Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic.

OBJECTIVE: The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)-or the capacities to control emotions, cognition, and behavior in response to challenge-is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic's onset in relation to family pandemic-related stress and youth SR. METHODS: Parents of youth with T1D (N = 88) and a subset of these youth (N = 43; Mean age 15.3 years [SD 2.2]) completed surveys regarding SR, stress, emotional functioning, and T1D-related functioning prior to and after March 2020. Outcomes were compared using mixed effects models adjusting for covariates. Family pandemic-related stress experiences and youth SR were tested as moderators of change. RESULTS: Parents' responsibility for T1D management increased across pandemic onset and their diabetes-related distress decreased. Family pandemic-related stress was associated with decreased emotional functioning over time. Youth SR, particularly emotional and behavioral aspects, predicted better emotional and T1D-related functioning. DISCUSSION: While youth with T1D whose families experienced higher pandemic-related stress had poorer adjustment, strong emotional and behavioral SR appeared to protect against worsening youth mood and adherence across pandemic onset. Both social-contextual and individual factors are important to consider when working with families managing T1D.

Cortisol in early childhood moderates the association between family routines and observed affective balance in children from low-income backgrounds.

The study of emotion regulation often addresses control of negative emotion. Researchers have proposed that affective balance is an indicator of emotion regulation that incorporates the role of positive emotion in the context of negative emotional experiences. Environmental and individual factors, such as family processes and biological stress regulation, are known to shape emotion regulation. The present study investigated whether child diurnal cortisol, an indicator of biological stress regulation, moderated the association between family routines and observed affective balance. Children (N = 222; M age = 4.70 years, SD = 0.60) from low-income households provided saliva samples to measure diurnal cortisol and completed a behavioral task designed to elicit negative emotions. Affective balance was defined as the difference score between the proportion of positive and negative emotional expressions displayed during the task. A higher affective balance score indicated greater positive compared with negative emotional displays. Simple slope analyses indicated that for children with a low morning cortisol intercept, more frequent family routines were associated with more affective balance. This pattern was not observed in children with average or high morning cortisol. Positive family routines may play an important role in shaping affective balance among children with disrupted cortisol levels from low-income backgrounds.

Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change.

Self-regulation, known as the ability to harness cognitive, emotional, and motivational resources to achieve goals, is hypothesized to contribute to health behaviors across the lifespan. Enhancing self-regulation early in life may increase positive health outcomes. During pre-adolescence, children assume increased autonomy in health behaviors (e.g., eating; physical activity), many of which involve self-regulation. This article presents results from a clinical trial (NCT03060863) that used a factorial design to test behavioral interventions designed to enhance self-regulation, specifically targeting executive functioning, emotion regulation, future-oriented thinking, and approach biases. Participants were 118 children (9-12 years of age, M = 10.2 years) who had a history of living in poverty. They were randomized to receive up to four interventions that were delivered via home visits. Self-regulation was assayed using behavioral tasks, observations, interviews, and parent- and child-report surveys. Results were that self-regulation targets were reliably assessed and that interventions were delivered with high fidelity. Intervention effect sizes were very small to moderate (d range = .02-.65, median = .14), and most were not statistically significant. Intercorrelation analyses indicated that associations between measures within each target varied based on the self-regulation target evaluated. Results are discussed with regard to the role of self-regulation-focused interventions in child health promotion. Implications of findings are reviewed for informing next steps in behavioral self-regulation interventions among children from low-income backgrounds.

The Role of Parent Self-Regulation in Youth Type 1 Diabetes Management.

PURPOSE OF REVIEW: Youth with strong self-regulation (SR), or the ability to manage thoughts, emotions, and behaviors, engage in more effective type 1 diabetes (T1D) management. However, while parent support and engagement are critical to ensuring positive youth T1D outcomes, it is rarely considered that parents' SR may also influence youth T1D management. If this is the case, novel interventions to improve parents' SR or ensure adequate support for parents with SR challenges offer great potential to improve family functioning and youth T1D management. RECENT FINDINGS: Theoretical and preliminary empirical evidence suggests that parental SR impacts family processes that support youth T1D treatment regimen adherence. Furthermore, parent and youth SR likely interact, with high parent SR enhancing the positive effects of high youth SR or compensating for low youth SR. Continued research is needed to better understand the ways in which parent SR matters to youth T1D management and identify how to support improvements in T1D management among families of parents with low SR.

Phenotypes of controlling feeding behaviours in mothers of toddlers: A mixed methods study.

BACKGROUND: Maternal feeding behaviours, in particular controlling behaviours, are associated with risk of childhood obesity. OBJECTIVES: To qualitatively examine patterns of mothers' beliefs and behaviours around controlling feeding through a semi-structured interview and to examine associations of those patterns with participant demographic characteristics and classical child feeding instruments. METHODS: A convenience sample of mothers (N = 35) of toddlers (mean age 25 months) participated in a semi-structured interview about their child feeding beliefs and behaviours. Anthropometrics were measured. Transcripts were analyzed using narrative analysis for patterns from which two emerged, known as phenotypes. A coding scheme was created and reliably applied. Bivariate correlates of the phenotypes with participant child characteristics and mother self-reported feeding behaviours were examined. RESULTS: The phenotypes were High Covert Control (n = 12) and Shared Control (n = 23). High Covert Control phenotype membership was correlated with higher child and mother BMI (body mass index) and child female sex. Shared Control phenotype membership was correlated with lower child and mother BMI and greater pressure to eat. CONCLUSIONS: Two controlling feeding phenotypes emerged among mothers of toddlers, which were associated with participant characteristics including BMI, but did not map onto classical child feeding instruments.

Sex Differences in the Association between Household Chaos and Body Mass Index z-Score in Low-Income Toddlers.

Background: Associations between household chaos and childhood overweight have been identified, but the mechanisms of association are not clearly established in young children, with some studies linking higher chaos to increased obesity risk, whereas other studies link higher chaos to lower obesity risk. Given the lack of consistent findings and early sex differences in vulnerability to chaos, we examined child sex as a moderator of the chaos-child overweight association. We also tested these associations with self-regulation, as self-regulation has been implicated in understanding the chaos-obesity risk association in low-income toddlers. Methods: Parent-reported household chaos and observed child self-regulation were collected at baseline [n = 132; M age 23.0 months (standard deviation 2.8)]. Children's body mass index z-score (BMIz) was measured at 33 months. Multivariate linear regression models were used to assess whether child sex moderated the chaos-BMIz association. A three-way interaction between chaos, child sex, and self-regulation was also tested. Results: Child sex moderated the chaos-BMIz association (b = -0.11, p = 0.04) such that chaos was positively associated with BMIz among boys (b = 0.12, p = 0.003), but unrelated in girls (b = 0.01, p = 0.78). A three-way interaction with self-regulation indicated that a positive chaos-BMIz association existed only for boys with average (b = 0.12, p = 0.004) and low (b = 0.22, p < 0.001) self-regulation. Conclusions: Boys with poor self-regulation may be particularly vulnerable to obesogenic effects of chaotic households.

Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol.

BACKGROUND: Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively. METHODS: We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group. DISCUSSION: If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03688919; registered September 28, 2018.

Developmentally informed behaviour change techniques to enhance self-regulation in a health promotion context: a conceptual review.

Self-regulation (SR), or the ability to manage thoughts, emotions, and behaviours in order to achieve a desired goal, is seen as underlying positive health behaviours. In adults, behaviour change techniques (BCTs) are recommended to promote SR across health domains; although establishing healthy habits early in life is important, studies of SR and health in children are rare. This conceptual review provides guidance on developmental considerations for applying BCTs to enhance SR capacity in children and youth with the goal of fostering positive behavioural health trajectories early in the lifespan. Key considerations include the nature of developmental changes in SR and interaction among SR processes; temporal associations between SR and health behaviours; and relevance of health goals for children and youth. Building on a meta-review of BCT's used to promote SR in adults and youth, this conceptual review highlights key SR milestones to consider in behaviour change-focused interventions from early childhood through adolescence and provides an overview of social-ecologic influences on SR development and associations between SR and health behaviours across these age periods. Implications for and examples of using developmentally-informed BCTs in interventions to enhance SR in children and youth are noted and suggestions for future research are discussed.

Functional Impairment Predicts Outcome of Youth With Headache in the Emergency Department.

Headache is a common presenting complaint in emergency departments (EDs), with the goal of improving acute pain. However, youth with chronic headaches may demonstrate broad functional impairment in their lives due to headaches. Our objective was to determine if degree of functional impairment predicts ED course for patients with headache as part of a clinical protocol. One hundred and thirty-seven pediatric patients presenting to an ED with headache were included. Patients and parents were administered the Functional Disability Index (FDI) and ED charts were reviewed to evaluate outcomes. Higher child-reported FDI scores were associated with more medications, longer ED stay, and admission. High parent-proxy FDI score was associated with longer ED stay. Both pain score and parent-proxy FDI score were associated with imaging. The FDI was a more useful predictor of visit resources than pain score. FDI scores could be used to help anticipate patients who may require greater time and resources.

Codevelopment of preschoolers' temperament traits and social play networks over an entire school year.

Children enter preschool with temperament traits that may shape or be shaped by their social interactions in the peer setting. We collected classroom observational measures of positive emotionality (PE), negative emotionality (NE), effortful control (EC), and peer social play relationships from 2 complete preschool classrooms (N = 53 children) over the course of an entire school year. Using longitudinal social network analysis, we found evidence that children's traits shaped the formation of play relationships, and that the traits of children's playmates shaped the subsequent development of children's own traits. Children who exhibited high levels of NE were less likely to form social play relationships over time. In addition, children were more likely to form play relationships with peers who were similar to their own levels of PE. Over the course of the school year, children's level of PE and EC changed such that they became more similar to their playmates in levels of these traits. Finally, we observed moderate to strong rank-order stability of behavioral observations of PE, NE, and EC across the school year. Our results provide evidence for the effects of traits on the formation of play relationships, as well as for the role of these play relationships in shaping trait expression over time. (PsycINFO Database Record

Neural evidence for enhanced attention to mistakes among school-aged children with a growth mindset.

Individuals who believe intelligence is malleable (a growth mindset) are better able to bounce back from failures than those who believe intelligence is immutable. Event-related potential (ERP) studies among adults suggest this resilience is related to increased attention allocation to errors. Whether this mechanism is present among young children remains unknown, however. We therefore evaluated error-monitoring ERPs among 123 school-aged children while they completed a child-friendly go/no-go task. As expected, higher attention allocation to errors (indexed by larger error positivity, Pe) predicted higher post-error accuracy. Moreover, replicating adult work, growth mindset was related to greater attention to mistakes (larger Pe) and higher post-error accuracy. Exploratory moderation analyses revealed that growth mindset increased post-error accuracy for children who did not attend to their errors. Together, these results demonstrate the combined role of growth mindset and neural mechanisms of attention allocation in bouncing back after failure among young children.

Associations between Disorder-Specific Symptoms of Anxiety and Error-Monitoring Brain Activity in Young Children.

Anxiety disorders are among the earliest emerging disorders and most common mental health problem across the lifespan. A common characteristic of individuals with anxiety is poor attentional and cognitive control. Therefore, researchers are interested in how cognitive functioning relates to anxiety in young children. In particular, research has demonstrated associations between anxiety and electrophysiological markers of cognitive control skills such as the error-related negativity (ERN). The nature of the anxiety-ERN relationship is not well understood, however. The purpose of the present study was to examine: 1) the association between the ERN and diagnostically-defined symptoms of different anxiety disorders; and 2) the extent to which disorder-specific symptoms of anxiety moderated the association between ERN and behavioral performance on a Go/No-Go task in a sample of 139 children 5-8 years of age (70 females and 69 males). Results suggest that more separation anxiety disorder (SAD) symptoms are associated with a smaller ΔERN, even after controlling for other anxiety disorder symptoms. Children with more SAD symptoms showed higher error rates and failed to exhibit the expected association between ΔERN and behavioral performance, suggesting ineffective error-monitoring in young children with SAD problems.

Measurement invariance and child temperament: An evaluation of sex and informant differences on the Child Behavior Questionnaire.

Parent reports of temperament are used to study many important topics in child development, such as whether boys and girls differ in their levels of emotional reactivity and self-regulation. However, questions regarding measurement equivalence in parental reports of temperament are largely unexplored, despite the fact that this issue is critical for drawing the correct conclusions from mean-level comparisons. In the current study, measurement invariance across boys and girls (as targets), and mothers and fathers (as informants), was investigated in the Child Behavior Questionnaire (CBQ; Rothbart et al., 2001) using a sample of children ranging in age from 3 to 7 years (N = 605). Several instances of noninvariance were identified across both girls and boys, and mothers and fathers. An evaluation of effect size indices suggests that the practical impact of this noninvariance ranges from negligible to moderate. All told, this study illustrates the importance of taking a psychometrically informed approach to the use of parent reports of child temperament. (PsycINFO Database Record

Neurophysiological evidence of an association between cognitive control and defensive reactivity processes in young children.

Interactions between cognitive control and affective processes, such as defensive reactivity, are intimately involved in healthy and unhealthy human development. However, cognitive control and defensive reactivity processes are often studied in isolation and rarely examined in early childhood. To address these gaps, we examined the relationships between multiple neurophysiological measures of cognitive control and defensive reactivity in young children. Specifically, we assessed two event-related potentials thought to index cognitive control processes--the error-related negativity (ERN) and error positivity (Pe)--measured across two tasks, and two markers of defensive reactivity processes--startle reflex and resting parietal asymmetry--in a sample of 3- to 7-year old children. Results revealed that measures of cognitive control and defensive reactivity were related such that evidence of poor cognitive control (smaller ERN) was associated with high defensive reactivity (larger startle and greater right relative to left parietal activity). The strength of associations between the ERN and measures of defensive reactivity did not vary by age, providing evidence that poor cognitive control relates to greater defensive reactivity across early childhood years.

Ecological validity of laboratory assessments of child temperament: evidence from parent perspectives.

The structure, stability, and validity of child temperament traits have primarily been examined with parent questionnaire methods, but laboratory methods represent an important complement. However, the novel setting and contrived scenarios of laboratory methods and their low convergence with parent questionnaire methods have led some to question their ecological validity. We tested this assumption by employing parents as sources of information regarding the ecological validity of laboratory assessments of child temperament. Parents observed their child participating in 10 different laboratory tasks and reported on the typicality of their child's behavior. The results suggested parents considered their child's responses during the laboratory tasks as highly typical representations of their child's behavior outside of the lab, supporting the ecological validity of trait-relevant behavior elicited with laboratory tasks.