PCIT engagement and persistence among child welfare-involved families: Associations with harsh parenting, physiological reactivity, and social cognitive processes at intake.

Parent-Child interaction therapy (PCIT) has been shown to improve positive, responsive parenting and lower risk for child maltreatment (CM), including among families who are already involved in the child welfare system. However, higher risk families show higher rates of treatment attrition, limiting effectiveness. In N = 120 child welfare families randomized to PCIT, we tested behavioral and physiological markers of parent self-regulation and socio-cognitive processes assessed at pre-intervention as predictors of retention in PCIT. Results of multinomial logistic regressions indicate that parents who declined treatment displayed more negative parenting, greater perceptions of child responsibility and control in adult-child transactions, respiratory sinus arrhythmia (RSA) increases to a positive dyadic interaction task, and RSA withdrawal to a challenging, dyadic toy clean-up task. Increased odds of dropout during PCIT's child-directed interaction phase were associated with greater parent attentional bias to angry facial cues on an emotional go/no-go task. Hostile attributions about one's child predicted risk for dropout during the parent-directed interaction phase, and readiness for change scores predicted higher odds of treatment completion. Implications for intervening with child welfare-involved families are discussed along with study limitations.

Person-centered profiles of parasympathetic physiology, anxiety symptoms, and depressive symptoms in mothers and fathers of young children.

Respiratory sinus arrhythmia (RSA) is a biomarker of mental health, but RSA-symptom relations in parents of young children are understudied. We examined how anxiety symptoms, depressive symptoms, resting RSA, and RSA reactivity during challenging parent-child interactions clustered in a community sample of mothers (N = 126) and fathers (N = 87) of 3-year-olds and whether profiles predicted child emotional and behavioral dysregulation at age 4. Mothers fit four profiles (Typical, Mild Risk, Moderate Risk/Withdrawal, and Moderate Risk/Augmentation), suggesting that RSA reactivity was distinct by predominant symptom type at higher levels of risk: specifically, heightened RSA withdrawal was associated with a higher probability of anxiety symptoms and RSA augmentation was associated with a higher probability of depressive symptoms. Fathers fit three profiles (Typical, Mild Risk, and Moderate Risk) where Moderate Risk was characterized by RSA augmentation and a higher probability of both anxiety and depressive symptoms. Mild risk profiles showed heightened resting RSA for mothers and fathers but no differences in RSA reactivity. Both mild and moderate risk profiles predicted higher child dysregulation 1 year later compared to typical profiles. Findings offer preliminary evidence that parasympathetic physiology covaries with symptoms differently for mothers and fathers and that parental profiles of physiology and symptoms inform children's developmental psychopathology.

The effects of maternal respiratory sinus arrhythmia and behavioral engagement on mother-child physiological coregulation.

Parent-child coregulation is thought to be an important precursor for children's developing self-regulation, but we know little about how individual parent factors shape parent-child physiological coregulation. We examined whether maternal baseline respiratory sinus arrhythmia (RSA), teaching, and disengagement were associated with stronger or weaker coregulation of RSA between mothers and their 3-year-old children (N = 47), modeled across 18 min of observed dyadic interaction using multilevel coupled autoregressive models. Whereas greater maternal teaching was associated with stronger coregulation in mother and child RSA over time, maternal disengagement was related to weaker coregulation, specifically more divergent parent and child RSA at higher levels of maternal disengagement. Coregulation of mother-child RSA was also weaker when mothers' baseline RSA was higher. Findings contribute to the emerging knowledge base on real-time patterns of parent-child physiological coregulation in early childhood and suggest that mothers' physiology and behavioral engagement with the child play an important role in mother-child physiological coregulation patterns.

Randomized trial of parent-child interaction therapy improves child-welfare parents' behavior, self-regulation, and self-perceptions.

OBJECTIVE: We conducted a large (N = 204) randomized, clinical trial to test the efficacy of parent-child interaction therapy (PCIT) on observed parenting, two key drivers of maladaptive parenting-self-regulation and social cognitions, and child behavior outcomes in a sample of child welfare-involved families. METHOD: Participants were randomly assigned to standard PCIT (n = 120) or services-as-usual (SAU; n = 84). The sample was characterized by low household income, significant exposures to adverse childhood experiences, and substance abuse. Intention-to-treat analyses were conducted on multiply imputed data followed by secondary per-protocol analyses. RESULTS: Significant PCIT effects emerged on (a) increased positive parenting, reduced negative parenting and disruptive child behavior (small-to-medium intention-to-treat effects and medium-to-large per-protocol effects); (b) gains in parent inhibitory control on the stop-signal task (small-to-medium effects); (c) gains in parent-reported emotion regulation and (d) positive, affirming self-perceptions (small-to-medium effects), relative to the SAU control group. PCIT's effects on gains in parent emotion regulation were mediated by reductions in observed negative parenting. No differences in rates of parent commands or child compliance were observed across conditions. Harsh child attributions moderated treatment impact on parenting skills acquisition. PCIT parents who held harsher attributions displayed greater gains in use of labeled praises and declines in negative talk/criticism with their child, than control group parents. CONCLUSIONS: This randomized trial presents the first evidence that PCIT improves inhibitory control and emotion regulation in a child welfare parents and replicates other published trials documenting intervention gains in positive parenting and child behavior in child welfare families. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parental depressive symptoms, parent-child dyadic behavioral variability, and child dysregulation.

Parental depressive symptoms are associated with greater variability and inconsistency in parenting behavior as well as children's emotional and behavioral dysregulation. The present study explored whether such relations extended to dyadic processes, examining whether maternal and paternal depressive symptoms at child age 3½ interacted with concurrent higher dyadic behavioral variability (DBV) in mother-child free play to heighten children's emotional and behavioral dysregulation at age 4 (N = 100). Child dysregulation was measured as mother-reported emotional lability-negativity and externalizing problems, and DBV was measured as the number of transitions among dyadic behavioral states using state space grids. Parent behaviors included parent directives, positive reinforcement, and disengagement, and child behaviors included child compliance, persistence, and noncompliance, among others. Analyses also accounted for the degree of positive (compared to negative) behavioral content. Moderation analyses showed that DBV predicted greater child dysregulation only when maternal or paternal depressive symptoms were higher. Further, DBV was detrimental only when dyadic positive interaction content was low. Findings suggest DBV combined with low positive content in parent-child interactions is a particular risk factor for children's regulatory development. Fostering positive, predictable interaction patterns may be an important target for family interventions with a depressed parent. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parent-child coregulation of parasympathetic processes varies by social context and risk for psychopathology.

The parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent-child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent-child interactions showed overall dynamic, positive concordance in mother-child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother-child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent-child physiological coregulation are discussed.

Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes.

Altered stress response theoretically contributes to the etiology of cardiometabolic disease. Mindfulness may be a protective buffer against the effects of stress on health outcomes by altering how individuals evaluate and respond to stress. We engaged adolescent girls at risk for developing Type 2 diabetes in a cold-pressor test in order to determine the relationship of dispositional mindfulness to cortisol response and subjective stress, including perceived pain and unpleasantness during the stressor, and negative affect following the stressor. We also evaluated mindfulness as a moderator of psychological distress (depressive/anxiety symptoms) and stress response. Participants were 119 girls age 12-17 years with overweight/obesity, family history of diabetes, and mild-to-moderate depressive symptoms. Greater mindfulness was associated with less perceived pain and negative affect, but was unrelated to cortisol response to the stressor. Regardless of mindfulness, greater depressive/anxiety symptoms related to a more blunted cortisol response. Mindfulness might promote better distress tolerance in adolescents at risk for diabetes by altering how youth perceive and relate to acute stress, rather than through altering the physiological stress response. At all levels of mindfulness, depressive/anxiety symptoms relate to greater blunting of cortisol response. Findings contribute to emerging literature on the role of mindfulness in promoting the mental and physical health and well-being of individuals at risk for Type 2 diabetes.

Pilot randomized controlled trial of a mindfulness-based group intervention in adolescent girls at risk for type 2 diabetes with depressive symptoms.

OBJECTIVE: (1) Evaluate feasibility and acceptability of a mindfulness-based group in adolescent girls at-risk for type 2 diabetes (T2D) with depressive symptoms, and (2) compare efficacy of a mindfulness-based versus cognitive-behavioral group for decreasing depressive symptoms and improving insulin resistance. DESIGN AND SETTING: Parallel-group, randomized controlled pilot trial conducted at a university. PARTICIPANTS: Thirty-three girls 12-17y with overweight/obesity, family history of diabetes, and elevated depressive symptoms were randomized to a six-week mindfulness-based (n=17) or cognitive-behavioral program (n=16). INTERVENTIONS: Both interventions included six, one-hour weekly group sessions. The mindfulness-based program included guided mindfulness awareness practices. The cognitive-behavioral program involved cognitive restructuring and behavioral activation. MAIN OUTCOME MEASURES: Adolescents were evaluated at baseline, post-intervention, and six-months. Feasibility/acceptability were measured by attendance and program ratings. Depressive symptoms were assessed by validated survey. Insulin resistance was determined from fasting insulin and glucose, and dual energy x-ray absorptiometry was used to assess body composition. RESULTS: Most adolescents attended ≥80% sessions (mindfulness: 92% versus cognitive-behavioral: 87%, p=1.00). Acceptability ratings were strong. At post-treatment and six-months, adolescents in the mindfulness condition had greater decreases in depressive symptoms than adolescents in the cognitive-behavioral condition (ps<.05). Compared to the cognitive-behavioral condition, adolescents in the mindfulness-based intervention also had greater decreases in insulin resistance and fasting insulin at post-treatment, adjusting for fat mass and other covariates (ps<.05). CONCLUSIONS: A mindfulness-based intervention shows feasibility and acceptability in girls at-risk for T2D with depressive symptoms. Compared to a cognitive-behavioral program, after the intervention, adolescents who received mindfulness showed greater reductions in depressive symptoms and better insulin resistance. ClinicalTrials.gov identifier: NCT02218138 clinicaltrials.gov.

Response monitoring and cognitive control in childhood obesity.

The ability to discern when actions deviate from goals and adjust behavior accordingly is crucial for efforts at self-regulation, including managing one's weight. We examined whether children with obesity differed from controls in response monitoring, an aspect of cognitive control that involves registering one's errors. Participants performed a cognitive interference task, responding to the colors of arrows while ignoring their orientations, and error-related neural activity was indexed via response-locked event-related potentials (ERPs). Compared to controls, participants with obesity exhibited significantly blunted "error-related negativity", an ERP component linked to response monitoring. Participants with obesity also exhibited a marginally blunted "error-related positivity", an ERP component linked to late-stage error processing, as well as in behavioral indices of cognitive control. These results suggest that childhood obesity may be associated with reduced response monitoring and that this aspect of cognitive control may play an important role in health-related self-regulatory behavior.