I Know What to Do; I Can Do It; It Will Work: The Brief Parental Self Efficacy Scale (BPSES) for Parenting Interventions.

Parental self-efficacy predicts outcomes for parenting interventions for child behaviour problems, but there is a need for a brief measure that can be repeated over treatment and applies to a wide age range. The present study describes the development of such a measure, the Brief Parental Self-Efficacy Scale (BPSES). The psychometrics of the BPSES is presented across a wide age range from preschool to late adolescent in a sample comprised of four different intervention contexts. Evidence for structural validity, internal consistency, content validity, configural measurement invariance (equivalent factor structure) and test-retest reliability is presented alongside convergent validity against measures of parental self-efficacy, child behaviour problems, as well as self-report and observed parenting styles. Finally, lower levels of BPSES at baseline predicted increased disengagement from an intensive, individualised family therapy intervention for antisocial youth, while higher baseline levels predicted increased response to a group parenting programme for primary school aged children. The BPSES shows promise as a measure that can be used across a wide age-range, for a variety of parenting interventions for disruptive behaviour problems and which is sufficiently brief to be used as a routine outcome measurement during treatment.

Secure attachment predicts lower societal cost amongst severely antisocial adolescents.

BACKGROUND: Social and economic costs associated with antisocial behaviour are well-established, but little is known about the potential costs savings/benefits of secure attachment in this high-risk group. We aimed to provide the first test of attachment quality as a distinct predictor of economic costs. METHODS: 111 adolescents (10-17 years of age, M = 15.0, SD = 1.6; 71% male) referred to young offender services due to high levels of antisocial behaviour were included. Costs were measured by detailed service-use interview, and attachment security to mother and father elicited through the Child Attachment Interview. The level of antisocial behaviour and callous-unemotional traits were assessed. Cost predictors were calculated using generalised linear models. RESULTS: Mean 12-months service costs were £5,368 (sd 5,769) per adolescent, with justice system and educational service costs being the main components. After adjusting for covariates, economic costs were predicted by attachment quality to fathers, with a difference of £2,655 per year between those with secure (£3,338) versus insecure attachment (£5,993); significant cost effects were not found for attachment quality to mothers. Higher levels of callous-unemotional traits, lower verbal IQ, higher levels of antisocial behaviour, and older age were also significant cost predictors. CONCLUSIONS: Secure attachment to fathers is a predictor of reduced public cost in adolescents with severe antisocial behaviour. This novel finding for severely antisocial youth extends previous findings in less antisocial children and underscores the public health and policy benefits of good caregiving quality and the value of population-level dissemination of evidence-based interventions that improve caregiving quality.

The Feasibility of Providing Remote Functional Family Therapy with Adolescents During the COVID-19 Pandemic: A Mixed-Method Study.

Background: Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care. Objective: This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach. Method: Study 1 consisted of semi-structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M age = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA's and chi-square tests. Results: In Study 1 two themes emerged around experienced challenges, namely 'Feeling in control' and 'Engagement and alliance'. Two other themes emerged around adaptations, namely 'Being more on top' and 'Connecting in different ways'. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy. Conclusions: The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted. Supplementary Information: The online version contains supplementary material available at 10.1007/s10566-022-09692-y.

Early caregiving predicts attachment representations in adolescence: findings from two longitudinal studies.

BACKGROUND: A growing research base demonstrates that adolescents' construction of secure attachment relationships may underlie successful social and personal relationships and healthy behavioral adjustment. Little is known about the early caregiving origins of adolescent attachment security; this study provides some of the first data on this topic. METHOD: The relative contribution of early and current caregiving quality to attachment security in adolescence was assessed in two longitudinal studies of a clinic-referred and an at-risk community sample using identical measures (n = 209). Quality of early parent-child relationships at age 3-7 years of age and parent-adolescent relationship quality at approximately 12 years were assessed using observational methods; psychosocial risk was derived from extensive interview and questionnaire assessments; adolescent attachment quality was assessed using a standard attachment interview. RESULTS: Analyses indicated moderate stability in observed parent-child interaction quality from early childhood to adolescence. Observational ratings of both early childhood and current caregiving quality were significantly associated with adolescent attachment security; however, early caregiver sensitivity was more strongly associated with adolescent attachment security and predicted later attachment security independently from current caregiving quality. Follow-up analyses indicated that this longitudinal prediction was significantly weaker in the clinic than in the at-risk community sample. CONCLUSIONS: Parental sensitive responding in childhood has enduring effects on attachment representation in adolescence, independent of current parenting relationship quality. These findings provide important new evidence supporting early parenting interventions for promoting youth well-being and adjustment.

Randomized controlled trial of Functional Family Therapy for offending and antisocial behavior in UK youth.

BACKGROUND: Youth offending and antisocial behavior (ASB) are associated with low quality mental health and relationships and usually lead to poor adult functioning; they are very costly for society. Family interventions are effective in children but there are few reliably effective and inexpensive interventions for adolescents. Functional Family Therapy (FFT) is an evidence-based intervention but seldom tested outside the United States. METHODS: One hundred and eleven adolescents (10-17 years of age, M = 15.0, SD = 1.63) and their families were randomized to FFT + Management As Usual (MAU) (n = 65) or to MAU (n = 46). Assessments were made at baseline 6, and 18 months after randomization and included interviews and questionnaires of parenting behaviors, conduct disorders (CDs) and offending. Parent-child interaction was directly observed and police records obtained. TRIAL REGISTRATION: ISRCTN27650478. RESULTS: Eighty-nine (80%) were followed-up. In both groups, there were large reductions over time in all measures of offending and antisocial behavior (e.g. primary outcome p < 0.001), but no significant changes over time in parenting behavior or the parent-child relationship. However, there were no differences between intervention and control groups at 6 or 18 months on self-reported delinquency, police records of offending, symptoms or diagnoses of CDs, parental monitoring or supervision, directly observed child negative behavior, or parental positive or negative behavior. Against predictions, the intervention group showed lower levels of directly observed child positive behavior at 18 months compared to controls. CONCLUSIONS: In contrast to most previous trials of FFT, FFT+MAU did not lead to greater reductions in youth ASB and offending compared to MAU alone, and did not lead to improvements in parenting or the parent-child relationship. This may be because the trial was more rigorously conducted than prior studies; equally, the possibility that MAU was effective requires further research.

Sensitivity to parenting in adolescents with callous/unemotional traits: Observational and experimental findings.

Children and adolescents with callous-unemotional (CU) traits have been distinguished as a subset of individuals with disruptive behavioral disorders who may be less sensitive to parenting influence; we test this hypothesis using multiple methods and assessment paradigms. Two hundred seventy-one adolescents (mean age = 12.6 years) from 3 samples at elevated risk for disruptive behavior disorders were studied. Symptoms of CU behavior were derived from standard questionnaire; assessments of behavioral adjustment were derived from clinical interview with parent, and parent-report, teacher-report, and self-report questionnaire. Parent-child relationship quality was based on observational assessments in which adolescent and parent behaviors were rated in 3 interaction tasks: (a) low conflict planning task; (b) problem-solving conflict task; (c) puzzle challenge task; parent interview and parent-report and child-report questionnaires of parenting were also assessed. Results indicated that the associations between parent-child relationship quality and behavioral adjustment were comparable in adolescents with and without CU traits. More notably, observational data indicated that adolescents with elevated CU traits showed comparatively greater within-individual variability in observed angry/irritable behavior across interaction tasks, suggesting greater sensitivity to and emotional dysregulation in challenging interpersonal contexts. The findings suggest that adolescents with CU are not less sensitive to parental influence and may in contrast show greater context-sensitive disturbances in emotional regulation. The results have implications for family-based assessment and treatment for adolescents with disruptive behavior disorders. (PsycINFO Database Record

Callous-unemotional traits and anxiety in a community sample of 7-year-olds.

In forensic samples of adults and adolescents, there is evidence to suggest that there may be distinct variants of psychopathy marked by the presence/absence of significant levels of anxiety. Callous-unemotional (CU) traits can be used to characterize children who share behavioural and neurocognitive features with adult psychopaths. The aims of this paper are to (a) investigate the genetic and environmental influences on CU traits with/without anxiety and (b) explore differences in terms of concurrent and early parenting and adjustment. Discrete groups were formed on the basis of scores in the top 10% of the sample on CU and anxiety scales at age 7. Estimates of group heritability were calculated using a Defries-Fulker (DF) extremes regression model. Follow back analyses of early parenting and adjustment were conducted using multivariate analyses of covariance. There was high group heritability for CU traits with/without anxiety. Children with both high CU and anxiety showed greater levels of adjustment problems than those with CU only at age 7. The two groups did not differ in parenting characteristics. In this general population sample, evidence did not support differences in etiology for the two groups high on CU traits differing in level of anxiety.

Heartless and cunning? Intelligence in adolescents with antisocial behavior and psychopathic traits.

Clinical theory predicts that individuals high in psychopathic traits possess average or above average intelligence; however findings in adult and child samples have been mixed. The present study aimed to investigate (1) the relationship between verbal and nonverbal intelligence and the three dimensions of psychopathy (callous-unemotional (CU) traits, narcissism, impulsivity); and (2) whether these dimensions moderate the association between verbal and nonverbal intelligence and the severity of antisocial behavior. Participants were 361 adolescents aged 9-18 years (68% boys) and their parents, drawn from four samples with different levels of risk for antisocial behavior. Families were disadvantaged and 25% were from an ethnic minority. Verbal intelligence was unrelated to parent-reported CU traits, narcissism or impulsivity after controlling for gender, sociodemographic disadvantage, sample, antisocial behavior and hyperactivity. Narcissism, but not CU traits or impulsivity, was significantly related to lower nonverbal IQ. None of the three psychopathic trait dimensions moderated the relationship between verbal or nonverbal IQ and antisocial behavior. CU traits, narcissism, hyperactivity and inclusion in the very high or high risk samples were significantly related to more severe antisocial behavior. Results contradict the widely held view that psychopathic traits are associated with better than average verbal or nonverbal intelligence.

Attachment in adolescence: overlap with parenting and unique prediction of behavioural adjustment.

BACKGROUND: Attachment theory was conceptualized by Bowlby as relevant across the life span, from 'cradle to grave'. The research literature on attachment in infants and preschool-aged children is extensive, but it is limited in adolescence. In particular, it is unclear whether or not attachment security is distinguishable from other qualities of the parent-adolescent relationship and predicts adjustment independently of alternate measures of it. METHODS: Data from three parallel studies of adolescents, representing normal- to high-risk status, were combined, n = 248. Attachment was assessed using the Child Attachment Interview, a recently constructed measure designed for older children and adolescents. Parent-adolescent relationship quality was assessed in detail through questionnaires, interviews and observation of a standard problem-solving interaction. Adolescent adjustment was assessed through parental psychiatric interview, teacher questionnaire and adolescent self-report. RESULTS: Bivariate analyses showed that secure attachment representations were modestly associated with diverse measures of the current parent-adolescent relationship such as monitoring, negative expressed emotion, and directly observed parental warmth and anger. In addition, attachment representations were reliably associated with key indicators of psychological adjustment in adolescence, including parent-rated oppositional-defiant disorder symptoms and teacher-reported emotional and behavioural difficulties. Regression analyses revealed that secure attachment representations explained unique variance in these indicators of adjustment, independent of alternative measures of the parent-adolescent relationship. CONCLUSION: Adolescents' representational models of attachment are related to but distinct from current parenting quality and provide unique insight into the understanding of behavioural adjustment. The findings support a distinct conceptual role of attachment representations in adolescence. Clinical assessment and treatment models should include attachment patterns in this age group.