Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion.

OBJECTIVE: To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. METHOD: In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). RESULTS: Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. DISCUSSION: Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. PUBLIC SIGNIFICANCE: Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.

RSA instability in mothers of preschoolers and adolescents is related to observations of supportive parenting behaviors.

Respiratory sinus arrhythmia (RSA; a measure of respiratory modulation of vagal control of heart rate) is a dynamic process. For mothers, RSA functioning has been associated with depressive symptoms and coincides with supportive parenting. However, research has largely focused on RSA suppression (i.e., difference score from rest to stress task). The present study examined depressive symptoms and supportive parenting with RSA instability-a dynamic measure of the magnitude of RSA change across a task. In two samples of mothers (N = 210), one with preschoolers (Study 1: n = 108, Mage = 30.68 years, SD = 6.06, 47.0% Black, 43.0% White) and one with adolescents (Study 2: n = 102, Mage = 35.51, SD = 6.51, 75.2% Black), RSA instability was calculated during an interaction task. In both studies, instrumental supportive parenting behaviors were negatively related to RSA instability. Findings provide preliminary support for RSA instability as an indicator of physiological dysregulation for mothers.

Preschoolers' dynamic respiratory sinus arrhythmia (RSA) change during a challenging parent-child interactive task: Relations with preschoolers' socioemotional health.

Respiratory sinus arrhythmia (RSA) is a biomarker of physiological functioning that has been implicated in self-regulatory processes and shown to relate to children's socioemotional health. RSA is a dynamic process reflecting an individual's response to their environment; thus, temporally sensitive methods are critical to better understanding this self-regulatory process in different contexts. Prior work has studied young children's RSA change in the context of emotion clips and interactions with a stranger. The present study meaningfully expanded upon this work by examining: (a) preschoolers' dynamic RSA change during a challenging task with their mothers, and (b) factors that may explain variability in children's dynamic RSA change. Preschoolers (N = 108; Mage  = 3.56 years) and their mothers from diverse backgrounds completed a challenging activity together while children's physiological activity was monitored. Mothers reported on children's positive affect, parent emotional support, and family cohesion and indicators of socioemotional health. Children's positive affect and family cohesion explained variability in children's dynamic RSA change, which concurrently related to better socioemotional health. This study advances research and theory on biological correlates implicated in the development of children's self-regulation and furthers our understanding of factors that may support children's developing self-regulation at the physiological level.

A Meta-analytic Review of the Five Minute Speech Sample as a Measure of Family Emotional Climate for Youth: Relations with Internalizing and Externalizing Symptomatology.

The Five Minute Speech Sample's (FMSS) measure of parental expressed emotion (EE), defined as criticism (CRIT) and emotional overinvolvement (EOI), has been increasingly used to measure family emotional climate in relation to youth psychopathological development. As CRIT and EOI were defined based on adults, a meta-analysis and systematic review was conducted to analyze the presence and strength of an effect among maternal CRIT and EOI with youth internalizing and externalizing problems. A random effects model was used to analyze the 42 studies on families of youth (aged 1.5 to 19). There was a small, significant relation among maternal CRIT with youth internalizing and externalizing problems and among EOI with youth internalizing problems. EOI was not significantly related to externalizing problems. The current study suggests that the FMSS measure of CRIT is a more robust correlate of youth internalizing and externalizing symptoms than EOI, but EOI does relate to internalizing behaviors. Few moderators emerged, highlighting a continued need to identify factors accounting for heterogeneity. The current results suggest that the FMSS measure of CRIT may be a valuable measure of the family emotional climate in families of youth, but care should be taken when including analyses on EOI.

A Model-Based Cluster Analysis of Maternal Emotion Regulation and Relations to Parenting Behavior.

In a diverse community sample of mothers (N = 108) and their preschool-aged children (Mage  = 3.50 years), this study conducted person-oriented analyses of maternal emotion regulation (ER) based on a multimethod assessment incorporating physiological, observational, and self-report indicators. A model-based cluster analysis was applied to five indicators of maternal ER: maternal self-report, observed negative affect in a parent-child interaction, baseline respiratory sinus arrhythmia (RSA), and RSA suppression across two laboratory tasks. Model-based cluster analyses revealed four maternal ER profiles, including a group of mothers with average ER functioning, characterized by socioeconomic advantage and more positive parenting behavior. A dysregulated cluster demonstrated the greatest challenges with parenting and dyadic interactions. Two clusters of intermediate dysregulation were also identified. Implications for assessment and applications to parenting interventions are discussed.

Preschoolers' genetic, physiological, and behavioral sensitivity factors moderate links between parenting stress and child internalizing, externalizing, and sleep problems.

This study examined three potential moderators of the relations between maternal parenting stress and preschoolers' adjustment problems: a genetic polymorphism-the short allele of the serotonin transporter (5-HTTLPR, ss/sl allele) gene, a physiological indicator-children's baseline respiratory sinus arrhythmia (RSA), and a behavioral indicator-mothers' reports of children's negative emotionality. A total of 108 mothers (Mage = 30.68 years, SDage = 6.06) reported on their parenting stress as well as their preschoolers' (Mage = 3.50 years, SDage = 0.51, 61% boys) negative emotionality and internalizing, externalizing, and sleep problems. Results indicated that the genetic sensitivity variable functioned according to a differential susceptibility model; however, the results involving physiological and behavioral sensitivity factors were most consistent with a diathesis-stress framework. Implications for prevention and intervention efforts to counter the effects of parenting stress are discussed.

Profiles of Emotion Deficits and Adolescent Nonsuicidal Self-Injury in an Inpatient Sample.

This study examined profiles of specific emotion deficits, including poor emotion awareness, reluctance to express emotion, sadness inhibition and dysregulation, and anger inhibition and dysregulation. Self-report questionnaires assessed adolescents' emotion skills and nonsuicidal self-injury (NSSI) engagement, frequency, severity, methods, and age of onset. Latent profile analysis yielded a three-profile solution: Low Deficit (LD; n = 49), Unaware/Anger Dysregulated (UAD; n = 24), and Anger Inhibited (AI; n = 20) profiles. Adolescents in the UAD profile were more likely to engage in NSSI, displayed a higher NSSI frequency, and reported a higher number of NSSI methods when compared to adolescents in the LD profile. No links emerged for NSSI severity or age of onset.

Introduction to the Special Series: Current Directions for Measuring Parenting Constructs to Inform Prevention Science.

Parenting behaviors are multifaceted and dynamic and therefore challenging to quantify. Measurement methods have critical implications for study results, particularly for prevention trials designed to modify parenting behaviors. Although multiple approaches can complement one another and contribute to a more complete understanding of prevention trials, the assumptions and implications of each approach are not always clearly addressed. Greater attention to the measurement of complex constructs such as parenting is needed to advance the field of prevention science. This series examines the challenges of measuring changes in parenting behaviors in the context of prevention trials. All manuscripts in the special series address measurement issues and make practical recommendations for prevention researchers. Manuscripts in this special series include (1) empirical studies that demonstrate novel measurement approaches, (2) re-analyses of prevention trial outcome data directly comparing and contrasting two or more methods, and (3) a statistical primer and practical guide to analyzing proportion data.

Treatment Effects of a Primary Care Intervention on Parenting Behaviors: Sometimes It's Relative.

The goal of this brief report is to demonstrate the utility of quantifying parental discipline practices as relative frequencies in measuring changes in parenting behavior and relations to child behavior following intervention. We explored comparisons across methodological approaches of assessing parenting behavior via absolute and relative frequencies in measuring improvements in parent-reported disciplinary practices (increases in positive parenting practices in response to child behavior; decreases in inconsistent discipline and use of corporal punishment) and child behavior problems. The current study was conducted as part of a larger clinical trial to evaluate the efficacy of a collaborative care intervention for behavior problems, ADHD, and anxiety in pediatric primary care practices (Doctor Office Collaborative Care; DOCC). Participants were 321 parent-child dyads (M child age = 8.00, 65 % male children) from eight pediatric practices that were cluster randomized to DOCC or enhanced usual care (EUC). Parents reported on their own discipline behaviors and child behavior problems. While treatment-related decreases in negative parenting were found using both the absolute and relative frequencies of parenting behaviors, results were different for positive parenting behaviors, which showed decreases when measured as absolute frequencies but increases when measured as relative frequencies. In addition, positive parenting was negatively correlated with child behavior problems when using relative frequencies, but not absolute frequencies, and relative frequencies of positive parenting mediated relations between treatment condition and outcomes. Our findings indicate that the methods used to measure treatment-related change warrant careful consideration.

Family stress moderates relations between physiological and behavioral synchrony and child self-regulation in mother-preschooler dyads.

From a bio-behavioral framework, the relations between physiological synchrony, positive behavioral synchrony, and child self-regulation under varying levels of risk were examined among 93 mother- (M age = 30.44 years, SD = 5.98 years) preschooler (M age = 3.47 years, SD =.52 years, 58.70% male) dyads. Physiological synchrony was examined using interbeat interval (IBI) data and measures of positive behavioral synchrony and self-regulation were based on observations of a mother-child interaction task. Results supported the phenomenon of physiological synchrony among mother-preschooler dyads during an interaction, but not a baseline, task. Moderation analyses indicated that under conditions of high family risk, positive behavioral synchrony and child self-regulation were greater when physiological synchrony was low. Positive behavioral synchrony was positively associated with child self-regulation, regardless of risk status. The results document physiological synchrony among mothers and their preschool-aged children and the complex ways that physiological attunement relates to important developmental processes.

Family Emotion Expressiveness Mediates the Relations Between Maternal Emotion Regulation and Child Emotion Regulation.

While there is a growing body of literature examining the influence of emotion socialization on children's emotional and social development, there is less research on what predicts emotion socialization behaviors among parents. The current study explores maternal emotion regulation difficulties as a predictor of emotion socialization practices, specifically, family emotion expressiveness. Further, the current study examines the role of family emotion expressiveness as a possible mediator of the relations between maternal and child emotion regulation in a community sample of 110 mother-child dyads with preschool-aged children. Analyses revealed that positive family expressiveness mediated the relations between maternal emotion dysregulation and child emotion regulation and thus presents important clinical implications for existing emotion socialization interventions.

Maternal positive affect mediates the link between family risk and preschoolers' positive affect.

The present study sought to further specify conceptual models of youth positive affect (PA) by examining mothers' observed PA as a mediator of the relation between family risk (based on maternal reports of demographic factors) and children's PA in a sample of 82 mothers (M = 31.25 years, SD = 6.16) and their preschool-aged children (M = 3.51 years, SD = .49, 63.00% boys). Results yielded a significant, negative correlation between family risk and child PA. Mediation analyses indicated that family risk was related to child PA through its effects on maternal PA, even after controlling for maternal depression symptoms. Findings suggest that family risk and maternal PA are important factors to consider in understanding preschoolers' PA development. Identifying children at risk for developing PA difficulties can aid in the implementation of prevention and intervention strategies for promoting young children's PA specifically, and their psychosocial functioning more broadly.

The relation of parental emotion dysregulation to children's psychopathology symptoms: the moderating role of child emotion dysregulation.

This study investigated the roles of parents' and children's emotion dysregulation in children's display of internalizing and externalizing symptoms by incorporating person- and variable-centered approaches. Sixty-four children (ages 8-11) participated in this study with their mothers. Study variables were collected via multiple methods, including behavioral observation and questionnaire assessment from both parents' and children's perspectives. Using model-based cluster analysis, children's profiles with regulating emotions were created by incorporating multiple measurements. Two profiles were identified and applied in a moderation model testing whether the combination of parents' and children's regulatory style influence child outcomes. Results showed that children's emotion dysregulation profiles moderated the relationship between parental emotion dysregulation and child internalizing symptoms, with children who adopted more internalizing regulatory styles display more internalizing symptoms in the context of high parental emotion dysregulation. Implications for the measurement of emotion regulation in the family context, and future directions for intervention, are discussed.

A Systematic Review of Parenting Scales Measurement Invariance/ Equivalence of by Race and Ethnicity: Recommendations for Inclusive Parenting Research.

The limited inclusion of racial/ethnic minorities in the development and validation of parenting measures limits our understanding of whether parenting constructs are valid in racial and ethnic minorities. Tests of measurement invariance/equivalence (MI/E) of parenting measures can help evaluate the validity of parenting constructs among racial/ethnic minorities. This systematic review summarized studies on MI/E of parenting constructs by race/ethnicity and evaluated the strength of the evidence. A literature search was conducted using various databases and references to retrieve studies from the United States. Indeed, 10 studies were identified that tested for MI/E of eight parenting scales by race/ethnicity. Only one scale showed moderate evidence of MI/E, five showed weak evidence of MI/E, and two showed no evidence of MI/E. Most studies (80%) used factor analytic methods to test for MI/E, but only two studies (20%) examined all levels of invariance. These findings show that differences exist in how racial/ethnic minorities perceive parenting constructs. Further research is needed to develop more inclusive parenting measures, to protect against the ways in which biased measures may pathologize or misrepresent parenting practices among racial/ethnic minorities.

Augmenting family based treatment with emotion coaching for adolescents with anorexia nervosa and atypical anorexia nervosa: Trial design and methodological report.

This article characterizes the design, recruitment, methodology, participant characteristics, and preliminary feasibility and acceptability of the Families Ending Eating Disorders (FEED) open pilot study. FEED augments family-based treatment (FBT) for adolescents with anorexia nervosa (AN) and atypical anorexia nervosa (AAN) with an emotion coaching (EC) group for parents (i.e., FBT + EC). We targeted families high in critical comments and low warmth (assessed by the Five-Minute Speech Sample), known predictors of poor response in FBT. Eligible participants included adolescents initiating outpatient FBT, diagnosed with AN/AAN, ages 12-17, with a parent high in critical comments/low in warmth. The first phase of the study was an open pilot which demonstrated feasibility and acceptability of FBT + EC. Thus, we proceeded with the small randomized controlled trial (RCT). Eligible families were randomized to either 10 weeks of FBT + EC parent group treatment or the 10- week parent support group (control condition). The primary outcomes were parent critical comments and parental warmth, while our exploratory outcome was adolescent weight restoration. Novel aspects of the trial design (e.g., specifically targeting typical treatment non-responders), as well as recruitment and retention challenges in the context of the COVID-19 pandemic are discussed.

Assessing parenting in racially and ethnically diverse families: A lack of measurement equivalence.

The present study explored measurement invariance of the Multidimensional Assessment of Parenting Scale (MAPS; Parent & Forehand, 2017) across White, Hispanic, Black, and Asian American parents. Participants included 2,734 parents, 58% of whom were mothers. On average, parents were 36.32 years old (SD = 9.54); the parent sample was 66.9% White non-Hispanic, 10.1% Black, 5.3% Asian, and 17.7% Hispanic regardless of race. Child ages ranged from 3 to 17 years (M = 9.84, SD = 3.71), and 58% were identified as male. Parents completed a demographics questionnaire about themselves and their target child, and the 34-item MAPS. We explored measurement equivalence of the MAPS Broadband Positive and Negative parenting scales using item response theory to identify differential item functioning (DIF). Univariate analyses for Positive and Negative Parenting showed reliability was excellent. Twelve items assessing negative aspects of parenting exhibited bias by race/ethnicity. Specifically, when comparing racial and ethnic groups, three items had nonuniform DIF comparing Black and Asian participants, two items had nonuniform DIF comparing Black and Hispanic participants, and one item showed nonuniform DIF comparing Asian and Hispanic participants. When looking at Positive Parenting, no items showed evidence of DIF. Results from the present study suggest broadband Positive Parenting can be compared across ethnoracial groups, while findings raise concern about assessing Negative Parenting items when examining invariance across race and ethnicity. Findings from the present study imply that racial and ethnic comparisons are potentially invalid. These findings offer guidance for improving parenting assessment for racially/ethnically diverse populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Links between maternal and child psychopathology symptoms: mediation through child emotion regulation and moderation through maternal behavior.

This study examined the intergenerational transmission of psychopathology symptoms with 7-12 year-old children (N = 97; 44 boys, 53 girls, M age = 9.14, SD = 1.38) and their mothers (M age = 38.46, SD = 6.86). Child emotion regulation mediated the links between maternal psychopathology and child internalizing and externalizing symptoms. In turn, the indirect effect was dependent on the level of maternal support in response to youth's expressions of negative emotions when considering particular constellations of maternal reactions and type of psychopathology symptoms. The findings indicate that the relations between maternal and child psychopathology symptoms and child emotion regulation are complex and vary by context. Regardless of the complexity, however, for both internalizing and externalizing symptoms in youth, the results suggest that building adaptive emotion regulation skills is an important target for prevention among children who are at risk for problems due to exposure to maternal psychopathology.

Validation of the Regulating Emotions in Parenting Scale (REPS): Factor structure and measurement invariance.

Parenting provides many positive experiences for mothers and fathers but also presents them with many challenges, such as regulating their emotions during interactions with their children. While emotion regulation (ER) has emerged as an important predictor of parenting behavior and a transdiagnostic target of parenting interventions, measures specifically targeting ER in the parenting context are lacking. This study describes the development and evaluation of the Regulating Emotions in Parenting Scale (REPS). Study 1 used an exploratory factor analysis and supported a 3-factor (Adaptive Strategies, Suppression, and Rumination) structure of the REPS in a sample of 331 parents (73% women) recruited from Amazon MTurk (parent Mage = 36.02, SDage = 9.27). This factor structure was confirmed in Study 2 using confirmatory factor analysis in an independent sample of 662 parents (61% women; parent Mage = 36.81, SDage = 14.18). Tests of measurement invariance and differential item functioning provided evidence of invariance of the REPS by gender. Correlations between REPS factors and related measures of parenting, psychopathology, and general ER were in the expected direction; correlations between the REPS and parenting and psychopathology were significantly higher in magnitude than correlations between general measures of ER and parenting and psychopathology. The REPS also explained more of the variance in parenting measures than general measures of ER. These findings indicated that the REPS may provide greater specificity than general measures of ER. Future studies should replicate these findings in other populations and establish invariance by race and ethnicity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Learning to let go: Parental over-engagement predicts poorer self-regulation in kindergartners.

Responsive parenting and parental scaffolding have been shown to foster executive functions (EFs) and self-regulation skills in young children, but could too much parental directive engagement be counterproductive? To answer this question, we examined parental responses when children were demonstrating active on-task behaviors in a community sample of 102 dyads. We measured the time that parents spend actively guiding children's behavior relative to following the child's lead and created a measure of parental over-engagement to index the degree of active parental engagement via positive control/scaffolding behaviors. We hypothesized that parental over-engagement would negatively relate to children's self-regulation and EF skills because it creates fewer opportunities for children to practice self-regulation by leading dyadic interaction with their parents. We used an innovative State-Space Grid method to capture second-to-second changes in parental and child behaviors during a set of structured tasks. We examined the conceptual overlap of over-engagement with the global ratings of parenting, revealing that parental over-engagement was negatively correlated with global ratings of parental scaffolding and unrelated to global ratings of parental sensitivity. Next, we showed that parental over-engagement predicted lower levels of child hot EFs and observed self-regulation, controlling for age, parent education, family income, and global ratings of parenting. The predictive validity of over-engagement was unique to times when the child was actively engaged and was absent when the child was passively engaged. This study contributes to the discussion of how parents can support the development of self-regulation during the transition to elementary school. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Psychological and Physical Intimate Partner Violence and Maternal Depressive Symptoms during the Pre- and Post-Partum Period among Women Living with HIV in rural South Africa.

PURPOSE: Women in South Africa also have high rates of depression and intimate partner violence, and they often co-occur. Women living with HIV who experience IPV are particularly likely to experience elevated levels of depressive symptoms and such symptoms are more likely to persist. Although the association between IPV and depression has been examined extensively, the role of depression on IPV has not. Therefore, this study examined the bidirectional association between intimate partner violence (IPV) and depression in South Africa (SA). METHOD: Participants were N=699 pregnant women with HIV in rural SA who completed measures of depressive symptoms and IPV at baseline (M=17.52±5.77 weeks of pregnancy), 32 weeks antenatally, and 6- and 12-months postnatally. RESULTS: Depressive symptoms were linked to increased psychological IPV from baseline to 32-weeks, and from 32-weeks to 6-months. However, from 6-months to 12-months, depressive symptoms were associated with decreased psychological IPV. Psychological IPV was linked to depressive symptoms from baseline to 32-weeks. Depressive symptoms were associated with physical IPV from 32-weeks to 6-months, and 6-months to 12-months. Physical IPV was associated with increased depressive symptoms from baseline to 32-weeks, and from 32-weeks to 6-months. CONCLUSIONS: Findings merit replication, as there may be measurement differences of psychological IPV in SA. However, targeting depressive symptoms and IPV concurrently in prevention and intervention programs may help optimize maternal and child outcomes in the context of prevention of mother-to-child transmission of HIV.