The predictors of change in reflective parenting therapy: Uncovering the influence of parental reflective functioning and child temperament in predicting the improvement in parent-child relationship and child outcome following DUET group intervention.

Parental reflective functioning (PRF) is the ability of parents to understand their child's behavior in light of underlying mental processes; it is a core element in the parent-child relationship. RF is also considered crucial for self-regulation for both parents and their children. We investigated the relationship between improvement in PRF after DUET group intervention (a RF-based intervention) and improvement in the parent-child interaction, child RF, and child adjustment, and we examined whether these improvements were distinct for children with different temperamental traits (e.g., effortful control). Eighty-four parents completed the DUET program and were assessed before and after the intervention. PRF was measured using observation (mind-mindedness) and a questionnaire. Statistical analysis included hierarchical regression and moderation of regression analysis. Results showed that improvement in the parent-child interaction, child RF, and child behavioral problems were related to improvement in PRF. Furthermore, we found that child temperament acted as a moderator in the link between PRF and child RF, supporting a vantage sensitivity model, meaning that it was the more sensitive children who benefitted the most as a result of the positive change in their parents' RF. Clinical and future directions of this study are discussed.

What works for whom? Moderators in parental reflective functioning intervention.

The DUET program (a group intervention) aims to enhance parental reflective functioning (PRF). We examined whether pretreatment levels of key outcomes as well as individual parental and family-environment characteristics predicted improvement after intervention with the DUET program. One hundred forty-two parents (native Israelis; mean age = 34.84 years) of preschool children (n = 107; mean child age = 4.3 years; 53% female) were assessed before, after, and 6 months following the intervention. Results indicated significant associations between lower levels of key outcomes at the pretreatment assessment and greater improvement after treatment in PRF, child self-regulation, and child self-distraction strategies. Furthermore, two subgroups of families were uncovered based on individual parental and family-environment characteristics: low-distress and high-distress parents. Following intervention, the high-distress group showed greater improvement in parental sensitivity and child problem behavior, whereas the low-distress group reported greater improvement in locus of control. Clinical and future directions are discussed.

Prematurity, maternal emotional distress, and infant social responsiveness among Arab-Bedouin families: The role of social support as a resilience factor.

This study investigated predictors of early infant social development and the role of social support as a resilience factor among Arab-Bedouin families. We propose a mediation model in which social support will be related to maternal postpartum emotional distress (PPED), which in turn will be related to infant social responsiveness. One hundred five Arab-Bedouin mothers (age range = 17-44 years) and their preterm (n = 48) and full-term (n = 57) infants were recruited shortly after birth and were followed up at age 12 months. Findings demonstrate that, among the preterm group, higher levels of social support predicted lower levels of maternal PPED, and this, in turn, predicted higher levels of infant social responsiveness.

Improving the parent-child relationship and child adjustment through parental reflective functioning group intervention.

Parental reflective functioning (PRF) is a core element in the parent-child relationship. This study set out to investigate changes in PRF following the DUET program, a 12-week group intervention program. We proposed that the DUET intervention would enhance maternal reflective capacities, resulting in better mother-child emotional availability, better child self-regulation, and decreased child behavioral problems. Seventy mothers completed the DUET group intervention. Of these mothers, nine mothers were first allocated to the waiting-list group and thereafter were included in an intervention group. PRF was measured using observation (mind-mindedness) and an interview (PDI). Following the intervention, a significant improvement was evident in PRF, in parental beliefs about feeling, and in parental sense of efficacy. In addition, the mother-child interaction was more positive, child behavioral problems decreased, and child self-regulation increased. This improvement remained stable over a period of 6 months. Clinical and future directions of this study are discussed.

Sleep, screen time and behaviour problems in preschool children: an actigraphy study.

Inadequate sleep and excessive exposure to media screens have both been linked to poorer mental health in youth. However, the ways in which these interact to predict behaviour problems have yet to be examined using objective sleep measurement. The lack of objective evidence for these relationships in young children has recently been defined by the World Health Organization (2019) as a gap in the field. We thus aimed to test the interacting effects of screen exposure and objectively measured sleep on behaviour problems in the preschool age. A total of 145 children aged 3-to-6-years participated in this cross-sectional study. Sleep was assessed objectively using actigraphy for 1-week, and subjectively using parent-reported daily sleep diaries. Parents reported the child's daily duration of screen exposure, and completed the Strengths and Difficulties Questionnaire. Results showed that actigraphic sleep duration, timing and efficiency were associated with screen exposure. The link between screen time and behaviour problems was moderated by sleep duration, as it was significant only for children with sleep duration of 9.88 h or less per night. Sleep duration also moderated the relation between screen time and externalizing-but not internalizing-problems. Hence, the combination of increased screen exposure and decreased sleep duration may be particularly adverse for child mental health. While these key relationships should be further examined in longitudinal and experimental investigations, our findings shed light on their complexity, underscoring the importance of the moderating role of sleep.

Mother-Child Interaction: Links Between Mother and Child Frontal Electroencephalograph Asymmetry and Negative Behavior.

It is well accepted that parent-child interactions are bidirectional by nature, yet not much is known about the psychophysiological activity underlying these interactions. This study examined, during a parent-child interaction, how a child's negativity statistically predicted maternal frontal electroencephalograph (EEG) asymmetry and how a mother's negativity statistically predicted child frontal EEG asymmetry. Thirty-four mother-child dyads participated in the study. Maternal and child behaviors and physiology were measured during a puzzle task. Results indicated that mothers whose children exhibited more challenging behaviors during the dyadic interaction displayed more right (relative to left) asymmetry, as did children whose mothers were high in negativity during the interaction. These findings suggest that mothers and children react to each other's signals not only behaviorally but also physiologically.

MOTHER-CHILD AND FATHER-CHILD PLAY INTERACTION: THE IMPORTANCE OF PARENTAL PLAYFULNESS AS A MODERATOR OF THE LINKS BETWEEN PARENTAL BEHAVIOR AND CHILD NEGATIVITY.

Based on the premise that father-child play is an important context for children's development and that fathers "specialize" in play, similarities and differences in the role of playfulness in the father-child and mother-child relationship were examined. Participants in this study included 111 families (children's age: 1-3 years). Father-child and mother-child play interactions were videotaped and coded for parental playfulness, sensitivity, structuring, and nonintrusiveness as well as child negativity. Results indicated that mothers and fathers did not differ in playfulness and that mothers and fathers who were higher in playfulness had children with lower levels of negativity. However, playfulness differently moderated the links between parents' and children's behaviors for mothers and fathers. A double-risk pattern was found for mothers, such that the links between child negativity and maternal sensitivity, structuring, and nonintrusiveness were significant only for the subgroup of mothers with low levels of playfulness. When mothers had high levels of playfulness, these effects were negligible. For fathers, a double-buffer pattern was revealed, indicating that the links between child negativity and paternal sensitivity and structuring were significant only for fathers with high levels of playfulness. When fathers had low levels of playfulness, these effects were negligible. These findings demonstrate the important role that parental playfulness has on parent-child interaction as well as the need to examine moderation patterns separately for fathers and mothers.

Mealtime dynamics in child feeding disorder: the role of child temperament, parental sense of competence, and paternal involvement.

OBJECTIVE: We examined how child temperament, parental sense of competence, and paternal involvement predicted observed mealtime dynamics. METHOD: 97 families of children with feeding disorder (FD), sleep problems (SP), and typically developing (TD) children participated in the study. Data were collected during home visits, where mother-child and father-child mealtime dynamics were videotaped and parents completed questionnaires. RESULTS: More mother-child and father-child conflict and control was observed during mealtimes in the FD than SP and TD groups. Among the FD group, maternal sense of competence was negatively correlated with mother-child conflict and control, and child temperament was linked to father-child conflict and control, but only for families in which fathers were highly involved. These correlations were not significant among the SP and TD groups. CONCLUSION: Different patterns of results were seen for mothers and fathers and among the FD and control groups. Clinical implications for the treatment of FD are discussed.

The Caregiving Environment and Developmental Outcomes of Preterm Infants: Diathesis Stress or Differential Susceptibility Effects?

The interactions between premature birth and the caregiving environment on infants' cognitive and social functioning were examined. Participants were 150 infants (83 preterm, 67 full-term) and their parents. When infants were 6 months old, parents reported on their levels of emotional distress, and triadic family interactions were filmed and coded. At 12 months of age, the infants' cognitive and social functioning was assessed. Prematurity moderated the effects of maternal (but not paternal) emotional distress and triadic interactions on infants' cognitive and social outcomes. Whereas for cognitive functioning the interactions were consistent with a diathesis-stress approach, for social functioning the interactions were consistent with a differential susceptibility approach. The differential effects of the caregiving environment between groups and outcomes are discussed.

The role of the father in child sleep disturbance: child, parent, and parent-child relationship.

The majority of studies on child sleep problems focus primarily on mothers, neglecting paternal influences. Guided by the transactional framework, we explored how child temperament, paternal and maternal stress, and the parent-child interactions differ between families having children with sleep disturbances and a selected comparison group. The role of paternal involvement in child caregiving as a moderator of these differences was assessed. The sample consisted of 51 children (1-3 years old) and their mothers and fathers. Data were collected during home visits, when mothers and fathers completed questionnaires and were interviewed. In addition, mother-child and father-child interactions were videotaped. Results indicate that compared to the comparison group, fathers rated children with sleep disturbances as fussier, both their mothers and fathers experienced higher levels of stress, and reported using more bedtime interactions that interfere with child's sleep-wake self-regulation. In addition, their fathers were less sensitive during father-child interaction and less involved in child caregiving. Finally, paternal involvement moderated the group differences seen in maternal stress, suggesting that high paternal involvement acted as a buffer to protect parents of children with sleep disturbances from experiencing parental stress. The important role of fathers in families having children with sleep disturbances is discussed.

It takes more than one for parenting: How do maternal temperament and child's conduct problems relate to maternal parenting behavior?

The current study examined how individual differences in maternal temperament and child problem behaviors correlate with observed maternal positivity and negativity toward the child. The sample consisted of 153 mothers of 3-to-7 year old children. Mothers reported their own temperament (surgency, orienting sensitivity, effortful control and negative affect) and their children's problem behaviors. Maternal behavior was videotaped in a set of structured interaction tasks with the child during a lab visit. Results indicated that children's problem behaviors were related to less maternal positivity and more negativity. In addition, observed maternal negativity was associated with less maternal effortful control and more negative affect. In contrast, maternal temperament was unrelated to observed maternal positivity toward the child. Furthermore, maternal temperament was related to mothers' positivity and negativity but only for children high in problem behaviors. The findings implicate that child problem behaviors may interact with maternal temperament in explaining variance in caregiving positivity and negativity.

Maternal Perceptions and Responsiveness to Cry in Armed Conflict Zones: Links to Child Behavior Problems.

Crying is a typical infant behavior that activates parental caregiving behaviors, acting as "human alarms" important for the infant's survival. When living under war-related threat, the auditory system may be sensitized given its importance for survival, potentially impacting maternal cry processing. Children living in armed-conflict zones are at increased risk for behavior problems, which may relate to both direct exposure and indirect effects through their parents' perceptions and behaviors. This hypothesis was examined in a sample of mothers and their first-born children (aged 10-45 months) living in the Gaza vicinity area in Israel, chronically exposed to missile alarms (high-exposure; n = 45), and a comparison group (low-exposure; n = 86). Group differences in child behavior problems and maternal perceptions of and responsiveness to cry were investigated. A moderated indirect-effect of maternal cry perceptions on child behavior problems via maternal responsiveness to cry was examined. In the high-exposure group, children had more externalizing problems and mothers rated cries as more aversive. Maternal cry perception was indirectly related to child behavior problems via responsiveness to cry only in the high-exposure group: higher perceptions of cry as aversive or the child as distressed were related to faster responding to crying, and faster cry responsiveness was linked with fewer behavior problems. Results suggest that in armed-conflict zones with auditory warning signals, the parental caring system may be easily activated by cries due to the strong association between alarms and threat. Furthermore, children may need their mothers to react faster when feeling distressed, possibly because of the surrounding threat.

Response inhibition in preschoolers at familial risk for attention deficit hyperactivity disorder: a behavioral and electrophysiological stop-signal study.

Children participating in the Ben-Gurion Infant Development Study were assessed with a dynamic-tracking version of the stop-signal task at the age of 5 years. The sample consisted of 60 males. Stop-signal reaction time (SSRT) was correlated with concurrent ratings of the child's attention deficit hyperactivity disorder (ADHD) symptoms. Paternal symptoms measured in the child's early infancy predicted the child's performance in the stop-signal task: Paternal inattentiveness predicted SSRT, whereas hyperactivity predicted error proportion. Maternal symptoms were not correlated with the performance of the child in the task. A subsample of children, who were tested while electrophysiological brain activity was measured, showed that having higher ADHD symptomatology, especially hyperactivity, correlated with less activity in the brain areas that are usually recruited by children for successful inhibition.

Parental guilt and children's internalizing and externalizing behavior: The moderating role of parental reflective functioning.

The immense responsibility inherent in parenthood makes feeling guilty highly prevalent among parents. Such feelings are natural, yet excessive guilt is related to depression and anxiety and could burden parents. Qualitative research suggested that guilt is predominant in parents whose children suffer from behavioral and emotional difficulties, making it necessary to quantify guilt and examine possible resilience factors that could alleviate the aversive aspects of it. In this study, we examined the association between children's externalizing and internalizing problems and different aspects of parental guilt, assessing whether parental reflective functioning (PRF) would moderate these associations. One hundred six parents of children aged 1.30-9.30 years were recruited from child daycare centers and community clinics. The Parent Development Interview was administered to measure PRF. Based on this interview, we created a new coding system, to quantify three aspects of parental guilt: intensity, reparation, and internal reaction to guilt. Children's difficulties as well as parents' depression and anxiety were assessed using validated self-report measures. We showed that children's difficulties were related to parental guilt, but only when levels of PRF were not high. Specifically, internalizing problems were related to greater intensity and negative internal reaction to guilt only when PRF was low or moderate, and externalizing problems were related to greater intensity of guilt only when PRF levels were low. These findings suggest that encouraging reflective functioning could reduce the burden of guilt. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Maternal Postpartum Emotional Distress and Preterm Social Withdrawal in the Bedouin Culture.

This study aimed to test a serial mediation model proposing that prematurity would be related to changes in maternal emotional distress, which in turn would be related to the mother-child (M-C) interaction, which would ultimately be related to infant social withdrawal. Bedouin mothers and their preterm (n = 48) and full-term (n = 57) infants participated in this study. Mothers' mean age was 27.67 years. In addition, 39.4% of the mothers were primiparas and 60.6% were multiparas. Infants and their mothers were recruited shortly after birth (T1) in the maternity ward or Neonatal Intensive Care Unit (NICU) at Soroka Medical Center and were followed up at ages 6 months (T2) and 12 months (T3). Findings indicated that HIGHER levels of maternal emotional distress during the second half of the first year postpartum and LOWER levels of mother-child interaction, were associated with HIGHER levels of infant social withdrawal at T3. Furthermore, the overall indirect effect suggested that HIGHER levels of maternal nonhostility was a main variable mediating the link between prematurity and LOW levels of infant social withdrawal. Our findings provide evidence that changes in maternal emotional distress during the first year are related to lower infant social withdrawal. Moreover, mothers of premature infants showed higher levels of nonhostility when interacting with their premature infants. These findings highlight the importance of gaining a better understanding of maternal behaviors. Specifically, our study provides important information for researchers and clinicians on a possible mechanism leading to early socioemotional difficulties of premature infants.

When COVID-19 Met Families Living in Armed-Conflict Zones: The Importance of Maternal Trauma and Child Self-Regulation.

The COVID-19 outbreak began in Israel at the end of February 2020, and on March 17, 2020, a general lockdown was announced. Families were instructed to stay at home and schools and non-essential businesses were closed. Aiming to understand how families who were already living in areas of high exposure to armed conflict would be affected by another external stressful condition, data were collected before and after the outbreak. Mothers and children (aged 10-45 months) were recruited from areas with high (n = 40) and low (n = 78) exposure to armed conflict. Mothers reported on their posttraumatic stress symptoms (PTSS) and on their child's effortful control tendencies prior to the outbreak. Toward the end of the first lockdown, mothers were interviewed regarding adverse effects of the outbreak on their family. No group differences were found for maternal perceptions of adverse effects of COVID-19. However, a moderation model was revealed, indicating that maternal PTSS as well as child effortful control predicted adverse effects of COVID-19 only in the high-exposure group. Results are discussed considering cumulative stress and risk factors.

The potential moderating role of living in a conflict area on the link between classroom psychosocial stressors, perceived stress and change in anxiety symptoms in Israeli school children.

Background: Perceived stress associated with relational victimization from peers and conflictual relations with the teacher have been linked with the development of anxiety symptoms in children. Living in conditions of ongoing stress from the broader environment has also been related to anxiety symptoms in children. In this study, we examined (a) the indirect effect between classroom psychosocial stressors (i.e., relational victimization and conflictual relationships with teachers), perceived stress and anxiety symptom development, and (b) whether this indirect effect was stronger for children living in a high threat region than for children living in a lower threat region. Methods: Children participating in the study attended elementary school either in a high threat of armed conflict region (15 s to hide in bomb shelter when alarm sounds, n = 220) or in a lower threat of armed conflict region (60 s to hide in a bomb shelter when alarm sounds, n = 188) in Israel. Children were first assessed on conflictual relationships with teachers and peers, subjectively perceived stress and anxiety in 2017 (T 0; M age = 10.61 years, SD = 0.78; 45% boys) and re-assessed (T 1) 1 year later, in 2018. Results: Perceived stress mediated the association between classroom psychosocial stressors and anxiety development. No moderation by threat-region was found in this indirect effect. However, the association between perceived stress and anxiety development was only significant for children in the high threat region. Conclusion: Our study suggests that threat of war conflict amplifies the association between perceived stress and the development of anxiety symptoms.

Home-quarantine during the initial Covid-19 outbreak in Israel: parent perceived impact on children with ASD.

Background: Studies have reported that Covid-19 home-quarantine periods have had mostly negative psychological impact on children with ASD and their families. Here we examined parent perceived impact of a 6-week quarantine period imposed in Israel at the beginning of the Covid-19 outbreak, in mid-March 2020. Methods: An anonymous online questionnaire was completed by parents of 268 children with ASD. Parents rated deterioration/improvement in their child's behaviors, abilities, mood, sleep, and anxiety along with changes in their own mood, sleep, parenting skills, and family relationships. We performed t-tests and ANOVA analyses to assess the significance of perceived impact on each domain and potential differences in the impact across families with children of different ages, genders, and levels of required support as well as families that experienced different magnitudes of economic hardships. Results: Parents reported significant deterioration in their mood and sleep along with significant improvements in relationships with their spouse and child with ASD, and in their parenting skills. Parents also reported significant increases in the severity of tantrums, anxiety, and restricted and repetitive behavior symptoms along with significant improvements in social and communication abilities of their child with ASD. Ratings were significantly lower in families of ASD children who regularly require more support and in families that experienced economic hardships. Conclusions: While periods of home-quarantine create numerous hardships for families of children with ASD, they may also offer an opportunity for improving parenting skills, family relationships, and children's social communication abilities with potential relevance for improving remote services.

Maternal worries about child underweight mediate and moderate the relationship between child feeding disorders and mother-child feeding interactions.

OBJECTIVE: To examine the role of maternal worries about child underweight and undereating in mother-child feeding interactions with children having a feeding disorder (FD). METHOD: Participants were 27 children diagnosed with nonorganic-based FD and 28 children without FD. Mothers were interviewed about their worries about child underweight and undereating. Mother-child interactions were videotaped during feeding. RESULTS: Maternal child weight-related worries acted as both a mediator and a moderator. The more negative mother-child interactions found in the FD group, compared to the control group, were explained by greater maternal worry regarding child underweight. Furthermore, mother-child interactions within the FD group were not at risk per se, but only when coupled with high maternal worries about children's underweight. CONCLUSION: Worry about child underweight partially explains the development of negative feeding interactions when having children with FD, signifying clinical implications for the treatment of FD.

Sleep patterns of 7-week-old infants at familial risk for attention deficit hyperactivity disorder.

Sleep patterns of 26 seven-week-old boys at familial risk for attention deficit hyperactivity disorder (ADHD) and 18 control infants were compared by objective (actigraph) and subjective (maternal sleep diary) measures, over five consecutive 24-hr periods. Actigraph findings indicated that the groups differed on stability (SD) of quiet sleep only during the day. Reports in maternal sleep diaries indicated that they also differed on stability of waking and stability of sleep duration, again only during the day. No group differences were found in terms of average scores, whether calculated for the entire 24-hr periods, for nights, or for days. Mothers in the risk group reported that fathers were less involved in infant care than did those in the control group. These findings suggest that as early as 7 weeks of age, infants at risk for ADHD differ from controls only on stability of their sleep patterns during the day, when environmental regulatory factors are more intensive.