Parent-child boundary dissolution and children's psychological difficulties: A meta-analytic review.

Boundary dissolution has broadly been defined as the breakdown of boundaries and loss of psychological distinctiveness in the parent-child subsystem. Qualitative reviews have highlighted the developmental and clinical value of examining boundary dissolution as a multidimensional construct. Though prior work suggests patterns share minimal variance, research has yet to quantitatively synthesize the weighted effect of distinct patterns. The primary aim of this meta-analysis was to aggregate empirical research on associations between boundary dissolution patterns and children's internalizing and externalizing symptoms. Four patterns of boundary dissolution were identified across developmental, clinical, and family systems literatures: (a) enmeshment-entanglement and blurring of the intergenerational parent-child boundary through psychologically controlling and intrusive behaviors, (b) disorganization-chaotic parent-child boundary (e.g., inexplicable, contradictory behaviors, and responses) reflecting no coherent pattern of relating, (c) caregiving-child functions as a caregiver providing parents with instrumental and emotional support and guidance, and (d) coerciveness-child operates as a disciplinarian or authoritarian to intimidate and control parents. The meta-analysis reviewed 478 studies. Although each boundary dissolution pattern was associated with internalizing and externalizing symptoms, weighted effects across patterns significantly varied in magnitude. Regarding externalizing symptoms, the weighted effect of enmeshment was stronger relative to the weighted effect of caregiving. Turning to internalizing symptoms, the weighted effect of enmeshment was stronger than the weighted effect of caregiving and coerciveness. Additionally, the weighted effect of disorganization was stronger than the weighted effect of caregiving. The robustness of weighted effects depended on child, contextual, and methodological characteristics as well as time lag. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Single centre observational study evaluating the impact of introducing High Flow Nasal Cannula outside of Paediatric Critical Care Unit.

AIM: To evaluate the impact of High Flow Nasal Cannula (HFNC) introduction outside of Paediatric Critical Care Units (PCCU), on PCCU admissions and intubation rates. Secondarily, to identify escalation predictors. METHODS: Retrospective observational study with matched PCCU admissions and intubation rates, 2-years before (Group 1) and 2-years after (Group 2) HFNC introduction outside of PCCU. Within Group 2, we compared those admitted to PCCU (escalation) and those who did not (non-escalation). Observations, change in observations and time to starting HFNC were analysed. RESULTS: Pre- and post-introduction comparison: Of 980 admissions in Group 1, 55 were admitted to PCCU, whereas of 1209 admission in Group 2, there were 85 admissions, P = 0.188. Group 1 had 25 intubations compared to 23 in Group 2, P = 0.309. Over twice as many children had some form of respiratory support in Group 2. Post-introduction: 104 children commenced HFNC, 72% for bronchiolitis. Median age was 4 months in the non-escalation group and 6.5 months in the escalation group, P = 0.663. Thirty-eight children escalated to PCCU: 33 required CPAP/BiPAP, 4 were intubated with 1 remaining on HFNC. Comparisons of age, gender, comorbidities, observations, change in observations and time to starting HFNC showed no significant escalation predictors. CONCLUSIONS: This study identified no statistically significant predictors of escalation. There was an observed increase in PCCU admissions with decreased intubations. The resource implications of this therapy are significant and further studies should examine cost effectiveness of HFNC use outside of PCCU.

A process model of parental executive functioning as a spillover mechanism linking interparental conflict and parenting difficulties across parenting domains.

There is a well-documented interdependency between destructive interparental conflict (IPC) and parenting difficulties (i.e., spillover effect), yet little is known about the mechanisms that "carry" spillover between IPC and parenting. Guided by a cascade model framework, the current study used a longitudinal, multimethod, multi-informant design to examine a process model of spillover that tested whether parental executive functioning (working memory, cognitive flexibility, inhibitory control) served as a mediator of the prospective associations between IPC and subsequent changes in parenting over a 2-year period. Mothers and fathers were separated into differentiated models and multiple domains of parenting were examined (i.e., authoritarian discipline and scaffolding behavior). Participants included 231 families (both mothers and fathers of preschoolers). Race was reported as White (62%), Black (21%), Mixed (8%), Asian (3%), or Other (6%) and 14% considered their ethnicity to be Hispanic/Latino. Median household income was $65,000. Results indicated that for fathers, IPC indirectly predicted domain-general parenting difficulties (increased authoritarian parenting and decreased scaffolding) via deficits in paternal cognitive flexibility (but not inhibitory control or working memory). In mothers, IPC directly predicted domain-specific parenting difficulties (decreased scaffolding only) that did not operate via maternal executive functions. Notably, these effects occurred over and above the influence of parental socioeconomic status. This study constitutes a first step toward documenting parental executive functioning as a mechanism underlying the spillover of IPC to the parent-child relationship. Family interventions intended to interrupt IPC spillover should emphasize father involvement and consider targeting parental executive functions as change mechanisms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Advancing differential susceptibility research: Development and validation of the temperamental sensitivity Q-scale.

Temperamental sensitivity (TS), which is a correlated suite of traits reflecting a lower threshold of environmental stimulation and heightened responsivity to a range of environmental contexts, is an empirically documented susceptibility factor that increases children's plasticity to supportive and harsh family environments. To expand the limited options for assessing TS, this article tested the psychometric properties of a new Q-set measure (i.e., TS Q-scale) derived from the California Child Q-Set (CCQ-Set) and completed by experimenters. Participants in Study 1 consisted of 243 mothers, their partners, and their preschool children (Mage = 4.60 years; 56% girls; 54% Black or multiracial; 16% Latinx). For Study 2, participants included 201 mothers and their young children (Mage = 2.25 years; 44% girls; 63% Black or multiracial; 11% Latinx). Both longitudinal studies utilized multimethod, multiinformant measurement batteries. The TS Q-scale evidenced satisfactory internal consistencies across both studies. Support for the convergent and discriminant validity in Study 1 was evident in its large, unique, and significantly stronger association with a standard, more extensive, observational assessment of TS when compared with conventional dimensions of temperament. In each study, the TS Q-scale significantly moderated the association between family functioning and latent change analyses of children's functioning for most of the forms of child adjustment. Supporting its predictive validity as a differential susceptibility attribute, children with higher scores on the TS Q-scale exhibited substantially better functioning than their peers in supportive socialization contexts and considerably worse functioning in harsh rearing conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Hostile interparental conflict and parental discipline: Romantic attachment as a spillover mechanism.

This study examined parental romantic attachment security as a mediator of prospective associations between hostile interparental conflict and parental discipline (i.e., power-assertive, permissive, and inductive discipline) for mothers and fathers of young children. Furthermore, this study utilized a novel, automatic assessment of romantic attachment security in examining whether romantic attachment assessed at controlled (i.e., self-reported) and automatic (i.e., a rapid word-sorting task) levels of representation differentially serve as spillover mechanisms. Participants included 235 mothers (62% White), fathers (55% White), and a target child between the ages of 2 and 4 (Mage = 2.97; 55% girls) recruited from a moderate-sized metropolitan area in the Northeastern United States. Families were assessed annually across three waves of data collection. Results from autoregressive structural equation model analyses revealed that romantic attachment operated as spillover mechanism for mothers. In particular, hostile interparental conflict was associated with power-assertive discipline through changes in mothers' automatic romantic attachment security. We also found that hostile interparental conflict was associated with inductive discipline through changes in mothers' romantic attachment avoidance. Neither controlled nor automatic romantic attachment representations served as spillover mechanisms for fathers. Findings are discussed within family systems and attachment frameworks. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Family risk, parental cortisol contagion, and parenting: A process-oriented approach to spillover.

This multi-method longitudinal study sought to investigate linkage in parental neuroendocrine functioning - indicated by cortisol - over two measurement occasions. In addition, we examined how parental cortisol linkage may operate as an intermediate factor in the cascade of contextual risks and parenting. Participants were 235 families with a young child (Mage = 33.56, 36.00 years for mothers and fathers respectively), who were followed for two annual measurement occasions. Parental cortisol linkage was measured around a laboratory conflict discussion task at both measurement occasions (i.e., pre-discussion, 20- and 40-minute post-discussion for each measurement occasion). Maternal and paternal parenting behavior was observed during a parent-child discipline discussion task. Findings indicated similar levels of cortisol linkage between parents over the two measurement occasions. Furthermore, cortisol linkage between parents operated as an intermediate factor between contextual risks and more compromised parenting behavior. That is, greater contextual risks, indicated by greater neighborhood risk and interparental conflict, were linked to greater cortisol linkage between parents over time, which was in turn linked to greater authoritarian parenting during parent-child interaction. Findings highlighted the importance of understanding physiological-linkage processes with respect to the impact of contextual risks on family functioning and may have crucial implications for clinical work.

Maternal alcohol dependence symptoms, maternal insensitivity to children's distress, and young children's blunted emotional reactivity.

Maternal insensitivity to children's emotional distress (e.g., expressions of sadness or fearfulness) is one mechanism through which maternal alcohol dependence may increase children's risk for psychopathology. Although emotion dysregulation is consistently associated with psychopathology, it remains unclear how or why alcohol dependence's effects on caregiving responses to children's distress may impact children's emotion regulation over time, particularly in ways that may engender risks for psychopathology. This study examined longitudinal associations between lifetime maternal alcohol dependence symptoms, mothers' insensitivity to children's emotional distress cues, and children's emotional reactivity among 201 mother-child dyads (Mchild age = 2.14 years; 56% Black; 11% Latino). Structural equation modeling analyses revealed a significant mediational pathway such that maternal alcohol dependence predicted increases in mothers' insensitivity to children's emotional distress across a one-year period (ß = .16, p = .013), which subsequently predicted decreases in children's emotional reactivity one year later (ß = -.29, p = .009). Results suggest that mothers with alcohol dependence symptoms may struggle to sensitively respond to children's emotional distress, which may prompt children to suppress or hide their emotions as an adaptive, protective strategy. The potential developmental benefits and consequences of early, protective expressive suppression strategies are discussed via developmental psychopathology frameworks.

Development of the Children's ACuTe UltraSound (CACTUS) point-of-care ultrasound (POCUS)-accredited training in the UK: a descriptive study.

Point-of-care ultrasound (POCUS) is an established, evidence-supported tool that can be used in neonatal and paediatric medicine, offering clinicians immediate diagnostic insights, assessment of interventions and improved safety profiles and success rate of various procedures. Its effective use requires an established education programme, governance and standardisation to ensure competence in this skill. While adult clinical practice has established POCUS training protocols, this had not been replicated in paediatrics. This article describes the development and launch of the UK's inaugural accredited paediatric-specific POCUS curriculum and training pathway: the 'Children's ACuTe UltraSound' course, addressing this significant gap in paediatric healthcare education and describing the training delivered and available for paediatricians and allied health professionals working with children.

Beyond form: The value of systems conceptualizations of function in increasing precision and novelty in the study of developmental psychopathology.

Developmental psychopathology has successfully advanced an understanding of risk and protective factors in multivariate models. However, many areas have relied on top-down approaches that define psychological constructs based largely or solely on their physical form. In this paper, we first describe how top-down approaches have significantly hindered progress by generating generic risk and protective models that yield little more than the conclusion that axiomatically positive and negative factors respectively beget an interchangeable array of positive and negative child sequelae. To advance precision and novelty as central priorities, we describe behavioral systems frameworks rooted in evolutionary theory that infuse both form (i.e., what it looks like) and function (what it is designed to do) into psychological constructs. We further address how this paradigm has generated new growing points for developmental models of interparental relationships and parenting. In the final section, we provide recommendations for expanding this approach to other areas of developmental psychopathology. Throughout the paper, we document how the focus on functional patterns of behavior in well-defined developmental contexts advance precision and novelty in understanding children's response processes to threats, opportunities, and challenges in associations between their developmental histories and their psychological sequelae.

Interparental conflict dimensions and children's psychological problems: Emotion recognition as a mediator.

This study tested children's emotion recognition as a mediator of associations between their exposure to hostile and cooperative interparental conflict and their internalizing and externalizing symptoms. From 2018 to 2022, 238 mothers, their partners, and preschool children (Mage = 4.38, 52% female; 68% White; 18% Black; 14% Multiracial or another race; and 16% Latinx) participated in three annual measurement occasions. Path analyses indicated that Wave 1 observations of hostile interparental conflict predicted residualized increases in children's emotion recognition accuracy (i.e., angry, sad, and happy) at Wave 2 (ß = .27). Wave 2 emotion recognition, in turn, predicted residualized decreases in children's internalizing symptoms at Wave 3 (ß = -.22). Mediational findings were partly attributable to children's accuracy in identifying angry and high-intensity expressions.

Interparental conflict and adolescent emotional security across family structures.

This study investigated whether interparental conflict was differentially related to forms of emotional security (i.e., family, interparental, parent-child) and whether forms of emotional security were differentially associated with mental health problems for adolescents in married versus divorced/separated families. Participants were 1032 adolescents (ages 10-15; 51% male, 49% female; 82% non-Hispanic White, 9% Black/African American, 5% Hispanic, 2% Asian or Pacific Islander, 2% Native American) recruited from a public school in a middle-class suburb of a United States metropolitan area. We used multiple group multivariate path analysis to assess (1) associations between interparental conflict and multiple measures of emotional insecurity (i.e., family, interparental, and parent-child), (2) associations between measures of emotional insecurity and internalizing and externalizing problems, and (3) moderation effects of parent-child relationships. The patterns of association were similar across family structures. A high-quality parent-child relationship did not mitigate the harmful effects of interparental conflict on emotional insecurity or mental health problems. Findings suggest that regardless of family structure, emotional security across multiple family systems may be a critical target for intervention to prevent youth mental health problems, in addition to interventions that reduce conflict and improve parent-child relationships.

Variation in Early Pediatric Intensive Care Management Strategies and Duration of Invasive Mechanical Ventilation for Acute Viral Bronchiolitis in the United Kingdom: A Retrospective Multicenter Cohort Study.

OBJECTIVES: Management of mechanically ventilated patients with bronchiolitis is not standardized and duration of mechanical ventilation has been shown to vary widely between centers. The aim of this study was to examine practice in a large number of U.K. PICUs with a view to identify if early management choices relating to fluid prescription, sedative agent use, and endotracheal tube (ETT) placement were associated with differences in duration of invasive mechanical ventilation (IMV). DESIGN: Retrospective multicenter cohort study. Primary outcome was duration of IMV. A hierarchical gamma generalized linear model was used to test for associations between practice variables (sedative and neuromuscular blocking agents, route of endotracheal intubation at 24 hr and fluid balance at 48 hr) and duration of IMV after adjustment for known confounders. SETTING: Thirteen U.K. PICUs. Duration of 2 months between November and December 2019. PATIENTS: Three hundred fifty infants receiving IMV for bronchiolitis. Excluded were patients receiving long-term ventilation, extracorporeal life support, or who died before separation from IMV. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: After adjustment for confounders, several variables were associated with an increase in the geometric mean duration of IMV (expressed as a percentage) including: nasal ETT use, 16% (95% CI, 1-32%); neuromuscular blockade use, 39% (95% CI, 21-61%); and fluid balance at 48 hr, 13% per 100 mL/kg positive fluid balance (95% CI, -1% to 28%). The association of sedative use varied with class of agent. The use of an alpha-2 agonist alone was associated with a reduction in duration of IMV by 19% in relation to no sedative agent (95% CI, -31 to -5%), whereas benzodiazepine uses alone or with alpha-2 agonist in combination were similar to using neither agent. CONCLUSIONS: Early management strategies for bronchiolitis were associated with the duration of IMV across U.K. centers after adjustment for confounders. Future work should prospectively assess the impact of fluid restriction, route of endotracheal intubation, and alpha-2 agonist use on duration of IMV in infants with bronchiolitis, with the aim of reducing seasonal bed pressure.

Emergency Inter-Hospital Transfer of Children to PICUs in the United Kingdom: Qualitative Exploration of Parents' Experiences of Retrieval Teams.

OBJECTIVES: Each year in the United Kingdom there are around 5,000 inter-hospital transfers of critically ill children into PICUs. There are few published descriptions of what this experience is like for parents. The objective was to describe parents' experiences of the inter-hospital transfer of their critically ill child to a PICU. DESIGN: Qualitative in-depth interviews. SETTING: Twenty-four PICUs in England and Wales. PARTICIPANTS: Parent interview participants ( n = 30) were purposively sampled from a larger pool of parent questionnaire respondents to create a sample diverse in child's age, presenting medical illness, retrieval team and whether a parent traveled in the ambulance. MEASUREMENT AND MAIN RESULTS: Open-ended semi-structured interviews using topic guides to encourage parents to describe their experiences of transfer. Interviews were audio recorded, transcribed verbatim and thematically analyzed using Framework Analysis. Parents' perceptions of transport staff as confident and competent through observation of clinical care, and positive communication experiences during the transfer process, were related to feelings of trust and being supported, as well as relief from distress. Parents varied in their needs for conversation and support. Parents who did not travel in the ambulance had fewer opportunities to interact with the transport team and experienced different challenges in the period prior to their child's admission to the PICU. CONCLUSIONS: Retrieval teams can influence how parents experience their child's emergency transfer to the PICU, offering parents proximity to knowledgeable staff. Satisfaction may be related to matching parents' needs. Understanding parents' needs and optimizing opportunities for effective communication between parents and staff are beneficial to parents.

Strengths-based spillover models: Constructive interparental conflict, parental supportive problem solving, and development of child executive functioning.

Empirical research examining the Spillover Hypothesis has largely substantiated that interparental conflict comprised of hostility and anger has negative implications for parenting behaviors and cascading effects on children's development. However, less is known about how constructive forms of interparental conflict may operate in spillover processes. Toward this, the present study examined how interparental supportive and problem-solving approaches to conflict were associated with parental guided learning in the caregiving context and by extension young children's executive functioning. Participants included 231 families (mothers, fathers, and their child). Assessments of constructive interparental conflict were derived from both observational tasks and multi-informant report. Parental supportive problem solving was assessed observationally during a goal-directed parent-child interaction. Children's inhibitory control, working memory, and visual-spatial reasoning were assessed using validated tasks. Analyses were conducted in a structural equation modeling framework, and significance of indirect paths were tested using RMediation. Results showed constructive interparental conflict was associated with increases in maternal supportive problem solving, which in turn predicted increases in children's working memory. Furthermore, constructive interparental conflict was indirectly associated with increases in children's inhibitory control via paternal supportive problem solving. These findings were significant over two waves of data collection after controlling for child sex, maternal and paternal age, and maternal and paternal education. Findings underscore the potential utility of family resilience theory and domain approaches to parenting for increasing specificity and precision in identifying spillover processes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Disentangling the relationship between callous-unemotional traits and unsupportive parenting through a developmental lens.

Research suggests that unsupportive parenting practices are consistent but modest risk factors for children's behavioral and social problems, emphasizing the importance in identifying sources of variability in children's vulnerability. To address this research direction, this study examined children's callous-unemotional (CU) traits (i.e., affective indifference; lack of guilt or empathy), as a moderator of the associations among maternal and paternal unsupportive parenting and their externalizing symptoms. Participants included 240 mothers, partners, and their children (Mage = 4.6 years; 56% girls) from diverse backgrounds (48% Black; 16% Latinx) who took part in a longitudinal multi-method study with two measurement occasions spaced 2 years apart. Findings from structural equation modeling indicated the prospective association between observational assessments of unsupportive maternal (but not paternal) parenting and residualized changes in teacher reports children's externalizing problems over 2 years was significantly moderated by maternal reports of children's callous-unemotional traits (ß = -.21, p < .05). Follow-up analyses of the interaction provided support for differential susceptibility. These findings highlight that children with elevated CU traits may experience diminished susceptibility to parenting, while children with lower levels of CU traits may exhibit plasticity in response to socialization environments.

Contextual risks, child problem-solving profiles, and socioemotional functioning: Testing the specialization hypothesis.

Guided by the evolutionary perspective and specialization hypothesis, this multi-method (behavioral observation, questionnaire) longitudinal study adopted a person-centered approach to explore children's problem-solving skills within different contexts. Participants were 235 young children (M age = 2.97 years at the first measurement occasion) and their parents assessed in two measurement occasions spaced one year apart. Latent profile analyses revealed four unique problem-solving profiles, capturing variability in children's performance, and observed engagement in abstract vs. reward-oriented (RO) problem-solving tasks at wave one. The four profiles included: (a) a high-abstract-high-RO, (b) a high-abstract-low-RO, (c) a low-abstract-high-RO, and (d) a low-abstract-low-RO classes. Contextual risks within and outside families during wave one, including greater neighborhood crime, impoverishment, and observed lower maternal sensitivity were linked to the elevated likelihood for children from the two profiles with low-abstract problem-solving, particularly those from the low-abstract-high-RO problem-solving profile. Furthermore, child problem-solving profiles were linked to meaningful differences in their socioemotional functioning one year later. The present finding has important implications in revealing the heterogeneity in child problem-solving within different contexts that responded differently to contextual risks. In addition, this study advanced the understanding of the developmental implications of child problem-solving capacity.

Domain specificity of differential susceptibility: Testing an evolutionary theory of temperament in early childhood.

According to differential susceptibility theory (DST), some children may be more sensitive to both positive and negative features of the environment. However, research has generated a list of widely disparate temperamental traits that may reflect differential susceptibility to the environment. In addition, findings have implicated these temperament × environment interactions in predicting a wide variety of child outcomes. This study uses a novel evolutionary model of temperament to examine whether differential susceptibility operates in a domain-general or domain-specific manner. Using a racially and socioeconomically diverse sample of 243 preschoolers and their parents (56% female; 48% African American), we examined the interactions between maternal and paternal parenting quality and two evolutionary informed temperament profiles (i.e., Hawks and Doves) in predicting changes in teacher-reported conduct problems and depressive symptoms from preschool to first grade. Results suggest that differential susceptibility operates in a domain-specific fashion. Specifically, the "Hawk" temperament was differentially susceptible to maternal parenting in predicting externalizing problems. In contrast, the "Dove" temperament was susceptible to both paternal and maternal parenting quality in predicting changes in depressive symptoms. Findings provide support for an integrative framework that synthesizes DST with an evolutionary, function-based approach to temperament.

Family instability, parenting, and child externalizing problems: Moderation by maternal sympathetic stress reactivity.

This multi-method longitudinal study evaluated how changes in maternal sensitive parenting may operate as an indirect factor linking family instability and the development of child externalizing problems over time. This study also investigated how mothers' stress reactivity within the sympathetic nervous system (SNS) may moderate the association between family instability and the development of maternal sensitivity. Participants were 235 families with a young child (Mage = 2.97 years at the first measurement occasion) and these families were followed for two annual measurement occasions. Maternal sensitivity was observed during two discipline tasks (i.e., forbidden toy, discipline discussion tasks), and maternal SNS stress reactivity was indicated by their salivary alpha-amylase (sAA) reactivity to an interpersonal stressor. Findings revealed significant direct effects of family instability and family instability-x-sAA reactivity interaction in association with the change in maternal sensitivity over time. For both tasks, mothers with greater sAA reactivity exhibited stronger associations between family instability and the growth of their sensitivity. Tests of indirect effects indicated that change in maternal sensitivity operated as an indirect factor between family instability-x-sAA reactivity interaction and the change in child externalizing problems. The present findings have important implications for understanding parental and child sequelae associated with unstable family contexts.

The moderating role of adrenocortical reactivity in the associations between interparental conflict, emotional reactivity, and school adjustment.

This study tested whether the associations between interparental conflict, children's emotional reactivity, and school adjustment were moderated by children's cortisol reactivity in a sample of young children (N = 243; mean age = 4.6 years at Wave 1; 56% female, 44% male) and their parents. Using a longitudinal, autoregressive design, observational assessments of children's emotional reactivity at Wave 2 mediated the relationship between an observational measure of Wave 1 conflict between parents and teacher's report of children's school adjustment at Wave 3. However, children's cortisol reactivity to parent conflict at Wave 1 moderated the first link, such that emotional reactivity operated as a mediator for children with heightened cortisol reactivity but not children with low cortisol reactivity. Moderation was expressed in a "for better" or "for worse" form hypothesized by biological sensitivity to context theory. Thus, children with high cortisol reactivity experienced greater emotional reactivity than their peers when faced with more destructive conflict but also lower emotional reactivity when exposed to more constructive interparental conflict. Results are discussed as to how they advance emotional security and biological sensitivity to context theories.