Randomized trial of parent-child interaction therapy improves child-welfare parents' behavior, self-regulation, and self-perceptions.

OBJECTIVE: We conducted a large (N = 204) randomized, clinical trial to test the efficacy of parent-child interaction therapy (PCIT) on observed parenting, two key drivers of maladaptive parenting-self-regulation and social cognitions, and child behavior outcomes in a sample of child welfare-involved families. METHOD: Participants were randomly assigned to standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income, significant exposures to adverse childhood experiences, and substance abuse. Intention-to-treat analyses were conducted on multiply imputed data followed by secondary per-protocol analyses. RESULTS: Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No differences in rates of parent commands or child compliance were observed across conditions. Harsh child attributions moderated treatment impact on parenting skills acquisition. PCIT parents who held harsher attributions displayed greater gains in use of labeled praises and declines in negative talk/criticism with their child, than control group parents. CONCLUSIONS: This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in a child welfare parents and replicates other published trials documenting intervention gains in positive parenting and child behavior in child welfare families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

PCIT engagement and persistence among child welfare-involved families: Associations with harsh parenting, physiological reactivity, and social cognitive processes at intake.

Parent-Child interaction therapy (PCIT) has been shown to improve positive, responsive parenting and lower risk for child maltreatment (CM), including among families who are already involved in the child welfare system. However, higher risk families show higher rates of treatment attrition, limiting effectiveness. In N = 120 child welfare families randomized to PCIT, we tested behavioral and physiological markers of parent self-regulation and socio-cognitive processes assessed at pre-intervention as predictors of retention in PCIT. Results of multinomial logistic regressions indicate that parents who declined treatment displayed more negative parenting, greater perceptions of child responsibility and control in adult-child transactions, respiratory sinus arrhythmia (RSA) increases to a positive dyadic interaction task, and RSA withdrawal to a challenging, dyadic toy clean-up task. Increased odds of dropout during PCIT's child-directed interaction phase were associated with greater parent attentional bias to angry facial cues on an emotional go/no-go task. Hostile attributions about one's child predicted risk for dropout during the parent-directed interaction phase, and readiness for change scores predicted higher odds of treatment completion. Implications for intervening with child welfare-involved families are discussed along with study limitations.

Person-centered profiles of parasympathetic physiology, anxiety symptoms, and depressive symptoms in mothers and fathers of young children.

Respiratory sinus arrhythmia (RSA) is a biomarker of mental health, but RSA-symptom relations in parents of young children are understudied. We examined how anxiety symptoms, depressive symptoms, resting RSA, and RSA reactivity during challenging parent-child interactions clustered in a community sample of mothers (N = 126) and fathers (N = 87) of 3-year-olds and whether profiles predicted child emotional and behavioral dysregulation at age 4. Mothers fit four profiles (Typical, Mild Risk, Moderate Risk/Withdrawal, and Moderate Risk/Augmentation), suggesting that RSA reactivity was distinct by predominant symptom type at higher levels of risk: specifically, heightened RSA withdrawal was associated with a higher probability of anxiety symptoms and RSA augmentation was associated with a higher probability of depressive symptoms. Fathers fit three profiles (Typical, Mild Risk, and Moderate Risk) where Moderate Risk was characterized by RSA augmentation and a higher probability of both anxiety and depressive symptoms. Mild risk profiles showed heightened resting RSA for mothers and fathers but no differences in RSA reactivity. Both mild and moderate risk profiles predicted higher child dysregulation 1 year later compared to typical profiles. Findings offer preliminary evidence that parasympathetic physiology covaries with symptoms differently for mothers and fathers and that parental profiles of physiology and symptoms inform children's developmental psychopathology.

Parental depressive symptoms, parent-child dyadic behavioral variability, and child dysregulation.

Parental depressive symptoms are associated with greater variability and inconsistency in parenting behavior as well as children's emotional and behavioral dysregulation. The present study explored whether such relations extended to dyadic processes, examining whether maternal and paternal depressive symptoms at child age 3½ interacted with concurrent higher dyadic behavioral variability (DBV) in mother-child free play to heighten children's emotional and behavioral dysregulation at age 4 (N = 100). Child dysregulation was measured as mother-reported emotional lability-negativity and externalizing problems, and DBV was measured as the number of transitions among dyadic behavioral states using state space grids. Parent behaviors included parent directives, positive reinforcement, and disengagement, and child behaviors included child compliance, persistence, and noncompliance, among others. Analyses also accounted for the degree of positive (compared to negative) behavioral content. Moderation analyses showed that DBV predicted greater child dysregulation only when maternal or paternal depressive symptoms were higher. Further, DBV was detrimental only when dyadic positive interaction content was low. Findings suggest DBV combined with low positive content in parent-child interactions is a particular risk factor for children's regulatory development. Fostering positive, predictable interaction patterns may be an important target for family interventions with a depressed parent. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parent-child coregulation of parasympathetic processes varies by social context and risk for psychopathology.

The parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent-child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent-child interactions showed overall dynamic, positive concordance in mother-child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother-child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent-child physiological coregulation are discussed.

The effects of maternal respiratory sinus arrhythmia and behavioral engagement on mother-child physiological coregulation.

Parent-child coregulation is thought to be an important precursor for children's developing self-regulation, but we know little about how individual parent factors shape parent-child physiological coregulation. We examined whether maternal baseline respiratory sinus arrhythmia (RSA), teaching, and disengagement were associated with stronger or weaker coregulation of RSA between mothers and their 3-year-old children (N = 47), modeled across 18 min of observed dyadic interaction using multilevel coupled autoregressive models. Whereas greater maternal teaching was associated with stronger coregulation in mother and child RSA over time, maternal disengagement was related to weaker coregulation, specifically more divergent parent and child RSA at higher levels of maternal disengagement. Coregulation of mother-child RSA was also weaker when mothers' baseline RSA was higher. Findings contribute to the emerging knowledge base on real-time patterns of parent-child physiological coregulation in early childhood and suggest that mothers' physiology and behavioral engagement with the child play an important role in mother-child physiological coregulation patterns.

Response monitoring and cognitive control in childhood obesity.

The ability to discern when actions deviate from goals and adjust behavior accordingly is crucial for efforts at self-regulation, including managing one's weight. We examined whether children with obesity differed from controls in response monitoring, an aspect of cognitive control that involves registering one's errors. Participants performed a cognitive interference task, responding to the colors of arrows while ignoring their orientations, and error-related neural activity was indexed via response-locked event-related potentials (ERPs). Compared to controls, participants with obesity exhibited significantly blunted "error-related negativity", an ERP component linked to response monitoring. Participants with obesity also exhibited a marginally blunted "error-related positivity", an ERP component linked to late-stage error processing, as well as in behavioral indices of cognitive control. These results suggest that childhood obesity may be associated with reduced response monitoring and that this aspect of cognitive control may play an important role in health-related self-regulatory behavior.