A Literature Review of Digital Behavioral Parent Training Programs for Parents of Adolescents.

Parents of adolescents are faced with a variety of challenges related to their children's behavior and development. Behavioral parent training (BPT) programs may be effective strategies to mitigate adverse childhood experiences (ACEs) and other common behavioral problems in the adolescent period. Adolescence is the period following the onset of puberty and describes the transition from childhood to adulthood. Digital BPTs, including those delivered via the internet, downloaded digital content, text message, tablet, and video call, may present a unique opportunity to reach a broad audience of parents of adolescents by removing barriers to program accessibility (e.g., cost and transportation). We conducted a literature review to synthesize the existing evidence on digital BPTs for parents of adolescents. We described the digital BPTs, study designs, and evaluation and feasibility outcomes. A structured literature search identified studies meeting the following criteria for inclusion: (a) published between January 2000 and October 2022, (b) peer-reviewed, (c) available in English language, (d) study included a description of a digital BPT methodological approach, (e) study had to identify at least one parent or child behavioral outcome (e.g., parent-reported communication with their child) or feasibility outcome associated with the digital BPT, and (f) study included parents of adolescents aged 10-18 years. We extracted data on the characteristics of the study and demographic characteristics of participants, digital BPT, and evaluation and feasibility outcomes. Twenty-eight studies met inclusion criteria. Twenty-two unique digital BPTs were evaluated across the published studies. Thirteen digital BPTs (59.1%) were developed from or grounded by an identified theory. Six digital BPTs were freely accessible by the public, while the remaining 16 were available through study participation or purchase. One digital BPT was specifically tailored to parents of adolescents of a racial/ethnic minority group. Of the 16 studies that reported either parent or adolescent race/ethnicity, 10 consisted of more than 50% White parent or adolescent participants. Twenty-four (88.9%) studies provided evaluation data for the digital BPT. Fourteen studies (63.6%) employed a randomized control trial study design, and the remaining study designs included quasi-experimental (n = 2), mixed methods (n = 1), open trial (n = 3), case study (n = 1), pretest-posttest design (n = 1), and feasibility and acceptability trial (n = 2). All studies reported improvements in at least one parent-reported or adolescent-reported behavioral outcome or feasibility outcomes, with effect sizes (Cohen's d) ranging from small (e.g., 0.20-0.49) to very large (e.g., > 1.20). The findings of this review illustrate that technology may be a valuable way to deliver BPTs to parents of adolescents. However, few digital BPTs were developed for parents of adolescents from racial/ethnic minority groups, and many digital BPTs were not available without cost or participation in a research study. Considerations for future research are discussed.

Outcomes from a Randomized Controlled Trial of the Relief Nursery Program.

An independent, randomized controlled trial of the community-developed, multiple-component Relief Nursery prevention program was conducted with families with young children considered "at risk" for child abuse and neglect. This established program, currently operating at multiple sites in the state of Oregon, comprises an integrated package of prevention services to children and families, including early childhood education, home visiting, and parent education and support, as well as other interventions tailored to the needs of each particular family. Families who contacted the Relief Nursery for the first time were randomly assigned to one of two conditions, the Full Program condition, whose members had access to all services available from the Relief Nursery, or the Respite Care condition, whose members had access only to respite care and referrals to services provided by other community agencies. A primary caregiver in each family was interviewed prior to intervention and then every 6 months across a period of 2 years. Standardized measures were collected on a variety of risk and protective factors related to child abuse and neglect. Analyses were conducted at the end of the study period. Differences were found between the conditions in terms of perceived helpfulness and satisfaction with services and in terms of social support, in each case favoring the Full Program condition. Implications of the findings for future studies of multicomponent child abuse prevention programs with similar characteristics to the Relief Nursery are discussed.

Intergenerational transmission of violence: The mediating role of adolescent psychopathology symptoms.

Evidence on the intergenerational continuity of intimate partner violence (IPV) suggests small to moderate associations between childhood exposure and young adult IPV involvement, suggesting an indirect effects model. Yet, few prospective studies have formally tested meditational mechanisms. The current study tested a prospective (over 9 years) moderated-mediational model in which adolescent psychopathology symptoms (i.e., internalizing, externalizing, and combined) mediated the association between exposure to IPV in middle childhood and young adult IPV perpetration. In a more novel contribution, we controlled for proximal young adult partner and relationship characteristics. The sample consisted of n = 205 participants, who were, on average, assessed for exposure to parent IPV at age 12.30 years, adolescent psychopathology symptoms at age 15.77 years, and young adult IPV at 21.30 years of age. Data suggest a small, significant direct path from IPV exposure to young adult perpetration, mediated only through adolescent externalizing. Gender moderation analyses reveal differences in sensitivity to exposure across developmental periods; for males, effects of exposure were intensified during the transition to adolescence, whereas for females, effects were amplified during the transition to adulthood. In both cases, the mediational role of psychopathology symptoms was no longer significant once partner antisocial behavior was modeled. Findings have important implications for both theory and timing of risk conveyance.

Family, Peer, and Pubertal Determinants of Dating Involvement Among Adolescents.

This study examines the influence of family, peer, and biological contributors to dating involvement among early adolescents (11-14 years of age; n = 244). Further, we assess how parental monitoring may be modified by pubertal maturation and older sibling risky behavior. Data on delinquent peer affiliation, pubertal maturation, parental monitoring, older sibling risky behavior, and dating involvement were gathered through observations and surveys from adolescents, mothers, older siblings, and teachers. Results indicate that lower levels of parental monitoring and higher levels of older sibling risky behavior were related to adolescents' dating involvement through delinquent peer affiliation. Pubertal maturation was directly related to dating involvement for early daters. Findings emphasize the value of examining social and biological factors, in concert, over time.

Path Analysis of Adverse Childhood Experiences, Early Marriage, Early Pregnancy, and Exposure to Intimate Partner Violence Among Young Women in Honduras.

Purpose: The pathways by which adverse childhood experiences (ACEs) are associated with early marriage and early pregnancy are poorly understood. Early marriage and early pregnancy may be risk factors for adulthood intimate partner violence (IPV). The aim of this study was to assess the relationships among ACEs, early marriage, early pregnancy, and IPV among women in Honduras. Method: We used weighted data from 1,436 women aged 18-24 years from the nationally representative 2017 Honduras Violence Against Children and Youth Survey. We used path analysis to estimate relationships and accounted for sample design, non-response, and within-country clustering. Results: We found that ACEs had differential relationships with outcomes of interest. For example, witnessing violence in the community was directly associated with increased probability of early pregnancy (10 percentage points (PP); 95% CI: 0.04, 0.15) and IPV (6 PP; 95% CI: 0.01, 0.10), while emotional violence was not directly or indirectly associated with any outcome. Early marriage and early pregnancy had no direct or indirect effect on IPV, but the total effect of early marriage on IPV was significant. Conclusions: Understanding the relationship between ACEs, early marriage, early pregnancy, and IPV may help inform prevention efforts. For example, programs aiming to reduce early pregnancy may consider addressing sexual violence experienced in childhood.

The interplay between interpersonal stress and psychological intimate partner violence over time for young at-risk couples.

The substantial number of young people in romantic relationships that involve intimate partner violence, a situation deleterious to physical and mental health, has resulted in increased attention to understanding the links between risk factors and course of violence. The current study examined couples' interpersonal stress related to not liking partners' friends and not getting along with parents as contextual factors associated with couples' psychological partner violence and determined whether and when couples' friend and parent stress increased the likelihood of couples' psychological partner violence. A linear latent growth curve modeling approach was used with multiwave measures of psychological partner violence, friend stress, parent stress, and relationship satisfaction obtained from 196 men at risk for delinquency and their women partners over a 12-year period. At the initial assessment, on average, the men were age 21.5 years and the women were age 21 years. Findings indicated that couples experiencing high levels of friend and parent stress were more likely to engage in high levels of psychological partner violence and that increases in couples' friend stress predicted increases in couples' partner violence over time, even when accounting for the couples' relationship satisfaction, marital status, children in the home, and financial strain. Interactive effects were at play when the couples were in their early 20s, with couples being most at risk for increases in psychological partner violence if they experienced both high friend stress and low relationship satisfaction. Couples' friend stress had the greatest effect on psychological partner violence when the couples were in their early to mid 20s when levels of friend stress were high. As the couples reached their 30s, low relationship satisfaction became the leading predictor of couples' psychological partner violence.

Sibling influences on adolescent substance use: the role of modeling, collusion, and conflict.

The longitudinal associations of older sibling substance use as well as dyadic sibling conflict and collusion to younger sibling substance use were examined in a community-based sample of 244 same-sex sibling pairs. Indirect effects of older siblings on younger sibling substance use were hypothesized via younger sibling deviant peer affiliation and conflict with friends. Adolescents, parents, friends, and teachers completed measures of substance use, conflict, and deviant peer involvement. Observational data were used for both measures of collusion and conflict. Findings suggest that older sibling substance use has a direct effect on younger sibling use, but relationship dynamics and reinforcement played a significant role as well. Specifically, collusion and conflict in the sibling relationship both had indirect effects through younger siblings' deviant peer affiliation. Findings validate the powerful socializing role of both siblings and peers, and elucidate the complex mechanisms through which socialization occurs. Furthermore, data underscore the importance of considering how multiple dimensions of socialization operate in the elaboration of antisocial behavior.

Stability of intimate partner violence by men across 12 years in young adulthood: effects of relationship transitions.

The present study examined the stability of young men's intimate partner violence (IPV) over a 12-year period as a function of relationship continuity or discontinuity. Multiwave measures of IPV (physical and psychological aggression) were obtained from 184 men at risk for delinquency and their women partners. The effects of relationship continuity versus transitions on change in IPV were examined using multilevel analyses. In general, men's IPV decreased over time. Men's physical aggression in their early 20s predicted levels of physical aggression about 7 years later, and men's psychological aggression in their early 20s predicted levels of psychological aggression about 10-12 years later. As hypothesized, higher stability in IPV was found for men who stayed with the same partners, whereas men experiencing relationship transitions showed greater change. The IPV of new partners was linked to the changes in men's IPV that occurred with repartnering. There was less change in men's IPV over time as men changed partners less frequently.

Associations between adverse childhood experiences and contraceptive use among young adults in Honduras.

OBJECTIVE: Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men. METHODS: We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use. FINDINGS: Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22). CONCLUSION: The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.

How do I feel about feelings? Emotion socialization in families of depressed and healthy adolescents.

Emotional and cognitive changes that occur during adolescence set the stage for the development of adaptive or maladaptive beliefs about emotions. Although research suggests that parents' behaviors and beliefs about emotions relate to children's emotional abilities, few studies have looked at parental socialization of children's emotions, particularly in families with depressed adolescents. The present study examined associations between parent and adolescent meta-emotion philosophies (MEP), defined as thoughts, reactions, and feelings about their own emotions. Additionally, adolescent depressive status was tested as a moderator of relationships between parents' and adolescents' MEP. One hundred and 52 adolescents, aged 14-18 (65.8% female), and their parents (148 mothers, 106 fathers) participated in a study on emotion socialization in families of depressed and healthy adolescents. Depressed adolescents (n = 75) and matched healthy adolescents (n = 77) were recruited based on research criteria for mental health status. The sample was largely Caucasian (82%) and of middle socioeconomic class status. Results indicated that mothers' and fathers' MEP about their children's emotions were associated with adolescents' MEP, although parents' MEP about their own emotions was unrelated to adolescents' MEP. Fathers' MEP about children's emotions made unique contributions to adolescents' MEP across both adolescent groups. Adolescents' depressive status moderated the relationship between mothers' and adolescents' MEP such that mothers' MEP was particularly relevant for depressed adolescents. The continued influence of parents in the emotional lives of adolescents is discussed as well as differences in emotion socialization in families with depressed and healthy adolescents.

Maternal emotion coaching, adolescent anger regulation, and siblings' externalizing symptoms.

BACKGROUND: Increases in externalizing behaviors during the transition to adolescence may put children at risk for developing mental disorders and related problems. Although children's ability to regulate their emotions appears to be a key factor influencing risk for maladjustment, emotion processes during adolescence remain understudied. In this longitudinal study, we examined a multi-level mediational model in which emotion coaching by parents was posited to influence the ability of adolescents to regulate their emotions, which in turn influences their expression of problem behaviors. METHODS: We recruited a representative community sample of 244 families with biological sibling pairs comprising a child in late elementary school and a child in middle school. Maternal meta-emotion interviews were coded for mother emotion coaching and adolescent difficulty with anger. Mothers also completed questionnaires on adolescent irritability. Ratings of adolescent problem behaviors were obtained from mother and teacher questionnaires completed at two time points. Using structural equation modeling, constructs were partitioned into components across older and younger siblings to examine shared and nonshared variance and contextual effects. RESULTS: Cross-sectional data indicated that mothers' emotion coaching of anger was related to better anger regulation in adolescent siblings, which was, in turn related to less externalizing behavior. Although support for mediational effects was limited in the longitudinal data, both older and younger siblings' difficulties in regulating anger predicted adolescent externalizing behavior three years later. Additional longitudinal predictors of externalizing behavior were observed for younger siblings. In particular, emotion coaching of anger by mothers was associated with decreased externalizing behavior, while conversely, older siblings' externalizing behavior was associated with increased externalizing behavior in the younger siblings over time. CONCLUSIONS: The findings highlight the importance of considering family emotion processes in understanding adolescent problem behavior. Both maternal emotion coaching of adolescent anger and adolescent difficulty in regulating anger influenced adolescent externalizing behavior. Emotion coaching interventions seem worthy of consideration for enhancing the impact of prevention and intervention programs targeting youth externalizing behaviors.

Autonomic cardiac control in depressed adolescents.

BACKGROUND: The aim of this study was to identify the aspects of cardiac physiology associated with depressive disorder early in life by examining measures of autonomic cardiac control in a community-based sample of depressed adolescents at an early phase of illness, and matched on a number of demographic factors with a nondepressed comparison group. METHODS: Participants were 127 adolescents (44 boys), ages 14-18, who formed two demographically matched groups of clinically depressed and nondepressed participants. Adolescents were excluded if they evidenced comorbid externalizing or substance-dependence disorders, were taking medications with known cardiac effects, or reported regular nicotine use. Resting measures of heart rate, respiratory sinus arrhythmia, skin conductance level, blood pressure, and pre-ejection period were collected. RESULTS: Depressed adolescents had resting heart rates significantly higher than those of healthy adolescents. No other measure of autonomic functioning differentiated the groups. Post hoc analyses were conducted to examine the influence of illness chronicity, severity, comorbidity, and sex on cardiac psychophysiology. These variables did not appear to exert a significant influence on the findings. CONCLUSIONS: Our findings suggest that neither autonomic cardiac control, illness chronicity, or severity, nor medication effects fully explain resting heart rate differences between depressed and nondepressed adolescents. Future research on depression and heart rate should consider mechanisms other than sympathetic or parasympathetic control as potential explanations of heart rate differences, including blood-clotting mechanisms, vascular and endothelial dysfunction of the coronary arteries, and inflammatory immune system response.

Associations of exposure to intimate partner violence and parent-to-child aggression with child competence and psychopathology symptoms in two generations.

BACKGROUND: Associations of exposure to intimate partner violence (IPV) and parent-to-child aggression (PCA) with child adjustment have not been examined adequately for community samples. OBJECTIVE: To examine main, cumulative, and interactive associations of IPV and PCA (separately for physical and psychological aggression) with four aspects of child adjustment (i.e., externalizing and internalizing behavior; social and scholastic competence). Associations were examined between (a) G1 parent behavior and the adjustment of G2 boys (N = 203) at ages 13-14 years and (b) G2 parent behavior and the adjustment of G3 children (N = 294) at ages 4-5 and 11-12 years. PARTICIPANTS AND SETTING: Families in a prospective, multigenerational dataset. METHODS: Measures included reports by caregivers, children, and teachers. Cross-sectional regression models (controlling for parent socioeconomic status and G3 child gender) examined: (a) main effects of IPV or PCA, (b) the simultaneous (i.e., cumulative) effects of both IPV and PCA, and (c) interactive effects of IPV and PCA (sample size permitting) on each of the child adjustment outcomes. RESULTS: When considered simultaneously, PCA (but not IPV) was associated with each aspect of child adjustment. The interaction between PCA and IPV indicated lower G2 adolescent scholastic competence and greater G3 preschool externalizing behavior for children exposed to lower levels of IPV and higher levels of PCA. CONCLUSION: Psychological and physical PCA were associated with child adjustment problems even when accounting for IPV. Findings support the use of evidence-based programs to prevent PCA and PCA-associated child adjustment problems.

Dynamics of affective experience and behavior in depressed adolescents.

BACKGROUND: Depression is often characterized as a disorder of affect regulation. However, research focused on delineating the key dimensions of affective experience (other than valence) that are abnormal in depressive disorder has been scarce, especially in child and adolescent samples. As definitions of affect regulation center around processes involved in initiating, maintaining, and modulating the occurrence, intensity, and duration of affective experiences, it is important to examine the extent to which affective experiences of depressed youth differ on these dimensions from those of healthy youth. METHODS: The affective behavior and experience of adolescents with major depressive disorder (MDD; n = 75) were compared to a demographically matched cohort of healthy adolescents (n = 77). Both samples were recruited from community high schools. A multi-source (parents and adolescent), multi-method (interviews, behavioral observations, questionnaires) assessment strategy was used to examine positive and negative affects. RESULTS: Depressed youth had significantly longer durations, higher frequency, and greater intensity when experiencing angry and dysphoric affects and shorter durations and less frequency of happy affect when compared to healthy youth. The most consistent, cross-method results were evident for duration of affect. CONCLUSIONS: Clinically depressed adolescents experienced disturbances in affective functioning that were evident in the occurrence, intensity, and duration of affect. Notably, the disturbances were apparent in both positive and negative affects.

Official incidents of domestic violence: types, injury, and associations with nonofficial couple aggression.

Official police reports of intimate partner violence (IPV) were examined in a community sample of young, at-risk couples to determine the degree of mutuality and the relation between IPV arrests and aggression toward a partner (self-reported, partner reported, and observed). Arrests were predominantly of the men. Men were more likely to initiate physical contact, use physical force, and inflict injuries than women, although few injuries required medical attention. In the context of nonofficial aggression toward a partner, overall, women had higher levels of physical and psychological aggression compared to men, and levels of severe physical aggression did not differ by gender. Couples with an IPV arrest were more aggressive toward each other than couples with no IPV arrests; however, nonofficial levels of aggression were not higher for men than for women among couples experiencing an IPV incident.

Relationship separation for young, at-risk couples: prediction from dyadic aggression.

Dyadic physical aggression in the relationships of 158 young, at-risk couples was examined as a predictor of relationship separation over the course of 6 years. A high prevalence of physical aggression and a high rate of separation were found, with 80% of couples engaging in physical aggression (as reported by either partner or as observed) and 62% separating over time. As predicted, physical aggression significantly increased the likelihood of relationship dissolution, even after accounting for psychological aggression, prior relationship satisfaction, and relationship contextual factors (length of relationship, relationship type, and children in the household). Of the contextual factors, relationship type was predictive of relationship dissolution: Married couples were least likely to dissolve their relationships compared with cohabiting and dating couples.

Emotion socialization in the context of risk and psychopathology: Mother and father socialization of anger and sadness in adolescents with depressive disorder.

This study examined parental emotion socialization processes associated with adolescent unipolar depressive disorder. Adolescent participants (N=107; 42 boys) were selected either to meet criteria for current unipolar depressive disorder or to be psychologically healthy as defined by no lifetime history of psychopathology or mental health treatment and low levels of current depressive symptomatology. A multisource/method measurement strategy was used to assess mothers' and fathers' responses to adolescent sad and angry emotion. Each parent and the adolescents completed questionnaire measures of parental emotion socialization behavior, and participated in meta-emotion interviews and parent-adolescent interactions. As hypothesized, parents of adolescents with depressive disorder engaged in fewer supportive responses and more unsupportive responses overall relative to parents of nondepressed adolescents. Between group differences were more pronounced for families of boys, and for fathers relative to mothers. The findings indicate that parent emotion socialization is associated with adolescent depression and highlight the importance of including fathers in studies of emotion socialization, especially as it relates to depression.

Intimate partner violence and diurnal cortisol patterns in couples.

This study examined whether physical intimate partner violence (IPV) victimization was associated with diurnal patterns of salivary cortisol in a community sample of 122 couples in their 30s from predominantly lower socioeconomic status backgrounds. Findings indicate that women with higher levels of victimization exhibited flatter patterns of diurnal cortisol characterized by both higher midday levels and more attenuated decreases in cortisol levels across the day, compared to women with lower levels of victimization. However, men's victimization was not associated with their diurnal cortisol levels. This study advances our understanding of the association between physical IPV victimization and dysregulated hypothalamic-pituitary-adrenal (HPA) axis functioning in women, which is likely to have further implications for their subsequent mental and physical health.

The role of adolescent friends, romantic partners, and siblings in the emergence of the adult antisocial lifestyle.

This study investigated the contribution of social processes in boys' adolescent relationships in 3 key domains--same-sex friends, cross-sex romantic partners, and younger siblings--to continued association with delinquent peers in young adulthood and, therefore, to continuance of an antisocial lifestyle. It was hypothesized that levels of negative interaction and antisocial talk observed during problem-solving discussions would be associated across the 3 domains. The influences of negative interactions and antisocial talk in the adolescent relationships on young-adult delinquent peer association were compared in 2 mediational models. It was posited that antisocial talk would be more predictive of continued association with delinquent peers than would negative interactions. Hypotheses were tested on an at-risk sample of young men (the Oregon Youth Study). Findings were generally in keeping with the hypotheses.

Project home: a pilot evaluation of an emotion-focused intervention for mothers reuniting with children after prison.

Nearly 2 million children in the United States have a parent in prison. The circumstances related to this situation place them at increased risk for behavioral and emotional disorders. The process of reunification between mother and child after release is a stressful and emotional one. A pilot study was conducted to develop and test a new program, Emotions: Taking Care of Yourself and Your Child When You Go Home. The objective of the Emotions Program was to teach emotion regulation and emotion coaching skills to incarcerated mothers so as to assist mothers and their children to cope better with the stress associated with incarceration and the transition home from prison. Pilot participants (N = 47) had previously participated in Parenting Inside Out, an evidence-based parenting program for incarcerated parents. The participants were then assigned to the Emotions Program (n = 29) or the comparison condition of no additional treatment (n = 18). All mothers were assessed before (T1) and after the program (T2), and again 6 months after release from prison (T3). Intervention effects of the Emotions Program on mothers' emotion regulation, emotion socialization, and adjustment were examined using repeated-measures analysis of variance with a between-subjects factor of group (Emotions Program vs. comparison) and a within-subjects factor of time (T1 vs. T2 vs. T3). Moderate time by group interaction effects were observed for aspects of emotion regulation, emotion socialization behavior, and criminal behavior in mothers, with participants in the Emotions condition showing improvement relative to those in the comparison condition.