Family and parenting factors are associated with emotion regulation neural function in early adolescent girls with elevated internalizing symptoms.

A prominent tripartite model proposes that parent role modeling of emotion regulation, emotion socialization behaviors, and the emotional climate of the family are important for young people's emotional development. However, limited research has examined the neural mechanisms at play. Here, we examined the associations between family and parenting factors, the neural correlates of emotional reactivity and regulation, and internalizing symptoms in early adolescent girls. Sixty-four female adolescents aged 10-12 years with elevated internalizing symptoms completed emotional reactivity, implicit (affect labeling) and explicit (cognitive reappraisal) emotion regulation tasks during functional magnetic resonance imaging. Positive family emotional climate was associated with greater activation in the anterior cingulate and middle temporal cortices during emotional reactivity. Maternal emotion regulation difficulties were associated with increased frontal pole and supramarginal gyrus activation during affect labeling, whereas supportive maternal emotion socialization and positive family emotional climate were associated with activation in prefrontal regions, including inferior frontal and superior frontal gyri, respectively, during cognitive reappraisal. No mediating effects of brain function were observed in the associations between family/parenting factors and adolescent symptoms. These findings highlight the role of family and parenting behaviors in adolescent emotion regulation neurobiology, and contribute to prominent models of adolescent emotional development.

Development and psychometric evaluation of a new domain-specific coparenting measure: Coparenting Children's Emotion Scale.

Caregivers play an integral role in supporting children's development, not only through their individual parenting practices but also how they work together as coparents. The literature on coparenting is extensive; however, most of the research has relied on global measures to assess the quality and functioning of the coparenting relationship. Examining the coparenting relationship with domain-specific measures enables a deeper understanding of this complex family process. One domain of particular interest is emotion socialization given the vast and long-term consequences emotion socialization has on children's emotional, social, behavioral, and psychological functioning. Emotion socialization literature would benefit from a domain-specific coparenting measure, as researchers have rarely explored how coparents work together when responding to their children's emotions (i.e., coparenting children's emotions). As such, an emotion-focused coparenting measure could address gaps in both coparenting and emotion socialization literature. This study outlines the development and psychometric evaluation of a domain-specific measure of coparenting, the Coparenting Children's Emotion Scale (CCES), which assesses how parents work together when responding to their children's emotions. In the current study, the factor structure, reliability, and validity of the CCES were examined in an Australian sample. Findings from exploratory and confirmatory factor analyses showed that the CCES comprises two subscales that capture coparents' levels of support/cooperation and undermining. In the current sample, both CCES subscales demonstrated good to excellent internal consistency, and good convergent and concurrent validity. The CCES will provide researchers and practitioners with a domain-specific measure to use in exploratory and intervention research.

Up you get: Norwegian parents' reactions to children's negative emotions.

INTRODUCTION: Developmental research suggests that children learn to regulate their emotions and behavior through a process of emotion socialization. The main body of literature is based on samples from the United States, and very little is known about the socialization of emotions in Nordic settings. OBJECTIVES: The current study aimed to explore associations between mothers' and fathers' reactions to children's negative emotions and externalizing behavior problems in a Nordic cultural context, and to explore gender differences in these associations. METHODS: Parent-report data on the Coping with Children's Negative Emotions Scale (CCNES) and the Eyberg Child Behavior Inventory 6 (ECBI) was collected in a large sample of Norwegian preschool-aged children (mothers, n = 242; fathers, n = 183; N = 257; M = 54 months, SD = 4.54; 49% boys). Teacher-report data was collected using the Strengths and Difficulties Questionnaire (SDQ) conduct scale (n = 117). RESULTS: Both parents' supportive and non-supportive reactions were associated with child externalizing difficulties in expected directions as evidenced by path models, controlling for socioeconomic status and age. A pattern emerged in which non-supportive reactions to a greater extent predicted an increase in externalizing problems in girls, and supportive reactions predicted lower levels of externalizing problems in boys. CONCLUSION: Our findings supported the basic assumptions of emotion socialization theory in a Nordic cultural context in which parental supportive and non-supportive responses are related to child externalizing difficulties. Nordic parents are important socialization agents for their children, but their behaviors had a differential effect on boys' and girls' externalizing behavior problems.

Same name, different representational levels? Misalignment of indirect parent-reported and direct alternative forced choice measures of emotion word comprehension in preschool children.

This study assessed the relationship between preschoolers' directly and indirectly assessed emotion word comprehension. Forty-nine two-to-five-year-old Norwegian children were assessed in a tablet-based 4-alternative forced choice (AFC) task on their comprehension of six basic and six complex emotions using facial expression photographs. Parents reported emotion word comprehension and production of the same words. Parent-reported emotion word production interacted with age to predict preschoolers' performance, with a parent-child alignment only observed for older children. Parent-reported word comprehension did not significantly predict accuracy. The results suggest that, in preschoolers, direct and indirect assessments might address distinct representational levels of emotion word comprehension.

Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families.

Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.

Pathways to behavior problems in Norwegian kindergarten children: The role of parent emotion socialization and child emotion understanding.

More than two decades of research have shown that parental emotion-related socialization behaviors (ERSBs) significantly predict child emotion understanding and externalizing behavior problems. This study aimed to replicate these findings in a sample of 40 Norwegian preschool children and to test whether the effect of parental ERSBs on externalizing child behavior problems was mediated through child emotion understanding. Parental report on ERSBs was obtained using the Coping with Children's Negative Emotions Scale (CCNES) questionnaire. Child emotion understanding was assessed directly using the Test of Emotion Comprehension (TEC). The results showed that parental distress reactions and externalizing child behavior problems were significantly correlated and that parental expressive encouragement was significantly correlated with child emotion understanding. Estimation of indirect effects was conducted using process analysis and showed that parental expressive encouragement was indirectly related to externalizing child behavior problems (b = -0.17) via child emotion understanding. The results suggest that better child emotion understanding, and lower parental distress are related to lower levels of behavior problems in preschool children. These findings provide support for the Parental Meta-Emotion Philosophy (PMEP) model, where the effect of parental emotion socialization on externalizing child behavior problems is mediated through emotion understanding.

A controlled trial of implementing a complex mental health intervention for carers of vulnerable young people living in out-of-home care: the ripple project.

BACKGROUND: Out-of-home care (OoHC) refers to young people removed from their families by the state because of abuse, neglect or other adversities. Many of the young people experience poor mental health and social function before, during and after leaving care. Rigorously evaluated interventions are urgently required. This publication describes the protocol for the Ripple project and notes early findings from a controlled trial demonstrating the feasibility of the work. The Ripple project is implementing and evaluating a complex mental health intervention that aims to strengthen the therapeutic capacities of carers and case managers of young people (12-17 years) in OoHC. METHODS: The study is conducted in partnership with mental health, substance abuse and social services in Melbourne, with young people as participants. It has three parts: 1. Needs assessment and implementation of a complex mental health intervention; 2. A 3-year controlled trial of the mental health, social and economic outcomes; and 3. Nested process evaluation of the intervention. RESULTS: Early findings characterising the young people, their carers and case managers and implementing the intervention are available. The trial Wave 1 includes interviews with 176 young people, 52% of those eligible in the study population, 104 carers and 79 case managers. CONCLUSIONS: Implementing and researching an affordable service system intervention appears feasible and likely to be applicable in other places and countries. Success of the intervention will potentially contribute to reducing mental ill-health among these young people, including suicide attempts, self-harm and substance abuse, as well as reducing homelessness, social isolation and contact with the criminal justice system. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000501549 . Retrospectively registered 19 May 2015.

Comparing an Emotion- and a Behavior-Focused Parenting Program as Part of a Multsystemic Intervention for Child Conduct Problems.

This study evaluated the effectiveness of a multisystemic early intervention that included a comparison of an emotion- and behavior-focused parenting program for children with emerging conduct problems. The processes that moderated positive child outcomes were also explored. A repeated measures cluster randomized group design methodology was employed with three conditions (Tuning in to Kids, Positive Parenting Program, and waitlist control) and two periods (preintervention and 6-month follow-up). The sample consisted of 320 predominantly Caucasian 4- to 9-year-old children who were screened for disruptive behavior problems. Three outcome measures of child conduct problems were evaluated using a parent (Eyberg Child Behavior Inventory) and teacher (Strengths and Difficulties Questionnaire) rating scale and a structured child interview (Home Interview With Child). Six moderators were assessed using family demographic information and a parent-rated measure of psychological well-being (Depression Anxiety and Stress Scales short form). The results indicated that the multisystemic intervention was effective compared to a control group and that, despite different theoretical orientations, the emotion- and behavior-focused parenting programs were equally effective in reducing child conduct problems. Child age and parent psychological well-being moderated intervention response. This effectiveness trial supports the use of either emotion- or behavior-focused parenting programs in a multisystemic early intervention and provides greater choice for practitioners in the selection of specific programs.

Tuning in to teens: Improving parental responses to anger and reducing youth externalizing behavior problems.

Parent emotion socialization plays an important role in shaping emotional and behavioral development during adolescence. The Tuning in to Teens (TINT) program aims to improve parents' responses to young people's emotions with a focus on teaching emotion coaching. This study examined the efficacy of the TINT program in improving emotion socialization practices in parents and whether this reduced family conflict and youth externalizing difficulties. Schools were randomized into intervention and control conditions and 225 primary caregiving parents and 224 youth took part in the study. Self-report data was collected from parents and youth during the young person's final year of elementary school and again in their first year of secondary school. Multilevel analyses showed significant improvements in parent's impulse control difficulties and emotion socialization, as well as significant reductions in family conflict and youth externalizing difficulties. This study provides support for the TINT program in reducing youth externalizing behavior problems.

A self-paced online emotion socialization intervention for parents of children with challenging behavior: Tuning in to Kids OnLine.

Background: Evidence-based parenting programs delivered using online technology are an important way to enhance program uptake. To date, programs that address emotion socialization processes, such as Tuning in to Kids, have always been delivered in person, via group or one-to-one delivery. This study used a randomized control design to examine the efficacy of the self-paced Tuning in to Kids OnLine (TIKOL). Method: Participants were 150 parents of children aged 4-10 years old with challenging behaviors, randomized into intervention or 10-month waitlist control. Parents and teachers completed questionnaires at baseline and 6 months after the intervention (equivalent time points for controls) measuring parent wellbeing, parent emotion socialization, parent efficacy, child behavior, and anxiety. Results: Analyses, using mixed methods multilevel modeling, showed that intervention parents reported significantly reduced emotion dismissiveness and increased emotion coaching, empathy and efficacy compared to controls who did not. Parents participating in TIKOL also reported that their children's behavior problems and anxiety were significantly improved. Greater engagement (modules watched and duration of support calls) was associated with more significant improvements. Conclusion: Findings provide preliminary support for the efficacy of TIKOL in improving parents' emotion socialization and reducing child behavior problems and anxiety, especially when efforts to support online engagement are utilized. Further evaluation using independent observations and a sample representing a wider demographic would strengthen these findings. Clinical trial registration: Australian and New Zealand Clinical Trials Registry No. ACTRN12618000310268.

"Tuning into Kids": reducing young children's behavior problems using an emotion coaching parenting program.

This study evaluated a 6-session group parenting program, Tuning into Kids (TIK), as treatment for young children (aged 4.0-5.11 years) with behavior problems. TIK targets parent emotion socialization (parent emotion awareness, regulation and emotion coaching skills). Fifty-four parents, recruited via a child behavior clinic, were randomized into intervention (TIK) or waitlist (clinical treatment as usual). Parents reported emotion awareness/regulation, emotion coaching, empathy and child behavior (pre-intervention, post-intervention, 6-month follow-up); teachers reported child behavior and observers rated parent-child emotion coaching and child emotion knowledge (pre-intervention, follow-up). Data were analyzed using growth curve modeling and ANCOVA. Parents in both conditions reported less emotional dismissiveness and reduced child behavior problems; in the intervention group, parents also reported greater empathy and had improved observed emotion coaching skills; their children had greater emotion knowledge and reduced teacher-reported behavior problems. TIK appears to be a promising addition to treatment for child behavior problems.

Evaluating an emotion coaching programme for parents of young adolescents attending Child Adolescent Mental Health Services (CAMHS) in New Zealand: protocol for a multi-site feasibility trial including co-design with service users.

BACKGROUND: Early adolescence is a time of increased vulnerability for the development of common mental health conditions such as anxiety and depression (internalising outcomes). Current treatments such as cognitive-behavioural therapy and antidepressant medication are focused on the individual and have small effect sizes, particularly in real-world clinical settings such as the public Child Adolescent Mental Health Services (CAMHS). Parents are an important and under-utilised resource in treating these conditions in young adolescents. Teaching parents how to respond to their young person's emotions can improve emotion regulation and reduce internalising outcomes. One emotion-focused programme for parents of this age group is Tuning in to Teens (TINT). This is a structured, manualised skills group for parents only focused on teaching skills to coach young people through their emotional experiences. This study aims to investigate the impact of TINT in the clinical setting of publicly funded CAMHS in New Zealand. METHODS: The trial will evaluate the feasibility of a two-arm multi-site randomised control trial (RCT). Participants will be 10-14-year-olds referred to CAMHS in Wellington, New Zealand, with anxiety or depression, and their parents or guardians. Arm 1 will be parents attending and implementing TINT (in addition to the usual care received at CAMHS). Arm 2 will be usual care only. TINT groups will be facilitated by CAMHS clinicians who have been trained in the programme and will be delivered over 8 weekly sessions. Prior to the RCT, a co-design methodology will be used with service users to inform outcome measures used in the trial. A group of service users meeting the RCT criteria will be recruited to take part in workshops to help determine their priority outcomes. Measures based on the results of workshops will be included in the outcome measures. The primary feasibility outcomes will be the recruitment and retention of participants, acceptability of the intervention for service users and clinicians and acceptability of outcome measures. DISCUSSION: There is a need to improve outcomes for the treatment of adolescent anxiety and depression. TINT is a programme with the potential to enhance outcomes for those accessing mental health services by providing targeted support to parents of adolescents. This trial will inform whether a full RCT is feasible to evaluate TINT. Including service users in the design will increase its relevance of an evaluation in this setting. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ACTRN): ACTRN12622000483752. Registered on 28 March 2022.

Qualitative evaluation of the implementation of "Tuning in to Kids" in Norwegian Kindergartens.

BACKGROUND: From January to June 2020, 22 FUS kindergartens across Norway implemented Tuning in to Kids for Kindergarten Teachers (TIK-KT) as part of a randomized control trial (RCT). Between the evaluation of an intervention and use of it in daily practice, a research-to-practice gap can often occur. The theory of planned behavior constituted the theoretical basis for the qualitative interviews that were administered to explore these gaps. This study aimed to explore motivation among kindergarten staff regarding the implementation of TIK-KT. METHODS: Participants from the FUS kindergartens RCT were part of the current study. A stepwise deductive inductive strategy was used in the thematic content analysis. The data were from eleven semi-structured telephone interviews with kindergarten leaders and teachers. Codes from interviews before and after implementation were grouped based on thematic connections, and code groups were further combined into themes. The Consolidated criteria for reporting qualitative research were used as a reporting standard. RESULTS: The interviews resulted in four main themes: (1) understanding the rationale of implementation, (2) "aha"-experiences, (3) the research-to-practice gap and (4) the main motivation. Kindergarten leaders and teachers expressed positive attitudes toward the intervention ideas and motivation to practice emotion coaching skills and toward implementing TIK-KT both before and after implementation. CONCLUSION: Kindergarten leaders' and teachers' motivation for implementation came from having a good understanding of the ideas of Tuning in to Kids for Kindergarten Teachers (TIK-KT), experiencing moments of "aha" regarding the intervention, not being held back by practical issues, and working toward their ultimate goal, the wellbeing of the children. These findings have implications for future implementation of TIK-KT and other mental health-promoting interventions and guide further areas of research to examine implementation mechanisms. TRIAL REGISTRATION: The study was registered with the Clinical Trials Registry (NCT03985124), June 13th, 2019.

Creation of a Short-Form and Brief Short-Form Version of the Coping With Children's Negative Emotions Scale.

The Coping with Children's Negative Emotions Scale (CCNES) is a widely used measure of parent emotion socialization; however, it is a lengthy measure and it is unclear whether all items are appropriately aligned with, and fully capture, the underlying constructs. We aimed to examine content validity of the CCNES, evaluate the theoretical alignment between the CCNES and Gottman, Katz and Hooven's meta-emotion theory, and develop two short-forms. Participants were parents of children aged 4 to 10 years (N = 937) from the longitudinal study the Child and Parent Emotion Study (https://bmjopen.bmj.com/content/10/10/e038124). Content experts qualitatively evaluated parent-report items of the CCNES and additional items that measured empathy. Nineteen of the 84 items were found to not align with the meta-emotion theory. The latent structures of the CCNES and empathy subscales were quantitatively evaluated via confirmatory factor analysis. Items with poor psychometric properties were subsequently removed. An 18-item short-form (three emotion coaching subscales, three emotion dismissing subscales) and 6-item brief short-form (one emotion coaching subscale, one emotion dismissing subscale) with strong psychometric properties were created using a calibration sample (n = 468, that is, 50% of N = 937) and cross-validated with a validation sample. The short-form CCNES measures provide viable, theoretically consistent alternatives to the original CCNES measure.

Profiles of parents' emotion socialization within a multinational sample of parents.

Introduction: Seminal emotion socialization theories classify parents according to two patterns of parent emotion socialization processes: 'emotion coaching' (i.e., parents validate and teach children about emotions) versus 'emotion dismissing' parenting (i.e., parents minimize and dismiss their children's emotions). However, empirical evidence supporting this binary distinction of parents remains limited. Our objective was to investigate whether parents can be differentiated by distinct patterns in their (1) beliefs about children's emotions, (2) emotion regulation, and (3) emotion-related parenting practices. Method: Participants were parents of children aged 4-10 years from the Child and Parent Emotion Study (N = 869) (https://bmjopen.bmj.com/content/10/10/e038124). Parents completed self-reported measures of emotion socialization processes via an online survey, which took 20-30 min to complete. Data included in the current study were collected May-August 2019. We conducted a latent profile analysis of parents' emotion socialization (13 indicators). To assess reliability of the profiles, we examined stability of the profiles across (1) parents of children in early versus middle childhood, and (2) fathers versus mothers, via measurement invariance testing. Further, to assess for construct validity of the profiles, we examined concurrent associations between six criterion constructs and parents' emotion socialization profiles. Results: A three-profile model emerged characterizing parents by: (1) emotion coaching; (2) emotion dismissing; (3) emotion disengaged. There was strong support for construct validity and reliability. Discussion: Our study provides empirical support for distinct differentiated classifications of emotion coaching and emotion dismissing parenting, aligned with emotion socialization theories. We further extend on extant theory and suggest a third 'emotion disengaged' classification, describing parents with moderate levels of emotion dismissing parenting and low levels of emotion coaching parenting. It should be noted that the profiles were derived with self-report data, therefore, data may have been biased by contextual factors. Furthermore, the study sample consisted of Western families from affluent backgrounds. The field should focus efforts on conducting person-centered studies with more diverse samples in future.

Corporal punishment of children in Australia: The evidence-based case for legislative reform.

OBJECTIVE: Across all of Australia's states and territories, it is legal for a parent or carer to hit their child. In this paper, we outline the legal context for corporal punishment in Australia and the argument for its reform. METHODS: We review the laws that allow corporal punishment, the international agreements on children's rights, the evidence on the effects of corporal punishment, and outcomes of legislative reform in countries that have changed their laws to prohibit corporal punishment. RESULTS: Legislative reform typically precedes attitude changes and reductions in the use of corporal punishment. Countries with the most ideal outcomes have instigated public health campaigns educating the population about law reform while also providing access to alternative non-violent discipline strategies. CONCLUSIONS: Extensive evidence exists demonstrating the adverse effects of corporal punishment. When countries change legislation, educate the public about these effects, and provide alternative strategies for parents, rates of corporal punishment decrease. IMPLICATIONS FOR PUBLIC HEALTH: We recommend law reform in Australia to prohibit corporal punishment, a public health campaign to increase awareness of corporal punishment and its effects, provision of access for parents to alternative evidence-based strategies to assist in parenting, and a national parenting survey to monitor outcomes.

The contribution of parenting practices and parent emotion factors in children at risk for disruptive behavior disorders.

The goal of this study was to examine the impact of different parenting characteristics on child disruptive behavior and emotional regulation among a sample of at-risk children. The sample consisted of 373 Australian 5- to 9-year-old children who were screened for serious behavior problems. Seven parenting variables based on self-report were evaluated, involving parenting practices, emotion beliefs and behaviors, emotion expressiveness, and mental health. Outcome variables based on parent/teacher report were child disruptive behavior problems and emotion regulatory ability. When entered simultaneously in a multiple regression analysis, inconsistent discipline, negative parental emotional expressiveness, and parent mental health demonstrated the strongest relationship to disruptive behavior problems and problems with emotion regulation. The data presented here elucidate multiple risk pathways to disruptive behavior disorders and can inform the design of prevention and early intervention programs.

Childhood Disintegrative Disorder (CDD): Symptomatology of the Norwegian Patient Population and Parents' Experiences of Patient Regression.

Childhood Disintegrative Disorder (CDD) is a rare and little researched developmental disorder characterised by regression in language and social skills after a period of seemingly normal development until at least the age of 2 years. The study contacted all parents of CDD patients in Norway to assess patient symptomatology and parents' experiences of regression via questionnaire or interview. There were 12 participants. Symptomatology was in-line with previous studies, with universal regression in language and social skills and onset predominantly at 2-4 years. Regression was connected to feelings of 'loss' and uncertainty over the prognosis for CDD patients. The study supported CDD diagnostic criteria and showed that CDD patient regression has profound implications for parental well-being.

The Interplay of Parental Response to Anger, Adolescent Anger Regulation, and Externalizing and Internalizing Problems: A Longitudinal Study.

Numerous studies have reported substantive correlations between anger socialization, children's anger regulation, and internalizing/externalizing problems. However, substantially less is known about the interplay among these constructs during the developmental stage of adolescence, and longitudinal studies on causal relations (i.e., parent-directed, adolescent-directed, or reciprocal effects) are rare. It is also unclear whether the development of internalizing and externalizing problems have similar causal relations. We collected three waves of longitudinal data (Grade 6, Grade 7, Grade 9) from multiple informants. A sample of N = 634 adolescents (mostly 11-12 years at Time 1; 50.6% male) and their parents (predominantly Caucasian with German nationality) completed questionnaires assessing parents' responses to anger, adolescents' anger regulation, and adolescents' internalizing/externalizing problems at each wave. Comparisons of different cross-lagged models revealed reciprocal rather than unidirectional effects. However, we found more parent-directed effects with respect to the development of internalizing problems, whereas relations regarding externalizing problems were more adolescent-directed, i.e., adolescents' externalizing problems and their anger regulation predicted changes in their parents' responses to anger across time. Adolescent anger regulation was an important maintaining factor of parents' responses to anger in later adolescence. Our findings suggest that assumptions regarding bidirectional relations should be emphasized much more in emotion socialization frameworks, particularly for the period of adolescence. Moreover, our study emphasizes the transdiagnostic importance of parents' responses to anger for both externalizing and internalizing problems and also suggests different underlying mechanisms.

A randomized controlled trial of an emotion socialization parenting program and its impact on parenting, children's behavior and parent and child stress cortisol: Tuning in to Toddlers.

This paper examines the efficacy of a universally-offered parenting program, Tuning in to Toddlers (TOTS), that aims to improve parent emotion socialization, reduce parent and toddler stress and improve social, emotional, and behavioral functioning in toddlers. Three hundred parents of an 18-36 month old toddler were cluster randomized into intervention or control. Parents in the intervention participated in 6 × 2 h group sessions of TOTS. Baseline and 12-months post-intervention measures were collected using parent-report questionnaires and hair samples from parents and toddlers of systemic cortisol stress. Compared to controls, intervention parents reported significantly greater reductions in difficulties in emotion regulation (difficulty remaining goal directed: 95% CI.10, 1.71, p = .028; lack of access to strategies: 95% CI 0.62, 2.42, p = .001), emotion dismissing (beliefs: 95% CI 2.33,4.82, p < .001; behaviors: 95% CI 0.32, 0.65, p = <.001), greater increase in empathy (95% CI -2.83, -1.50, p < .001), emotion coaching (beliefs: 95% CI -2.56, -0.27, p = .016; behaviors: 95% CI -0.58, -0.24, p = <.001), children's behavior (95% CI 0.19, 2.43, p = .022) and competence (95% CI -1.46, -0.22, p = .008). Significant greater reductions in systemic cortisol were found for intervention but not control children (95% CI 0.01, 0.35, p = .041). Findings provide preliminary support for the use of TOTS as a universal prevention program to improve parent emotion socialization and children's functioning. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12615000962538.