Multiple Informant Cluster Analysis Findings: Which Military-Connected Preschool Aged Children Are Doing Well and Why?

Informed by models of resilience in military families, we explored factors theorized to be associated with social-emotional resilience and risk among young military-connected children. Our secondary analysis of cross-sectional data from 199 military-connected families (n = 346 parents) with at least one preschool-age child in the home (n = 199) led to the empirical identification of two distinct clusters: families with children demonstrating healthy social-emotional functioning and those showing indicators of poor social-emotional functioning. We then identified factors associated with membership in each cluster to determine which deployment and parental wellbeing variables were salient for young child adjustment. Parent psychological health symptoms, parenting, child behavior, and parent-child relationships were measured by parent report and observed interaction. Children with healthier social-emotional functioning were found to be residing with families experiencing less stress and distress. The importance of maternal trauma history is highlighted in our study, as elevated maternal symptoms across all three posttraumatic stress disorder symptom domains were associated with child social-emotional risk. Basic family demographic characteristics did not contribute significantly to the cluster distinctions, nor did military service factors such as active duty, reserve or veteran status, military rank or parent deployment history. These findings are important as the results deemphasize the importance of military service characteristics and highlight the importance of parent wellbeing when considering social-emotional risk and resilience of young children within military families.

Hybrid delivery of behavioral health screening and prevention intervention for pediatric heart transplant recipients and families: A randomized pilot study.

BACKGROUND: A significant number of pediatric heart transplant recipients and their families experience post-traumatic stress symptoms following transplantation, which can impact recipient behavioral and medical health outcomes. Preventive behavioral health interventions may improve outcomes, especially if interventions can be delivered at a distance to decrease barriers to mental health care. This pilot study examined the acceptability and accessibility of an evidence-informed resilience training program delivered using a video telehealth platform. A secondary aim was to assess the preliminary efficacy of the intervention on recipient behavioral health outcomes, perceived barriers to recipient medication adherence, parent behavioral health outcomes, and family functioning. METHODS: Seventeen heart transplant recipients (8-18 years old) and their families were recruited and randomly assigned to a treatment as usual (n = 8) or an intervention group (n = 9). Baseline assessment data collected included demographic information and validated behavioral health measures. Follow-up assessments included the validated measures and acceptability and satisfaction ratings. RESULTS: The study demonstrated that the program has high acceptability by recipients and parents, and a positive impact on recipients and parents, including significant reductions in youth behavioral difficulties as well as parent depression and post-traumatic stress symptoms. CONCLUSIONS: Results of this study are promising and call for further evaluation of hybrid delivery models for behavioral health screening and prevention interventions for pediatric heart transplant recipients and their families.

A Trauma-Informed, Family-Centered, Virtual Home Visiting Program for Young Children: One-Year Outcomes.

Military-connected families face many challenges associated with military life transitions, including deployment separations. We report on a randomized controlled trial to evaluate the efficacy of Families OverComing Under Stress-Early Childhood (FOCUS-EC) delivered through an in-home, virtual telehealth platform. FOCUS-EC is a trauma-informed, family-centered preventive intervention designed to promote family resilience and well-being. Military-connected families with 3- to 6-year-old children (194 mothers; 155 fathers; 199 children) were randomized to FOCUS-EC or an online education condition. Parent psychological health symptoms, child behavior, parenting, and parent-child relationships were examined by parent-report and observed interaction tasks for up to 12 months. Longitudinal regression models indicated that FOCUS-EC families demonstrated significantly greater improvements than online education families in parent-reported and observational measures of child behavior, parenting practices, and parent-child interaction, as well as greater reductions in parent posttraumatic stress symptoms. Findings provide support for the benefit of a virtually-delivered preventive intervention for military-connected families.

Parental Wartime Deployment and Socioemotional Adjustment in Early Childhood: The Critical Role of Military Parents' Perceived Threat During Deployment.

Infants, toddlers, and preschool-aged children have unique developmental needs that render them vulnerable to challenges associated with parental military service. We used a sample of military-connected families with 3-6-year-old children (N = 104) to examine associations among children's socioemotional development and fathers' trauma-related deployment experiences, including perceived threat during deployment and exposure to combat and the aftermath of battle. Of these potential stressors, only paternal perceived threat during deployment was significantly associated with measures of mother-reported child adjustment. Fathers' perceived threat during deployment was associated with child behavior problems even after accounting for demographic variables and current paternal symptoms of posttraumatic stress, depression, and anxiety, ß = .36, p = .007. The association between fathers' perceived threat during deployment and child behavior problems was mediated by several family processes related to emotion socialization, including father-reported sensitive parenting, indirect effect (IE) B = 0.106, 95% CI [0.009, 0.236]; parent-child dysfunctional interaction, IE B = 0.119, 95% CI [0.014, 0.252]; and mother-reported family emotional responsiveness, IE B = 0.119, 95% CI [0.011, 0.258]. Implications for future research on the intergenerational transmission of traumatic stress as well as prevention and intervention efforts for military-connected families with young children are discussed.

An empirical test of the model of socialization of emotion: Maternal and child contributors to preschoolers' emotion knowledge and adjustment.

This study tested child characteristics (temperamental executive control and negative reactivity) and maternal characteristics (parenting behaviors and maternal depressive symptoms) as predictors of a mother's emotion-related socialization behaviors (ERSBs). Further, parenting behaviors and ERSBs were examined as predictors of children's emotion knowledge, social competence, and adjustment problems. ERSBs and children's emotion knowledge were tested as mediators of the effects of child and parent characteristics on adjustment. A community sample (N = 306) of mothers and children (36-40 months at T1) were assessed 4 times, once every 9 months, and assessments included maternal reports of depressive symptoms, observed temperament, observational ratings of general parenting at T1, maternal report of ERSBs at T1 & T2, behavioral measures of emotion knowledge at T3, and teacher ratings of children's adjustment at T4. There were no predictors of ERSBs above prior levels. Higher executive control and lower maternal depressive symptoms predicted greater child emotion knowledge, highlighting the roles of maternal and child contributors to emotion knowledge. Greater emotion knowledge and positive affective quality in parenting predicted children's adjustment, with emotion knowledge mediating the effects of executive control on children's adjustment. In addition, lower levels of maternal supportive ERSBs predicted greater adjustment problems. This study highlights the roles of key variables in Eisenberg, Cumberland, and Spinrad's (1998) heuristic model of emotion socialization and the importance of emotion socialization and emotion knowledge in children's adjustment. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Pathways from early adversity to later adjustment: Tests of the additive and bidirectional effects of executive control and diurnal cortisol in early childhood.

Additive and bidirectional effects of executive control and hypothalamic-pituitary-adrenal (HPA) axis regulation on children's adjustment were examined, along with the effects of low income and cumulative risk on executive control and the HPA axis. The study utilized longitudinal data from a community sample of preschool age children (N = 306, 36-39 months at Time 1) whose families were recruited to overrepresent low-income contexts. We tested the effects of low income and cumulative risk on levels and growth of executive control and HPA axis regulation (diurnal cortisol level), the bidirectional effects of executive control and the HPA axis on each other, and their additive effects on children's adjustment problems, social competence and academic readiness. Low income predicted lower Time 4 executive control, and cumulative risk predicted lower Time 4 diurnal cortisol level. There was little evidence of bidirectional effects of executive control and diurnal cortisol. However, both executive control and diurnal cortisol predicted Time 4 adjustment, suggesting additive effects. There were indirect effects of income on all three adjustment outcomes through executive control, and of cumulative risk on adjustment problems and social competence through diurnal cortisol. The results provide evidence that executive control and diurnal cortisol additively predict children's adjustment and partially account for the effects of income and cumulative risk on adjustment.

Parenting as a moderator of the effects of cumulative risk on children's social-emotional adjustment and academic readiness.

This study examined whether parenting moderated the association between cumulative risk and preschool children's adjustment problems, social competence and academic readiness. The sample consisted of 306 families representing the full range of income, with 29% at or near poverty and 28% lower income. Cumulative risk and observed maternal parenting behaviors were assessed when the children were 36-40 months, and teachers rated outcomes at 63-68 months. Greater cumulative risk was more strongly related to higher adjustment problems when scaffolding was low, and unrelated when it was high, suggesting a protective effect. Consistent limit setting was associated with higher academic readiness regardless of risk level, and at low levels of risk it was associated with the highest levels of social competence. A pattern potentially indicating differential effectiveness emerged for warmth, such that at lower levels of risk, higher warmth was associated with better outcomes, but at higher levels of risk, it was associated with higher levels of problems and poorer social competence and academic readiness. Results suggest that buffering effects of particular parenting behaviors, both alone and in combination, may be context-specific.

The Interplay of Familial and Individual Risk in Predicting Clinical Improvements in Pediatric Anxiety Disorders.

Bioecological models of developmental psychopathology underscore the role of familial experiences of adversity and children's individual-level characteristics in heightening risk for pediatric anxiety through direct, combined, and interactive effects. To date, much of the existing research dedicated to pediatric anxiety disorders has largely been examined in bioecological models of diathesis-stress using community samples. This study extends our understanding of children's differential responsiveness to familial adversity by examining the diathesis-stress interaction of cumulative risk and children's individual-level vulnerabilities (negative affectivity and coping efficacy) within a clinic-referred treatment study for pediatric anxiety disorders. A cumulative risk index assessing exposure to familial adversity (e.g., socioeconomic status [SES], parent psychiatric illness) and self-reported measures of children's negative affectivity and coping efficacy were each measured at the intake of a randomized controlled clinical trial for the treatment of pediatric anxiety disorders (N = 488; 7-17 years of age). Trajectories of interviewer-rated anxiety symptoms were assessed across 12 weeks of treatment at baseline, 4 weeks, 8 weeks, and 12 weeks. Consistent with models of temperamental risk for mental health problems, negative affectivity predicted higher anxiety symptoms at intake. A significant diathesis-stress interaction between cumulative risk and coping efficacy emerged, as high risk and perceptions of lower coping efficacy attenuated declines in anxiety across 12 weeks. These patterns did not differ across treatment conditions. The results indicate that for youth experiencing high levels of stress, additional treatment efforts targeting familial stressors and coping efficacy may be important in maximizing treatment outcomes.

A state-trait model of cortisol in early childhood: Contextual and parental predictors of stable and time-varying effects.

This study examined state-trait models of diurnal cortisol (morning level and diurnal slope), and whether income, cumulative risk and parenting behaviors predicted variance in trait and state levels of cortisol. The sample of 306 mothers and their preschool children included 29% families at or near poverty, 27% families below the median income, and the remaining families at middle and upper income. Diurnal cortisol, income, cumulative risk, and parenting were measured at 4 time points, once every 9months, starting when children were 36-40months. State-trait models fit the data, suggesting significant state but not trait variance in cortisol. Low income and cumulative risk were related to trait levels of diurnal cortisol with little evidence of time-varying or state effects. Stable levels of parenting predicted trait levels of diurnal cortisol and time-varying levels of parenting predicted time-varying state levels of diurnal cortisol. Findings highlight the allostatic process of adaptation to risk as well as time-specific reactivity to variability in experience.

Bidirectional Relations Between Temperament and Parenting Predicting Preschool-Age Children's Adjustment.

Bidirectional associations between child temperament (fear, frustration, positive affect, effortful control) and parenting behaviors (warmth, negativity, limit setting, scaffolding, responsiveness) were examined as predictors of preschool-age children's adjustment problems and social competence. Participants were a community sample of children (N = 306; 50% female, 64% European American) and their mothers. Observational measures of child temperament and parenting were obtained using laboratory tasks at two time points (children's ages 36 and 54 months). Teacher-reported adjustment measures were collected at the first and third time points (children's ages 36 and 63 months). Cross-lagged analyses were performed to examine whether child temperament and parenting predict changes in one another, whether they each contribute independently to children's adjustment, and whether these transactional relations account for adjustment outcomes. Maternal negativity at 36 months predicted increases in child frustration at 54 months. Maternal negativity and child effortful control predicted decreases in each other from 36 to 54 months. Maternal warmth predicted increases in child effortful control over time. Child frustration, child effortful control, maternal warmth, and maternal negativity at 54 months each independently predicted child adjustment problems at 63 months, controlling for problems at 36 months. Child executive control at 54 months predicted increases in child social competence at 63 months. The findings suggest that temperament and parenting have independent and additive effects on preschool-age child adjustment, with some support for a bidirectional relation.

Variable- and Person-Centered Approaches to Examining Temperament Vulnerability and Resilience to the Effects of Contextual Risk.

Using both variable- and person-centered approaches, this study examined the role of temperament in relation to children's vulnerable or resilient responses to cumulative risk. Observed reactivity and regulation dimensions of temperament were tested as mediating and moderating the relation between family cumulative risk and teacher-reported adjustment problems in a sample of 259 preschool-age children. Further, latent profile analyses were used to examine whether profiles of temperament, accounting for multiple characteristics simultaneously, provided additional information about the role of temperament in children's responses to risk. Results support a diathesis-stress model in which high frustration, low fear, and low delay ability confer particular vulnerability for children in high-risk contexts. Benefits of multiple approaches are highlighted.

The Impact of Deployment on Parental, Family and Child Adjustment in Military Families.

Since 9/11, military service in the United States has been characterized by wartime deployments and reintegration challenges that contribute to a context of stress for military families. Research indicates the negative impact of wartime deployment on the well being of service members, military spouses, and children. Yet, few studies have considered how parental deployments may affect adjustment in young children and their families. Using deployment records and parent-reported measures from primary caregiving (N = 680) and military (n = 310) parents, we examined the influence of deployment on adjustment in military families with children ages 0-10 years. Greater deployment exposure was related to impaired family functioning and marital instability. Parental depressive and posttraumatic stress symptoms were associated with impairments in social emotional adjustment in young children, increased anxiety in early childhood, and adjustment problems in school-age children. Conversely, parental sensitivity was associated with improved social and emotional outcomes across childhood. These findings provide guidance to developing preventive approaches for military families with young children.

Income, cumulative risk, and longitudinal profiles of hypothalamic-pituitary-adrenal axis activity in preschool-age children.

Environmental risk predicts disrupted basal cortisol levels in preschool children. However, little is known about the stability or variability of diurnal cortisol morning levels or slope patterns over time in young children. This study used latent profile analysis to identify patterns of the hypothalamic-pituitary-adrenal axis activity during the preschool period. Using a community sample (N = 306), this study measured income, cumulative risk, and children's diurnal cortisol (morning level and slope) four times across 2.5 years, starting when children were 36 months old. Latent profile analysis profiles indicated that there were predominantly stable patterns of diurnal cortisol level and slope over time and that these patterns were predicted by income and cumulative risk. In addition, there were curvilinear relations of income and cumulative risk to profiles of low morning cortisol level and flattened diurnal slope across time, suggesting that both lower and higher levels of income and cumulative risk were associated with a stress-sensitive physiological system. Overall, this study provides initial evidence for the role of environmental risk in predicting lower, flattened basal cortisol patterns that remain stable over time.

Examining gene-environment interactions in comorbid depressive and disruptive behavior disorders using a Bayesian approach.

OBJECTIVE: The objective of this study was to apply a Bayesian statistical analytic approach that minimizes multiple testing problems to explore the combined effects of chronic low familial support and variants in 12 candidate genes on risk for a common and debilitating childhood mental health condition. METHOD: Bayesian mixture modeling was used to examine gene by environment interactions among genetic variants and environmental factors (family support) associated in previous studies with the occurrence of comorbid depression and disruptive behavior disorders youth, using a sample of 255 children. RESULTS: One main effect, variants in the oxytocin receptor (OXTR, rs53576) was associated with increased risk for comorbid disorders. Two significant gene × environment and one signification gene × gene interactions emerged. Variants in the nicotinic acetylcholine receptor α5 subunit (CHRNA5, rs16969968) and in the glucocorticoid receptor chaperone protein FK506 binding protein 5 (FKBP5, rs4713902) interacted with chronic low family support in association with child mental health status. One gene × gene interaction, 5-HTTLPR variant of the serotonin transporter (SERT/SLC6A4) in combination with µ opioid receptor (OPRM1, rs1799971) was associated with comorbid depression and conduct problems. CONCLUSIONS: Results indicate that Bayesian modeling is a feasible strategy for conducting behavioral genetics research. This approach, combined with an optimized genetic selection strategy (Vrieze et al., 2012), revealed genetic variants involved in stress regulation (FKBP5, SERT × OPMR), social bonding (OXTR), and nicotine responsivity (CHRNA5) in predicting comorbid status.

Relations of growth in effortful control to family income, cumulative risk, and adjustment in preschool-age children.

The study examined growth in effortful control (executive control, delay ability) in relation to income, cumulative risk (aggregate of demographic and psychosocial risk factors), and adjustment in 306 preschool-age children (50 % girls, 50 % boys) from families representing a range of income (29 % at- or near-poverty; 28 % lower-income; 25 % middle-income; 18 % upper-income), with 4 assessments starting at 36-40 month. Income was directly related to levels of executive control and delay ability. Cumulative risk accounted for the effects of income on delay ability but not executive control. Higher initial executive control and slope of executive control and delay ability predicted academic readiness, whereas levels, but not growth, of executive control and delay ability predicted social competence and adjustment problems. Low income is a marker for lower effortful control, which demonstrates additive or mediating effects in the relation of income to children's preschool adjustment.

Parental anxiety as a predictor of medication and CBT response for anxious youth.

The aim of this investigation was to evaluate how parental anxiety predicted change in pediatric anxiety symptoms across four different interventions: cognitive-behavioral therapy, medication (sertraline; SRT), their combination (COMB), and pill placebo. Participants were 488 youths (ages 7-17) with separation anxiety disorder, generalized anxiety disorder, and/or social phobia and their primary caregivers. Latent growth curve modeling assessed how pre-treatment parental trait anxiety symptoms predicted trajectories of youth anxiety symptom change across 12 weeks of treatment at four time points. Interactions between parental anxiety and treatment condition were tested. Parental anxiety was not associated with youth's pre-treatment anxiety symptom severity. Controlling for parental trait anxiety, youth depressive symptoms, and youth age, youths who received COMB benefitted most. Counter to expectations, parental anxiety influenced youth anxiety symptom trajectory only within the SRT condition, whereas parental anxiety was not significantly associated with youth anxiety trajectories in the other treatment conditions. Specifically, within the SRT condition, higher levels of parental anxiety predicted a faster and greater reduction in youth anxiety over the acute treatment period compared to youths in the SRT condition whose parents had lower anxiety levels. While all active treatments produced favorable outcomes, results provide insight regarding the treatment-specific influence of parental anxiety on the time course of symptom change.

Effects of Timing of Adversity on Adolescent and Young Adult Adjustment.

Effects of Timing of Adversity on Adolescent and Young Adult Adjustment Abstract Exposure to adversity during childhood and adolescence predicts adjustment across development. Further, adolescent adjustment problems persist into young adulthood. This study examined relations of contextual adversity with concurrent adolescent adjustment and prospective mental health and health outcomes in young adulthood. A longitudinal sample (N = 808) was followed from age 10 through 27. Perceptions of neighborhood in childhood predicted depression, alcohol use disorders, and HIV risk in young adulthood. Further, the timing of adversity was important in determining the type of problem experienced in adulthood. Youth adjustment predicted adult outcomes, and in some cases, mediated the relation between adversity and outcomes. These findings support the importance of adversity in predicting adjustment and elucidate factors that affect outcomes into young adulthood.

Understanding the relation of low income to HPA-axis functioning in preschool children: cumulative family risk and parenting as pathways to disruptions in cortisol.

This study examined the relation of low income and poverty to cortisol levels, and tested potential pathways from low income to disruptions in cortisol through cumulative family risk and parenting. The sample of 306 mothers and their preschool children included 29 % families at or near poverty, 27 % families below the median income, and the remaining families at middle and upper income. Lower income was related to lower morning cortisol levels, and cumulative risk predicted a flatter diurnal slope, with a significant indirect effect through maternal negativity, suggesting that parenting practices might mediate an allostatic effect on stress physiology.