comparative judgment and may reduce response style biases. The present study aimed to compare these two methods for assessing the hierarchy of personal values among adolescents. METHODS: A total of 191 community-dwelling adolescents aged 12-15 years old completed the rating scale and paired comparison version of the Brief Personalized Value Inventory. Descriptive statistics and latent class analyses were used to assess the difference between the rating scale and paired comparison methods. RESULTS: The two methods yielded similar rankings and means for personal values. The number of subgroups identified by latent class analysis was higher in the paired comparison method than in the rating scale method (10-class vs. 5-class). In the results using the rating scale method, there was a subgroup with high scores on all personal values items. CONCLUSIONS: The paired comparison method captured substantially more heterogeneity in the hierarchy of personal values among adolescents compared to the rating scale, which may be influenced by response style bias.

Why do bilinguals code-switch when emotional? Insights from immigrant parent-child interactions.

Previous research has found that bilingual speakers' first (L1) and second languages (L2) are differentially associated with their emotional experiences. Moreover, bilinguals appear to code-switch (alternate between two or more languages in a single conversation) during emotional episodes. However, prior evidence has been limited to clinical case studies and self-report studies, leaving open the specificity of the link between code-switching (CS) and emotion and its underlying mechanisms. The present study examined the dynamic associations between CS and facial emotion behavior in a sample of 68 Chinese American parents and children during a dyadic emotion-inducing puzzle box task. Specifically, bilingual parents' language use (L1 Chinese or L2 English), CS behavior (L1→L2 or L2→L1 switches), and facial emotion behavior (positive and negative valence) were coded at each 5-s interval. Multilevel modeling was used to analyze whether facial emotion behavior predicted later CS and vice versa. We found that negative facial emotion predicted higher subsequent CS in both L1→L2 and L2→L1 directions, with stronger associations for the L2→L1 direction. On the other hand, positive facial emotion was associated with lower contemporaneous L2→L1 CS. CS did not predict later facial emotion behavior, suggesting language switching may not have an immediate effect on emotion. The present findings are consistent with the idea that emotional arousal, especially negative arousal, reduces cognitive control and may trigger spontaneous CS. Together, these findings provide insight into why bilingual speakers switch languages during emotional episodes and hold implications for clinical interventions serving bilingual individuals and families. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relations of English and Heritage Language Proficiency to Response Inhibition and Attention Shifting in Dual Language Learners in Head Start.

This study examined the concurrent relations of English (EL) and heritage language (HL) proficiency to executive functions (EF) among low-income dual language learners (DLLs) from immigrant families. In a sample of 90 children (age = 38 to 70 months) from Chinese-speaking Chinese American and Spanish-speaking Mexican American families recruited from Head Start preschools, children's EL and HL proficiency was assessed using receptive and expressive vocabulary tests, and EF was assessed using behavioral tasks measuring response inhibition and attention shifting. Multiple regressions were conducted to test the unique and interactive relations of EL and HL vocabulary to EF, controlling for family socioeconomic status and other demographic characteristics. Higher EL and higher HL vocabulary were uniquely associated with higher attention shifting. By contrast, neither EL nor HL vocabulary was uniquely associated with response inhibition. Interaction effects of EL × HL in relation to EF were also found. The results provided some evidence for the dual benefits of EL and HL proficiency on EF (especially attention shifting) among DLLs from low-income, immigrant families.

The Effectiveness of Telepsychiatry-Based Culturally Sensitive Collaborative Treatment for Depressed Chinese American Immigrants: A Randomized Controlled Trial.

OBJECTIVE: This study evaluates the effectiveness of a telepsychiatry-based culturally sensitive collaborative treatment (T-CSCT) intervention to improve treatment outcomes for depressed Chinese American immigrants. METHODS: Participants were Chinese Americans recruited from primary care settings from February 1, 2009, to July 31, 2012, with DSM-IV major depressive disorder (MDD) identified by the Mini-International Neuropsychiatric Interview. Eligible patients were randomized to receive either T-CSCT or treatment as usual (TAU) for 6 months. T-CSCT involves (1) cultural consultation via videoconference and (2) care management. The primary outcome measure was the 17-item Hamilton Depression Rating Scale (HDRS17); positive response was defined as a ≥ 50% decrease in HDRS17 score, and remission was defined as HDRS17 score ≤ 7. Secondary outcome measures were the Clinical Global Impressions-Severity of Illness (CGI-S) and Improvement (CGI-I) scales and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q). Outcomes were compared using multivariate logistic regression and mixed-model for repeated measures methods. RESULTS: Among participants (N = 190), 63% were female, and the mean (SD) age was 50 (14.5) years. They were randomized to T-CSCT (n = 97; 51%) or TAU (n = 93; 49%). Using multivariate logistic regression analyses, the odds of achieving response and remission were significantly greater for the T-CSCT group compared to the control group (odds ratio [OR] = 3.9 [95% CI, 1.9 to 7.8] and 4.4 [95% CI, 1.9 to 9.9], respectively). Multivariate general linear model analyses showed that patients in the T-CSCT group had significantly greater improvement over time in HDRS17 (F4,95 = 4.59, P = .002), CGI-S (F4,95 = 4.22, P = .003), and CGI-I (F4,95 = 2.95, P = .02) scores. CONCLUSIONS: T-CSCT is effective in improving treatment outcomes of Chinese immigrants with MDD. TRIAL REGISTRATION: ClincialTrials.gov identifier: NCT00854542.

The reliability and validity of the Japanese version of the Temperament and Personality Questionnaire for patients with non-melancholic depression.

BACKGROUND: Parker et al. (2006) proposed a new approach to classify specific sub-types of non-melancholic depression caused by various stress factors and premorbid personality styles: the Temperament and Personality Questionnaire (T&P). The current study aim was to develop the Japanese version of the T&P and evaluate its reliability and validity. METHODS: We studied 114 patients with non-melancholic depression. Reliability was assessed using the test-retest method. Convergent validity of the T&P was compared with the clinician ratings of each patient for the eight personality traits. We also assessed the impact of depressive state on the T&P. RESULTS: The test-retest intraclass correlation coefficients among eight constructs of the T&P ranged from 0.77 to 0.89, indicating good-to-excellent reliability. Anxious Worrying (rho=0.29), Perfectionism (rho=0.17), Personal Reserve (rho=0.18), Irritability (rho=0.38), and Social Avoidance (rho=0.32) showed adequate levels of convergent validity; Rejection Sensitivity (rho=0.16), Self-criticism (rho=-0.02), and Self-focus (rho=0.07) showed relatively weak convergent validity. Perfectionism (rho=-0.06), Social Avoidance (rho=0.17), Anxious Worrying (rho=0.40), Personal Reserve (rho=0.30), Irritability (rho=0.28), Rejection Sensitivity (rho=0.35), Self-criticism (rho=0.49), and Self-focus (rho=0.24) showed minimal sensitivity to mood state effects. LIMITATIONS: Only one site was used. While a Likert scale was used, the clinician-rated personality trait measure had not been validated. CONCLUSIONS: The J-T&P is a reliable and valid measure for assessing temperament and personality in Japanese patients with non-melancholic depression.

Comparison of Initial Psychological Treatment Selections by US and Japanese Early-Career Psychiatrists for Patients with Major Depression: A Case Vignette Study.

OBJECTIVE: The authors compared early-career psychiatrists' selection of psychological treatments for patients with mild to moderate major depressive disorder (MDD) in the US and Japan. METHODS: A total of 120 early-career psychiatrists from two residency programs in the US and Japan participated in web-based surveys. The psychiatrists selected first- and second-line psychological treatments in response to two case vignettes of patients with mild and moderate MDD. RESULTS: Eighty-one psychiatrists (68%) returned the surveys, of whom 39 (48%) were American and 42 (52%) Japanese. In response to the mild MDD case, more US psychiatrists selected high-intensity psychological treatments (P < 0.001), whereas more Japanese psychiatrists selected low-intensity psychological treatments (P < 0.001). In both countries, more psychiatrists selected psychological treatment than medication. In response to the moderate MDD case, one third of the US psychiatrists selected high-intensity psychological treatments (P < 0.001), whereas half of the Japanese psychiatrists selected low-intensity psychological treatments (P = 0.010). CONCLUSIONS: Residency training, availability of psychological treatments, and cultural beliefs may shape differences in treatment selections, which in turn may impact the dissemination and implementation of psychological treatment in clinical practice across cultures.

Comparison of treatment selections by Japanese and US psychiatrists for major depressive disorder: A case vignette study.

AIMS: A review of the published work on treatments for major depressive disorder suggests that there is an alarming gap between guideline recommendations and actual clinical practices worldwide. The purpose of this study was to compare early-career psychiatrists' selections of treatment for mild to moderate major depression in Japan and the USA. METHODS: The authors surveyed 120 early-career psychiatrists from two residency programs in Japan and the USA using web-based questionnaires. In response to two case vignettes of mild to moderate major depression, the subjects selected treatment modalities and first- and second-line pharmacotherapy. RESULTS: Eighty-one psychiatrists (68%) returned surveys, of whom 42 (52%) were Japanese and 39 (48%) American. Fewer Japanese subjects selected psychotherapy than Americans. The Japanese psychiatrists favored benzodiazepine monotherapy for the treatment of mild depression, whereas the American psychiatrists favored antidepressant monotherapy. For the initial treatment of moderate depression, approximately half of the Japanese selected antidepressant monotherapy, and a quarter selected benzodiazepine monotherapy, whereas the Americans unanimously selected selective serotonin reuptake inhibitors monotherapy. As a second-line strategy, the Japanese were more likely to augment medication and less likely to increase dosage for moderate depression than their American counterparts. CONCLUSIONS: Differences were found between the treatment selections of early-career psychiatrists in Japan and the USA, despite comparable guidelines and postgraduate training. The results suggest that the gap between guidelines and practice may also be shaped by physician workload, attitudes toward side-effects, and the sociocultural contexts in which clinical decisions are made.

Web-based depression screening and psychiatric consultation for college students: a feasibility and acceptability study.

Background. A steady rise in the prevalence of depression among college students has negatively affected student quality of life. This study investigates the feasibility and acceptability of a Web-based model, including Skype, to screen and provide psychiatric consultation to depressed college students. Methods. Students completed the 9-item Patient Health Questionnaire (PHQ-9) online; those who screened positive (PHQ-9 ≥ 10) or endorsed any level of suicidal ideation were offered Web-based psychiatric consultation using Skype. After the consultation, students filled out a 7-item satisfaction questionnaire to report on the acceptability of this Web-based method. Results. A total of 972 students consented to the online depression screening and 285 screened positive. Of those, 69 students consented and 17 students successfully completed the psychiatric consultation via Skype. Thirteen (76.4%) students found the interview useful in helping them understand their depression. Fifteen (88.2%) students thought that psychologists and psychiatrists could successfully see patients via videoconferencing. Conclusions. Current online technologies can provide depression screening and psychiatric consultation to college students; those who participated reported a positive experience. Future studies will need to address the low levels of participation among college students and attract students who are underserved, as well as use a videoconferencing platform that adequately protects data confidentiality.