Elucidating mechanisms linking mothers' and fathers' mind-mindedness in infancy with children's self-regulation at early preschool age.

Extensive research has examined factors that contribute to individual differences in children's self-regulation (SR), a key social-emotional competence crucial to adjustment and mental health. Those differences become salient and measurable at late toddler age. In the CAPS (N = 200 community families), we examined mothers' and fathers' appropriate mind-mindedness (MM)-the ability to view the child as a psychological agent and correctly interpret his or her mental states-as a predictor of children's SR. MM was observed in parent-child interactions at 8 months, and SR was observed as the capacity for deliberate delay in standard tasks at 3 years. Reflecting a family system perspective, processes both within and across mother-child and father-child relationships were examined in one model. Parent-child mutual responsiveness, observed during interactions at 16 months, was modeled as a mediator of the paths from MM to SR. Fathers' MM had a significant, direct positive effect on SR; in addition, it enhanced mutual responsiveness in both father-child and mother-child dyads and promoted child SR through enhanced mother-child mutual responsiveness. The findings elucidate relatively poorly understood mechanisms linking parental MM in infancy with SR at early preschool age, highlight similarities and differences in the processes unfolding in mother-child and father-child relationships, and emphasize interparental dynamics in socialization.

Family systems approaches in pediatric obesity management: a scoping review.

Family-based obesity management interventions targeting child, adolescent and parental lifestyle behaviour modifications have shown promising results. Further intervening on the family system may lead to greater improvements in obesity management outcomes due to the broader focus on family patterns and dynamics that shape behaviours and health. This review aimed to summarize the scope of pediatric obesity management interventions informed by family systems theory (FST). Medline, Embase, CINAHL and PsycInfo were searched for articles where FST was used to inform pediatric obesity management interventions published from January 1980 to October 2023. After removal of duplicates, 6053 records were screened to determine eligibility. Data were extracted from 50 articles which met inclusion criteria; these described 27 unique FST-informed interventions. Most interventions targeted adolescents (44%), were delivered in outpatient hospital settings (37%), and were delivered in person (81%) using group session modalities (44%). Professionals most often involved were dieticians and nutritionists (48%). We identified 11 FST-related concepts that guided intervention components, including parenting skills, family communication, and social/family support. Among included studies, 33 reported intervention effects on at least one outcome, including body mass index (BMI) (n = 24), lifestyle behaviours (physical activity, diet, and sedentary behaviours) (n = 18), mental health (n = 12), FST-related outcomes (n = 10), and other outcomes (e.g., adiposity, cardiometabolic health) (n = 18). BMI generally improved following interventions, however studies relied on a variety of comparison groups to evaluate intervention effects. This scoping review synthesises the characteristics and breadth of existing FST-informed pediatric obesity management interventions and provides considerations for future practice and research.

Mary Main's contributions to our family systems approach to interventions with parents of young children.

In this paper we describe our Berkeley colleague Mary Main's intellectual contributions to our program of creating and evaluating couples group interventions for parents of young children. The first section presents the theoretical model and the projects at the heart of our research program. The second section illustrates how the Adult Attachment Interview, a Couple Attachment Interview, or a questionnaire describing attachment styles helped us to understand how internal working models of both parent-child and couple relationships added to our observational measures of couple and parenting behavior to provide unique information. In a third section, we conclude that we did not have the kind of impact on Mary's thinking that Mary had on ours, but we are heartened by seeing increasing attempts of some developmental attachment theorists to include fathers in their studies and others who focus on the effects of the quality of relationship between the parents on their children's development.

Couple differentiation and health-related quality of life.

The purpose of this study was to examine whether couple differentiation influenced mental and physical health-related quality of life in couple members. Data for this study were derived from a larger study at a couple a family therapy clinic. One hundred and thirty-three couples were included in a latent profile analysis, and seventy-two couples were included in analyses of mean differences. The latent profile analysis resulted in three distinct groups by level of couple differentiation: high, moderate, or low in differentiation of self. Analyses of variance indicated evidence that couple differentiation influenced health-related quality-of-life measures. Findings are discussed in the context of Bowen Family Systems Theory and the existing literature.

The indirect impact of infant negative emotionality on interparental conflict via perceptions of coparenting challenges: What prenatal resources mitigate this risk?

Research clearly demonstrates that conflictual interparental relationship dynamics can create a family context that contributes to child emotional insecurity and psychopathology. Significantly less research has examined familial factors that contribute to maladaptive conflict between parents. Scholars have alluded to the disruptive impacts of parenting a child with certain temperamental characteristics (e.g., negative emotionality). Yet, there is a lack of empirical research examining if and how child temperament contributes to later interparental conflict. Using an established multi-informant, multi-method sample of 150 families first assessed during pregnancy, and again when the child was 1, 2, and 3.5 years of age, the present study aimed to test an integrated conceptual model examining whether infants' negative emotionality assessed at age 1 predicts interparental conflict at age 3.5, as mediated through destructive coparenting dynamics in toddlerhood, and identifying prenatal protective factors mitigating this maladaptive pathway. Findings suggest that greater infant negative emotionality predicts worse interparental conflict management during preschool age by undermining the mother's (but not the father's) report of coparenting relationship quality during toddlerhood. However, these results were significant only to the extent that parents were lacking certain prenatal regulatory resources (i.e., low paternal self-compassion; less secure relationship between parents). Importantly, results point to the need for intervention and prevention efforts during pregnancy that might disrupt the deleterious impacts of parenting a child who is more reactive and prone to expressing negative emotions.

Experiences of cisgender youth with a transgender and/or nonbinary sibling.

While recent research has begun to address the effects of family support on transgender and/or nonbinary youth (TNY), almost no studies have directly examined how cisgender siblings in families with TNY navigate their sibling's gender disclosure and affirmation within both their families and their larger communities. We conducted an exploratory secondary analysis of in-person, semi-structured interviews with 15 adolescent and young adult siblings (age 13-24 years) of TNY from the northeastern United States from the baseline wave of the community-based, longitudinal, mixed methods Trans Teen and Family Narratives Project. Interview transcripts were analyzed using immersion/crystallization and template organizing approaches. Analyses yielded three main themes: gender-related beliefs and knowledge, peri- and post-disclosure family dynamics, and assessing responses to their sibling. Subthemes included anticipation of their sibling's TN identity, expectations post-disclosure, participants' level of involvement in gender-related family processes, perceptions of changes in family relationships, concern for their sibling (including a high degree of attunement to gender-affirming name and pronoun usage), and concern for themselves. Findings from this study suggest the need to engage directly with siblings of TNY to further elucidate their intrapersonal, intra-familial, and extra-familial experiences related to having a TN sibling and determine their unique support needs. Implications for families, clinicians, and communities are discussed.

A special section: Contributions of family science to anti-racism efforts.

Concomitant with a growing recognition of demographic shifts toward greater racial/ethnic diversity in the United States and widespread depictions of racial injustice, desires for increased racial/ethnic tolerance and inclusivity have been expressed in various sectors of U.S. society, including education, healthcare, and business. However, the literature on effective strategies and interventions for advancing anti-racism, or efforts to reduce racial/ethnic injustice, is minimal and underdeveloped. The family science field, characterized by rich theories on human systems and interactions, strategies for changing interpersonal dynamics, and the recognition that perceived knowledge is dependent on sociopolitical location, has much to offer the study of strategies to actualize increased racial/ethnic equity. The articles in this special section demonstrate potential contributions family science can make to the endeavor for racial/ethnic equity, through presenting theoretical, empirical, and practice innovations and findings steeped in the family science orientation toward addressing systems, cycles, and change.

Embracing the other: Revisiting the epistemological foundations of family systems therapy.

Family systems therapy originated in the 1960s, 1970s, and 1980s through the work of innovative thinkers and clinicians. However, despite the creative contributions of the mentioned colleagues and of later innovations in family therapy theory and practice, it seems as though the dominant culture of establishment psychiatry in the United States (and in most Western countries) to this day has not seriously incorporated relationships, social context, or community connectedness into the treatment of individuals with psychiatric diagnoses. For the "psychiatric" patients diagnosed according to the DSM-5, the dominant underlying epistemological perspective is the medical "scientific" paradigm. Within this approach there is a dearth of reflections about the truthfulness of so-called "empirical facts" and a lack of skepticism about the techniques of "measurement" of the psychiatric illness. The alternative, relationship-oriented, context-sensitive, and community-connected thinking paradigm is highlighted here in contrast to the "psychiatric" foundation. This paradigm consists of (a) the awareness that all human Subjects (including "psychiatric" clients) are constituted as such by their relational connection to others; (b) the awareness of our sensitivity to and embeddedness in a socio-economic, cultural, and racial context; and (c) the awareness of our involvement in and connectedness with many kinds of communities.

Should I stay or should I go? The collective effects of work, family, and mental health on military career intentions among active-duty and national guard and reserve soldiers.

This study examined diverse predictors of military career intentions, specifically whether to stay in the military or leave, and differences based on duty status (i.e. active-duty versus National Guard or Reserve [NG/R] Service members). The combined perspectives of the personal choice model of military retention and family systems theory suggest that work factors (i.e. unit support, morale), family factors (i.e. work-family balance, romantic relationship quality), and mental health (i.e. depressive symptoms) simultaneously influence Service members' military career intentions. Understanding how these factors together impact different dimensions of retention, namely, intentions to stay and intentions to leave, and whether they have a similar impact based on duty status are needed next steps. With data from the Army Study to Assess Risk and Resilience (Army STARRS; N = 3,506 Soldiers), path models examined the direct and indirect paths through which these factors contributed to Soldiers' intentions to remain and intentions to leave. Then, a multigroup mediation analysis explored possible model differences based on duty status. Unit support and work-family balance directly and indirectly contributed to intentions to remain and/or leave through romantic relationship quality, depressive symptoms, and morale. Few differences emerged between active-duty and NG/R Soldiers. In sum, work factors, family factors, and depressive symptoms worked together simultaneously to explain Soldiers' military career intentions. Military leadership, at multiple levels, is encouraged to promote supportive work environments and work-family balance. Practitioners may reinforce mental health resources to promote retention.

Parent couple conflict and emotional and behavioral problems in youth with autism: Longitudinal investigation of bidirectional effects.

Families of youth with autism spectrum disorder (ASD) are vulnerable to maladaptive psychosocial experiences, including elevated youth emotional and behavioral problems (EBPs) and poor parent couple relationship outcomes. Yet, the extent to which these family psychosocial experiences are intertwined has been given little research attention. The present study longitudinally investigated the bidirectional associations between parent couple conflict (PCC) and youth EBPs in 188 families of children and adolescents with ASD (initially aged 5 to 12 years) across four time points (T1, T2, T3, T4), each spaced 12 months apart. Mother- and father-report of youth EBPs and PCC were entered into a cross-lagged panel model. After adjusting for youth age and intellectual disability status and parent education and couple relationship length, the results indicated that father-report of PCC predicted increased youth EBPs 12 months later (T1→T2 and T2→T3). In addition, father-report of youth EBPs predicted increased PCC 12 months later (T3→T4). Mother-report did not demonstrate cross-lagged effects. The findings suggest that fathers' perceptions of PCC and youth emotional and behavioral functioning are transactionally related, highlighting the need for family-wide interventions.

Empirical support for a model of risk and resilience in children and families during COVID-19: A systematic review & narrative synthesis.

BACKGROUND.: The COVID-19 Family Disruption Model (FDM) describes the cascading effects of pandemic-related social disruptions on child and family psychosocial functioning. The current systematic review assesses the empirical support for the model. METHODS.: Study eligibility: 1) children between 2-18 years (and/or their caregivers); 2) a quantitative longitudinal design; 3) published findings during the first 2.5 years of COVID-19; 4) an assessment of caregiver and/or family functioning; 5) an assessment of child internalizing, externalizing, or positive adjustment; and 6) an examination of a COVID-19 FDM pathway. Following a search of PsycINFO and MEDLINE in August 2022, screening, full-text assessments, and data extraction were completed by two reviewers. Study quality was examined using an adapted NIH risk-of- bias tool. RESULTS.: Findings from 47 studies were summarized using descriptive statistics, tables, and a narrative synthesis. There is emerging support for bidirectional pathways linking caregiver-child functioning and family-child functioning, particularly for child internalizing problems. Quality assessments indicated issues with attrition and power justification. DISCUSSION.: We provide a critical summary of the empirical support for the model, highlighting themes related to family systems theory and risk/resilience. We outline future directions for research on child and family well-being during COVID-19. Systematic review registration. PROSPERO [CRD42022327191].

Changes in children's attachment security to mother and father after the birth of a sibling: Risk and resilience in the family.

Changes in children's attachment security to mother and father were examined for 230 firstborn children (M = 31.17 months), their mothers and fathers participating in a longitudinal investigation starting in the last trimester of the mothers' pregnancy and 1, 4, 8, and 12 months after the birth of an infant sibling. Both parents completed the Attachment Q-set at prenatal, 4, and 12 months. Growth mixture models revealed four latent classes in which children's attachments were (a) both secure with a modest decline to both parents (68.3%); (b) more secure with father than mother with a steep decline for both (12.6%); (c) both insecure with no change (10%); and (d) more secure with mother than father with a modest increase for both (9.1%). Multi-group latent growth curve analyses revealed that parenting and coparenting differed across families. Children had lower externalizing behavior problems in families with two secure attachments than in families with one secure attachment, either to mother or to father, who, in turn, had fewer problems than children with two insecure attachments. Findings underscore the strengths of a family systems framework to understand attachment relationships with multiple caregivers and the family risks and protective factors that covary with children's behavioral adjustment after the birth of a sibling.

Resource dilution in maternal feeding practices after birth of a secondborn.

Firstborn children have higher prevalence of obesity than secondborn siblings. The birth of a sibling typically results in resource dilution when mothers begin to divide their time and attention between two children. This mixed-methods analysis applies the family systems process of resource dilution to test the hypothesis that characteristics of the secondborn impact how parents feed the firstborn. Participants (n = 76) were mothers of consecutively born firstborn and secondborn siblings who participated in the INSIGHT trial and an observational cohort. Quantitative analyses involved multilevel models to test if characteristics of secondborns (temperament at 16 weeks, appetite at 28 weeks) were associated with maternal feeding practices of firstborns (structure and control-based feeding) at 1, 2, and 3 years, adjusting for firstborn child characteristics. A purposive subsample (n = 30) of mothers participated in semi-structured interviews to contextualize potential sibling influences on maternal feeding practices during infancy and toddlerhood. Quantitative data showed secondborn temperament and appetite were associated with how mothers fed their firstborn. Qualitative data explained maternal feeding practices in three primary ways: 1) Mothers explained shifting predictable meal and snack routines after birth of the secondborn, but did not perceive sibling characteristics as the source; 2) Family chaos following the secondborn's birth led to "survival mode" in feeding; and 3) Social support was protective against feeding resource dilution. The family systems process of resource dilution is a focus for future research and support for families during key transitions and a direction for efforts to reduce risk for child obesity.

Family-systems interventions for families of people with an intellectual disability or who are autistic: a systematic review.

BACKGROUND: Family-systems interventions have been proposed as one way of supporting families of people with an intellectual disability (ID) or who are autistic. This systematic review aimed to summarise what family-systems interventions have been studied with this population, what evidence there is for their effectiveness and families' experiences of the interventions. METHODS: The review was preregistered on PROSPERO (CRD42022297516). We searched five electronic databases, identified 6908 records and screened 72 full texts. Study quality was evaluated using the Mixed Methods Appraisal Tool, and a narrative synthesis was used. RESULTS: We identified 13 eligible articles with 292 participating families. Most studies reported positive effects of the interventions on wellbeing and family relationships, and families reported positive experiences. However, research quality was poor and there are no any sufficiently powered randomised controlled trials demonstrating family-systems interventions' effectiveness for this population. CONCLUSIONS: There is a need for higher-quality research to establish whether family-systems interventions are beneficial for families of people who have an ID or who are autistic.

Experiences of families and health professionals along the care continuum for low-birth weight neonates: A constructivist grounded theory study.

AIMS: To explore the experiences of health professionals and families concerning supporting low-birth weight (LBW) infants along the continuum of care (CoC) in Ghana with the goal to unveil new strategies to improve the quality of neonatal care. DESIGN: A constructivist grounded theory. METHOD: Simultaneous data collection and analysis among health professionals alongside families with LBW infants from September 2020 to April 2021. The study used constructivist grounded theory strategies for data collection and analysis. RESULTS: The analysis of 25 interviews resulted in a theoretical model describing 10 themes along the CoC for LBW infants, categorized into health and family systems drivers. In this paper, we focus on the latter. Early bonding and family involvement were empowering. Mothers needed assistance in balancing hope and confidence which enabled them to render special care to their LBW infants. Providing mothers with financial and domestic support as well as creating awareness on newborn health in communities were important. CONCLUSION: To achieve family involvement, a coordinated CoC must entail key players and be culturally inclusive. It must be applied at all levels in the CoC process in a non-linear faction. This can help LBW infants to thrive and to reach their full developmental potential. IMPACT: The theoretical model developed shows the importance of family involvement through family systems care for a comprehensive response in addressing needs of health professionals and families with LBW infants and bridging the fragmentations in the neonatal CoC in Ghana. Context-tailored research on family systems care in the neonatal period is necessary to achieve a quality CoC for LBW infants and their families. PATIENT OR PUBLIC CONTRIBUTION: Caregivers and providers participated by granting in-depth interviews. Care providers further contributed through their feedback on preliminary findings.

Development of the internal family systems model: Honoring contributions from family systems therapies.

We describe Richard Schwartz's development of the Internal Family Systems model (IFS) from his position as a Structural/Strategic family therapist. Four decades ago, Schwartz struggled to help clients who exhibited serious risk of harm to self and others. Through a process of inquiry, he began to work with the positive intentions behind his most challenging clients' harmful thoughts and behaviors. He applied foundational ideas from family systems thinking to patterns of internal experiences. As he experimented with ways of applying these ideas, he created an approach to healing. We summarize the IFS model delineating ways a range of family systems theory and practice inform its development and contribute to its best practice. Our purposes are to inform IFS practitioners who are not trained in foundational family systems models as well as to acknowledge the significant contributions family therapy theories made in the development and best practice of the IFS model.

The Attachment Versus Differentiation Debate: Bringing the Conversation to Parent-Child Relationships.

This article contributes to the attachment versus differentiation debate, bringing the conversation to parent-child relationships. While attachment theory's (AT) approach emphasizes bonding, Bowen family systems theory's (BFST) differentiation approach emphasizes emotional boundaries. They both suggest that balancing autonomy and connection is important, but AT conceptualizes this in terms of the parent's ability to meet the child's needs for autonomy and connection, while BFST conceptualizes this in terms of the parent's and child's ability to be connected due to mutual respect for each other's emotional boundaries. They similarly recognize that: (1) emotionally mature parents respect children individuality, (2) emotionally immature parents may project their needs and wishes onto children, and (3) emotionally mature parents focus on calming themselves to help their children to be calm. They differ in that: (1) BFST suggests that children may project their needs and wishes onto their parents and intrude on their parents' emotional boundaries, and AT does not conceptualize this; (2) BFST suggests that caregiver over-involvement may be experienced as positive for a child and program them to be excessively needy, and AT suggests that caregiver over-involvement is negative for children and neediness is caused by under-involved caregiving; and (3) BFST suggests that therapists should not try to be a parent to their clients as this can replicate the fusion that the client experienced with their parents, and AT suggests that therapists should try to be like a good parent to their clients to help them to develop more secure attachment styles.

An innovative Australian doctors' health service: using systems therapy to work with individual medical leaders in an acute public health setting.

OBJECTIVE: To describe an innovative doctors' health service (Professional Support Unit) utilising systems therapy to support individual medical leaders across an Australian local public health district. METHOD: Therapeutic interventions were informed by systems theory, the study of social systems, coherent entities with hierarchical orders united by organising relations of rules, roles, structures and alliances. Systems therapy addresses these relations to effect change. Working with leaders individually was based on the premise of effecting change in the system by changing part of the system, particularly the 'decider subsystem' of the medical lead. RESULTS: Support was provided to 30 medical leaders (50% of potential cohort). All but five self-referred with zero dropouts. Referrals snowballed gradually and exponentially following psychoeducation sessions normalising struggling and seeking help. Diversity of themes presented or emerging included requests for: (i) psychological support for lead/family, or staff/family; (ii)didactic sessions regarding impairment, ageing doctor, performance management and mental health first aid for doctors; (iv) anger management; (v) difficult staff; and (vi) being undermined or placed in untenable positions. Interventions were accordingly diverse and tailored. A vulnerable-resilience model was developed with practical tips. CONCLUSIONS: Supporting medical leaders using therapeutic interventions grounded in systems theory may go towards addressing organisational duty of care to maintain safe work systems.

Mothers' Parenting in an Era of Proactive Policing.

A family systems perspective suggests the repercussions of adolescent police contact likely extend beyond the adolescent to proliferate to the broader family unit, but little research investigates these relationships. I used data from the Fragile Families and Child Wellbeing Study, a longitudinal survey of children who became adolescents during an era of proactive policing, to examine the relationship between adolescent police contact and four aspects of family life: mothers' parenting stress, mothers' monitoring, mothers' discipline, and the mother-adolescent relationship. Adolescent police contact, especially invasive police contact, is associated with increased parenting stress, increased discipline, and decreased engagement, net of adolescent and family characteristics that increase the risk of police contact. There is also suggestive evidence that adolescent police contact is more consequential for family life when mothers themselves experienced recent police contact. These findings suggest the repercussions of police contact extend beyond the individual and proliferate to restructure family relationships.

Barriers and Facilitators Influencing Nurses' Confidence in Managing Family Nursing Conversations in the Treatment of Chronic Noncancer Pain: A Longitudinal Qualitative Study.

This mixed-methods research examined the translation of a family nursing conversation intervention to the multidisciplinary treatment of patients experiencing chronic noncancer pain. The intervention required educating nurses who offered family nursing interventions to these families. The research uncovered barriers and facilitators influencing the nurses' perceived self-efficacy related to the process of incorporating family nursing conversations in their nursing care. A qualitative, descriptive, longitudinal design with three focus group interviews was implemented. A template analysis, using a priori themes based on Bandura's self-efficacy theory, illuminated a process initially predominated by barriers. Learning how to offer family nursing conversations was initially overwhelming for nurses because they were concerned about harming the family. Over time, the nurses came to understand the usefulness of the therapeutic conversation with families. Significant facilitators were the project manager's role, a strong nursing community, and the positive influence of the family intervention on the nurses' professional identity.