Parenting in a Pandemic: Preliminary Support for Delivering Brief Behavioral Parent Training Through Telehealth.

Behavioral problems, such as noncompliance and aggression, are a common referral reason to mental health services for young children. Behavioral parent training (BPT) is the leading intervention for addressing behavioral problems and leads to benefits in a variety of parental factors (e.g., parenting efficacy and parenting stress). While the COVID-19 pandemic dramatically shifted service delivery toward telehealth services, limited work has evaluated the effectiveness of BPT when delivered in a brief, group format through telehealth. The current retrospective chart review study evaluated the engagement to and preliminary effectiveness of a brief version of BPT delivered through telehealth to 64 families of 3- to 7-year-olds referred for behavioral problems. Families attended an average of 4.55 of 6 sessions and most families had two caregivers who engaged in the intervention. Significant reductions in caregivers' report of children's behavioral problems and improvements in parenting self-efficacy resulted. Future research and clinical implications are discussed.

Predicting children's differential trajectories of emotion dysregulation: A study on the intergenerational transmission of child and caregiver maltreatment.

BACKGROUND: Child maltreatment and caregiver history of abuse is negatively associated with the development of emotion regulation, and maltreatment in early childhood may be particularly disruptive. OBJECTIVE: We examined patterns of emotion dysregulation and the contribution of caregiver victimization and early maltreatment history on the development of distinct emotion dysregulation trajectories. PARTICIPANTS: The current study sample (n = 1354) came from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a longitudinal study of the antecedents and consequences of child maltreatment. Children had a varied risk of maltreatment from high risk but not referred to child protective services to children who were removed from parental care. METHOD: We employed a growth mixture modeling approach to model differential trajectories of children's emotion dysregulation from age four to age ten and assessed whether children's experiences of maltreatment prior to age four and caregiver histories of abuse were associated with children's probable class membership in the identified trajectories. RESULTS: We identified three classes of emotion dysregulation trajectories: Well-Regulated, Increasingly Dysregulated, and Highly Dysregulated. Early experiences of multiple maltreatment types and caregiver history of abuse were associated with higher odds that children would be in the Increasingly Dysregulated and Highly Dysregulated classes compared to the Well-Regulated class. CONCLUSION: The current study extends the literature on the negative associations of caregiver histories of abuse and child experiences of multiple maltreatment types to children's emotion dysregulation, which may be long-lasting. Furthermore, our findings highlight the need for intervening early as a crucial component of breaking the intergenerational impact of maltreatment.

Working toward Socially Responsive Recruitment Practices of Psychology Interns in an Academic Medical Center.

OBJECTIVE: This study describes a quality improvement (QI) process to reduce bias and increase inclusion and equity in the recruitment of health service psychology interns in an American Psychological Association-accredited psychology internship program at a national children's hospital. METHODS: This QI project utilized two Plan-Do-Study-Act (PDSA) cycles targeting the application review and the interview processes primarily using supervisor engagement and feedback to inform these processes. The goal of the PDSA cycles was to increase diversity in psychology doctoral interns offered interviews and ultimately recruited to the internship program. RESULTS: The application rating form was revised to place a greater emphasis on factors related to diversity, such as increasing the number of points applicants could earn for being bilingual. Regarding the interview process, structured interview questions were created, and a new, unified rubric was used to score interviewees. The changes in demographics of applicants selected for interviews and feedback from applicants who interviewed are reported. CONCLUSIONS: The QI process resulted in tangible changes to improve equitable and inclusive internship recruitment. Lessons learned throughout this process included the need for continual auditing of practices through an equity lens, engaging supervisors at all stages of the process, and implementing incremental actions.

Associations between dispositional parental emotion regulation and youth mental health symptoms: A systematic review and meta-analysis.

Theoretical perspectives propose that parents' dispositional emotion regulation (ER) tendencies are likely associated with youth mental health concerns. The aim of the current study was to conduct a systematic review and meta-analysis to evaluate the relationship between parental dispositional ER tendencies - both maladaptive and adaptive - and youth mental health symptoms. Regarding maladaptive parental ER, 32 unique studies (N = 6399) with 126 effects were included. A significant, small-to-moderate, effect was observed (r = 0.25) such that higher maladaptive parental ER was linked to heightened youth mental health symptoms. No differences were observed based on youth age or psychiatric risk status, yet effects were stronger when drawn from the same informant in contrast to different informants. Further, 12 studies (N = 4241) including 28 effects were identified and a significant, albeit small, relation (r = -0.16) between adaptive parental ER and youth mental health symptoms occurred. A narrative review of these studies evaluating adaptive parental ER and youth mental health symptoms was performed due to the limited number of effects found beyond parental dispositional mindfulness. These findings generally support the notion that parental dispositional ER tendencies are modestly associated with youth mental health concerns. Future directions and clinical implications are discussed.

Relationships between attention to emotion and anxiety among a community sample of adolescents.

BACKGROUND: Attentional bias to threat has been implicated as a cognitive mechanism in anxiety disorders for youth. Yet, prior studies documenting this bias have largely relied on a method with questionable reliability (i.e. dot-probe task) and small samples, few of which included adolescents. The current study sought to address such limitations by examining relations between anxiety - both clinically diagnosed and dimensionally rated - and attentional bias to threat. METHODS: The study included a community sample of adolescents and employed eye-tracking methodology intended to capture possible biases across the full range of both automatic (i.e. vigilance bias) and controlled attentional processes (i.e. avoidance bias, maintenance bias). We examined both dimensional anxiety (across the full sample; n = 215) and categorical anxiety in a subset case-control analysis (n = 100) as predictors of biases. RESULTS: Findings indicated that participants with an anxiety disorder oriented more slowly to angry faces than matched controls. Results did not suggest a greater likelihood of initial orienting to angry faces among our participants with anxiety disorders or those with higher dimensional ratings of anxiety. Greater anxiety severity was associated with greater dwell time to neutral faces. CONCLUSIONS: This is the largest study to date examining eye-tracking metrics of attention to threat among healthy and anxious youth. Findings did not support the notion that anxiety is characterized by heightened vigilance or avoidance/maintenance of attention to threat. All effects detected were extremely small. Links between attention to threat and anxiety among adolescents may be subtle and highly dependent on experimental task dimensions.

Maternal corticosteroids and depression during gestation and decreased fetal heart rate variability.

OBJECTIVE: Maternal depression during gestation is an adverse factor in fetal brain development that manifests in later childhood behavioral problems. Fetal heart rate variability (FHRV) mediated by parasympathetic input is a marker of gestational nervous system development. Biological mediators of adverse effects of maternal depression may involve the mother's corticosteroids; however, links between depression, corticosteroids, and early nervous system development remain inconclusive. METHODS: Heart rate was recorded in 23 fetuses by transabdominal Doppler at 28-33 weeks gestation. The SD of interbeat intervals over 20 min assessed FHRV. Maternal depression ratings and hair concentrations of cortisol and cortisone were assayed. An auditory sensory gating paradigm assessed newborn development of cerebral inhibition. Parents rated their infant's temperament characteristics on the Infant Behavior Questionnaire-Revised Short Form (IBQ-R). RESULTS: Maternal depression was associated with lower FHRV, especially for male fetuses, ß = -0.633, P = 0.045. Maternal depression was associated with lower cortisol to total corticosteroids ratios, ß = -0.519, P = 0.033. Lower cortisol ratios were associated with decreased FHRV, ß = 0.485, P = 0.019. Decreased FHRV was associated with increased newborn sensory gating deficits, ß = -0.992, P = 0.035, indicating poorer development of cerebral inhibition. Higher FHRV was related to increased infant IBQ-R self-regulatory behaviors, r = 0.454, P = 0.029. CONCLUSION: Maternal depression is associated via corticosteroids with decreased development of nervous system control of fetal heart rate. Decreased FHRV indicates developmental alterations in gestation that correlate with altered brain function and subsequent regulatory challenges in early infancy.

Development and Application of an Innovative Transdiagnostic Treatment Approach for Pediatric Irritability.

Recent work has drawn attention to the previously underrecognized role that irritability plays in childhood psychopathology. Despite increased recognition of the clinical importance of pediatric irritability as a transdiagnostic symptom dimension, there is a lack of evidence-based treatments for this population that simultaneously and equitably addresses both child and contextual (e.g., parental) factors implicated in the development and maintenance of associated emotional and behavioral difficulties. In the current pilot study, we adapted the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) for the treatment of pediatric irritability in a sample of 19 children (ages 8 to 12) with primary presenting concerns of irritability and/or disruptive behaviors. Results supported the feasibility and acceptability of this treatment and provided preliminary evidence that such an approach may yield improved outcomes for symptoms of pediatric irritability and disruptive behaviors. Implications of these findings for future research and clinical interventions for pediatric irritability are discussed.