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.

Conceptualizing Emotion Regulation and Coregulation as Family-Level Phenomena.

The ability to regulate one's emotions is foundational for healthy development and functioning in a multitude of domains, whereas difficulties in emotional regulation are recognized as a risk factor for a range of adverse outcomes in childhood, adolescence, and adulthood. Caregivers play a key role in cultivating the development of emotion regulation through coregulation, or the processes by which they provide external support or scaffolding as children navigate their emotional experiences. The vast majority of research to date has examined coregulation in the context of caregiver-child dyads. In this paper, we consider emotion regulation and coregulation as family-level processes that unfold within and across multiple family subsystems and explore how triadic and whole family interactions may contribute to the development of children's emotion regulation skills. Furthermore, we will examine the implications of a family-centered perspective on emotion regulation for prevention of and intervention for childhood emotional and behavioral disorders. Because emotion regulation skills undergo such dramatic maturation during children's first several years of life, much of our focus will be on coregulation within and across the family system during early childhood; however, as many prevention and intervention approaches are geared toward school-aged children and adolescents, we will also devote some attention to later developmental periods.

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.

Parental emotion and emotion regulation: A critical target of study for research and intervention to promote child emotion socialization.

Parents' behaviors-particularly their emotion socialization behaviors (ESBs)-drive children's emotion socialization (Eisenberg, Cumberland, & Spinrad, 1998). We propose that a major next step in the effort to promote healthy emotional development is to improve the field's understanding of the most proximal contributor to parent ESBs: parents' own experience and regulation of emotions in the context of caregiving. As an initial step, this paper integrates Eisenberg and colleagues' model of emotion socialization with theoretical and empirical work on parental emotion. We review the literature on the emotionally evocative nature of parenting, which influences parental ESBs, including parents' expressions of emotions and their responses to children's emotions. However, whereas parental emotions influence behavior, they do not necessarily determine it; parents may regulate their emotions to engage in optimal ESBs. Thus, parental regulation contributes to emotion socialization not only by modeling emotion regulation strategies for children, but also by influencing the quality of parents' ESBs. From a clinical perspective, parental emotion regulation is of utmost importance due to the degree of parental involvement in interventions for childhood emotional and behavioral disorders, which are often aimed at promoting child self-regulation. To illustrate practical applications of Eisenberg's model, we discuss evidence-based practices that include enhancement of parent emotion regulation as a primary target, with the ultimate goal of promoting child emotional development. Ultimately, we aim to spur future theoretical, empirical, and translational work in this area. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Fetal Alcohol Spectrum Disorders and Challenges Faced by Caregivers: Clinicians' Perspectives.

BackgroundThere is a notable absence of evidence based early interventions for young children with FASD.  ObjectiveThis study examines clinicians' perspectives regarding the needs of caregivers of children with FASD and how such perspectives informed the development of a family-centered early intervention for young children with prenatal alcohol exposure.  Method19 professionals who work with children with prenatal alcohol exposure and / or in out-of-home care were recruited to participate in focus groups. The facilitator used a semi-structured topic guide to elicit feedback from participants. These data were transcribed, coded, and categorized to reflect themes in a manner informed by a grounded theory approach. A second investigator repeated the process. Codes were chosen and assigned to data by consensus.   ResultsThe coded data yielded five distinct perceived challenges faced by caregivers: (1) seeking and possibly receiving a diagnosis; (2) processing emotions and coming to terms with the child's difficulties; (3) seeking support and belonging within a knowledgeable community; (4) developing a new understanding of the child's behavior; and (5) becoming an educator, advocate, and expert on the child and FASD.   ConclusionProfessionals believe specific capacities are essential insofar as the human service systems that caregivers engage are perceived to be under-equipped to respond to the distinct set of challenges faced by children with FASD and their families. Findings are discussed in terms of how the proposed intervention was designed to address such challenges and to cultivate those key capacities in order for families to meet their children's needs.

Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure (ND-PAE): Proposed DSM-5 Diagnosis.

Over the past 40 years, a significant body of animal and human research has documented the teratogenic effects of prenatal alcohol exposure (PAE). Neurobehavioral Disorder associated with PAE is proposed as a new clarifying term, intended to encompass the neurodevelopmental and mental health symptoms associated with PAE. Defining this disorder is a necessary step to adequately characterize these symptoms and allow clinical assessment not possible using existing physically-based diagnostic schemes. Without appropriate diagnostic guidelines, affected individuals are frequently misdiagnosed and treated inappropriately (often to their considerable detriment) by mental health, educational, and criminal justice systems. Three core areas of deficits identified from the available research, including neurocognitive, self-regulation, and adaptive functioning impairments, are discussed and information regarding associated features and disorders, prevalence, course, familial patterns, differential diagnosis, and treatment of the proposed disorder are also provided.

Family systems and ecological perspectives on the impact of deployment on military families.

The scope of sustained military operations in Iraq and Afghanistan has placed great demands on the Armed Forces of the United States, and accordingly, military families have been faced with deployments in more rapid succession than ever before. When military parents fulfill occupational duties during wartime, military children and families face multiple challenges, including extended separations, disruptions in family routines, and potentially compromised parenting related to traumatic exposure and subsequent mental health problems. Such challenges can begin to exert a significant toll on the well-being of both individuals and relationships (e.g., marital, parent-child) within military families. In order to respond more effectively to the needs of military families, it is essential that mental health clinicians and researchers have a better understanding of the challenges faced by military families throughout the entire deployment experience and the ways in which these challenges may have a cumulative impact over multiple deployments. Moreover, the mental health field must become better prepared to support service members and families across a rapidly evolving landscape of military operations around the world, including those who are making the transition from active duty to Veteran status and navigating a return to civilian life and those families in which parents will continue to actively serve and deploy in combat zones. In this article, we utilize family systems and ecological perspectives to advance our understanding of how military families negotiate repeated deployment experiences and how such experiences impact the well-being and adjustment of families at the individual, dyadic, and whole family level.

Translation of an evidence-based social skills intervention for children with prenatal alcohol exposure in a community mental health setting.

BACKGROUND: Children with prenatal alcohol exposure (PAE) have significant social skills deficits and are often treated in community mental health settings. However, it remains unclear whether these children can be effectively treated using manualized, evidence-based interventions that have been designed for more general mental health populations. METHODS: To shed light on this issue, the effectiveness of Children's Friendship Training (CFT) versus Standard of Care (SOC) was assessed for 85 children ages 6 to 12 years with and without PAE in a community mental health center. RESULTS: Children participating in CFT showed significantly improved knowledge of appropriate social skills, improved self-concept, and improvements in parent-reported social skills compared to children in the SOC condition. Moreover, results revealed that within the CFT condition, children with PAE performed as well as children without PAE. Findings indicated that CFT, an evidence-based social skills intervention, yielded greater gains than a community SOC social skills intervention and was equally effective for children with PAE as for those without PAE. CONCLUSIONS: Results suggest that children with PAE can benefit from treatments initiated in community settings in which therapists are trained to understand their unique developmental needs, and that they can be successfully integrated into treatment protocols that include children without PAE.

Behavioral interventions for children and adolescents with fetal alcohol spectrum disorders.

Exposure to alcohol in utero is considered to be a leading cause of developmental disabilities of known causation. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of facial anomalies, growth retardation, and central nervous system dysfunction. Both animal and human studies, however, suggest that there may be considerable variability in the manifestations of in utero alcohol exposure across individuals, and, consequently, the term fetal alcohol spectrum disorders (FASD) has come into usage to reflect the entire continuum of effects associated with such exposure. In addition to FAS, this term encompasses the conditions of partial FAS, alcohol-related neurodevelopmental disorder, and alcohol-related birth defects. Despite extensive evidence of significant cognitive, behavioral, and social deficits in people with FASD, research on behavioral interventions for FASD has lagged behind. However, in recent years there has been a marked increase in efforts to design and test interventions for this population. This article will review current empirically tested interventions, methodological challenges, and suggestions for future directions in research on the treatment of FASD.

Impact of a social skills intervention on the hostile attributions of children with prenatal alcohol exposure.

BACKGROUND: Prenatal alcohol exposure (PAE) has been linked to a wide array of developmental deficits, including significant impairments in social skills. Given the extensive body of evidence linking social information-processing patterns with social behavior, it is possible that social information-processing may represent one mechanism of behavioral change. The present investigation sought to answer the question of whether a well-established social skills intervention decreased the hostile attributions of children with PAE. Further, was there a differential impact of the intervention on hostile attributions in the context of peer provocation versus group entry scenarios? METHODS: Participants consisted of 100 children (51% male) with PAE between the ages of 6 and 12 years. Participants were randomly assigned to either a social skills intervention, Children's Friendship Training (CFT), or to a Delayed Treatment Control (DTC) condition. RESULTS: Analyses indicated that the social skills intervention resulted in a significantly lower proportion of hostile attributions in peer group entry, but not peer provocation, scenarios. This decrease was maintained over a 3-month follow-up period. CONCLUSIONS: Deficits in social information-processing among individuals with PAE can be improved through social skills intervention, and these changes may lead to more positive developmental outcomes.

Intervention for individuals with fetal alcohol spectrum disorders: treatment approaches and case management.

Exposure to alcohol in utero is considered to be the leading cause of developmental disabilities of known etiology. The most severe consequence of such exposure, fetal alcohol syndrome (FAS), is characterized by a distinct constellation of characteristic facial anomalies, growth retardation, and central nervous system (CNS) dysfunction. Some individuals with prenatal alcohol exposure (PAE) do not meet the full criteria for FAS, but instead are diagnosed with partial FAS, alcohol related neurodevelopmental disorder (ARND), or alcohol related birth defects (ARBD). The entire continuum of effects from PAE is increasingly being referred to under the umbrella term of fetal alcohol spectrum disorders (FASDs). An extensive body of research has documented major cognitive, behavioral, adaptive, social, and emotional impairments among individuals with FASDs. Although FAS was identified in the U.S. over 35 years ago, the development, evaluation, and dissemination of evidence-based interventions for individuals with FASDs have lagged behind significantly. Encouragingly, however, in recent years there has been a marked increase in efforts to design and test interventions to remediate the impairments associated with prenatal alcohol exposure. This article will review treatment needs and considerations for individuals with FASDs and their families, current empirically tested treatment approaches, case management issues, and suggestions for future directions in research on the treatment of FASDs.

Psychiatric conditions associated with prenatal alcohol exposure.

Since the identification of fetal alcohol syndrome (FAS) over 35 years ago, mounting evidence about the impact of maternal alcohol consumption during pregnancy has prompted increased attention to the link between prenatal alcohol exposure (PAE) and a constellation of developmental disabilities that are characterized by physical, cognitive, and behavioral impairments. These disabilities include a continuum of developmental disorders known as fetal alcohol spectrum disorders (FASDs). Longitudinal studies suggest that individuals with FASDs are at a greatly increased risk for adverse long-term outcomes, including mental health problems and poor social adjustment. This review summarizes the existing literature on mental health outcomes for individuals with PAE across the lifespan, including findings in infancy and early childhood, middle childhood, and adolescence and early adulthood. Research on the psychiatric disabilities suffered by individuals with FASDs throughout development highlights the need for training of mental health professionals in the identification and the provision of specific treatments to address the unique features of this developmental disability since early identification and treatment have been demonstrated to be protective against more serious secondary disabilities. It is hoped that with greater awareness of the mental health problems experienced by individuals with FASDs, these individuals can receive appropriate and early treatment resulting in more adaptive and rewarding lives.

Integrating case topics in medical school curriculum to enhance multiple skill learning: using fetal alcohol spectrum disorders as an exemplary case.

OBJECTIVES: This article describes the use of fetal alcohol spectrum disorders (FASDs) as a theme to connect the learning of basic neurosciences with clinical applications across the age span within a systems-based, integrated curricular structure that emphasizes problem-based learning. METHODS: In collaboration with the Centers for Disease Control and Prevention (CDC) and the National Organization on Fetal Alcohol Syndrome, the Western Regional Training Center for Fetal Alcohol Exposure at UCLA developed and integrated educational materials on FASDs into the curriculum for first-year medical students. RESULTS: Quantitative and qualitative evaluations suggested materials were effective in enhancing student knowledge and skills related to FASDs, as well as embryology, brain development, substance abuse, developmental psychopathology, and medical ethics. CONCLUSION: The use of a unifying theme integrating basic science and clinical information and skills is effective for medical student training in the prevention and treatment of common medical problems.

Behavioral regulation as a predictor of response to Children's Friendship Training in children with fetal alcohol spectrum disorders.

Children with fetal alcohol spectrum disorders (FASDs) evidence an array of structural brain abnormalities and neurocognitive deficits. Furthermore, previous research suggests that deficits in executive functioning (EF) may be associated with significant difficulties in the formation of positive peer relationships in this population. The purpose of the current study was to examine the role of EF as a predictor of treatment response to a controlled social skills intervention for children with FASDs. A total of 100 children between the ages of 6 and 12 received Children's Friendship Training (CFT). Prior to treatment, parents completed the Behavior Rating Inventory of Executive Functioning (BRIEF). Treatment outcome was measured using parent report on the Social Skills Rating System (SSRS). The results demonstrated that behavioral regulation as measured on the BRIEF predicted the effectiveness of CFT for children with FASDs, regardless of general intellectual functioning. Specifically, the ability to control impulses, solve problems flexibly, and monitor emotional responses significantly predicted improvement in social skills and reduction in problem behaviors following CFT.

Predictors of stress in parents of children with fetal alcohol spectrum disorders.

This study examined child characteristics and family factors as predictors of stress in the biological or adoptive parents of 6- to 12-year-old children with fetal alcohol spectrum disorders (FASDs). Impaired executive functioning, poorer adaptive functioning, externalizing and internalizing behavior problems, and adoptive parent status all made significant and independent contributions to the prediction of higher levels of child domain stress, as reported by parents on the Parenting Stress Index. Biological parent status and fewer family resources were associated with higher levels of parent domain stress. Teacher ratings of the child"s executive functioning impairments and externalizing and internalizing behavior problems also were associated with parent reports of child domain stress. Findings highlight the need to provide support not only to children with FASDs, but to their caregivers as well.