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.

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.

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.

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.

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.

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.

Testing different sources of environmental unpredictability on adolescent functioning: ancestral cue versus statistical learning and the role of temperament.

BACKGROUND: The dimensional model of environmental adversity highlighted the effects of an unpredictable environment in promoting risky development. Toward gaining greater specificity in understanding, this multimethod, longitudinal study investigated the role of two sources of environmental unpredictability-ancestral cues versus statistical learning, and their interaction with dove temperament conceptualized within the evolutionary model of temperament, in shaping adolescent functioning. METHODS: Participants were 192 families with an adolescent (Mage  = 12.4) followed for two annual waves. We measured unpredictability within the ancestral-cue approach as incidents of disruptive family events, and statistical-learning unpredictability as the random variability in observed moment-to-moment maternal hostility during parent-child interaction. We focused on dove temperament, which characterizes strategies of cautious and inhibited behavior in novel contexts and persistence and intrinsic engagement in benign contexts. RESULTS: Findings indicated unique effects of ancestral-cue versus statistical-learning unpredictability-in interaction with dove temperament-in association with adolescent functioning. Ancestral-cue unpredictability interacted with dove temperament in association with vagal stress reactivity, and the interactive effects of statistical-learning unpredictability were only associated with set-shifting. Furthermore, the family instability-x-dove temperament interaction was linked to adolescent adjustment via vagal reactivity. Adolescents with lower dove temperament showed dampened vagal reactivity within the more unpredictable environments, which was in turn associated with a greater decrease in social withdrawal over time. CONCLUSIONS: The findings highlighted the specificity in different sources of environmental unpredictability in shaping adolescent development.

Understanding heterogeneity in pathways between interparental conflict and children's involvement: The moderating role of affect-biased attention.

The study examined the moderating role of children's affect-biased attention to angry, fearful, and sad adult faces in the link between interparental conflict and children's distinct forms of involvement. Participants included 243 preschool children (Mage  = 4.60 years, 56% female) and their parents from racially (48% African American, 43% White) and socioeconomically (median annual household income = $36,000) diverse backgrounds. Data collection took place in the Northeastern United States (2010-2014). Utilizing a multi-method, multi-informant, longitudinal design, attention away from anger selectively amplified the link between interparental conflict and children's subsequent coercive involvement (ß = -.15). Greater attention to fear potentiated the pathway between interparental conflict and children's later cautious (ß = .14) and caregiving involvement (ß = .15). Findings are interpreted in the context of environmental sensitivity models.

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.

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.

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.

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.

Interparental conflict as a quadratic predictor of children's reactivity to interparental conflict and school adjustment: Steeling effects or risk saturation?

This study examined interparental conflict as a curvilinear predictor of children's reactivity to interparental conflict and, in turn, their school problems across three annual measurements. Participants included 243 preschool children (Mage  = 4.60 years; 56% girls) and their parents from racially (e.g., 48% Black; 16% Latinx) diverse backgrounds. Interparental conflict was a significant quadratic predictor of children's emotional reactivity (ß = .23) and behavioral dysregulation (ß = .27) to conflict over a 1-year period. The robust association between interparental conflict and behavioral dysregulation weakened at high levels of interparental conflict. In contrast, interparental conflict more strongly predicted children's emotional reactivity as conflict exposure increased. Children's emotional reactivity, in turn, predicted their greater school problems 1 year later (ß = .25).

Delineating the developmental sequelae of children's risky involvement in interparental conflict.

The present study examined the developmental value of parsing different forms of children's risky involvement in interparental conflict as predictors of children's subsequent psychological adjustment. Participants included a diverse sample of 243 preschool children (Mage = 4.6 years) and their mothers across two measurement occasions spaced 2 years apart. Three forms of risky involvement (i.e., cautious, caregiving, and coercive) were identified using maternal narratives describing children's emotional and behavioral reactivity during and immediately following interparental conflict. Utilizing a multimethod, multi-informant design, findings revealed that each form of involvement prospectively predicted unique configurations of children's developmental outcomes. Greater coercive involvement was associated with higher levels of externalizing problems, callous and unemotional traits, and extraversion. Higher levels of caregiving involvement were linked with greater separation anxiety. Finally, cautious involvement predicted more separation anxiety and social withdrawal.

Maternal and paternal unsupportive parenting and children's externalizing symptoms: The mediational role of children's attention biases to negative emotion.

This study examined children's duration of attention to negative emotions (i.e., anger, sadness, fear) as a mediator of associations among maternal and paternal unsupportive parenting and children's externalizing symptoms in a sample of 240 mothers, fathers, and their preschool children (Mage = 4.64 years). The multimethod, multi-informant design consisted of three annual measurement occasions. Analysis of maternal and paternal unsupportive parenting as predictors in latent difference changes in children's affect-biased attention and behavior problems indicated that children's attention to negative emotions mediated the specific association between maternal unsupportive parenting and children's subsequent increases in externalizing symptoms. Maternal unsupportive parenting at Wave 1 predicted decreases in children's attention to negative facial expressions of adults from Wave 1 to 2. Reductions in children's attention to negative emotion, in turn, predicted increases in their externalizing symptoms from Wave 1 to 3. Additional tests of children's fearful distress and hostile responses to parental conflict as explanatory mechanisms revealed that increases in children's fearful distress reactivity from Wave 1 to 2 accounted for the association between maternal unsupportive parenting and concomitant decreases in their attention to negative emotions. Results are discussed in the context of information processing models of family adversity and developmental psychopathology.

Sensory processing sensitivity behavior moderates the association between environmental harshness, unpredictability, and child socioemotional functioning.

Building on Ellis et al.'s theorization for potent dimensions of environmental adversity, the present work sought to evaluate how environmental harshness and unpredictability might function directly and in interaction with child sensory processing sensitivity (SPS) to shape the development of child socioemotional functioning. Participants were 235 young children (Mage = 2.97 at the first measurement occasion) and their parents, who were followed for two consecutive annual measurement occasions. Child SPS was measured through behavioral observation across multiple tasks within the laboratory setting. Greater environmental unpredictability was significantly associated with the development of children's externalizing problems over a year only for children with high SPS. Follow-up analyses indicated that the unpredictability-x-SPS interaction was consistent with differential susceptibility, such that high SPS children showed greater increases in externalizing problems under high unpredictability, but also lower increases/greater decreases in externalizing problems under low unpredictability. Such association did not apply to children with low SPS.

Why does children's temperamental exuberance increase their vulnerability to externalizing symptoms? A process-oriented approach.

This study examined children's exposure to family adversity, hostile reactivity to parental conflict, and negative family representations as mediators of the prospective relation between their temperamental exuberance and externalizing symptoms. Participants included 243 preschool children (Mage = 4.60 years; 56% girls) and parents (48% Black; 16% Latinx) in a multi-method and multi-informant study with three annual measurement occasions. Structural equation model results specifically supported children's hostile reactivity to parental conflict and negative family representations as mediators. Exuberance predicted residualized increases in children's hostile reactivity and negative family representations over a 1-year period. In turn, children's hostile reactivity and negative family representations predicted their greater externalizing symptoms 1 year later after controlling for prior externalizing symptoms. Results are discussed in the context of their relation and refinement of temperamental models of developmental psychopathology.